We have developed a new noninvasive method to evaluate regional left ventricular (LV) function by digital subtraction angiography (DSA) without the use of contrast medium. DSA images of the left ventricle with and without contrast medium were obtained from 35 patients with anterior myocardial infarction (MI) and from 35 control subjects. Using an image-processing computer, regional LV time-density curves were constructed for one cardiac cycle. Regional LV time-density curves obtained from DSA without the use of contrast medium presented a pattern similar to those from intravenous DSA. The amplitude of regional LV time-density curves in patients with MI decreased along with increasing severity of regional wall motion abnormality assessed by conventional left ventriculography. In attempting semi-quantitative evaluation by DSA without the use of contrast medium, the regional wall motion index (RWI) in the 6 segments of the left ventricle was calculated by normalizing segmental density changes to the maximal segmental density changes. When compared with control subjects, patients with MI have significantly lower RWIs in the anterolateral and apical regions. RWI showed a good correlation with the regional ejection fraction (REF) obtained from intravenous contrast DSA (r=0.83). RWI decreased with increasing severity of regional wall motion abnormality by qualitative analysis in conventional left ventriculography, being consistent with REF. The diagnostic accuracy of RWI therefore seemed to be comparable to that of REF derived from intravenous contrast DSA. These results indicate that computerized analysis of DSA without the use of contrast medium is a valuable noninvasive method for semi-quantitative assessment of regional LV function.

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Congestive cardiomyopathy is a fatal myocardial disease which can be diagnosed by clinical findings, electrocardiography, roentgenography and echocardiography. Tissue characterization and pathology have been determined recently using histogram methods to analyze ultrasonographs. In this study ultrasonic backscatter analysis for differentiation of normal and diseased myocardium was tested. Two-dimensional echo data and radio frequency signals of long-axis views of the left ventricular posterior wall of 10 healthy children and 14 patients with congestive cardiomyopathy in systolic and diastolic phase were digitized online into the computer memory. Cyclic variation was obtained in the control group but no variation was detectable in myopathic hearts.

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To determine the genesis of the high incidence of stenotic lesions of the left anterior descending artery (LAD) in the young, we have investigated the anatomical characteristics of coronary arteries in the following 3 groups; young (≤40 yr) myocardial infarction (MI) patients with LAD lesions, young (≤40 yr) patients without coronary stenosis and aged (≥60 yr) MI patients. The angle between the left main coronary artery (LMT) and the LAD in the young MI patient group (146.7±7.4°) was significantly wider than those of the young normal (126.0±13.4°) or the aged MI patient groups (127.1±18.6°) (p<0.01, p<0.02, respectively). The angle between the LMT and the left circumflex artery (LCX), and the angle between the LAD and the LCX were not significantly different among the 3 groups. The LMT length in the young MI patient group was 18.3±4.7mm, which was not significantly longer than those of the young normal (12.7±6.9mm) or the aged patient groups (14.8±6.0mm). The internal diameter ratio of the LAD and LCX was also not significantly different among the 3 groups. These results suggest that the angle between the LMT and LAD was significantly wider in young MI patients, and should be regarded as an inherited characteristic influencing the development of coronary atherosclerosis of the LAD, particularly in young MI patients.

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Death from postinfarction cardiac rupture (PCR) may occur in two ways. There are patients who die suddenly without symptoms or with symptoms of less than an hour's duration (sudden cardiac death), whereas other patients die several hours after the onset of the rupture. Ninety-six patients who died from AMI and underwent autopsy have been studied. Sixteen patients displayed a rupture of the free wall of the left ventricle at the site of infarction, cardiac hypertrophy and severe coronary alterations. Six of these patients were included among patients who died suddenly. The other 10 showed signs before death that occurred from 240 to 660min after their appearance. Signs of impending rupture were appearance or increase of chest pain that was not improved by opiates, preterminal sinus rhythm with an unchanged ST-segment and echocardiographic infarct expansion or pericardial effusion. We propose that the emergence of these signs during AMI suggests an impending rupture. Early surgical intervention is essential to save those patients who survive several hours after the initial signs of PCR.

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Cardiovascular responses to sympathetic stimulation may be altered in the early phases of life of subjects with a family history of hypertension. The possible influence of physical activity on adrenergic modulation in children is still not well known. In this study we evaluated, in a group of 162 11-year-old children from a secondary school near Naples, blood pressure and heart rate measured 4 times at 3-week intervals at rest and during adrenergic system stimulation by mental arithmetic stress and isometric exercise. Children were divided into sedentary and physically active groups according to the levels of a Saltin modified questionnaire. Family history of hypertension was also investigated. Systolic and diastolic blood pressure at rest were slightly higher in the sedentary group at each control (107/75±11/11 vs 105/73±11/11mmHg at the first and 100/70±14/14 vs 98/69±9/9 at the last control); heart rate in the same group was higher as well (91±11 vs 87±12 beats/min, p<0.02 at the first and 80±9 vs 77±11 at the last control).
Systolic and diastolic blood pressure increased by 7/15% during mental stress and by 23/45% during isometric exercise in the sedentary group. The corresponding blood pressure increases in the physically active group were 6/12% and 20/40%, respectively. These responses were independent of sex, body weight and family history of hypertension. These results support the hypothesis that regular physical activity in young adolescents only mildly influences resting blood pressure and cardiovascular responses during the stimulation of the sympathetic nervous system.

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The BIO 14.6 cardiomyopathic Syrian hamster is a well-known animal model of congestive cardiomyopathy. To evaluate the role of free radicals and antioxidant protection in the pathogenesis of cardiomyopathy in this animal, we studied the concentration of heart mitochondrial free radicals, the activities of glutathione peroxidase (GSHPx) and superoxide dismutase (SOD), and the effect of α-tocopherol on the early stage of myocardial damage (up to 90 days). The GSHPx activity in BIO 14.6 hamsters was found to be twice that in the normal control hamsters at 30 days of age, while SOD activity was unchanged at 30 and 90 days of age. The concentrations of mitochondrial free radicals in BIO 14.6 hamsters at 40 and 90 days of age were significantly higher than those in the normal control hamsters. A protective effect of α-tocopherol therapy was shown in BIO 14.6 hamsters treated during the early stage of cardiomyopathy (up to 90 days). These results show the role of free radicals and antioxidant protection in the pathogenesis of hamster cardiomyopathy. We suspect that an increase in the GSHPx activity in BIO 14.6 hamsters may be due to a compensatory mechanism to counteract oxidative stress, but antioxidant reserve was not sufficient to protect the heart from the toxic effects of increased free radicals in the early stage of cardiomyopathy.

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Elevated levels of 1, 2-diacylglycerol (DG) have been observed in streptozotocin-induced diabetic and insulin-treated diabetic rat hearts. The fatty acid moieties of 1, 2-DG are considered to be related to its ability to activate protein kinase C. Therefore, we determined the fatty acids of 1, 2-DG by gas chromatography and compared them with those of triglycerides in the myocardium. The triglyceride content returned to control levels after 4 weeks of untreated diabetes followed by 4 weeks of insulin treatment. There was a significant difference in the fatty acid composition of triglycerides between diabetic and control rats. Insulin treatment also returned the fatty acids of triglycerides in diabetes to the profile observed in control rats. On the other hand, insulin treatment of the diabetic rats did not normalize 1, 2-DG content and its fatty acid composition. Fatty acid analysis of 1, 2-DG showed that its profile in insulin-treated diabetic rats was different from that of either control or diabetic rats, suggesting that insulin-induced 1, 2-DG differs from that seen in cases of diabetes.

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The effects of long term administration of pravastatin (a competitive inhibitor of hydroxymethylglutaryl CoA reductase) were assessed by measuring serum lipids and aortic and coronary atherosclerosis in Watanabe Heritable Hyperlipidemic (WHHL) rabbits. Six-month-old WHHL rabbits were given either 50mg/kg/day of the drug or vehicle. The rabbits were sacrificed following 6 or 12 months of treatment and serum cholesterol and triglycerides and aortic cholesterol and hydroxyproline were measured. Atherosclerotic plaques in the aorta and coronary arteries were quantified with morphometric methods.
Mean serum cholesterol±SEM(n) in the control vs. pravastatin groups after 6 months were: 535±34 (11) vs. 411±22 (12) (p<0.005) and after 12 months 458±43 (9) vs. 309±29mg/dl (12) (p<0.005). In the pravastatin group, percent aortic area covered with plaque and aortic cholesterol content were reduced 35% (ns) and 55%, (p<0.05) at 6 months, and 26% (ns) and 44% (ns) at 12 months, respectively. Little difference was found in serum triglycerides and aortic hydroxyproline in the 2 groups. There was strong correlation of serum cholesterol with aortic cholesterol content (r=0.61, p<0.003) and with the percent aortic plaque area (r=0.67, p<0.001), at 12 months. Morphometric analysis of wall thickness and lumen area of major coronary arteries revealed no significant differences in the 2 groups. In conclusion, pravastatin effectively lowered the serum cholesterol level in an animal model defective in low density lipoprotein receptors; this reduction was strongly correlated with amelioration of such atherosclerotic processes as lipid deposition and plaque formation.

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The study tested whether an experimental myocardial infarction can be detected from two-dimensional echocardiograms (2DE) by analysis of regional gray levels. The mid-left anterior descending coronary artery was ligated for 3 hours in 14 dogs (group 1) and for 5 hours in 6 dogs (group 2). 2DE were performed before, and after 3 and 5 hours of coronary artery ligation. The ultrasonic amplitude of the control and infarcted regions were obtained from digitized 2DE in the short axis view, at the mid-papillary muscle level. The mean gray levels (±SD) of the control and infarcted regions were compared during end-diastolic stop frames. After sacrifice, the hearts were cut into 1cm thick slices and stained with 1% triphenyl tetrazolium chloride (TTC) solution. The myocardium was then studied by light microscopy. Computerized tomographic scans were also obtained in vitro from 3 hearts of both groups.
There was no difference in mean gray levels of the control region during the experiments. However, in the region of wall motion abnormality (area of infarction), the mean gray levels increased from 49.9±3.5 (before ligation) to 62.0±7.4 (after 3 hours of ligation, p<0.005) in 10 group 1 dogs, but no differences were seen in mean gray levels (49.6±3.8 vs 50.4±4.0) in those without a myocardial infarction in 4 group 1 dogs; gray levels also increased from 50.4±2.9 (before ligation) to 58.6±6.1 (after 3 hours of ligation, p<0.05) and to 65.0±4.2 (after 5 hours of ligation, p<0.005) in group 2 dogs. The area of left ventricular asynergy corresponded precisely to the area of myocardial infarction, determined by both TTC staining and the computerized tomographic scans. The light microscopy of the infarcted area also demonstrated interstitial edema and polymorphonuclear cell infiltration.

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The aim of the present study was to investigate alterations in catecholamine release in the central nervous system of spontaneously hypertensive rats. Slices of hypothalamus, medulla oblongata and striatum were prepared from spontaneously hypertensive rats (SHR: 9-10 weeks old) and age-matched Wistar Kyoto rats (WKY). The slices were incubated with (³H)norepinephrine (NE) or (³H)dopamine (DA), superfused with Krebs-solution in vitro, and the release of the catecholamines was compared between the two strains. The basal release of hypothalamic (³H)NE did not differ between SHR and WKY slices. However, stimulation (1 Hz)-evoked (³H)NE release was significantly greater in SHR than in WKY (percent fractional release of total tissue NE: WKY 0.494±0.019%, n=6, SHR 0.730±0.053%, n=6, p<0.05). The stimulation-evoked (³H)NE release from the medulla oblongata did not differ significantly between SHR and WKY slices.
Finally stimulation-evoked release of striatal (³H)DA was significantly depressed in SHR (percent fractional release of total tissue DA: WKY 2.048±0.024%, n=6, SHR 1.460±0.068%, n=6, p<0.05).
These results indicate that the release of hypothalamic NE and striatal DA are altered in SHR. It is suggested that enhanced hypothalamic noradrenergic activity and reduced striatal dopaminergic activity can increase sympathetic outflow to the periphery, which may play a role in the pathogenesis of this form of hypertension.

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We evaluated the effects of pressure loading produced by gradual aortic occlusion on left ventricular (LV) myocardial contractility by assessing changes in the slope of the LV end-systolic force-diameter (F_es-D_es) relation. Eleven adult mongrel dogs were prepared with ultrasonic crystals for measuring LV diameter and a micromanometer for measuring LV pressure. Preload was decreased by vena caval occlusion (VCO), and afterload was increased by aortic occlusion (AOO). The slopes (E_c) and extrapolated diameter intercepts (D_o) of the LV F_es-D_es relation were determined for each dog from the end-systolic data obtained during VCO and AOO. During VCO and also AOO, the heart rate showed little change (134±18 vs. 134±16bpm in VCO, 135±16 vs. 132±17bpm in AOO). The values of E_c and D_o during VCO were 62.8±15.6g/cm and 1.20±0.36cm, respectively, while during AOO the respective values were 122.6±18.6g/cm and 1.66±0.38cm. E_c and D_o were both significantly increased during AOO in comparison with VCO (p<0.001). These results suggest that gradual aortic occlusion increases LV myocardial contractility in anesthetized, open-chest dogs under autonomic blockade. This phenomenon might be related to length-dependent calcium activation.

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An extremely rare case of hypereosinophilic syndrome is reported. The patient had congestive heart failure due to left ventricular obliteration by a giant thrombus in the apex. Arteriosclerosis obliterans resulted in serious lower extremity gangrene. Combination therapy with a con ticosteroid and hydroxyurea caused a marked reduction in eosinophil count, and heart failure recovered in stages. Although the patient was discharged, he returned to our hospital 3 months later with acute myeloblastic leukemia and subsequently died of respiratory failure with pneumonia.

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We report a case of a 40-year-old man who had a quadricuspid aortic valve associated with aortic regurgitation. The anomaly was revealed by transesophageal echocardiography (TEE), and confirmed by cardiac surgery. TEE is a useful noninvasive method for identifying the quadricuspid aortic valve.

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A small-for-gestational-age infant with cyanosis due to double outlet right ventricle with severe pulmonary stenosis and patent ductus arteriosus was treated with oral prostaglandin E₁ derivative (OP-1206). The constricting ductus arteriosus dilated and the ductus-dependent pulmonary blood flow increased. The recommended dosage was 1.5-2.0μg/kg/day which was lower than that of intravenous PGE₁ or of oral PGE₂. The administration interval was 6 hours, which was longer than that of oral PGE₂. The patient was treated as an out-patient because continuous intravenous infusion was not necessary. Treatment was continued for 2 months without complication, at which time a Blalock-Taussig shunt operation was performed. Orally administered PGE1 derivative (OP-1206) was found to be equally effective to intravenous infusion of PGE1 for both short and long-term management of cyanotic heart disease in which the pulmonary blood flow is mostly dependent on the patency of the ductus arteriosus. Oral PGE₁ derivative (OP-1206) may be a possible substitute for intravenous PGE₁ infusion therapy.

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Herein we report a case of a cardiac echinococcal cyst located in the interventricular septum and producing a mild obstruction of the left ventricular outflow tract. The cyst was detected by cross-sectional echocardiography and thoracic computed tomography and treated successfully with mebendazole.

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Intracardiac lipomas that consist of mature fat cells with fibrous and myxoid tissues are regarded as rather rare lesions. The diagnosis may frequently be established during surgical intervention or at autopsy.
The patient presented is a 23-year-old male who had had no complaints. The lesion had been incidentally detected on x ray examination which had revealed an enlarged heart shadow. His physical examination revealed no abnormality except displacement of the heart to the right and sinus tachycardia.
A solid mass derived from the pericardium was observed on CT scans and echocardiography. On CT scans the mass exhibited a density consistent with a lipoma. The patient was operated on and the mass, which was encapsulated and 19×17×10cm in size, was removed. Histopathological examination revealed a lipoma.

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