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Owing to vascular malformations, it is difficult to perform catheter operation following the radial artery approach in percutaneous coronary intervention for acute ST-segment elevation myocardial infarction (STEMI) with Kommerell’s diverticulum on the right-sided aortic arch. However, only few studies have reported the use of the femoral artery approach to achieve early reperfusion; however, there is no established approach for patients with a right-sided aortic arch. In this study, we retrospectively analyzed the usefulness of the femoral artery approach in patients with STEMI and a right-sided aorta from January 2010 to March 2021.The total number of computed tomography (CT) cases was 180,514, of which 2 involved STEMI. In one of the two cases, the right radial artery approach was used. Therefore, only one patient with STEMI with a right-sided aortic arch underwent and operation using the femoral artery approach. In this patient, early revascularization was achieved with a door-to-balloon time of 70 min, suggesting the usefulness of the femoral artery approach.

Aim: The importance of sarcopenia in cardiovascular diseases has been recently demonstrated. This study aims to examine whether skeletal muscle mass (SMM), an important component of sarcopenia, is associated with an increased risk of poor outcome in patients after ST-segment elevation myocardial infarction (STEMI). Methods: We measured SMM in 387 patients with STEMI using dual-energy X-ray absorptiometry. Patients were divided into low- and high-appendicular skeletal mass index (ASMI: appendicular SMM divided by height squared (kg/m2)) groups using the first quartile of ASMI (≤ 6.64 kg/m2 for men and ≤ 5.06 kg/m2 for women). All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization. Results: Low-ASMI group was older and had a more complex coronary lesion, a lower left ventricular ejection fraction, and a higher prevalence of Killip classification ≥ 2 than high-ASMI group. During a median follow-up of 33 months, the event rate was significantly higher in low-ASMI group than in high-ASMI group (24.7% vs 13.4%, log-rank p = 0.001). Even after adjustment for patients' background, low ASMI was independently associated with the high risk of primary composite events (adjusted hazard ratio 2.06, 95% confidence interval 1.01–4.19, p = 0.04). In the subgroup analyses of male patients (n = 315), the optimal cutoff point of ASMI for predicting primary composite outcome was 6.75 kg/m2, which was close to its first quartile value. Conclusions: Low ASMI is independently associated with poor outcome in patients with STEMI.

Background Sleep-disordered breathing (SDB) is associated with cardiovascular complications. However, the effect of SDB on renal function in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI) remains unclear. Methods We enrolled 154 consecutive ACS patients without heart failure. A sleep study was performed immediately after PCI. Results The mean apnea-hypopnea index (AHI) was 16.4 ± 13.1, and 33 patients (21%) had severe SDB, defined as AHI ≥ 25. Estimated glomerular filtration rate (eGFR) values on admission (60 ± 12 mL/min/1.73 m2 vs. 67 ± 17 mL/min/1.73 m2, p = 0.046) and at discharge (54 ± 15 mL/min/1.73 m2 vs. 63 ± 15 mL/min/1.73 m2, p = 0.002) were lower in patients with severe SDB than in those patients without severe SDB. Multiple linear regression analysis showed that AHIs were significantly correlated with absolute changes in eGFR values from admission to discharge (β = 0.201, p = 0.004). Median 24-h urinary noradrenaline excretion measured on the same day of the sleep study was higher [297 (interquartile range {IQR}: 232–472) vs. 174 (IQR: 107–318) μg/day, p = 0.021] in patients with severe SDB. On multivariate logistic regression analysis, the presence of severe SDB was a significant predictor (adjusted odds ratio 3.76, 95% confidence interval 1.06–13.9, p = 0.047) for eGFR of less than 45 mL/min/1.73 m2 at discharge. This association was independent of age, eGFR on admission, and a presentation of ST-segment elevation myocardial infarction. Conclusion In patients with ACS who undergo PCI, severe SDB is associated with impaired renal function on admission and its deterioration during hospitalization. Further studies will be needed to conclude that SDB would be a therapeutic target in ACS.

Endothelial dysfunction is reportedly associated with worse outcomes in patients with chronic heart failure. Ubiquinol is a reduced form of coenzyme Q10 (CoQ10) that may improve endothelial function. We assessed the hypothesis that ubiquinol improves peripheral endothelial function in patients with heart failure with reduced ejection fraction (HFrEF). In this randomized, double-blind, placebo-controlled, crossover pilot study, 14 patients with stable HFrEF were randomly and blindly allocated to ubiquinol 400 mg/day or placebo for 3 months. After a 1-month washout period, patients were crossed over to the alternative treatment. Before and after each treatment, we assessed peripheral endothelial function using the reactive hyperemia index (RHI) and analyzed it using the natural logarithm of RHI (LnRHI). Peripheral endothelial function as assessed by LnRHI tended to improve with ubiquinol 400 mg/day for 3 months (p = 0.076). Original RHI values were also compared, and RHI significantly improved with ubiquinol treatment (pre-RHI 1.57 [interquartile range (IQR) 1.39–1.80], post-RHI 1.74 [IQR 1.63–2.02], p = 0.026), but not with placebo (pre-RHI 1.67 [IQR 1.53–1.85], post-RHI 1.51 [IQR 1.39–2.11], p = 0.198). Ubiquinol 400 mg/day for 3 months led to significant improvement in peripheral endothelial function in patients with HFrEF. Ubiquinol may be a therapeutic option for individuals with HFrEF. Large-scale randomized controlled trials of CoQ10 supplementation in patients with HFrEF are needed. Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000012604.

Background An early IV beta blocker during primary percutaneous coronary intervention (PCI) has been shown to reduce infarct size in ST-segment elevation acute myocardial infarction (STEMI), although the underlying mechanism is unknown. The aim of this study was to investigate the efficacy of early infusion of landiolol, the short-acting beta-1 adrenergic receptor blocker, on the reperfusion status in a STEMI. Methods We conducted a prospective, single-group trial of landiolol during the primary PCI for a STEMI. Landiolol was started intravenously just before reperfusion. The reperfusion status and outcomes in 55 treated patients were compared with those in 60 historical controls treated without landiolol. The optimal reperfusion was assessed by an ST-segment resolution (STR), coronary flow, and myocardial brush grade (MBG) after reperfusion. Results Patients in the landiolol group achieved a higher rate of an STR (64% vs. 42%, p =0.023) and MBG 2/3 (64% vs. 45%, p =0.045), whereas coronary flow was comparable between the two groups. A multivariate analysis showed that landiolol use was an independent predictor of an STR (odds ratio 2.99, 95% confidence interval 1.25–7.16, p =0.014). The incidence of non-sustained ventricular tachycardia (27% vs. 50%, p =0.014), hypotension (15% vs. 32%, p =0.046), and progression to Killip class grade III or IV (0% vs. 10%, p =0.028) were lower in the landiolol group. Conclusion Early infusion of landiolol during the primary PCI was associated with optimal reperfusion and a lower incidence of adverse events in comparison with the control group.

Trimethylamine N-oxide (TMAO), a metabolite derived from the gut microbiota, is proatherogenic and associated with cardiovascular events. However, the change in TMAO with secondary prevention therapies for ST-segment elevation acute myocardial infarction (STEMI) remains unclear. The purpose of this study was to investigate the sequential change in TMAO levels in response to the current secondary prevention therapies in patients with STEMI and the clinical impact of TMAO levels on cardiovascular events We included 112 STEMI patients and measured plasma TMAO levels at the onset of STEMI and 10 months later (chronic phase). After the chronic-phase assessment, patients were followed up for cardiovascular events. Plasma TMAO levels significantly increased from the acute phase to the chronic phase of STEMI (median: 5.63 to 6.76 μM, P = 0.048). During a median period of 5.4 years, 17 patients experienced events. The chronic-phase TMAO level independently predicted future cardiovascular events (adjusted hazard ratio for 0.1 increase in log chronic-phase TMAO level: 1.343, 95% confidence interval 1.122–1.636, P = 0.001), but the acute-phase TMAO level did not. This study demonstrated the clinical importance of the chronic-phase TMAO levels on future cardiovascular events in patients after STEMI.

The fictitious spin-1/2 Hamiltonian approach is the putative method to analyze the fine-structure/hyperfine ESR spectra of high spin metallocomplexes having sizable zerofield splitting (ZFS), thus giving salient principal g-values far from around g = 2 without explicitly providing their ZFS parameters in most cases. Indeed, the significant departure of the g-values from g = 2 is indicative of the occurrence of their high spin states, but naturally they never agree with true g-values acquired by quantum chemical calculations such as sophisticated DFT or ab initio MO calculations. In this work, we propose facile approaches to determine the magnetic tensors of high spin metallocomplexes having sizable ZFS, instead of performing advanced high-field/high-frequency ESR spectroscopy. We have revisited analytical expressions for the relationship between effective g-values and true principal g-values for high spins. The useful analytical formulas for the geff–gtrue relationships are given for S's up to 7/2. The genuine Zeeman perturbation formalism gives the exact solutions for S = 3/2, and for higher S's it is much more accurate than the pseudo-Zeeman perturbation approach documented so far (A. Abragam and B. Bleaney, Electron Paramagnetic Resonance of Transition Metal Ions, 1970; J. R. Pilbrow, J. Magn. Reson., 1978, 31, 479; F. Trandafir et al., Appl. Magn. Reson., 2007, 31, 553; M. Fittipaldi et al., J. Phys. Chem. B, 2008, 112, 3859), in which the E(Sx2 − Sy2) term is putatively treated to the second order. To show the usefulness of the present approach, we exploit FeIII(Cl)OEP (S = 5/2) (OEP: 2,3,7,8,12,13,17,18-octaethylporphyrin) and CoIIOEP (S = 3/2) well magnetically diluted in the diamagnetic host crystal lattice of NiIIOEP. The advantage of single-crystal ESR spectroscopy lies in the fact that the molecular information on the principal axes of the magnetic tensors is crucial in comparing with reliable theoretical results. In high spin states of metallocomplexes with sizable ZFS in pseudo-octahedral symmetry, their fine-structure ESR transitions for the principal z-axis orientation appear in the lower field far from g = 2 at the X-band, disagreeing with the putative intuitive picture obtained using relevant ESR spectroscopy. A ReIII,IV dinuclear complex in a mixed valence state exemplifies the cases, whose fine-structure/hyperfine ESR spectra of the neat crystals have been analyzed in their principal-axis system. The DFT-based/ab initio MO calculations of the magnetic tensors for all the high spin entities in this work were carried out.

Background The biphasic inflammation after ST ‐segment elevation myocardial infarction ( STEMI ) plays an important role in myocardial healing and progression of systemic atherosclerosis. The purpose of this study is to investigate the impact of fever during the first and second phases of post‐ STEMI inflammation on long‐term cardiac outcomes. Methods and Results A total of 550 patients with STEMI were enrolled in this study. Axillary body temperature ( BT ) was measured and maximum BT s were determined for the first (within 3 days: max‐ BT 1–3d ) and second (from 4 to 10 days after admission: max‐ BT 4–10d ) phases, respectively. Patients were followed for cardiac events (cardiovascular death, acute coronary syndrome, and rehospitalization for heart failure) for a median 5.3 years. During the follow‐up period, 80 patients experienced cardiac events. A high max‐ BT 4–10d was strongly associated with long‐term cardiac events (hazard ratio, 95% CI ) for a 1°C increase in the max‐ BT 4–10d : 2.834 (2.017–3.828), P BT 1–3d was not associated with cardiac events (1.136 [0.731–1.742], P =0.57). Even after adjustment for coronary risk factors, estimated glomerular filtration rate, infarct size, pericardial effusion, and medications on discharge, fever during the second phase (max‐ BT 4–10d ≥37.1°C) was significantly associated with future cardiac events (hazard ratio [95% CI ] 2.900 [1.710–5.143], P Conclusions Fever during the second phase but not the first phase of post‐ STEMI inflammation was a strong associated factor with worse long‐term cardiac outcomes in patients after STEMI , suggesting the need to consider the optimal timing for anti‐inflammatory strategies after STEMI .

Introduction: Heart failure (HF) is a clinical syndrome associated with diverse metabolic disturbances. Recent studies suggest that failing heart through secretion of soluble myostatin may induce skeletal muscle wasting in HF patients and skeletal muscle plays an important role in pathogenesis of exercise intolerance in patients with chronic HF. However, the clinical significance of skeletal muscle mass in patients with acute decompensated HF (ADHF) remains unclear. Hypothesis: We hypothesized that low appendicular skeletal muscle mass could predict the occurrence of future cardiovascular (CV) events in patients with ADHF. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 96 patients with ADHF (age 72±11, left ventricular ejection fraction (LVEF) 38±15%, B-type natriuretic peptide (BNP) levels on admission 752 [377-1398] pg/ml). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height 2 ) was defined according to the Asia Working Group for Sarcopenia criteria (2 in male, 2 in female). ADHF patients were followed until occurring CV events (CV death, nonfatal myocardial infarction, ischemic stroke, or HF re-hospitalization). Results: ASMI significantly correlated with age (r=-0.51, P Conclusions: Low ASMI could predict the future CV events in patients with ADHF, irrespective of LV systolic function and other clinical profile.

Multi-Detector Computed Tomography (MDCT) has been used to detect coronary lesions in a number of earlier studies. Here, we describe a rare case of congenital anomaly of the coronary artery, i.e., the R-II-B subtype (Lipton classification) of single coronary artery (SCA). A 61 year old man with angina was referred to our hospital. Assessment by coronary angiography (CAG) suggested SCA. The R-II-B subtype was confirmed by MDCT. Coronary artery bypass grafting (CABG) was then performed, and success of the grafting was evaluated by post- CABG MDCT. This subtype of SCA has been reported to be associated with high risk of cardiac sudden death because the aberrant vessel, which passes between the aorta and the main pulmonary artery, is readily compressed by these arteries. This subtype of SCA is also very rare: there is only one previously reported case in which MDCT was used for diagnosis. Ours is the first case of this subtype in which MDCT together with CAG was used for evaluation both pre- and post-CABG. Our results show that MDCT may be useful not only prior to CABG for risk stratification in patients with anomalous coronary arteries but also after CABG for evaluation.

The properties of a rat brain glucuronyltransferase, which is presumed to be associated with the biosynthesis of the HNK-1 epitope on sulfoglucuronyl glycolipids, are described. The enzyme required divalent cations for reaction, with maximal activity at 10 mM Mn2+, and exhibited a dual optimum at pH 4-5 and pH 6 depending upon the buffer used, with the highest activity at pH 4.5 in MES buffer. This enzyme strictly recognized the Gal beta 1-4GlcNAc terminal structure, and was highly specific for neolacto (type 2) glycolipids as acceptor. The enzyme was localized specifically in the brain, and was barely detected in other issues, including the thymus, spleen, liver, kidney, lung, and sciatic nerve fibres. Phosphatidylinositol and phosphatidylserine increased the enzymatic reaction 4.4- and 2.3-fold, respectively, whereas phosphatidylcholine slightly decreased the rate.