Changes of ischemic heart disease in Utsunomiya, Japan, over 10 years: a survey of primary care physicians.

A total of 502 patients presenting in Utsunomiya city and its suburbs during a 10-year period were studied to determine the clinical features of ischemic heart disease and to identify coronary risk factors. The male/female ratio was 1.21, but the ratio decreased with increasing age. The duration of chest pain showed a continuous spectrum between angina and infarction, with a short duration of chest pain not being useful for excluding the diagnosis of myocardial infarction. Hypertension was more common than hypercholesterolemia in this study, although the prevalence of the latter increased slightly with time, along with the shift towards a modernized occupational pattern. Smoking was a more important risk factor for ischemic heart disease in younger individuals than in the elderly, and diabetes mellitus was highly associated with the development of myocardial infarction. The incidence of radiologically diagnosed cardiac hypertrophy and aortic calcification decreased over time. These changes may have resulted in part from improved blood pressure control and the development of new anti-hypertensive and cholesterol-lowering agents.

Predicting the severity of coronary lesions by the continuous recording method of exercise two-dimensional echocardiography.

We estimated the severity of coronary artery disease by the continuous-recording method of exercise two-dimensional echocardiography (Ex.2DE) in 56 patients with angiographically significant coronary artery stenosis ( > 50% diameter narrowing) who had undergone both Ex.2DE and coronary angiography. Patients were divided into two groups on the basis of findings of coronary angiography: group 1 had 50% to 89% stenosis (n = 24) and group 2 had 90% or greater stenosis (n = 32). The sensitivity and specificity of Ex.2DE for the detection of ischemic segments were 82% and 88%, respectively in the overall patient population. The sensitivity was 67% in group 1 and 94% in group 2. Hyperkinesis occurred at the beginning of exercise in 21 (88%) of 24 patients in group 1 and 15 (47%) of 32 patients in group 2 (p < 0.05). Our findings demonstrated that patients who did not show hyperkinesis at the beginning of exercise had more severe coronary artery disease. Careful observation of serial wall motion during exercise by the continuous-recording method may provide important information about myocardial ischemia.

Polysplenia accompanied by major cardiovascular anomalies with prolonged survival.

A 52-year-old female with polysplenia accompanied by major cardiovascular anomalies (a ventricular septal defect, atrial septal defect, persistent left superior vena cava, absent inferior vena cava with a hemiazygos connection and visceral heterotaxia) is reported. She underwent successful surgical treatment and showed prolonged survival.

[Long-term retrospective study of patients with connective tissue diseases accompanied by pulmonary hypertension].

To determine clinical and serological features that are related with the prognosis of connective tissue diseases with pulmonary hypertension (PH), we studied a long-term prognosis of 14 patients (4 SLE, 1 PSS, 3 MCTD, 2 primary Sjögren's syndrome, and 5 OL) accompanied by PH. The patients were divided into three groups; group A (4 cases) that is alive for 5-12 years until present, group B (6 cases) in which PH was the main cause of death, and group C (4 cases) was dead of pulmonary fibrosis and pericardial tamponade. No significant difference was observed in background connective tissue diseases among the three groups. However, the mean ages at the onset of PH was obviously younger in group B (25.7 yrs.) than both in group A (38.3 yrs.) and in group C (42.0 yrs.) (group A vs group B, p < 0.02, and group B vs group C, p < 0.05). Sudden death occurred in 5 of the 6 in group B, whereas it was not observed either in group A or in group C. Also, the interval between onset of PH and death was shorter in group B (1.3 yrs.) than in group C (3.5 yrs.). The incidence of digital necrosis and pericardial effusion was higher in group B (83% and 83%, respectively) than both in group A (0% and 25%, respectively) and in group C (25% and 40%, respectively). A large amount of pericardial effusion was detected in 4 of 5 cases in group B. The incidence of digital necrosis between group A and group B was significantly different (p < 0.05, Fisher's test).(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of hypertensive heart by 2-dimensional echocardiography in mass screening.

Two-dimensional echocardiography (2DE) was used in the mass screening of 3,017 participants (1,195 males, 1,822 females, mean age 59) living in 13 areas in Japan. The 2DE findings of left ventricular hypertrophy (LVH) and LV function were compared with the presence and severity of hypertension (Ht). Out of 1,100 patients who had an evident history of Ht above 160/95 mmHg (Ht group), 298 patients (27.4%) were complicated by LVH. In contrast, LVH was also recognized in 60 (11.2%) of 535 borderline Ht cases and in 87 (6.3%) of 1,382 normotension cases. LVH cases in the Ht group were divided into 3 groups: mild (220: 73.8%), moderate (63: 21.2) and severe (15: 5.0). Asymmetric septal hypertrophy (ASH) was recognized in 111 patients (37.2%) of the 298 LVH cases. The prevalence of ASH in these LVH patients was higher according to the severity of the LVH: mild LVH = 31%, moderate LVH = 51% and severe LVH = 67%. The prevalence of LVH was higher in males than in females. This was especially apparent in the moderate to severe LVH groups and also noted to be higher according to the increase of mean blood pressure. The prevalence of mild to moderate LVH was significantly higher in the poorly-controlled group than in the well-controlled group. In contrast, no significant difference in prevalence of severe LVH was noted between the well-controlled and poorly-controlled groups. The prevalence of LV dysfunction was significantly greater in moderate or severe LVH groups than in non or mild LVH groups. It tended to be higher in the poorly-controlled group compared with the well-controlled group. The regression of LVH was frequently detected in the well-controlled group by the follow-up study. We conclude that 2DE observation of LV performance in mass screening will be extremely valuable in the long term follow-up of Ht patients.

[Mass screening of cardiovascular disorders by two-dimensional echocardiography].

We used two-dimensional echocardiography (2-D echo) for the mass screening of 2,673 subjects for cardiovascular disorders (1,032 men, 1,641 women, aged 23-95 years with a mean age of 59), who lived in 12 rural areas in Japan. In 1,665 of the 2,673 subjects (62.3%), cardiac abnormalities were recognized. Three major abnormalities included sclerotic aortic (33.0%) and mitral valves (21.8%), and left ventricular (LV) hypertrophy (15.9%). Apparent pericardial effusion (54 cases), mitral valve prolapse (44 cases), and dilated cardiomyopathy (4 cases) were incidentally found in this study. Prevalence of the abnormalities insidiously increased with age (below 49 years: 39%, and above 80 years: 97%), and this was apparently higher in men than in women. The abnormal findings which were significantly higher in men were the sclerotic aortic valves, LV hypertrophy and dysfunction, the prevalence of which was particularly high in ages 40-79, but it became nearly equal beyond 80 years of age. These results may indicate a sexual difference in the influence of age on the cardiovascular system. It was concluded that 2-D echo is helpful for primary screening and prevention of cardiovascular disorders.

Prediction of prognosis of patients with idiopathic dilated cardiomyopathy: a comparison of echocardiography with cardiac catheterization.

The prognostic values of indices obtained by M-mode and two-dimensional echocardiography (Echo) and by cardiac catheterization (Cathe) were assessed in patients with idiopathic dilated cardiomyopathy. Fifty-one patients with this disorder (38 males and 13 females) were studied for an average of 4.2 years. Of those, 24 died of cardiac causes during follow-up. The overall 5-year survival rate was 49%. Significant differences between the surviving patients and the patients who died were noted in the following indices measured by Cathe: left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and the cardiac index (CI). The 5-year survival rate in patients with the following index values measured by Cathe at the initial examination were: LVEDV greater than or equal to 150 ml/M2 - 29%; LVEDP greater than 12 mmHg - 35%, EF less than 30% - 21%, and CI less than 3.0 L/min/M2 - 29%. In contrast, the 5-year survival rate in patients with the following parameter values measured by Echo were: left ventricular end-diastolic dimension greater than or equal to 45 mm/M2 - 16%; left atrial dimension greater than or equal to 25 mm/M2 - 12%; ejection fraction less than 30% - 31%; and a relative wall thickness (a ratio of left ventricular posterior wall thickness to left ventricular end-diastolic dimension) less than or equal to 0.12 - 9%. In assessing the cumulative survival rate, the indices provided by Echo revealed similar values when compared with those obtained by Cathe. The relative wall thickness determined by Echo would be the most reliable parameter for forecasting the 5-year survival rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term survival of a patient with Lutembacher's syndrome.

An elderly woman with Lutembacher's syndrome remained asymptomatic until the age of 55, when she was treated for exertional dyspnea with digitalis and diuretics. She died of gastrointestinal hemorrhage and hepatic failure at the age of 69. The autopsy revealed a large atrial septal defect and mitral stenosis without rheumatic changes. This patient is the oldest reported survivor of Lutembacher's syndrome with nonrheumatic mitral stenosis.

The partial agonist activity of xamoterol (ICI 118,587) studied by heart rate response in pithed rats.

The partial agonist activity of xamoterol was evaluated by measuring changes in heart rate (HR) in pithed rats. Xamoterol showed dose-dependent positive chronotropic effects in catecholamine-depleted pithed rats (HR: 199 +/- 6 beats/min) and dose-dependent negative chronotropic effects in sympathetic nerve-stimulated pithed rats (HR: 325 +/- 16 beats/min). In contrast, isoproterenol exerted dose-dependent positive chronotropic effects in either condition (HR: 189 +/- 7 and 332 +/- 5 beats/min) and propranolol exerted dose-dependent negative chronotropic effects in either condition (HR: 209 +/- 5 and 344 +/- 19 beats/min). When exogenous noradrenaline was continuously infused into catecholamine-depleted pithed rats, xamoterol showed dose-related positive chronotropic effects with noradrenaline at 0.5 micrograms/(kg min) (HR: 235 +/- 4 beats/min), virtually no effects at 1.5 micrograms/(kg min) (HR: 297 +/- 11 beats/min) and dose-related negative chronotropic effects at 5 micrograms/(kg min) (HR: 330 +/- 5 beats/min). During continuous infusion of xamoterol [100 ng/(kg min)] into pithed rats, the control HR before stimulation was increased and the maximum increase produced by the sympathetic nerve stimuli at 0.25 to 4 Hz decreased. The maximum increase in HR brought about by xamoterol was about 71% of that induced by isoproterenol, and those by pindolol and practolol were about 40% and 21% respectively. It is concluded that xamoterol is a partial agonist with a strong agonist action.

[Serial changes in cardiovascular dimensions and left ventricular function after surgery of valvular heart disease: a follow-up study by echocardiography].

Serial changes in cardiac function after surgery were studied in 84 patients with various valvular heart diseases using M-mode and two-dimensional echocardiography (2-DE). The results were as follows: 1. Serial postoperative changes in cardiac dimensions and left ventricular functions were well documented by M-mode and 2-DE. 2. The change in left ventricular function became most pronounced one month after surgery, and remained unchanged in many patients during the subsequent observation periods. 3. Open mitral commissurotomy (OMC) and mitral valve replacement (MVR) were compared as to their benefits for patients with isolated mitral stenosis (MS) accompanied by left ventricular dysfunction, and MVR proved superior to OMC in terms of magnitude of functional improvement. 4. (a) Ejection fraction (EF) in patients with left ventricular volume overload was overestimated due to the influence of increased preload. Accordingly, EF which tended to be depressed one month after surgery was judged to reflect altered loading conditions; it did not represent myocardial damage caused by valve replacement. (b) In patients who had MVR or aortic valve replacement (AVR) without postoperative heart failure, EF remained unchanged in the MVR group after a lapse of one month postoperatively, while it tended to improve in the AVR group. This difference was thought to be caused by changes in left ventricular systolic overload resulting from correction of regurgitation. (c) In patients with MR and postoperative heart failure, there was a tendency for EF to decrease after a lapse of one month postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of nicorandil on exercise performance in patients with effort angina: a multicenter trial using a treadmill exercise test.

The effects of a single oral dose (20 mg) of a new vasodilator, nicorandil, on exercise performance were assessed in 29 patients with stable effort angina using a symptom-limited treadmill exercise test. A single-blind, placebo-controlled, randomized, crossover design was employed. Compared with placebo, 20 mg of nicorandil significantly increased maximal exercise duration and time to 1 mm of ST-segment depression at 1, 3, and 6 h after administration. Systolic blood pressure was reduced both at rest and during exercise. Heart rate increase during exercise did not differ significantly compared with control, though resting heart rate was increased. The maximal pressure-rate product at peak exercise was increased in association with increased exercise time in about half of the patients, while it was unchanged or decreased in the others. It was suggested that nicorandil may act by either reducing myocardial oxygen demand and/or increasing myocardial oxygen supply.

Prognostic significance of regional wall motion abnormality in patients with prior myocardial infarction: a prospective correlative study of two-dimensional echocardiography and angiography.

In this pilot study of 50 consecutive patients with prior myocardial infarction, the results of two-dimensional echocardiographic and angiographic analysis of wall motion abnormalities were correlated, and their prognostic significance was determined. There was overall good agreement (88%) between the two methods. In general, the greater the left ventricular dysfunction, the worse was the prognosis. The 3-year survival was significantly reduced for patients with a left ventricular wall motion score index of 2.5 or greater (P = 0.024). These findings were essentially similar to the reduced survival rate associated with decreased angiographic ejection fractions (less than 40%). This study suggests that two-dimensional echocardiography, a noninvasive and relatively inexpensive technique, can provide prognostic information in patients with prior myocardial infarction.

The cardiovascular effects of xamoterol, a beta 1-adrenoceptor partial agonist, in healthy volunteers at rest.

The cardiovascular effects of three single intravenous doses of a beta 1-adrenoceptor partial agonist, xamoterol (0.025, 0.05 and 0.1 mg kg-1) and placebo were studied in six healthy volunteers at rest using a single-blind design. In addition to heart rate and blood pressure measurements, cardiac contractility was measured by means of M-mode echocardiography and systolic time intervals. Ambulatory 24 h Holter-monitoring of the electrocardiogram was performed. Plasma concentrations of xamoterol were measured. Compared to baseline, xamoterol (0.025 mg kg-1) increased heart rate (61 +/- 3-68 +/- 3 beats min-1, means and SEM) and systolic blood pressure (119 +/- 3-138 +/- 5 mm Hg) but decreased pre-ejection period (100 +/- 4-76 +/- 5 msec). Stroke volume (88 +/- 6-104 +/- 10 ml), cardiac output (4.8 +/- 0.4-6.6 +/- 0.61 min-1), velocity of circumferential fibre shortening (1.15 +/- 0.06-1.50 +/- 0.06 circ s-1) were increased by xamoterol. No significant changes were produced by placebo. No dose-dependent effects were seen and maximum effects were produced by 0.025 mg kg-1 xamoterol. Significant effects were observed for 2 h. The areas under the plasma concentration curves (AUC0-12) showed a linear dose response. No adverse effects attributable to xamoterol were seen in haematological, biochemical, urinalysis or electrocardiographic tests. Four volunteers were aware of a more forceful heart beat after xamoterol, but this was mild and transient. It is concluded that xamoterol has a positive inotropic action.

Earlobe crease and coronary heart disease in Japanese.

To evaluate whether a significant statistical correlation exists between earlobe crease (EC) and coronary heart disease (CHD), 1000 Japanese adult patients (573 males, 427 females) were examined for the presence or absence of EC, clinical or angiographic evidence of CHD, and the following coronary risk factors: male sex, age over 50 years, obesity, hypertension, diabetes mellitus, cigarette smoking, and hyperlipidemia. Patients were divided into two groups according to clinical evidence of CHD: 237 patients with angina pectoris and/or myocardial infarction (CHD+ group); 720 patients without evidence of CHD (CHD- group). Coronary angiography was performed on 200 patients from this sample population; these patients were also divided into two groups: 119 patients with greater than 50% luminal narrowing of at least one major coronary artery (stenosis+ group); 81 patients with no significant atherosclerotic changes in the coronary arteries (stenosis- group). EC was present in 58 of 237 CHD+ patients (24.5%) but in only 35 of 720 CHD- patients (4.8%; P less than 0.001); it was present in 31 of 199 stenosis+ patients (26.1%) but in only 3 of 81 stenosis- patients (3.7%; P less than 0.01). EC was also found to correlate significantly with some coronary risk factors; the correlations between the presence of EC and the presence of CHD and coronary risk factors were investigated by multivariate analysis. In a multivariate setting, the existence of CHD and an age of over 50 years was significantly related to the presence of EC. To investigate the relationship between EC and advancing age, all patients were separated into age-groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prediction of coronary lesions by two-dimensional echocardiography in patients with healed myocardial infarction].

Regional left ventricular wall motion abnormalities were assessed by two-dimensional echocardiography (2-DE) in 66 patients with healed myocardial infarction (MI) and the results were compared with those of coronary angiography which was performed at nearly the same time as 2-DE. The left ventricular wall was divided into 14 segments and asynergy was assessed in each segment. To compare the severity of segmental asynergy with coronary artery lesions, relation between segments and coronary artery perfusion was assumed as follows: the anterior wall, anterior septum and apex corresponded to the anterior descending artery (LAD); the lateral and inferior walls corresponded to the left circumflex artery (LCX); and the posterior septum and inferior wall corresponded to the right coronary artery (RCA). One vessel disease: In all 24 patients with MI induced by LAD lesions, regional asynergy was identified in the anterior wall, anterior septum and apex. All patients had advanced asynergy (severe hypokinesis, akinesis or dyskinesis) except one with subendocardial infarction. Advanced asynergy was identified in the other segments including the lateral wall (one patient) and the posterior septum (11 patients), but such asynergy was not associated with that of the inferior wall. In four patients with MI induced by RCA lesions, regional asynergy appeared in localized segments of the posterior septum and inferior wall, and the asynergy was severe in all patients except one in whom collaterals were well-developed. In four patients with MI induced by LCX lesions, asynergy was observed in both the lateral and inferior walls. In only one patient, mild asynergy was identified in the apex. Multi-vessel disease: In both groups with double vessel (16 patients) and triple vessel (16 patients) disease, asynergy was recognized in the affected areas of the major coronary artery which was considered responsible for the infarction, irrespective of the severity of the coronary stenosis. Also, there was no significant correlation between the severity of coronary artery stenosis and segmental wall motion abnormalities in non-infarcted areas. No significant correlation was observed between the severity of regional wall motion abnormalities in the infarcted areas and the degree of development of collaterals. In patients with MI induced by LAD lesions, more extensive asynergy in the anterior wall and anterior septum at the basal portion was observed in the patient group with proximal stenosis than in the group with distal stenosis.(ABSTRACT TRUNCATED AT 400 WORDS)