Koichi Kihara

Beneficial effects of Waon therapy on patients with chronic heart failure: Results of a prospective multicenter study

BACKGROUND We conducted a prospective multicenter case-control study to confirm the clinical efficacy and safety of Waon therapy on chronic heart failure (CHF). METHODS Patients (n=188) with CHF were treated with standard therapy for at least 1 week, and then were randomized to Waon therapy (n=112) or a control group (n=76). All patients continued conventional treatment for an additional 2 weeks. The Waon therapy group was treated daily with a far infrared-ray dry sauna at 60 degrees C for 15 min and then kept on bed rest with a blanket for 30 min for 2 weeks. Chest radiography, echocardiography, and plasma levels of brain natriuretic peptide (BNP) were measured before and 2 weeks after treatment. RESULTS NYHA functional class significantly decreased after 2 weeks of treatment in both groups. Chest radiography also showed a significant decrease of the cardiothoracic ratio in both groups (Waon therapy: 57.2+/-8.0% to 55.2+/-8.0%, p<0.0001; control: 57.0+/-7.7% to 56.0+/-7.1%, p<0.05). Echocardiography demonstrated that left ventricular diastolic dimension (LVDd), left atrial dimension (LAD), and ejection fraction (EF) significantly improved in the Waon therapy group (LVDd: 60.6+/-7.6 to 59.1+/-8.4 mm, p<0.0001; LAD: 45.4+/-9.3 mm to 44.1+/-9.4 mm, p<0.05; EF: 31.6+/-10.4% to 34.6+/-10.6%, p<0.0001), but not in the control group (LVDd: 58.4+/-10.3 mm to 57.9+/-10.4 mm; LAD: 46.3+/-9.7 mm to 46.2+/-10.1 mm; EF: 36.6+/-14.1% to 37.3+/-14.0%). The plasma concentration of BNP significantly decreased with Waon therapy, but not in the control group (Waon: 542+/-508 pg/ml to 394+/-410 pg/ml, p<0.001; control: 440+/-377 pg/ml to 358+/-382 pg/ml). CONCLUSION Waon therapy is safe, improves clinical symptoms and cardiac function, and decreases cardiac size in CHF patients. Waon therapy is an innovative and promising therapy for patients with CHF.

A New Predictor of Restenosis After Successful Percutaneous Transluminal Coronary Angioplasty in Patients With Multivessel Coronary Artery Disease

With the goal of improving prediction of restenosis after percutaneous transluminal coronary angioplasty (PTCA) for multivessel coronary artery disease (CAD), we evaluated the usefulness of serial exercise treadmill tests. We previously reported that an increase in the deltaST/delta heart rate (HR) index at follow-up over the value obtained several days after PTCA was useful for detecting restenosis following PTCA for 1-vessel CAD. In that report, comparison of the deltaST/deltaHR index was made based on measurements from the lead disclosing the greatest ST displacement before PTCA. This method was not applicable to patients with multivessel CAD. Seventy-eight patients with multivessel CAD before and several days after PTCA and just before follow-up performed exercise treadmill tests. Simple HR-adjusted indexes of ST-segment depression during exercise (deltaST/deltaHR index) and the sum of the deltaST/deltaHR index in leads II, III, aVF, V4, V5, and V6 (sigma deltaST/deltaHR index) were determined. We compared the predictive power of an increase in sigma deltaST/deltaHR index at follow-up with that of a positive exercise treadmill test and a positive thallium scintigram for restenosis. At follow-up, 37 of the 78 patients showed restenosis. The sigma deltaST/deltaHR index had increased in 30 of these 37 patients (81%), and in 12 of the 41 patients (29%) without restenosis. An increase in sigma deltaST/deltaHR index had a significantly higher sensitivity than the other methods and a significantly higher specificity than a positive exercise treadmill test.

Predicting the effects on patients with dilated cardiomyopathy of β-blocker therapy, by using iodine-123 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy

We examined whether the iodine-123 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) myocardial scintigraphy was useful for predicting the treatment response to β-blocker in patients with dilated cardiomyopathy (DCM).Sixteen patients with DCM were studied. BMIPP single photon emission computed tomography (SPECT) was performed before β-blocker therapy. The count ratio of the heart (H) to the upper mediastinum (M) (H/M ratio) was calculated. Several measurements including the BMIPP H/M ratio before the administration of metoprorol were retrospectively compared among the 10 “good responders” (showing improvement by at least one NYHA class or an increase in the ejection fraction of ≧0.10, 6 months after the start of the drug therapy) and the 6 “poor responders.” The bull’s eye map of BMIPP was divided into 17 areas. Each segmental score was analyzed quantitatively by means of a two-point scoring system (good uptake ≧67%, poor uptake < 67%). The total score was regarded as the uptake score.The H/M ratio was significantly higher in the good responders than in the poor responders (2.41 ±0.24 vs. 1.86 ±0.17 p < 0.01). There were no significant differences between the two groups in any other variable data at entry.The uptake score was also a good index for predicting the therapeutic effect. When a relative uptake of 67% or higher was scored as 1, uptake scores of 9 to 17 corresponded to good responses (sensitivity = 100%, specificity = 100%, accuracy = 100%, positive and negative predictive value = 100%).Although the number of patients studied is small, our results suggest that BMIPP myocardial scintigraphy can predict the response to a β-blocker in patients with DCM.

A New Criterion Combining ST/HR Slope and ΔST/ΔHR Index for Detection of Coronary Artery Disease in Patients on Digoxin Therapy

Abstract We evaluated the clinical value of a new index combining ΔST/Δheart rate (HR) index and ST/HR slope for diagnosing coronary artery disease (CAD) in patients on digoxin therapy. Exercise treadmill tests were performed by 72 patients on digoxin therapy. Simple HR–adjusted indexes of ST-segment depression during exercise (ΔST/ΔHR index) and the decline calculated from the final 12 data points relating ST-segment depression to HR (ST/HR slope) were determined. A new index was obtained by subtracting the ΔST/ΔHR index from the ST/HR slope. On thallium scintigraphy, 37 of the 72 patients showed reversible perfusion defects related to the diseased coronary artery. The new index derived from this ST-HR relation was 4.1 ± 3.6 μV/beats/min in the ischemic group and 1.3 ± 1.0 μV/beats/min in the group of patients without ischemia (p

Increase in the ΔSTΔheart rate (HR) index: A new predictor of restenosis after successful percutaneous transluminal coronary angioplasty

Abstract after percutaneous transluminal coronary angioplasty (PTCA), we evaluated the usefulness of the ΔST Δheart rate (HR) index derived from serial exercise treadmill tests. Exercise treadmill tests were performed by 125 patients with single-vessel coronary artery disease before and several days after PTCA, and just before followup angiography 3 to 12 months later. Simple HR-adjusted indexes of ST-segment depression during exercise ( ΔST ΔHR index) were derived. We compared the usefulness of the increase in ΔST ΔHR index at follow-up over the value obtained several days after PTCA for prediction of restenosis with that of a positive exercise treadmill test and a positive thallium scintigram at follow-up. At follow-up, 47 of the 125 patients showed restenosis. The ΔST ΔHR index increased in 43 of 47 patients in the restenosis group and in 18 of 78 patients without restenosis (p ΔST ΔHR index at follow-up: 91%, 77%, 70%, and 94%; positive exercise treadmill test: 83%, 65%, 59%, and 86%; and positive thallium scintigram: 79%, 78%, 69%, and 86%. The increased ΔST ΔHR index had a significantly (p ΔST ΔHR index at follow-up identifies subgroups of patients who are at high risk for restenosis after PTCA.

No reflow-like pattern in intramyocardial coronary artery suggests myocardial ischemia in patients with hypertrophic cardiomyopathy.

BACKGROUND AND PURPOSE To evaluate intramyocardial coronary flow velocity pattern by transthoracic Doppler echocardiography and its clinical significance in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS In 48 patients with HCM who had angiographically normal coronary artery, coronary flow velocity in the left anterior descending coronary artery (LAD) and intramyocardial coronary artery (IMCA) derived from LAD were evaluated using transthoracic Doppler echocardiography. Two clearly different flow patterns in the IMCA were observed in patients with HCM. Twenty-seven HCM patients (group A) had slow deceleration slope in the IMCA flow (average diastolic deceleration time, 989+/-338; range, 585-1680) and the remaining 21 patients (group B) had steep deceleration slope with diastolic deceleration time <300 ms, resulting in a no reflow-like pattern in the IMCA flow (average diastolic deceleration time, 166+/-67; range, 55-280). There were no significant differences in the clinical characteristics and LAD flow velocity profiles between the two groups. The incidence of cardiovascular symptoms (chest pain or syncope) was significantly higher in group B than in group A (67% vs. 26%, p<0.01). Additionally, exercise-induced ischemia as detected by thallium-201 scintigraphy was significantly more frequent in group B than in group A (6 of 9 (67%) vs. 0 of 9 (0%), p<0.01). CONCLUSIONS Two different intramyocardial coronary flow velocity patterns are observed in patients with HCM using transthoracic Doppler echocardiography. No reflow-like pattern in the IMCA is strongly related to myocardial ischemia in the absence of epicardial coronary artery stenosis, suggesting that coronary microvascular dysfunction may be a causative mechanism.

Mechanisms of Limited Maximum Coronary Flow in Severe Single-Vessel Coronary Artery Disease in Humans Due to Vertical Steal

We evaluated the usefulness of a decrease in the average peak velocity from 4 to 10 minutes after infusion of dipyridamole for detecting myocardial ischemia in 50 patients, including patients with a prior myocardial infarction. The decrease in the average peak velocity from 4 to 10 minutes associated with vertical steal and combined with a coronary flow reserve of < 1.6 had a high predictive value for myocardial ischemia in patients with or without prior myocardial infarction.

Attenuated early diastolic interventricular septum bulging by pulmonary hypertension due to later developed aortic regurgitation

A woman was admitted due to dyspnea. She had familial pulmonary arterial hypertension and typical echocardiographic findings including early diastolic bulging of the interventricular septum toward the left ventricular cavity. Her symptoms improved with medication. Five months later, she was hospitalized again due to severe dyspnea. Echocardiography demonstrated aortic valve vegetation and its regurgitation. Echocardiography also showed attenuation of early diastolic compression of the interventricular septum, however, the peak tricuspid regurgitant flow velocity did not improve. It is likely that development of left-sided heart failure attenuated abnormal interventricular septal motion due to pulmonary hypertension.

TCTAP C-239 Transdermal Balloon Puncture for Extracting Remained Un-deflated Balloon Below-the-Knee Lesion

### Patient initials or identifier number 8091 ### Relevant clinical history and physical exam A 65 year-old-female referred to our hospital because of a right lower limb ulceration. Past medical history included chronic renal failure and hemodialysis. A clinical examination showed her right leg

TCTAP C-202 Coil Embolization for Peripheral Vessel Perforation

PTA lesion, a 0.014 inch guide wire with micro-catheter was further advanced intodorsalis pedis artery (DPA) retrogradely. However, occlusion site of DPA was so hard that a stiff wire could easily advanced into subintimal space. We advanced another guide wire into ATA antegradely. Wire rendezvous technique was performed in the proximal DPA, followed by balloon angioplasty. Finally, complete revascularization of ATA and PTA including pedal arch was achieved. Case Summary. Re-vascularization of below-the-knee (BTK) including BTA lesion has been reported to be helpful for limb salvage inpatients with critical limb ischemia (CLI). On the other hand, the efficacy of endovascular therapy (EVT) for collagen-vascular disease might be controversial. In this case, complete re-vascularization of BTA lesions might be effective for limb salvage of a collagen-vascular disease patient.