Idiopathic ventricular tachycardia originating from the posteroseptal mitral annulus: a case report.

Idiopathic VT originating from posteroseptal mitral annulus. We describe a 71-year-old man with a ventricular tachycardia (VT) originating from the mitral annulus. A sustained VT was induced by exercise or an isoproterenol administration, but not by pacing. Frequent premature ventricular contractions(PVCs) with the same QRS as the VT were transiently suppressed by an adenosine triphosphate injection,suggesting that it was due to cyclic-AMP mediated triggered activity. The PVCs and VT were all abolished by radiofrequency catheter ablation guided by the earliest activation and a perfect pace map, which was located at the posteroseptal mitral annulus. The patient has been free from any symptoms for 2 years.(J Cardiovasc Electrophysiol, Vol. 17, pp. 1375-1377, December 2006)

Different effects of simvastatin and losartan on cytokine levels in coronary artery disease.

BACKGROUND AND OBJECTIVE: Use of HMG-CoA reductase inhibitors (statins) and angiotensin II type 1 (AT(1)) receptor antagonists reduces the incidence of cardiovascular events. The cytokines macrophage colony-stimulating factor (M-CSF) and transforming growth factor (TGF)-beta may exert proatherogenic and antiatherogenic effects, respectively. In this study, we examined whether treatment with a statin or an AT(1) receptor antagonist alters M-CSF and TGF-beta levels in patients with coronary artery disease. METHODS: Twenty-seven consecutive patients with coronary artery disease were randomly assigned to the following three treatment groups for 8 weeks: simvastatin 5 mg/day (n = 10); losartan 50 mg/day (n = 9); or control (usual treatment; n = 8). Blood samples were collected before and after treatment. RESULTS: Clinical characteristics and baseline cytokine levels were comparable among the three groups. Serum levels of M-CSF were significantly decreased only in the simvastatin group (from 403 +/- 71 to 303 +/- 116 pg/mL; p = 0.009). Plasma levels of TGF-beta were significantly increased only in the losartan group (from 5.01 +/- 1.13 to 7.50 +/- 3.83 ng/mL; p = 0.021). Simvastatin decreased serum M-CSF levels independently of changes in total cholesterol or low-density lipoprotein-cholesterol. CONCLUSIONS: The results of this study indicate that simvastatin decreases serum levels of M-CSF while losartan increases plasma levels of TGF-beta, suggesting that the two drugs may have different anti-atherosclerotic properties.

Prognostic significance of plasma concentrations of transforming growth factor-beta in patients with coronary artery disease.

BACKGROUND: Cytokines play an important role in modulating inflammatory and proliferative responses, including atherosclerosis. Transforming growth factor-beta (TGF-beta) and macrophage-colony stimulating factor (M-CSF) are one of the major antiinflammatory and proinflammatory cytokines, respectively. We have previously demonstrated that plasma concentrations of TGF-beta are decreased while those of M-CSF are increased in patients with coronary artery disease (CAD). In this study, we examined whether those alterations in plasma levels of cytokines have a prognostic significance in patients with CAD. METHODS AND RESULTS: Sixty-eight consecutive patients with proven CAD were studied. The plasma concentrations of TGF-beta and those of M-CSF were measured by enzyme-linked immunosorbent assay (ELISA). They were divided into groups: high (> or =6 ng/ml, n = 19) and low (<6 ng/ml, n = 49) TGF-beta groups and high (>500 ng/ml, n = 52) and low (< or =500 ng/ml, n = 16) M-CSF groups. The long-term prognosis of these patients was prospectively followed up for a mean period of 979 +/- 27 days. The prognosis was analyzed by Kaplan-Meier analysis in terms of total survival, survival without myocardial infarction, survival without cardiovascular events and survival without coronary interventions. The analysis showed that the low TGF-beta group had a significantly poor prognosis in terms of survival without cardiovascular events and survival without coronary interventions as compared with the high TGF-beta group (both P < 0.05), while other prognoses were comparable between the two groups. By contrast, no significant prognostic influence was noted regarding M-CSF. CONCLUSIONS: These results suggest that plasma concentrations of TGF-beta may have a prognostic significance in patients with CAD.

The dexmedetomidine concentration required after remifentanil anesthesia is three-fold higher than that after fentanyl anesthesia or that for general sedation in the ICU.

PURPOSE: The general dexmedetomidine (DEX) concentration required for sedation of intensive care unit patients is considered to be approximately 0.7 ng/mL. However, higher DEX concentrations are considered to be required for sedation and/or pain management after major surgery using remifentanil. We determined the DEX concentration required after major surgery by using a target-controlled infusion (TCI) system for DEX. METHODS: Fourteen patients undergoing surgery for abdominal aortic aneurysms (AAA) were randomly, double-blindly assigned to two groups and underwent fentanyl- or remifentanil-based anesthetic management. DEX TCI was started at the time of closing the peritoneum and continued for 12 hours after stopping propofol administration (M0); DEX TCI was adjusted according to the sedation score and complaints of pain. The doses and concentrations of all anesthetics and postoperative conditions were investigated. RESULTS: Throughout the observation period, the predicted plasma concentration of DEX in the fentanyl group was stable at approximately 0.7 ng/mL. In contrast, the predicted plasma concentration of DEX in the remifentanil group rapidly increased and stabilized at approximately 2 ng/mL. The actual DEX concentration at 540 minutes after M0 showed a similar trend (0.54±0.14 [fentanyl] versus 1.57±0.39 ng/mL [remifentanil]). In the remifentanil group, the dopamine dose required and the duration of intubation decreased, and urine output increased; however, no other outcomes improved. CONCLUSION: The DEX concentration required after AAA surgery with remifentanil was three-fold higher than that required after AAA surgery with fentanyl or the conventional DEX concentration for sedation. High DEX concentration after remifentanil affords some benefits in anesthetic management.

Clinical and angiographic predictors of luminal changes beyond 6 months after implantation of thicker strut coronary stents.

BACKGROUND: Late luminal changes beyond 6 months after thicker strut stent implantation have not been fully elucidated. The purpose of this study was to clarify the clinical and angiographic predictors of late changes in minimal lumen diameter (MLD) after 6-month follow-up of stenting. METHODS AND RESULTS: Fifty-one lesions from 44 patients who underwent successfully S670/660 stent (Medtronic Vascular, Santa Rosa, CA, USA) implantations without target lesion revascularization were studied at 6-month follow-up and coronary angiography was repeated after the follow-up. Late luminal loss beyond 6 months after stenting significantly correlated with late loss (r=-0.42, p=0.0025) and MLD (r=0.28, p=0.047) at 6-month follow-up. On multivariate analysis, age (p=0.005), diabetes mellitus (p=0.002), hyperlipidemia (p=0.023), smoking (p=0.015), bifurcation lesion (p=0.018), small stent diameter (p=0.001) and MLD at 6-month follow-up (p<0.001) were identified as independent predictors of late luminal loss. CONCLUSIONS: This study demonstrated that older age, diabetes mellitus, hyperlipidemia, smoking and small stent diameter (<3.0 mm) were associated with late luminal loss beyond 6 months after stenting, and that a bifurcation lesion and small lumen diameter at 6 months were associated with late luminal recovery.

Reentrant ventricular tachycardia originating from the aortic sinus cusp: a case report.

We report a case of idiopathic reentrant ventricular tachycardia (VT) originating from the left aortic sinus cusp. A prepotential preceding the QRS complex by 58 ms was recorded from the posterior right ventricular (RV) outflow tract. During VT entrainment observed by pacing from the midseptal RV, it initially was orthodromically captured with a long conduction time but then antidromically captured as the pacing cycle rate was increased. Pacing at that site failed to show concealed entrainment despite a postpacing interval similar to the VT cycle length. Radiofrequency catheter ablation abolished the VT in the left aortic sinus cusp where a prepotential preceding the QRS complex by 78 ms with a postpacing interval similar to the VT cycle length was recorded in addition to concealed entrainment. The findings suggest that, in this VT, a critical slow conduction zone is partially present extending from the left aortic sinus cusp to the posterior right ventricular outflow tract. The patient has remained free from VT recurrence after 5-month follow-up.

Postprandial increase in plasma concentrations of remnant-like particles: an independent risk factor for restenosis after percutaneous coronary intervention.

Postprandial increase in remnant lipoprotein concentrations has been suggested as an important atherogenic factor. However, the influence of these remnants on the development of restenosis after percutaneous coronary intervention (PCI) remains to be examined. The present study was designed to address this point. In 60 consecutive patients with successful PCI, the influences of possible risk factors on the development of restenosis, including remnant-like particles (RLP) cholesterol (RLP-C) and triglyceride (RLP-TG), were examined. While mean concentrations of RLP-C and RLP-TG were normal in fasting state, postprandial change in RLP-C concentrations was a significant and independent risk factor for restenosis after PCI. The calculated cut-off index (COI) for the change was +64%. When the patients were divided into 2 groups according to this COI, minimal lumen diameter (MLD) and reference coronary diameter were comparable before and immediately after PCI between the high- (COI < 64%) and the low- (COI < 64%) responders. However, follow-up coronary angiography 3 to 6 months after PCI demonstrated that MLD, late loss, and loss index were all worse in the high responders compared with the low responders. These results indicate that post-prandial increase in RLP-C concentrations is an independent risk factor for restenosis after successful PCI, even in patients with normal fasting RLP-C levels.