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To determine the relation between the concentration of lipoprotein(a) [Lp(a)] and restenosis after percutaneous transluminal coronary angioplasty (PTCA) in Japan, we studied 80 consecutive patients with single-vessel disease who successfully underwent PTCA. All were evaluated by follow-up angiography a mean of 6.9 months after PTCA and were divided into the restenosis (30 patients) and the non-restenosis (50 patients) groups. The serum Lp(a) concentration of 29 +/- 17 mg/dl in the restenosis group was significantly higher than that of 17 +/- 14 mg/dl in the nonrestenosis group (p < 0.01). Multiple logistic regression analysis for risk factors revealed a significant correlation between restenosis and Lp(a) (p < 0.003). The serum Lp(a) concentration was positively correlated with the coronary artery percent stenosis at the time of follow-up angiography (r = 0.32, p < 0.01). High serum concentration of Lp(a) is therefore a risk factor for restenosis after PTCA in Japan.

Although posthemorrhagic hydrocephalus has been observed in premature infants, few cases of its intrauterine occurrence in fetuses have been reported. We report a case of posthemorrhagic hydrocephalus in a fetus with severe tachycardia. This case indicates that its possible occurrence should be considered in a case of a preterm fetus with distress.

Objectives: The purpose of this study was to examine whether coronary reperfusion can be diagnosed rapidly and accurately by myoglobin measurements., Background: When intravenous thrombolysis is used for acute myocardial infarction, it is important to determine coronary reperfusion rapidly and noninvasively so that further treatment can be initiated., Methods: We determined myoglobin, creatine kinase (CK) and creatine kinase, MB fraction (CK-MB) isoenzyme levels in 63 patients with acute myocardial infarction with total occlusion of the infarct-related artery that was confirmed by coronary angiography. Myoglobin was measured by turbidimetric latex agglutination, which has an assay time of 10 min. We measured myoglobin, CK and CK-MB every 15 min in 45 patients with and 18 patients without reperfusion. The condition of the infarct-related artery was confirmed every 5 to 8 min by coronary angiography., Results: The rate of increase in myoglobin, CK, and CK-MB at 15, 30, 45 and 60 min after treatment and reperfusion was significantly higher in the reperfused than in the nonreperfused group. In the reperfused group, the rate of increase in myoglobin was significantly higher than the corresponding rate of increase in CK and CK-MB at 15, 30 and 45 min after reperfusion. When reperfusion was evaluated on the basis of a cutoff level (myoglobin > or = 2.0, CK > or = 1.8, CK-MB > or = 1.5), the predictive accuracy of myoglobin (95%) was significantly higher than that of CK (68%) and CK-MB (73%) at 15 min after reperfusion., Conclusions: Coronary reperfusion can be rapidly and accurately detected by measurement of the plasma myoglobin every 15 min.

A rare case of a 6-year-old male with idiopathic familial cardiomyopathy manifesting severely restrictive physiology is reported. The patient showed congestive heart failure with dilatation of both atria with a normal ventricular cavity. A square-root configuration was revealed in the ventricular pressure tracings. His elder brother had died of hypertrophic cardiomyopathy at the age of 3 years. Endomyocardial biopsy disclosed marked disorganization of muscle bundles with hypertrophy of the myocytes and interstitial fibrosis. The patient died suddenly during hospitalization. Autopsy revealed diffuse hypertrophy of both the ventricular walls and the ventricular septum with extensive myocardial disorganization and interstitial fibrosis. These advanced myopathic changes in the myocardium may have been related to the restrictive physiology in this case.

A case of arrhythmogenic right ventricular dysplasia with histological abnormality of the left ventricle is reported. Right ventriculography showed severe dilatation and hypokinesis, and left ventriculography also showed slightly diffuse hypokinesis. Histological findings of both ventricles revealed myocytolysis, severe fibrosis, and marked fatty infiltrations. It is therefore important to examine histologically both the left and right ventricles for such lesions.

To evaluate exercise capacity in ischemic heart disease, we measured the peak aortic flow velocity by continuous wave Doppler (CWD) echo from the suprasternal notch at rest and during multiple load ergometer testing in the supine position. The study subjects consisted of 14 normal controls, 10 patients with effort angina and 21 patients with old myocardial infarction (OMI). In all the patients and in five normal subjects, thallium-201 emission CT (SPECT) was also performed immediately after exercise and four hours subsequently. Change in the peak aortic flow velocity during exercise was compared with the extent of perfusion defects and the presence or absence of redistribution images on SPECT. At rest, the peak aortic flow velocity was not different from that of the other three groups. During exercise, it increased progressively (crescendo type) as the exercise was increased in normal subjects. In patients with angina pectoris it increased at the initial stage of exercise, but was unchanged (crescendo-plateau type) or decreased (crescendo-decrescendo type) at the maximum exercise stage. Redistribution images on SPECT were seen in nine of 10 patients with angina pectoris. In patients with OMI, change in the peak aortic flow velocity was of the crescendo type in 14, crescendo-decrescendo in three and crescendo-plateau in one. In the remaining three it decreased from the beginning of exercise (decrescendo type). Redistribution images were seen in all patients with the crescendo-decrescendo, crescendo-plateau or decrescendo types. Furthermore, myocardial damage was much more extensive in the decrescendo type. We conclude that exercise continuous wave Doppler echocardiography is a useful means of evaluating exercise capacity in ischemic heart disease.

We studied the relationship between QT interval and RR interval when the heart rate was changed by atrial pacing, atropine, isoproterenol, and exercise in nine healthy adult males. The following results were obtained: (1) QT shortening with an increase in heart rate was minimal in atrial pacing and an equation QT = k4 square root RR was obtained from the QT-RR relationship during atrial pacing (r = 0.64, p less than 0.001); (2) shortening of QT with shortening of RR was least in atrial pacing; (3) during recovery from exercise it was largest and almost coincident with Bazett's formula; (4) Bazett's formula, therefore, is clearly applicable in the evaluation of ECGs recorded at rest or after exercise; (5) Bazett's formula can not be applied in the evaluation of an effect of some drug or maneuver on the QT when such a drug or maneuver can affect both the QT and the RR directly. The RR-dependent QT change can be estimated from the equation QT = k4 square root RR and the difference between a measured QT and the estimated RR-corrected QT would be a genuine effect of the drug or maneuver on the QT at that heart rate. We conclude that atropine, isoproterenol and exercise actually shorten the QT interval.