A 65-year-old male in the dilated phase of hypertrophic cardiomyopathy and with persistent atrial fibrillation was admitted to our hospital because of an episode of ventricular fibrillation following ...an appropriate shock from an implantable cardiac defibrillator (ICD). At admission, electrocardiography showed a normal sinus rhythm. He had complained of back pain 7 days after the ICD shock. Renal infarction was suspected, although computed tomography and magnetic resonance imaging could not be performed because of chronic renal failure and the presence of his ICD. We, therefore, used contrast-enhanced ultrasonography with a contrast agent to evaluate his acute kidney injury. This showed the left kidney contained a wedge-shaped area that was not enhanced by the contrast agent, indicating an area of infarction.
We attempted to assess coronary artery flow using adenosine-stress and dual-energy mode with dual-source CT (DE-CT). Data of 18 patients with suspected coronary arteries disease who had undergone ...cardiac DE-CT were retrospectively analyzed. The patients were divided into two groups: 10 patients who performed adenosine stress CT, and 8 patients who performed rest CT as controls. We reconstructed an iodine map and composite images at 120 kV (120 kV images) using raw data with scan parameters of 100 and 140 kV. We measured mean attenuation in the coronary artery proximal to the distal portion on both the iodine map and 120 kV images. Coronary enhancement ratio (CER) was calculated by dividing mean attenuation in the coronary artery by attenuation in the aortic root, and was used as an estimate of coronary enhancement. Coronary stenosis was identified as a reduction in diameter of >50% on CT angiogram, and myocardial ischemia was diagnosed by adenosine-stress myocardial perfusion scintigraphy. The iodine map showed that CER was significantly lower for ischemic territories (0.76 ± 0.06) or stenosed coronary arteries (0.77 ± 0.06) than for non-ischemic territories (0.95 ± 0.21,
P
= 0.02) or non-stenosed coronary arteries (1.07 ± 0.33,
P
< 0.001). The 120 kV images showed no difference in CER between these two groups. Use of CER on the iodine map separated ischemic territories from non-ischemic territories with a sensitivity of 86% and a specificity of 75%. Our quantification is the first non-invasive analytical technique for assessment of coronary artery flow using cardiac CT. CER on the iodine map is a candidate method for demonstration of alteration in coronary artery flow under adenosine stress, which is related to the physiological significance of coronary artery disease.
Background: The interventricular septum in hypertrophic cardiomyopathy (HC) has a unique shape, which is characterized by the convex curvature toward the left ventricle (LV). The aim of this study ...was to examine the relationship between curvature of the LV wall and regional myocardial strain. Methods and Results: Fifty-six patients with HC (mean age, 55±12 years) and 20 age- and sex-matched control subjects (mean age, 56±8 years) were enrolled. The curvature index (1/radius) was measured by drawing along the endocardial surface from the apical 4-chamber and short axis views. Peak systolic strain was calculated in the septal and lateral walls using 2-D speckle tracking echocardiography. The septal curvature index and septal longitudinal strain were significantly lower in the HC group than in the control group. A multivariate model using the HC patient data showed that the septal curvature index and septal thickness were the independent determinants of septal longitudinal strain (septal curvature index: β=–0.421, P<0.001; septal thickness: β=0.401, P=0.002). In addition, global longitudinal strain and E/e’ were worse in the lower septal curvature index group compared with the higher group. Conclusions: Septal longitudinal strain is associated with the degree of septal curvature. This indicates a possible link between LV wall configuration and regional myocardial function. (Circ J 2013; 77: 1040–1045)
Recently we have cloned angiotensin II type 2 receptor–interacting protein 1 (ATIP1) as a novel protein that interacts specifically with the C-terminal tail of the angiotensin II type 2 receptor; ...however, the pathophysiological roles of ATIP1 in vascular remodeling are still unknown. Here, we generated ATIP1-transgenic (ATIP1-Tg) mice expressing mouse ATIP1 and investigated the role of ATIP1 in vascular remodeling using these transgenic mice. ATIP1-Tg mice exhibited no significant difference in blood pressure compared with wild-type (WT) mice. Angiotensin II type 2 receptor mRNA expression in the femoral artery was increased in injured femoral arteries, reaching a peak at 7 days after operation in WT mice, and a similar result of angiotensin II type 2 receptor expression was observed in ATIP1-Tg mice. In ATIP1-Tg mice, neointimal formation of the femoral artery 14 days after cuff placement was significantly smaller than that in WT mice. 5-Bromo-2′-deoxyuridine incorporation was significantly reduced in the injured arteries of ATIP1-Tg mice compared with WT mice. In ATIP1-Tg mice, superoxide anion production and the expression of a proinflammatory cytokine, tumor necrosis factor-α, were markedly attenuated. Moreover, cell proliferative signaling, such as extracellular signal-regulated kinase phosphorylation, was significantly attenuated in ATIP1-Tg mice compared with WT mice. Taken together, these results suggest that ATIP1 plays an important role in cuff-induced vascular remodeling in mice.
IMPORTANCE: Very short mandatory dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with a drug-eluting stent may be an attractive option. OBJECTIVE: To test the ...hypothesis of noninferiority of 1 month of DAPT compared with standard 12 months of DAPT for a composite end point of cardiovascular and bleeding events. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, open-label, randomized clinical trial enrolling 3045 patients who underwent PCI at 90 hospitals in Japan from December 2015 through December 2017. Final 1-year clinical follow-up was completed in January 2019. INTERVENTIONS: Patients were randomized either to 1 month of DAPT followed by clopidogrel monotherapy (n=1523) or to 12 months of DAPT with aspirin and clopidogrel (n=1522). MAIN OUTCOMES AND MEASURES: The primary end point was a composite of cardiovascular death, myocardial infarction (MI), ischemic or hemorrhagic stroke, definite stent thrombosis, or major or minor bleeding at 12 months, with a relative noninferiority margin of 50%. The major secondary cardiovascular end point was a composite of cardiovascular death, MI, ischemic or hemorrhagic stroke, or definite stent thrombosis and the major secondary bleeding end point was major or minor bleeding. RESULTS: Among 3045 patients randomized, 36 withdrew consent; of 3009 remaining, 2974 (99%) completed the trial. One-month DAPT was both noninferior and superior to 12-month DAPT for the primary end point, occurring in 2.36% with 1-month DAPT and 3.70% with 12-month DAPT (absolute difference, −1.34% 95% CI, −2.57% to −0.11%; hazard ratio HR, 0.64 95% CI, 0.42-0.98), meeting criteria for noninferiority (P < .001) and for superiority (P = .04). The major secondary cardiovascular end point occurred in 1.96% with 1-month DAPT and 2.51% with 12-month DAPT (absolute difference, −0.55% 95% CI, −1.62% to 0.52%; HR, 0.79 95% CI, 0.49-1.29), meeting criteria for noninferiority (P = .005) but not for superiority (P = .34). The major secondary bleeding end point occurred in 0.41% with 1-month DAPT and 1.54% with 12-month DAPT (absolute difference, −1.13% 95% CI, −1.84% to −0.42%; HR, 0.26 95% CI, 0.11-0.64; P = .004 for superiority). CONCLUSIONS AND RELEVANCE: Among patients undergoing PCI, 1 month of DAPT followed by clopidogrel monotherapy, compared with 12 months of DAPT with aspirin and clopidogrel, resulted in a significantly lower rate of a composite of cardiovascular and bleeding events, meeting criteria for both noninferiority and superiority. These findings suggest that a shorter duration of DAPT may provide benefit, although given study limitations, additional research is needed in other populations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02619760
The diagnosis of lesions with severe calcium or in-stent stenosis using coronary computed tomography angiography (CCTA) is still difficult. The aim of the present study was to evaluate the accuracy ...of transthoracic Doppler echocardiography (TTDE) in patients with suspected angina pectoris, who had a proximal left coronary artery (LCA) site that could not be evaluated by CCTA. Fifty-eight patients were evaluated. The proximal LCA was defined as the left main coronary artery and proximal left anterior descending coronary artery. All patients underwent TTDE and had coronary angiography performed as a reference method. We measured the proximal left coronary flow velocity (CFV) by both color and pulse Doppler methods. Proximal coronary flow was detected in 45 (78%) of 58 patients. CFVs measured by both methods were significantly greater in the group with severe stenosis (percent diameter stenosis >70%) than in the groups with moderate stenosis (percent diameter stenosis 40% to 70%) or without stenosis (color Doppler: 148 ± 42 cm/s, 89 ± 40 cm/s, and 41 ± 22 cm/s, respectively, p <0.05; pulse Doppler: 143 ± 61 cm/s, 82 ± 33 cm/s, and 39 ± 17 cm/s, respectively, p <0.05). Receiver operating characteristic curve analysis showed that the optimal CFV cut-off values obtained by color and pulse Doppler to diagnose severe stenosis were 92 cm/s (sensitivity, 100%; specificity, 90%) and 81 cm/s (sensitivity, 100%; specificity, 85%), respectively. In conclusion, TTDE could diagnose proximal LCA stenosis with good accuracy in patients who could not be evaluated by CCTA.
Along with the increase of detector rows on the z-axis and a faster gantry rotation speed, the spatial and temporal resolutions of the multislice computed tomography (CT) have been improved for ...noninvasive coronary artery imaging. We investigated the feasibility of the second specification prototype 256-detector row four-dimensional CT for assessing coronary artery and cardiac function.
The subjects were five patients with coronary artery disease. Contrast medium (40-60 ml) was intravenously administered at the rate of 3-4 ml/s. The patient's whole heart was scanned for 1.5 s to cover at least one cardiac cycle during breathholding without electrocardiographic gating. Parameters used were 0.5 mm slice thickness, 0.5 s/rotation, 120 Kv, and 350 mA, with a half-scan reconstruction algorithm (temporal resolution 250 ms). Twenty-six transaxial datasets were reconstructed at intervals of 50 ms.
The assessability of the coronary arteries in AHA segments 1, 2, 3, 5, 6, 7, 9, and 11 was visually evaluated, resulting in 29 of 32 (90.9%) segments being assessable. Functional assessment was also performed using animated movies without banding artifacts in all cases.
The 256-detector row four-dimensional CT can assess the coronary artery and cardiac function using data during 1.5 s without banding artifacts.
The study objective was to compare the left ventricular (LV) dyssynchrony and torsional behavior between right ventricular apical (RVA) and right ventricular septal (RVS) pacing.
Forty-six patients ...with symptomatic sick sinus syndrome and preserved LV function were assigned to 2 groups: RVA (n = 23) and RVS (n = 23). Echocardiographic study including two-dimensional speckle tracking imaging was performed in the AAI and DDD modes.
Mean QRS width during DDD mode was significantly longer with RVA pacing than with RVS pacing. Dyssynchrony, torsion, and untwisting rate during DDD mode were significantly worse with RVA than with RVS pacing. In patients with RVA pacing, there was an increase in longitudinal dyssynchrony from AAI to DDD mode that significantly correlated with the deterioration of untwisting rate.
In bradyarrhythmic patients with preserved LV function, RVS pacing resulted in a reduced LV dyssynchrony and better torsional behavior than RVA pacing.
Augmentation index (AI), brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are available for the assessment of arterial stiffness in clinical practices. However, ...influences of meal intake on these indices are still poorly understood. The aim of this study is to elucidate the effects of daily meal intake on pulse wave indices in patients with type 2 diabetes. We studied 17 patients with type 2 diabetes. AI was measured at fasting, 60 and 120 min after a commercial mixed meal (500 kcal) intake. The baPWV and CAVI were measured at fasting and 80-100 min after meal intake. All pulse indices decreased significantly after meal intake (AI, 89.3+/-9.7% to 77.9+/-9.4%, 82.0+/-8.4%, P<0.001; baPWV, 1652+/-286-1586+/-240 cm s(-1), P=0.002; CAVI, 9.52+/-0.92-9.20+/-0.89, P=0.037). Delta(120) (value 120 min after meal intake-fasting value) AI correlated significantly with age, body weight, Delta(120) systolic blood pressure (SBP), Delta(120) diastolic blood pressure, Delta(120) pulse pressure, Delta(120) heart rate and fasting AI. Delta (postprandial value-fasting value) baPWV correlated significantly with fasting baPWV, Delta SBP, Delta pulse pressure and HbA1c. In contrast, Delta CAVI did not correlate with any clinical variables. In conclusion, postprandial decreases in AI, baPWV and CAVI can lead to underestimate arterial stiffness in patients with type 2 diabetes. Postprandial changes in AI and baPWV, but not CAVI, are associated with changes in hemodynamic variables after daily meal intake.
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