Conduction Delay-Induced J-Wave Augmentation in Patients With Coronary Heart Disease.

Electrocardiogram records were surveyed for the presence of an atrial premature beat (APB) and J waves in patients with coronary heart disease and patients with noncardiac diseases. The prevalence and response of J waves to sudden shortening of the RR interval on the conducted APB were determined and compared between the 2 patients groups. The change in the QRS complexes on the APB was also determined. Among 17,013 patients, 243 patients who underwent percutaneous coronary intervention for acute myocardial infarction or angina pectoris had an APB, and J waves were observed in 16 patients (6.6%). In an additional 729 patients with noncardiac diseases and APB, 19 patients showed J waves (2.6%; p = 0.010). The clinical features were almost similar between the ischemic and nonischemic groups. J waves were located more often in inferior and high lateral leads in the ischemic group. When the RR interval shortened from 942 ± 228 to 621 ± 175 ms and 869 ± 158 to 570 ± 118 ms at baseline and in the conducted APB (p<0.001 for both), the J-wave amplitude increased from 0.16 ± 0.04 to 0.19 ± 0.06 mV (p<0.001) and 0.21 ± 0.07 to 0.24 ± 0.08 mV (p = 0.010) in the ischemic and nonischemic groups, respectively. J waves in patients with chronic coronary heart disease and in patients with noncardiac diseases were augmented at short RR intervals together with distinct changes in the QRS complexes, and an augmentation of J waves at short RR interval may represent a conduction delay.

Effects of caffeine on fractional flow reserve values measured using intravenous adenosine triphosphate.

We investigated the effects of caffeine intake on fractional flow reserve (FFR) values measured using intravenous adenosine triphosphate (ATP) before cardiac catheterization. Caffeine is a competitive antagonist for adenosine receptors; however, it is unclear whether this antagonism affects FFR values. Patients were evenly randomized into 2 groups preceding the FFR study. In the caffeine group (n = 15), participants were given coffee containing 222 mg of caffeine 2 h before the catheterization. In the non-caffeine group (n = 15), participants were instructed not to take any caffeine-containing drinks or foods for at least 12 h before the catheterization. FFR was performed in patients with more than intermediate coronary stenosis using the intravenous infusion of ATP at 140 µg/kg/min (normal dose) and 170 µg/kg/min (high dose), and the intracoronary infusion of papaverine. FFR was followed for 30 s after maximal hyperemia. In the non-caffeine group, the FFR values measured with ATP infusion were not significantly different from those measured with papaverine infusion. However, in the caffeine group, the FFR values were significantly higher after ATP infusion than after papaverine infusion (P = 0.002 and P = 0.007, at normal and high dose ATP vs. papaverine, respectively). FFR values with ATP infusion were significantly increased 30 s after maximal hyperemia (P = 0.001 and P < 0.001 for normal and high dose ATP, respectively). The stability of the FFR values using papaverine showed no significant difference between the 2 groups. Caffeine intake before the FFR study affected FFR values and their stability. These effects could not be reversed by an increased ATP dose.

Successful Ablation for Atrial Tachycardia Originated from Sinus Venosa with Tachycardia-Induced Cardiomyopathy.

A 74-year-old male suffering from congestive heart failure with atrial tachycardia (AT) with 2 : 1 atrioventricular conduction was admitted to our hospital. After the therapy with diuretics and ß-blocker, his rapid AT was still sustained. He took the catheter ablation for his AT. Postpacing interval mapping from entrainment and noncontact mapping system revealed the mechanism of his AT, originated from sinus venosa. His AT was successfully terminated and eliminated by radiofrequency catheter ablation. After the successful ablation, he has been free from any AT, and his cardiac function was also improved.

Recurrence of sickness absence due to depression after returning to work at a Japanese IT company.

There have been few epidemiological studies on recurrent sickness absence due to depression after returning to work (RTW). The objective of this study was to investigate the prognosis of workers who are RTW with depression in a Japanese company. This study employed a descriptive epidemiology study design. Subjects of this study were 540 employees who worked full-time and were registered in the Health Data System and returned to work from April 2002 to March 2008 after their first leave of absence due to depression. We investigated the recurrence of sickness absence due to depression after returning to work using the Kaplan-Meier survival curve method. During the 8.5 yr follow-up period, almost half of the RTW employees experienced recurrent sickness absence. There was a steep increase in recurrent rates the first two years after RTW, and 85.2% of total recurrence of sickness absence had occurred within three years after the index episode.

Longitudinal heterogeneity of coronary artery distensibility in plaques related to acute coronary syndrome.

BACKGROUND: How coronary distensibility contributes to stable or unstable clinical manifestations remains obscure. We postulated that the heterogeneous plaque distensibility is associated with unstable clinical presentations in patients with acute coronary syndrome (ACS). METHODS AND RESULTS: Seventeen and 19 ACS-related and -unrelated lesions, respectively, were visualized using intravascular ultrasound imaging with simultaneous intracoronary pressure recording. Systolic and diastolic lumen cross-sectional areas were measured at the lesion site and at five evenly spaced sites between the proximal and distal reference sites. The coronary distensibility index and stiffness index ß were calculated for each site and averaged for each coronary segment. Maximal distensibility index, standard deviation and the difference between maximal and minimal distensibility indices within each segment were significantly higher in the ACS-related than -unrelated plaques (5.6 ± 2.3 vs. 3.7 ± 1.8, p < 0.001, 2.1 ± 0.9 vs. 1.1 ± 0.6, p < 0.001 and 5.3 ± 2.3 vs. 2.8 ± 1.5, p < 0.001, respectively). Moreover, the difference in the distensibility index between the lesion site of ACS-related plaques and the immediate proximal site was significantly larger (2.88 ± 2.35 vs. 1.17 ± 1.44, p = 0.022) than that in ACS-unrelated plaques. CONCLUSIONS: Coronary artery distensibility is longitudinally more heterogeneous in ACS-related than-unrelated plaques, especially between the lesion and the immediate proximal site.

Effect of angiotensin converting enzyme inhibitors and beta-blockers on left ventricular remodeling after coronary artery bypass graft surgery.

Preventing left ventricular (LV) remodeling after coronary artery bypass graft surgery (CABG) is important to avoid long-term congestive heart failure. The present study evaluated the effects of angiotensin converting enzyme inhibitors (ACEIs) and beta-blockers on LV remodeling. Twenty-three patients with angina pectoris and 36 with old myocardial infarction underwent CABG. We assessed end diastolic volume index (EDVI), end systolic volume index (ESVI), and ejection fraction (EF) using left ventriculography before and after CABG. Changes in EDVI, ESVI, and EF were studied in the ACEI, beta-blocker, and control groups. Although EDVI was reduced in the ACEI group, ESVI and EF improved only slightly, whereas in the group given beta-blockers, ESVI was reduced, EF improved, and EDVI was minimally reduced. These results indicate that ACEIs and beta-blockers both protect against LV remodeling, although through different mechanisms.