[Prognosis of silent myocardial ischemia and its strategy for treatment].
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Aged↗
Biomedical subjects
H Kishida
Publications and source records attributed to H Kishida.
Angiographic response to a vasodilating drug, nicorandil, in patients with coronary artery disease.
To investigate the usefulness of nicorandil as an antianginal drug, we compared the coronary vasodilatory response in nonstenotic coronary artery segments and the hemodynamic response in 26 coronary artery disease patients. Both responses were studied prior to sublingual administration of 10 mg of this drug and 10, 30 and 60 min afterward. The plasma nicorandil concentration was determined up to 120 min after administration. The mean coronary dilating ratio of nicorandil was 117% 30 min after administration (p less than 0.01) and showed a good correlation to the plasma nicorandil concentration. The mean maximum dilating ratio of each patient was 125%. There was no difference between individual coronary arteries or between proximal and distal segments in terms of the coronary artery dilating ratio. The plasma nicorandil concentration required for 120% dilation of the coronary arteries was 26 ng/ml, 89 ng/ml and 142 ng/ml for those cases with variant angina, exertional angina and postinfarction angina, respectively. Hemodynamic changes due to administration of this drug included a decrease in blood pressure, and a reduction in total peripheral resistance, rate-pressure product, pulmonary capillary pressure and stroke-work index. These results indicate that the antianginal effects of nicorandil are derived from its coronary vasodilatory action and an inhibitory effect on myocardial oxygen consumption.
Administration, Sublingual↗
Evaluation of a new vasodilating beta-blocking agent, carvedilol, in exertional angina using holter monitoring.
Antianginal and antiischemic effects and clinical pharmacologic actions of carvedilol, a novel beta-blocking agent with a vasodilator action, were determined by Holter electrocardiographic monitoring in 13 patients with exertional angina. The patients were observed for 1 week prior to entry into the study, followed by 1 to 2 weeks of treatment with carvedilol. During the observation period the patients received one placebo tablet daily, and during the treatment period one 20 mg tablet of carvedilol daily. Before and after the treatment 24-hour Holter electrocardiographic tracings were obtained. The mean interval of Holter monitoring was 11.2 +/- 4.5 days for the observation and treatment periods, and the mean time of drug administration was 8:25 a.m. (+/- 30 min). The Holter electrocardiographic tracings which were obtained twice in 9 patients during the observation period showed a high degree of reproducibility with respect to the frequency, magnitude and duration of ST-segment depression. The total frequency of ST depression per patient was 4.5 +/- 3.4 events/day pre-drug and 2.1 +/- 2.1 events/day post-drug. There was a significant reduction in total frequency of ST depression post-drug (p less than 0.01). The frequency of asymptomatic ST depression was similarly decreased post-drug (p less than 0.01), and the total magnitude and duration of ST depression were significantly improved post-drug (p less than 0.01 and p less than 0.05, respectively). These effects of carvedilol lasted for 24 hours after administration. Considering that the heart rate was not excessively reduced during the night, and nocturnal myocardial ischemic episodes were not exacerbated, the mode of action of this drug seems to be based on not only a beta-blocking action but also on a vasodilator action. Carvedilol benefits exertional angina when used in a 20 mg s.i.d. regimen.
Adrenergic beta-Antagonists↗
[Serum rifampicin concentrations by means of different assay methods and their critical estimation].
Determination of serum rifampicin (RFP) after dose of the drug is often requested not only for the clinical criteria on its use, but also for the check of its adverse reactions. In comparative examination on each clinical use of 2 kinds of RFP commercial products: Rifadin and Aptesin, the authors had a chance of simultaneous determination of serum RFP by means of 3 different assay methods: solvent extraction method (SE), biological activity method (BA) and liquid-chromatography method (LC). Ten healthy male volunteers and 19 hospital patients (14 males and 5 females) with lung tuberculosis cooperated for this investigations. RFP blood samples were taken serially after oral administration of 450 mg RFP, at 1, 2, 3, 4, 6, 8, 12 and 24 hours in the volunteers, and at 2 and 4 hours in the patients. The serum RFP concentrations determined by the present methods showed generally a good correlation between each other, but there was a considerable difference in their quantity. The highest determinations were presented by the SE, which was devised as total assay method determining desacetyl RFP and 3-formyl rifamycin SV besides free RFP. The lowest determinations were brought about by the LC, which was devised fundamentally for the assay of free RFP. Thus the difference between both determinations by SE and LC was caused by RFP metabolites. This explanation was further proved by the fact that the difference rate, namely (SE-LC)/SE, increased clearly with the lapse of time, and could be used as an index of serial pattern of RFP metabolism. The serum determinations by BA appeared to be useful to monitor clinical efficacy of the drug, but seemed to be out of the absolute estimation. Incidentally the determination by BA was always ranked between both determinations by SE and LC figures. The detailed analysis of two examinations at ten-day intervals in the same volunteers revealed that the RFP determinations by SE appeared to show much better reproducibility than those by BA and LC. By the present assay methods, nearly no difference was demonstrated in the blood level of 2 RFP products. Some attensions were called to the practical estimation of the serum RFP concentrations: Clear individual differences were found in the serum RFP concentrations after dose of the drug, and appeared to become clearer in the stage of its continuous administrations. Above all, it was noteworthy that the individual difference in the first dose of RFP was found to be decided by the grade of absorption within 2 hours after the dose.(ABSTRACT TRUNCATED AT 400 WORDS)
Administration, Oral↗
The effect of nitroglycerin ointment on exercise-induced angina: a multicenter trial.
The efficacy of nitroglycerin ointment was determined by treadmill exercise testing through a randomized, double-blind crossover trial with placebo in 22 patients with chronic stable exertional angina. On different days, 3 cm of nitroglycerin ointment (NGO, 18 mg) and placebo ointment were applied over the epigastric region, followed by the exercise test 1 hour later. The maximal exercise time was 459 +/- 124 seconds after application of placebo and 510 +/- 113 seconds after application of NGO, and the exercise time to 1 mm of ST-segment depression was significantly extended to 297 +/- 110 seconds after placebo and 366 +/- 134 seconds after NGO (p less than 0.01, p less than 0.001, respectively). ST-segment depression at the endpoint of exercise was significantly reduced from 2.4 +/- 1.2 mm to 1.5 +/- 0.7 mm after application of NGO (p less than 0.01). There was no difference in rate-pressure product at the endpoint of exercise between placebo and NGO. Adverse reactions were elicited in 5 of 22 patients. The results of this present study suggest that NGO is effective in the treatment of exertional angina.
Aged↗
Clinical significance and management of silent myocardial ischemia in patients with angina pectoris and myocardial infarction.
The present study was canued out to clarify the relationship between silent myocardial ischemia in patients with angina pectoris and onset of myocardial infarction, and the former's prognostic significance. The peak incidences of onset of myocardial infarction in patients were at 2 a.m., 9 a.m., 2 p.m., 8 p.m., and 9 p.m., and the peak onsets of transient silent myocardial ischemia in angina pectoris patients were at 9 a.m., 2 p.m., 8 p.m., and 9 p.m. Thus the most likely onset times were almost the same with both events. Of 169 patients with coronary artery disease admitted for treatment, 128 patients had no anginal attacks during follow-up and the remaining 41 had persistent angina despite adequate medical treatment. Holter monitoring electrocardiography was performed twice with the non-angina patients, during admission. Of these 128 patients, 54 showed no silent myocardial ischemia on either of the electrocardiographic recordings, 34 showed silent ischemia with the first Holter monitoring but not with the second one, and the remaining 41 showed silent myocardial ischemia on both tests. The subsequent incidences of "cardiac events" were 9.4%, 14.7%, and 36.6%, respectively for these three groups. Therefore, it is concluded that the presence of silent myocardial ischemia is closely related to onset of myocardial infarction and is an important prognostic factor in patients with coronary artery disease.
Adult↗
Characteristics of symptomatic and asymptomatic myocardial ischemia during ambulatory electrocardiographic monitoring in patients with angina pectoris.
The purpose of the present study was to clarify the characteristics of myocardial ischemic attacks in patients with exertional angina (EA, 56 cases), exertional and rest angina (ERA, 28 cases), rest angina (RA, 4 cases), and variant angina (VA, 39 cases). The Holter electrocardiographic findings were compared among the four types of angina pectoris. The frequency of symptomatic ischemic attacks in descending order was 46.0% in EA, 29.0% in ERA, 28.1% in RA, and 21.6% in VA, while the frequency of asymptomatic ischemic attacks was in the reverse order. The maximal heart rates during symptomatic ischemic attacks were in descending order, EA, ERA, RA, and VA. The maximal heart rate during ischemic attacks was significantly lower in patients with spontaneous angina than in those with exercise-induced ischemia for all types of angina (p less than 0.05, respectively). Further, the difference in maximal heart rate during ischemic attacks between the ambulatory electrocardiogram and exercise test was greater in patients with RA and VA than in those with EA. Therefore, this suggests that increased coronary vascular tone is a cause of spontaneous ischemic attacks in each type of angina pectoris.
Aged↗
Prognostic value of low-level exercise testing in patients with myocardial infarction.
The prognostic value of low-level exercise testing (EXT) before hospital discharge was assessed in 111 patients with uncomplicated acute myocardial infarction (AMI). Of 111 patients, 94 were followed for 1 year after AMI to find that 22 carried a poor prognosis: reduction in duration of EXT (6 patients), postinfarction angina (2 patients), congestive heart failure (3 patients), coronary bypass graft surgery (7 patients) and reinfarction (4 patients). The prognosis was poor in 3.7% of 54 patients who tolerated exercise for 721 seconds or longer (4.2 METs) and 50% of 40 patients tolerating it no longer than 720 sec (p less than 0.0001). Of 22 patients who turned out to be carriers of a poor prognosis, 12 (54.5%) had an ST segment change during EXT, but 10 of the 12 patients were asymptomatic. Our results suggest that reduction in duration of exercise and asymptomatic ST segment changes during EXT provide important clues to establishing the short-term prognosis of AMI.
Adult↗
A case of progressive muscular dystrophy with numerous arterioluminal vessels.
A 48-year-old man had histologically demonstrated cardiac involvement associated with progressive muscular dystrophy. On coronary arteriography, numerous vascular communications between the coronary arteries and the left ventricular chamber were found. These vascular communications are considered to be the arterioluminal vessels. This is the first report of a case of progressive muscular dystrophy with numerous arterioluminal vessels.
Coronary Angiography↗
Evaluation of a new antianginal agent, nipradilol, in effort angina using holter monitoring.
The purpose of this study was to investigate the efficacy, effective dose, administration frequency and antianginal effect of a new antianginal agent, nipradilol, in 12 patients with stable effort angina. A single blind design was employed; the test consisted of an observation period (1 week) and a treatment period (1-2 weeks). Twenty four hour Holter monitoring was performed on the penultimate day of each period. Nipradilol was administered twice a day at a daily dose of 3-12 mg (mean 7.9 +/- 3.3 mg). The mean frequency of ST-segment depression was 7.1 +/- 6.7 times per day at baseline and 3.1 +/- 2.7 after drug administration, showing a significant reduction (p less than 0.05). The suppression of ST-segment depression and decrease in heart rate due to this drug persisted for 12 hours following administration. The plasma drug concentration at a daily dose of 12 mg peaked at 9.5 +/- 2.4 ng/ml 1 hour after administration and the 12 hour value was 2.3 +/- 1.2 ng/ml. No side effects were observed. Therefore, it seems that, when administered twice a day (total daily dose 6 mg) this drug is effective in effort angina and that the antianginal effect is mainly attributable to beta-adrenoceptor blockade.
Adrenergic alpha-Antagonists↗
Effect of a new calcium antagonist, nilvadipine, on variant angina pectoris evaluated by 24-hour Holter electrocardiography.
The clinical effect of nilvadipine, a new calcium antagonist, was investigated in a single blind trial in 19 patients with variant angina pectoris. The efficacy of the drug was evaluated on the basis of frequency of anginal attacks and Holter electrocardiographic findings during observation periods and during two treatment periods when the drug was given in doses of 4 mg twice a day or 4 mg 3 times a day. The frequency of anginal attacks and the consumption of sublingual nitroglycerin tablets decreased significantly in both treatment periods in comparison with those in the observation period before treatment, but in the observation period after treatment tended to increase in comparison with those during the second treatment period. The frequency and duration of ST-segment elevation and the maximum ST-segment elevation confirmed by Holter electrocardiography also improved significantly in both treatment periods, compared with those in the observation period before treatment. Our findings show that nilvadipine is effective for variant angina pectoris at doses of 4 mg twice a day.
Angina Pectoris, Variant↗
Human leucocyte antigen in variant angina.
Human leucocyte antigen analysis of 45 patients with variant angina was performed to determine the presence of causative genetic factor(s). A significantly low frequency of human leucocyte antigen DQ omega 3 was found in these patients, as compared with that in 152 normal Japanese adults. There were no differences in frequencies of antigens between patients with normal and those with atherosclerotic coronaries. These data suggest that some genetic factor(s) may contribute to the pathogenesis of coronary spasm.
Angina Pectoris, Variant↗
Effect of a new coronary vasodilator, nicorandil, on variant angina pectoris.
The effect of nicorandil, a new coronary vasodilator, was evaluated in 32 patients with variant angina pectoris in a single-blind trial. The study was comprised of a pretreatment period of 2 days with a placebo, a 3-day nicorandil medication period (20 mg/day), and a 2-day posttreatment period with the placebo. Anginal attacks disappeared completely in 24 of the 32 patients. The number of attacks during the pretreatment period, 3.6 +/- 0.4 per day, became significantly reduced to 0.7 +/- 0.2 per day during nicorandil therapy (P less than 0.001) and significantly increased to 1.3 +/- 0.3 per day after withdrawal of the drug (P less than 0.05). In 17 patients with continuous ECG monitoring, the frequency of occurrence of ST-segment elevation was 8.6 +/- 2.7 per day during the preobservation period, significantly decreased to 0.4 +/- 0.2 per day during nicorandil therapy (P less than 0.01), and significantly increased to 1.9 +/- 0.7 per day after withdrawal of the drug (P less than 0.05). The results demonstrate the effectiveness of nicorandil in the treatment of variant angina pectoris.
Angina Pectoris, Variant↗
Prognosis of patients with persistent negative U wave following myocardial infarction.
In order to clarify the clinical significance of a persistent negative U wave in patients with myocardial infarction, the clinical features and prognosis of a group of such patients were compared with a group without negative U waves. The persistent negative U wave was defined as the presence of a negative U wave at the time of discharge. The subjects were classified into 2 groups: group A--55 patients (50 males and 5 females, 59 +/- 10 years) with negative U waves; group B--70 patients (55 males and 15 females, 61 +/- 9 years) without negative U waves. The average follow-up periods were 49 +/- 21 months in group A and 42 +/- 18 months in group B. Negative U waves appeared in leads where r or R waves were present, but were not observed in leads with a QS pattern. The incidences of a diseased left anterior descending artery, multi-vessel disease, left ventricular wall motion abnormality and left ventricular ejection fraction below 50% were higher in group A than in group B. The recurrence of myocardial infarction was 18.2% in group A and 7.1% in group B, and the number of patients treated with antianginal drugs was higher in group A than in group B. The rate of recurrence of myocardial infarction at 1, 3 and 5 years was 6%, 17% and 26%, respectively in group A and 6%, 8% and 11%, respectively in group B. Thus, it was concluded that patients in group A require more active treatment than those in group B.
Adult↗
Factors influencing the clinical course and the long-term prognosis of patients with variant angina.
The purpose of this study was to clarify the factors influencing the clinical course and prognosis in variant angina. Also, the mechanism of acute myocardial infarction in variant angina is reviewed. The subjects were 110 patients with variant angina who, after the initial visit or admission, were observed for a period of at least 2 months, the average observation period being 68 +/- 49 months (range: 2 months-16 years). The incidence of acute myocardial infarction was 21.8% of these patients and 87.5% of the infarctions occurred within 1 month of the initial visit or admission. In variant angina, the average rate over 1 year was 2.2%; however, in classical angina the rate was 3.7% and in postinfarction angina 5.0%. The mortality rate was 5.5%, with death in the majority of cases occurring within 1 month, as in myocardial infarction. When treatment was stopped, spontaneous remission occurred in at least 26 of the 110 cases (23.6%). Beyond 3 months, the remission continued in 19 of these 26 cases. Seven cases had acute myocardial infarction in spite of the suppression of anginal attacks with administration of calcium antagonists. Apparently coronary spasm is the cause of anginal attacks, and the cause of acute myocardial infarction in patients with variant angina appears to be coronary thrombus formation.
Adult↗
Hemodynamic characteristics of echocardiographic findings in hypertensive patients with negative U waves and effect of an antihypertensive drug, tripamide.
Twenty-four hypertensive patients were divided into a group A with negative U waves (n = 8, mean age, 50 +/- 11 years) and a group B without negative U waves (n = 16, mean age, 49 +/- 11 years). Echocardiographic findings were compared with a group of 20 age-matched normotensive subjects without cardiovascular disease (mean age, 49 +/- 11 years). In addition, the effects of the antihypertensive agent tripamide were assessed in groups A and B. Although hemodynamic parameters such as left ventricular end-systolic and diastolic dimensions, stroke volume and cardiac output were elevated in group A, group B showed an increase in total peripheral resistance. Thus, group A was characterized by high cardiac output, while group B displayed increased peripheral resistance. Tripamide was administered to 14 patients. In group A (6 patients receiving tripamide), left ventricular end-systolic and end-diastolic dimensions were significantly reduced by tripamide along with stroke volume and cardiac output. However, in group B the only significant change in hemodynamic parameters after tripamide administration was a drop in total peripheral resistance. These findings suggest that both the hemodynamics of hypertensive patients and responses to tripamide vary with the presence of negative U waves.
Adult↗
Electrophysiological effects of flecainide on guinea pig ventricular muscle in high [K+]o, acidosis and hypoxia.
The electrophysiological effects of flecainide on the action potential were examined in guinea pig ventricular muscles using microelectrode recording methods. Under the control conditions, flecainide (0.5-1 microgram/ml) did not alter the resting potential, action potential duration (APD) or effective refractory period (ERP). The major effect of flecainide was on maximum upstroke velocity (Vmax), which was depressed in a dose-dependent manner. In high [K+] medium (potassium concentration = 10 mM), Vmax was depressed by 16.8% at a concentration of 1.0 microgram/ml (8.8% in normal [K+]o). In metabolic acidosis (pH = 6.89), it was depressed by 15.7% at the same concentration of the drug (8.3% in normal condition). The changes in ERP and ERP/APD90% in high [K+]o and metabolic acidosis were not significantly different from the normal condition. After hypoxic perfusion for 15 min, Vmax depression by flecainide was 16.3% (7.4% in control medium). The increase of ERP/APD90% was also greater in hypoxia. These data indicate that the most prominent effect of flecainide is Vmax depression which is enhanced under the high K+, acidic and hypoxic conditions. Therefore, it is suggested that flecainide may be most effective for ventricular arrhythmias occurring in myocardial ischemia.
Acidosis↗
[Long-term results of valve replacement with the Liliehei-Kaster and Omniscience tilting disc prostheses].
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Adolescent↗