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The prevalence of Fabry disease (FD) in male patients with left ventricular hypertrophy (LVH) is about 1%. From the perspective of performing more efficient screening with measurement of α-galactosidase (α-Gal) activity, it is important to raise the pretest probability.We retrospectively investigated the prevalence of FD in 701 male patients with LVH who already had been screened by measurement of α-Gal activity in eight hospitals. From the viewpoint of enzymatic screening, we validated previously reported clinical features of FD including the electrocardiographic and echocardiographic characteristics with comparing each clinical determinant between patients with FD and non-FD patients. We finally aimed to establish a new screening approach for the detection of patients at high risk of FD.There were five FD patients (0.7%) in the 701 male patients with LVH. Those five patients with FD all had the cardiac variant type and age at detection of LVH was ≥35 years in all patients. In LVH patients with LV ejection fraction (EF) ≥ 50%, Pend-Q interval 40 msec, SV1 + RV5 4.0 mV, and diffuse LVH were important determinants of FD. In LVH patients with LVEF 50%, asymmetric septal hypertrophy and posterior wall motion abnormality seemed to be associated with FD.In our retrospective study, the prevalence of FD in male patients with LVH was found to be 0.7%. We established the efficient combinations of clinical determinants using age at detection of LVH, Pend-Q interval, high voltage, and LVH pattern in an echocardiogram.

Background Numerous studies have shown that 123I-metaiodobenzylguanidine (MIBG) scintigraphy, an index of cardiac sympathetic nervous (CSN) activity, is useful for predicting prognosis in patients with heart failure. However, the factors influencing the CSN activity of patients with severe aortic stenosis (AS) remain unclear. Methods We enrolled 91 patients with severe AS who underwent 123I-MIBG scintigraphy, coronary computed tomography (CCT), and transthoracic echocardiography. When CCT angiography (CCTA) showed an obstructive epicardial artery, invasive coronary angiography was performed within 1 week of CCTA. Results There were 21 male and 70 female patients with a mean age of 84±5 years. Eighty-five (85) patients (93%) had hypertension and 13 patients (14%) had diabetes. Two (2) patients (2%) had previous myocardial infarction and eight (9%) had a previous coronary intervention. All patients had severe AS: aortic valve area was 0.63±0.18 cm2 and the mean pressure gradient was 56±19 mmHg. Regarding 123I-MIBG parameters, early heart-to-mediastinum (H/M) ratio was 3.1±0.5, delayed H/M ratio was 2.8±0.6, and the washout rate (WR) was 35%±13%. Multivariable linear regression analysis showed that coronary artery disease (β=–0.30, p=0.002) was an independent predictor of delayed H/M ratio, and that aortic valve area (β=–0.20, p=0.048) was an independent predictor of WR. Conclusions Our findings suggest that coronary artery disease is an independent predictor of delayed H/M ratio, and aortic valve area is an independent predictor of WR in patients with severe AS.

The monocyte to high-density lipoprotein cholesterol (HDL-C) ratio has been considered to be a prognostic marker. Whether this ratio is associated with left ventricular (LV) diastolic function remains undetermined. We tested the hypothesis that the monocyte to HDL-C ratio is associated with LV diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no significant perfusion abnormality.The study population included 196 patients with no significant perfusion abnormalities and preserved ejection fraction. The peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters using gated SPECT. Monocyte counts and plasma HDL-C levels were also examined.Significant associations were observed between the monocyte to HDL-C ratio and PFR (r = -0.20; P = 0.005) and 1/3 MFR (r = -0.19; P = 0.009). Multivariate linear regression analysis was performed to determine factors associated with LV diastolic parameters. Age (β = -0.27; P < 0.001), LV end-diastolic volume (β = -0.19; P = 0.034), and monocyte to HDL-C ratio (β = -0.15; P = 0.027) were determined to be significantly associated with PFR. Moreover, age (β = -0.13; P = 0.007), LV mass index (β = -0.18; P = 0.037), and the monocyte to HDL-C ratio (β = -0.13; P = 0.045) were significantly associated with 1/3 MFR.These results demonstrated that the monocyte to HDL-C ratio is associated with LV diastolic function, as derived from gated SPECT in patients with no significant perfusion abnormality.

The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) on changes in cardiac sympathetic nervous (CSN) function remains unclear. Using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, we investigated the impact of PPM after TAVR on CSN activity.We enrolled 44 of 117 patients with severe aortic stenosis who underwent TAVR for analysis in the present study. We conducted 123I-MIBG scintigraphy at baseline and at about 9 months after TAVR. Differences between baseline and post-TAVR 123I-MIBG parameters were compared between cases with and without PPM.There were 17 and 27 patients with and without PPM, respectively. Those without PPM exhibited significantly decreased left ventricular mass index (122 ± 36 g/m2 versus 108 ± 30 g/m2, P < 0.001) following TAVR, whereas those with PPM did not (117 ± 21 g/m2 versus 110 ± 17 g/m2, P = 0.09). Significant improvements in delayed heart-to-mediastinum (H/M) ratio (2.8 ± 0.4 versus 3.0 ± 0.4, P = 0.004) and washout rate (WR) (33% ± 10% versus 24% ± 12%, P < 0.001) were observed after TAVR in patients without PPM but not in those with PPM. Multivariable linear regression analysis revealed PPM to be a negative predictor of improvements in delayed H/M ratio and WR.Delayed H/M ratio and WR improve significantly after TAVR in the absence of PPM, whereas these improvements are not observed in patients with PPM. Hence, the presence of PPM is a negative predictor of improvements in delayed H/M ratio and WR in patients undergoing TAVR.

Objective The QRS-T angle has been established as a repolarization marker. In the present study, we determined whether or not newly developed bundle branch block (BBB) affected the QRS-T angle in patients with a narrow QRS. Methods Twenty-four patients with newly developed BBB and no adverse cardiac events were retrospectively included. The frontal QRS-T angle was defined as the absolute value of the difference between the frontal plane QRS axis and the T-wave axis. These electrocardiogram parameters were serially measured in the settings of narrow QRS and BBB. Results Twelve patients had newly developed right BBB (RBBB), and 12 had newly developed left BBB (LBBB). The development of RBBB did not affect the QRS axis, T-wave axis of QRS-T angle (41° ±42° to 53° ±65°, p = 0.63). In contrast, the development of LBBB shifted the QRS axis to the left (25° ±29° to -18° ±31°, p = 0.003), resulting in an increased QRS-T angle (72° ±50° to 123° ±39°, p = 0.001). Regarding RBBB, an excellent correlation and agreement were found between the QRS-T angles in the setting of narrow QRS and RBBB (r = 0.88; p

Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. We tested the hypothesis that aging had impacts on coronary flow velocities and CFR in patients with no evidence of myocardial perfusion abnormality on single photon emission computed tomography (SPECT). Seventy-six patients undergoing transthoracic Doppler echocardiography with no evidence of myocardial perfusion abnormality on SPECT were enrolled in this study. CFR was defined as the ratio of hyperemic to resting peak diastolic coronary flow velocity. Patients were divided into the three groups based on age: 17 patients aged less than 70 years (Group I), 38 patients aged 70–79 years (Group II), and 21 patients aged 80 years or more (Group III). Compared with Group I, CFR was significantly lower in Group II (p < 0.01) and Group III (p < 0.01). Multivariate linear regression analysis showed that female (β = − 0.26, p = 0.03), cigarette smoking (β = − 0.32, p = 0.004), hemoglobin level (β = − 0.40, p = 0.001) and LV mass index (β = 0.24, p = 0.03) were determinants for resting coronary flow velocity. On the other hand, age (β = -0.30, p = 0.008), hemoglobin level (β = -0.47, p < 0.001) and LV mass index (β = 0.24, p = 0.04) were determinants for hyperemic coronary flow velocity. Age was only determinant for CFR (β = -0.48, p < 0.001). Our data suggested that that aging had a decreased effect on hyperemic coronary flow velocity rather than resting coronary flow velocity, and was further associated with impaired CFR in patients with no evidence of myocardial perfusion abnormality.

Serum levels of cholesterol absorption and synthesis markers are known to be associated with cardiovascular risk. Individuals with reduced kidney function or chronic kidney disease (CKD) are at an increased risk for cardiovascular disease. Hence, we examined the relationship between estimated glomerular filtration rate (eGFR) and serum markers of cholesterol absorption and synthesis.The CACHE (Cholesterol Absorption and Cholesterol synthesis in High-risk patiEnts) Consortium, comprised of 13 research groups in Japan possessing data of lathosterol (Latho, synthesis marker) and campesterol (Campe, absorption marker) measured via gas chromatography, compiled the clinical data using the REDCap system. Among the 3597 records, data from 2944 individuals were utilized for five analyses including this CKD analysis.This study analyzed data from 2200 individuals including 522 hemodialysis patients; 42.3% were female, the median age was 58 years, and the median eGFR was 68.9 mL/min/1.73 mWe showed that individuals with lower eGFR have lower cholesterol synthesis marker levels and higher cholesterol absorption marker levels in this large sample.

Risk of cardiovascular disease is increased in patients with diabetes mellitus (DM). Cholesterol metabolism (hepatic synthesis and intestinal absorption) is known to be associated with cardiovascular risk. Next, we examined the association of DM with cholesterol absorption/synthesis.The CACHE Consortium, which is comprised of 13 research groups in Japan possessing data of lathosterol (Latho, synthesis marker) and campesterol (Campe, absorption marker) measured by gas chromatography, compiled the clinical data using the REDCap system. Among the 3597 records, data from 2944 individuals were used for several analyses including this study.This study analyzed data from eligible 2182 individuals including 830 patients with DM; 42.2% were female, median age was 59 years, and median HbA1c of patients with DM was 7.0%. There was no difference in Latho between DM and non-DM individuals. Campe and Campe/Latho ratio were significantly lower in DM individuals than in non-DM individuals. When the associations of glycemic control markers with these markers were analyzed with multivariable-adjusted regression model using restricted cubic splines, Campe and Campe/Latho ratio showed inverse associations with glucose levels and HbA1c. However, Latho showed an inverted U-shaped association with plasma glucose, whereas Latho showed a U-shaped association with HbA1c. These associations remained even after excluding statin and/or ezetimibe users.We demonstrated that DM and hyperglycemia were independent factors for lower cholesterol absorption marker levels regardless of statin/ezetimibe use.

The monocyte to high-density lipoprotein cholesterol (HDL-C) ratio has been considered to be a prognostic marker. Whether this ratio is associated with left ventricular (LV) diastolic function remains undetermined. We tested the hypothesis that the monocyte to HDL-C ratio is associated with LV diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no significant perfusion abnormality.The study population included 196 patients with no significant perfusion abnormalities and preserved ejection fraction. The peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters using gated SPECT. Monocyte counts and plasma HDL-C levels were also examined.Significant associations were observed between the monocyte to HDL-C ratio and PFR (r = -0.20; P = 0.005) and 1/3 MFR (r = -0.19; P = 0.009). Multivariate linear regression analysis was performed to determine factors associated with LV diastolic parameters. Age (β = -0.27; P0.001), LV end-diastolic volume (β = -0.19; P = 0.034), and monocyte to HDL-C ratio (β = -0.15; P = 0.027) were determined to be significantly associated with PFR. Moreover, age (β = -0.13; P = 0.007), LV mass index (β = -0.18; P = 0.037), and the monocyte to HDL-C ratio (β = -0.13; P = 0.045) were significantly associated with 1/3 MFR.These results demonstrated that the monocyte to HDL-C ratio is associated with LV diastolic function, as derived from gated SPECT in patients with no significant perfusion abnormality.

Objective The frontal QRS-T angle on a 12-lead electrocardiogram (ECG) has recently become accepted as a variable of ventricular repolarization. We compared the effects of myocardial perfusion defect (MPD) on the frontal QRS-T angle between anterior and inferior myocardial infarction (MI) using single-photon emission computed tomography. Methods The frontal QRS-T angle was defined as the absolute value of the difference between the frontal plane QRS axis and T-wave axis. A QRS-T angle more than 90° was considered abnormal. Patients Forty-two patients with anterior MI and 42 age- and sex-matched patients with inferior MI were enrolled. For controls, 42 age- and sex-matched patients with no MPD were selected. Results The mean frontal QRS-T angles in anterior MI, inferior MI and control subjects were 94.7±46.2°, 26.7±22.1° and 27.0±23.2°, respectively. Compared with controls, the frontal QRS-T angle was larger in anterior MI subjects (p

It has been shown in several studies that coronary artery calcium (CAC) burden or CAC progression is associated with heart failure. We tested the hypothesis that the extent of CAC is associated with left ventricular (LV) diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no evidence of myocardial ischemia.157 patients undergoing coronary computed tomography (CT), gated SPECT, and transthoracic echocardiography (TTE) were enrolled in this study. The CAC score was calculated according to the Agatston method. The peak filling rate (PFR) and the one-third mean filling rate (1/3MFR) were obtained as LV diastolic parameters.There were 139 patients with CAC and 18 patients without. The CAC score ranged from 0 to 4,976. There were no significant differences in the LV end-diastolic volume (LVEDV) (61 ± 21 mL versus 62 ± 22 mL, P = 0.79) and LV ejection fraction (LVEF) (66 ± 9% versus 68 ± 9%, P = 0.43). Patients with CAC had lower PFR than those without (2.2 ± 0.5 EDV/s versus 2.6 ± 0.7 EDV/s, P = 0.03). Multivariate linear regression analysis showed that ln (CAC score + 1) was significantly associated with PFR (β = -0.20, P = 0.01) and 1/3MFR (β = -0.18, P = 0.049).Our data suggest that the extent of CAC is inversely associated with LV diastolic parameters derived from gated SPECT independent of myocardial ischemia.

Background Inflammation is associated with endothelial dysfunction and plays an important role in the pathogenesis and development of cardiovascular diseases. It has been shown that colchicine, an anti-inflammatory drug, improves the cardiovascular outcome in patients with cardiovascular disease. The purpose of this study was to evaluate the short-term effect of low-dose colchicine on endothelial function in patients with coronary artery disease (CAD). Methods This was a double-blind, randomized, placebo-controlled, crossover-within-subject clinical trial. A total of 28 patients with CAD received low-dose colchicine (0.5 mg/day) or a placebo for 7 days with a washout period of at least 14 days. Flow-mediated vasodilation (FMD) and serum concentrations of high-sensitivity C-reactive protein (hs-CRP) were measured after the 7-day treatment with colchicine or the placebo. Results The serum concentration of hs-CRP was significantly decreased after administration of colchicine compared with that after administration of the placebo [median (interquartile range): 0.04 (0.02–0.08) mg/dL vs. 0.07 (0.04–0.11) mg/dL, P = 0.003], while there was no significant difference in FMD between the treatments [median (interquartile range): 3.1% (1.5–5.3%) vs. 3.3% (1.9–5.2%), P = 0.384]. Colchicine, however, significantly improved FMD in coronary artery disease patients with white blood cell (WBC) counts of ≥7500 WBC/mm3 [median (interquartile range): 3.3% (2.1–6.6%) vs. 2.0% (1.4–3.8%), P = 0.043]. Conclusions Administration of low-dose colchicine did not improve endothelial function in patients with CAD, but exploratory analysis suggested that endothelial function is significantly improved in patients with leukocyte activation.

The frontal QRS-T angle on the electrocardiogram has been described as a variable of ventricular repolarization. We evaluated how deep inspiration affected QRS axis, T-wave axis and frontal QRS-T angle. We also assessed the effects on left ventricular volume on the association using myocardial perfusion SPECT. Fifty patients undergoing ECGs both in resting state and in deep inspiration and subsequent SPECT were enrolled. Frontal QRS-T angle was defined as the absolute value of the difference between the frontal QRS axis and T-wave axis. Change in frontal QRS-T angle was calculated using (QRS-T angle in deep inspiration−QRS-T angle in resting state). In resting state, QRS axis and T-wave axis were 20.9° ± 30.0° and 40.9° ± 36.1°, respectively. Frontal QRS-T angle was 35.9° ± 36.1°. Deep inspiration caused rightward shifts of QRS axis (42.3° ± 29.5°, p

Background: Left ventricular (LV) diastolic dysfunction represents an earlier step of the ischaemic cascade. We tested the hypothesis that the index of LV diastolic function from electrocardiogram (ECG)-gated single photon emission computed tomography (SPECT) is useful in detecting myocardial ischaemia in patients with non-obstructive coronary artery disease (CAD).Methods: One-hundred-ten patients with non-obstructive CAD and summed redistribution score of zero were enrolled. Summed difference score (SDS) of ≥2 was considered as the presence of myocardial ischaemia. Peak filling rate (PFR) defined as the maximum dV/dt divided by LV end-diastolic volume was obtained as the index of LV diastolic function.Results: Of 110 patients with non-obstructive CAD, 51 patients had myocardial ischaemia. SDSs in patients with myocardial ischaemia and those without were 3.5 ± 1.8 and 0.4 ± 0.5, respectively (p < 0.001). PFRs after stress (r = -0.22, p = 0.02) and at redistribution (r = -0.24, p = 0.01) were inversely correlated with SDS. Multivariate logistic regression analysis showed that PFR at redistribution was an independent predictor of the presence of myocardial ischaemia in patients with non-obstructive CAD (odds ratio: 0.15, 95% confidence interval: 0.04-0.51, p = 0.002).Conclusion: Our data suggest that PFR, the index of LV diastolic function from ECG-gated SPECT, helps to find myocardial ischaemia in patients with non-obstructive CAD.

The frontal QRS-T angle is one of the markers of ventricular repolarization. We sought to assess the effects of myocardial perfusion defect on QRS-T angle in patients with prior anterior myocardial infarction (MI). Seventy-one patients with prior anterior MI and 71 age- and sex-matched control subjects having no myocardial perfusion defect were selected. Frontal QRS-T angle was defined as the absolute value of the difference between the frontal plane QRS axis and T-wave axis. The extent of myocardial perfusion defect was determined using myocardial perfusion single-photon emission computed tomography (SPECT). The extent of myocardial perfusion defect of patients with prior anterior MI was 21.8 ± 13.7%. Frontal QRS-T angle was significantly larger in patients with prior anterior MI than control subjects (82° ± 49° vs 30° ± 26°, p

The frontal QRS-T angle is one of markers of ventricular repolarization. We investigated whether or not the frontal QRS-T angle could predict left ventricular (LV) volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease (CKD). Two hundred and twelve patients with advanced CKD defined as estimated glomerular filtration rate of 90°, and was considered abnormal. Enlarged LV end-diastolic volume (LVEDV) was defined as LVEDV index of > 76 ml m−2 in men and > 57 ml m−2 in women. Reduced LV ejection fraction (LVEF) was defined as LVEF of

The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) on changes in cardiac sympathetic nervous (CSN) function remains unclear. Using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, we investigated the impact of PPM after TAVR on CSN activity.We enrolled 44 of 117 patients with severe aortic stenosis who underwent TAVR for analysis in the present study. We conducted 123I-MIBG scintigraphy at baseline and at about 9 months after TAVR. Differences between baseline and post-TAVR 123I-MIBG parameters were compared between cases with and without PPM.There were 17 and 27 patients with and without PPM, respectively. Those without PPM exhibited significantly decreased left ventricular mass index (122 ± 36 g/m

Numerous studies have shown thatWe enrolled 91 patients with severe AS who underwentThere were 21 male and 70 female patients with a mean age of 84±5 years. Eighty-five (85) patients (93%) had hypertension and 13 patients (14%) had diabetes. Two (2) patients (2%) had previous myocardial infarction and eight (9%) had a previous coronary intervention. All patients had severe AS: aortic valve area was 0.63±0.18 cmOur findings suggest that coronary artery disease is an independent predictor of delayed H/M ratio, and aortic valve area is an independent predictor of WR in patients with severe AS.

Background Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. Purpose We tested the hypothesis that aging had impacts on coronary flow velocities and CFR in patients with no evidence of myocardial perfusion abnormality on single photon emission computed tomography (SPECT). Methods and results Seventy-six patients with no evidence of myocardial perfusion abnormality on SPECT undergoing transthoracic Doppler echocardiography were enrolled in this study. Patients were divided into three age groups: 17 patients aged Conclusions Our data suggested that aging impaired CFR in patients with no evidence of myocardial perfusion abnormality primarily due to the decrease in hyperemic coronary flow velocity. Comparison of coronary flow reserve amon Funding Acknowledgement Type of funding source: None

Background: Several studies have shown that aortic valve calcium (AVC) is associated with cardiovascular events. Furthermore, the extent of AVC is associated with adverse prognosis even in patients without significant aortic stenosis. We investigated the relationship between AVC and left ventricular (LV) diastolic parameters determined by gated single-photon emission computed tomography (SPECT) in patients with no evidence of ischaemic heart disease.Methods: This study included 157 patients with no evidence of ischaemic heart disease who underwent both coronary computed tomography and gated SPECT. The AVC scores were calculated by the Agatston method, and peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were determined as LV diastolic parameters.Results: There were 93 (59%) and 64 (41%) patients with and without AVC, respectively, and the AVC scores ranged from 0 to 1251. There was no significant difference in LV end-diastolic volume (EDV) (60 ± 18 vs 62 ± 25 mL, p = 0.52) or LV ejection fraction (67% ± 10% vs 66% ± 8%, p = 0.60) between the two groups. Patients with AVC had lower PFR (2.2 ± 0.5 vs 2.4 ± 0.5 EDV/s, p = 0.002) and 1/3 MFR (1.3 ± 0.3 vs 1.5 ± 0.4 EDV/s, p = 0.003) than those without AVC. Multivariate linear regression analysis showed that ln(AVC score + 1) was significantly associated with PFR and 1/3 MFR.Conclusion: In patients without evidence of ischaemic heart disease, the extent of AVC was inversely correlated with gated SPECT-derived parameters of LV diastolic function.

The frontal QRS-T angle, defined as the angle between QRS and T-wave axes, has recently become an area of research interest. We tested the hypothesis that the frontal QRS-T angle is associated with left ventricular (LV) diastolic function in the absence of significant perfusion abnormality using ECG-gated SPECT. One hundred twenty eight patients with no significant perfusion abnormality and preserved LV ejection fraction were enrolled. The peak filling rate (PFR) and the one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters on ECG-gated SPECT. There were 115 male and 13 female patients with a mean age of 70 ± 9 years. The PFR and 1/3 MFR were 2.1 ± 0.4/s and 1.2 ± 0.3/s, respectively. The frontal QRS-T angle was 33° ± 31°, ranging from 0° to 151°. There were significant associations of frontal QRS-T angle with PFR (r = − 0.29, p = 0.001) and 1/3 MFR (r = − 0.30, p

Background The frontal QRS-T angle, defined as the absolute value of the difference between QRS axis and T-wave axis on 12‑lead electrocardiogram (ECG), is the difference in orientation between ventricular depolarization and repolarization. We tested the hypothesis that QRS-T angle is affected by obesity. Methods A total of 177 patients undergoing both ECG and echocardiography within one month were recruited from outpatient clinic. Using the World Health Organization (WHO) classification of body mass index (BMI), the patients were classified into the four groups: underweight ( 2 , n = 25), normal weight (18.5–24.9 kg/m 2 , n = 79), overweight (25–29.9 kg/m 2 , n = 38) and obese (≥30 kg/m 2 , n = 35). Results Obese patients were significantly younger than those in other groups. As for echocardiographic variables, left ventricular internal dimension and left ventricular mass (LVM) increased with increased WHO classification of BMI. QRS axis and T-wave axis decreased with increased WHO classification of BMI, whereas QRS-T angle increased. Multivariate linear regression analysis showed that BMI (β = 0.23, p = 0.01) and LVM (β = 0.19, p = 0.046) were independent determinants of QRS-T angle. Conclusions Our results suggest that BMI is an independent determinant of QRS-T angle.

Myocardial perfusion single-photon emission computed tomography (SPECT) with thallium (Tl)-201 is an established modality for evaluating myocardial ischemia. We assessed the effects of atrial fibrillation (AF) on the myocardial washout rate (WR) of Tl-201 on myocardial perfusion SPECT.A total of 231 patients with no evidence of myocardial ischemia were enrolled retrospectively in this study. Patients were divided into two groups on the basis of the ECG at the time of myocardial perfusion SPECT. The mean myocardial WR of Tl-201 was calculated from the stress and the redistribution Bull's eye maps.There were 34 patients with AF and 197 patients with sinus rhythm. There were no significant differences in clinical variables, except for older age and higher heart rate in patients with AF. Myocardial WR of Tl-201 was significantly lower in patients with AF than those with sinus rhythm (46±12 vs. 51±8%, P=0.03). Multivariate analysis including these factors showed that female sex (β=0.18, P=0.02), AF (β=-0.14 P=0.03), hemoglobin (β=-0.18, P0.01), and serum creatinine (β=0.24, P0.01) were determinants of myocardial WR of Tl-201.Our data suggest that AF is associated with reduced myocardial WR of Tl-201 on myocardial perfuison SPECT.

Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy. ispartof: EUROPEAN HEART JOURNAL vol:39 issue:22 pages:2032-2046 ispartof: location:England status: published

Atrial fibrillation (AF) is the most common arrhythmia, characterized by a lack of atrial contraction and an irregular ventricular rhythm. We assessed the effect of fibrillatory wave amplitude on coronary blood flow in patients with AF using the thrombolysis in myocardial infarction (TIMI) frame count. Sixty-one patients with AF persisting for longer than 30 days were included. For controls, 61 age- and sex-matched patients with sinus rhythm were selected. Coarse AF was defined as any fibrillatory wave ≥ 1 mm and fine AF as any fibrillatory wave

Purpose The purpose of this study was to evaluate acute effects of coffee with a high content of chlorogenic acids and different hydroxyhydroquinone contents on postprandial endothelial dysfunction. Methods This was a single-blind, randomized, placebo-controlled, crossover-within-subject clinical trial. A total of 37 patients with borderline or stage 1 hypertension were randomized to two study groups. The participants consumed a test meal with a single intake of the test coffee. Subjects in the Study 1 group were randomized to single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone or coffee with a high content of chlorogenic acids and a high content of hydroxyhydroquinone with crossover. Subjects in the Study 2 group were randomized to single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone or placebo coffee with crossover. Endothelial function assessed by flow-mediated vasodilation and plasma concentration of 8-isoprostanes were measured at baseline and at 1 and 2 h after coffee intake. Results Compared with baseline values, single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone, but not coffee with a high content of chlorogenic acids and high content of hydroxyhydroquinone or placebo coffee, significantly improved postprandial flow-mediated vasodilation and decreased circulating 8-isoprostane levels. Conclusions These findings suggest that a single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone is effective for improving postprandial endothelial dysfunction. Clinical Trial Registration URL for Clinical Trial: https://upload.umin.ac.jp; Registration Number for Clinical Trial: UMIN000013283.

Even intermediate QRS prolongation without bundle branch block is associated with worse clinical outcome after myocardial infarction (MI). We assessed the association of QRS duration with left ventricular (LV) volume and ejection fraction after anterior MI by using quantitative gated single photon emission computed tomography (SPECT).Eighty-two patients with prior anterior MI were enrolled. Intermediate QRS prolongation was defined as QRS duration ≥100 ms without bundle branch block. Quantitative analysis of thallium SPECT was performed on the redistribution image. LV end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were obtained.There were 25 patients with intermediate QRS prolongation and 57 patients with normal QRS duation. Compared to patients with normal QRS duration, patients with intermediate QRS prolongation had larger LVEDV (137.4 ± 75.1 ml vs 87.9 ± 43.6 ml, p = .004), larger LVESV (89.9 ± 69.6 ml vs 49.2 ± 35.5 ml, p = .009) and lower LVEF (39.3 ± 14.6% vs 47.6 ± 12.0%, p = .02). QRS duration was positively associated with LVEDV (r = 0.49, p .001) and LVESV (r = 0.47, p .001), and was inversely associated with LVEF (r= -0.32, p .001). Multivariate analysis showed that male sex (β = 0.22, p = .04), QRS duration (β = 0.34, p = .002) and number of abnormal Q waves (β = 0.37, p .001) were associated with LVEDV. QRS duration (β= -0.32, p = .003) and number of abnormal Q waves (β = -0.40, p .001) were associated with LVEF.Our results suggest that QRS duration as well as number of abnormal Q waves is independently associated with LV volume and ejection fraction after anterior MI.

Cardiopulmonary exercise testing (CPET) is useful for the evaluation of patients with suspected or confirmed pulmonary hypertension (PH). End-tidal carbon dioxide pressure (PETCO2) during exercise is reduced with elevated pulmonary artery pressure. However, the utility of ventilatory parameters such as CPET for detecting PH remains unclear. We conducted a review in 155 patients who underwent right heart catheterization and CPET. Fifty-nine patients had PH [mean pulmonary arterial pressure (mPAP) ≥25 mmHg]. There was an inverse correlation between PETCO2 at the anaerobic threshold (AT) and mPAP (r = -0.66; P

The augmentation index (AI) obtained from applanation tonometry of the radial artery is technically the easiest and quickest of available methods for assessing arterial stiffness. We tested the hypothesis that the radial AI is associated with the extent of coronary artery calcium (CAC) as assessed by coronary computed tomography (CCT).This study included 161 patients with known or suspected coronary artery disease undergoing central hemodynamic measurements and CCT. Radial AI was recorded and was corrected in accordance with heart rate (radial AI@75). Thirty-seven patients had no CAC (CAC score = 0), 85 had low-grade CAC (CAC score = 1-399), and 39 had high-grade CAC (CAC score ≥400). Coronary risk factors, except for age and serum creatinine, were similar among the three groups. There were significant differences in brachial systolic blood pressure (SBP) (p = 0.011) and radial AI@75 (%) (p = 0.006). Multivariate analysis showed that age (β = 0.27, p = 0.001), serum creatinine (β = 0.18, p = 0.03), and radial AI@75 (β = 0.24, p = 0.005) were significantly associated with ln (CAC score + 1), whereas brachial SBP was not. Additionally, serum creatinine (odds ratio: 11.91, 95% confidence interval: 1.46-112.0, p = 0.02) and radial AI@75 (per 10%) (odds ratio: 1.76, 95% confidence interval: 1.22-2.64, p = 0.002) were independent factors associated with high-grade CAC.Our results suggest that the radial AI is better for estimating CAC than brachial SBP in patients with known or suspected coronary artery disease.

Myocardial perfusion single-photon emission computed tomography (SPECT) is often performed even in patients with suspected coronary artery disease complicated by anemia. We assessed the effects of hemoglobin level on myocardial washout rate of Thallium-201 (Tl-201) in patients with normal myocardial perfusion assessed by SPECT. The study population consisted of 231 patients with summed stress score of zero on SPECT. The mean myocardial washout rate of Tl-201 in the left ventricle was calculated from the stress and the redistribution Bull’s eye map. Hematological test was performed within 2 weeks before gated SPECT. There were 135 male and 96 female patients with a mean age of 72.6 ± 9.0 years. The mean hemoglobin was 12.9 ± 1.9 mg/dl; the median was 13.2 mg/dl and the range was 8.0–16.5 mg/dl. There was a significant inverse correlation between hemoglobin level and myocardial washout rate of Tl-201 (r = −0.45, p

Aortic knob width on chest radiography represents the extent of aortic dialation and tortuosity of the aortic arch. We tested the hypothesis that aortic knob width reflected left ventricular (LV) diastolic function assessed by gated myocardial perfusion single photon emission computed tomography (SPECT) in patients with normal myocardial perfusion.One hundred and thirty patients with preserved LV ejection fraction and normal myocardial perfusion were enrolled in this study. Aortic knob width was measured along the horizontal line from the point of the lateral edge of the trachea to the left lateral wall of the aortic knob. The peak filling rate (PFR) and the one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters.There were 114 male and 16 female patients. Age ranged from 43 to 88 years (69.9 ± 8.9 years). Aortic knob width ranged from 24.2 to 53.4 mm (37.6 ± 5.7 mm). There was a significant correlation between age and aortic knob width (r = 0.34, p 0.001). Aortic knob width was inversely correlated with both PFR (r = -0.53, p 0.001) and 1/3 MFR (r = -0.42, p 0.001). Multivariate linear regression analysis revealed that serum creatinine (β = -0.16, p = 0.045) and aortic knob width (β = -0.45, p 0.001) were significant predictors of PFR, and that age (β = -0.20, p = 0.02) and aortic knob width (β = -0.33, p 0.001) were significant predictors of 1/3 MFR.Our data suggested that aortic knob width on chest radiography was a simple marker of LV diastolic function in patients with normal myocardial perfusion.

A 79-year-old man with a history of partial resection of the lung and the bladder due to cancer, hypertension, dyslipidemia, and heart failure, underwent transcatheter aortic valve replacement with a SAPIEN 3 (S3) valve (Edwards Lifesciences, Irvine, CA, USA). Preprocedural examination showed a bicuspid aortic valve and severe calcification of the leaflets. Computed tomography showed great tortuosity of the descending aorta. A 29-mm S3 valve prosthesis was advanced into the aorta, but a high degree of resistance was encountered in the middle of the descending aorta. The prosthesis was advanced to the level of aortic valve and an attempt was made to deploy the valve. However, the valve balloon did not expand. A balloon rupture was suspected. The balloon catheter was pulled back into the eSheath (Edwards Lifesciences), and the catheter and eSheath were removed together. Rupture of the balloon was confirmed. A new eSheath and prosthesis were prepared, with delivery supported with a Lunderquist guidewire (Cook Medical, Bloomington, IN, USA). The valve alignment procedure was performed in a straighter portion of the descending aorta. The new 29-mm S3 valve was then successfully implanted.

In part 2 of this two-part manuscript on takotsubo syndrome (TTS), we discuss typical biomarkers (particularly excess catecholamines and what kinds of electrocardiographic information operators should look for) and numerous complications the syndrome can cause. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. New structured algorithms are also proposed to aid clinicians in the decision-making process as well as future directions for research given the current lack of evidence-based medical approaches.

BACKGROUND Some electrocardiographic indexes such as Cornell index, Cornell product index, or Sokolow-Lyon index remain to be used in the clinical setting. We assessed the effects of body mass index (BMI) on the correlations between these ECG indexes and left ventricular mass (LVM). METHODS One hundred ninety-six outpatients who underwent both ECG and echocardiography on the same day were included in this study. In accordance with the World Health Organization (WHO) classification of BMI, the patients were classified into the four groups: underweight (

Selvester QRS scoring system has an advantage of being inexpensive and easily accessible for estimating myocardial infarct (MI) size. We assessed the correlation and agreement between QRS score and total perfusion deficit (TPD) calculated by quantitative gated single-photon emission computed tomography (QGS) in patients with prior anterior MI undergoing coronary intervention. Sixty-six patients with prior anterior MI and 66 age- and sex-matched control subjects were enrolled. QRS score was obtained using a 50-criteria and 31-point system. QRS score was significantly higher in patients with prior anterior MI than control subjects (12.8 ± 8.9 vs 1.1 ± 2.7 %, p

Impaired left ventricular (LV) diastolic function is a sensitive and early sign of myocardial ischemia. We evaluated the effects of LV size on the accuracy of diastolic parameters derived from SPECT. The study population consisted of 151 patients with known or suspected coronary artery disease who underwent both SPECT and transthoracic echocardiography. Peak filling rate (PFR), one-third mean filling rate (1/3 MFR) and the ratio of time to PFR to the RR interval (TPFR/RR) were calculated by quantitative gated SPECT. Peak early mitral annular velocity (e′) was used as the reference standard of LV diastolic function. There were 43 patients with end-systolic volume (ESV) of ≤10 ml, 43 patients with ESV of 11–20 ml and 65 patients with ESV of >20 ml. There were significant differences in PFR (p

Left ventricular (LV) remodeling often results from conditions with an elevated LV hemodynamic load or after myocardial infarction. The present study was undertaken to investigate the associations of LV shape with LV volumes and functions in patients without significant perfusion abnormality. One hundred and sixty-seven patients without significant perfusion abnormality on ECG-gated SPECT were enrolled. LV ejection fraction (LVEF) was obtained for assessing LV systolic function. Peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained for assessing LV diastolic function. LV shape index (LVSI) was defined as the ratio of the maximum three-dimensional short- and long-axis LV dimension, and varies from 0 (line) to 1 (sphere). There were 125 male and 42 female patients with a mean age of 70 ± 8 years. End-systolic LVSI was 0.49 ± 0.07 (0.34-0.65). End-systolic LVSI was associated with LV end-diastolic volume (r = 0.51, p 0.001) and LV end-systolic volume (LVESV) (r = 0.64, p 0.001), and was inversely associated with LVEF (r = - 0.69, p 0.001), PFR (r = - 0.45, p 0.001) and 1/3 MFR (r = - 0.26, p = 0.008). End-systolic LVSI was increased with increased LVESV, and was not any more with LVESV of 40 ml. Multivariate liner regression analysis showed that age (β = 0.16, p = 0.01), LVESV (β = 0.20, p = 0.03) and LVEF (β = - 0.53, p 0.001) were significantly associated with end-systolic LVSI. Our data suggest that end-systolic LVSI, a measurement of LV shape, has close correlations with LV volumes and functions in patients without significant perfusion abnormality.

Takotsubo syndrome (TTS) is an acute cardiac condition independent of epicardial coronary obstruction that mimics acute coronary syndrome and is characterized by acute heart failure with reversible ventricular motion abnormalities. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Experts in the field provide a thorough and detailed review of this syndrome. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. In part 1 of this two-part manuscript, we discuss how TTS came to be known, several patterns and forms it can take in patients, epidemiology and pathophysiology of the syndrome, and clinical presentation.

The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians. ispartof: EUROPEAN HEART JOURNAL vol:39 issue:22 pages:2047-2062 ispartof: location:England status: published