Percutaneous transluminal coronary angioplasty of coronary artery occlusions forms a routine part of cardiological practice. However, only a few angiographic variables which might predict success have been investigated and identified.
Video densitometry was used to assess structural features of the occlusion that have not been investigated previously. The sharpness and eccentricity of the tapering, the presence of any distal vessel and the presence of a reservoir or atrium in which the end of the wire could become trapped were measured. Other measurements taken from the cineangiogram included the minimum radius of curvature of the artery immediately before the occlusion, the number of bends and the distance traversed before the occlusion. The number, size, location and angle of branching of side branches from the artery in question were noted. The number of bridging collaterals and presence of distal opacification were noted.
There was a significantly higher success rate in patients with less than 3 bends before the occlusion (p=0.01) and a distance down the artery to the occlusion of less than 27mm (p<0.05). An atrium was present in 36% and was associated with an unsuccessful outcome (p=0.02). Distal opacification, despite occlusion of the artery, was found to be associated with failure to cross the lesion (p<0.05). The angle of branches of the artery was only found to be important near (within 7.5mm) the occlusion (p<0.05). None of the video densitometric measurements of the fine structure of the stump of the coronary artery were found to be helpful.

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To evaluate the behavior of circulating endothelin and atrial natriuretic peptide (ANP) during coronary artery bypass graft (CABG) surgery, blood samples from patients with coronary artery disease (n=8) were investigated before, during and after operation. Plasma levels of endothelin and ANP were determined using the radioimmunoassay method. Baseline plasma levels were compared to those of normal volunteers (n=6). Left ventricular function at rest and as a response to isometric exercise was evaluated using radionuclide ventriculography before and after coronary bypass surgery.
The mean endothelin value was found to be within normal limits, however the mean ANP value was slightly higher than control. Patients had significantly improved left ventricular systolic and diastolic function after surgery. The mean endothelin level was higher than initial values immediately after extra-corporeal circulation and returned to initial values in two hours. However, ANP values were increased and remained higher than initial values. Baseline endothelin values were negatively correlated with systolic function parameters, whereas endothelin and heart rate had a positive correlation before extra-corporeal circulation.
Coronary artery bypass graft surgery may cause an increase in the circulating endothelin level either due to endothelial injury or due to myocardial ischemia and hypothermia. Following surgery, increased endothelin levels returned to normal values immediately.

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The administration of atrial natriuretic factor (ANF) increases coronary blood flow and decreases coronary vascular resistance. However, little is known about the feasibility and reliability of intravenous long-term infusion of ANF in patients with coronary heart disease. We therefore examined the effects on hemodynamic parameters and water input-output balance of 24-hour administration of synthetic ANF (ANF-[99-126]: 20-50ng/kg/min) in 8 patients with acute myocardial infarction (6 men and 2 women; mean age 55 years). The ANF infusion significantly decreased pulmonary capillary wedge pressure to a maximum of greater than 50% 4 hours after infusion (from 16±2 to 7±2 mmHg; p<0.01), and the effect was sustained throughout the 24-hour infusion without diuresis (mean water balance, +25±12ml/hr). This reduction was significantly correlated with the baseline value before infusion (r=-0.85, p<0.01). The effect on pulmonary capillary wedge pressure was accompanied by small reductions (approximately 20%) in systemic blood pressure and cardiac index, without significant changes in systemic vascular resistance and heart rate. These results indicate that prolonged administration of low to medium doses of synthetic ANF causes potent and sustained left ventricular unloading without reflex tachycardia and volume depletion, and may thus be safe and have potential benefits for patients with coronary heart disease.

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The theoretical and clinical validity of immunochemiluminometric assay of creatine kinase (CK)-MB protein mass was assessed in patients with acute myocardial infarction and the results were compared with those of immunoinhibition assay of CK activity. Serial changes of both CK-MB protein mass and CK-MB activity were analyzed in 20 consecutive patients. In all 312 samples from 20 patients, protein mass and activity of CK-MB showed good correlation. The exponential fitting of the time-value curve of CK-MB protein mass showed a better correlation coefficient than that of CK-MB activity (0.97±0.02 vs 0.93±0.07, p<0.05), indicating that the CK-MB level measured by the immunochemiluminometric assay was less scattered than that measured by the immunoinhibition method. This finding was most evident at lower CK-MB values (<500IU/l). The rate of disappearance from serum of CK-MB protein mass was faster than that of CK-MB activity (0.54±0.23hr^-1 vs 0.28±0.13hr^-1, p<0.001). This may indicate that some amount of the CK-MB activity may be inactivated in the early phase of the release into the serum from the necrotic myocardium.
Thus, the immunochemiluminometric assay of CK-MB protein mass has superiority in the diagnosis of acute myocardial infarction compared with the immunoinhibition method, especially when the measured CK-MB level is low. This feature may be useful to distinguish a small myocardial infarction from severe ischemia without myocardial necrosis.

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The aim of this study was to determine whether the time of occurrence of sudden death exhibits a circadian rhythm depending on its different anatomoclinical causes.
A longitudinal prospective investigation of 610 nonhospitalized subjects who died suddenly in the Emergency Room of Ferrara Hospital between January 1983 and December 1990 was conducted. All subjects underwent autopsy.
Sudden death was classified on the basis of the following pathological causes; acute myocardial infarction, acute myocardial failure, intracerebral hemorrhage, rupture of aortic aneurysm, pulmonary embolism, and clinical causes, i.e., arrhythmia and circulatory failure.
The investigated cases were stratified into 2 groups according to age; Group A=age<70 years (n=301, 49.3%), and Group B=age≥70 (n=309, 51.7%).
The assessment of circadian rhythmicity was performed utilizing the single cosinor method.The results by cosinor analysis found a circadian rhythmicity for cases of sudden death (peak at 14.04, n=610, p=0.036), and in particular for females (peak at 13.12, n=200, p=0.004). Spectral analysis detected a statistical ultradian cycle in males having an 8-hour period (p=0.015).
A statistically significant circadian rhythm was found for cases of sudden death due to acute myocardial infarction (peak at 15.28, n=330, p=0.013), pulmonary embolism (peak at 11.46, n=56, p=0.003) and arrhythmia (peak at 13.08, n=291, p=0.04).
In Group A no significant circadian rhythm was found, whereas in Group B a significant rhythmicity was found for sudden death from cardiac causes at 13.32 (n=249, p=0.015), from myocardial infarction at 15.02 (n=154, p=0.018) and from arrhythmia at 13.07 (n=122, p=0.014).
Different circadian patterns of onset of sudden death may be shown in various subgroups of patients, due not only to different pathophysiologic mechanisms but also to anatomo-clinical aspects.

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Cine magnetic resonance imaging (MRI) was used to assess aortic regurgitation (AR) in 13 patients with valvular disease and 3 normal subjects, and the results were compared to color Doppler flow mapping findings. AR produced a signal void in the left ventricle during the diastolic phase in all patients by MRI. There were no false positive or negative results compared with echocardiographic findings. Visual grading of cine MRI gave results similar to color flow Doppler echocardiography (88%). The distance and the area of aortic regurgitation using MRI correlated well with color Doppler flow mapping (r=0.82 and 0.88). However, measurements of distance and area by color flow Doppler tended to be larger than those by cine MRI. With current techniques echocardiography may overestimate the severity of AR as compared with cine MRI. In addition, MRI gives clinically useful information in patients in whom transthoracic Doppler echocardiography is not adequate.

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We evaluated the relation of atrial rhythm to a clinical course of treatment in 147 patients diagnosed with dilated cardiomyopathy (DCM). Thirty-six of the patients (24%) had either transient (9 patients) or persistent (27 patients) atrial fibrillation (AF). Compared with DCM patients with sinus rhythm (SR), the AF patients did not differ in age, left ventricular (LV) dimension, fractional shortening, or hemodynamic parameters, but the AF patients had slightly larger left atria. After a mean follow-up of 3.8±2.9 years, the NYHA functional classifications in the AF patients improved in 20 of the 36 (56%), whereas those of the SR patients improved in only 30 (27%) (p<0.01). The actuarial 5-year survival rate was significantly better for AF patients than for SR patients (93% versus 68%, p<0.05). LV function remained unchanged in SR patients but improved significantly in AF patients, particularly in patients with transient AF and with "rate-controlled" AF (those with a mean heart rate of less than 90beats/min).
This study suggests that atrial fibrillation may result in significant LV dysfunction, which is reversible in some cases once the arrhythmia is controlled. Aggressive antiarrhythmic therapy should be considered for patients initially diagnosed with dilated cardiomyopathy and atrial fibrillation.

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The effects of smoking on maternal and cord plasma lipid and lipoprotein levels were measured in 40 smoker mothers and their newborns and compared to nonsmokers. Significantly higher levels of total cholesterol, low density lipoprotein cholesterol and very low density lipoprotein cholesterol and lower levels of high density lipoprotein cholesterol were found in smoker mothers and their newborns in comparison to nonsmokers. These results suggest that smoking does not affect only the lipids and lipoproteins of pregnant women but also those of their fetuses.

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Carnitine deficiency has been demonstrated in diabetic hearts, and it is also well known that L-carnitine administration has a beneficial effect on car-diac function. Carnitine treatment would be expected to reduce the accumulation of long-chain acylcarnitine. However, many reports have shown that myo-cardial long-chain acylcarnitine levels were increased following treatment with L-carnitine in whole-heart studies. Since acylcarnitine exists in both the mitochondrial and cytosolic compartments, it is difficult to investigate changes in subcellular distribution by studying whole-heart preparations. The present study investigated the myocardial subcellular distribution of carnitine and its acyl derivatives in diabetic rats with or without L-carnitine treatment. Approximately 90% of total cellular carnitine was located in the cytosol in the diabetic hearts. Both mitochondrial and cytosolic levels of free carnitine and short-chain acylcarnitine were significantly decreased in the diabetic heart. However, the mitochondrial level of long-chain acylcarnitine was significantly increased. L-carnitine treatment reduced the mitochondrial level of long-chain acylcarnitine, but the cytosolic level of long-chain acylcarnitine was significantly increased. These results show that L-carnitine treatment prevents the accumulation of long-chain acylcarnitine in the mitochondrial space and then reduces the detergent effect of long-chain acylcarnitine on the mitochondrial membrane. We suggest that it is a possible mechanism of the beneficial effect of L-carnitine treatment on the diabetic heart.

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A study was designed to clarify the effects of captopril (CAP) or nitrendipine (NITR) on cardiac hypertrophy and left ventricular expression of the laminin B2 or collagen (COL) gene in spontaneously hypertensive rats (SHRs). Cardiac weight was significantly increased in 20-week-old SHRs.Gene expression of the α1 chain of type IV COL determined by northern blot analysis decreased with age in Wistar-Kyoto rats and SHRs. Left ventricular laminin B2 mRNA was decreased at 12 weeks and increased again at 20 weeks in both strains. Daily oral administration of CAP (40mg/kg, n=5) or NITR (30mg/kg, n=4) to SHRs from 8 to 20 weeks decreased blood pressure to 142mmHg (p<0.01 vs 197mmHg in controls, n=5). Cardiac weight was 1.26±0.04 (SE)g in controls and was reduced to 1.03±0.05g (p<0.01) by CAP, but not by NITR (1.24±0.04). Left ventricular laminin B2 gene expression was attenuated by CAP and NITR to 41% and 32% of the control value, respectively. CAP significantly decreased left ventricular at type IV COL mRNA to 11% of the control level, whereas NITR caused a reduction only to 75%. CAP also decreased α1 or α2 type I COL mRNA. These results suggest that angiotensin converting enzyme inhibitors prevent and/or cause regression of cardiac hypertrophy by inhibiting the gene expression of extracellular matrix, and that angiotensin II may have a pivotal role in cardiac hypertrophy.

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In order to study alterations of peripheral substance P (SP) and vasoactive intestinal peptide (VIP) in the immunoreactive nervous system in essential hypertension, plasma SP and VIP concentrations in stroke-prone spontaneously hypertensive rats (SHRSP) at 8, 12, 18, 28, 30, 35 and 48 weeks of age and agematched Wistar-Kyoto rats (WKY) were measured, using enzyme immunoassays (EIAs).
The mean plasma SP concentrations of SHRSP (n=61) and WKY (n=58) were 4.9±1.2fmol/ml and 6.6±1.9fmol/ml, respectively. The value of SHRSP was significantly lower than that of WKY (p<0.01). The mean SP concentration of young SHRSP was significantly higher than those of other ages.
The mean plasma VIP concentrations of SHRSP (n=61) and WKY (n=58) were 0.80±0.25fmol/ml and 1.01±0.32fmol/ml, respectively. The value of SHRSP was significantly lower than that of WKY (p<0.01).
These decreases in plasma SP and VIP concentrations of SHRSP were observed at all ages. Decreases in the peripheral release of SP and VIP from the endings of SP- and VIP-immunoreactive nerves of SHRSP were seen, and the functional involution of peripheral SP- and VIP-immunoreactive nerves in essential hypertension was suggested.

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This study describes the relationship between left ventricular mass and systolic arterial pressure (SAP) in normotensive and hypertensive rats. The genetically hypertensive rats (SHR) were stratified according to their SAP val-ues in to hypertensive (SHRH) and normotensive (SHRN) subgroups. Males and females of both subgroups exhibited biventricular hypertrophy and the left ventricular mass was not correlated with SAP values. An overall cardiac en-largement was also found in female rats of the normotensive WKY group. In DOCA-salt and 2K/1C hypertensive rats the left ventricular mass was corre-lated positively with SAP. These data suggest that SAP is not a factor in the development of left ventricular hypertrophy in the SHR strain, however, they also revealed a right ventricular mass increase in this strain with respect to the Wistar strain. (Jpn Heart J 34: 795-801, 1993)

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Acute myocardial infarction after artificially induced abortion is an uncommon event because such patients are usually young females and are not usually subject to atherosclerosis. This report describes two premenopausal females who developed acute myocardial infarction after administration of ergot derivatives which were used following abortion. Coronary arteries in both cases were angiographically normal. Both patients were smokers. We concluded that the ischemic event was caused by coronary vasospasm which was precipitated by the acute administration of ergot derivatives.

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This report describes a 69-year-old Japanese woman with bilateral forearm thrombophlebitis that developed soon after transvenous permanent pacemaker insertion. Intravenous administration of urokinase and heparin rapidly resolved fever, painful forearm swelling and inflammatory findings. Digital subtraction venograms revealed a brachiocephalic vein thrombosis. A ten-month treatment with warfarin and ticlopidine resulted in the complete restoration of venous flow. Although thrombophlebitis associated with transvenous permanent pacemaker insertion has a relatively low incidence (0.3%), prompt diagnosis and treatment with anticoagulant and/or thrombolytic agents are important for the late clinical outcome in cases with deep venous thrombosis.

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A 42-year-old man developed acute myocardial infarction 20 minutes following transnasal inhalation of amphetamine. To our knowledge, no cases of amphetamine-induced myocardial infarction by transnasal inhalation have ever been reported. Consequently its pharmacological effects on the cardiovascular system are discussed.

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