Search

To evaluate the influence of a history of cancer on clinical outcomes in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI).

ObjectivesTo clarify the effect of single-session multivessel percutaneous coronary intervention (PCI) strategy relative to the staged multivessel strategy on clinical outcomes in patients with stable coronary artery disease (CAD) or non-ST-elevation acute coronary syndrome.MethodsIn the Coronary REvascularisation Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting registry cohort-2, there were 2018 patients who underwent elective multivessel PCI. Primary outcome measure was composite of all-cause death, myocardial infarction and stroke at 5-year follow-up.ResultsSingle-session multivessel PCI and staged multivessel PCI were performed in 707 patients (35.0%) and 1311 patients (65.0%), respectively. The cumulative 5-year incidence of and adjusted risk for the primary outcome measure were not significantly different between the single-session and staged groups (26.7% vs 23.0%, p=0.45; HR 0.91, 95% CI 0.72 to 1.16, p=0.47). The 30-day incidence of all-cause death was significantly higher in the single-session group than in the staged group (1.1% vs 0.2%, p=0.009). However, the causes of death in 11 patients who died within 30 days were generally not related to the procedural complications, but related to the serious clinical status before PCI. For the subgroup analyses including age, gender, extent of CAD, severe chronic kidney disease and heart failure, there was no significant interaction between the subgroup factors and the effect of the single-session strategy relative to the staged strategy for the primary outcome measure.ConclusionsThe single-session multivessel PCI strategy was associated with at least comparable 5-year clinical outcomes compared with the staged multivessel PCI, although the prevalence of the single-session strategy was low in the present study.

Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been yet fully elucidated.

There still remain safety concerns on surgical procedures after coronary drug-eluting stents (DES) implantation, and optimal management of perioperative antiplatelet therapy (APT) has not been yet established.

Recently, elevation of circulating muscle-specific microRNA (miRNA) levels has been reported in patients with acute myocardial infarction. However, it is still unclear from which part of the myocardium or under what conditions miRNAs are released into circulating blood. The purpose of this study was to identify the source of elevated levels of circulating miRNAs and their function in cardiovascular diseases.

Brugada syndrome (BrS) has a significantly higher incidence among the male sex. Among genes coding ion channels and their modulatory proteins, KCNE5(KCNE1L) is located in the X chromosome and encodes an auxiliary -subunit for K channels. KCNE5 has been shown to modify the transient outward current (Ito), which plays a key role in determining the repolarization process in the myocardium. This study investigated whether KCNE5mutations could be responsible for BrS and other idiopathic ventricular fibrillation (IVF).

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an uncommon type of cardiomyopathy with fibrofatty tissue replacement. Magnetic resonance imaging (MRI) is a sophisticated method for the diagnosis of ARVD/C. Electroanatomical mapping has been reported to rapidly provide accurate data that facilitates catheter ablation of VT in ARVD/C. In addition, multislice CT (MSCT) is fast, easy to perform, and has a more reliable image quality. MSCT is considered a clinically valuable, noninvasive tool for assessment of myocardial pathology. However, the relationship between MSCT, cardiac MRI and electroanatomical mapping imaging in patients with ARVD/C is unknown. We report two cases diagnosed as ARVD/C by endomyocardial biopsy. In one case MRI imaging revealed marked wall thinning and a decrease in wall motion in the inferior wall and basal interventricular septum of the left ventricle. In another case an electroanatomical map of the RV was created. Endocardial voltage mapping in sinus rhythm revealed a large low voltage area and a focal pattern of activation was documented in activation mapping during VT. In both cases MSCT demonstrated low density areas indicative of focal fatty infiltration and morphological and functional abnormalities which were simultaneously assessed with MRI or electroanatomical mapping.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an uncommon type of cardiomyopathy with fibrofatty tissue replacement. Magnetic resonance imaging (MRI) is a sophisticated method for the diagnosis of ARVD/C. Electroanatomical mapping has been reported to rapidly provide accurate data that facilitates catheter ablation of VT in ARVD/C. In addition, multislice CT (MSCT) is fast, easy to perform, and has a more reliable image quality. MSCT is considered a clinically valuable, noninvasive tool for assessment of myocardial pathology. However, the relationship between MSCT, cardiac MRI and electroanatomical mapping imaging in patients with ARVD/C is unknown. We report two cases diagnosed as ARVD/C by endomyocardial biopsy. In one case MRI imaging revealed marked wall thinning and a decrease in wall motion in the inferior wall and basal interventricular septum of the left ventricle. In another case an electroanatomical map of the RV was created. Endocardial voltage mapping in sinus rhythm revealed a large low voltage area and a focal pattern of activation was documented in activation mapping during VT. In both cases MSCT demonstrated low density areas indicative of focal fatty infiltration and morphological and functional abnormalities which were simultaneously assessed with MRI or electroanatomical mapping.

Management of chronic total occlusions (CTOs) remains a challenge for interventional cardiologists. Despite advances in the design of angioplasty hardware and increased operator experience, percutaneous angioplasty of CTO still is associated with a relatively low primary success rate compared with non‐CTO. Although the stent has dramatically improved initial and long‐term outcome, the incidence of restenosis and reocclusion continues to be high in patients with excessive lesion length and/or small vessel size. Adjunctive pharmacotherapy, such as platelet glycoprotein IIb/IIIa receptor antagonist, may play an important role in the prevention of early reocclusion as well as late restenosis. Similarly, radiation therapy may be useful in the prevention/treatment of in‐stent restenosis. Although observational data have shown a poor long‐term survival in patients with CTO, convincing prospective or randomized data are lacking. Future investigations will need to focus on the long‐term outcome of patients with CTO referred for angioplasty compared with CABG or medical therapy.

Peptidylglycine monooxygenase (PGM) is a copper-containing monooxygenase that plays a key role in the peptide C-terminal α-amidation. Comparative analysis of the amino acid sequences of rat, human, bovine and frog PGMs revealed that ten histidines (residues 107, 108, 172, 235, 242, 244, 279, 364, 366 and 367 in rat PGM) are conserved among the four species. We introduced site-directed mutations to the ten histidines of rat PGM and found that the mutation of His- 107 → Ala, His-108 → Ala, His-172 → Ala, His-242 → Arg or His-244 → Ala abolished the enzyme activity. The five mutant proteins lacking the enzyme activity bound to a substrate, Phe-Gly-Phe-Gly, as did the wild type PGM. These results along with available evidence indicate that the five histidine residues (His-107, 108, 172, 242 and 244) are essential for PGM activity, acting as copper ligands.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Background:Cardiac resynchronization(CRT) therapy by biventricular pacing(BiV) was reported recently as a therapy for patients with moderate to severe heart failure and ventricular asynchrony. In our country, specialized modality for BiV were available since april, 2004. The aim of our study is to investigate how BiV effects in Japanese patients with severe heart failure. Methods & Results:Fourteen patients (11 males, 3 females, mean age 70.6 +/- 8.8 years), in NYHA class III-IV, underwent CRT by BiV. Three (21.4%) had an ischemic heart disease, four (28.6%) had a previous pacemaker, and six (42.9%) were in chronic atrial fibrillation. One patient (7%) died of severe CHF and VF. One patient (7%) failed CRT because of absence of optimal coronary sinus location. The QRS width, NYHA functional class, left ventricular ejection-fraction (LVEF), left ventricular end-diastolic diameter (LVDd) were measured both before and 1 month after CRT. Comparison of these parameter between before and after CRT, QRS width (180.8 → 144.2 msec, p < 0.0001), NYHA (3.2 → 1.8, p < 0.0001), LVEF(26.8 → 31.0%, p=0155) were improved significantly, and LVDd were also reduced (63.5 → 62.8 mm, p=0.2767). Conclusion:Our study suggest that CRT by BiV is very effective therapeutic modality for Japanese patients with severe heart failure.