The aim of the present study was to investigate the properties of diastolic left atrioventricular plane displacement (AVPD) in coronary artery disease (CAD) patients. In 125 patients (mean age 58.7±13.7) with CAD and in 51 age-matched healthy subjects, a complete transthoracic echocardiographic study was performed. The AVPD was recorded by M-mode echocardiography, from apical four and two chamber views at four sites corresponding to the septal, lateral, anterior and inferior walls of the left ventricle. Mean AVPD in early diastole (E-AVPD), mean AVPD from atrial systole (A-AVPD) and the ratio A-AVPD/E-AVPD were determined. In normal subjects, such as in 35 patients without left ventricular segmental wall motion abnormalities (SWMA), stepwise multiple regression analysis showed none of these factors to be significantly related to E-AVPD or A-AVPD. Aging was correlated negatively to the E-AVPD/A-AVPD ratio (p<0.05). In 90 patients with left ventricular SWMA, stepwise multiple regression analysis showed that indices of left ventricular systolic function correlated positively to E-AVPD (p<0.001) and A-AVPD (p<0.001). The E-AVPD/A-AVPD ratio was correlated to left ventricular ejection fraction and heart rate (p<0.005). Mean E-AVPD was significantly lower in CAD patients than in normal subjects (p<0.001), while A-AVPD was higher in patients without left ventricular SWMA in comparison to normal subjects (p=0.02). Also, mean A-AVPD/E-AVPD was higher in CAD patients than in the control group (p<0.001). Mean E-AVPD/A-AVPD was correlated to the E/A ratio of transmitral flow in CAD patients with (r=0.669) and without (r=0.771) SWMA.
The E-AVPD and A-AVPD in CAD patients with SWMA is reduced according to the deterioration of left ventricular systolic function. The atrial contribution to the longitudinal distension of the left ventricle is increased in CAD patients. In CAD patients, especially those without left ventricular SWMA, the E-AVPD/A-AVPD ratio has a good correlation to left ventricular filling behavior.(Jpn Heart J 36: 545-556, 1995)

抄録全体を表示

The insertion/deletion DNA polymorphism of the gene coding human angiotensin converting enzyme (ACE) was examined in 109 patients with coronary artery disease (CAD) and 93 non-coronary subjects (NCS) living in a northern part of Japan. The presence of risk factors including age, hypertension, hypercholesterolemia, tobacco use, diabetes mellitus and hyperuricemia were also examined. An insertion (I) / deletion (D) polymorphism of the ACE-gene was determined by the polymerase chain reaction with oligonucleotide primers encompassing the polymorphic region in intron 16. The template DNA was isolated from peripheral blood leukocytes of patients. The frequency of the D-allele in NCS was 0.27, significantly lower than that reported in Caucasians or in Japanese living in the Osaka area. The frequency of the D-allele in patients with myocardial infarction (MI) and angina pectoris was 0.39 and was higher than that in NCS. The frequencies of genotypes DD, ID, and II were 17.8, 43.3 and 38.9%, respectively, in CAD except in young patients (below 40 years of age) with MI and AP groups, and 6.5, 40.9 and 52.7%, respectively in NCS (p<0.05 between CAD and NCS). Young MI showed similar frequencies in ACE gene polymorphisms to those in NCS, a pattern which differed from that seen in subjects with CAD (p<0.05). The numbers of risk factors did not alter the frequency of ACE gene genotype among patients with CAD, however, in normotensives, the odds ratio of DD-genotype was significantly increased to 3.4. Accordingly, ACE gene polymorphism may be associated with morbidity from CAD in Japanese living in northern Japan as has been noted in Caucasians, despite the lower frequencies of the D-allele in the Japanese population. (Jpn Heart J 36: 557-564, 1995)

抄録全体を表示

The long-term outcome of PTCA and medical therapy were compared in patients with SVD. All patients were confirmed to have ≥75% stenosis of a major coronary artery by coronary arteriogram. The 5-year survival rates were 96.0% for medical therapy and 98.9% for successful angioplasty. Both therapies achieved an equally good long-term outcome for SVD. The incidence of nonfatal cardiac events during follow up was higher in patients treated by PTCA than in those on medical therapy, but there was no difference between the two groups in the incidence of nonfatal MI at 5 years (2.5% vs 1.8%). The most common cardiac event in patients undergoing successful PTCA was repeat intervention associated with restenosis.
In view of the long-term efficacy of PTCA, the high restenosis rate remains an important problem and it is necessary to elucidate the causes of restenosis and develop countermeasures as soon as possible. (Jpn Heart J 36: 565-572, 1995)

抄録全体を表示

QT and QT dispersion, which is the time difference between QT maximum and QT minimum, were evaluated in 22 patients with anterior myocardial infarction approximately one month after onset. The purpose of this study was to observe how LV wall motion abnormality is related to these variables. Twenty age-matched patients without overt heart disease were also studied as a control group.
QT and QT max in patients with acute myocardial infarction (AMI) were markedly prolonged compared to those in normal controls (472.8±48.0, 483.2±32.1 vs 390.2±18.8, and 418.0±21.0msec, respectively). QT dispersion and QTc dispersion in patients with AMI were significantly more prolonged than in normal controls (111.2±33.9, 113.4±32.9 vs 54.3±15.0, and 60.3±17.2msec, respectively). QT dispersion has a positive correlation with QT max in AMI patients. Ejection fraction (EF) of the left ventricle was relatively well maintained in cases where only one segment of the left anterior ventricular wall was impaired in its motion. It decreased, however, in accordance with the extent of wall motion abnormality. QT max and QTc max were prolonged as the number of LV wall segments with impairment increased. This, however, was not statistically significant. QT dispersion and QTc dispersion had no relation to the extent of LV wall motion abnormality nor to EF of the left ventricle.
In conclusion, no definite relationships between QT dispersion (QTc dispersion) and EF of the left ventricle, or between these variables and the extent of left ventricular wall motion abnormality were found in patients with anterior myocardial infarction in our study. Although both QT max and QT dispersion were prolonged in patients with myocardial infarction, this suggests that electrical heterogeneity or regional variation in electrical ventricular recovery did not always parallel the severity of mechanical abnormality of the left ventricle. (Jpn Heart J 36: 573-581, 1995)

抄録全体を表示

T1 scintigraphic abnormalities have been reported in patients with an implanted permanent pacemaker, but little is known about the MIBG scintigraphic findings in such patients. This study was performed to assess the MIBG scintigraphic findings in patients with an implanted permanent pacemaker, and to test the hypothesis that imaging characteristics of MIBG scintigraphy differ according to its mode. Twelve patients (4 men and 8 women, mean age: 72.4±9.5 years), who had undergone the implantation of a permanent pacemaker for bradyarrhythmias, underwent MIBG scintigraphy. The patients were divided into VVI pacemaker and DDD pacemaker groups. The tomograms were divided into nine segments and the MIBG defect in each segment scored on a scale ranging from 0 (normal uptake) to 3 (no uptake). Total MIBG defect scores were generated by summing the scores for the nine segments in each patient. MIBG scintigraphic abnormalities were found in ten of the twelve patients. The six patients with the VVI pacemaker manifested MIBG scintigraphic abnormalities. These MIBG scintigraphic abnormalities were observed in all segments, particularly in the posterior segments. The mean total defect score of the VVI group was higher than that of the DDD group (14.8±9.8 vs 3.0±3.5, respectively p<0.05). Therefore, we conclude that despite several limitations of the study, MIBG scintigraphic abnormalities occur in patients with implanted permanent pacemakers, and that such abnormalities are more prominent with the VVI than DDD pacemaker. (Jpn Heart J 36: 583-591, 1995)

抄録全体を表示

The aim of this study was to assess whether intraoperative transesophageal echocardiography with nitroglycerin infusion could identify viable myocardium. Twenty-eight patients with coronary artery disease with regional dysfunction underwent transesophageal echocardiography during bypass surgery. A transgastric left ventricular cross-sectional image at the midpapillary level was obtained and divided into four segments for wall motion analysis. Forty-four segments were graded as asynergic. Nitroglycerin was then given intravenously with an initial infusion rate of 1μg/kg/min, followed by an increase in dose up to 3μg/kg/min. Functional improvement with nitroglycerin was observed in 33 of 44 asynergic segments, while 11 remained unchanged. Follow-up transthoracic echocardiography was performed at 15.9±5.5 days after surgery. A segment was defined as viable when wall motion was better than or equal to severe hypokinesis at baseline or follow-up. Forty-three of 44 asynergic segments at baseline were defined as viable; these were the same segments demonstrating wall thickening with nitroglycerin. In particular, four of 5 akinetic segments at baseline demonstrated viability at follow-up, which had been predicted with nitroglycerin. Transesophageal echocardiography with nitroglycerin correctly identified viability (p<0.05). No adverse hemodynamic effect was observed. Intraoperative transesophageal echocardiography with nitroglycerin appears to be a safe, noninvasive, feasible, and widely available method to identify myocardial viability under the condition supported by cardiopulmonary bypass. (Jpn Heart J 36: 593-603, 1995)

抄録全体を表示

In mitral regurgitation the left ventricle enlarges in order to increase its stroke volume because of the regurgitation through the mitral valve. The amount of this volume increase, and of the consequent increase in left ventricular mass, is dependent upon the amount of the regurgitant volume, but many other factors come into play, such as left ventricular pumping capability (contractility), the level of peripheral pressure, resistance and compliance of the arterial tree. The aim of this study is to predict the final left ventricular volumes and mass given the amount of mitral regurgitation. The predicted results are compared with actual data in real patients. In most cases prediction is fairly good; some discrepancies can be interpreted as an index of advanced decompensation. (Jpn Heart J 36: 605-616, 1995)

抄録全体を表示

We evaluated the characteristics of left ventricular diastolic hemodynamics in hypertrophic cardiomyopathy (HCM) by measuring left ventricular inflow (LVIF) and pulmonary venous flow (PVF) velocities in 62 patients with asymmetric septal hypertrophy and 34 normal controls. The patients were divided into four groups according to the LVIF pattern and left ventricular end-diastolic pressure (LVEDP): 1) the pseudonormalization group; 13 patients with the ratio of peak atrial systolic (A) to early diastolic (E) LVIF velocity (A/E) ≤1 and LVEDP ≥15mm Hg, 2) the normal pattern group; 10 patients with the A/E ≤1 and LVEDP <15mm Hg, 3) the relaxation failure group; 25 patients with the A/E >1, and 4) the mid-diastolic wave group; 14 patients with a mid-diastolic wave. The peak early diastolic LVIF velocities in the pseudonormalization, relaxation failure and mid-diastolic wave groups were significantly smaller than in the control group. The deceleration time from the peak of the E wave and the isovolumic relaxation time were significantly prolonged in the relaxation failure and mid-diastolic wave groups. The peak diastolic PVF velocity in the relaxation failure and mid-diastolic wave groups was significantly decreased, and was significantly increased in the pseudonormalization group. The peak atrial systolic PVF velocity was significantly increased in all patients with HCM, particularly in the pseudonormalization group. LVEDP was the highest in the pseudonormalization group, followed by the mid-diastolic wave, relaxation failure and normal pattern groups, in that order. In conclusion, combined analysis of the LVIF and PVF provides useful information regarding various abnormalities of left ventricular diastolic hemodynamics in patients with HCM. (Jpn Heart J 36: 617-627, 1995)

抄録全体を表示

Doppler echocardiographic determinations, left ventricular (LV) fractional shortening (FS), cardiac output (CO), diastolic function parameter (E/A ratio) and carotid artery pulse wave velocity and stiffness were evaluated in 36 patients with essential hypertension before and after nisoldipine treatment. Blood pressure decreased significantly, and carotid artery width and fractional shortening increased significantly following nisoldipine administration (p<0.0001). Carotid artery pulse wave peak velocity did not change following the treatment period (p>0.05). In conclusion, short term nisoldipine administration improved blood pressure and LV systolic function, whereas LV diastolic function and carotid artery stiffness did not change. Nisoldipine did not alter serum biochemical parameters, including cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol (p>0.05). Only one patient manifested symptoms of hypotension as an adverse effect of the drug. (Jpn Heart J 36: 629-637, 1995)

抄録全体を表示

We retrospectively reviewed all patients with a final diagnosis of spontaneous thoracic aortic dissection treated at Linkou Chang Gung Memorial Hospital between January 1989 and December 1994. There were a total of 109 patients with a mean age of 55±11 years ranging from 19 to 88 years. The male-to-female ratio was 2 to 1 (73 to 36). There was a predilection to present during the colder months, with 69% seen between September 1 and February 28 and only 31% during the warmer half of the year. In most patients, hypertension (85%) was the major predisposing factor with another 7% having Marfan syndrome. The remaining 8% had no obvious underlying disease except for one patient who had an atrial septum defect.
Presenting chief complaints in order of frequency included: anterior chest pain 58.7% (64/109), back pain 19.2% (21/109), abdominal pain 10.1% (11/109), consciousness change 3.7% (4/109), neck pain 2.7% (3/109), paraparesis 2.7% (3/109), dyspnea 1.8% (2/109), and hemoptysis 0.9% (1/109). The diagnostic breakdown revealed 46% to be type A (50/109) and 54% type B (59/109). A total of 26 (24%) patients died in hospital (16% were type A and 8% were type B). (Type A includes all proximal dissections and those distal dissections that extend retrograde to involve the arch and ascending aorta; Type B refers to the other distal dissections without proximal extension; proposed by Daily et al.)
Thoracic aortic dissection remains an important concern in patients with a history of hypertension. Patients seem particularly susceptible during cold weather months. The average age of our patients was only 55 years and 24% of them died during hospitalization. Earlier identification and more aggressive antihypertensive treatment is required. (Jpn Heart J 36: 639-645, 1995)

抄録全体を表示

We measured intracellular Na⁺ concentration ([Na⁺]i) of diabetic rat ventricular myocytes using sodium-binding benzofuran isophthalate (SBFI). We used diabetic rats at 8 weeks after the injection of streptozotocin (45mg/kg i.v.). The level of [Na⁺]i during the control perfusion was significantly lower in diabetic myocytes than that in normal myocytes (9.2±0.4mM v.s. 12.0±0.3mM, p<0.01). After the 40min perfusion of 1μM hexamethylene amiloride (HMA), [Na⁺]i decreased significantly in both groups. However, there was no difference in [Na⁺]i between the two groups after the perfusion of HMA. It was suggested that the lower [Na⁺]i in diabetic myocytes could be due to the decreased activity of Na⁺/H⁺ exchange system. (Jpn Heart J 36: 647-656, 1995)

抄録全体を表示

The efficacy of local delivery of an antithrombotic drug on neointimal hyperplasia was investigated in 17 rabbits. One rabbit iliac artery was injured by a balloon catheter as a control injured artery. The other iliac artery was also injured and treated by local delivery of 25U/kg of heparin. One hour after the balloon injury, angioscopy demonstrated an occlusive or mural thrombus in all the controls, but few in the locally-treated arteries. Four weeks after balloon injury, the percent stenosis was 34±31% in the heparin treated group (n=7, p<0.005 vs control side 73±17%). Accumulation of FITC-labeled heparin at the injured site was confirmed by microscopy. The activated partial thromboplastin time and fibrinogen level did not change significantly. PDGF-B chain was prominent at the neointimal layer in all the controls, whereas it was less in the locally treated arteries. Thus local delivery of heparin can inhibit neointimal hyperplasia after balloon injury by reducing thrombus-related growth stimulation. (Jpn Heart J 36: 657-668, 1995)

抄録全体を表示

Vasospastic angina was observed in two sisters. The 52-year-old younger sister presented with rest angina at midnight and in the early morning. The coronary arteriogram showed no significant organic stenosis. Vasospasm to the left anterior descending and right coronary arteries was induced by the intracoronary administration of acetylcholine. The 57-year-old elder sister complained of rest and effort angina. Her coronary arteriogram was also normal. Vasospasm to the left circumflex and right coronary arteries was provoked by acetylcholine. In both cases, human leukocyte antigen DQw3 was negative. In the present cases, genetic factors may partly contribute to the mechanism of vasospastic angina. (Jpn Heart J 36: 669-673, 1995)

抄録全体を表示

A surgically treated case of both Wolff-Parkinson White syndrome and atrial septal defect complicating a single coronary artery and partial pericardial defect is reported. These complications are very rare. In addition, the accessory pathway of this case had unique decremental conduction characteristics. (Jpn Heart J 36: 675-680, 1995)

抄録全体を表示

We report the case of a 38-year-old man who developed fatal, systemic amyloidosis following ankylosing spondylitis. He was admitted for symptoms of congestive heart failure. Based on parotid gland biopsy and echocardiography, he was diagnosed as having systemic amyloidosis following active ankylosing spondylitis. However, the clinical course was rapidly progressive and eventually the patient died of acute necrotizing pancreatitis. The association has been reported thus far in a limited number of cases worldwide. The literature has featured localized lesions and a benign clinical course of the amyloidosis. This case, the first report from Japan, indicates that the amyloidosis associated with ankylosing spondylitis might exhibit a rapidly progressive clinical course, thereby suggesting that in such a case, meticulous treatment is required. (Jpn Heart J 36: 681-688, 1995)

抄録全体を表示