[Show abstract][Hide abstract] ABSTRACT: Serum deoxyribonuclease I (DNase I) activity was reported to increase in the early phase after onset of acute myocardial infarction (AMI). Up to now, DNase I activity has been quantified by the single radial enzyme diffusion (SRED) method, which unfortunately requires a long incubation time. Therefore it is necessary to develop another assay suitable for measurement of serum DNase I concentrations in a clinical setting.
A sandwich ELISA was established for measurement of DNase I protein using a polyclonal antibody directed against DNase I protein and a biotinylated monoclonal for subsequent detection. Concentrations of serum DNase I protein were measured in healthy individuals and patients with AMI.
This method was as precise as SRED, and took less time than SRED. A significant correlation was observed between DNase I concentration and enzyme activity (r=0.839; P<0.001). The average of serum DNase I in AMI patients within 0-12 h of chest pain was significantly higher than that in healthy individuals (P<0.001), and decreased with time.
We have developed a sensitive ELISA capable of measuring DNase I protein concentrations. This method may be a useful alternative to SRED as an aid to diagnosis of AMI based on the serum DNase I level.
Clinica chimica acta; international journal of clinical chemistry 04/2009; 403(1-2):219-22. DOI:10.1016/j.cca.2009.03.005 · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Functional mitral regurgitation (MR) is common in patients with chronic heart failure (CHF). During exercise, hemodynamic changes such as elevation of blood pressure and an increase in the left ventricular end-diastolic dimension may increase MR. Severity of CHF is reflected by exercise tolerance and, therefore, MR during exercise is supposed to indicate the severity of heart failure. The degree of MR increase and left ventricle (LV) shape was quantified during exercise in CHF patients and were compared with exercise tolerance.
Twenty patients with CHF (mean age: 63 years) underwent dynamic cycle exercise at steady-state levels of 80% and 150% of the anaerobic threshold (AT). The MR jet area and left atrial (LA) area were measured during exercise and the ratio of MR/LA was calculated. The LV shape was assessed by calculating the ratio of the major to the minor axis. The MR/LA ratio increased during exercise (rest: 16.9+/-6.5%, 80% AT: 21.9+/-8.9%, 150% AT: 30.9+/-11.2%; p<0.01) and the LV shape became more spherical (rest: 1.34+/-0.10, 80% AT: 1.31+/-0.10, 150% AT: 1.23+/-0.11; p<0.05). There was a negative correlation between MR/LA ratio and the ratio of the major to the minor axis (-0.722, r<0.01).
MR during exercise increases as the severity of CHF increases. Functional MR is correlated with the shape of the LV.
[Show abstract][Hide abstract] ABSTRACT: Iodine-123 MIBG imaging has been used to study cardiac sympathetic function in various cardiac diseases. Central sleep apnea syndrome (CSAS) occurs frequently in patients with chronic heart failure (CHF) and is reported to be associated with a poor prognosis. One of the mechanisms of its poor prognosis may be related to impaired cardiac sympathetic activity. However, the relationship between chemosensitivity to carbon dioxide, which is reported to correlate with the severity of CSAS, and cardiac sympathetic activity has not been investigated. Therefore, this study was undertaken to assess cardiac sympathetic function and chemosensitivity to carbon dioxide in CHF patients.
The oxygen desaturation index (ODI) was evaluated in 21 patients with dilated cardiomyopathy (male/female: 19/2, LVEF < 45%, 65 +/- 12 yr). Patients with an ODI > 5 times/h underwent polysomnography. Patients with an apnea hypopnea index > 15/h but without evidence of obstructive apnea were defined as having CSAS. Early (15 min) and delayed (4 hr) planar MIBG images were obtained from these patients. The mean counts in the whole heart and the mediastinum were obtained. The heart-to-mediastinum count ratio of the delayed image (H/M) and the corrected myocardial washout rate (WR) were also calculated. The central chemoreflex was assessed with the rebreathing method using a hypercapnic gas mixture (7% CO2 and 93% O2).
Ten of the 21 patients had CSAS. The H/M ratio was similar in patients both with and without CSAS (1.57 +/- 0.18 vs. 1.59 +/- 0.14, p = 0.82). However, the WR was higher in patients with CSAS than in patients without CSAS (40 +/- 8% vs. 30 +/- 12%, p < 0.05). ODI significantly correlated with central chemosensitivity to carbon dioxide. Moreover, there was a highly significant correlation between WR and central chemosensitivity (r = 0.65, p < 0.05). However, there was no correlation between ODI and the WR (r = 0.36, p = 0.11).
Cardiac sympathetic nerve activity in patients with CHF and CSAS is impaired. However, central sleep apnea might not directly increase cardiac sympathetic nerve activity. We suggest that central chemosensitivity, which is considered to be one of the mechanisms of CSAS, is correlated with cardiac sympathetic nerve activity.
Annals of Nuclear Medicine 02/2007; 21(1):73-8. DOI:10.1007/BF03034002 · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Functional mitral regurgitation (MR) is common in patients with chronic heart failure (CHF) and left ventricular dysfunction. The severity of CHF is expressed in terms of exercise tolerance, so MR during exercise would affect the severity of heart failure. However, it is not well known how much MR increases during exercise, or if it is related with severity of heart failure.
Seventeen subjects underwent dynamic cycle exercise at steady-state levels of 80% and 150% of anaerobic threshold (AT). During each exercise level, the MR jet and left atrial (LA) area were measured, and the degree of MR was expressed as the ratio (MR/LA). The MR/LA increased slightly at 80% AT (rest: 15.5+/-7.8%, 80% AT: 21.7+/-9.3%, p<0.05). It increased more at 150% AT (29.2+/-11.6%, p<0.01). The MR/LA at both 80% and 150% AT weakly correlated with peak oxygen consumption/heart rate (r=-0.509). They showed a weakly positive correlation with the ventilatoly equivalent/CO(2) production slope (r=0.340).
MR during exercise increases as stroke volume worsens during exercise, so evaluation of MR during exercise is important in the management of patients with CHF.
[Show abstract][Hide abstract] ABSTRACT: The minute ventilation/carbon-dioxide output (VE/VCO2) slope as a marker of cardiac events has been established in patients with severe heart failure, but it is not known whether it is useful for other heart diseases.
The present study investigated 215 patients with various heart diseases (age 59+/-11 years; ischemic heart disease, n=89; dilated cardiomyopathy, n=38; valvular disease, n=37; hypertensive heart disease, n=33; others, n=18) who underwent cardiopulmonary exercise testing to determine the VE/VCO(2) slope. Patients were divided into 2 groups according to the VE/VCO2 slope and were followed-up for 3 years. Forty-eight cardiac events (6 deaths, 42 re-hospitalizations) occurred during the observation period. Patients with a VE/VCO2 slope >34 had a significantly higher 3-year cardiac event rate (32.1%) than patients with VE/VCO2 slope <34 (18.9%, p<0.05). When patients were selected with relatively preserved peak oxygen uptake values (>16 ml . kg (-1) . min(-1)), patients with VE/VCO2 slope >34 still demonstrated a significantly higher cardiac event rate than other patients (35.0% vs 13.3%, p<0.01).
The VE/VCO2 slope may be a prognostic indicator of cardiac events in a heterogeneous group of patients with heart disease, independent of exercise tolerance.
[Show abstract][Hide abstract] ABSTRACT: A prospective randomized study compared the preventive effects of ticlopidine plus aspirin therapy versus cilostazol plus aspirin therapy on subacute thrombosis (SAT) and restenosis after coronary stenting.
After successful stenting of 327 coronary lesions in 282 consecutive patients, the patients were randomized to receive ticlopidine (200 mg/day) or cilostazol (200 mg/day). Aspirin (81 mg/day) was administered concomitantly in both groups. SAT occurred in 1 patient in the ticlopidine group (0.7%) and in 8 patients in the cilostazol group (5.6%, p=0.037). Based on follow-up angiography, restenosis occurred in 30 patients (23.3%) in the ticlopidine group and 35 patients (26.9%) in the cilostazol group (NS). The late loss was significantly smaller in the cilostazol group than the ticlopidine group (1.08+/-0.95 mm vs 0.78+/-0.93 mm, respectively, p=0.037). No significant differences between the 2 groups were observed with respect to the rates of total death, non-fatal cardiovascular events, or bleeding complications.
The ticlopidine group showed significantly less SAT after stenting compared with the cilostazol group. After 6 months of treatment, the inhibition of neointimal proliferation was greater in the cilostazol group than in the ticlopidine group, but the prevention of restenosis was not confirmed.
[Show abstract][Hide abstract] ABSTRACT: Background A prospective randomized study compared the preventive effects of ticlopidine plus aspirin therapy versus cilostazol plus aspirin therapy on subacute thrombosis (SAT) and restenosis after coronary stenting. Methods and Results After successful stenting of 327 coronary lesions in 282 consecutive patients, the patients were randomized to receive ticlopidine (200 mg/day) or cilostazol (200 mg/day). Aspirin (81 mg/day) was administered concomitantly in both groups. SAT occurred in 1 patient in the ticlopidine group (0.7%) and in 8 patients in the cilostazol group (5.6%, p=0.037). Based on follow-up angiography, restenosis occurred in 30 patients (23.3%) in the ticlopidine group and 35 patients (26.9%) in the cilostazol group (NS). The late loss was significantly smaller in the cilostazol group than the ticlopidine group (1.08±0.95 mm vs 0.78±0.93 mm, respectively, p=0.037). No significant differences between the 2 groups were observed with respect to the rates of total death, non-fatal cardiovascular events, or bleeding complications. Conclusion The ticlopidine group showed significantly less SAT after stenting compared with the cilostazol group. After 6 months of treatment, the inhibition of neointimal proliferation was greater in the cilostazol group than in the ticlopidine group, but the prevention of restenosis was not confirmed. (Circ J 2004; 68: 610 - 614)
[Show abstract][Hide abstract] ABSTRACT: The significance of exercise-induced ST segment depression in patients with left circumflex artery involvement was investigated by comparing exercise electrocardiography with exercise thallium-201 single photon emission computed tomography(Tl-SPECT) and the wall motion estimated by left ventriculography. Tl-SPECT and exercise electrocardiography were simultaneously performed in 51 patients with left circumflex artery involvement(angina pectoris 30, myocardial infarction 21). In patients with myocardial infarction, exercise-induced ST depression was frequently found in the V2, V3 and V4 leads. In patients with angina pectoris, ST depression was frequently found in the II, III, aVF, V5 and V6 leads. There was no obvious difference in the leads of ST depression in patients with myocardial infarction with ischemia and without ischemia on Tl-SPECT images. In patients with myocardial infarction, the lateral wall motion of the infarcted area evaluated by left ventriculography was more significantly impaired in the patients with ST depression than without ST depression(p < 0.01). Exercise-induced ST depression in the precordial leads possibly reflects wall motion abnormality rather than ischemia in the lateral infarcted myocardium.
Journal of Cardiology 04/2000; 35(4):239-45. · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the regional wall motion and the myocardial fatty acid metabolism at hibernating myocardium after revascularization (PTCA or CABG), we performed dual SPECT with 201Tl and 123I-beta-methyliodophenyl-pentadecanoic acid (BMIPP), and left ventriculography (LVG) in 34 patients with coronary artery disease before and 3 to 4 months after revascularization. In the SPECT, regional tracer uptake was estimated qualitatively (visual) and quantitatively (% uptake). Regional wall motion was estimated qualitatively (visual) and quantitatively (shortening fraction). At the 78 hibernating areas, the improvement of regional wall motion was more significantly (p < 0.05) correlated with that of regional tracer uptake of 123I-BMIPP (r = 0.63) than 201Tl (r = 0.39), and also correlated with the improvement of the difference between 201Tl and 123I-BMIPP regional uptake (r = 0.36). These results suggest that the improvement of wall motion at hibernating myocardium is more significantly correlated with the improvement of 123I-BMIPP than 201Tl uptake after revascularization.
Kaku igaku. The Japanese journal of nuclear medicine 06/1996; 33(6):607-15.
[Show abstract][Hide abstract] ABSTRACT: The association between the lack of adrenergic symptoms during hypoglycemia and myocardial 123I-metaiodobenzylguanidine (MIBG) accumulation was investigated in 12 insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients who had no evidence of heart disease. These patients were divided into 2 groups according to the presence (group A) or absence (group B) of adrenergic symptoms during hypoglycemia. Autonomic function tests revealed significantly severe autonomic dysfunction in group B compared to that in group A. Insulin infusion test indicated no significant difference in the catecholamine response between the two groups. 123I-MIBG scintigraphy showed that the heart/mediastinum ratio of MIBG uptake was significantly lower, and scintigraphic defect was greater in group B than in group A. There were no significant differences in the washout rate between the two groups. These results suggested that the lack of adrenergic symptoms during hypoglycemia may be associated with cardiac sympathetic nervous dysfunction in insulin-treated NIDDM patients, and this dysfunction is mainly due to cardiac sympathetic denervation.
Internal Medicine 03/1996; 35(2):94-9. DOI:10.2169/internalmedicine.35.94 · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A pair of 37-year-old identical twins with diabetes mellitus are described. One of the brothers was admitted for heart failure without pain, and autonomic neuropathy was found. The clinical diagnosis was inferior myocardial infarction with anteroseptal healed myocardial infarction. Cardiac catheterization revealed triple coronary vessel involvement. The diagnosis was confirmed at autopsy after sudden death. The other brother was also examined by cardiac catheterization, which revealed total right coronary occlusion and hypokinesis of the wall. There had been no previous pain nor upper body discomfort until that time in either twin. Thus, genetic factors should possibly be considered in the genesis of asymptomatic or silent myocardial infarction.
Japanese journal of medicine 01/1991; 30(2):170-4. DOI:10.2169/internalmedicine1962.30.170
[Show abstract][Hide abstract] ABSTRACT: A case of native valve endocarditis due to Acinetobacter calcoaceticus in a patient with dental caries is presented. The aortic, mitral and tricuspid valves were affected and showed vegetation by echocardiography in the affected valves. In spite of a good response to antibiotic therapy, multiple embolisms resulted in the patient's death. An autopsy confirmed the vegetation, which was calcified and contained no bacteria.
Japanese Circulation Journal 01/1991; 54(12):1563-5. DOI:10.1253/jcj.54.12_1563
[Show abstract][Hide abstract] ABSTRACT: A 65-year-old man with idiopathic myocarditis is described. He was admitted with symptoms of acute heart failure. Examination revealed left ventricular hypokinesis. Results of an endomyocardial biopsy showed "resolving myocarditis". Immunological studies of the peripheral blood showed a low helper-suppressor (CD4/CD8) ratio on admission and depressed natural killer (NK) cell activity coincident with the onset of myocarditis. We considered that this immunological imbalance may have occurred during the progression of myocarditis to dilated cardiomyopathy.
Japanese Heart Journal 10/1990; 31(5):741-4. DOI:10.1536/ihj.31.741 · 0.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fifty-eight patients with symptomatic congestive heart failure were examined for T-lymphocyte subsets in the peripheral blood using two-color laser flow cytometry as a noninvasive diagnostic procedure. The final diagnosis established by catheterization and endomyocardial biopsy were dilated cardiomyopathy (DCM, n = 24), myocarditis (MC) by the Dallas criteria (n = 12), and coronary heart disease (CHD, n = 16). The CD8+CD11- (cytotoxic T) subset was significantly low in patients with DCM (13.9 +/- 4.4 vs. controls, p less than 0.05) in comparison with MC (20.7 +/- 10.9) and CHD (22.3 +/- 5.9). Moreover, the CD4+2H4+ (suppressor/inducer T) subsets were higher in patients with DCM (27.3 +/- 6.9 vs. controls, p less than 0.01) than in those with MC (17.3 +/- 7.8) and CHD (15.6 +/- 7.9). The CD4/CD8 and CD4+2H4+/CD8+CD11- ratio were examined and compared with those of normal controls (NC n = 16). The CD4+2H4+/CD8+CD11- ratio was clearly higher in patients with DCM (2.2 +/- 0.9 vs. controls, p less than 0001) than in those with MC (1.1 +/- 0.6) CHD (0.9 +/- 0.7). A CD4+2H4+/CD8+CD11- ratio of greater than 1.6 was considered to facilitate diagnosis of dilated cardiomyopathy with 79% sensitivity and 70% specificity. There was no significant increase in the ratios between MC and CHD. However, the proportion of the CD8+Leu7+ (natural suppressor) subset of circulating T lymphocytes in patients with MC was statistically higher (19.1 +/- 6.3% vs. controls, p less than 0.05) than in DCM or CHD. An elevated ratio of CD4+2H4+/CD8+CD11- among peripheral blood lymphocytes may thus be a useful marker for differential diagnosis of dilated chronic cardiomyopathy from myocarditis and coronary heart disease.
[Show abstract][Hide abstract] ABSTRACT: A 44 year-old woman died after a history of chronic right heart failure for 25 years. Roentgenological studies showed marked pulmonary aneurysm, and hemodynamics at rest revealed severe pulmonary hypertension. The diagnosis of chronic pulmonary thromboembolism was made by MRI which identified a high intensity mass in the dilated right pulmonary artery. At autopsy, a large organized thrombus adhered to the atherosclerotic pulmonary artery, and pulmonary thromboembolism or hemorrhagic infarction were identified. Microscopic examination revealed intimal and medial proliferation in small arteries and plexiform lesions. In addition, hypoplasty of the portal vein and portacaval shunt, which were thought to be congenital, were present. It has been recognized that the portacaval shunt can be attributed to pulmonary hypertension. In this case it was considered that the main cause of pulmonary thrombus formation was both pulmonary atherosclerosis and pulmonary artery aneurysm caused by prolonged pulmonary hypertension. This is the first case of chronic pulmonary thromboembolism associated with congenital hypoplasty of portal vein.
[Show abstract][Hide abstract] ABSTRACT: We reviewed the histories and laboratory data of 67 young patients with ischemic heart disease under the age of 40 years. Twenty-three cases were associated with hypercholesterolemia. Of these, 10 were of the familial type. Twenty patients had hypertension, while 14 were diabetics and 13 were heavy smokers. It is noteworthy that 13 of 17 patients with multi-vessel disease and hypercholesterolemia. Significant atherosclerotic coronary stenosis was demonstrated in 51 cases. The incidences of hypercholesterolemia, hypertension and diabetes mellitus in these 51 patients were not only significantly higher than those in age-matched normal health subjects and young patients with non-ischemic heart disease, but also higher than those in patients with ischemic heart disease over the age of 40 years. The results indicated that hypercholesterolemia is the most important risk factor for ischemic heart disease in young patients, although the three previously accepted risk factors (hypertension, diabetes mellitus and cigarette smoking) were all associated with the development of the disease. We could not find any obvious risk factor in 18 young patients with ischemic heart disease, including 12 cases of myocardial infarction. Myocardial infarction in the absence of any obvious risk factor occurred during strenuous physical exercise in 5 patients and following excessive alcohol consumption in 4.
Japanese Circulation Journal 05/1990; 54(4):436-41. DOI:10.1253/jcj.54.436