Japanese heart journal最新文献

Restenosis after stent deployment remains a major clinical problem. Antioxidants have been proposed as a promising strategy against restenosis. We tested the antioxidant probucol for its efficacy against neointimal hyperplasia in porcine coronary arteries after stent implantation. Probucol was then tested in vivo in 8 coronary arteries of 4 pigs (1000 mg/day orally beginning 7 days before stenting) and was compared to placebo (10 coronary arteries, 5 pigs) 28 days after stenting. Quantitative intravascular ultrasound (IVUS) revealed 38.8 +/- 4.0 versus 40.1 +/- 3.0% area stenosis in the probucol versus control group. Histopathologic assessment showed that probucol had no beneficial effect on inhibiting the neointimal proliferative response in stent lesions compared to placebo (2.35 +/- 0.26 versus 2.88 +/- 0.25 mm(2)), despite similar injury scores (1.20 +/- 0.12 versus 1.28 +/- 0.14). An edge segment (axially 2-mm proximal to the stent margins) was assessed by IVUS. Remodeling index, which is a good marker of constrictive remodeling, was defined by the ratio of the vessel area in the lesion site (stent edge) to the vessel area in the proximal reference site (6-mm proximal to the stent margins). The remodeling index was significantly larger in the probucol group that in the placebo group (1.18 +/- 0.10 versus 0.90 +/- 0.06, P = 0.0012). In conclusion, probucol reduced constrictive remodeling at the edge of the implant but did not inhibit the tissue response within the stent.

Immune-mediated mechanisms are thought to play a key role in the development of coronary artery disease and its thrombotic complications. Preinfarction angina has been suggested to improve left ventricular function and short-term outcomes. The purpose of the present study was to investigate the relation between the immune response and in-hospital clinical course in preinfarction angina. We prospectively evaluated 93 patients. Forty-three patients exhibited preinfarction angina within 24 hours before the onset of acute myocardial infarction (AMI) (preinfarction angina group) and 50 patients were free from preinfarction angina (sudden onset group). The incidence of complications (heart failure, recurrent angina, arrhythmia and coronary interventions) and in-hospital mortality were assessed in the two study groups. We detected some immune markers, including white blood cells, C-reactive protein, immunoglobulins, and complement. White blood cells and CRP were significantly lower in the preinfarction angina group than in the sudden onset group (P < 0.001, P < 0.005, respectively). Conversely, IgE and C(4) were significantly higher in the preinfarction angina group than in the sudden onset group (P < 0.001, P < 0.001, respectively). The incidences of heart failure and severe arrhythmias were lower in the preinfarction group than in the sudden onset group (P < 0.005, P < 0.05 respectively). The beneficial effect of preinfarction angina may be associated with an immune-inflammatory response modified by a brief ischemic episode.

Nowadays, evidence-based medicine has entered the mainstream of clinical judgement and the human genome has been completely decoded. Even the concept of individually designed medicine, that is, tailor-made medicine, is now being discussed. Due to their complexity, however, management methods for clinical information have yet to be established. We have conducted a study on a universal technique which enables one to select or produce by employing information processing technology clinical findings from various clinical information generated in vast quantity in day-to-day clinical practice, and to share such information and/or the results of analysis between two or more institutions. In this study, clinically useful findings have been successfully obtained by systematizing actual clinical information and genomic information obtained by an appropriate collecting and management method of information with due consideration to ethical issues. We report here these medical achievements as well as technological ones which will play a role in propagating such medical achievements.

Brucellosis is a multisystemic disease. The most common cause of death from the disease is endocarditis. The aortic valve is most commonly affected. The disease rarely involves the mitral valve. A 30 year-old woman presented with complaints of chills and fever up to 38 degrees C at night, fatigue, palpitations, and dyspnea for the previous 3 weeks. Cardiac auscultation revealed a diastolic murmur in the mitral area. Her temperature was 38.3 degrees C. On echocardiographic examination, the mitral valve area was 0.62 cm (2) and an isoechoic mass thought to be a vegetation was detected on the anterior mitral leaflet. A diagnosis of infective endocarditis was made and vancomycin administration was commenced. Brucella melitensis was isolated in all three blood samples, however, the patient remained seronegative with Brucella agglutination titers of up to 1/160. The antibiotic therapy was then shifted to doxycycline (200 mg/day), rifampicin (600 mg/day), and ciprofloxacin (1000 mg/day). After 30 days of treatment, surgery was performed for the severely stenotic mitral valve and to remove the vegetation. The operation was successful. The postoperative period was uneventful. On the follow-up she had no complaints. In cases with Brucella endocarditis, after diagnosis, antibiotic therapy must be started immediately and when the clinical condition improves, surgical intervention should be performed when indicated.

A 51-year-old male presented with sudden onset lower abdominal pain followed by weakness of both legs. Examination revealed blood pressure of 220/130 mmHg, with a grade 2/6 systolic murmur audible at the apex of the heart, and absence of both femoral arterial pulses. Two-dimensional and transesophageal echocardiography showed no evidence of intracardiac tumor or dissection of the ascending and thoracic aorta. Moreover, an aortogram demonstrated total occlusion of the abdominal aorta just below the renal arteries. A myxomatous-like material occupying the abdominal aorta just above the bifurcation of the common iliac arteries was discovered during surgery. Histologic examination of the embolic material confirmed the diagnosis of myxomatous embolus. One year after the embolic episode, the patient was well and two-dimensional and transesophageal echocardiography revealed no evidence of residual intracardiac tumor.

In the present study, we evaluated whether stenting is useful for cardiac overloading, using ANP, BNP, and (99m)Tc-tetrofosmin myocardial scintigraphy. It has been reported that coronary artery stenting is useful for cardiac functions for acute myocardial infarction (AMI). The subjects were 110 patients with AMI successfully treated by direct angioplasty. These patients were subgrouped into two groups: the S group (underwent stenting; 54 patients) and the P group (underwent POBA alone; 56 patients). Extent scores reflecting decreased myocardial blood flow were calculated at myocardial areas showing a radioactivity count of less than (-)2 x standard deviations compared to the database of normal subjects.The ratio of extent scores to defect scores (extent/defect ratio) was compared between the P and S groups. Both ANP and BNP levels in the S group were lower than in the P group at the chronic stage (1 and 3 months after reperfusion therapy). Moreover, the end-diastolic volume index from the left ventriculography 3 months after reperfusion therapy was significantly larger in the P than the S group. The extent/defect ratio was significantly lower in the P group (2.8 +/- 0.2) than the S group (3.5 +/- 0.3), suggestive of a microcirculation disorder. These results suggest that cardiac overloading and left ventricular remodeling are decreased more by stenting than by POBA alone, probably because stenting prevents decreased myocardial blood flow around the infarct myocardium.

This case report describes three hypertrophic cardiomyopathy patients with abnormal His-Purkinje conduction and complete atrioventricular block with attacks of syncope and cardiopulmonary arrest. Although arrhythmias are common in hypertrophic cardiomyopathy, complete atrioventricular block is very rare. Prolonged QRS duration and abnormal His-Purkinje system conduction may result in complete atrioventricular block.

Symptom-limited cardiopulmonary exercise testing was performed in 37 patients with mitral stenosis (MS) without significant coronary artery stenosis to evaluate factors affecting ST depression in exercise electrocardiograms. The degree of ST depression was not associated with gender or exercise tolerance. The incidence of significant ST depression was higher in the patients receiving than in those not receiving digitalis (P < 0.05). In addition, the patients with atrial fibrillation and a higher heart rate response were more likely to have a high prevalence of significant ST depression than those with sinus rhythm and a lower response (P < 0.05). We concluded that atrial fibrillation, a higher maximum heart rate, and oral digitalis administration were involved in ST depression during exercise testing in patients with mitral stenosis without coronary heart disease.

We studied the long-term follow up of abnormal T wave morphology (notched, low amplitude, and inverted T waves) of five female patients with LQT2 (HERG) mutations. The patients, aged 43, 19, 27, 26, and 56 years, had experienced syncopal attacks and were followed up for 3-17 years (average 9.4 years). Patients were treated with a beta-blocker alone (2) or combined with other drugs (3). The mutation in four patients was missense (A614V, T613, E130K) and its location was the pore region (3) or between the S1 transmembrane region and N-terminal (one). The fifth patient had an intragenic deletion (49 bp deletion) at HERG exon 4 (S1 transmembrane region and N-terminal), which was not identified as having any mutation. The patients manifested a notched T wave in at least one left precordial or limb lead (I, II or aVF). A low T wave amplitude was shown in at least one lead, and deeply inverted or biphasic waves in right precordial leads were also associated with these findings. The abnormal T wave finding in any of the 12 leads in our 5 LQT2 patients was shown to be widespread and was always found during the long-term follow up. The present cases suggest that notched T waves are useful for diagnosing female symptomatic LQT2 patients.

Differences in structural remodeling are believed to be influenced by hormonal systems in hypertension. The objective of the present study was to investigate the change in the circulating catecholamine beta-adrenergic system in the left ventricle remodeling process in hypertensives. One hundred and thirty-four men (mean age, 53 years) had essential hypertension and underwent echocardiography before treatment. Normal morphology (n = 26) and concentric remodeling (n = 41) were defined by a relative wall thickness at diastole (RWT) of < 0.44 and > or = 0.44, respectively, and concentric hypertrophy (n = 28) and eccentric hypertrophy (n = 39) by a left ventricular mass index (LVMI) of < 150 g/m(2) and > or = 150 g/m(2), respectively. Forty healthy males were studied as normal controls. Plasma levels of norepinephrine (NE) and epinephrine (E) were measured by high performance liquid chromatography. The density of lymphocyte beta-adrenoceptors (beta-AR) and the content of intralymphocyte cyclic AMP (cAMP) in peripheral blood were measured using (3)H-dihydroalpneol as a ligand and protein binding assay, respectively. The plasma levels of NE and E in the 4 groups of patients with essential hypertension were significantly increased compared with the control group. The density of lymphocyte beta-AR and the content of intralymphocyte cAMP of peripheral blood in the normal morphology, concentric remodeling, and concentric hypertrophy groups were significantly higher than those in the control group, while the values in the eccentric hypertrophy group were significantly lower than those in the control group. Among the 4 groups, the plasma levels of NE and E had increased the most in the normal morphology group, followed in decreasing order by the concentric remodeling, concentric hypertrophy, and eccentric hypertrophy groups; the density of lymphocyte beta-AR and the content of intralymphocyte cAMP of peripheral blood in the normal morphology, concentric remodeling, and concentric hypertrophy groups increased while they decreased in the eccentric hypertrophy group in patients with essential hypertension. The catecholamine beta-adrenergic system appears to be related to left ventricular remodeling of hypertension. In this process, catecholamines increased continually. The density of beta-AR and the content of cAMP in peripheral lymphocytes increased at first and then decreased.