[Show abstract][Hide abstract] ABSTRACT: The mechanisms responsible for the development of apical aneurysms in cases of hypertrophic cardiomyopathy (HCM) are currently unclear but likely involve multiple factors. Here, we present a case of HCM with marked subendocardial fibrosis involving the apical and proximal portions of the left ventricle. A 71-year-old man with left ventricular hypertrophy presented with signs and symptoms of heart failure. The presence of asymmetrical left ventricular hypertrophy and bilateral, thickened ventricular walls with an apical aneurysm on transthoracic echocardiography suggested a diagnosis of HCM with ventricular dysfunction. No intraventricular pressure gradients with obstruction were identified. Late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging and endomyocardial biopsies showed subendocardial fibrosis involving the apical aneurysm and proximal portion. Whereas LGE in a transmural pattern is commonly observed in HCM apical aneurysms, subendocardial LGE, as noted in the present case, is a relatively rare occurrence. Thus, the present case may provide unique insights into the adverse remodeling process and formation of apical aneurysms in cases of HCM.
[Show abstract][Hide abstract] ABSTRACT: The imaging features of chronic periaortitis resemble those of infected aneurysms. Two illustrative cases of chronic periaortitis, in which the etiologies were caused by IgG4-related disease, are presented. The first case involved a 68-year-old man who presented with vague discomfort in his lower abdomen. The second case was a 42-year-old man who presented with a fever of 38°C and persistent, vague chest discomfort. Both cases demonstrated an increased amount of connective tissue around the aorta in computed tomography images and low intensity in the T2-weighed sequence and high intensity in the diffusion-weighed sequence, suggesting the presence of inflammation, in the magnetic resonance imaging. Negative blood cultures, elevated IgG4 levels, and pathological findings confirmed the diagnosis as chronic periaortitis due to IgG4-related disease. This is a newly recognized syndrome of unknown etiology, characterized by a fibroinflammatory condition, tumefactive lesions, and a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells. Both cases were successfully treated with corticosteroids. Infected aneurysms need to be carefully differentiated from this syndrome in view of the similar imaging features.
[Show abstract][Hide abstract] ABSTRACT: Whole-body periodic acceleration (WBPA) has been developed as a passive exercise device capable of improving endothelial function by applying pulsatile shear stress to vascular endothelium. We hypothesized that treatment with WBPA improves exercise capacity, myocardial ischemia, and left ventricular (LV) function because of increased coronary and peripheral vasodilatory reserves in patients with angina. Twenty-six patients with angina who were not indicated for percutaneous coronary intervention and/or coronary artery bypass grafting were randomly assigned to remain sedentary (sedentary group) or undergo 20 sessions of WBPA with the motion platform for 4 weeks (WBPA group) in addition to conventional medical treatment. WBPA was applied at 2 to 3 Hz and approximately ±2.2 m/s² for 45 minutes. We repeated the symptom-limited treadmill exercise test and adenosine sestamibi myocardial scintigraphy. In the WBPA group, the exercise time until 0.1-mV ST-segment depression increased by 53% (p <0.01) and the double product at 0.1-mV ST-segment depression by 23% (p <0.001). Severity score of myocardial scintigraphy during adenosine infusion decreased from 20 ± 10 to 14 ± 8 (p <0.001) and severity score at rest also decreased from 13 ± 10 to 8 ± 10 (p <0.01). On scintigraphic images at rest, LV end-diastolic volume index decreased by 18% (p <0.01) with an augmentation of LV ejection fraction from 50 ± 16% to 55 ± 16% (p <0.01). In contrast, all studied parameters remained unchanged in the sedentary group. In conclusion, treatment with WBPA for patients with angina ameliorates exercise capacity, myocardial ischemia, and LV function.
No preview · Article · Jan 2011 · The American journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Long-persistent atrial fibrillation (CAF) causes structural remodeling. Ablation for CAF can contribute to reversing CAF-mediated remodeling. However, the extents of the reverse atrial remodeling (RAR) remain unpredictable before ablation. We attempted to determine a predictor for RAR.Methods: For 20 consecutive CAF (>1 year) patients, left atrial volume index (LAVI) was calculated on echo-cardiograms. We sought to restore sinus rhythm by pulmonary vein-isolation and ablation targeting complex fractionated atrial electroactivities with or without DC. Catheterization study was performed during the ablation. LAVAI and Velocity in atrial wave in trans-mitral valve flow (ATMF) was measured serially.Results: Cardiac index (CI) significantly increased after the defibrillation (p<0.01). For 19 cases, sinus rhythm was maintained for 19.0±9.5 months. LAVI significantly reduced from 30.3±8.4 to 22.8±4.5 ml/m2 (6 months after the procedure, P<0.01) and ATMF increased from 0.45±0.23 (7 days after the procedure) to 0.52±0.15 m/s (6 months after the procedure, p<0.01). CI before the defibrillation had a tendency to inversely correlate with reduction in LAVI at 6 months after the procedure (p=0.06). Patient with smaller LAVI had a greater reduction in LAVI and a greater increase in ATMF (r=−0.71, 0.52, respectively, p<0.01). Lower ATMF 7 days after the procedure predicted greater reduction in LAVI during the follow up.Conclusion: Hemodynamic parameters during the procedure and ATMF immediately after defibrillation may be a predictor of RAR.
No preview · Article · Jan 2011 · Journal of Arrhythmia
[Show abstract][Hide abstract] ABSTRACT: Exercise intolerance is a main symptom of long-persistent atrial fibrillation (CAF). Ablation for CAF can contribute to maintaining sinus rhythm and reversing CAF-mediated remodeling. However, it remains unknown whether ablation affects exercise tolerance (ET) through the reverse remodeling.Methods
For 20 consecutive CAF (>1 year) patients, ET was evaluated using a cardio-pulmonary exercise test and left atrium volume index (LAVI) was measured on echo-cardiograms. We sought to maintain sinus rhythm by pulmonary vein-isolation and ablation targeting complex fractionated atrial electroactivities with anti-arrhythmic drugs. ET and LAVI were re-evaluated after six months maintenance of sinus rhythm.ResultsFor 19 cases, sinus rhythm was maintained regardless of the value of peak VO2. Peak VO2 significantly improved from 19.3±5.0 to 23.1±5.4 ml/kg min after six months maintenance of sinus rhythm (P<0.01). LAVI significantly reduced from 30.3±8.4 to 22.2±4.5 ml/m2 (P<0.01). However, peak VO2 before the procedure did not predict reduction in LAVI during the follow up. Patients with higher LVEF before the procedure obtained lower improvement in peak VO2 (r=−0.84, P<0.01). Improvement in peak VO2 did not correlated with the reduction in LAVI, but increase in LVEF during the follow up (r=0.83; P<0.01).Conclusion
Ablation contributed to improvement in the ET mainly through restoration of LVEF from the maintenance of sinus rhythm. The reverse remodeling may not be directly involved in the improvement.
No preview · Article · Jan 2011 · Journal of Arrhythmia
[Show abstract][Hide abstract] ABSTRACT: A 75-year-old male presented with palpitation on exertion. He suffered from frequent tachycardia attacks. His 12-leads electrocardiogram showed irregular cycle lengths (400–550 ms) of tachycardia with occasional 2:1 atrioventricular conduction (thus AV reentry was excluded). He had a complex anatomy of persistent left superior vena cava (PLSVC)/ enlarged coronary sinus (CS). The activation map in a 3-dimensional CARTO system (Biosense-Webster, USA) was merged with the multi-detector computed tomography image and revealed that the tachycardia spread centrifugally from the junction between the PLSVC and enlarged CS. However, delivery of radio frequency (RF) energy to the earliest atrial activation site did not affect the tachycardia. Finally, the tachycardia was diagnosed as a fast/ slow type atrioventricular nodal reentrant tachycardia (AVNRT) because the tachycardia was cured only after the anterograde/retrograde AV conduction was disturbed by the application of RF energy to the posteroseptal perimitral area, possibly due to the injury to the AV node.
Preview · Article · Dec 2010 · Journal of Arrhythmia