Kazuyuki Tanoue

Mid-term mortality of very elderly patients with acute myocardial infarction with or without coronary intervention

BACKGROUND The risk benefit of percutaneous coronary intervention (PCI) in very elderly patients with acute myocardial infarction (AMI) is currently unclear. Here, we aim to identify the characteristics of these patients and clarify their mid-term mortality rate with or without PCI. METHODS AND RESULTS 77 patients (> or =80 years) were chosen from 506 patients with AMI, and treated with (n=32) or without (n=45) PCI. The mean age and time from onset to admission increased in patients having undergone no PCI. The reasons for PCI refusal were patient/family preference (40%), renal dysfunction (17.8%), or cognitive impairment (13.3%). Patients treated with PCI had lower mid-term mortality than those without PCI (34.4% vs 62.2%; p=0.02), while patients taking beta-blockers displayed a significantly lower mortality rate than those without (18.2% vs 63.6%; p=0.0003). Cognitively impaired patients had a higher mortality rate compared with cognitively normal patients (80.0% vs 46.3%; p=0.005). Multivariate analysis indicated that systolic blood pressure on admission, PCI, and beta-blocker therapy independently decreased mid-term mortality in these patients. CONCLUSIONS PCI and beta-blocker therapy displayed significantly beneficial effects on mid-term mortality in very elderly AMI patients. Elderly-specific trials concerning coexisting disorders are needed to further examine the treatment-related benefits.

Swallowing-Induced Atrial Tachyarrhythmia Triggered by Solid Foods

A 51-year-old woman had a 1-year history of recurrent episodes of presyncope while eating. She received treatment for vertigo, but symptoms did not improve. Because she also had dimmed vision, she was admitted to our hospital. There were no abnormal findings on physical examination and blood tests. Her resting 12-lead ECG showed sinus rhythm and no abnormality (Figure 1). Transthoracic echocardiography revealed normal left ventricular function and no structural heart disease (Figure 2, Movie IA and IB in the online-only Data Supplement). …

The Value of Lung Perfused Blood Volume Computed Tomography in Selecting the Target Lesions for the Effective Treatment of Chronic Thromboembolic Pulmonary Hypertension

Pulmonary endarterectomy is a conventional definitive therapeutic strategy for the treatment of chronic thromboembolic pulmonary hypertension.1 Several reports recently demonstrated that balloon pulmonary angioplasty (BPA) improves clinical status and hemodynamics in patients with chronic thromboembolic pulmonary hypertension.2 Because the success of reperfusion of occluded pulmonary vessels is considered to depend on the patency of the distal vessels via the systemic collateral circulation, the assessment of regional pulmonary perfusion is important for the selection of the candidates when performing either BPA or pulmonary endarterectomy. Lung perfusion scintigraphy cannot provide information regarding lung perfusion via the systemic collateral circulation. Lung perfused blood volume computed tomography (PBV-CT) is useful for the assessment of lung perfusion in occluded areas during the pulmonary arterial phase and the systemic arterial phase.3 A 73-year-old man was referred to …

Prediagnostic electrocardiographic and echocardiographic findings of biopsy-proven hypertrophic cardiomyopathy

We present two cases of biopsy‐proven hypertrophic cardiomyopathy (HCM). Both cases showed abnormal electrocardiographic (ECG) findings more than 8 years before diagnosis. A 16‐year‐old healthy male experienced a rescued cardiac arrest. Another male adolescent showed abnormal Q wave and thickened ventricular wall at 15 years old. Retrospective analyses of ECGs performed at 6 years old indicated abnormal ECG findings. However, the diagnosis was normal because no ventricular wall thickening was present in echocardiography. For early diagnosis of HCM to prevent sudden cardiac arrest or death, it is essential to establish ECG and echocardiographic criteria to screen HCM in the young.