To investigate the prevalence, clinical characteristics, and prognosis of familial cases of idiopathic dilated cardiomyopathy (IDC), family screenings were carried out in 117 IDC patients and their relatives. Familial occurrence was suspected in 29 families (25%). Ten families (9%) with 24 patients were confirmed to be familial, but the other 19 families (16%) remained suspected. The age at the time of diagnosis was lower and the cardiac symptoms tended to be milder in the familial group than in the non-familial group, but there were no differences in other clinical parameters. There was also no difference in the survival rate. However, when only NYHA class III and IV patients were selected, the 1-year and 5-year survival rates were lower in the familial group than in the non-familial group. Congestive heart failure was the most common cause of death in the non-familial group, while sudden death was the most common cause of death in the familial group. Among familial IDC patients who were deceased, the left ventricular end-diastolic pressure was higher and the cardiac index was lower at the time of diagnosis than those in patients who were still alive. We conclude that, since the prognosis of familial IDC patients is poor once their cardiac symptoms become severe, early diagnosis and treatment are extremely important.

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To assess the clinical utility of ¹²³I-metaiodobenzylguanidine (MIBG) scintigra-phy in evaluating cardiac sympathetic nerve disturbance in diabetic patients, we performed MIBG scintigraphy in 18 diabetic patients and 11 normal controls. Diabetic patients with symptomatic neuropathy (DM2) had a significantly lower heart to mediastinum uptake ratio than did those without neuropathy or normal controls in initial and delayed images (initial image, 1.90±0.27 vs 2.32±0.38, 2.41±0.40, p<0.01; delayed image, 1.80±0.31 vs 2.48±0.35, 2.56±0.28, p<001, respectively). Defect score, assessed visually, were higher in DM2 patients than in patients in the other two groups (initial image, 7±2.6 vs 1.5±1.9, 0.7±0.9; delayed image l0.6±3.3 vs 4.0±2.5, 1.7±1.6 p<0.01, respectively). The maximum washout rate in DM2 patients was also higher than those in patients in the other two groups. The findings of these indices obtained from MIBG scintigraphy coincided with the % low-frequency power extracted from heart rate fluctuations using a power spectral analysis and the results of the Schellong test, which were used to evaluate sympathetic function. These results suggest that MIBG scintigraphy may be useful for evaluating cardiac sympathetic nerve disturbance in patients with diabetes.

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Impaired function of the endothelium may be a mechanism of the coronary vasospasm induced by acetylcholine. We examined whether purified eicosapentaenoic acid (EPA), a major component of fish oil, improves the coronary vasomotion in response to acetylcholine, and the effect of purified EPA on acetylcholine (ACh)-induced coronary vasospasm in 22 patients with variant angina. ACh was infused into the coronary artery both before and after 4 months of EPA treatment (EPA 1.8 g/day, n=12). In the control group (n=10) that did not receive EPA, the response of the coronary diameter to ACh did not change over time. In the EPA-treated group, the cholinergic response in non-spastic sites changed from vasoconstriction to vasodilation, while ACh-induced coronary vasospasm persisted at the spastic sites. Therefore, EPA treatment improved the coronary vasomotor responsiveness to ACh, but did not inhibit ACh-induced coronary vasospasm.

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We investigated the relationship between changes in atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and changes in cardiac function during mild exercise in patients with mild hypertension. The handgrip test (HGT) was performed by 21 untreated, mildly hypertensive patients, mean age 45±5 years. M-mode and pulse Doppler echocardiograms were recorded before and during HGT. In 7 patients (Group A), diastolic function, which was determined by the peak early velocity and peak atrial velocity (E/A) ratio using Doppler echocardiography was attenuated during HGT (1.19±0.21 to 1.04±0.16, p<0.05). There was no change in diastolic function in the remaining 14 patients (Group B) (1.04±0.19 to 1.03±0.18, NS). Neither left ventricular mass index, left atrial diameter, cardiac index, ejection fraction, plasma renin activity, plasma norepinephrine, blood pressure, nor heart rate were different between the two groups. While ANP was increased in Group A during HGT (from 41.0± 18.2 to 54.0±24.1 pg/ml, p<0.05) it was unchanged in Group B (36.8±16.3 to 33.5±11.9 pg/ml). BNP did not change in either Group (Group A: 2.9±3.1 to 3.0±3.4 pg/ml, Group B: 2.6±1.6 to 3.6±4.8 pg/ml). The percent change in ANP during HGT did not correlate with the percent change in BNP. Thus, the impairment of cardiac functional reserve appeared to influence ANP excretion in patients with mild hypertension.

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Angiotensin-converting enzyme inhibitors may regress left ventricular hypertrophy (LVH) without decreasing blood pressure (BP). The aim of the present study was to compare the effects of low and high doses of lisinopril and the angiotensin II receptor antagonist TCV116 (TCV) on LVH and hemodynamics in spontaneously hypertensive rats (SHR). Lisinopril (0.5 and 3 mg/kg per day) and TCV (0.3 mg/kg per day) were given to 8-week-old male SHR daily for 2 weeks. Untreated SHR and Wistar-Kyoto rats (WKY) served as controls. Untreated SHR had a greater left ventricular (LV) weight than WKY (p<0.01). Lisinopril (3 mg/kg per day) decreased both LV weight and BP. Lisinopril (0.5 mg/kg per day) significantly decreased LV weight, but not BP. In contrast, although TCV significantly decreased BP, LVH was not suppressed. Renal blood flow (RBF) in untreated SHR was less than that in WKY (p<0.05), but was increased with either lisinopril (3 mg/kg per day) or TCV. Cardiac output was increased only in lisinopril (3 mg/kg per day)-treated rats (p<0.05). These findings suggest that factors other than afterload reduction play a role in the regression of LVH with lisinopril, whereas a longer duration of treatment and/or a higher dose may be necessary with TCV. Despite the decrease in BP, TCV normalized RBF in SHR, perhaps due to the blockade of renal angiotensin II.

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We examined changes in the distribution of extracellular matrix components in the myocardium of cardiomyopathic Syrian hamsters (BIO 14.6). Fibronectin, laminin, and type IV collagen, and type I and III collagens were immunohistochemically stained by the avidin-biotin-peroxidase complex method, using a polyclonal antibody for each component. Hearts obtained from 4 stages of BIO 14.6 cardiomyopathy were examined. Peri- and endomysial fibrosis increased as the disease progressed. Replacement and meshwork (perimysial fibrosis penetrating the intercellular space) fibrotic lesions appeared beginning in the 2nd stage, ie, the fibrotic and healing stage. All of the components examined, ie, fibronectin, laminin and type IV collagen, and type I and III collagens, were present in various fibrotic lesions and played a significant role in fibrotic changes throughout all of the stages of the disease. No primary deficit of any of these components was seen. An increased distribution of fibronectin was observed in both the enlarged peri-and endomysial spaces beginning in the initial stage, ie, the necrotic stage, when myocyte hypertrophy was inconspicuous, and distribution throughout the myocardium increased further as the disease progressed. Laminin and type IV collagen in the fibrotic lesions were not restricted to the myocyte membrane. Type III collagen was distributed in replacement and meshwork fibrotic lesions, and the extent of its distribution increased in proportion to that of type I collagen. The continuous increases in the distribution of fibronectin, laminin and type III collagen indicate that fibrotic changes occurred continuously in this model. The deposition of type I and III collagens and fibronectin before myocyte hypertrophy suggests that the fibrotic changes in this model were not related to myocyte hypertrophy in the early stage.

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An 18-year-old woman with primary antiphospholipid syndrome developed a major cerebral infarction leading to brain death despite intensive treatment with steroids, urokinase, glyceol and heparin. Fatal strokes associated with this syndrome are rare. A computed tomographic scan of the brain suggested occlusion of the main trunk of the right middle cerebral artery. The titer of antibodies against cardiolipin/ β₂-glycoprotein I complex in serum was extremely high.

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