Daisuke Kitano

Miglitol improves postprandial endothelial dysfunction in patients with acute coronary syndrome and new-onset postprandial hyperglycemia

BackgroundHyperglycemia, a risk factor for development of cardiovascular disease, causes endothelial dysfunction. Alpha-glucosidase inhibitors (α-GIs) improve postprandial hyperglycemia (PPHG) and may have favorable effects on associated cardiovascular disease. Effects of α-GIs in patients with acute coronary syndrome (ACS) and PPHG remain unclear; thus, we assessed the effect of α-GI miglitol on endothelial function in such patients by digital reactive hyperemia peripheral arterial tonometry (RH-PAT).MethodsFifty-four patients with ACS who underwent primary percutaneous coronary intervention were enrolled in the study: 36 with new-onset PPHG and 18 with normal glucose tolerance. Eighteen PPHG patients were given 50 mg of miglitol with each meal for 1 week. Endothelial function was assessed on the basis of the RH-PAT index (RHI) before and after the 1-week miglitol treatment. The other 18 PPHG patients and the 18 NGT patients were not given any anti-diabetic agent for 1 week, and endothelial function was assessed.ResultsPostprandial RHI decreased significantly in patients with PPHG. Miglitol improved PPHG significantly; postprandial RHI also improved (pu2009=u20090.007). Significant inverse correlation was found between the postprandial change in RHI and postprandial fasting-to-60-minutes surge in glucose (ru2009=u2009-0.382, pu2009=u20090.009). Moreover, the improvement in endothelial function correlated with the reduced postprandial glucose surge achieved with miglitol (ru2009=u2009-0.462, pu2009=u20090.001).ConclusionsPostprandial changes in glucose are related to endothelial dysfunction in ACS. Miglitol-based improvement in PPHG appears to improve endothelial function. The effect of miglitol on glucose-dependent endothelial function might improve outcomes of ACS.

Serial change and its determinants of residual plaque characteristics under sirolimus-eluting stent: A coronary angioscopic study

OBJECTIVESnTo examine serial change in the residual plaque behind the sirolimus-eluting stent (SES) using coronary angioscopy in patients with SES implantation and to identify its baseline determinants.nnnBACKGROUNDnPrevious coronary angioscopic studies have demonstrated that SES enhances the yellow grade of residual plaque during follow-up period.nnnMETHODSnA total of 42 patients with stable angina pectoris or silent ischemic heart disease, who had a successful SES implantation were examined by coronary angioscopy both at the baseline (SES implantation) and the follow-up period (9-14 month follow-up). The patients were divided into three groups as: worsened group (WS: yellow color grade of coronary plaque at the follow-up period was worsened compared to the baseline period, n=15), no change group (NP: no change compared to the baseline, n=16), and improved group (IP: improved compared to the baseline, n=11). Then, the determinants of the nominal change of yellow color grade were examined by multiple regression analysis.nnnRESULTSnThe low-density lipoprotein cholesterol (LDL-C) level in IP group at the follow-up was significantly decreased compared to baseline (from 120.0±29.8mg/dl to 74.3±16.7mg/dl, p=0.0005), and was the lowest among three groups (WS: 103.5±16.4mg/dl, NC: 105.7±18.7mg/dl, and IP: 74.3±16.7mg/dl). Multiple regression analysis revealed that family history, statin administration, baseline serum creatinine, baseline in-stent thrombus, and follow-up LDL-C were significant determinants to the nominal change of yellow color grade after the SES implantation (p<0.0001).nnnCONCLUSIONSnSerial change in tissue characteristics within residual plaque under SES is determined by several factors, especially LDL-C level as well as statin administration. Adequate management of LDL-C by statins might be crucial for stabilizing residual plaque after SES implantation.

Angioscopic differences of coronary intima between diffuse and focal coronary vasospasm: Comparison of optical coherence tomography findings

BACKGROUNDnCoronary artery vasospasm (CS) can be identified as either a diffuse type or focal type; however, the difference in endothelial characteristics between these spasm types remains unclear. The features of coronary intima associated with diffuse spasm and focal spasm using coronary angioscopy (CAS) were evaluated and the optical coherence tomography (OCT) findings were compared.nnnMETHODSnCAS and/or OCT observational analysis was performed in 55 patients (mean age: 61.4 years, 31 men) who had acetylcholine-provoked CS (diffuse CS, 31 patients; focal CS, 24 patients). The yellowness of the intima, presence of thrombus in CAS, and intimal characteristics based on the OCT results were evaluated.nnnRESULTSnCAS showed more atherosclerotic yellow plaques at the focal spasm segment than at the diffuse spasm segment (p=0.032). Moreover, there were more thrombi at the focal spasm segment (p=0.039). In addition, OCT results revealed that the intima area, maximum intima thickness, and lipid content in the focal CS group were larger than the diffuse CS group (4.22±1.67mm2 vs. 3.45±2.36mm2; 0.71±0.29mm vs. 0.53±0.30mm; 55.9% vs. 32.0%, p<0.001, respectively).nnnCONCLUSIONSnThese results indicate that the presence of atherosclerotic plaques at the spasm site is likely to be related to the occurrence of a focal vasospasm. This may support the difference of features between focal CS and diffuse CS and contribute to precise treatment for each spasm type.

Multiple cardiovascular stenoses in a 66-year-old woman with neurofibromatosis type 1: virtual-histology intravascular ultrasound findings

A 66-year-old Japanese woman with neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, visited our hospital with worsened dyspnoea and diagnosed congestive heart failure. She presented a differential blood pressure in the forearm arteries, vascular bruits in the right cervical region and periumbilical region, and left ventricular dysfunction on the echocardiogram. Both coronary and

Identification of left ventricular chamber-like aneurysm related to cardiac sarcoidosis

A 58-year-old woman was referred to us with an abnormal ECG, showing complete right bundle branch block and left anterior fascicular block. An echocardiogram showed left ventricular (LV) septal thinning and hinted at the presence of an LV aneurysm. An enhanced CT indeed revealed an LV aneurysm-like structure. After appropriate testing to exclude coronary artery disease, this LV anomaly led us to suspect the possibility of cardiac sarcoidosis (CS). Cine cardiac magnetic resonance (CMR)xa0imaging showed an apparent chamber-like aneurysm, and late gadolinium enhancement (LGE) CMR showed transmural positive enhancement in the mid-portion of the LV at the region of the aneurysm (figure 1A,B). As our institution lacked anxa0FDG-PET scanner, gallium scintigraphy was instead performed, which showed uptake in the heart and bilateral hilar lymph nodes …

A comparative study of time-specific oxidative stress after acute myocardial infarction in patients with and without diabetes mellitus

BackgroundOxidative stress is involved in the initiation and progression of atherosclerosis, and hyperglycemia is known to increase oxidative stress, which injures the endothelium and accelerates atherosclerosis. To clarify the relation between oxidative stress, diabetes mellitus (DM), and acute myocardial infarction (AMI), we evaluated and compared time-specific oxidative stress after AMI in patients with and without DM by simple measurement of derivatives of reactive oxygen metabolites (d-ROMs) levels as indices of reactive oxygen species production.MethodsSixty-eight AMI patients were enrolled (34 non-DM patients and 34 DM patients). Using the FRAS4 free radical analytical system, we measured d-ROMs levels in each patient at two time points: 1 and 2xa0weeks after AMI onset.Resultsd-ROM levels decreased significantly between week 1 and week 2 (from 475.4u2009±u2009119.4 U.CARR to 367.7u2009±u200987.9 U.CARR, pu2009<u20090.001) in the non-DM patients but did not change in the DM patients (from 463.1u2009±u2009109.3 U.CARR to 461.7u2009±u2009126.8 U.CARR, pu2009=u20090.819). Moreover, significant correlation was found in the total patient group between d-ROMs levels at 1xa0week and N-terminal prohormone of brain natriuretic peptide (ru2009=u20090.376, pu2009=u20090.041) and between d-ROM levels at 2xa0weeks and 2-hour oral glucose tolerance test glucose levels (ru2009=u20090.434, pu2009<u20090.001).ConclusionsExposure to oxidative stress is greater in AMI patients with DM than AMI patients without DM. Our study results suggest that it is the continuous hyperglycemia that increases oxidative stress in these patients, causing endothelial dysfunction and accelerating atherosclerosis. However, long-term follow up study is needed to assess whether the increased oxidative stress affects patient outcomes.

STENT-SPECIFIC PREVALENCE OF ANGIOSCOPIC CHARACTERISTICS AFTER DRUG-ELUTING STENT IMPLANTATION TO PATIENTS WITH DIABETES MELLITUS, COMPARISON BETWEEN PACLITAXEL- VERSUS EVEROLIMUS-ELUTING STENTS

Background: Drug-eluting stents(DES) have reduced in-stent restenosis(ISR) and target legion revascularization(TLR). However, diabetes mellitus(DM) is still major concern of ISR and TLR in the early phase after DES implantation. Previous reports have shown the advantage of paclitaxel compared to limus-derivative drugs for the treatment of diabetes. Thus, we investigated whether there is stent-specifc prevalence of angioscopic characteristics in the patients with DM having paclitaxel-eluting stent(PES) or everolimus-eluting stent(EES).