Tomofumi Mizuno

Clinical Characteristics and Long-Term Outcomes of Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) has various morphological and clinical features. A decade has passed since the previous survey of the epidemiological and clinical characteristics of Japanese HCM patients. The Aichi Hypertrophic Cardiomyopathy (AHC) Registry is based on a prospective multicenter observational study of HCM patients. The clinical characteristics of 42 ambulant HCM patients followed up for up to 5 years were investigated. The primary endpoint was major adverse cardiac events (MACE), defined as death, non-fatal stroke, admission due to congestive heart failure (CHF), or episodes of sustained ventricular tachycardia/fibrillation. The MACE-free survival during the 5-year follow-up period was 76% according to Kaplan-Meier analysis. HCM-related death occurred in 3 (7%) patients and SCD occurred in 2 (5%) patients. Additionally, 3 (7%) patients were admitted to the hospital due to CHF. Meanwhile, sustained VT was detected in one (2%) of the patients who received ICD implantation and subsequently terminated with antitachycardia pacing using an ICD. The patients with HCM exhibiting left ventricular outflow obstruction (HOCM) had a slightly lower MACE-free survival rate than those with neither HOCM nor dilated-HCM (dHCM) (71% versus 81%, log-rank P = 0.581). Furthermore, the patients with dHCM demonstrated a significantly lower MACE-free survival rate than those with neither HOCM nor dHCM (33% versus 81%, log-rank P = 0.029). In the AHC Registry targeting current Japanese HCM patients, we demonstrated that many HCM patients continue to suffer from MACE despite the development of various treatments for HCM.

Impact of Continuous Administration of Tolvaptan on Preventing Medium-Term Worsening Renal Function and Long-Term Adverse Events in Heart Failure Patients with Chronic Kidney Disease

Tolvaptan (TLV) has an inhibiting effect for worsening renal function (WRF) in acute decompensated heart failure (HF) patients. However, there are limited data regarding the effect of continuous TLV administration on medium-term WRF.This was a retrospective observational study in hospitalized HF patients with chronic kidney disease (CKD). TLV was administered to those patients with fluid retention despite standard HF therapy. We compared 34 patients treated with TLV (TLV group) to 33 patients treated with conventional HF therapy with high-dose loop diuretics (furosemide ≥ 40 mg) (Loop group). Clinical outcomes, including the incidence of medium-term WRF, defined as increase of serum creatinine > 0.3 mg/dL, at 6 months after discharge and adverse events rate, were evaluated.Baseline patient characteristics were not different between the TLV and Loop group. The TLV group consisted of less frequent use of loop diuretics and carperitide compared with the Loop group. The incidence of medium-term WRF was significantly lower in the TLV group than in the Loop group (3.2% versus 31.0%, P = 0.002). Multivariate logistic analysis showed that the TLV non-user was an independent predictor of medium-term WRF. Kaplan-Meier analysis revealed that the long-term event-free survival was significantly higher in the TLV group (log-rank P = 0.01).Continuous administration of TLV may reduce the risk of medium-term WRF, resulting possibility in improvement of long-term adverse outcomes in HF patients with CKD.

Effects of polyunsaturated fatty acids on periprocedural myocardial infarction after elective percutaneous coronary intervention.

AIMS The aim of this study was to address the association of lipid profiles with periprocedural myocardial infarction (pMI) after elective percutaneous coronary intervention (PCI). METHODS AND RESULTS Of the 302 consecutive patients who received elective PCI at the Chubu Rosai Hospital, Nagoya, Japan between June 2009 and December 2010, data from 231 native coronary lesions were analysed. Various biomarkers including serum troponin T (TnT), eicosapentaenoic acid (EPA), arachidonic acid (AA), and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol were measured at baseline and at 18 hrs after PCI. pMI was defined as a post-procedural increase of TnT >3 times above the upper normal limit. Patients with pMI had significantly lower EPA/AA (0.25 [0.19-0.28] vs. 0.45 [0.21-0.62], p<0.001) and higher LDL/HDL cholesterol (3.00±1.05 vs. 2.36±0.90, p=0.008) than patients without pMI. On multivariate logistic analysis, EPA/AA per 0.1 increase (hazard ratio [HR] 0.62, 95% CI: 0.43-0.88, p=0.007), LDL/HDL (HR 1.92, 95% CI: 1.15-3.19, p=0.012), stented length (HR 1.40, 95% CI: 1.07-1.83, p=0.015), and the presence of unstable angina pectoris (UAP) (HR 8.89, 95% CI: 2.83-27.9, p<0.001) were significantly and independently associated with the incidence of pMI. CONCLUSIONS EPA/AA and LDL/HDL were significantly associated with pMI after PCI, creating the possibility of a new therapeutic target of pMI.

Relaxant properties mediated by nitroglycerin in aortic coarctation hypertensive rats.

Abstract Nitroglycerin-mediated vasorelaxation is chiefly attributed to the cyclic guanosine monophosphate (cGMP)-dependent pathway, and partly to the cGMP-independent pathway via calcium-activated K+ channels (KCa). To investigate whether chronic hypertension alters responses of vascular smooth muscle to vasoactive agonists, we determined nitroglycerin-mediated relaxation of aortic rings from coarctation hypertensive rats. Banding the abdominal aorta above the renal arteries for 4 weeks elevated blood pressure and caused cardiac hypertrophy by 49%. In response to nitroglycerin, the relaxation of aortic rings precontracted with 10−7 M norepinephrine was lower in the banded group than in the sham-operated group. Methylene blue, a guanylate cyclase inhibitor, suppressed a greater part of nitroglycerin-mediated relaxation and reached similar levels of relaxation in the two groups. Charybdotoxin, a specific KCa channel blocker, also suppressed the relaxation by about 40% in the aortic rings from sham-operated animals, but not in those from the banded group. The response to charybdotoxin was markedly diminished or virtually eliminated in the banded group in the presence or absence of methylene blue. The combination of charybdotoxin and methylene blue nearly abolished nitroglycerin-mediated relaxation in the sham-operated group, whereas nitroglycerin-mediated relaxation was seen to remain in the banded group. These results indicate that the involvement of cGMP-independent KCa channels in nitroglycerin-mediated relaxation disappeared after the development of hypertension produced by aortic coarctation.

Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives

A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being well-controlled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.

CLINICAL IMPACT OF INTRACORONARY NICORANDIL INFUSION COMPARED TO INTRAVENOUS ADENOSINE TRIPHOSPHATE ON MEASUREMENT OF FRACTIONAL FLOW RESERVE IN INTERMEDIATE CORONARY LESIONS

Fractional flow reserve (FFR) has been recognized as useful modality to assess functional significance of coronary stenosis. It is important to obtain maximal hyperemia for optimal FFR measurement. Although adenosine triphosphate (ATP) is generally used as hyperemic stimulus, we sometimes encounter

TCT-229 The Safety and Feasibility of Nicorandil Compared to Adenosine Triphosphate as Hyperemic Agents for Fractional Flow Reserve Measurements

Withdrawn