Junko Nomoto

Relationship of Cigarette Smoking to the Severity of Coronary and Thoracic Aortic Atherosclerosis

We studied the relationship of cigarette smoking to the severity of coronary and thoracic aortic atherosclerosis in 116 men who received coronary angiography and transesophageal echocardiography. Severity of coronary atherosclerosis was assessed in terms of Gensinis score (GS), and that of thoracic aortic atherosclerosis was assessed by the average sclerotic length (ASL) and average sclerotic area (ASA). The plasma fibrinogen levels were significantly positively correlated with smoking, and fasting blood sugar levels tended to be positively associated with smoking. GS was inversely associated with serum levels of high density lipoprotein (HDL) cholesterol. ASL and ASA were positively associated with age, fasting blood sugar levels and plasma fibrinogen levels, and these associations were statistically significant. Analysis of covariance was used to examine the net association between cigarette smoking and GS, ASL or ASA controlling for age, total cholesterol, HDL cholesterol, fasting blood sugar and plasma fibrinogen. We found that GS, ASL, and ASA were all significantly increased with increasing number of cigarette years. Additional adjustment for other risk factors (triglyceride, uric acid, body mass index, alcohol use and hypertension) also showed a strong independent contribution of smoking to GS, ASL and ASA. We concluded that the cumulative exposure to cigarette smoking was an independent indicator of the severity of coronary atherosclerosis as well as thoracic aortic atherosclerosis.

Evaluation of the Coagulation and Fibrinolytic Systems in Men with Intermittent Claudication

The authors evaluated elements of the coagulation and fibrinolytic systems in 18 male patients with intermittent claudication vs 19 men matched for risk factors who served as controls. Prothrombin time and activated partial thromboplastin time did not significantly differ in the patients and the controls. The plasminogen level in the two groups was not significantly different. The level of lipoprotein(a) was significantly higher in the patients than in the controls. The levels of antigen and the activity of protein C did not differ significantly between the two groups. The thrombomodulin level was significantly higher in the patients than in the controls. There were no significant differences between the two groups in the levels of α2-macroglobulin, C1-inactivator, or antithrombin III. The levels of fibrinogen and α-antitrypsin were significantly higher in the patients vs the controls. Significantly lower levels of α2-plasmin inhibitor and higher levels of α2-plasmin inhibitor/plasmin complex and thrombin/antithrombin III complex were found in the patients vs the controls. These findings suggest that the levels of thrombin/antithrombin III complex, α2- plasmin inhibitor/plasmin complex, and thrombomodulin may perhaps serve as indica tors for injury to the peripheral endothelium and that the coagulation and fibrinolytic systems may be activated in patients with intermittent claudication.

A giant left ventricular thrombus in a patient with acute myocardial infarction--a case report.

The authors report a patient with acute anteroseptal myocardial infarction with a giant left ventricular thrombus at the apex. The patient also had nephrotic syndrome due to diabetic nephropathy. Coronary angiography showed 90% stenosis at segment 6 of the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty and intracoro nary stenting were performed on the 30th day, and effective coronary blood flow was obtained. Heparin was injected intravenously for the first 7 days, and warfarin was administered there after. The left ventricular thrombus disappeared after 46 days. No evidence of arterial throm boembolism was found during the disappearance of the left ventricular thrombus as deter mined by echocardiography.

The associations among thoracic aortic atherosclerosis, coronary atherosclerosis and the function of high density lipoprotein

We sought to determine the associations among thoracic aortic atherosclerosis, coronary atherosclerosis and the function of high density lipoprotein (HDL) in a case-control study. The function of HDL can be assessed by the fractional esterification rate of cholesterol in low density lipoprotein (LDL)- and very low density lipoprotein (VLDL)-depleted plasma (FER(HDL)), which reflects a balance of cholesterol uptake by HDL and cholesterol ester (CE) transport in the reverse cholesterol transport (RCT) system in humans. Cases (n=51, age: 64.3+/-8.0 years) and controls (n=51, age: 58.7+/-13.1 years) were defined as subjects with/without angiographically proven coronary artery disease (CAD), respectively and examined for thoracic aortic atherosclerosis (TAA) by transesophageal echocardiography. The severity of TAA was determined by the ratio of average sclerotic areas (ASA) and average sclerotic lengths (ASL). The cases had significantly (P<0.05) higher values of ASA (0.22+/-0.18 vs. 0.10+/-0.11), ASL (0.82+/-0.56 vs. 0.48+/-0.45), ASA/ASL ratio (0.23+/-0.08 vs. 0.17+/-0.09) and FER(HDL) (10.3+/-3.8 vs. 8.3+/-3.5% per hour) and lower HDL-C and apolipoprotein A-I levels than the controls. A receiver operating characteristic (ROC) curve analysis showed that ASA/ASL and FER(HDL) had moderate discriminating ability for CAD and the diagnostic accuracy of ASA/ASL was better than that of FER(HDL) (area under ROC curve: 0.703 and 0.656, respectively). Multivariate logistic regression analysis indicated that ASA/ASL and FER(HDL) were independent indicators for CAD [odds ratio (95% CI): 7.5 (2.4-27), P<0.01 and 4.0 (1.2-15), P<0.05] after adjusting for age, gender and other conventional risk factors, and that a high FER(HDL) value greatly increased the relative risk of CAD associated with a high ASA/ASL. The function of HDL, as assessed by FER(HDL), enhances the ability of TAA to predict CAD.

Evaluation of hemodynamic effects of nitroglycerin on the utility of transesophageal echocardiography for diagnosis of coronary artery stenosis

Abstract We evaluated left anterior descending coronary artery stenosis by transesophageal echocardiography using the acute hemodynamic effects produced by administration of nitroglycerin (NTG) spray in 11 patients with stenosis and 8 subjects without stenosis (normal group). Before administration of NTG, there were no differences in systolic and diastolic blood pressure, heart rate, the diameter of the left main trunk, systolic flow velocity (SFV), diastolic flow velocity (DFV), or the ratio of diastolic flow velocity to systolic flow velocity (DFV:SFV) between the normal and stenosis groups. NTG administration significantly reduced systolic and diastolic blood pressures and significantly increased heart rate and the diameter of the left main trunk in each group. The increase in diameter of the left main trunk was significantly greater in the normal group compared with the stenosis group, despite the lack of significant differences in NTG-induced changes in blood pressure and heart rate between the two groups. NTG significantly increased peak SFV and DFV in both groups. The average NTG-induced change in SFV was similar in both groups, but the increase in DFV was significantly greater in the stenosis group compared with the normal group. Consequently, the DFV:SFV decreased significantly after NTG administration in the normal group but not in the stenosis group. The change in DFV:SFV was significantly different between the two groups. Our results suggest that NTG spray is potentially useful for enhancing the diagnostic utility of transesophageal echocardiography for stenosis of the left descending coronary artery.

Relationship of alcohol consumption and smoking to plasma cortisol and blood pressure

The role of plasma cortisol in the relationship of alcohol consumption and smoking with BP was investigated in a study of 297 Japanese men, aged 50-54 years, who were not receiving antihypertensive agents. They were admitted to the Self-Defense Forces Fukuoka Hospital between January and June 1992 for a detailed pre-retirement health examination. A history of alcohol consumption and cigarette smoking were determined from a self-administered questionnaire. The plasma level of cortisol and BP were determined in the morning of the first admission day. While the plasma level of cortisol was positively related to systolic and diastolic BP, cortisol levels did not vary substantially with alcohol consumption. Both BP and plasma cortisol levels were lower among current smokers than nonsmokers. The lower BP observed among current smokers was ascribed in part (about 20-30%) to the plasma cortisol levels. While the cortisol levels may contribute the lower BP among current smokers, the data did not support its role in mediating the alcohol-BP relationship.