Beneficial effect of combination therapy comprising angiotensin II receptor blocker plus calcium channel blocker on plasma adiponectin levels.

The study aim was to examine the effect of combination therapy comprising angiotensin receptor blocker plus calcium antagonist on post-treatment plasma adiponectin levels compared to pretreatment levels. There was a significant gender difference in the relationship between preadiponectin level and age. In the search for contributing factors for treatment-based changes in adiponectin levels, these effects of gender and age were considered in statistical analysis. The adiponectin level in the combination therapy group was further increased compared to that in each of the monotherapy groups, despite there being no significant difference in antihypertensive effect, indicating that the combined medication provided an effect beyond that of lowering blood pressure.

Ventricular pacing thresholds following high-energy implantable cardioverter defibrillator shocks in integrated bipolar defibrillation systems.

BACKGROUND: Increased ventricular pacing thresholds have been observed following monophasic implantable cardioverter defibrillator (ICD) shocks. AIM: To examine changes following high-energy biphasic shocks delivered by integrated bipolar ICD systems. METHOD: Ten episodes of ventricular fibrillation (VF) were induced at 10 min intervals in nine pigs with integrated ICD systems. After 10 s of each episode of VF, a 40 J biphasic shock was delivered, which successfully terminated VF (a total of 10 shocks). The bipolar pacing threshold at the right ventricular apex was measured before each shock and at 1 min intervals after each shock. RESULTS: The mean pacing threshold was 0.029+/-0.059 muJ before the first shock and gradually increased to 0.14+/-0.10 muJ after the 10th shock. CONCLUSION: It may be necessary to pace at a high-voltage output following biphasic shocks delivered by integrated bipolar ICD systems.

Additive antihypertensive and antihypertrophic effects of long-acting Ca blockers in uncontrolled hypertensive patients with angiotensin-receptor blocker based treatment.

The aim of the present study was to examine the antihypertensive and antihypertrophic effects of combined treatment with a long-acting calcium antagonist on top of an angiotensin II receptor blocker (ARB) in uncontrolled hypertensive patients. Patients with essential hypertension and a blood pressure > 140/90 mmHg on ARB monotherapy (losartan 50 mg/day or candesartan 8 mg/day) were randomly assigned to a nifedipine controlled release (CR) group (n = 15) or amlodipine group (n = 11). A significant additional antihypertensive effect was noted from 1 month with nifedipine and 2 months with amlodipine. The average daily dose was 25 mg for nifedipine and 5 mg for amlodipine. The cardiothoracic ratio was significantly reduced in both groups after 3 months. Left ventricular wall thickness and left ventricular mass index also decreased. Metabolic parameters, hepatic function, and renal function did not change significantly. Additional treatment with a long-acting calcium antagonist achieved further blood pressure reduction as well as an antihypertrophic effect in the uncontrolled patients with prior ARB monotherapy.

Prognostic factors for the long-term survival in patients with vasospastic angina--analysis of effects of patients' characteristics and therapeutic drugs.

OBJECTIVES: A retrospective study was conducted to elucidate contributing factors on the outcome of patients with vasospastic angina. SUBJECTS AND METHODS: Two hundred ninety-two patients with angina in whom coronary vasospasm was documented were followed up (mean 4.3+/-3.6 years) to determine the relationship between the occurrence of cardiovascular events with available clinical factors including therapeutic drugs. Cardiovascular events were defined as fatal and non-fatal cardiovascular disorder events. RESULTS: Several clinical variables including age, elevated creatinine level, low high-density lipoprotein (HDL) cholesterol level, presence of severe coronary artery stenosis, low left ventricular ejection fraction, low cardiac index (CI), large left ventricular mass, and use of beta-blockers proved to be significant risk factors for cardiovascular events. Further analysis by a stepwise regression analysis revealed that, older age (hazard ratio (HR)=1.42), low HDL cholesterol level (HR=0.877), presence of severe coronary artery stenosis (HR=49.32), and decreased CI (HR=14.18) proved to be independent prognostic factors. Ca antagonists were prescribed to 261 patients (89.4%). Among four Ca antagonists, there were significant differences in the frequency of cardiovascular events (2.6% with benidipine, 4.2% with nifedipine, 6.0% with diltiazem, 23.1% with amlodipine; amlodipine vs. benidipine, P<0.05) although the background characteristics of the four different patient groups were non-equivalent. CONCLUSION: These results indicate that the morbidity of patients with vasospastic angina increased with older age, lower CI or HDL cholesterol, and presence of severe coronary artery stenosis, and that treatment with benidipine appeared to reduce cardiovascular events in patients with vasospastic angina.

Left main coronary trunk connecting into right atrium with an aneurysmal coronary artery fistula.

Congenital coronary artery fistula (CAF) is an infrequent vascular anomaly that establishes a direct link between an epicardial coronary artery and a cardiac chamber, major vessels, or other vascular structures. In this case there was an aneurysmal-CAF between a left main trunk and the right atrium, which was initially diagnosed as a Kawasaki disease by transthoracic echocardiography and subsequently confirmed by coronary angiography and multi-slice CT angiography. A multi-slice CT angiography might well become the modality of choice for the characterization of these rare congenital anomalies.

Successful intensive lipid-lowering therapy using atorvastatin stabilizes coronary artery plaque as assessed by multi-detector row computed tomography.

A 35-year-old male was diagnosed as angina pectoris and showed severe stenosis with soft plaque in the proximal segment of the left anterior descending (LAD) coronary artery as detected by multi-detector row computed tomography (MDCT). Although percutaneous coronary stent implantation to the LAD lesion was performed, soft plaque remained in the proximal lesion of the stent. Atorvastatin increased the coronary plaque density at the 6-month follow-up MDCT examination, and the low-density lipoprotein cholesterol level fell from 141 to 63 mg/dl after 6 months. This case may indicate that assessment of the shape or composition of coronary plaque by MDCT is a useful strategy for judging the effects of intensive lipid-lowering therapy using statin.

Strong linkage disequilibrium and association of -1131T>C and c.553G>T polymorphisms of the apolipoprotein A5 gene with hypertriglyceridemia in a Japanese population.

BACKGROUND: The apolipoprotein A5 gene (ApoA5) plays an important role in modulating triglyceride metabolism. Polymorphisms of ApoA5, including -1131T>C and c.553G>T (G185C), have been reported to correlate with hypertriglyceridemia (HTG). In the present study the relationships of 5 single nucleotide polymorphisms, including the -1131T>C, c.56C>G, IVS3+476G>A, c.553G>T, and c.1259T>C polymorphisms of ApoA5, with HTG were investigated. METHODS AND RESULTS: The study group comprised 95 Japanese patients with HTG and 119 unrelated normolipidemic subjects. Frequencies of the C allele of -1131T>C (0.511) and the T allele of c.553G>T (0.205) in the hypertriglyceridemic patients were significantly higher than in the normolipidemic subjects (0.315 and 0.105, respectively). The c.56C>G (S19W) polymorphism was not observed, and the other 4 polymorphic sites were in strong linkage disequilibrium. Five of the 8 detected haplotypes with the C allele of -1131T>C correlated with HTG. Promoter activities of ApoA5, including that with the -1131T>C polymorphism, were estimated using a luciferase assay. Analysis of ApoA5 promoters showed that the -1131T>C polymorphism alone had no effect. Comparison of expression of mutant G185C and wild-type ApoA5-green fluorescent protein (GFP) in HepG2 cells showed that ApoA5-GFP was abundant in punctate endosome-like structures, and ApoA5 (G185C)-GFP expression resembled that of the wild type. CONCLUSIONS: The -1131T>C and c.553G>T (G185C) polymorphisms correlated with HTG in this Japanese population, but neither polymorphism directly affected ApoA5 expression.

Left ventricular pseudoaneurysm following acute myocardial infarction.

We describe a case of 57-year-old man who presented with acute myocardial infarction (AMI) and heart failure with rapid progression of cardiomegaly. Cardiac multislice computed tomography and echocardiography showed the ventricular pseudoaneurysm, probably due to cardiac free wall rupture caused by AMI. Cardiac CT is another useful tool for the non-invasive diagnosis of cardiac rupture.

Clinical significance of the coronary calcification score by multidetector row computed tomography for the evaluation of coronary stenosis in Japanese patients.

BACKGROUND: The coronary artery calcification (CAC) score measured by multidetector row computed tomography (MDCT) has emerged as a marker for predicting coronary artery disease (CAD). To evaluate the clinical significance of the CAC score, coronary artery stenosis as assessed by coronary angiography (CAG) was compared with the CAC score determined by MDCT, risk factors and medications. METHODS AND RESULTS: Subjects included 374 consecutive patients who underwent ECG-gate CT angiography using MDCT. The accuracy in patients with a CAC score >or=400 was 84%, and significantly lower than that in patients with a CAC score =0. In addition 92 patients (68 males, 24 females; mean age, 63+/-11 years) who underwent both MDCT and CAG within a 1-month period were selected for further investigation. Patients with significant coronary stenosis had a significantly higher CAC score than those without stenosis. In addition, a higher number of stenosed vessels was associated with a higher CAC score. The subjects were divided into 3 groups according to the CAC score: low (0-12), intermediate (13-444) and high (>or=445). The CAC score was significantly associated with age, and plasma levels of total cholesterol and hemoglobinA1c, and logistic regression analysis revealed that significant coronary stenosis as assessed by CAG was most closely correlated with the CAC score (p=0.03). CONCLUSIONS: The CAC score determined by MDCT can predict CAD independent of other factors, such as age, metabolic diseases and medications, when coronary stenosis can not be diagnosed because of severe calcification.

Genetic analysis of Brugada syndrome in Western Japan: two novel mutations.

BACKGROUND: Brugada syndrome is a form of idiopathic ventricular fibrillation characterized by right bundle-branch block pattern and ST elevation in the right precordial leads of the ECG. The SCN5A gene encodes the alpha-subunit of the human heart sodium channel, which plays a critical role in cardiac excitability, and mutations of SCN5A could underlie Brugada syndrome. METHODS AND RESULTS: To detect mutations of SCN5A, DNA samples from 12 Japanese patients with Brugada syndrome were analyzed using direct sequencing. Two patients had novel mutations, G292S and S835L, but no other mutations of SCN5A were detected in the remaining patients. The first mutation, G292S, was identified adjacent to the pore-lining region between the DIS5 and DIS6 transmembrane segments of SCN5A, and the second mutation, S835L, was in the intracellular loop connecting the DIIS4 to DIIS5. Both mutations were not detected in 100 unrelated control subjects. CONCLUSION: Two novel SCN5A mutations have been found in Japanese patients with Brugada syndrome.