Impact of spinal surgery on locomotive syndrome in patients with lumbar spinal stenosis in clinical decision limit stage 3: a retrospective study.

BACKGROUND: Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one of the causes of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbar surgery and independent factors for improving the CDL stage in patients with LSS. METHODS: This retrospective study was conducted at the Department of Orthopaedic Surgery at our University Hospital. A total of 157 patients aged ≥ 65 years with LSS underwent lumbar surgery. The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the Timed Up and Go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in the CDL stage following lumbar surgery were included in the improvement group. Differences in lower limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test. The Spearman's rank correlation coefficient was used to determine correlations between Δ lower limb pain and Δ GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS. RESULTS: The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). Δ Lower limb pain was significantly reduced in the improvement group compared with that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p = 0.0107). Δ GLFS-25 was significantly correlated with Δ lower limb pain (r = 0.3774, p = 0.0031). Multiple logistic regression analysis revealed that TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47). CONCLUSIONS: Lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL.

Risk Factors for Surgical Site Infection in Spinal Surgery and Interventions: A Retrospective Study.

BACKGROUND: Surgical site infection following spinal surgery causes prolonged delay in recovery after surgery, increases cost, and sometimes leads to additional surgical procedures. We investigated risk factors for the occurrence of surgical site infection events in terms of patient-related, surgery-related, and postoperative factors. METHODS: This retrospective study included 1000 patients who underwent spinal surgery in our hospital between April 2016 and March 2019. RESULTS: Patient-related factors were dementia, length of preoperative hospital stay (≥ 14 days), and diagnosis at the time of surgery (traumatic injury or deformity). The one surgery-related factor was multilevel surgery (≥ 9 intervertebral levels), and the one postoperative factor was time to ambulation (≥ 7 days) were statistically significant risk factors for spinal surgical site infection. CONCLUSION: One risk factor identified in this study that is amenable to intervention is time to ambulation. As delayed ambulation is a risk factor for postoperative surgical site infection, how medical staff can intervene in postoperative ambulation to further reduce the incidence of surgical site infection is a topic for future research.

Phase angle is related to physical function and quality of life in preoperative patients with lumbar spinal stenosis.

Lumbar spinal stenosis (LSS) can interfere with daily life and quality of life (QOL). Evaluating physical function and QOL and helping patients to improve is the focus of rehabilitation. Phase angle (PhA) assessment is widely used to measure body composition and is considered an indicator of physical function and QOL. This study investigated the relationship between PhA and physical function, physical activity, and QOL in patients with LSS. PhA, handgrip strength, walking speed, Timed Up and Go test (TUG), Life Space Assessment (LSA), Prognostic Nutritional Index (PNI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and EQ-5D were assessed and statistically analyzed. The study included 133 patients with LSS. Multiple regression analysis of PhA adjusted for age, sex, and body mass index (Model 1) and for Model 1 + PNI (Model 2) showed significant correlations (P < 0.05) with handgrip strength, walking speed, TUG, and LSA. Regarding QOL, PhA was significantly correlated (P < 0.05) with lumbar function in JOABPEQ. PhA was associated with physical function and QOL in patients with LSS and might be a new clinical indicator in this population.

Effect of atorvastatin vs. rosuvastatin on cardiac sympathetic nerve activity in non-diabetic patients with dilated cardiomyopathy.

BACKGROUND: Effects of statin therapy on cardiac sympathetic nerve activity in patients with chronic heart failure (CHF) have not previously been evaluated. METHODS AND RESULTS: To compare the effects of lipophilic atorvastatin and hydrophilic rosuvastatin on cardiac sympathetic nerve activity in CHF patients with dilated cardiomyopathy (DCM), 63 stable outpatients with DCM, who were already receiving standard therapy for CHF, were randomized to atorvastatin (n = 32) or rosuvastatin (n = 31). We evaluated cardiac sympathetic nerve activity by cardiac ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and after 6 months of treatment. There were no differences in the baseline characteristics of the 2 groups. In the rosuvastatin group, there were no changes in MIBG parameters, left ventricular ejection fraction or plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) after 6 months of treatment. In contrast, the atorvastatin group showed a significant increase in the delayed heart/mediastinum count ratio (2.18 ± 0.4 vs. 2.36 ± 0.4, P < 0.0001), and the washout rate was significantly decreased (34.8 ± 5.7 vs. 32.6 ± 6.3%, P = 0.0001) after 6 months of treatment compared with the baseline values. The plasma NT-proBNP level was also significantly decreased (729 ± 858 vs. 558 ± 747 pg/ml, P = 0.0139). CONCLUSIONS: Lipophilic atorvastatin but not hydrophilic rosuvastatin improves cardiac sympathetic nerve activity in CHF patients with DCM.

Lipocalin-type prostaglandin D synthase is associated with coronary vasospasm and vasomotor reactivity in response to acetylcholine.

BACKGROUND: Lipocalin-type prostaglandin D synthase (L-PGDS) catalyzes the biosynthesis of PGD(2), which acts as an anticoagulant, vasodilator, and inflammatory mediator. We examined the serum L-PGDS level, coronary macro- and microvasomotor functions, and their relationship in patients with chest pain and angiographically normal coronary arteries. METHODS AND RESULTS: The study included 96 patients who underwent diagnostic coronary angiography and had angiographically normal coronary arteries. Blood flow of the left anterior descending coronary artery (LAD) was analyzed by Doppler guidewire examination. Serum L-PGDS level was determined by ELISA. Infusion of acetylcholine (ACh) induced vasospasm of the LAD in all patients with vasospastic angina (VSA) (n=45), but in none of the patients without VSA (n=51). There were no significant differences in the baseline clinical characteristics of the nonVSA and VSA groups, except for the frequency of smoking. Serum L-PGDS level in the VSA group was significantly higher than that in the nonVSA group (77.1±4.4 vs. 63.9±2.5 µg/dl, P<0.01). Significant negative correlations were observed between the degree of LAD vasomotion in response to ACh and serum L-PGDS level (3 µg/min: r=-0.33; 10 µg/min: r=-0.35; 30 µg/min: r=-0.33, P<0.01). CONCLUSIONS: The L-PGDS level was elevated in patients with VSA and was associated with epicardial coronary vasomotion in response to ACh.

Association between brachial-ankle pulse wave velocity and endothelium-dependent and -independent coronary vasomotor function.

1. Coronary endothelial function and brachial-ankle pulse wave velocity (baPWV) are independent predictors of cardiovascular events. Thus, in the present study we examined the relationship between baPWV and endothelium-dependent and -independent coronary vasodilatory functions. 2. Sixty-five patients (12 diabetic and 53 non-diabetic) with no significant stenosis of the coronary artery were studied and baPWV determined. After cardiac catheterization, graded doses of bradykinin (BK; 0.2, 0.6 and 2.0 µg/min), nitroglycerin (NTG; 250 µg) and papaverine (Pa; 12 mg) were administered into the left anterior descending coronary artery. Coronary blood flow (CBF) was measured using a Doppler flow wire. 3. In the 65 patients, an inverse correlation was found between baPWV and the percentage change in epicardial coronary artery diameter (Δ%CoD), as well as the percentage change in CBF (Δ%CBF), following administration of BK (endothelium-dependent vasodilator). Moreover, inverse correlations were found between baPWV and Δ%CoD following administration of NTG (endothelium-independent vasodilator) and Δ%CBF following administration of Pa (endothelium-independent vasodilator). 4. Multivariate analysis revealed diabetes to be independently and significantly associated with baPWV, BK-induced Δ%CBF and Δ%CoD and Pa-induced Δ%CBF. 5. In conclusion, the results of the present study suggest that increased baPWV is associated with endothelium-dependent and -independent coronary vasodilatory dysfunction. Non-invasive and straightforward baPWV measurement may be useful for the assessment of coronary risk factors, particularly in diabetic patients.

Clinical features of myocardial triglyceride in different types of cardiomyopathy assessed by proton magnetic resonance spectroscopy: comparison with myocardial creatine.

BACKGROUND: Myocardial lipid overstorage may produce cardiomyopathy, leading to dysfunction, but advanced heart failure may cause lipolysis via sympathetic nerve activation. In the failing heart, the creatine kinase system may also be impaired. The aims of this study were to assess myocardial triglyceride (TG) and creatine (CR) in different types of cardiomyopathy and to investigate whether they are related to the severity of cardiac dysfunction. METHODS AND RESULTS: In patients with hypertrophic cardiomyopathy (HCM, n = 8), dilated cardiomyopathy (DCM, n = 12) or ischemic cardiomyopathy (ICM, n = 10), and normal subjects (NML, n = 22), myocardial TG and CR were evaluated using proton magnetic resonance spectroscopy. To assess cardiac sympathetic nerve activity, myocardial MIBG (a radioactive guanethidine analog) uptake was measured in DCM. Myocardial TG was significantly lower in hypertrophic cardiomyopathy (HCM) (1.92 ± 0.99 µmol/g), but higher in ICM (7.59 ± 4.36 µmol/g) than in NML hearts (4.05 ± 1.94 µmol/g). There was no significant difference in TG between DCM (4.84 ± 6.45 µmol/g) and NML. Myocardial CR in HCM (20.4 ± 8.4 µmol/g), DCM (14.8 ± 4.8 µmol/g), and ICM (19.4 ± 6.3 µmol/g) was significantly lower than that in NML hearts (27.1 ± 4.3 µmol/g). Overall, myocardial CR correlated positively with the severity of heart failure estimated by ejection fraction or myocardial BMIPP (a radioactive fatty acid analog) uptake, but TG did not. In DCM, myocardial TG correlated with body mass index, but not with MIBG uptake. CONCLUSIONS: Myocardial TG may be related to the specific cause of disease rather than the severity of cardiac dysfunction. In contrast, myocardial CR reflects the severity of heart failure despite different pathoetiologic mechanisms of dysfunction. In DCM, myocardial TG may be affected by an overweight state rather than cardiac sympathetic nerve dysfunction. Thus, myocardial CR has a closer relationship to heart failure severity than does myocardial TG.

Clinical significance of diastolic function as an indicator of myocardial ischemia assessed by 16-frame gated myocardial perfusion SPECT.

OBJECTIVE: Studies have suggested that ischemia-induced diastolic dysfunction persists longer than systolic dysfunction. We examined whether global left ventricular (LV) diastolic function during stress testing assessed by 16-frame gated myocardial perfusion single-photon emission computed tomography (SPECT) is useful as an indicator of myocardial ischemia. METHODS: Thirty-nine patients underwent 16-frame technetium-99m (Tc-99m) quantitative gated SPECT (QGS), including treadmill exercise testing for suspected ischemic heart disease. Diastolic parameters of the first-third filling fraction (1/3FF), and the peak filling rate (PFR) were calculated by a time-volume curve from the QGS data. RESULTS: The patients were divided into four groups, namely, IS, NL, DN, and DD, on the basis of tracer accumulation and the LV ejection fraction (LVEF) at rest. In the IS group (reversible tracer uptake reduction suggesting ischemia; n=11), LVEF, 1/3FF, and PFR after stress were significantly lower than those at rest, whereas in the NL group (normal perfusion; n=10) and DN group (fixed tracer uptake reduction with normal systolic function; EF>or=60% at rest; n=10), LVEF, 1/3FF, and PFR after stress did not differ from those at rest. However, in the DD group (fixed tracer uptake reduction with cardiac dysfunction; EF<60%, average 47.1%; n=8), LVEF, 1/3FF, and PFR were significantly altered after stress. CONCLUSIONS: Altered global LV diastolic function during stress assessed by 16-frame gated myocardial perfusion SPECT is useful for the detection of myocardial ischemia. However, similar findings are observed in patients with cardiac dysfunction but without detectable ischemia. Our findings do suggest that tests should be performed with caution to determine whether ischemia exists on the basis of altered global LV function after stress in patients with cardiac dysfunction.

A giant main pulmonary artery aneurysm associated with infundibular pulmonary stenosis.

We report a case of a giant pulmonary artery aneurysm associated with infundibular pulmonary stenosis. Echocardiography disclosed markedly enlarged main pulmonary artery, but no left to right shunt flow at levels of the atrial septum, ventricular septum and the pulmonary artery. Continuous wave Doppler revealed a maximum velocity of 1.5 m/s which corresponded to the pressure gradient between the right ventricle and the pulmonary artery of 9.5 mmHg. Contrast-enhanced multidetector-row computed tomography with a 16-slice scanner revealed pulmonary artery aneurysm with the maximum diameter of 67 mm on axial image.

Cigarette smoking impairs bradykinin-stimulated tissue plasminogen activator release in human coronary circulation.

BACKGROUND: Cigarette smoking is a major risk factor for acute coronary thrombosis. Bradykinin (BK) can induce the release of tissue plasminogen activator (tPA) from the coronary vasculature. The purpose of this study was to investigate whether smoking reduces BK-stimulated tPA release in human coronary circulation. MATERIALS AND METHODS: We examined two groups: 20 current smokers and 19 nonsmokers. By cardiac catheterization, graded doses of BK (0.2, 0.6 and 2.0 microg/min) and papaverine (PA) (12 mg) were administered into the coronary artery. Coronary blood flow (CBF) was measured using a Doppler flow wire. Blood samples from the aorta (Ao) and coronary sinus (CS) were assayed. RESULTS: BK increased both coronary artery diameter (CD) and CBF to a similar extent in the two groups. The net coronary tPA release was dose-dependently increased by BK in the two groups, but the degree of this increase in current smokers was significantly lower than that in nonsmokers. BK did not change plasminogen activator inhibitor type 1 (PAI 1) levels in either group. PA did not alter either tPA or PAI-1 levels in either group. CONCLUSIONS: These results suggest that cigarette smoking deteriorates coronary fibrolytic activity, independent of changes in CBF. These findings can at least partly explain the higher risk of coronary thrombosis in smokers.

A novel clinical indicator using Tc-99m sestamibi for evaluating cardiac mitochondrial function in patients with cardiomyopathies.

BACKGROUND: Technetium 99m sestamibi (MIBI) is a technetium-labeled myocardial perfusion agent that is taken up by the myocardial cell in proportion to myocardial regional blood flow and remains fixed in the myocardial cell over a long period of time. Previous studies have suggested that MIBI shows very slow myocardial clearance after its initial uptake in an animal model, which is related to mitochondrial function. This study was designed to test the hypothesis that MIBI washout can be used to evaluate the severity of congestive heart failure in comparison to other clinical parameters in patients with cardiomyopathies. METHODS AND RESULTS: After administration of MIBI, 61 patients with nonischemic congestive heart failure (49 with dilated cardiomyopathy and 12 with other cardiomyopathies) and 7 normal control subjects were examined by electrocardiography-gated myocardial perfusion single photon emission computed tomography and planar data acquisition in the early and delayed phases (interval of 3 hours). Myocardial MIBI washout rates were calculated from the early and delayed planar images. Left ventricular function (systolic and diastolic) was analyzed by use of QGS data. Plasma levels of B-type natriuretic peptide and iodine 123 metaiodobenzylguanidine (MIBG) parameters were also measured. Patients were followed up for a mean of 12 months (range, 1-19 months). As the severity of the New York Heart Association (NYHA) functional class advanced, the washout rate of MIBI increased (21.6% +/- 2.4% in those with NYHA class I [n = 23], 28% +/- 4% in those with NYHA class II [n = 27], and 35% +/- 5% in those with NYHA class III [n = 10]; P < .05, analysis of variance). The washout rate of MIBI was positively correlated with the level of B-type natriuretic peptide (r = 0.31, P < .05), end-diastolic volume (r = 0.396, P < .01), and end-systolic volume (r = 0.496, P < .01) and was negatively correlated with left ventricular ejection fraction (r = 0.523, P < .01), peak filling rate (r = 0.444, P < .01), and first-third ejection fraction (r = 0.414, P < .01). The parameters of MIBG scintigraphy were calculated as the heart-mediastinum count ratio (1.9 +/- 3) and washout rate (38% +/- 4%). We found a significant relationship between the washout rate of MIBI and the heart-mediastinum count ratio of MIBG (r = 0.51, P < .01). Patients with a higher washout rate of MIBI had a higher cardiac event rate (> or =28%) than those with a lower washout rate (<28%) (P < .05). CONCLUSIONS: The myocardial washout rate of MIBI is thought to be a novel marker for the diagnosis of myocardial damage or dysfunction, providing prognostic information in patients with congestive heart failure.

Assessment of cardiac function in patients with heart disease by quantitative gated myocardial perfusion SPECT.

OBJECTIVE: We examined the cardiac function of patients who underwent Tc-99m sestamibi quantitative gated myocardial single photon emission computed tomography with 16-framing data acquisition between January 1, 2004 and March 31, 2006 for an evaluation of suspected or known heart disease in our hospital. METHODS: In 192 patients aged >or=40 years, the left ventricular (LV) systolic function [parameter: ejection fraction (EF)] and diastolic function [first third filling fraction (1/3FF), peak filling rate (PFR), and time-to-peak filling (TPF)] were estimated by volume curve analysis. In 51 (age >or=60 years) of 192 patients, brachial-ankle pulse wave velocity (baPWV) was also measured. RESULTS: The correlation between diastolic parameters PFR and 1/3FF was mild (r = 0.28, P < 0.001). On the basis of EF and PFR, 192 patients were divided into four groups: P (preserved LV function), Q (isolated systolic dysfunction, EF < 50%), R (isolated diastolic dysfunction, PFR < 1.8 EDV/s), and S (both dysfunctions). The numbers of patients in P, Q, R, and S groups were 94 (49.0%), 7 (3.6%), 31 (16.1%), and 60 (31.3%), respectively. The 1/3FF correlated weakly but significantly with age (r = -0.16, P < 0.05). The TPF also correlated weakly with age (r = 0.25, P < 0.01), but EF did not. The baPWV, an indicator of cardiovascular stiffness, correlated inversely with 1/3FF (r = -0.59, P < 0.001) or correlated positively with TPF (r = 0.45, P < 0.001), but not with EF. CONCLUSIONS: Our study suggests that cardiovascular stiffness associated with increased baPWV may contribute to the occurrence of diastolic dysfunction in elderly patients.

The role of impaired sympathetic nerve function in enhancing coronary vasoconstriction in patients with hypertrophic cardiomyopathy.

Coronary vasospasm and diminished coronary blood flow reserve have often been reported in patients with hypertrophic cardiomyopathy (HCM). However, the mechanism of coronary spasm in HCM is unknown. Thus, coronary endothelial function and sympathetic nerve function in 11 patients with HCM and 11 control patients matched for age and sex were examined. The diameter of the left anterior descending coronary artery was assessed by quantitative coronary angiography, and the change in coronary blood flow was estimated using an intracoronary Doppler flow wire. To assess myocardial sympathetic nerve function, metaiodobenzylguanidine images - 15 min and 180 min after the injection of (123)I-metaiodoben-zylguanidine at a dosage of 111 MBq - were obtained, and the heart to mediastinum (H/M) count ratio and the washout rate (WR) were calculated. The H/M ratio was significantly lower in patients with HCM (2.1+/-0.3) than in control patients (2.6+/-0.4) (P<0.01). In addition, the WR was higher in patients with HCM (35+/-6%) than in control patients (28+/-3%) (P<0.01). The HCM subjects with coronary spasm had lower H/M ratios and higher WRs than HCM subjects without coronary spasm (P<0.05, respectively). In conclusion, impaired sympathetic nerve function may be associated with coronary vasospasm and diminished coronary blood flow reserve in HCM.

Disseminated Mycobacterium intracellulare infection with multiple abscesses on extremities in a woman with chronic corticosteroid therapy.

A 78-year-old Japanese woman with rheumatoid arthritis was admitted to our hospital due to fever. She had been prescribed prednisolone and bucillamine. Computed tomography revealed abscesses on extremities. M. intracellulare was cultured from her calcaneus osteomyelitis, and this result pointed to a disseminated mycobacterial infection. We drained the abscesses and found M. intracellulare. We started antimycobacterial agents, but the patient died finally. Disseminated mycobacterial infection is rare but critical, and the possibility of such an infection in an immunocompromised patient should be a prime consideration when choosing appropriate drugs and surgical approaches.

Impact of paraoxonase polymorphism (Q192R) on endothelial function in intact coronary circulation.

Paraoxonase-1 (PON1) can protect endothelial function by preventing the oxidation of low-density lipoprotein (LDL) cholesterol and retarding the development of atherosclerosis. We examined whether PON1 polymorphism influences endothelium-dependent coronary vasomotor responses. Sixty-seven patients underwent diagnostic cardiac catheterization, but showed no significant coronary artery stenosis. In all patients, PON1 genotypes (Q/Q, Q/R and R/R) were determined, and provocative testing was performed by the intracoronary administration of graded doses of bradykinin (BK; 0.2, 0.6 and 2.0 mug/min) and acetylcholine (ACh; 3, 10 and 30 mug/min). Coronary blood flow (CBF) was evaluated by a Doppler guide wire. The patients were divided into 2 groups on the basis of ACh testing: one with coronary spastic angina (CSA) and one with non-CSA. The frequencies of the PON1 genotype in the CSA group did not differ significantly from those in the non-CSA group. In the non-CSA group, the patients were subdivided into 2 groups: a group with the Q/Q or Q/R genotypes and a group with the R/R genotype. The vasoconstrictive responses of the epicardial coronary artery to ACh were comparable between the Q/Q + Q/R and R/R groups. Also, the coronary vasodilations induced by BK in the R/R group were similar to those in the QR + QQ group. There were no significant differences in the CBF responses induced by BK or ACh between the Q/Q + Q/R and R/R groups. In conclusion, as estimated by BK and ACh testing, our findings suggest that PON1 genotypes may not play a critical role in the modulation of endothelial vasomotor function in the intact coronary circulation.

Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction--analysis by quantitative ECG-gated SPECT--.

BACKGROUND: We hypothesized that endothelial cell integrity in the risk area would influence left ventricular remodeling after acute myocardial infarction. PATIENTS AND METHODS: Twenty patients (61 +/- 8 y.o.) with acute myocardial infarction underwent 99mTc-tetrofosmin imaging in the subacute phase and three months after successful primary angioplasty due to myocardial infarction. All patients were administered angiotensin-converting enzyme inhibitor after revascularization. Cardiac scintigraphies with quantitative gated SPECT were performed at the sub-acute stage and again 3 months after revascularization to evaluate left ventricular (LV) remodeling. The left ventricular ejection fraction (EF) and end-systolic and end-diastolic volume (ESV, EDV) were determined using a quantitative gated SPECT (QGS) program. Three months after myocardial infarction, all patients underwent cardiac catheterization examination with coronary endothelial function testing. Bradykinin (BK) (0.2, 0.6, 2.0 microg/min) was administered via the left coronary artery in a stepwise manner. Coronary blood flow was evaluated by Doppler flow velocity measurement. Patients were divided into two groups by BK-response: a preserved endothelial function group (n = 10) and endothelial dysfunction group (n = 10). RESULTS: At baseline, both global function and LV systolic and diastolic volumes were similar in both groups. However, LV ejection fraction was significantly improved in the preserved-endothelial function group, compared with that in the endothelial dysfunction group (42 +/- 10% to 48 +/- 9%, versus 41 +/- 4% to 42 +/- 13%, p < 0.05). LV volumes progressively increased in the endothelial dysfunction group compared to the preserved-endothelial, function group (123 +/- 45 ml to 128 +/- 43 ml, versus 111 +/- 47 ml to 109 +/- 49 ml, p < 0.05). CONCLUSION: In re-perfused acute myocardial infarction, endothelial function within the risk area plays an important role with left ventricular remodeling after myocardial infarction.

Evaluation of cardiac resynchronization therapy in drug-resistant dilated-phase hypertrophic cardiomyopathy by means of Tc-99m sestamibi ECG-gated SPECT.

This case describes a 65-year-old male with drug-resistant heart failure. Cardiac resynchronization therapy was performed. We evaluated cardiac function with volume curve differentiation software (VCDiff) from QGS data with Tc-99m sestamibi. Left ventricular parameters during atrial-right ventricular pacing were left ventricular ejection fraction (LVEF) 30%, end-diastolic volume (EDV) 156 ml, end-systolic volume (ESV) 108 ml and peak filling rate 1.12 (EDV/sec). And during dual chamber pacing, those were LVEF 35%, EDV 145 ml and ESV 95 ml and PFR 1.58 (EDV/sec). And during atrial-left ventricular pacing, those were LVEF 36%, EDV 152 ml, ESV 97 ml and peak filling rate (PFR) 1.35 (EDV/sec). Cardiac resynchronization therapy may improve cardiac function as well as dyssynchrony, which could be evaluated non-invasively and accurately by ECG-gated SPECT.

Primary malignant lymphoma of the right atrium resulting in superior vena caval syndrome in an HIV-positive patient: depiction at multislice computed tomography and magnetic resonance imaging.

An HIV-positive 32-year-old male presenting with superior vena cava syndrome underwent multislice computed tomography (MSCT) and magnetic resonance imaging (MRI), which showed a large tumor in the right atrium, which extended to the superior vena cava. Pathologic examination revealed that the mass was consistent with B cell-type malignant lymphoma. The tumor size markedly decreased after the initiation of chemotherapy and patient recovery has been uneventful for 1 year.

Proton magnetic resonance spectroscopy can detect creatine depletion associated with the progression of heart failure in cardiomyopathy.

OBJECTIVES: This study noninvasively examined total creatine (CR) of the myocardium in dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) using proton magnetic resonance spectroscopy ((1)H-MRS). BACKGROUND: Abnormalities in CR metabolism in failing hearts have been reported. A biochemical study suggested that myocardial metabolic changes are very similar in DCM and HCM despite the different heart failure (HF) mechanisms. METHODS: Using cardiac-gated (1)H-MRS with magnetic resonance image (MRI)-guided point-resolved spectroscopy (PRESS) localization, we quantitatively measured septal CR. Patients with either DCM (n = 11) or HCM (n = 7) and age-matched normal subjects (n = 14) were examined. RESULTS: Myocardial CR was significantly lower in DCM patients (16.1 +/- 4.5 micromol/g wet weight [range 10.2 to 22.9], p < 0.05) than that in subjects with normal hearts (27.6 +/- 4.1 micromol/g [range 21.4 to 36.2]). Myocardial CR in HCM patients (22.6 +/- 8.1 micromol/g [range 12.2 to 34.5]) was significantly lower than that in subjects with normal hearts (p < 0.05) but was significantly higher than that in DCM patients (p < 0.05). In 18 patients with either DCM or HCM, myocardial CR correlated positively with left ventricular ejection fraction (LVEF) (y = 0.22x + 9.8, r = 0.73, p = 0.0006) but correlated negatively with plasma B-type natriuretic peptide (BNP) levels (y = -0.012x + 22.4, r = -0.54, p = 0.022). CONCLUSIONS: This study showed that (1)H-MRS can noninvasively detect CR depletion associated with the severity of HF in cardiomyopathy.

Dilated cardiomyopathy relieved as a result of beta-blocker therapy: a case report--key points in assessment of prognosis based on MIBG myocardial scintigraphy and BNP levels.

A 48-year-old male patient was admitted to our hospital with dyspnea accompanied by orthopnea. Chest x-rays showed a cardiothoracic ratio of 68% and pulmonary congestion. He was diagnosed with dilated cardiomyopathy. Beta-Blocker (carvedilol) therapy was initiated on Day 22 of the disease using a small initial dose. He was followed up based on BNP levels and MIBG scintigraphy. The H/M ratio and MIBG washout rate were 1.98 and 33.4%, respectively, on Day 20 and 2.15 and 28.1%, respectively, on Day 72. The patient was discharged on Day 72 when congestive heart failure improved. Relatively high BNP levels were observed for 1 month after starting treatment with a beta-blocker. Plasma BNP levels were still as high when his heart failure was improved. BNP is useful as a convenient indicator for the severity of cardiac diseases. MIBG scintigraphy may be used thereafter to evaluate the severity in greater detail and more precisely determine the prognosis.