JAPANESE CIRCULATION JOURNAL
Online ISSN : 1347-4839
Print ISSN : 0047-1828
ISSN-L : 0047-1828
Volume 60, Issue 10
Displaying 1-12 of 12 articles from this issue
Clinical Study
  • Naoko Nishioka, Toru Takeuchi, Yoshinari Goseki, Tetsu Matsubara, Hiro ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 719-730
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    Exercise testing (EX) and Holter ECG (DCG) were performed consecutively in 52 patients with ischemic heart disease. A total of 100 episodes of myocardial ischemia (IE) were recorded during DCG in 30 patients, who constituted 94% of the patients with myocardial ischemia under 6 metabolic equivalents (METS) during EX. A significant increase in heart rate (HR) was observed before the development of IE. The duration of this increase in HR was longer in IE than in periods in which the HR increased above the ischemic threshold, but without ischemia. The incidence of IE showed two peaks at 8-10 am and 4-6 pm. The frequency of IE among all of the periods with increased HR was highest at 8-10 am (51%), IE in the morning was associated with a lower HR than that in the afternoon, and LF/HF, which reflects sympathetic activity, evaluated using power spectral analysis, increased before IE in the morning. The early appearance of myocardial ischemia in EX can predict its appearance in daily life. The increase in HR and its duration appear to be associated with the development of IE. The increase in sympathetic activity in the morning and the increase in myocardial oxygen demand accompanied by physical activity in the afternoon most likely contributed to the circadian variation in the incidence of ischemic episodes. (Jpn Circ J 1996; 60: 719 - 730)
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  • Bunji Kaku, Masami Shimizu, Hiroyuki Yoshio, Hidekazu lno, Sumio Mizun ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 731-741
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    Anomalous origin of the coronary artery can lead to angina pectoris, acute myocardial infarction or even sudden death in the absence of atherosclerosis. However, in Japan, this anomaly is usually treated medically rather than surgically. To clarify the clinical features of anomalous origin of the coronary artery in Japanese and the prognosis of such patients who are treated medically, we reviewed 56 patients with anomalous origin of the coronary arteries, The mean age of these patients was 55.9±11.5 years. Anomalous origin of the right coronary artery from the left sinus of Valsalva was seen most frequently (78.6%). In contrast, we found no cases of anomalous origin of the left corolnary artery from the right sinus of Valsalva traversing between the aorta and the pulmonary trunk. A history of syncope (14.3%) and aortic regurgitation (21.4%) was frequent and serious complications during exercise stress testing occurred in 5 patients. These patients were treated medically, such as by limiting exercise or by the oral administration of medicine. During the follow up period (mean 5.64.2 years), death directly related to anomalous origin of the coronary artery was not found despite the lack of surgical treatment. Our results suggest that the prognosis of these middle-aged-tolelderly patients without atherosclerosis is relatively good, despite the lack of surgical treatment. (Jpn Circ J 1996; 60: 731 - 741)
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  • Hiroshi Morita, Hiroshi Yamanari, Tohru Ohe
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 742-748
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    Congenital long QT syndrome (LQTS) is a rare hereditary disease characterized by a prolonged QT interval and lethal ventricular tachycardia (Torsades de Pointes: TdP). The pathogenesis of LQTS and the induction of TdP have been thought to be closely related to autonomic nervous abnormalities. We examined autonomic activity in 13 LQTS patients by analyzing heart rate variability from 24 h Holter ambulatory electrocardiographic recordings without medications. In a frequency-analysis of RR variability, we calculated the power in the low-frequency domain (LF) and the high-frequency domain (HF) over 24 h. The ratio of LF to HF (an index of sympathetic nervous activity) was lower in LQTS patients than in controls, whereas HF (an index of parasympathetic nervous activity) was higher. Moreover, LQTS patients with TdP had lower abnormal sympathetic nervous activity than those without TdP. The index of autonomic nervous activity obtained using this method could be useful for evaluating the severity in LQTS. (Jpn Circ J 1996; 60: 742 - 748)
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  • Toshio Imanishi, Satoshi Nakatani, Masakazu Yamagishi, Shintaro Beppu, ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 749-757
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    The jet size of flow in color Doppler is dependent on both jet momentum and the compliance of the receiving chamber. Thus, the jet size of left ventricular (LV) Iate filling standardized by its jet momentum should reflect LV compliance. We investigated the feasibility of using color Doppler echocardiography to differentiate a pseudonormal from a normal transmitral flow pattern. We divided 37 patients with ischemic heart diseases who demonstrated a "normal" transmitral flow pattern into 2 groups according to their LV end-diastolic pressure (LVEDP): a pseudonormalization group (LVEDP≥ 18 mmHg, 16 patients), and a normal group (LVEDP<18 mmHg, 21 patients). We measured the maximum color Doppler jet length (L) and the peak velocity of transmitral flow during atrial contraction (Av). Filling volume (Q) was measured as the increase in LV volume during atrial contraction. A simplified jet momentum index (M) was obtained from Av×Q, and L/M was considered to reflect LV compliance. L/M was significantly lower in the pseudonormalization group than in the normal group (1.55±0.46×10-3 vs 2.72±0.59×10,-3 p<0.01). On the other hand, conventional Doppler variables such as isovolumic relaxation time and the deceleration time of early diastolic filling were not sufficient for discriminating between the 2 groups. In conclusion, color Doppler echocardiogram during atrial contraction was useful for differentiating a pseudonormal from a normal transmitral flow pattern. (Jpn Circ J 1996; 60: 749 - 757)
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  • Akira Satoh, Kazuhiro Katayama, Takafumi Hiro, Masafumi Yano, Toshiro ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 758-766
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    This study was undertaken to investigate the effect of chronic right ventricular (RV) volume overload on left ventricular (LV) diastolic function. Twelve patients with atrial septal defect and 7 age-matched normal controls were examined. Patients with atrial septal defect were divided into 2 groups based on their Qp/Qs values (ASD1:Qp/Qs≤3, n=7; ASD2:Qp/Qs>3, n=5). The LV volume curve and its first derivative were derived by a frame-by-frame analysis of the left ventriculogram. The peak filling rate was defined by the peak positive first derivative of the LV volume curve. We measured the time constant, isovolumetric relaxation time, stiffness constant and compliance at LV end-diastole. The time constant was significantly prolonged in the ASD2 group compared with the controls, and the isovolumetric relaxation time in both atrial septal defect groups was also prolonged compared with the controls. The peak filling rate, which was normalized by end-diastolic volume, was lower in the ASD2 group than in the controls. Although the stiffness constant and the compliance at LV end-diastole in the controls were not significantly different from those in the atrial septal defect group, an upward and leftward displacement of the left ventricular pressure-volume curve was observed in patients with atrial septal defect. Moreover, a significant correlation (r=0.78, p<0.01) was observed between the time constant and RV end-diastolic pressure. Thus, these results suggest that chronic RV volume overload affects left ventricular diastolic function. (Jpn Circ J 1996; 60: 758 - 766)
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  • Michihiro Suwa, Takahide Ito, Yoshiaki Otake, Ayaka Moriguchi, Yuzo Hi ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 767-773
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    Beta-blocking agents reduce mortality and improve symptoms in patients with dilated cardiomyopathy (DCM). There have been reports that diltiazem, a calcium-blocking agent, is also effective in such patients. We prospectively compared the effects of the beta-blocking agent bisoprolol with those of the calcium-blocking agent diltiazem in 18 patients (11 males and 7 females, age 14 to 68) with DCM. The 18 patients (10 in New York Heart Association functional class III and 8 in class IV) were randomly assigned to 2 groups. Bisoprolol was administered as the first drug in 10 patients and diltiazem was administered in 8. Cross-over to bisoprolol was also performed in 3 patients. At the end of the study, among the 13 patients who had been given. bisoprolol, 9 showed a good response (efficacy rate: 69%). In contrast, only 3 of the 8 patients who received diltiazem showed a good response (efficacy rate: 37.5%). Among the patients in NYHA class III, all 7 (100%) who were treated with bisoprolol responded but only 2 of the 4 (50%) treated with diltiazem responded (p<0.05). Among the patients in class IV, 2 of 6 (33%) responded to bisoprolol and 1 of 4 (25%) responded to diltiazem (not significant). These results suggest that diltiazem, Iike bisoprolol, has a beneficial effect in patients with DCM, with a greater effect in class III patients. However, we conclude that diltiazem should usually be used as a second choice to improve heart failure in DCM, and as the first medication only in those with contraindications to beta-blocking agents. (Jpn Circ J 1996; 60: 767 - 773)
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  • Ikuo Misumi, Yoshihiro Kimura, Youichi Hokamura, Yoshio Honda, Tadamas ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 774-778
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    The presence of defects on resting thallium (201Tl) myocardial scintigraphy has been previously demonstrated in myocardial sarcoidosis. To examine cardiac sympathetic nerve activity in patients with cardiac sarcoidosis, we performed 201Tl and I-123 MIBG (meta-iodobenzylguanidine) myocardial scintigraphy in patients with sarcoidosis. Sixteen patients with sarcoidosis were classified into 2 groups according to the presence or absence of defects on 201Tl scintigraphy. Myocardial images by both 201Tl and I-123 MIBG were then divided into 20 segments and scored using a 6-point scoring system. Defect Score was defined as a the sum of significant scores in each image. The mean Defect Score in I-123 MIBG images was higher in the 201Tl defect group (44.3+13.3) than in both the normal 201Tl group (25.1+10.5) and the control group (22.7+11.4). Moreover, the locations of defects on I-123 MIBG scans were consistent with those on 201Tl scans. This study suggests that cardiac adrenergic function may be impaired in cardiac sarcoidosis, and I-123 MIBG scintigraphy may be more sensitive in detecting cardiac sarcoidosis than 201T1 scintigraphy, although the clinical significance of these findings requires further study. (Jpn Circ J 1996; 60: 774 - 778)
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  • Kinji Ishikawa, Ken Kanamasa, Iwao Ogawa, Toshihiko Takenaka, Takeo Na ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 779-788
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    Background Nitrates dilate coronary arteries, ameliorate myocardial ischemia, minimize left ventricular remodeling, and reduce mortality in patients with acute myocardial infarction. However, the effects of long-term treatment with nitrates on cardiac events in patients with healed myocardial infarction are not known. Methods and Results A total of 1,002 patients with healed myocardial infarction (789 male and 213 female) were randomly divided into 2 groups: treatment with nitrates or nontreatment. The mean observation period was 18.0 ±19.9 months. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death. Baseline characteristics of the 2 groups were also compared to determine any effects on outcome. Among the 621 cases treated with nitrates, 41 cases (6.6%) experienced cardiac events during the observation period, whereas only 12 of the 381 cases that were not treated with nitrates (3.1%) had cardiac events. This difference was statistically significant (p<0.05; odds ratio 2.17; 95% confidence interval 1.13-4.19). There were no differences in the incidence of noncardiac death or being lost to follow-up between the 2 groups. Although the precise mechanism of this increase in the occurrence of cardiac events by long-term treatment with nitrates is not clear, nitrate tolerance with possible rebound and neurohormonal effects may be involved. Conclusion Long-term treatment with nitrates increased cardiac events in patients with healed myocardial infarction. (Jpn Circ J 1996; 60: 779 - 788)
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  • Hiromitsu Nishijima, Hiroshi Meno, Hideki Higashi, Kensuke Yamada, Nor ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 789-796
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    To elucidate the changes in coronary vasomotion in a previously balloon-dilated segment, we examined the vasoconstricting response of previously balloon-dilated and non-dilated segments to acetylcholine. Acetylcholine was administered into the coronary arteries cumulatively (left and right coronary artery: 10-100/μg) in 15 patients (age: 60±3 years, 12 males and 3 females) at 7.4±1.5 months after successful percutaneous transluminal coronary angioplasty (PTCA). In PTCA segments with no restenosis, dose-dependent constriction in response to acetylcholine was observed in only 1 patient. In non-PTCA segments of PTCA and non-PTCA arteries, 12 patients showed dose-dependent vasoconstriction in response to acetylcholine. Coronary spasm, which was defined as a more than 75% reduction in coronary diameter compared with that after isosorbide dinitrate, was provoked in one PTCA segment (7%). In non-PTCA segments of PTCA and non-PTCA arteries, 15 of 44 arteries (34%) demonstrated coronary spasm in 9 of 15 patients (60%, p<0.005 vs PTCA segment). In conclusion, PTCA segments free of restenosis showed no hyperreactivity to acetylcholine, while non-PTCA segments showed hypercontractility in response to acetylcholine. Coronary balloon angioplasty may alter the coronary vasomotor reaction to acetylcholine several months after angioplasty. (Jpn Circ J 1996; 60: 789 - 796)
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Experimental Study
  • Yoshihisa Matsumoto, Seigo Ueda, Satoru Matsushita, Toshio Ozawa, Hiro ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 797-804
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    Calcitonin gene-related peptide (CGRP) is a potent vasodilator in humans. CGRP receptors have also been found in various tissues other than blood vessels, such as the central nervous system, kidney, and heart. However, Iittle is known about the effects of CGRP on human platelets. We investigated the effect of CGRP (human α type) on platelet aggregation in 21 healthy subjects (9 men and 12 women, mean age 54.6 years). CGRP inhibited platelet aggregation in vitro in 19 of the subjects (90.5%) in a dose-dependent manner with 50% inhibitory doses of 1.6 μmol/L and 1.1 μmol/L for aggregation induced by epinephrine and collagen, respectively. 125I-labeled CGRP bound specifically to intact platelets. The dissociation constant (Kd) was 61.9±17.7 pmol and the maximum number of binding sites (Bmax) was 6.4±3.9 pmol/109 platelets. The CGRP analogue (8-37)CGRP, but not calcitonin, inhibited the binding of 125I-CGRP to platelets. CGRP (5 μmol/L), but not (8-37)CGRP or calcitonin, increased the platelet cyclic AMP (cAMP) concentration by 31.7 ±3.6%. Thus, CGRP inhibits platelet aggregation via a specific receptor and by increasing the platelet cAMP concentration. CGRP may play a role in the modulation of platelet function in humans. (Jpn Circ J 1996; 60: 797-804)
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Case Report
  • Shinji Satoh, Tetsuji Inou
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 805-808
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    We present a 38-year-old woman who had experienced an acute febrile illness lasting more than 1 week at the age of 6, with erythema on the palms and soles following skin desquamation in the subacute phase and skin eruption. Thirty one years later, she experienced acute myocardial infarction and episodes of angina pectoris. She had no coronary risk factors or autoimmune diseases. Coronary angiography revealed an aneurysm of the proximal left coronary artery with occluded lesions at the distal site. The right coronary artery was also occluded at the proximal site. These findings strongly suggest Kawasaki disease should be considered in the differential diagnosis of early-onset ischemic heart disease in young adults. (Jpn Circ J 1996; 60: 805 - 808)
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  • Kazumasa Adachi, Masahito Kawata, Shun-ichi Araki, Akira Matsumoto, To ...
    Article type: None
    Subject area: None
    1996 Volume 60 Issue 10 Pages 809-814
    Published: 1996
    Released on J-STAGE: December 25, 2001
    JOURNAL FREE ACCESS
    A 54-year-old male experienced the Hanshin earthquake at 5:46 am on Jan. 17, 1995. He was rescued after being buried under his house for 20 h. After being treated at two hospitals, he was admitted to our hospital with acute renal failure caused by crush syndrome. The maximal serum creatinine kinase level was 35,000 IU/L (CK-MM: 100%), and the maximal myoglobin level was 12,600 ng/ml. An electrocardiogram showed inverted T waves in V5,6 which later became giant negative T waves, and a QS pattern in aVL and V1-6. Two-dimensional echocardiography showed a hypokinetic left ventricle . He was treated with hemodialysis 13 times. Cardiac contraction gradually improved to the normal level. Coronary angiography revealed normal coronary arteries and acetylcholine did not induce coronary spasm. Biopsy specimens from the right ventricular septum showed slight degeneration. 201T1 imaging showed hypoperfusion except in the anterior wall and 123I-MIBG imaging showed a perfusion defect except in the anterior wall. After about 1 month, only 201T1 imaging showed improvement. We believe that myocardial ischemia, cardiac sympathetic nerve damage and/or cardiac contusion caused giant negative T waves and left ventricular dysfunction. This is a rare case which showed significant myocardial damage with crush syndrome. (Jpn Circ J 1996; 60: 809 - 814)
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