Jun Kitamura

Hemorrhagic Myocardial Infarction After Coronary Reperfusion Detected In Vivo by Magnetic Resonance Imaging in Humans: Prevalence and Clinical Implications

With the advent of thrombolytic therapy, hemorrhagic myocardial infarction (HMI) has been observed in experimental and human autopsy studies. However, its clinical implications remain undetermined, because of the absence of a reliable method to detect its presence in vivo. This study was designed to evaluate the clinical implications of HMI detected by magnetic resonance (MR) imaging in vivo after coronary reperfusion. Thirty-nine patients with acute myocardial infarction (AMI) were studied. Percutaneous transluminal coronary angioplasty (PTCA) was used to reopen the occluded coronary artery. Electrocardiogram (ECG)-gated T2*-weighted gradient-echo MR imaging was performed to detect intramyocardial hemorrhage, using a 1.5-T magnet within 2 weeks after coronary reperfusion (average, 5.7 days). Thirteen patients (33%) showed intramyocardial hemorrhage as a distinct hypointense zone by gradient-echo MR imaging and 26 patients showed homogeneous intensity consistent with absence of intramyocardial hemorrhage. Coronary angiograms showed lesser development of collateral flow in the patients with HMI than in those without (81% vs. 37%). Infarct size, estimated 1 month after coronary reperfusion by thallium-201 scintigraphy, was larger among patients with HMI than in those without (37 +/- 14% vs. 21 +/- 14%, respectively, p < 0.05). Left ventricular ejection fraction at 1 month follow-up showed less recovery in patients with HMI than in those without (47 +/- 9 to 51 +/- 10%; p = 0.47, vs. 53 +/- 10 to 60 +/- 9%, respectively, p < 0.05). ECG-gated T2*-weighted gradient-echo MR imaging offers a noninvasive means of detection of intramyocardial hemorrhage in patients with reperfused AMI. HMI occurred even after primary PTCA and may be a common finding associated with severely injured myocardium.

Association between Takayasu arteritis and ulcerative colitis – case report and review of serological HLA analysis

Summary Background Takayasu arteritis and ulcerative colitis are immune-mediated inflammatory diseases; genetic factors are assumed to play an important role in the pathogenesis of these 2 diseases. However, the coexistence of these 2 diseases has rarely been reported. Case Report In this report, we present a rare case of a 29-year-old man with a 4 years history of ulcerative colitis who developed Takayasu arteritis. He was found to carry the following human leukocyte antigens (HLA): A11, A24, B52, B62, DR4, and DR9. Conclusions We present a case report and review of the pertinent literature on serological analysis of HLA haplotype of the patients who exhibit both these diseases. In patients with both Takayasu arteritis and ulcerative colitis, high frequency of HLA-A24, B52, and DR 2 is observed. The pathological relevance of HLA-A24, B52, and DR2 to concomitant Takayasu arteritis and ulcerative colitis requires further investigation.

Circadian release of serotonin across the coronary bed in patients with endothelial dysfunction.

Transcardiac serotonin differences in nonischemic patients with endothelial dysfunction significantly increased in the early morning. Platelet secretion could occur without coronary stenosis.

Factors influencing left atrial volume in treated hypertension

BACKGROUND Left atrial (LA) enlargement has been documented to occur in hypertension (HT), and has been an index for evaluating the diastolic function of the left ventricle. Enlargement of the LA is one of the vital factors that induce heart failure and atrial fibrillation (AF) in patients with HT. METHODS AND SUBJECTS 130 treated hypertensive patients were enrolled. All recruits participated in an echocardiogram, electrocardiogram, a routine blood examination including brain natriuretic peptide (BNP), and physical examinations. RESULTS Left ventricular mass (LVM) indexed to height(2.7) had a significant positive correlation with left atrial volume index (LAVI) (p<0.0001), as well as natural logarithm BNP (p<0.001). Blood pressure levels were not associated with LAVI, neither body mass index nor age. LAVI had a positive correlation with factors involving the left ventricle volume, LVM, and right ventricle systolic pressure (RVSP) (r=0.687, p<0.0001). The parameters of LV diastolic function were positively but weakly associated with LA size. In the subgroup of LAVI, the evidence of paroxysmal atrial fibrillation (PAF): LAVI<32 ml/m(2) had no PAF, whereas the incidence of PAF was 7.5%, 11.4%, and 15.2%, respectively in the LAVI>32 ml/m(2) group. Of anti-hypertension drugs, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers had a tendency to reduce LAVI; however, there was no statistical significance within the groups. CONCLUSIONS Left ventricular volume and mass are independent factors affecting LAVI in treated HT. The incidence of PAF is associated with LA size. In patients with treated HT, LA size may be a useful surrogate marker for monitoring the effectiveness of medical therapy and occurrence of AF.

Transcardiac 5-hydroxytryptamine release and impaired coronary endothelial function in patients with vasospastic angina.

1. The present study was designed to test the hypotheses whether platelet degranulation across the coronary bed is detectable during non‐ischaemic periods in patients with vasospastic angina (VSA) and whether the exogenous nitric oxide (NO) donor nitroglycerin (GTN) is able to modify platelet degranulation, reflecting an impaired endothelial production of NO.

Morphological observation by intravascular ultrasound in superior vena cava syndrome after pacemaker implantation

We report a case of superior vena cava (SVC) syndrome that was assessed by intravascular ultrasound (IVUS). A highly echogenic eccentric lesion was demonstrated by IVUS. The use of IVUS also confirmed in vivo that SVC syndrome following pacemaker insertion occurs as a result of intimal thickening of the venous wall.

Troponin T In The Coronary Sinus And Percutaneous Transluminal Coronary Angioplasty Related Myocardial Injury

1. Myocardial injury has been shown to be associated with successful percutaneous transluminal coronary angioplasty (PTCA). The present study was designed to determine whether uncomplicated successful PTCA results in myocardial injury by measuring coronary sinus (CS) cardiac troponin T (cTnT).

S38-3 Prognostic Impact of Peripheral Endothelial Function in Heart Failure

[N-terminal pro-] B-type natriuretic peptide, and left ventricular ultrasonography). Each test is individually scored as 0 if normal, 1 if borderline and 2 with an abnormal test. The total disease score is the sum of all the test scores. We have evaluated this early cardiovascular disease score in patients attending the Rasmussen Center for Cardiovascular Disease Prevention Center and who have no overt cardiovascular disease. This disease score was more predictive for events than the classical cardiovascular risk assessment. Angiotensin II antagonist has been studied in the reduction of this disease score and its effect on the different components (DETECTIV Study). The DETECT Study is now comparing the effect of ACE-inhibitor lisinopril, carvedilol and their combination vs placebo on the disease score in subjects with no overt disease, but already presence of subclinical disease. Early detection of cardiovascular disease in asymptomatic subjects seems to be a better diagnostic and therapeutic stratification than assessment of cardiovascular risk based on a biostatistical approach of the classical risk factors.

P-126 Diagnosis of Cardiac Amyloidosis with Quantitative Analysis of Myocardial Technetium-99m-Pyrophosphate Scintigraphy

Objective: To determine the correlation of Duke treadmill score with gated SPECT-MPI in patients evaluated for chest pain. Methods: We conducted a retrospective study on 200 consecutive patients referred to our imaging laboratory for evaluation of chest pain by using stress MPI from January to August 2008. DTS was calculated after exercise testing and categorized as low, moderate and high subgroups. Subsequent gated SPECT-MPI was performed and stratified according to severity of perfusion defect. Spearmans rho was applied to determine the correlation. Results: The overall result shows positive linear correlation between DTS and MPI (p 0.001). Out of 200 patients, 136 (68%) had low DTS, 51 (25.5%) had moderate and 13 (6.5%) had high DTS respectively. In low DTS group 129 (95%) patients had low risk MPI and 7 (5%) had intermediate risk MPI. In moderate risk DTS group 25 (49%) had low risk MPI whereas 15 (29.5%) and 11 (21.5%) had intermediate and high risk MPI respectively. In high DTS group all 13 patients had high risk MPI. Conclusion: On the basis of our findings it can be hypothesized that patients with high DTS can be referred for coronary angiography without imaging and patients with low DTS can be followed on medical management. However for definite conclusion diagnostic accuracy need to be determine in further studies.