Hideki Onoyama

Atrial fibrillation in acute myocardial infarction

To elucidate the genesis and effect of atrial fibrillation (AF), 102 patients with acute myocardial infarction were studied. Eighteen patients had AF during the first 72 hours in the coronary care unit. The hospital mortality rate was 23%. Discriminant analysis was used to determine the important variables contributing to the genesis of AF and hospital mortality based on the following variables: cardiac output, pulmonary capillary wedge pressure, right atrial pressure, systolic blood pressure (at admission and before the onset of AF or most abnormal value), age, location of infarction, sex and pericarditis. Pulmonary capillary wedge pressure, right atrial pressure and age were the important factors contributing to AF, whereas pulmonary capillary wedge pressure and age were important for hospital mortality. Therefore, the hemodynamic change imposed on the left atrium and aging are the major factors related to the occurrence of AF and hospital mortality.

Left Ventricular Regional Function After Acute Anterior Myocardial Infarction in Diabetic Patients

To elucidate the pathophysiological role of diabetes mellitus in determining the left ventricular regional function of the noninfarcted area, 55 patients with acute Q wave anterior myocardial infarction (MI) were studied. The regional ejection fraction of the noninfarcted area was obtained by radionuclide angiocardiography and was used to estimate the left ventricular regional function of the noninfarcted area. Multiple regression analysis was performed to determine the important variables contributing to the regional ejection fraction based on 10 clinical variables: age, sex, QRS score, diabetes mellitus, hypertension, smoking, postinfarction angina, body mass index, serum cholesterol, and coronary atherosclerosis. A high QRS score (P < .001) and the association of diabetes mellitus (P < .05) were the important factors contributing to regional left ventricular dysfunction. The regional ejection fraction and QRS score had an inverse linear relationship in the diabetic and nondiabetic groups, and the regional ejection fraction was significantly lower in diabetic patients at every QRS score (P < .05). The association of hypertension, severity of coronary atherosclerosis, serum cholesterol level, age, and body mass index did not differ between diabetic and nondiabetic patients, which indicates that diabetes mellitus was not mediated through these atherogenic traits. Thus, diabetes mellitus is another discrete cause of regional left ventricular dysfunction of the noninfarcted area after acute MI.

Effect of coenzyme Q10 on hemodynamic response to ocular timolol.

Coenzyme Q10 (CoQ10) is an essential component of the mitochondrial membrane and plays an important role in the maintenance of normal cardiac function. To evaluate the effects of ocular timolol on the cardiovascular system and determine the protective effect of CoQ10, 16 patients with glaucoma were studied using impedance cardiography. Following instillation of 1 mg timolol maleate in each eye, heart rate (HR) and stroke index (SI) decreased, and total peripheral resistance index (TPRI) increased significantly. Reexamination was performed after 6 weeks of 90 mg oral CoQ10. Despite decreases in HR, percent changes in HR were significantly less after CoQ,10 at 120 min. Stroke index showed an initial increase which was not observed without CoQ10. These data suggest that CoQ10 delayed the appearance of inotropic blockade of timolol and hastened the disappearance of chronotropic blockade. Additional study of six normal volunteers with 6 weeks of oral CoQ10 showed a similar decrease of intraocular pressure after timolol instillation as compared to those without CoQ10. Thus, administration of oral CoQ10 in patients receiving ocular timolol may be useful in mitigating cardiovascular side effects without affecting intraocular pressure in the treatment of glaucoma.

Left Ventricular Dysfunction during Dynamic Exercise in Noninsulin-Dependent Diabetic Patients with Retinopathy

Systolic time intervals were obtained from 19 middle-aged noninsulin-dependent diabetic patients without clinically evident cardiovascular disease (8 patients had and 11 did not have retinopathy) and 14 normal subjects using ear densitography. All subjects had neither ischemic electrocardiographic response nor chest pain during maximal treadmill exercise. Although left ventricular ejection time (LVET) and preejection period (PEP) did not differ significantly at rest between the three groups, a prolongation of LVET with a nearly identical PEP response was observed during exercise in diabetic patients with retinopathy. These data indicate that the diabetic patients with retinopathy relied on the enhanced ventricular filling in maintaining stroke volume during exercise. Thus, retinopathy is associated with impaired left ventricular systolic function in noninsulin-dependent diabetic patients.

The New Editorial Board: 1991-1996

The New Editorial Board: 1991-1996 Cardiology was first published in 1937; the original editors were Drs. Bruno Kirsch of Cologne and W. Löffler of Zurich. The journal was originally named Cardiologia International Archives of Cardiology. In 1970, the name of the journal was changed to Cardiology. The Editorial Board at the time the journal was founded consisted of 24 distinguished cardiologists from Europe, North and South America, and Asia. The United States had 5 members including Paul D. White and Frank N. Wilson; Switzerland had 3 members, the UK and Czechoslovakia 2. The remaining 14 members came from the Netherlands, Portugal, Rumania, France, Germany, Sweden, Denmark, Austria, Mexico, and Japan. The 3 eastern European members are of even greater interest given current political changes in that region. More than half the articles in the first two volumes were in German, a quarter were in French, 15% were in Italian, and only 5% were in English. By 1960, the majority of the articles were in English, although French and German manuscripts were still being published. In 1970, when the journal took its present name, English became the sole language of the publication. Contributions in those first two volumes (1937-1938) came from the Netherlands, Italy, Germany, Denmark, France, Switzerland, and the USA. Each article ended with summaries in French, German, English, and Italian. There were no editorials and only occasional book reviews. Slightly more than one-third of the articles dealt with laboratory investigations in animals. Most studies were observational rather than experimental. It is interesting to review the topics covered in the first two volumes of Cardiologia. A number of animal studies were published including one of particular merit on the circulatory effects of intravenous epinephrine and adrenal cortical hormones. Clinical studies of note included work dealing with ventricular premature beats recorded by electrocardiography, congenital heart block, pathological observations on the etiology of atherosclerosis, and the application of cardiac output determinations to clinical problems. Thus, many of the topics which interest us today were already being considered in 1937 and 1938. Modern cardiology was already prefigured at that time. The new Editor and Editorial Board are honored to be part of a scholarly enterprise that is more than 50 years old. On behalf of the publisher and the members of the new Board, I would like to take a few minutes of 2 The New Editorial Board: 1991-1996