Yasuhiko Yamauchi

C-Reactive Protein in Dilated Cardiomyopathy

The prognosis for patients with idiopathic dilated cardiomyopathy (DCM) is poor, although clinical features are variable. Prediction of outcome has been difficult in individual patients based on laboratory data. In some patients with DCM, myocardial damage secondary to viral or immune-mediated myocardial inflammation may persist. To objectively assess inflammation, we measured plasma concentrations of C-reactive protein (CRP) in 188 patients with idiopathic DCM over 5–8 years. All had dyspnea and fatigue at rest; all patients had a left ventricular ejection fraction less than 40% by echocardiography or by contrast or radionuclide ventriculography. We divided these patients into two groups: patients dying within 5 years following admission (n = 49) and the remainder surviving for at least 5 years (n = 139). CRP concentrations in the patients dying early were significantly higher than in the long-term survivors (1.05 ± 1.37 vs. 0.49 ± 1.04 mg/dl, p < 0.05). Sixty-two percent of the patients with CRP>1.0 died within 5 years. In addition to other laboratory tests including electrocardiography and echocardiography, routine CRP measurements proved to be valuable for identifying high-risk patients who require special treatment strategies.

Indium 111-Labeled Platelets Accumulation Over Abdominal Aortic Graft with Chronic Disseminated Intravascular Coagulation-A Case History:

The authors describe a seventy-six-year-old man with aortic graft, which became the focus of chronic disseminated intravascular coagulation (DIC). The patient had abdominal aortic aneurysm (AAA) and the size had increased up to 38 mm in diameter. The AAA was excised and replaced by Dacron graft. Ten months later, the DIC became chronic with renal dysfunction. Indium 111-labeled platelets scintigraphy showed increased accumulation of radioactivity over the graft. In the treatment of chronic DIC, low-dose subcutaneous heparin injection (5,000-10,000/day) was effective, and he was discharged. In this case there was also suspicion of lung cancer and recurrent aortic aneurysm, which were a more reasonable cause of chronic DIC. This case suggests that an aortic graft prosthesis may be a cause of localized chronic DIC and that indium 111-labeled platelets scintigraphy is useful for the detection of localized chronic DIC. Moreover, subcutaneous heparin administration may be effective for chronic DIC in patients with an abdominal aortic graft prosthesis.

Does myocardial thallium-201 SPECT combined with electron beam computed tomography improve the detectability of coronary artery disease? : Comparative study of diagnostic accuracy

ObjectiveThe aim of this study is to evaluate the diagnostic accuracy of myocardial201T1 SPECT combined with EBT for detecting CAD.MethodsThe study was based on 34 patients with suspected CAD, who had EBT and myocardial201Tl SPECT. The CAD was diagnosed by the findings of coronary arteriography. Sensitivity, specificity and accuracy of EBT, myocardial201Tl SPECT and the combined diagnosis on a per vessel basis and a per-patient basis were studied.ResultsThe sensitivity for detecting CAD of myocardial201Tl SPECT, EBT and the combined diagnosis was 85%, 77%, and 62%, respectively. No significant difference in the accuracy of myocardial201T1 SPECT, EBT and the combined diagnosis was observed on a patient basis and per vessel basis. In the over 70 yr age subgroup, the sensitivity and accuracy of EBT for detecting LAD lesion were significantly superior to those of myocardial201Tl SPECT. Regardless of age-based subgroups and gender, the combined diagnosis did not contribute to an improvement in diagnostic accuracy.ConclusionAlthough the sensitivity of EBT for detecting LAD lesion in patients over 70 yr of age was significantly higher than that of myocardial201Tl SPECT, in the detectability of CAD, combined use of myocardial201Tl SPECT and EBT offers no improvement.