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Background Some epidemiological studies have demonstrated the association between psoriasis vulgaris and coronary artery disease (CAD). However, there is a lack of specific data regarding the association between psoriasis vulgaris and myocardial infarction (MI), the more severe and critical presentation of CAD, in the Japanese population. Methods and results We retrospectively analyzed 113,065 patients of all ages at our hospital from January 1, 2011 to January 1, 2013. We extracted the data of patients with psoriasis vulgaris, diabetes mellitus, dyslipidemia, or MI (acute, sub-acute, or old), including sex and age from the electronic medical record database. The prevalence of MI in patients with hypertension, dyslipidemia, diabetes mellitus, and psoriasis vulgaris were 4.8% (794/16,476), 5.0% (459/9236), 4.6% (531/11,555), and 2.7% (32/1197), respectively. Multivariate analysis showed that psoriasis vulgaris was significantly associated with MI [adjusted odds ratio (OR): 1.87; 95% confidence interval (CI): 1.26–2.68; p = 0.0022]. In a subgroup analysis of 24,069 patients who had one or more comorbidities including diabetes mellitus, dyslipidemia, and hypertension, psoriasis vulgaris was still independently associated with MI after adjusting for sex and age (adjusted OR, 1.49; 95% CI: 1.02–2.18; p = 0.0358) in adults. Conclusion Psoriasis vulgaris was significantly associated with MI in a Japanese hospital-based population.

Background: Using the normal values for the East Asian population, we evaluated age- and body size-adjusted left ventricular end-diastolic dimension (LVEDD) and its prognostic impact in a hospital-based population in Japan. Methods and Results: We retrospectively analyzed data obtained from 4, 444 consecutive patients who had undergone both transthoracic echocardiography and electrocardiography at Kitano Hospital in 2013. Those who presented with a history of previous episodes of myocardial infarction and severe or moderate valvular disease or with low ejection fraction (

This study investigated the relationship between atrial fibrillation (AF) and left ventricular (LV) geometric patterns in a hospital-based population in Japan. We retrospectively analyzed 4444 patients who had undergone simultaneous scheduled transthoracic echocardiography (TTE) and electrocardiography during 2013. A total of 430 patients who had findings of previous myocardial infarctions (n = 419) and without the data on body surface area (n = 11) were excluded from the study. We calculated the LV mass index (LVMI) and relative wall (RWT) and categorized 4014 patients into four groups as follows: normal geometry (n = 3046); concentric remodeling (normal LVMI and high RWT, n = 437); concentric hypertrophy (high LVMI and high RWT, n = 149); and eccentric remodeling (high LVMI and normal RWT, n = 382). The mean left atrial volume indices (LAVI) were 22.5, 23.8, 33.3, and 37.0 mm/m2 in patients with normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. The mean LV ejection fractions (LVEF) were 62.7, 62.6, 60.8, and 53.8%, respectively, whereas the prevalence of AF was 10.4%, 10.5%, 14.8%, and 16.8% in patients with normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy, respectively. In conclusion, the prevalence of AF was increasing according to LV geometric remodeling patterns in association with LA size and LVEF.

Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by interatrial right-to-left shunting that is exacerbated in the upright position. We herein report a 78-year-old woman with POS that remained undiagnosed for 2 years, despite repetitive transthoracic echocardiography (TTE). POS was ultimately diagnosed using contrast transesophageal echocardiography (TEE), which revealed a marked increase in right-to-left shunting in the sitting position, associated with simultaneous desaturation. Therefore, we propose that POS should be considered according to the clinical symptoms, regardless of the repetitive TTE results, and contrast TEE should be performed in both the supine and sitting positions to exclude a diagnosis of POS.

The Fukushima Daiichi Nuclear Power Plant disaster on March 11, 2011, caused radiation hazards throughout Fukushima Prefecture. Cesium was absorbed by soil and plants and transferred to livestock. Removing radioactive cesium from the bodies of farm animals and humans is essential. It has recently been reported that H2 scavenges reactive oxygen species and suppresses oxidative stress-related diseases. The hypothesis is that ?active hydrogen? (hydrogen water) scavenges active oxygen species. We hypothesized that high-energy electrolytic hydrogen water will effectively decontaminate cesium-exposed chickens. A test group of chickens drank high-energy electrolytic hydrogen water, while the control group drank regular water. Cesium contents in the test group were significantly lower than in the controlled one, possibly because more cesium excretion occurred in the test group than the control group. Lower 137Cs concentrations were found in test-group tissues than in control-group tissues, showing that high-energy electrolytic hydrogen water increased the rate of elimination of 137Cs incorporated into chicken tissue.

Recently, it has been reported that spontaneous left ventricular wall thickening occurs among patients with takotsubo syndrome, which affects the long-term prognosis of such patients due to cerebral and cardiac complications. We herein report two cases of transient left ventricular wall thickening with takotsubo syndrome in which sequential cardiac magnetic resonance imaging revealed the existence of edematous changes in the thickened wall. Notably, a left ventricular aneurysm was detected during the course of ventricular wall thickening and may have played a role in the development of serious complications accompanied by takotsubo syndrome. This is the first case report of left ventricular aneurysm occurring with ventricular wall thickening due to takotsubo syndrome.

Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by interatrial right-to-left shunting that is exacerbated in the upright position. We herein report a 78-year-old woman with POS that remained undiagnosed for 2 years, despite repetitive transthoracic echocardiography (TTE). POS was ultimately diagnosed using contrast transesophageal echocardiography (TEE), which revealed a marked increase in right-to-left shunting in the sitting position, associated with simultaneous desaturation. Therefore, we propose that POS should be considered according to the clinical symptoms, regardless of the repetitive TTE results, and contrast TEE should be performed in both the supine and sitting positions to exclude a diagnosis of POS.

Whole-body periodic acceleration (WBPA) has been developed as a passive exercise device capable of improving endothelial function by applying pulsatile shear stress to vascular endothelium. We hypothesized that treatment with WBPA improves exercise capacity, myocardial ischemia, and left ventricular (LV) function because of increased coronary and peripheral vasodilatory reserves in patients with angina. Twenty-six patients with angina who were not indicated for percutaneous coronary intervention and/or coronary artery bypass grafting were randomly assigned to remain sedentary (sedentary group) or undergo 20 sessions of WBPA with the motion platform for 4 weeks (WBPA group) in addition to conventional medical treatment. WBPA was applied at 2 to 3 Hz and approximately ±2.2 m/s(2) for 45 minutes. We repeated the symptom-limited treadmill exercise test and adenosine sestamibi myocardial scintigraphy. In the WBPA group, the exercise time until 0.1-mV ST-segment depression increased by 53% (p

The S100A8/A9 complex is expressed in a subset of activated neutrophils and macrophages in acute inflammatory lesions associated with various diseases.To investigate (a) whether serum S100A8/A9 levels are increased in patients with unstable angina (UA); and (b) whether S100A8/A9 expression is upregulated in coronary atherosclerotic plaques of patients with UA.Serum S100A8/A9 levels in 39 patients with stable angina (SA) and 53 patients with UA were measured. In addition, the presence of the S100A8/A9 complex in directional coronary atherectomy specimens was studied immunohistochemically. Cell types which stain positive for S100A8/A9 were identified by immunodouble staining with neutrophils and macrophages.Mean (SD) serum S100A8/A9 levels were significantly higher in patients with UA than in those with SA (3.25 (3.08) microg/ml vs 0.77 (0.31) microg/ml, p0.05). In patients with UA, immunodouble staining clearly showed that the S100A8/A9 complex was expressed in infiltrated neutrophils and occasional macrophages. The S100A8/A9-positive area was significantly higher in UA than in SA (mean (SD) 18.3 (14.2)% vs 1.3 (2.4)%, respectively, p0.001).The S100A8/A9 complex may be involved in the inflammatory process of coronary atherosclerotic plaques in patients with UA.

Purpose The effects of formaldehyde (FA) exposure on allergic disorders are not clearly understood. This cross-sectional study examined the relationship between FA exposure and the prevalence of allergic disorders in Japan. Metohds Subjects were 998 pregnant women. Participants were considered to have asthma, atopic eczema, or allergic rhinitis (including cedar pollinosis) if they had received any medical treatment for any of these allergic disorders during the previous 12 months. Passive air sampling tubes were worn for 24 hours and analyzed for FA. Results When FA levels were categorized into four groups, there was a tendency for a positive exposure-response relationship between FA levels and the prevalence of atopic eczema, although the adjusted odds ratio for highest vs. lowest FA categories did not reach statistical significance. When FA levels were categorized into two groups to assess the effects of exposure to high levels of FA on allergic disorders, FA levels of 47 ppb or more were independently associated with an increased prevalence of atopic eczema (adjusted odds ratio = 2.25; 95% confidence interval, 1.01–5.01). The positive association was more pronounced in women with a negative familial allergic history than in those with a positive familial allergic history. No clear association was found between FA levels and the prevalence of asthma or allergic rhinitis. Conclusions FA exposure may be associated with an increased prevalence of atopic eczema in Japanese pregnant women.

Introduction. The aim of this study was to examine the incidence and risk factors of catheterization-related CI in the contemporary era, using diffusion-weighted magnetic resonance imaging.Methods. We retrospectively analyzed consecutive 84 patients who underwent MRI (magnetic resonance imaging) after2.81±2.4days(mean±SD)of catheterization via aortic arch. We categorized the patients by the presence or absence of acute CI determined by diffusion-weighted MRI and analyzed the incidence and predictors.Results. Of 84 patients that underwent MRI after catheterization, acute CI was determined in 27 (32.1%) patients. In univariate analysis, dyslipidemia, age, coronary artery disease, antiplatelet agents, number of catheters used, urgent settings, and interventional procedures were significantly different. Multivariate analysis revealed dyslipidemia (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.41–16.03;p=0.01), higher age (OR, 1.09; 95% CI, 1.007–1.19;p=0.03), and the number of catheters used (OR, 2.21; 95% CI, 1.21–4.36;p=0.01) as independent predictors of the incidence of catheterization-related acute CI.Conclusions. Dyslipidemia, higher age, and number of catheters used were independent predictors for acute CI after catheterization. These findings imply that managing dyslipidemia and comprehensive planning to minimize the numbers of catheters are important.

It remains uncertain whether intake of fish or n-3 polyunsaturated fatty acids is preventive against allergic disorders. This cross-sectional study investigated the association of intake of selected high-fat foods and specific types of fatty acids with the prevalence of allergic rhinitis in Japan where intake of fish is high.Study subjects were 1002 Japanese pregnant females. Allergic rhinitis (including cedar pollinosis) was defined as present if subjects had received drug treatment at some point during the previous 12 months. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for age, gestation, parity, cigarette smoking, passive smoking at home and at work, indoor domestic pets, family history of asthma, atopic eczema, and allergic rhinitis, family income, education, mite antigen level in house dust, changes in diet in the previous month, season when data were collected, and body mass index.There was a tendency for an inverse dose-response association between fish intake and allergic rhinitis although the adjusted odds ratio for comparison of the highest with the lowest quartile was not statistically significant (p for trend = 0.09). Intake of eicosapentaenoic and docosahexaenoic acids was independently associated with a decreased prevalence of allergic rhinitis: the multivariate odds ratio for the highest quartile was 0.56 (95% confidence interval: 0.32-0.96, p for trend = 0.03). Intake of n-6 polyunsaturated fatty acids in the third quartile but not the second and fourth quartiles showed a tendency for an inverse association with the prevalence of allergic rhinitis. No measurable relationship was found between consumption of meat, eggs, dairy products, total fat, saturated, monounsaturated, and n-3 polyunsaturated fatty acids, and cholesterol or the ratio of n-3 to n-6 polyunsaturated fatty acids and allergic rhinitis.Our findings suggest that the intake of eicosapentaenoic and docosahexaenoic acids may be associated with a reduced prevalence of allergic rhinitis.

Purpose It may be worthwhile to assess the possible protective effect of the traditional Japanese diet on allergic disorders. This cross-sectional study investigated the relationship between dietary intake of seaweed, vegetables, fruit, antioxidants, fiber, and minerals and the prevalence of allergic rhinitis. Methods Study subjects were 1002 Japanese pregnant women. Allergic rhinitis (including cedar pollinosis) was defined as present if subjects had received drug treatment at some point during the previous 12 months. Information on dietary factors was collected by using a self-administered diet history questionnaire. Results Seaweed intake was associated independently with a decreased prevalence of allergic rhinitis. Significant inverse dose-response relationships were found between calcium and phosphorus intake and allergic rhinitis prevalence. There also was a tendency for an inverse association between magnesium consumption and allergic rhinitis. Additional adjustment for calcium or magnesium intake apparently did not influence the inverse association with seaweed consumption. Consumption of vegetables, fruit, vitamins C and E, fiber, and zinc showed no association with allergic rhinitis, whereas a significant positive relationship was observed between beta-carotene intake and allergic rhinitis. Conclusions High dietary intake of seaweed, calcium, magnesium, and phosphorus may be associated with a decreased prevalence of allergic rhinitis.

Background— Left ventricular (LV) remodeling after myocardial infarction is associated with hypertrophy of surviving myocytes and represents a major process that leads to heart failure. One of the intrinsic histone acetyltransferases, p300, serves as a coactivator of hypertrophy-responsive transcriptional factors such as a cardiac zinc finger protein GATA-4 and is involved in its hypertrophic stimulus-induced acetylation and DNA binding. However, the role of p300-histone acetyltransferase activity in LV remodeling after myocardial infarction in vivo is unknown. Methods and Results— To solve this problem, we have generated transgenic mice overexpressing intact p300 or mutant p300 in the heart. As the result of its 2–amino acid substitution in the p300-histone acetyltransferase domain, this mutant lost its histone acetyltransferase activity and was unable to activate GATA-4–dependent transcription. The two kinds of transgenic mice and the wild-type mice were subjected to myocardial infarction or sham operation at the age of 12 weeks. Intact p300 transgenic mice showed significantly more progressive LV dilation and diminished systolic function after myocardial infarction than wild-type mice, whereas mutant p300 transgenic mice did not show this. Conclusions— These findings demonstrate that cardiac overexpression of p300 promotes LV remodeling after myocardial infarction in adult mice in vivo and that histone acetyltransferase activity of p300 is required for these processes.

Background It has been hypothesized that isoflavones reduce the risk of many chronic diseases, but there are no data on the effects of dietary soy and isoflavone consumption on allergic disorders. Objective This cross-sectional study examined the relationship between dietary soy products and isoflavone intake and the prevalence of allergic rhinitis. Methods Study subjects were 1002 Japanese pregnant women. Allergic rhinitis (including cedar pollinosis) was defined as present if subjects had received drug treatment at some point during the previous 12 months. Adjustment was made for age; gestation; parity; cigarette smoking; passive smoking at home and at work; indoor domestic pets; family history of asthma, atopic eczema, and allergic rhinitis; family income; education; mite allergen level in house dust; changes in diet in the previous month; season when data were collected; and body mass index. Results Compared with dietary intake of total soy product, soy protein, daidzein, and genistein in the first quartile, consumption of these substances in the fourth quartile was independently associated with a reduced prevalence of allergic rhinitis, although no significant dose-response relationships were observed. A clear inverse linear trend for miso intake across quartiles was found, whereas the adjusted odds ratio for comparison of the highest with the lowest quartile was not statistically significant. Consumption of tofu, tofu products, fermented soybeans, boiled soybeans, and miso soup was not related to the prevalence of allergic rhinitis. Conclusion A high intake of soy and isoflavones may be associated with a reduced prevalence of allergic rhinitis.

BACKGROUND Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self-protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA). HYPOTHESIS Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF. METHODS We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24-h ambulatory electrocardiogram monitoring before and after an 8-week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high-frequency (0.15 to 0.40 Hz) power (nHF) and the low-frequency (0.04 to 0.15 Hz)/high-frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively. RESULTS When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 +/- 20 vs. 52 +/- 19 nu, p = 0.87; LF/HF, 1.39 +/- 1.11 vs. 1.32 +/- 1.32, p =0.93; L, nHF, 28 +/- 13 vs. 47 +/- 19 nu, p = 0.019; LF/HF, 3.34 +/- 2.48 vs. 1.56 +/- 1.39, p = 0.029; S, nHF, 38 +/- 17 vs. 53 +/- 16 nu, p = 0.0023; LF/HF, 2.43 +/- 2.21 vs. 1.03 +/- 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 +/- 30 vs. 18 +/- 24%, p = 0.0018; L, 11 +/- 20 vs. 27 +/- 26%, p = 0.025). CONCLUSIONS In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears after the treatment.

Doxorubicin is an anti-tumor agent that represses cardiac-specific gene expression and induces myocardial cell apoptosis. Doxorubicin depletes cardiac p300, a transcriptional coactivator that is required for the maintenance of the differentiated phenotype of cardiac myocytes. However, the role of p300 in protection against doxorubicin-induced apoptosis is unknown. Transgenic mice overexpressing p300 in the heart and wild-type mice were subjected to doxorubicin treatment. Compared with wild-type mice, transgenic mice exhibited higher survival rate as well as more preserved left ventricular function and cardiac expression of alpha-sarcomeric actin. Doxorubicin induced myocardial cell apoptosis in wild-type mice but not in transgenic mice. Expression of p300 increased the cardiac level of bcl-2 and mdm-2, but not that of p53 or other members of the bcl-2 family. These findings demonstrate that overexpression of p300 protects cardiac myocytes from doxorubicin-induced apoptosis and reduces the extent of acute heart failure in adult mice in vivo.

Background: Heart-type cytoplasmic fatty acid-binding protein (H-FABP) has been reported as a sensitive and specific marker for the early diagnosis of acute myocardial infarction. Our hypothesis was that serum or pericardial fluid levels of H-FABP can reflect not only myocardial infarction but also myocardial ischemia. Methods: A total of 34 patients with unstable angina, who had anginal symptoms and/or ST-changes in ECG monitoring within 24 h before operation, were classified into group A ( n =17), and those without these symptoms and changes into group B ( n =17). Blood and pericardial fluid samples were obtained immediately after median sternotomy, and serum and pericardial fluid levels of creatine kinase-MB, cardiac troponin-T, and H-FABP were measured. Results: Serum H-FABP levels were slightly elevated compared with their normal values in both groups. While they showed no difference between groups A and B (group A vs. B: 8.5±1.0 vs. 7.1±0.7 ng/ml, P =0.25), pericardial fluid levels of H-FABP were significantly higher in group A than in group B (16.3±2.0 vs. 9.6±1.0 ng/ml, P =0.0046). H-FABP showed a weak correlation between its serum levels and pericardial fluid levels ( r =0.40). Conclusions: Pericardial fluid levels of H-FABP reflect myocardial ischemia occurring within 24 h of their measurements. H-FABP may be secreted into the interstitial space by increased permeability of the myocardial cell membrane associated with severe myocardial ischemia. Thus, pericardial fluid reflects pathophysiological conditions of cardiomyocytes more sensitively than circulating blood.

Introduction We previously reported that the prevalence of abdominal aortic aneurysms (AAAs) was higher in patients undergoing scheduled transthoracic echocardiography (TTE) than in patients undergoing abdominal ultrasonography (AUS); however, intergroup patient backgrounds differed significantly in that report. Purpose We tested the hypothesis that TTE could detect AAA as effectively as AUS. Design A propensity score-matching analysis of a cross-sectional study was adopted as the design for this study. Methods We enrolled 7,619 and 15,433 patients scheduled to undergo TTE with additional evaluation of abdominal aorta at the end of the routine study and AUS, respectively, from 2009 to 2010 in our hospital, as reported. A propensity score for profiles of patients who underwent TTE or AUS was developed to adjust for potential confounding bias. Consequently, 4,388 patients in each group were matched for analyses. Results In propensity-matched patients, AAA was detected in 59 patients of the TTE group and in 48 patients of the AUS group; the prevalence of AAA detection did not differ significantly between TTE and AUS groups ( P = 0.331). Positive associations were observed between AAA detection and male sex (adjusted odds ratio [OR]: 3.25; 95% confidence interval [CI], 2.05-5.15; P < 0.001), older age (adjusted OR: 1.029; 95% CI: 1.01-1.04; P < 0.001), and the presence of ischemic heart disease (adjusted OR: 1.78; 95% CI: 1.04-3.03; P = 0.033) and hypertension (adjusted OR: 2.16; 95% CI: 1.38-3.37; P = 001). Conclusion TTE detected AAA with comparable efficacy as AUS in propensity-matched groups who underwent scheduled TTE and AUS.

This article will review the recumbent positions of patients with chronic congestive heart failure. The time for the right lateral decubitus position was two-fold longer than that for the supine and left lateral decubitus positions. Sympathetic nervous modulation was most attenuated and parasympathetic tone was most augmented in the right lateral decubitus position. The underlying mechanisms why heart failure patients prefer this position will be discussed. In conclusion, the right lateral decubitus position preferred by patients with chronic congestive heart failure may be a self-protecting mechanism to augment cardiac output and to attenuate the imbalance of cardiac autonomic nervous activity.

Background: There is evidence that adrenomedullin has autocrine or paracrine activities that oppose cardiac remodelling. However, it remains unclear whether it exerts those local functions in heart failure patients. Objective: To investigate the relation between plasma and pericardial fluid concentrations of adrenomedullin and left ventricular haemodynamic variables. Design: Samples of plasma and pericardial fluid were obtained from 50 patients undergoing cardiac surgery. They were classified into two groups: group N (n = 27) with a left ventricular end diastolic volume index (LVEDVI) ≤ 90 ml/m2; and group R (n = 23) with LVEDVI > 90 ml/m2. Plasma and pericardial fluid concentrations of total adrenomedullin (tAM) and mature adrenomedullin (mAM) were measured and related to the preoperative haemodynamic variables. Results: Pericardial fluid concentrations of mAM were much higher than the plasma concentration in both group N and group R (mean (SEM), 10.6 (1.7) v 3.3 (0.2) fmol/ml, p = 0.0001; and 21.2 (2.8) v 3.9 (0.3) fmol/ml, p < 0.0001, respectively). The ratio mAM/tAM in pericardial fluid was significantly higher than in plasma (0.56 (0.02) v 0.28 (0.02), p < 0.0001). Pericardial fluid concentrations of mAM, but not plasma concentrations, were significantly correlated with LVEDVI, left ventricular end systolic volume index, left ventricular ejection fraction, and left ventricular mass index (r = 0.60, 0.63, −0.54, and 0.47, respectively). Conclusions: Raised pericardial fluid concentrations of mAM may reflect the actions of adrenomedullin as a local mediator against cardiac remodelling in patients with left ventricular dysfunction.

The left ventricular (LV) extracellular matrix participates in progressive LV remodeling that is strongly associated with morbidity and mortality in patients with heart failure. Matrix metalloproteinases (MMPs), an endogenous family of zinc-dependent enzymes, increase proteolytic activity in the extracellar spaces, leading to increased extracellular remodeling. 1,2 Several lines of evidence in experiment animals suggest that MMPs and tissue inhibitors of metalloproteinases (TIMPs) may play an important role in modulating LV remodeling. 3,4 In humans, however, little information is available regarding MMPs and TIMPs of cardiac origin in the presence or absence of LV remodeling in patients with ischemic heart disease. It is generally considered that pericardial fluid is not only an ultrafiltrate of plasma, but also a transudate from the cardiac interstitium. 5 Thus, the purposes of this study were: (1) to measure plasma and pericardial fluid levels of total MMP-1 and -2, active MMP-2, and TIMP-1 and -2 in patients with ischemic heart disease, and (2) to investigate their relations to LV volume and function to obtain clinical evidence that MMPs act as autocrine and/or paracrine factors in the process of LV remodeling.

[Objective] To elucidate the factors associated with high left ventricular mass index (LVMI) and to test the hypothesis that high LVMI is associated with worse outcome in severe aortic stenosis (AS). [Methods] We analysed 3282 patients with LVMI data in a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan. The management strategy, conservative or initial aortic valve replacement (AVR), was decided by the attending physician. High LVMI was defined as LVMI >115 g/m2 for males and >95 g/m2 for females. We compared the risk between normal and high LVMI in the primary outcome measures compromising aortic valve-related death and heart failure hospitalisation. [Results] Age was mean 77 (SD 9.6) years and peak aortic jet velocity (Vmax) was 4.1 (0.9) m/s. The factors associated with high LVMI (n=2374) included female, body mass index ≥22, absence of dyslipidemia, left ventricular ejection fraction

Introduction: Due to improvements of catheter design and approach, catheterization-related cerebral infarctions are expected to decrease, whereas this may be counterbalanced by increased risk profile of patients who undergo catheterization. Aims: The aim of this study is to examine the prevalence and risk factors of symptomatic and asymptomatic catheterization-related cerebral infarctions in the contemporary era, using diffusion-weighted magnetic resonance imaging (MRI). Methods and Results: We retrospectively analyzed 84 patients who underwent 1237 diagnostic and interventional catheterization procedures conducted within 2010 and 2011 in our hospital and who obtained the MRI within 14 days after catheterization. Among these, 10 patients developed a neurological event underwent MRI for suspected cerebral infarction (group A), whereas 74 patients were asymptomatic and underwent MRI for various reasons (group B); 52% of patients for the assessment before coronary bypass or surgery of aortic valve, 19% for the systemic vascular assessment for atherosclerotic diseases, and 28% for other reasons. The MRI revealed a fresh cerebral infarction in 5 patients in group A and 22 patients (29.7%) in group B. In patients with infarct lesions, more number of catheters were used (p=0.01), the intravascular procedure was longer (mean ± SEM, 17.1 ± 1.7 minutes vs. 22.7 ± 2.4 minutes, p=0.06), and the mean age tended to be higher (mean ± SEM, 74.1 ± 1.67 vs. 70.4 ± 1.1, p=0.07). The features of infarction were as follows: 62.9% of patients had multiple lesions and relatively small lesions in asymptomatic patients compared to those in symptomatic patients. Conclusions: Symptomatic cerebral infarction occurred after 5 of 1237 (0.4%) procedures. However, the rate of asymptomatic catheterization-related cerebral infarctions detected using diffusion-weighted MRI remains high in high-risk patients or candidates for cardiac surgery, when the rate is compared to that reported by previous studies conducted around 10 years ago. More number of catheters used and longer procedure time were associated with cerebral infarction in present study and careful procedural planning is warranted.

Background: Increasing evidence suggests that N-terminal probrain natriuretic peptide (NT-proBNP) may be a more discerning marker for the detection and evluation of heart failure than BNP. However, fundamental mechanisms that contribute to the heart failure in aortic stenosis (AS) and ischemic heart disease (IHD) via NT-proBNP remain unclear. Objectives: The purpose of this study was to investigate whether NT-proBNP represents autocrine/paracrine factors and are accumulated in pericardial fluid (PF) in patients with AS and IHD. Methods: With an electrochemiluminescent immunoassay, we measured the concentrations of NT-proBNP in serum and pericardial fluid simultaneously in 48 patients undergoing aortic valve replacement and 101 patients undergoing coronary artery bypass grafting. We investigated the correlation of NT-proBNP levels in serum or PF with hemodynamic variables. Results: In patients with AS, the PF levels of NT-proBNP were markedly elevated compared with serum levels (10747±17619 pg/ml vs. 2828±7787 pg/ml, p=0.0054). In patients with IHD, the PF levels of NT-proBNP were markedly elevated compared with serum levels (7224±16345 pg/ml vs. 764±1199 pg/ml, p=0.0001). In AS, NT-proBNP levels in PF but not in serum had closer relations with left ventricular (LV) end-diastolic (r=0.338, p=0.0463) and systolic volume indexes (r=0.551, p=0.0005). In AS, NT-proBNP levels in PF but not in serum inversely correlated with LV ejection fraction (EF) (r=-0.510, p=0.0002). In IHD, NT-proBNP levels in PF but not in serum had closer relations with left ventricular (LV) end-diastolic (r=0.493, p Conclusion: Increased PF concentrations of NT-proBNP reflects the direct actions as a local mediator against cardiac pressure overload in AS patients and cardiac voume overload in IHD patients with left ventricular systolic dysfunction.

OBJECTIVESWe aimed to clarify which recumbent position is preferred by patients with congestive heart failure (CHF) and to evaluate whether cardiac autonomic nervous activity is different among three recumbent positions (supine, left lateral decubitus, right lateral decubitus) in patients with CHF.BACKGROUNDIt remains unclear whether cardiac autonomic nervous activity is different among three recumbent positions in patients with CHF.METHODSWe studied 17 male CHF patients (66 ± 7 years) and 17 age- and gender-matched healthy subjects (66 ± 7 years). Each subject underwent 24-h ambulatory electrocardiographic monitoring. A channel was used to record the CM5lead, and another to record the signal of the patient’s posture with use of a newly developed small-sized detector (3.2 cm × 3.2 cm). By using spectral analysis of heart rate variability, frequency-domain measures were calculated and compared among the three recumbent positions. Normalized high-frequency (HF: 0.15 to 0.40 Hz) power was used as an index of vagal activity and the low frequency (0.04 to 0.15 Hz)/HF power ratio was used as an index of sympathovagal balance.RESULTSIn patients with CHF, the time for the right lateral decubitus position was two-fold longer than that for the supine and left lateral decubitus positions. The increased cardiac sympathetic activity and decreased vagal tone in CHF patients were normalized in the right lateral decubitus position.CONCLUSIONSThe right lateral decubitus position in patients with CHF may be a self-protecting mechanism of attenuating the imbalance of cardiac autonomic nervous activity.

The TAMI-6 trial has demonstrated that coronary reperfusion >6h after onset (ie, late reperfusion) in patients with acute myocardial infarction (AMI) does not improve left ventricular (LV) function during the chronic phase of infarction. However, the low patency rate (only 60%) of the infarct-related artery (IRA) during the chronic phase in the TAMI-6 trial raises a new hypothesis that late reperfusion with a higher patency rate may improve LV function during the chronic phase. Forty-four patients with AMI, who were admitted to hospital 6-24h after the symptom onset and in whom emergency coronary angiography revealed a total occlusion of the IRA, were randomly assigned to either the late reperfusion group (n=22) or the non-reperfusion group (n=22). The initial success rate of reperfusion therapy in the late reperfusion group was 86% and the chronic patency rate of the IRA was 91%. The improvements in ejection fraction and chord shortening in the infarct region from the acute phase to the chronic phase were significantly greater in the late reperfusion group than in the non-reperfusion group. Late reperfusion with a high patency rate of the IRA significantly improves LV global and regional function in patients with AMI.

To investigate the bidirectional functional adequacy of collateral perfusion, we performed percutaneous transluminal coronary angioplasty (PTCA) on highly stenosed or occluded coronary arteries visualized by the collateral circulation,which were fed by the contralateral coronary artery with severe stenosis. After successful PTCA in all three patients, the contralateral artery was reversely filled by good collateral circulation originating from the dilated coronary artery. These findings indicated that dilation of the receiving coronary artery reversed the pressure gradient across the collateral network, establishing collateral flow in the opposite direction. It was concluded that human collateral channels serve as a bidirectionally functional conduit.

The purpose of this study was to evaluate whether age influences collateral development in patients with coronary artery disease. The extent of collateral development to the area perfused by the infarct-related artery was graded, depending on the degree of opacification of the occluded infarct-related artery. We evaluated the extent of collateral development using coronary cineangiography in 102 patients with an acutely occluded infarct-related coronary artery within 12 h after the onset of the first acute myocardial infarction, and who had a history of long-standing effort angina. Well-developed collateral circulation was observed in 54 (53%) of the patients. The patients were divided into two groups based on their age. The prevalence of well-developed collateral circulation in the younger group (or = 64 years, n = 48) was 69% (33 of 48), being significantly (P = 0.003) higher than 39% (21 of 54) in the older group (or = 65 years, n = 54). We conclude that in the presence of stimuli for collateral development i.e., long-standing effort angina accompanied by severe coronary stenosis, the age of patients is a key determinant of collateral development.

Acidic fibroblast growth factor (FGF) is a potent mitogen that can induce angiogenesis in vivo. We have recently reported a marked increase of basic FGF in the pericardial fluid of patients with severe coronary stenosis and an increase in vascular endothelial growth factor (VEGF) in the pericardial fluid of patients with severe myocardial ischemia. The purpose of this study was to evaluate whether acidic FGF levels in the pericardial fluid are associated with severe myocardial ischemia. Immediately after incision of the pericardium in 48 patients during open-heart surgery, 3-5ml of pericardial fluid was obtained. Concentrations of basic FGF and VEGF in the pericardial fluid were measured using an enzyme-linked immunosorbent assay (ELISA). The ELISA system for human acidic FGF was newly developed using a rabbit antibovine acidic FGF antibody. The patients were divided into three groups (group A: 13 patients undergoing emergency coronary artery bypass grafting (CABG) for unstable angina; group B: 17 patients undergoing elective CABG for stable angina; group C: 18 patients undergoing nonischemic open-heart surgery). The VEGF level in the pericardial fluid in group A was 68 +/- 59pg/ml, which was significantly higher than 33 +/- 9 pg/ml in group B and 31 +/- 20 pg/ml in group C (P0.05). The concentrations of basic FGF in the pericardial fluid in groups A and B were 722 +/- 601 and 773 +/- 763pg/ml, respectively, significantly higher than 263 +/- 349pg/ml in group C. The pericardial acidic FGF level in group A was 4,291 +/- 2,336 pg/ml, which was also significantly higher than 2,386 +/- 1,048 pg/ml in group B and 2,589 +/- 990 pg/ml in group C (P0.05). The acidic FGF level correlated well with the level of VEGF (r = 0.61, P0.0001). It is concluded that the level of acidic FGF in pericardial fluid is associated with severe myocardial ischemia. This result indicates that the release of acidic FGF from the myocardial tissue into pericardial fluid is closely related to severe myocardial ischemia.

The six-minute walk test is a submaximal exercise test that can be performed even by a patient with heart failure not tolerating maximal exercise testing. To elucidate the clinical significance and prognostic value of the six-minute walk test in patients with primary pulmonary hypertension (PPH), we sought ( 1 ) to assess the relation between distance walked during the six-minute walk test and exercise capacity determined by maximal cardiopulmonary exercise testing, and ( 2 ) to investigate the prognostic value of the six-minute walk test in comparison with other noninvasive parameters. The six-minute walk test was performed in 43 patients with PPH, together with echocardiography, right heart catheterization, and measurement of plasma epinephrine and norepinephrine. Symptom-limited cardiopulmonary exercise testing was performed in a subsample of patients (n 5 27). Distance walked in 6 min was significantly shorter in patients with PPH than in age- and sex-matched healthy subjects (297 6 188 versus 655 6 91 m, p , 0.001). The distance significantly decreased in proportion to the severity of New York Heart Association functional class. The distance walked correlated modestly with baseline cardiac output (r 5 0.48, p , 0.05) and total pulmonary resistance (r 5 2 0.49, p , 0.05), but not significantly with mean pulmonary arterial pressure. In contrast, the distance walked correlated strongly with peak O2 (r 5 0.70, p , 0.001), oxygen pulse (r 5 0.57, p , 0.01), and E -V CO2 slope (r 5 2 0.66, p , 0.001) determined by cardiopulmonary exercise testing. During a mean follow-up period of 21 6 16 mo, 12 patients died of cardiopulmonary causes. Among noninvasive parameters including clinical, echocardiographic, and neurohumoral parameters, only the distance walked in 6 min was independently related to mortality in PPH by multivariate analysis. Patients walking , 332 m had a significantly lower survival rate than those walking farther, assessed by Kaplan-Meier survival curves (log-rank test, p , 0.01). These results suggest that the six-minute walk test, a submaximal exercise test, reflects exercise capacity determined by maximal cardiopulmonary exercise testing in patients with PPH, and it is the distance walked in 6 min that has a strong, independent association with mortality. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K. Clinical correlates and prognostic significance of sixminute walk test in patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing. AM J RESPIR CRIT CARE MED 2000;161:487‐492. . V . V

A lightly doped drain (LDD) structure was used in a gate-all-around TFT (GAT). This suppresses the leakage current much more than the LDD used in a single-gate TFT (SGT), and the current level of the GAT with the LDD is almost the same as that of the single-gate TFT (SGT) with the LDD keeping the GAT's advantage of a high on-current. This is because the LDD effectively relaxes the electric field at the drain edge and reduces the effect of the electric field from the surrounded gate of the GAT. Furthermore, the GAT can suppress individual performance variations. The suppression mechanism of the individual performance variation in a GAT was investigated using a poly-Si TFT simulator. The thinner the channel poly-Si, the smaller the individual performance variation of the TFT. The GAT is more effective in decreasing the individual performance variation for thin channels than the SGT because the GAT can achieve the full depletion of the channel poly-Si with a channel thickness twice as large as the SGT. The GAT is eminently suitable for use in high-density, low-voltage operations, and low-power SRAM's.

It has been demonstrated that field shield (FS) isolation technology can suppress the delay time instability according to the operating frequency. The FS isolation technology has been proposed to fix the body potential without any area penalty in a gate array. In this technology, an FS plate, which is an additional polysilicon gate, is introduced to electrically isolate active regions. The body potential of the SOI MOSFET can be fixed through the SOI layer under the FS plate. The effect of body resistance on the delay time instability was also investigated using device simulation. The simulation showed that although the body potential momentarily falls to a nonsteady level due to capacitive coupling during switching operation, the body potential recovers to a steady level, following the RC law. From the simulation result, a helpful design guideline concerning the body resistance was deduced. This guideline showed that the FS isolation has a superior capability to suppress the frequency-dependent instability for practical deep submicron SOI circuits.

Sympathetic nerve activity is augmented by calcium-channel blocker treatment as a result of decreased blood pressure. Dihydropyridine calcium-channel blockers are divided into three different types. The purpose of the present study was to investigate whether treatment effects on hemodynamics, cardiac autonomic nerve activity and plasma norepinephrine levels differ among amlodipine (L type), efonidipine (L + T type) and cilnidipine (L + N type). We enrolled 14 hypertensive patients (seven males, seven females, 70 ± 6 years old) undergoing a monotherapy of amlodipine, efonidipine or cilnidipine into this prospective, open-labeled, randomized, crossover study. At baseline and every 6 months of the treatment period, we repeated the evaluation of hemodynamics, spectral analysis of heart rate variability and plasma norepinephrine levels. Blood pressure and pulse rate were comparable among the three treatments. The low-frequency (LF)/high-frequency (HF) power ratio, an index of cardiac sympathovagal balance, was significantly lower with efonidipine and cilnidipine than with amlodipine, while the HF/total power ratio, an index of cardiac vagal activity, revealed the opposite results. There was no significant correlation between the LF/HF ratio and plasma norepinephrine levels. Antihypertensive monotherapy with efonidipine or cilnidipine attenuates cardiac sympathetic nerve activity more effectively than amlodipine monotherapy.

Atrial fibrillation following cardiac surgery remains as a most common complication. Tachycardia with atrial fibrillation just after the operation could lead to cardiac deterioration. Although we have to control tachycardia, we often have great difficulties in managing these arrhythmias. Many reports have showed landiolol, ultra short-acting beta1 blocker, and amiodarone were effective against postoperative atrial fibrillation. However there has been no report on comparison between these 2 drugs. As excessively sympathetic activity might cause atrial fibrillation, landiolol was introduced into our therapy concomitant with the sedative. Our investigation confirmed that both landiolol and amiodarone were effective in preventing atrial fibrillation, and that the timing of transition from intravenous administration to oral intake was acceptable. When landiolol was administered, enough attention should be paid to the patients whose left ventricular function was low. The patients in whom atrial fibrillation occurred under landiolol therapy showed tendency of lower heart rate in comparison with the patients under amiodarone therapy.

Background: The development of congestive heart failure (CHF) is associated with left ventricular (LV) remodeling. However, fundamental mechanisms that contribute to this remodeling process remain unclear. The matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) have been demonstrated to play a significant role in tissue remodeling through a number of pathological processes. Objectives: The purpose of this study was to investigate whether MMPs and TIMPs represent autocrine/paracrine factors and are accumulated in pericardial fluid. We previously reported that active MMP-2 levels in pericardial fluid served as more sensitive and accurate indicators of LV remodeling than did active MMP-2 levels in plasma. Methods: We measured the concentrations of the enzyme (active MMP-9) in both plasma and pericardial fluid in 20 patients during coronary artery bypass graft surgery. Results: The active MMP-9 level was significantly higher in pericardial fluid than in plasma (4.68 ± 1.17 vs. 2.58 ± 0.29 ng/ml, p Conclusions: Active MMP-9 levels in pericardial fluid serve as more sensitive and accurate indicators of LV remodeling than did active MMP-9 levels in plasma. Thus, active form of MMP-9 may be also secreted from the heart into the pericardial space with the progression of CHF, and it may have a pathophysiologic role in LV remodeling process as an autocrine/paracrine factor.