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Background: Accurate blood pressure (BP) measurement is critical for optimal cardiovascular risk management. Age-related trajectories for cuff-measured BP accelerate faster in women compared with men, but whether cuff BP represents the intraarterial (invasive) aortic BP is unknown. This study aimed to determine the sex differences between cuff BP, invasive aortic BP, and the difference between the 2 measurements. Methods: Upper-arm cuff BP and invasive aortic BP were measured during coronary angiography in 1615 subjects from the Invasive Blood Pressure Consortium Database. This analysis comprised 22 different cuff BP devices from 28 studies. Results: Subjects were 64±11 years (range 40–89) and 32% women. For the same cuff systolic BP (SBP), invasive aortic SBP was 4.4 mm Hg higher in women compared with men. Cuff and invasive aortic SBP were higher in women compared with men, but the sex difference was more pronounced from invasive aortic SBP, was the lowest in younger ages, and the highest in older ages. Cuff diastolic blood pressure overestimated invasive diastolic blood pressure in both sexes. For cuff and invasive diastolic blood pressure separately, there were sex*age interactions in which diastolic blood pressure was higher in younger men and lower in older men, compared with women. Cuff pulse pressure underestimated invasive aortic pulse pressure in excess of 10 mm Hg for both sexes in older age. Conclusions: For the same cuff SBP, invasive aortic SBP was higher in women compared with men. How this translates to cardiovascular risk prediction needs to be determined, but women may be at higher BP-related risk than estimated by cuff measurements.

Background RSV causes respiratory infections that can lead to serious respiratory complications in older adults (OA). Presently, there is no approved vaccine to prevent RSV infections. RSVPreF3 OA is an investigational vaccine containing 120 µg RSVPreF3 and the AS01E adjuvant. Here we show safety results up to month (M) 6 post-vaccination with RSVPreF3 OA. Methods This phase 3 multi-country ongoing study (NCT04732871) enrolled adults ≥ 60 years of age over a period of 3 years. Participants were randomized (3:1:1) to receive RSVPreF3 OA with different vaccination schedules. All participants received a dose of RSVPreF3 OA on day 1. Solicited and unsolicited adverse events (AEs) were evaluated within 4 and 30 days post-vaccination. All serious AEs (SAEs) and potential immune mediated diseases (pIMDs) were collected up to M6 post-vaccination. SAEs and pIMDs related to vaccination, and fatal AEs are collected up to study end but reported here up to M6. Results Overall, 1653 participants received a dose of RSVPreF3 OA and 1618 completed the M6 follow-up. The mean age was 70.0 (±6.6) years and 54.6% were women. The most frequently reported solicited injection site reaction within 4 days post-vaccination was pain (996 participants; 60.5%, 95% confidence interval [CI]: 58.1–62.9). Twenty-two participants (1.3%, 95% CI: 0.8–2.0) reported grade 3 pain (Figure). The most reported solicited systemic reactions were myalgia (551 participants; 33.5%, 95% CI: 31.2–35.8) and fatigue (517 participants; 31.4%, 95% CI: 29.2–33.7). Twenty-five participants (1.5%) reported fever (no grade 3). Most solicited AEs were transient lasting ∼2 days and were of mild to moderate intensity. Overall, 212 (12.8%, 95% CI: 11.3–14.5) participants reported at least 1 unsolicited AE within 30 days post-vaccination. At least 1 SAE was reported by 65 participants (3.9%, 95% CI: 3.0–5.0). Seven participants (0.4%, 95% CI: 0.2–0.9) reported at least 1 pIMD. Of the SAEs and pIMDs reported, 1 event (Guillain-Barre syndrome) was considered by the investigator as related to vaccination. Fatal SAEs were reported for 6 participants; none related to vaccination. Conclusion One dose of investigational RSVPreF3 OA vaccine was well tolerated and had an acceptable safety profile in adults ≥ 60 years of age. Funding GlaxoSmithKline Biologicals SA. Disclosures Tino F. Schwarz, Prof. Dr. MD, Biogen, Merck-Serono, Pfizer, Alexion, Bavarian Nordic, Janssen-Cilag, AstraZeneca, Biontech, MSD: Grants|GlaxoSmithKline Biologicals SA: Honoraria John E. Ervin, MD, The Alliance for Multispecialty Research – KCM: Contractual agreement for conduct of study protocol Charles Andrews, MD, GlaxoSmithKline Biologicals SA: Institutional grant|Merck and Boehringer Ingelheim: Consulting fees outside of the submitted work Miguel Vicco, PhD MD, GlaxoSmithKline Biologicals SA: Employee|GlaxoSmithKline Biologicals SA: Stocks/Bonds Marc Lievens, MSc, GlaxoSmithKline Biologicals SA: Employee|GlaxoSmithKline Biologicals SA: Stocks/Bonds Céline Maréchal, PhD, GlaxoSmithKline Biologicals SA: Employee|GlaxoSmithKline Biologicals SA: Stocks/Bonds Phoebe Nakanwagi, Master’s in Biostatistics, GlaxoSmithKline Biologicals SA: Employee Veronica Hulstrøm, PhD MD, GlaxoSmithKline Biologicals SA: Employee.

Direct oral anticoagulants (DOAC) are useful for preventing embolism and venous thrombosis in patients with atrial fibrillation. There are also reports that DOAC can dissolve existing intracardiac thrombus. Here, we report a case in which DOAC lysed a thrombus in an abdominal aortic aneurysm (AAA), resulting in impending rupture of the AAA. An 85-year-old woman was admitted to our hospital with a diagnosis of congestive heart failure. She has had atrial fibrillation and started taking DOAC. Computed tomography (CT) performed on admission revealed an AAA with a large amount of intraluminal thrombus (ILT). Fifty days after the start of DOAC, she visited our hospital with the chief complaint of severe abdominal pain. CT showed no enlargement of the AAA, but the ILT in the AAA had dissolved. She was diagnosed with an impending rupture of an AAA. She underwent emergency aortic replacement with a Y-shaped vascular prosthesis. When using DOAC in patients with aortic aneurysms with ILT, we need to be aware of the risk of the thrombus dissolving.

Naka Shiratori,1,2 Yusuke Nishio,1,2 Ayaka Takeda,1,2 Shio Sugimoto,1,2 Kenji Takazawa,2 Naomi Otsuka,3 Naruhiro Ishida,3 Daisuke Shii,3 Kiyotaka Hori,3 Kenji Nakamoto1 1Department of Ophthalmology, Nippon Medical School, Tokyo, Japan; 2Shinanozaka Clinic, Tokyo, Japan; 3Japan Medical Affairs Group, Santen Pharmaceutical Co. Ltd., Osaka, JapanCorrespondence: Naka ShiratoriDepartment of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, JapanTel +81-3-3822-2131Fax +81-3-5685-0988Email shiratori@nms.ac.jpPurpose: To clarify the intraocular pressure (IOP)-lowering effect of a selective prostanoid EP2 receptor agonist, omidenepag isopropyl (OMDI) during a 24-hour period.Patients and Methods: Subjects aged ≥ 20 years and with diagnosed, untreated primary open-angle glaucoma or ocular hypertension were enrolled. IOP measurements were performed every 4 hours over a 24-hour period using a Goldmann applanation tonometer (GAT) and Icare PRO tonometer (PRO). The baseline 24-hour IOP was measured in untreated subjects. After the baseline measurements, participants were given OMDI 1 drop once daily at night for 4 weeks. At week 4, the IOP measurement was repeated under the same conditions. Diurnal (9 am, 1 pm, 5 pm) and nocturnal (9 pm, 1 am, 5 am) IOP measurements were compared between baseline and treatment with OMDI. Safety measures included adverse events, slit-lamp biomicroscopy, visual acuity, heart rate and blood pressure.Results: Of 27 participants enrolled, 25 patients (20 males and 5 females, average age 52.2 ± 8.5 years) completed the study. In the sitting position, the baseline diurnal and nocturnal mean IOPs (GAT) were 19.1 ± 2.1 mmHg and 18.2 ± 2.6 mmHg, respectively, the diurnal and nocturnal mean IOP reduction from baseline were – 2.8 ± 2.6 mmHg (p < 0.0001) and – 3.3 ± 2.9 mmHg (p < 0.0001), respectively, mean 24-hour IOP (GAT) was significantly lower with the OMDI treatment (− 3.1 ± 2.5 mmHg, p < 0.0001). In the supine position, the baseline nocturnal mean IOP (PRO) was 17.99 ± 2.22 mmHg, and the nocturnal mean IOP reduction from baseline was − 1.78 ± 2.37 mmHg (p = 0.0009) after 4 weeks of the treatment. Nine adverse events were observed in 8 patients including mild conjunctival hyperemia (n = 8) and mild iritis (n=1). There were no significant effects on systemic safety.Conclusion: Once daily OMDI treatment was able to produce stable 24-hour IOP reduction.Keywords: omidenepag isopropyl, prostanoid EP2 agonist, 24-hour IOP control

The management of chronic disseminated intravascular coagulation( DIC) caused by aortic dissection has not yet been established. We report the successful treatment of a case of aortic dissection with a patent false lumen using danaparoid sodium for acute exacerbation of chronic DIC. 2,000 U danaparoid sodium per day has been stabilizing the coagulative and fibrinolytic parameters and has been relieving bleeding tendencies with no side effects for a long term.

Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55–72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/

Blood pressure (BP) is a leading global risk factor. Increasing age is related to changes in cardiovascular physiology that could influence cuff BP measurement, but this has never been examined systematically and was the aim of this study. Cuff BP was compared with invasive aortic BP across decades of age (from 40 to 89 years) using individual-level data from 31 studies (1674 patients undergoing coronary angiography) and 22 different cuff BP devices (19 oscillometric, 1 automated auscultation, 2 mercury sphygmomanometry) from the Invasive Blood Pressure Consortium. Subjects were aged 64±11 years, and 32% female. Cuff systolic BP overestimated invasive aortic systolic BP in those aged 40 to 49 years, but with each older decade of age, there was a progressive shift toward increasing underestimation of aortic systolic BP ( P P P

Introduction: Isolated systolic hypertension (ISH) is the most common form of hypertension in older people. However, accurate identification of ISH may be hindered because cuff blood pressure (BP) underestimates systolic BP (SBP) and overestimates diastolic BP (DBP). This study aimed to determine the influence of cuff BP accuracy on the identification of ISH. Methods: Cuff BP and invasive aortic BP were measured simultaneous (or near-simultaneously) in 1737 subjects (63 ± 12 years, 68% male) during coronary angiography. Data was derived from 32 studies, using 20 different cuff BP devices, from the Invasive Blood Pressure Consortium (INSPECT). ISH was defined as ≥140/

Background: Cuff blood pressure (BP) is intended to approximate central aortic BP and accuracy is paramount. Sex differences in BP physiology could influence the accuracy of cuff BP as an estimate of invasive aortic BP, but this has not been explored in-depth and was the aim of this study. Methods: Cuff and invasive aortic BP were measured in 1701 subjects (31.9% female, aged 63 ± 12) during coronary angiography from the INvaSive blood PressurE ConsorTium (INSPECT) database. Cuff accuracy was defined as cuff–invasive BP. In a sub-sample (n = 376, 27% female, aged 63 ± 11), invasive brachial BP was recorded to assess systolic (SBP) amplification (invasive brachial–aortic SBP). Results: Invasive aortic SBP was higher in females compared with males (mean [95% CI]: 141.8 mmHg [137.1, 146.3] versus 132.9 mmHg [129.4, 136.4], p < 0.001). Cuff SBP significantly underestimated invasive aortic SBP in females compared with males (−3.1 mmHg [−5.9, −0.2] versus 1.4 mmHg [−1.1, 4.0], p < 0.001 for difference). Sex differences remained after adjustment for age and height. In the sub-sample, aortic-to-brachial SBP-amplification was lower in females (7.1 mmHg [3.3, 10.8] versus 10.2 mmHg [5.1, 15.4], p = 0.0070). Sex, SBP-amplification, height and age were associated with cuff BP inaccuracy, but only SBP-amplification and age remained associated in multivariable analysis (p < 0.05). Conclusion: Females have greater propensity towards cuff BP inaccuracy through underestimation of aortic SBP. Both age and the magnitude of aortic-to-brachial SBP-amplification are related to cuff BP inaccuracy, which provide greater understanding of sex differences in BP physiology and may help improve the accuracy of cuff BP methods.

It is not established whether central blood pressure (BP) evaluated by a radial pulse wave analysis is useful to predict cardiovascular prognoses. We tested the hypothesis that central BP predicts future cardiovascular events in treated hypertensive subjects. We conducted a multicenter, observational cohort study of 3566 hypertensives being treated with antihypertensive medications at 27 institutions in Japan. We performed the radial pulse wave analyses using applanation tonometry in all subjects. The primary outcome was the incidence of any of the following: stroke, myocardial infarction (MI), sudden cardiac death, and acute aortic dissection. The mean age of the subjects was 66.0 ± 10.9 years, and 50.6% were male. The mean brachial SBP and central SBP were 138 ± 18 mm Hg and 128 ± 19 mm Hg, respectively. When the central SBP was divided into quintiles, the number of events was least in the 2nd quintile, and we set it as the reference. In the Cox regression analysis adjusting for age, sex, body mass index, creatinine, diabetes, use of β-blocker, and history of MI/stroke, the patients in the 3rd (hazard ratio (HR) 3.55, 95% confidence interval 1.29-9.78, p = 0.014), 4th (HR 4.12, 95% CI 1.53-11.10, p = 0.005), and 5th quintiles (HR 2.87, 95% CI 1.01-8.18, p = 0.048) had a significantly higher incidence of cardiovascular events compared to the 2nd quintile. The results were essentially unchanged when brachial DBP was additionally adjusted. In conclusion, in treated hypertensives, high central SBP was associated with worse cardiovascular outcomes.

Objectives: Accurate blood pressure (BP) measurement is critical for appropriate hypertension diagnosis and management. Aortic BP represents pressure loading on vital organs and this can be approximated using upper arm cuff BP. With advancing age, cuff systolic BP (SBP) increases and diastolic BP (DBP) decreases (widening pulse pressure [PP]), but whether age may influence cuff BP compared with invasive BP is unknown and was the aim of this study. Methods: Cuff BP was measured simultaneously, or near-simultaneously, with invasive aortic BP during catheterization in 1696 individuals within the INSPECT consortium (an international collaboration comprising data from 31 studies and 19 different cuff BP devices [17 oscillometric, 2 mercury sphygmomanometry]). Differences in cuff and invasive BP were assessed using mixed models. Results: Subjects were aged 63.3 ± 10.6 years and 32% female. Cuff SBP overestimated invasive aortic SBP in those aged 40–49, but with increasing age there was a progressive increase in the underestimation of aortic SBP (Table). Conversely, cuff DBP systematically overestimated aortic DBP, increasingly with age. Thus, there was a progressively higher error (underestimation) in cuff PP with older age. Adjusting models for sex, mean arterial pressure, heart rate and catheter type did not alter the findings, and no interactions between these parameters and age were found. Conclusion: Cuff BP is progressively more biased with increasing age, exposing older people to greater chance for misdiagnosis of risk related to BP. The findings highlight the need to improve cuff BP methods to ensure all people receive appropriate diagnosis and management of hypertension.

Direct vasodilator effects of nitroglycerin, nifedipine, cilnidipine and diltiazem on human skeletonized internal mammary artery graft harvested with ultrasonic scalpel were assessed in the presence of 0.1 or 0.2 µM of noradrenaline. Ring preparations were made of distal end section of the bypass grafts, and those dilated by acetylcholine were used for assessment. Each drug dilated the artery in a concentration-related manner (0.01-10 µM, n = 6 for each drug) with a potency of nitroglycerin > nifedipine = cilnidipine > diltiazem. These results indicate that nitroglycerin can be useful for treating internal mammary artery spasm, that clinical utility of diltiazem may not depend on its vasodilator effect on the bypass graft, and that cilnidipine as well as nifedipine will have anti-spastic action which is in the middle between those of nitroglycerine and diltiazem.

Brachial systolic pressure (BSP) is often monitored during exercise by the stress test; however, central systolic pressure (CSP) is thought to be a more direct measure of cardiovascular events. Although some studies reported that exercise and aging may play roles in changes of both BSP and CSP, the relationship between BSP and CSP with age following the exercise stress test remains unclear. The aim of this study was to evaluate the effect of age on the relationship between BSP and CSP measured after exercise. Ninety-six subjects underwent the diagnostic treadmill exercise stress test, and we retrospectively divided them into the following 3 groups by age: the younger age group (43 ± 4 years), middle age group (58 ± 4 years), and older age group (70 ± 4 years). Subjects exercised according to the Bruce protocol, to achieve 85 % of their age-predicted maximum heart rate or until the appearance of exercise-associated symptoms. BSP, CSP, and pulse rate (PR) were measured using a HEM-9000AI (Omron Healthcare, Japan) at rest and after exercise. BSP, CSP, and PR at rest were not significantly different among the 3 groups (p = 0.92, 0.21, and 0.99, respectively). BSP and PR immediately after exercise were not significantly different among the groups (p = 0.70 and 0.38, respectively). However, CSP immediately after exercise was 144 ± 18 mmHg (younger age), 149 ± 17 mmHg (middle age), and 158 ± 19 mmHg (older age). CSP in the older age group was significantly higher than that in the younger age group (p

Central systolic blood pressure (C-SBP) has been shown to be a better predictor of cardiovascular risk than brachial SBP. In this study, the effects of eicosapentaenoic acid (EPA) on C-SBP were compared with pravastatin. Twenty-four patients with hyperlipidemia were assigned 13 to receive 1800 mg/day EPA (EPA group) and 11 to receive 10 mg/day pravastatin (pravastatin group) for 3 months. In the EPA group, there were no changes in the LDL-cholesterol level. However, the radial augmentation index (AI) and C-SBP decreased after treatment by 5.7% (p < 0.01) and 8.7% (p < 0.001), respectively. Moreover, systolic and diastolic brachial BPs decreased by 7.1% and 8.0%, respectively (p < 0.01 for both). In the pravastatin group, the LDL-cholesterol level decreased by 29.5% (p < 0.001). However, there were no significant changes in brachial BP, AI and C-SBP between. These results suggested that EPA but not pravastatin may reduce cardiac afterload by reducing vascular reflected waves and lowering C-SBP.

Objective This study was designed to identify why the central blood pressure (cSBP) values obtained using the catheter method tend to be higher than brachial systolic blood pressure (bSBP) values obtained using the cuff method. Methods This study enrolled 20 patients who underwent coronary angiography (CAG) (mean age, 68.9 years; 13 men). Using the catheter method, a pressure guide wire was inserted via the radial artery at the time of CAG to measure the cSBP. The guide wire was then removed and the bSBP was obtained using two methods (the pressure guide wire method and the cuff method). The cSBP obtained with the catheter and the bSBP obtained with the cuff were compared, as were the bSBP obtained with the cuff and the bSBP obtained with the catheter. Results The cSBP obtained with the catheter was 4.6 mmHg higher than the bSBP obtained with the cuff. The bSBP obtained with the cuff was 8.3 mmHg lower than the bSBP obtained with the catheter. The cSBP obtained with the catheter was 1.7 mmHg lower than the bSBP obtained with the catheter. Conclusion In elderly patients with evident or suspected coronary heart disease, the finding of a higher cSBP measured using the catheter method than the bSBP obtained using the cuff method is attributable to bSBP underestimation (by 8.3 mmHg) using the cuff method compared to the bSBP directly obtained using the catheter method.

Central blood pressure (BP) is a useful predictor of cardiovascular risk. Recently, a fully automated device that measures central SBP (cSBP) from radial late SBP (rSBP2) has been developed.We measured cSBP using this device, compared it with aortic SBP (aSBP) measured with a high-fidelity pressure sensor, and evaluated the accuracy of cSBP before and after vasodilator administration. The data of 66 patients (mean age, 63.4 ± 9.7 years; 49 men) who underwent cardiac catheterization were analyzed. The radial artery pulse waveform and brachial BP were measured sequentially and used to calculate cSBP. Brachial SBP and DBP were used for radial SBP (rSBP) and radial DBP to calculate the absolute value of rSBP2. The radial pulse waveform was recorded by an applanation tonometer (HEM-9000AI; Omron Healthcare Co. Ltd). A high-fidelity pressure sensor was placed in the ascending aorta, and aSBP was measured simultaneously by an invasive method.Significant positive correlations between directly measured aortic late SBP and cSBP or rSBP were observed (r = 0.93, 0.88, respectively). Changes in aSBP before and after vasodilator administration showed a trend toward higher correlation with changes in cSBP than with changes in rSBP (r = 0.84, 0.78, respectively). The slope of the linear regression line of aSBP with cSBP (slope: 0.94) was closer to unity than with rSBP (0.66).Noninvasive cSBP calculated with rSBP2 accorded well with aSBP measured by the invasive method. Vasodilator medication and four of five diseases did not affect this relation.

右房内から心嚢内に突出した転移性心臓腫瘍を経験したので報告する．64歳，男性．2年前に右前腕軟部腫瘍切除術を行った．病理学的には悪性線維性組織球腫malignant fibrous histiocytomaと診断された．1年後，右大腿部，1年半後，右肺中葉に再発し，それぞれ切除術を行った．その後，右大腿部に局所再発し，術前の心電図異常より，経胸壁心臓超音波検査を行ったところ，右房内に可動性のある，48×30 mm大の腫瘍を認めた．また，術前の冠動脈造影検査で左前下行枝に75%の狭窄を認めた．右房腫瘍摘出，1枝冠動脈バイパス術（左内胸動脈-左前下行枝）を行った．右房腫瘍は右心耳から房室間溝で心嚢内へ突出し，露出していた．切除断端には凍結凝固治療を用いて，局所再発の予防に努めた．

Background: The aim of this study was to compare the effect of atorvastatin treatment on high-grade yellow coronary plaques (grade ≥2, group H) vs. low-grade yellow plaques (grade ≤1, group L). Methods and Results: Twenty-nine hypercholesterolemic patients with coronary heart disease were treated with atorvastatin (10-20mg/day) for 80 weeks and were divided into 2 groups by baseline plaque color grade. The angioscopic plaque grade and the vessel, plaque, and luminal volumes were measured by intravascular ultrasound at baseline and in weeks 28 and 80. The plaque color grade decreased significantly from baseline to weeks 28 and 80 in group H (2.27±0.48, 1.47±0.75, and 1.55±0.86, respectively), but not significantly in group L (0.90±0.31, 0.83±0.61, and 0.89±0.56, respectively). The plaque volume of group HP was greater than that of group LP (respectively 158.0±45.8 vs. 107.5±21.9mm3 at baseline, 144.5±41.1 vs. 97.5±24.8mm3 in week 28, and 128.8±31.5 vs. 87.9±31.5mm3 in week 80 (P

Katsuya Suzuki1, Shigekazu Tsubaki2, Masami Fujita3, Naoto Koyama1, Michio Takahashi1, Kenji Takazawa41Research Institute for Health Fundamentals, Ajinomoto Co., Inc., Kawasaki; 2Samoncho Clinic, Tokyo; 3Shinanozaka Clinic, Tokyo; 4Tokyo Medical University Hachioji Medical Center, Tokyo, JapanAbstract: Safflower seed extract (SSE) contains characteristic polyphenols and serotonin derivatives (N-(p-coumaroyl) serotonin and N-feruloylserotonin), which are reported to inhibit oxidation of low-density lipoprotein (LDL), formation of atherosclerotic plaques, and improve arterial stiffness as assessed by pulse wave analysis in animal models. The effects of long-term supplementation with SSE on arterial stiffness in human subjects were evaluated. This double-blind, placebo-controlled study was conducted in 77 males (35–65 years) and 15 postmenopausal females (55–65 years) with high-normal blood pressure or mild hypertension who were not undergoing treatment. Subjects received SSE (70 mg/day as serotonin derivatives) or placebo for 12 weeks, and pulse wave measurements, ie, second derivative of photoplethysmogram (SDPTG), augmentation index, and brachial-ankle pulse wave velocity (baPWV) were conducted at baseline, and at weeks 4, 8, and 12. Vascular age estimated by SDPTG aging index improved in the SSE-supplemented group when compared with the placebo group at four (P = 0.0368) and 12 weeks (P = 0.0927). The trend of augmentation index reduction (P = 0.072 versus baseline) was observed in the SSE-supplemented group, but reduction of baPWV by SSE supplementation was not observed. The SSE-supplemented group also showed a trend towards a lower malondialdehyde-modified-LDL autoantibody titer at 12 weeks from baseline. These results suggest long-term ingestion of SSE in humans could help to improve arterial stiffness.Keywords: safflower, serotonin derivatives, antioxidants, augmentation index, pulse wave velocity

症例は69歳，男性．発熱，胸痛を主訴に来院．胸部単純X線で肺炎と診断され緊急入院．喀痰，血液培養からStreptococcus pneumoniaeが検出された．入院時心臓超音波検査で少量の心嚢水を認めていたが，2日後に心嚢水が増加しており，心嚢ドレナージを行った．心嚢水は膿性で感染を疑われたが培養は陰性であった．入院8日目ごろより右心不全症状出現．心臓超音波検査で収縮性心膜炎と診断され，利尿剤の増量行うも改善傾向見られず，入院24日目に心膜剥離術および切除術を行った．心嚢内および胸腔内より膿性の浸出液を認めたため，ドレーンを心嚢内，両側胸腔内に合計6本留置し一期的に創を閉鎖し，術後生理食塩水による持続洗浄を5日間行った．術後経過は良好で34病日に退院となった．術後の閉鎖的持続洗浄は感染再燃の予防として有効な手段であると思われた．

The coagulase-negative Staphylococcus lugdunensis, a bacterium similar to Staphylococcus aureus, produces tannase that degrades tannin. We developed a polymerase chain reaction-based method to rapidly and simply identify this species by detecting the tanA gene for S. lugdunensis tannase.

Pharmaceutical angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce arterial stiffness; the possible effect of food-derived putative ACE inhibitory peptides on this degenerative process, however, has not been reported. In the present study, casein hydrolysate containing the lactotripeptides, Val-Pro-Pro (VPP) and Ile-Pro-Pro (IPP), which has been found to have an antihypertensive effect in a number of clinical studies, was investigated for its ability to improve hemodynamic parameters, including central systolic blood pressure (cSBP), in hypertensive subjects. Twelve hypertensive subjects who were not on prescribed medication were monitored for various hemodynamic parameters, including brachial blood pressure (peripheral blood pressure), cSBP, and augmentation index (AI), at the start and then after 3, 6, and 9 weeks of a daily treatment comprising four tablets containing VPP and IPP. Compared with basal levels, treatment with casein hydrolysate for 6 and/or 9 weeks showed a significant reduction in peripheral systolic and diastolic blood pressure, AI, and cSBP, but not in heart rate or pulse pressure. cSBP showed a reduction sooner and greater (-21.8 mm Hg) than did brachial systolic blood pressure (-16.4 mm Hg) during the 9-week treatment. Although small and not placebo-controlled, this study suggests that continuous intake of VPP and IPP might have the potential to improve arterial stiffness as well as cSBP and peripheral brachial blood pressure.

Pulse wave velocity (PWV) has been used clinically as a direct measure of arterial stiffness. We investigated the inhibitory effects of defatted safflower seed extract (SSE) and serotonin derivatives (N-(p-coumaroyl)serotonin, N-feruloylserotonin; CS+FS), which are the active components in SSE, on hypercholesterolemia and atherosclerosis, using PWV in Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits. SSE and CS+FS were supplemented with a commercial diet containing 0.5% cholesterol for 8 weeks in male KHC rabbits, aged 2 months. Pulse waves were recorded at different aortic positions using two catheters with micromanometers under pentobarbital anesthesia. The atherosclerotic lesioned area in the aorta was significantly reduced in the SSE and CS+FS groups, without significant changes in serum cholesterol and triglyceride levels among the three groups after supplementation. Local PWV (LPWV) in the middle thoracic and distal abdominal aortas was significantly smaller in the SSE and CS+FS groups than in the control group. PWV in the entire aorta was also significantly lower in the SSE and CS+FS groups, compared with that in the control group. Pressure-strain elastic modulus, an index of wall distensibility, was significantly lower in the middle thoracic and middle abdominal aortas in the SSE and CS+FS groups than in the control group. Wall thickness was also significantly smaller in the middle thoracic aorta in the SSE and CS+FS groups compared with that in the control group. Serotonin derivatives inhibited the progress of atherosclerosis and ameliorated wall distensibility, which contributed, in part, to the lowering of LPWV. Serotonin derivatives may be beneficial in improving vascular distensibility and in reducing cardiovascular risk.

Microbial surveillance of environmental bacteria was performed in order to study the microbial changes in a newly established hospital building. Airborne bacteria and surface-associated bacteria on floors and sinks were systematically collected between 2002 and 2005. The number of isolates obtained from frequently used floors was significantly higher than that obtained from those floors used less often. A significant increase in Staphylococcus aureus, the appearance of Pseudomonas aeruginosa, and changes among species of Gram-negative bacilli were observed 8-11 months after the new building had been opened. Furthermore, pulsed-field gel electrophoresis (PFGE) typing of meticillin-resistant S. aureus (MRSA) and P. aeruginosa showed that strains of the same PFGE groups were isolated from different sinks, floors and the adjoining old buildings. The number of MRSA isolates obtained from the new building increased as time passed. The sinks from which P. aeruginosa strains of the same PFGE type were isolated are connected by the same drainage pipe. Human movement has considerable effects on bacterial flora and their subsequent spread.

The main way that methicillin-resistant Staphylococcus aureus (MRSA) is spread is through contact in hospitals but there is also the possibility of horizontal transmission of the methicillin resistance gene mecA among S.aureus since mecA is located on the mobile element SCCmec .In this study,through the typing of MRSA and methicillin-susceptible S.aureus (MSSA) by pulse field gel electrophoresis (PFGE),MSSA and MRSA belonging to a similar genetic group were identified.When mecA was deleted from the MRSA,its PFGE pattern became similar to that of MSSA.Our results therefore suggest that there is a strong possibility that MRSA spreads by the horizontal transmission of mecA to MSSA as well as through contact.

For infection control purposes,we conducted microbial surveillance targeting the air,floors,and sinks at approximately 250 locations from 1999 to 2004.Annual changes in the average number of microbial isolates from air,floor,and sink samples were not correlated but changes in particular sampling items were correlated.Hospital wards where there was greater movement of people produced larger average numbers of isolates than other parts of the hospital,for example examination rooms.We found that the average number of isolates from air and floor samples was higher when a new hospital ward was under construction as well as just after its opening.Methicillin-resistant Staphylococcus aureus (MRSA) was frequently isolated from floor samples (68.8%) and Pseudomonas aeruginosa was isolated from both floor (10.3%) and sink (89.7%) samples.The numbers of MRSA and Pseudomonas aeruginosa isolated from hospital ward samples were larger than those from other parts of the hospital.Our microbial surveillance clearly showed that the distribution of environmental bacteria changed in the hospital overall rather than for individual units and was affected by human activity and environmental changes.Furthermore,the species of bacteria isolated from the air,floor,and sink samples were different.Therefore,our results suggest that it is important to address the sanitization of the hospital environment as a whole,not on a ward by ward basis.

Since a decrease of central aortic pressure contributes to the prevention of cardiovascular events, simple measurement of not only brachial blood pressure but also central aortic pressure may be useful in the prevention and treatment of cardiovascular diseases. In this study, we simultaneously measured radial artery pulse waves non-invasively and ascending aortic pressure invasively, before and after the administration of nicorandil. We then compared changes in central aortic pressure and radial arterial blood pressure calibrated with brachial blood pressure in addition to calculating the augmentation index (AI) at the aorta and radial artery. After nicorandil administration, the reduction in maximal systolic blood pressure in the aorta (Deltaa-SBP) was -14+/-15 mmHg, significantly larger than that in early systolic pressure in the radial artery (Deltar-SBP) (-9+/-12 mmHg). The reduction in late systolic blood pressure in the radial artery (Deltar-SBP2) was -15+/-14 mmHg, significantly larger than Deltar-SBP, but not significantly different from Deltaa-SBP. There were significant relationships between Deltaa-SBP and Deltar-SBP (r=0.81, p

Single lead VDD pacemakerでの心房unipolar電極 (遠位: d-ring, 近位: p-ring) の有用性を検討した.対象は85名で植込み7日, 3ヵ月, 6カ月以後6ヵ月ごとに最長54ヵ月間背臥位と座位にてunipolarとbipolarでの最小心房波高を測定した, 全平均で心房波高はbipolar, d-ring, p-ringの順で高値を示した.unipolar設定時の間歇的無症候性sensing failureは38名中29名 (76%) に認められた.心房同期率はd-ring92%, p-ring95%, bipolar83%であった.d-ringでは7日後と比較し54カ月後 (背臥位0.72±0.74mV vs0.95±0, 78mV) でも同等な心房波高であった.Bipolar電極が使用不能の際, d-ringの使用にて良好な心房同期率を長期維持することが可能であり心房単極は有用と考えられる.

Background and aims. Arterial hypertension doubles the risk of coronary heart disease, heart and kidney failure, and peripheral arterial disease. Less variation in diurnal ambulatory blood pressure monitoring (ABPM) patterns may affect mortality outcome. Therefore, as hypertension occurs in over 95% of older subjects, the prognostic value of dipping status in older hypertensive patients will be assessed. Method. The retrospective study group consisted of 170 hypertensive patients, aged 75 84 years, enrolled in the years 2005 to 2007. Baseline measures included 24-h ABPM. Diurnal index and dipping status was calculated and stratified the group into dippers (40 patients, 23.5%), non-dippers (65 patients, 38.2%) and reverse-dippers (65 patients, 38.2%). Results. During a 5-year observation, after baseline we have observed 69 deaths (40.9%) from the whole group of 170 patients with 23 (35.4%) being non-dippers and 36 (55.4%) reverse-dippers. There were significant differences between the groups divided according to diurnal dipping status in survival time, number of recorded deaths and night mean blood pressure. We have identified and confirmed risk factors for the all-cause mortality: age, mean systolic and diastolic blood pressure, diurnal index and dipping status (dipping, non-dipping or reverse-dipping). Conclusion. Reverse-dippers and non-dippers revealed worse prognosis compared with dippers.

The coexistence of hypertension and hypercholesterolaemia from youth may increase the prevalence of and mortality from cardiovascular disease and stroke. We thus investigated haemodynamics of mild hypertension in young Kurosawa and Kusanagi-hypercholesterolaemic (KHC) rabbits aged 10–12 months old, as models of heritable hypercholesterolaemia. Pressure and flow waves were simultaneously recorded at the ascending aorta with a catheter-tip micromanometer and ultrasonic flow meter under pentobarbital anaesthesia, respectively. Systolic (119.3 ± 6.5 and 138.4 ± 7.4 mmHg (mean ± SD) for control and KHC rabbit groups; p < 0.001), diastolic (95.7 ± 6.1 and 109.8 ± 5.2; p < 0.001), mean (105.8 ± 6.5 and 122.5 ± 4.9; p < 0.001) and pulse (23.7 ± 2.5 and 28.6 ± 4.0; p < 0.001) pressures as well as total peripheral vascular resistance (0.32 ± 0.02 and 0.37 ± 0.03 mmHg/ml/min; p < 0.001) were significantly greater in the KHC rabbit group than those in the age-matched control rabbit group, respectively, while there were no significant differences in the mean aortic flow, heart rate or stroke volume between the two rabbit groups. Aortic input impedance (p < 0.05) and reflection coefficient (p < 0.05) were significantly greater at lower frequency in the KHC rabbit group than in the control rabbit group, whereas there was no significant difference in the characteristic impedance between the two rabbit groups. Plasma angiotensin I (p < 0.01) and II (p < 0.01) levels and serum angiotensin converting enzyme activity (p < 0.05) were significantly greater in the KHC rabbit group than in the age-matched control rabbit group. Atheromatous plaque was in the early stage and composed mainly of abundant foam cells. Neither sclerotic lesions nor stenosis were observed in main peripheral arteries. The mild hypertension in young KHC rabbits was due partly to the increased activity of the renin–angiotensin system. These findings may be thought provoking in elucidating the mechanism and developing preventive and therapeutic strategies in young patients with coexistent hypertension and hypercholesterolaemia.

Analysis of the contour of the peripheral pulse to assess arterial properties was first described in the nineteenth century. With the recognition of the importance of arterial stiffness there has been a resurgence of interest in pulse wave analysis, particularly the analysis of the radial pressure pulse acquired using a tonometer. An alternative technique utilizes a volume pulse. This may conveniently be acquired optically from a finger (digital volume pulse). Although less widely used, this technique deserves further consideration because of its simplicity and ease of use. As with the pressure pulse, the contour of the digital volume pulse is sensitive to changes in arterial tone induced by vasoactive drugs and is influenced by ageing and large artery stiffness. Measurements taken directly from the digital volume pulse or from its second derivative can be used to assess these properties. This review describes the background to digital volume pulse contour analysis, how the technique relates to contour analysis of the pressure pulse, and current and future applications.

Background The aim of the present study was to quantitatively assess the physiological acute recoil after percutaneous coronary intervention (PCI), and to determine the relation between it and target lesion revascularization (TLR) in the chronic phase. Methods and Results This study evaluated 76 patients who underwent elective PCI between May 1997 and December 2001: plain old balloon angioplasty (POBA) in 50 patients and bare metal stent implantation in 26 patients. Fractional flow reserve (FFR) was measured immediately (FFR0m) and 15 min (FFR15m) after the final dilation, and the difference (dif-FFR) was calculated. In POBA patients with TLR, FFR15m was significantly low (0.79±0.05 vs 0.87 ±0.08, p

To examine acute-phase outcomes in acute myocardial infarction (AMI) according to different initial treatments.This retrospective study involved 405 patients with AMI who had undergone coronary angiography during the acute phase. The patients were retrospectively examined by dividing into groups according to treatment received: intravenous coronary thrombolysis (IVCT) (n=83), intracoronary thrombolysis (ICT) (n=62), and percutaneous coronary intervention (PCI) (n=221).TIMI 3 flow at the initial angiography was higher in the IVCT group (P0.05) at 32.5% in the IVCT group and 21.7% in the non-IVCT group. The time from onset to initiation of treatment was shorter in the IVCT group (P0.001) at 227 min in the IVCT group, 337 min in the ICT group, and 479 min in the PCI group. The acute-phase mortality was lower in the IVCT group (P0.05) at 2.4% in the IVCT group, 3.2% in the ICT group, and 11.8% in the PCI group. According to sub-analysis, the restenosis rate during the chronic phase after PCI did not differ with or without antecedent administration of a thrombolytic agent.IVCT as an initial treatment for AMI enabled the fastest reperfusion at TIMIor = 2 flow, resulting in a good acute-phase outcome.

New techniques for the evaluation of specific components of blood pressure waveforms have been shown to have broad applications in cardiology. One of the more useful parameters of pressure wave analysis is the augmentation index (AI), which measures the interaction of the forward pressure wave with reflected waves from the distal circulation. Analysis of AI and associated wave functions show differences related to cardiac risk, the presence of disease, and the effects of drug administration. The AI can provide useful additional information in the evaluation of high-risk populations and is a useful research tool in evaluating drug and treatment effects. New techniques have allowed AI to become more widely available and current measurements are convenient and reliable.

The objective of this study was to examine the usefulness of fractional flow reserve (FFR) in determining the indication of target lesion revascularization (TLR) at follow-up angiography after percutaneous coronary intervention (PCI). One hundred forty-seven patients with 155 lesions that had intermediate restenosis took part in this study. FFR was measured in all patients for the evaluation of stenosis severity. Then TLR was performed when FFR was < 0.75, and TLR was deferred when FFR was ≥ 0.75. Patients in whom TLR was deferred were followed up clinically (25 ± 11 months). In 98 patients (67%) who underwent stress myocardial scintigraphy before angiography, the results of the scintigraphy were compared with FFR results. TLR was performed in 34 lesions (22%). After TLR, the Canadian Cardiovascular Society class decreased significantly (from 1.5 ± 0.7 to 1.1 ± 0.5; P < 0.05). In 113 patients who did not undergo TLR, only 4 patients (3.5%) had cardiac events (re-PCI in 1 patient and a positive SPECT in 3 patients). Discordance between the results of scintigraphy and FFR was observed in 30 patients (30%), but the patients who had good values of FFR ≥ 0.75 showed a nil event rate (0%). FFR might be useful for the determination of the indication of TLR. © 2005 Wiley-Liss, Inc.

Recently, a measurement device that can simultaneously measure the ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (PWV) has become available. The present study compares the applicability of ABI and PWV as markers for predicting the prevalence of coronary artery disease (CAD) in subjects with a high risk of atherosclerotic cardiovascular disease. The ABI and brachial-ankle PWV were measured in 472 consecutive subjects who subsequently underwent coronary angiography for diagnosis or exclusion of CAD. The prevalence of CAD in the lowest ABI quartile was higher than those in the other 3 ABI quartiles, whereas the prevalence in the lowest brachial-ankle PWV quartile was lower than those in the other 3 brachial-ankle PWV quartiles. A multivariate logistic regression analysis demonstrated that the lowest ABI quartile was a significant independent variable for the prevalence of CAD and that the lowest brachial-ankle PWV quartile was a significant independent variable for the absence of CAD in a population. Thus, a low ABI is an independent marker for an additive risk of CAD, whereas a low brachial-ankle PWV may be used as an independent marker for excluding the risk of CAD among subjects with a high risk of atherosclerotic cardiovascular disease.

Background Cardiac allograft vasculopathy (CAV), a disorder characterized by rapid development and progression of obliterative vasculopathy in the transplanted heart, continues to be a major cause of graft failure in long-surviving human transplants. The mechanisms and histopathologic processes of CAV remain unknown. Previous animal studies have shown that inhibition of matrix metalloproteinase (MMP) prevents migration and proliferation of smooth muscle cells in CAV. In this study, we hypothesized that MMPs may be expressed in and may play an important role in CAV. Methods An F344-to-WKAH rat heterotopic heart transplantation model was used. Tacrolimus was administered intramuscularly 14 days after transplantation to prevent acute rejection and to allow the development of CAV. We divided the animals into 2 groups according to post-operative treatment: an ONO group received an MMP inhibitor (ONO-4817) daily by oral gavage for 14 days after transplantation ( n = 6), and a control ( n = 6) group received no treatment. Grafts were harvested 60 days after treatment. Results Immunohistochemical staining revealed that MMP-2 and tissue inhibitors of metalloproteinase-2 (TIMP-2) were expressed more strongly in the neointima and media of the control CAV animals than in the ONO-CAV animals. The animals given ONO-4817 exhibited a significant decrease in the percentage of affected vessels, in the percentage of intimal proliferation, in the intima-to-media ratio, and in the expression of MMP-2 and TIMP-2. Conclusion These results suggest that MMP-2 and TIMP-2 play an important role in the development of CAV and that the use of an MMP inhibitor (ONO-4817) may prevent neointimal proliferation in patients with CAV.

Recent studies have shown that triptolide inhibits T cell activation through mechanisms different from those of cyclosporine A and tacrolimus and we postulated that triptolide might have a synergistic effect with tacrolimus to enhance immunosuppression. Using a F344 donor-to-Lewis recipient rat combination, we investigated the immunosuppressive effects of triptolide alone or in combination with tacrolimus on the survival of cardiac allografts. Recipients were treated with placebo, triptolide, tacrolimus, and triptolide in combination with tacrolimus at different doses. The median survival time (MST) was 8 days for placebo; 9.5, 11, 14 and 19 days for triptolide monotherapy at doses of 0.04, 0.08, 0.16, and 0.32 mg/kg/day, respectively, and 11, 13.5, and 52 days for tacrolimus monotherapy at doses of 0.025, 0.05, and 0.1 mg/kg/day, respectively. Tacrolimus 0.025 mg/kg/day combined with triptolide 0.08 and 0.16 mg/kg/day prolonged the MST to 17.5 and 20 days, respectively; while tacrolimus 0.05 mg/kg/day combined with triptolide 0.04, 0.08, and 0.16 mg/kg/day prolonged the MST to 21, 23, and 23 days, respectively. These results suggest that triptolide is a moderately effective immunosuppressive agent. Triptolide combined with a subtherapeutic dose of tacrolimus produced a synergistic effect in prolonging rat cardiac allograft survival.

Background Although the development of a coronary guidewire mounted with a pressure sensor has facilitated the measurement of pressure-derived fractional flow reserve (FFR) to assess the functional severity of coronary artery stenoses, the theoretical limitations include diabetes mellitus because of the associated microvascular abnormalities. Methods and Results In the present study 304 vessels and their coronary territories in 96 diabetic and 149 nondiabetic patients were evaluated by pressure-derived FFR and thallium-201 single photon emission computed tomography (SPECT) to determine the applicability of measuring FFR in diabetic subjects. The best cut-off value for FFR to detect myocardial ischemia, as demonstrated by 201Tl SPECT, was 0.725 in the diabetic and 0.745 in the nondiabetic patients. Sensitivity and specificity were similar for the 2 groups (83% and 75% (diabetic) vs 79% and 83%). However, diabetic patients with homoglobin (Hb) A1c ≥7.0% showed lower specificity in comparison with those having HbA1c