Yumie Matsui

Residual left ventricular pump function following acute myocardial infarction in postmenopausal diabetic women

BackgroundThe Framingham Study indicated that women with diabetes mellitus developed cardiac failure four times more often than those without diabetes mellitus after acute myocardial infarction. However, there is little information on residual left ventricular pump function after myocardial infarction in female diabetic patients. MethodsTo evaluate the difference between postmenopausal women and age-matched men in the impact of diabetes mellitus on left ventricular pump function during the first year after myocardial infarction, radionuclide angiography was performed during the third week after acute myocardial infarction and again 1 year later in 50 patients (21 women, 29 men) with diabetes mellitus and 62 patients (25 women, 37 men) without diabetes mellitus. ResultsAlthough the radionuclide angiographie indices did not change during the first year after myocardial infarction in non-diabetic patients, left ventricular end-diastolic volume increased, and the left ventricular ejection fraction, the regional ejection fraction of the non-infarcted area, and the ratio of arterial systolic blood pressure to left ventncular end-systolic volume (pressure:volume ratio) decreased in the diabetic patients. Furthermore, the degree of change in the left ventricular end-diastolic volume, the left ventricular ejection fraction, the regional ejection fraction of the non-infarcted area, and the pressure: volume ratio in diabetic women was larger than that in diabetic men. ConclusionThe increase in the left ventricular end-diastolic volume and the decrease in the regional ejection fraction of the non-infarcted area during the first year after myocardial infarction in postmenopausal women with diabetes mellitus indicate that female sex associated with diabetes mellitus may be important factors in left ventricular remodeling in postmenopausal women.

Effect of Ventriculoarterial Coupling on Residual Left Ventricular Pump Function in Diabetic Patients with Myocardial Infarction

To study the ventriculoarterial coupling in diabetic patients with myocardial infarction (MI), 26 diabetic and 34 nondiabetic patients were investigated using radionuclide angiography in the 3rd week after acute MI. Effective arterial elastance was nearly one half of left ventricular end-systolic elastance in nondiabetic patients. On the other hand, effective arterial elastance was twice left ventricular end-systolic elastance in diabetic patients. These data suggest that a decrease in left ventricular contractility and an increase in effective arterial elastance lead to increased potential energy and decreased work efficiency in diabetic patients.

Effect of subadipose tissue on the variables of signal-averaged electrocardiography in healthy subjects

Abstract Ventricular late potentials are high-frequency, low-amplitude signals in the terminal portion of the QRS complex obtained by signal-averaged electrocardiography. 1,2 Although late potentials are thought to represent delayed and inhomogeneous conduction, quantitative variables that define late potentials have been reported to be affected by gender, 13 body size 4 or echocardiographically estimated left ventricular mass. 5 However, the effect of subadipose tissue (which is well known to influence the QRS amplitude of surface electrocardiography) on late potentials has not been evaluated. This study assessed the relation between late potentials and various obesity indexes evaluated by body weight and height, skin folds and left ventricular mass.

The effectiveness of super-selective injection with anchor balloon technique for collateral channel assessment

The careful assessment of collateral channels is important for a retrograde approach for a chronic total coronary occlusion (CTO). This case report describes a percutaneous coronary intervention for CTO of the distal right coronary artery with good collateral circulation. All visible collateral channels failed by the retrograde approach; however, the procedure was successful using the distal atrial circumflex (AC) channel. Although this distal channel was poorly visualized on standard coronary angiography, it was clearly contrasted retrogradely from the CTO exit using a super-selective injection through the proximal AC channel as the antegrade flow was obstructed by the anchor balloon. This case highlights a unique super-selective injection with anchor balloon technique for collateral channel assessment.

The potential hazard of drug-eluting stent-induced coronary vasospasm causing subacute stent thrombosis: a case report.

BackgroundDrug-eluting stent (DES) -induced coronary vasospasm is a well known phenomenon after stent implantation; however, the extent of this risk is still unknown. We report a case in which DES-induced severe coronary vasospasm was clinically suspected as a cause of subacute stent thrombosis (ST).Case presentationA 67-year-old man came to our hospital due to chest pain with mild exercise. He was diagnosed with effort angina by coronary angiography and underwent DES implantation in the mid-left ascending artery (LAD) after the administration of dual anti-platelet therapy. The procedure was uneventful, but his symptoms changed from effort angina to rest angina after stenting. Five days after the procedure, subacute ST occurred, requiring aspiration thrombectomy and balloon angioplasty. Thereafter, he continued to report early morning chest discomfort. We performed a spasm provocation test to evaluate the coronary vasomotor response; it revealed severe stent-edge spasm in the left main trunk to the LAD, except for the stented lesion, and total occlusion of the left circumflex artery.ConclusionsTo our knowledge, the present case is the first report describing in-stent thrombosis secondary to stent-edge spasm. This case describes the potential hazard of DES-induced coronary vasospasm. Although there are several overlapping risk factors for ST development, we consider that stent-edge spasm also plays an important role in ST development. Therefore, we should monitor new-onset rest angina after stent implantation and carefully assess DES-induced coronary vasospasm.

Catheter Ablation for ERS

Since its first clinical evidence in 2008, there have been only few clinical reports of ablation in early repolarization syndrome (ERS). What is still undetermined is whether the mechanism of the ablation effect is due to the suppression of the trigger or substrate modification. In idiopathic ventricular fibrillations (VFs), the triggering sources mainly arose from either the Purkinje system or, less commonly, from the ventricular muscle. In ERS, VF sources from right or left Purkinje tissue are dominant (83%), with the site of origin correlating with the electrocardiographic location of early repolarization. RF catheter ablation of ERS is feasible and can be used as a bailout therapy for drug-refractory VF storms. Further studies are needed to evaluate the precise mechanisms of this arrhythmia.

Left bundle branch block during antegrade balloon aortic valvuloplasty caused by stiff-wire loop stress

An 88-year-old female with recurrent heart failure due to severe aortic stenosis underwent antegrade balloon aortic valvuloplasty (ant-BAV) using Inoue balloon catheter (Toray, Tokyo, Japan). Preprocedural coronary angiogram revealed no significant stenosis. The stiff wire was across from left atrium, via mitral valve and left ventricle to the descending aorta and captured by the snare catheter (Fig. 1a). The Inoue balloon was advanced over the intraventricular wire loop to a position across aortic valve. During this manipulation, holding the stiff wire made the snare fixing point and the wire to be pulled down near to aortic valve, indicating strong wire tension (Fig. 1b). Incidentally, there was a new-onset left bundle branch block (LBBB) (Fig. 1c). Her hemodynamic state was stable and then, dilatation was performed using stepwise technique (Fig. 1d). Even though the LBBB was continued during the procedure, it was improved after 6 h without advancement to atrioventricular block (Fig. 1e, f). The successful reduction in transaortic valve gradient and increase in AV area resulted in improvement of her clinical condition. Cardiac conduction disturbances while retrograde BAV (retro-BAV) and transcatheter aortic valve implantation are previously reported and associated with balloon oversizing [1]. In this case, the mechanical stress by stiff-wire intraventricular loop during advancement of the Inoue balloon caused the new-onset LBBB regardless of balloon inflation. Although the maximum characteristic of ant-BAV the stiffwire loop with snare fixing offers several advantages over retro-BAV, this procedure gives stronger wire-loop stress for intra-ventricular conduction systems. In positioning of the

Effect of atrial and ventricular activation interval on hemodynamics during atrioventricular and ventriculoatrial pacing : determination from pressure-volume loops in dogs

To determine the effect of relative timing of atrial and ventricular activation on hemodynamic indices, we evaluated pressure-volume loops during pacing at 160 beats/min with various atrioventricular intervals in dogs. End-systolic pressure, end-diastolic volume, and stroke volume were reduced during pacing at atrioventricular intervals of 0 ms, compared with 80 ms. These changes were more significant during pacing at atrioventricular intervals of -50 and -100 ms than at 0 ms. During tachycardia, the abnormal timing of atrial contraction leads to unfavorable hemodynamic change and the degree of the changes are determined by the ventriculoatrial activation interval.

Effect of Subadipose Tissue on the Variables of Signal-Averaged Electrocardiograms in Healthy Subjects

Ventricular late potentials are obtained by signal averaging of surface electrocardiograms. Late potentials have been reported to be affected by body size or left ventricular mass. However, the effect of subadipose tissue, which is known to influence QRS amplitudes of surface ECG, on the variables of late potentials has not been evaluated. The relationships between the variables of late potentials and various obesity indices were assessed in 45 men, aged 24-38 years, without structural heart disease and bundle branch blocks. QRS duration, root mean square voltage in the last 40 ms and low-amplitude signals < 40 microV were obtained by signal-averaged ECG. Left ventricular mass was determined by echocardiography. QRS duration and root mean square voltage had no correlation with body height, weight, body mass index, sum of skin folds (triceps and subscapular) or left ventricular mass. Positive linear correlations were found between low-amplitude signals and weight (r = 0.48, p < 0.002) body mass index (r = 0.54, p < 0.002), sum of skin folds (r = 0.57, p < 0.002), percent body mass index (r = 0.54, p < 0.002). Subadipose tissue may shift the onset of the 40-microV point of low-amplitude signals to the left with a consequent prolongation of low-amplitude signals by attenuation of the QRS complex. These data suggest that the use of low-amplitude signals alone or as a combination in an obese population for the definition of positive late potentials is inappropriate. The low-amplitude signal has to be used with caution in obese patients.(ABSTRACT TRUNCATED AT 250 WORDS)