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Biomedical subjects

Yasushi Kitaura

Publications and source records attributed to Yasushi Kitaura.

At least 37 records · Page 2Linked to original sources

Angiotensin II type 1a receptor is involved in cell infiltration, cytokine production, and neovascularization in infarcted myocardium.

OBJECTIVE: Angiotensin II is critically involved in left ventricular remodeling after myocardial infarction. Neovascularization has been thought to prevent the development of left ventricular remodeling and deterioration to heart failure. To elucidate the role of angiotensin II in neovascularization during cardiac remodeling, we induced myocardial infarction in angiotensin II type 1a receptor (AT1) knockout (KO) mice. METHODS AND RESULTS: There were more vessels in the border zone of infarcted hearts of wild-type (WT) mice and AT1KO mice at 14 days after operation, compared with in the left ventricle of sham-operated mice, and the number was larger in WT mice than in AT1KO mice. Consistent with these observations, the infarcted heart of AT1KO mice expressed lower levels of matrix metalloproteinase and endothelial nitric oxide synthase activity. More inflammatory cells such as granulocytes and macrophages were infiltrated in the infarcted hearts of WT mice than AT1KO mice at 4 days. A variety of cytokines and chemokines were increased in infarcted hearts of WT and AT1KO mice, and many of them were more remarkable in WT mice than in AT1KO mice at 14 days. CONCLUSIONS: AT1 plays a critical role in inflammatory cell infiltration, cytokine production, and neovascularization in infarcted hearts.

Angiotensin II↗

Repeated ambulatory monitoring reveals a Monday morning surge in blood pressure in a community-dwelling population.

BACKGROUND: Although weekly variations with a peak on Monday have been reported in the incidence of cardiovascular events, few studies have investigated weekly variations in blood pressure (BP). METHODS: One hundred and thirty-five community-dwelling subjects had 24-h ambulatory BP monitoring for 7 days. We calculated the mean awake, asleep, morning (during the first 3 h after awaking) BP, and morning BP surge (mean morning systolic BP minus mean asleep systolic BP) for each day. RESULTS: Monday surge in BP was found in the awake and morning BP (awake BP: 128.8 +/- 15.4/79.1 +/- 9.2 v 131.5 +/- 16.3/80.7 +/- 10.0 mm Hg, P < 0.01, respectively; morning BP: 127.3 +/- 17.8/78.8 +/- 11.4 v 132.5 +/- 18.2/81.2 +/- 10.0 mm Hg, P < 0.01, respectively) but was not found in the asleep BP (112.7 +/- 18.3/68.4 +/- 10.7 v 113.1 +/- 17.6/68.7 +/- 10.5 mm Hg, P = NS, respectively). The morning BP surge on Monday was higher than on the other days of the week except for Tuesday (Monday: 19.7 +/- 13.3 mm Hg v Friday: 16.4 +/- 12.9 mm Hg, P < 0.05; v Saturday: 14.7 +/- 13.3 mm Hg, P < 0.01 v Sunday: 13.7 +/- 12.0 mm Hg, P < 0.01; v Wednesday: 15.5 +/- 14.3 mm Hg, P < 0.01). CONCLUSION: Morning BP surge was the greatest on Monday in a community-dwelling population. This may be in accord with clinical evidence that cardiovascular events more frequently occur in the morning on Monday.

Aged↗

Assessment of regional left ventricular filling dynamics using color kinesis in patients with hypertrophic cardiomyopathy.

OBJECTIVES: Using color kinesis, we evaluated regional left ventricular filling dynamics in patients with hypertrophic cardiomyopathy (HCM). METHODS: In all, 20 patients (14 men and 6 women) and 20 age-matched healthy control subjects (10 men and 10 women) were studied. From color kinesis diastolic images in a left ventricular short-axis view, we generated regional time curves (6 segments) of left ventricular filling. The percent filling fraction at 25%, 50%, and 75% of filling time was averaged for all segments in each patient, and the SD of its mean was used as an asynchrony index at each particular filling time. The mean filling time for each segment was also measured. RESULTS: The asynchrony index was increased significantly in mid (50%) to late (75%) diastole in patients with HCM as compared with control subjects. Patients with HCM had regional mean filling times prolonged even in the nonhypertrophic segments. Moreover, there was significant correlation between the asynchrony index at mid and late diastole, and the global mean filling time. CONCLUSIONS: Color kinesis is useful in evaluating regional filling dynamics in patients with HCM. Our data reinforce the notion that HCM is a functionally heterogeneous disorder.

Adult↗

Acute effects of diltiazem on regional left ventricular diastolic filling dynamics in patients with hypertrophic cardiomyopathy as assessed by color kinesis.

BACKGROUND: The effect of calcium antagonists on regional left ventricular (LV) filling dynamics in patients with hypertrophic cardiomyopathy (HCM) is not well known, so the present study evaluated the results of echocardiography with color kinesis (CK) analysis during diltiazem infusion. METHODS AND RESULTS: Nineteen patients (16 men, 3 women; mean age 55+/-15 years) underwent echocardiography with CK analysis during intravenous diltiazem (10 mg/2 min). Using the quantitative CK software the LV short-axis image was divided into 6 segments and the percent endocardial expansion at the early, mid- and late-diastolic filling time was averaged for all segments, with the standard deviation of the mean used as an index of diastolic asynchrony (asynchrony index). The regional mean filling time was also measured for the corresponding segments. As global diastolic parameters, the global filling time, peak filling rate, and the time-to-peak filling were calculated. After the administration of diltiazem, the asynchrony index was decreased for all three diastolic filling times. Diltiazem shortened the mean filling time overall, especially in the posterior and lateral wall segments. These findings were associated with significant improvement in the CK-derived global diastolic parameters. CONCLUSIONS: Diltiazam has a favorable effect on LV diastolic asynchrony, which may account for the acute changes in global LV relaxation.

Adult↗

Effects of cellular cardiomyoplasty on ventricular remodeling assessed by Doppler echocardiography and topographic immunohistochemistry.

BACKGROUND: Myocardial infarction (MI) promotes deleterious remodeling of the myocardium, resulting in ventricular dilation and pump dysfunction. Supplementing infarcted myocardium with neonatal myocyte would attenuate deleterious remodeling and so the present study used Doppler echocardiography and histology to analyze the cardiac function and histological regeneration of the damaged myocardium after cellular cardiomyoplasty. METHODS AND RESULTS: Experimental MI was induced by 24-h coronary ligation followed by reperfusion in adult male Lewis rats and neonatal myocytes were injected directly into the infarct and peri-infarct regions. Three groups of animals were studied at 4 weeks after cellular cardiomyoplasty: noninfarcted control (control), MI plus sham injection (MI), and MI plus cell injection (MI + cell). Ventricular remodeling and cardiac performance were assessed by Doppler echocardiography or contrast echocardiography. At 4 weeks after cellular cardiomyoplasty, MI + cell hearts exhibited attenuation of global ventricular dilation and cardiac function compared with MI hearts not receiving cellular cardiomyoplasty. Immunohistochemically, connexin-43-positive small cells were observed in the vicinity of the infarction in MI + cell heart. By electron microscopy, these cells contained myofilaments with Z-bands and poorly developed intercalated disks, suggesting neonatal myocardial cells. Furthermore, the myocardial cells were often making close contact with interstitial cells. CONCLUSIONS: Implanted neonatal myocytes form viable grafts after MI, resulting in attenuated ventricular dilation and enhanced contractile function. Echocardiography, electron microscopy, and immunohistochemistry are useful methods for assessing the functional and histological regeneration of the damaged myocardium.

Actin Cytoskeleton↗

Use of a whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin tests.

PURPOSE: We sought to determine the clinical utility of a newly developed qualitative test to measure heart-type fatty acid-binding protein levels in blood for the early identification of myocardial infarction. METHODS: We measured heart-type fatty acid-binding protein levels in 371 consecutive patients with acute chest pain and suspected myocardial infarction, and compared the performance of this test with those of troponin T and myoglobin tests. Levels of heart-type fatty acid-binding protein >or=6.2 ng/mL were considered as positive results. RESULTS: A final diagnosis of acute myocardial infarction was made in 181 patients (49%). Of the 68 patients who presented within 2 hours of the onset of symptoms, 37 (54%) had a final diagnosis of myocardial infarction. The sensitivity of the rapid heart-type fatty acid-binding protein test was 89% (33/37), significantly higher than for troponin T (22% [8/37]; P<0.001) and myoglobin (38% [14/37]; P<0.001). However, the specificity of troponin T (94% [29/31]) was significantly better than for heart-type fatty acid-binding protein (52% [16/31]; P= 0.002) within 2 hours. The area under the receiver operating characteristic curve for heart-type fatty acid-binding protein levels was greater than that for myoglobin (0.72 vs. 0.61, P = 0.01) among patients who presented within 2 hours. CONCLUSION: A novel whole blood rapid heart-type fatty acid-binding protein test can be useful in the early evaluation of patients who present with acute chest pain.

Acute Disease↗

Gated blood pool SPECT improves reproducibility of right and left ventricular Fourier phase analysis in radionuclide angiography.

OBJECTIVES: The ventricular phase angle, a parametric method applied to Fourier phase analysis (FPA) in radionuclide ventriculography, allows the quantitative analysis of ventricular contractile synchrony. However, FPA reproducibility using gated blood pool SPECT (GBPS) has not been fully evaluated. The present study evaluates whether by using GBPS, the reproducibility of FPA could be improved over that in planar radionuclide angiography (PRNA). METHODS: Forty-three subjects underwent both GBPS and PRNA, of which 10 subjects were normal controls, 25 had dilated cardiomyopathy, and 8 had various heart diseases. Interventricular contractile synchrony was measured as the absolute difference in RV and LV mean ventricular phase angle as delta(phi) (RV - LV). Intraventricular contractile synchrony was measured as the standard deviation of the mean phase angle for the RV and LV blood pools (RVSD(phi), LVSD(phi)). Two nuclear physicians processed the same phase images of GBPS to evaluate the interobserver reproducibility of the phase angles using data from the 43 study participants. Phase images acquired from PRNA were processed in the same manner. RESULTS: Excellent reproducibility of delta(phi) (RV - LV) was obtained with both GBPS (Y = -3.10 + 0.89 x X; r = 0.901) and PRNA (Y = -4.51 + 0.81 x X; r = 0.834). In regard to RVSD(phi) reproducibility was not adequate with PRNA (Y = 18.56 + 0.35 x X; r = 0.424), while it was acceptable with GBPS (Y = 5.22 + 0.85 x X; r = 0.864). LVSD(phi) reproducibility was superior using both GBPS (Y = 4.15 + 0.97 x X; r = 0.965) and PRNA (Y = -0.55 + 0.98 x X; r = 0.910). CONCLUSION: Our results demonstrate FPA obtained using GBPS to be highly reproducible for evaluating delta(phi) (RV - LV), RVSD(phi) and LVSD(phi), in comparison with the PRNA method. We thus consider GBPS appropriate for evaluating ventricular contractile synchrony.

Adult↗

Efficacy of edaravone, a free radical scavenger, on left ventricular function and structure in diabetes mellitus.

This study was designed to assess the efficacy of edaravone (3-methyl-1-phenyl-2-pyrazolin-5-one), a free radical scavenger that possesses anti-oxidant effects, on cardiac function and fine structure of the left ventricular myocardium in diabetes mellitus. Male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, a model of spontaneous development of type II diabetes (30 weeks; n = 15) were divided into two groups and treated with edaravone 30 mg/kg/d or vehicle for 2 weeks. OLETF rats showed hyperglycemia (352 +/- 71 mg/dl vs normal control; 128 +/- 52 mg/dl), increased thiobarbituric acid-reactive substances (TBARS; 6.9 +/- 2.5 nM/ml vs 2.8 +/- 0.6 nM/ml), and decreased superoxide dismutase activity (21.5 +/- 0.9 U/ml vs 25.8 +/- 0.7 U/ml). Increased left ventricular end-diastolic pressure (12 +/- 3 mm Hg vs 6 +/- 2 mm Hg) and hypertrophied cardiocytes (23.1 +/- 1.4 vs 17.6 +/- 1.0 microm) were also observed (P < 0.05, respectively). Edaravone could not improve plasma glucose level and hemodynamic parameters but significantly decreased TBARS values (3.8 +/- 0.5) and increased superoxide dismutase activity (24.5 +/- 0.8) (vs OLETF, P < 0.05, respectively). Moreover, edaravone effectively preserved cardiocyte diameter (18.2 +/- 0.9 microm) and the fine structure of mitochondria. Thus, edaravone exhibits modest cardiac protection in diabetes mellitus independent of blood sugar level.

Animals↗

Digitalis-like immunoreactive substances in maternal and umbilical cord plasma: a comparative sensitivity study of fluorescence polarization immunoassay and microparticle enzyme immunoassay.

Digitalis-like immunoreactive substances (DLIS) obtained from maternal and umbilical cord plasma at delivery were measured by fluorescence polarization immunoassay (FPIA; TDX, Abbott) and microparticle enzyme immunoassay (MEIA; IMX, Abbott). In each sample, concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulfate, estradiol, estriol, hydrocortisone, progesterone, and testosterone were measured by radioimmunoassay, and cross-reaction tests of DLIS with these substances were conducted. By FPIA, the concentration of DLIS in umbilical cord plasma (0.55 +/- 0.22 ng/mL) was significantly higher than that in maternal plasma (0.23 +/- 0.11 ng/mL). In the cross-reaction tests, when the concentration of dehydroepiandrosterone sulfate was higher than 1.0 microg/mL or that of progesterone was higher than 0.5 microg/mL, DLIS were detected by FPIA. However, DLIS were not found either in the samples or in the cross-reaction tests by MEIA. By radioimmunoassay, there was no significant difference in the dehydroepiandrosterone sulfate concentration between the maternal plasma (2,917 +/- 1,001 ng/mL) and the umbilical cord plasma (1,957 +/- 376 ng/mL). The progesterone concentration in the umbilical cord plasma (310.0 +/- 85.7 ng/mL) was significantly higher than that in the maternal plasma (126.4 +/- 38.5 ng/mL). These results suggest that dehydroepiandrosterone sulfate in maternal plasma and progesterone in maternal and umbilical cord plasma may be measured as digoxin by FPIA.

Adult↗

Gene-environment interactions in wet beriberi: effects of thiamine depletion in CD36-defect rats.

Selective vulnerability to thiamine deficiency is known to occur between individuals and within different tissues. However, no comprehensive explanation for this has been found, and there are no reports that reproduce the cardiovascular manifestations of human wet beriberi in animals. We hypothesized that the distinction of substrate reliance, namely, the primary dependency on glucose as substrate, could be an underlying factor in the selective vulnerability of thiamine deficiency. In the setting of impaired fatty acid entry, which occurs in CD36-defect rats, substrate reliance shifts from fatty acid to glucose, which would be expected to lead to a susceptibility to thiamine deficiency. Genomic DNA was analyzed for CD36 defects in three cognate strains of rats [spontaneously hypertensive rats (SHR)/NCrj, SHR/Izm, and Wistar-Kyoto (WKY)/NCrj], which identified the presence of a CD36 defect in SHR/NCrj rats but not in SHR/Izm and WKY/NCrj rats. Treatment with 2 wk of thiamine-depleted chow on 4-wk-old rats of each of these strains resulted in increased body and lung weight in the SHR/NCrj rats but not in the SHR/Izm and WKY/NCrj rats. The increased lung weight in the SHR/NCrj rats was accompanied with histological changes of congestive vasculopathy, which were not observed in either the SHR/Izm or the WKY/NCrj rats. Thiamine-deficient 12-wk-old SHR/NCrj rats demonstrated increased body weight (305.6 +/- 6.2 g in thiamine-deficient rats vs. 280.8 +/- 9.1 g in control; P < 0.0001), lactic acidemia (pH, 7.322 +/- 0.026 in thiamine-deficient rats vs. 7.443 +/- 0.016 in control; P < 0.0001; lactate, 2.42 +/- 0.28 mM in thiamine-deficient rats vs. 1.20 +/- 0.11 mM in control; P < 0.0001) and reduced systemic vascular resistance (4.61 +/- 0.42 x 104 dyn.s.cm-5 in thiamine-deficient rats vs. 6.55 +/- 1.36 x 104 dyn.s.cm-5 in control; P < 0.0001) with high cardiac output (186.0 +/- 24.7 ml in thiamine-deficient rats vs. 135.4 +/- 27.2 ml in control; P < 0.0019). In conclusion, SHR/NCrj rats harboring a genetic defect of long-chain fatty acid uptake present the relevant clinical cardiovascular signs of human wet beriberi, strongly indicating a close gene-environment interaction in wet beriberi.

Animal Feed↗

Immunologic interaction between infiltrating eosinophils and T lymphocytes in murine spontaneous eosinophilic myocarditis.

BACKGROUND: Eosinophilic myocarditis often occurs spontaneously in DBA/2 mice. Relationships between infiltrating eosinophils (Eos), T lymphocytes and interleukin-5 (IL-5) in this disorder were investigated microscopically and immunohistochemically. METHODS: Hearts from male DBA/2 mice were studied from 5 to 10 weeks of age. Anti-CD4 and anti-CD8 antibodies were used. Infiltrating Eos, white blood cells (WBC), and CD4+ and CD8+ T cells were counted. Interactions were assessed with multiple regression and forward stepwise regression tests. Additionally, IL-5 distribution in heart tissue was histologically observed with special reference to immunological findings. RESULTS: Beginning at 5 weeks, several necrotic foci containing many damaged cardiocytes were seen in the epicardium of the right ventricle. Eos and lymphocytes were numerous within and around the necrotic foci. Eos were occasionally seen adjacent to degenerating cardiocytes. Three quarters of the mice exhibited such Eo-related myocardial damage. CD4+ lymphocytes were often seen infiltrating actively inflamed foci where Eos could also be observed. The lesional CD4+-to-CD8+ ratio (CD4/CD8) was 5.2 +/- 3.3 at 6 weeks, 6.8 +/- 3.7 at 7 weeks, and 1.5 +/- 0.8 at 10 weeks of age. The lesional Eo/WBC ratio was directly proportional to the CD4/CD8 ratio (p < 0.05), and was also significantly related to lesional CD4+ T cell count (p < 0.05). IL-5 was also expressed in Eo-rich areas. CONCLUSIONS: In this mouse strain with susceptibility to eosinophilic myocarditis, Eo infiltration was related to increased lesional CD4+ cell count. We suspect that CD4+ T cells induce local eosinotaxis, mediated by IL-5, and participate in myocardiocyte injury via Eo induction.

Animals↗

Forearm hyperemia is a better marker than carotid intima-media thickness or ankle-brachial index for coronary artery disease in Japanese males under 65.

Forearm hyperemia, carotid intima-media thickness (IMT), and ankle-brachial pressure index (ABI) are subclinical markers associated with coronary artery disease (CAD). However, it is not known which marker is most highly correlated with CAD. We therefore compared these three parameters in the same patients under 65 years of age. In 40 males with documented CAD (mean age, 53 years), we measured forearm hyperemia by plethysmography, carotid IMT by B-mode ultrasound, and ABI by Doppler ultrasonography. Microalbuminuria, serum lipids, glucose and C-reactive protein (CRP) were also measured. Thirteen normal males served as controls (mean age, 49 years). Compared with normal subjects, CAD patients had lower hyperemia (42 vs. 92%; p < 0.001) and greater carotid IMT (0.81 vs. 0.67 mm; p < 0.01), but ABI was similar. The sensitivity of forearm hyperemia (72%) was higher than that of carotid IMT (22%) or ABI (3%) (abnormal criteria: forearm hyperemia < 60%, carotid IMT 21.0 mm, and ABI < 0.9). The patients had higher serum low-density lipoprotein (LDL) cholesterol, glucose and CRP, and lower high-density lipoprotein (HDL) cholesterol than the controls. Albuminuria was present in 49% of patients. Subclinical markers were further analyzed by age (35-54 vs. 55-64 years). The sensitivity of carotid IMT was lower in the younger patients (4% vs. 33%), while that of forearm hyperemia (69% vs. 75%) and albuminuria (47% vs. 52%) did not change with age. While carotid ultrasound was useful in older patients ( > or = 55 years), forearm hyperemia and microalbuminuria were sensitive markers irrespective of age. ABI was not useful in the Japanese men with CAD under age 65.

Adult↗

[Influenza myocarditis--pathophysiology and developmental mechanism of myocarditis].

Acute myocarditis is a rare complication in influenza infection, but it is serious and occasionally fatal. Recent application of intraaortic balloon pumping(IABP) and/or percutaneous cardiopulmonary support(PCPS) to the serious cases of viral myocarditis brought a better prognosis. We should recognize that the patient with viral infection such as influenza infection may have acute myocarditis and should make an early diagnosis for adequate treatment in time. To avoid misdiagnosis of acute myocarditis complicated with influenza infection, we must know characteristic symptoms, signs and laboratory findings of acute myocarditis during influenza infection. The mechanism of cardiocyte injury in experimental influenza myocarditis of mice is also discussed.

Acute Disease↗

Csx/Nkx2-5 is required for homeostasis and survival of cardiac myocytes in the adult heart.

Csx/Nkx2-5, which is essential for cardiac development of the embryo, is abundantly expressed in the adult heart. We here examined the role of Csx/Nkx2-5 in the adult heart using two kinds of transgenic mice. Transgenic mice that overexpress a dominant negative mutant of Csx/Nkx2-5 (DN-TG mice) showed degeneration of cardiac myocytes and impairment of cardiac function. Doxorubicin induced more marked cardiac dysfunction in DN-TG mice and less in transgenic mice that overexpress wild type Csx/Nkx2-5 (WT-TG mice) compared with non-transgenic mice. Doxorubicin induced cardiomyocyte apoptosis, and the number of apoptotic cardiomyocytes was high in the order of DN-TG mice, non-transgenic mice, and WT-TG mice. Overexpression of the dominant negative mutant of Csx/Nkx2-5 induced apoptosis in cultured cardiomyocytes, while expression of wild type Csx/Nkx2-5 protected cardiomyocytes from doxorubicin-induced apoptotic death. These results suggest that Csx/Nkx2-5 plays a critical role in maintaining highly differentiated cardiac phenotype and in protecting the heart from stresses including doxorubicin.

Animals↗

Genomic heterogeneity of type II CD36 deficiency.

BACKGROUND: CD36 deficiency has been classified in two types, i.e., type I and type II CD36 deficiency. Possible pathological involvement of CD36 deficiency has been suggested in humans, but is still confounding. Homozygous or compound heterozygous mutations (CD36(-/-)) were demonstrated in type I CD36 deficiency, while the genomic or molecular background of type II CD36 deficiency is still unclear, which may bring confounding interpretations of the cause-and-effect events in human CD36 deficiency. In this study, we analyzed the genotype and frequency of type II CD36 deficiency in Japanese populations, and its hereditary pattern in three families. METHODS: Genotypes and protein expression levels of CD36 were examined in 238 Japanese subjects. Genotype was analyzed in the coding region of the CD36 gene. The expression level of CD36 protein was analyzed by flow cytometry after staining with monoclonal anti-CD36 antibody and assessed as mean fluorescence intensity (MFI). RESULTS: Among 238 subjects, subjects for wild-type gene (WT), a single mutation (CD36(+/-)), and CD36(-/-) were 141, 44 and 53, respectively. Monocyte MFI (mean+/-SD) in subjects for WT, CD36(+/-), and CD36(-/-) were 35.7+/-8.5, 15.2+/-3.4, and 0.4+/-0.3, respectively (P<0.0001, between groups). Those of platelets in subjects for WT, CD36(+/-), and CD36(-/-) were 27.1+/-10.6, 11.5+/-6.3, and 0.5+/-0.3, respectively (P<0.0001, between groups). Subjects of both WT and CD36(+/-) were observed in type II CD36 deficiency. Monocyte and platelet MFI in family members of type II CD36 deficiency and 218 unrelated Japanese suggested that the expression level of CD36 protein in monocytes was directly dependent on genotypes. On the other hand, those in platelets were affected by additional heritable factor(s) in addition to the coding region genotype. CONCLUSIONS: MFI in monocytes showed a strong gene-dosage-dependency. On the other hand, MFI in platelets was affected by heritable factor(s) in addition to the coding region genotype, which resulted in heterogeneity of type II CD36 deficiency.

Adolescent↗

Influence of propranolol infusion on cyclic variation of myocardial integrated backscatter in hypertrophic obstructive cardiomyopathy.

It has been demonstrated that cyclic variation, assessed by myocardial integrated backscatter, reflects regional myocardial contractile function. The aim of this study was to investigate the influence of administration of beta-blocker propranolol on cyclic variation in patients with hypertrophic cardiomyopathy and persistent left ventricular (LV) pressure gradient and to test the hypothesis that the reduction of LV pressure gradient would be related to the change in regional contractile function. Before and after 2 mg propranolol infusion, transthoracic echocardiography with integrated backscatter analysis was performed on 11 patients (8 men and 3 women, mean age 54 +/- 12 years old). Integrated backscatter curves were obtained from the ventricular septum and LV posterior walls. With propranolol infusion, there was a significant reduction of LV fractional shortening (0.39 +/- 0.08 to 0.34 +/- 0.09, P <.01) and LV pressure gradient (83 +/- 40 mm Hg to 42 +/- 32 mm Hg, P <.001). In the posterior wall, the magnitude of cyclic variation significantly decreased (7.1 +/- 2.2 dB to 5.6 +/- 1.8 dB, P <.01), whereas in the septum, no apparent change in this parameter was observed (5.8 +/- 2.1 dB to 4.7 +/- 1.9 dB). Our findings suggest that in this form of cardiomyopathy, (1) the posterior wall myocardium is more susceptible to negative inotropic effects than the septum; (2) the reduction of LV pressure gradient is not related to that of regional wall motion; and (3) poor response of the ventricular septum is possibly because of more severe myocardial disarray and hypertrophy.

Adrenergic beta-Antagonists↗

National survey of fulminant myocarditis in Japan: therapeutic guidelines and long-term prognosis of using percutaneous cardiopulmonary support for fulminant myocarditis (special report from a scientific committee).

Although fulminant myocarditis is known as a fatal disease, patients have been able to recover and return to normal life with the help of mechanical cardiopulmonary support. However, therapeutic guidelines for using percutaneous cardiopulmonary support (PCPS) for fulminant myocarditis have not been established, and the clinical course and long-term prognosis of such patients are still controversial issues. The present national survey considered the current situation of patients as the basis for proposing therapeutic guidelines. Thirty of 52 patients (57.7%) survived and returned to social life. Important factors concerning the prognosis were the severity and grade of cardiac and renal dysfunction, the adjusted support flow rate to enable recovery from circulatory failure, and prevention of circulatory disturbances of the legs and multiple organ failure directly associated with PCPS. With regard to the long-term prognosis of patients treated with PCPS, the readmission rate was 10%, the exacerbation rate was 3.3%, and mortality was 10% during the average follow-up period of 962 days. Optimal management of the mechanical cardiopulmonary support and curative treatment for the myocarditis further improve the outcome of this disease.

Blood Gas Analysis↗

Long-term outcome of a residual scar from myocardial infarction after coronary artery bypass grafting: a 100-month study using myocardial perfusion scintigraphy.

The prognosis for patients with a residual scar from myocardial infarction (MI) after coronary artery bypass grafting surgery (CABG) has not been fully evaluated, so the present study retrospectively evaluated such patients with stress myocardial single photon emission computed tomography (SPECT) at 100 months after CABG. The study group consisted of 24 subjects (23 males, 1 female; mean age, 59+/-9 years) in whom CABG had been performed more than 100 months (mean follow-up period 135+/-25 months) previously. The 24 subjects were classified into 3 groups according to their summed stress score (SSS) and summed reversibility score (SRS) in the early period after CABG. Eight subjects with MI (SSS> or =2 and SRS<2) were classified into the group MI, 8 subjects with ischemic myocardium (SSS> or =2 and SRS> or =2) was classified into the group RE, and 8 subjects with normal perfusion (SSS<2 and SRS<2) was classified into group N. None of the subjects in group MI required revascularization. Cardiac events occurred in 4 of the group RE patients and all required revascularization. As to the SPECT scoring system, the long-term SSS of group MI (6.4+/-3.1) was not different from that in the early periods (4.3+/-4.0; NS). However, the long-term SSS values of group RE (8.8+/-6.2) were significantly greater than those soon after CABG (3.4+/-1.8; p=0.03). In group N, there was also no difference in the SSS values between the early period (0.3+/-0.5) and the long-term period (0.0+/-0.0; NS). Patients with a residual scar from MI in the early period after CABG did not worsen over a period of 100 months. Moreover, there was no significant difference in the SPECT score in the segment with the residual scar in the short or long term after CABG. However, the extent of reversibility was directly associated with the presence of clinical events. Therefore scintigraphic imaging remains an important and clinically relevant risk stratification tool. Stress myocardial SPECT, early after CABG, can be used to predict the possibility of future cardiac events or the need for revascularization.

Aged↗