Effects of a vigorous gait on mechanical work and oxygen uptake during treadmill walking.

This study was conducted to compare mechanical work during vigorous walking (which utilizes greater arm swings and step lengths) with that during normal walking and to examine whether individual differences (delta: vigorous walking - normal walking) in mechanical work during vigorous walking affected oxygen uptake (VO2). Six adult men (M age = 28.5 yr., SD = 3.9) performed normal and vigorous walking on a treadmill at 1.11, 1.53, and 1.94 m/sec. At all speeds, external work during vigorous walking was greater than that during normal walking, and the delta of total work was significantly correlated with that of VO2. Thus, it was suggested that increased mechanical work (particularly total work) in vigorous walking would increase the metabolic cost.

Erythropoietin in patients with acute coronary syndrome and its cardioprotective action after percutaneous coronary intervention.

BACKGROUND: Erythropoietin (EPO) has been shown to have effects beyond hematopoiesis, such as prevention of cardiac apoptosis. The purpose of the current study is to examine the influence of the time-course change in the serum concentration of endogenous EPO on cardiac functions in the chronic phase in patients with acute coronary syndrome, who successfully achieved reperfusion by primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: The prospective study included 34 patients with angiographically documented coronary artery disease, including 24 patients with acute myocardial infarction (AMI) and 10 patients with unstable angina pectoris (UAP) who underwent successful PCI within 24 h from the onset. Serum EPO concentration significantly increased at Day 3 and Day 7 compared with that at Day 1 in the AMI group, and the level at Day 3 was significantly higher in the AMI group than in the UAP group. There were significant correlations between DeltaEPO and Delta left ventricular ejection fraction (LVEF) or Delta left ventricular end-diastolic volume index and between peak EPO concentration and DeltaLVEF. CONCLUSIONS: These data showed the time-dependent increase of serum EPO in AMI patients after primary PCI, indicating its possible contribution to cardioprotective effect in the chronic phase.

Cardioprotective effects of erythropoietin in rats subjected to ischemia-reperfusion injury: assessment of infarct size with 99mTc-annexin V.

UNLABELLED: Administration of erythropoietin (EPO) during or immediately after myocardial ischemia can reduce subsequent myocardial apoptosis, a key phenomenon in myocardial ischemia-reperfusion injury. In this study, we assessed the effect of EPO on (99m)Tc-annexin V myocardial uptake and whether the accumulation of (99m)Tc-annexin V can predict cardiac remodeling and functional deterioration. METHODS: Eighteen rats with left coronary artery (LCA) occlusion were randomized to receive either an intravenous injection of EPO (EPO group) or saline (nontherapy [nT] group) immediately after release of the occlusion. After 20 min of LCA occlusion and 30 min of reperfusion, the rats were injected with (99m)Tc-annexin V. One hour after (99m)Tc-annexin V injection, the LCA was reoccluded and (201)Tl was injected intravenously, and the rats were sacrificed 1 min later. The heart was removed and sectioned, and dual-tracer autoradiography was performed to evaluate the distribution of the area at risk (defined on the thallium autoradiograph) and the area of apoptosis (defined on the annexin autoradiograph). Adjacent histologic specimens had deoxyuridine triphosphate nick-end labeling (TUNEL) staining to confirm the presence of apoptosis and were compared with autoradiography. Another 16 rats were randomized to EPO and nT groups and underwent echocardiography immediately after release of the LCA occlusion and at 2 and 4 wk after surgery. RESULTS: The areas of (99m)Tc-annexin V accumulation in the EPO group were smaller than those in the nT group, though the (201)Tl defect areas of these 2 groups were comparable (area ratio, 0.318 +/- 0.038 vs. 0.843 +/- 0.051, P < 0.001, for annexin and 24.8 +/- 2.1 vs. 25.9 +/- 2.6 mm(2), P = NS, for thallium). (99m)Tc-annexin V accumulation correlated with the density of TUNEL-positive cells (r = 0.886, P < 0.001). In the nT group, left ventricular end-diastolic dimension (Dd) increased from baseline at 2 wk by 34.7% +/- 3.8% and remained stable at 34.9% +/- 5.0% at 4 wk after coronary occlusion. In the EPO group, Dd increased by 8.5% +/- 2.1% (P < 0.01 vs. nT at 2 wk) and 13.2% +/- 2.8% (P < 0.01 vs. nT at 4 wk). In the nT group, the left ventricular percentage of fractional shortening decreased by 42.2% +/- 3.4% and 52.9% +/- 3.4% at 2 and 4 wk, respectively, whereas in the EPO group it decreased 9.0% +/- 1.9% at 2 wk (P < 0.01 vs. nT at 2 wk) and 11.1% +/- 6.7% at 4 wk (P < 0.01 vs. nT at 4 wk). CONCLUSION: This study demonstrated that a single treatment with EPO immediately after release of coronary ligation suppressed cardiac remodeling and functional deterioration. (99m)Tc-annexin V autoradiographs and TUNEL staining confirm that this change is due to a decrease in the extent of myocardial apoptosis in the ischemic/reperfused region.

Early cardiac involvement in senile systemic amyloidosis: a case report.

Senile systemic amyloidosis (SSA) is caused by the deposition of wild-type transthyretin (TTR)-derived amyloid fibrils. This type of amyloidosis is not rare in elderly individuals over the age of 80 and is usually detected on postmortem microscopic examination of myocardium. We report a 67-year-old male patient who was clinically diagnosed as having SSA with cardiac involvement. The initial event was cerebral infarction conceivably due to cardiac embolism. Endomyocardial biopsy was performed twice, which led to a definitive diagnosis of amyloidosis at the second biopsy. This amyloid was immunolabeled by an anti-TTR antibody and direct DNA sequencing of the TTR gene did not detect any mutation. Clinical confirmation of SSA in individuals before the age of 70 is infrequent and cardiac amyloidosis associated with this disease might have been the cause of cerebral embolism in our patient. Additionally, it is important to distinguish cardiac amyloidosis of SSA from that of primary immunoglobulin light chain (AL)-derived amyloidosis, because the treatment and prognosis differ considerably from those of primary AL amyloidosis.

Brain natriuretic peptide concentration in pericardial fluid is independently associated with atrial fibrillation after off-pump coronary artery bypass surgery.

OBJECTIVES: Postoperative atrial fibrillation is associated with the increased incidence of morbidities and mortality. Predisposing determinants of atrial fibrillation development after off-pump coronary artery bypass grafting remain unclear. We hypothesized that pericardial fluid natriuretic peptide concentrations have a predictive value for developing postoperative atrial fibrillation in patients who have undergone off-pump coronary artery bypass grafting. METHODS: We prospectively measured atrial natriuretic peptide and brain natriuretic peptide concentrations in plasma and pericardial fluid in 42 consecutive patients undergoing off-pump coronary artery bypass grafting, then continuously observed the occurrence of atrial fibrillation following off-pump coronary artery bypass grafting until the time of discharge. RESULTS: Postoperative atrial fibrillation was documented in nine patients (21%, atrial fibrillation group), and not in 33 patients (no atrial fibrillation group). Between the groups, there was neither significant difference in plasma atrial natriuretic peptide concentrations nor in pericardial atrial natriuretic peptide concentrations. Plasma brain natriuretic peptide concentrations were comparable in both groups [56.2 (interquartile range 42.7-102.8) vs. 35.2 pg/ml (13.8-75.0), P=0.07]. Pericardial fluid brain natriuretic peptide concentrations were significantly higher in the atrial fibrillation group than in the no atrial fibrillation group [188.0 (124.8-411.0) vs. 39.3 pg/ml (10.0-88.4), P=0.0001]. In a multivariable logistic regression model, pericardial brain natriuretic peptide concentration was significantly associated with a higher risk of postoperative atrial fibrillation (odds ratio=3.0 every 50 pg/ml increase; 95% confidence interval, 1.1-8.6; P=0.04). CONCLUSION: Our results suggested that pericardial fluid brain natriuretic peptide concentration is independently associated with the development of atrial fibrillation after off-pump coronary artery bypass grafting.

Ectopic cystic thymoma associated with Raynaud's phenomenon.

Mediastinal cystic tumors are well-marginated round lesions that comprise 12% to 18% of all mediastinal masses. These lesions include a variety of diseases with overlapping radiologic appearances and variable prognoses. Pathological examinations are almost always required for differential diagnosis. We encountered a case of anterior mediastinal tumor discovered in the process of investigation of Raynaud's phenomenon. Taking into account the tumor location, a pericardial cyst was initially suspected. However, the tumor was surgically resected and histopathological examinations demonstrated thymus-like tissue in the cyst walls. Raynaud's phenomenon greatly improved after surgery. These findings suggested that cystic thymoma originated from ectopic thymic tissue and is accompanied by paraneoplastic syndrome.

Carbon dioxide-rich water bathing enhances collateral blood flow in ischemic hindlimb via mobilization of endothelial progenitor cells and activation of NO-cGMP system.

BACKGROUND: Carbon dioxide-rich water bathing has the effect of vasodilatation, whereas it remains undetermined whether this therapy exerts an angiogenic action associated with new vessel formation. METHODS AND RESULTS: Unilateral hindlimb ischemia was induced by resecting the femoral arteries of C57BL/J mice. Lower limbs were immersed in CO2-enriched water (CO2 concentration, 1000 to 1200 mg/L) or freshwater (control) at 37 degrees C for 10 minutes once a day. Laser Doppler imaging revealed increased blood perfusion in ischemic limbs of CO2 bathing (38% increase at day 28, P<0.001), whereas N(G)-nitro-L-arginine methyl ester treatment abolished this effect. Angiography or immunohistochemistry revealed that collateral vessel formation and capillary densities were increased (4.1-fold and 3.7-fold, P<0.001, respectively). Plasma vascular endothelial growth factor (VEGF) levels were elevated at day 14 (18%, P<0.05). VEGF mRNA levels, phosphorylation of NO synthase, and cGMP accumulation in the CO2-bathed hindlimb muscles were increased (2.7-fold, 2.4-fold, and 3.4-fold, respectively) but not in forelimb muscles. The number of circulating Lin-/Flk-1+/CD34- endothelial-lineage progenitor cells was markedly increased by CO2 bathing (24-fold at day 14, P<0.001). The Lin-/Flk-1+/CD34- cells express other endothelial antigens (endoglin and VE-cadherin) and incorporated acetylated LDL. CONCLUSIONS: Our present study demonstrates that CO2 bathing of ischemic hindlimb causes the induction of local VEGF synthesis, resulting in an NO-dependent neocapillary formation associated with mobilization of endothelial progenitor cells.

Resting ST-segment depression predicts exercise-induced subendocardial ischemia in patients with hypertrophic cardiomyopathy.

BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) sometimes display characteristic electrocardiographic (ECG) findings at rest and develop subendocardial ischemia during exercise in the absence of coronary lesions. However, their relationship has not yet been fully clarified. METHODS: Exercise Tc-99m-tetrofosmin myocardial scintigraphy was performed in 48 patients with non-obstructive HCM. We quantified transient left ventricular cavity dilation (LVCD) on exercise scintigrams, a parameter of subendocardial ischemia, and correlated the results with the ECG findings at rest and during exercise. RESULTS: Transient LVCD occurred during exercise in 17 (35%) patients with HCM. Hemodynamic parameters during exercise did not differ between HCM patients with and without transient LVCD. Multiple logistic regression analysis showed that transient LVCD was significantly associated with ST-segment depression at rest (chi2=5.00, odds ratio=5.70, 95% confidence intervals 1.24-26.18, P=0.025) and a greater total number of leads with resting ST-segment depression (chi2=6.38, odds ratio=1.60, 95% confidence intervals 1.12-2.42, P=0.012). The degree of LVCD was correlated with the total number of leads with ST-segment depression at rest (P=0.002); the optimal cutoff for the diagnosis of transient LVCD was 3 with a sensitivity of 65%, a specificity of 90%, and an accuracy of 81%. CONCLUSIONS: In patients with HCM, ST-segment depression at rest was accompanied by exercise-induced subendocardial perfusion abnormality as detected by myocardial scintigraphy. ST-segment depression at rest suggests that the subendocardium is predisposed to exertional ischemia.

A case presenting with myocardial ischemia-like electrocardiogram findings after laryngopharyngoesophagectomy.

Laryngopharyngoesophagectomy and reconstruction by using stomach roll with retrocardiac anastomosis were performed in a 60-year-old man with hypopharyngeal cancer. Postoperative electrocardiogram showed marked ST-segment elevation in leads I and aVL and depression in leads II, III, aVF, and V1-6. However, the patient did not present with abnormal findings on physical examination and vital signs were normal. Further, the laboratory data were normal. Echocardiography was a poor technique, but the stomach roll was observed to be expanded due to wall edema with exudates and exerted pressure on the posterior side of the heart. These findings were also ascertained by contrast-enhanced chest computed tomography scanning. Technetium-99m-tetrofosmin myocardial scintigraphy clearly showed that coronary blood perfusion and left ventricular wall motion were quite normal. The characteristic electrocardiogram returned to a near-normal state, and the expanded stomach roll shrank back to its ordinary size after one week. Coronary angiography showed neither organic stenoses nor vasospasm. The physical pressure of the expanded stomach roll might have influenced the electrocardiogram findings.

Mobile stenosis in a left internal mammary artery graft: a case report.

The authors report a case of percutaneous transluminal angioplasty (PTA) with coronary stent for stenosis in a left internal mammary artery (IMA) graft, which led to newly developed stenosis at both sides of the stent in the IMA graft. The intravascular ultrasound (IVUS) revealed that the stenotic lesion consisted of intramural hematoma, which had shifted owing to the stent deployment. They suggest that the cause of stenotic lesions in IMA grafts at the early postoperative period is luminal compression by intramural hematoma, which can be visualized by use of IVUS. The strategy of PTA for IMA grafts performed at the early postoperative period should include consideration for hematoma shift.

Beneficial effect of gabexate mesilate on microscopic polyangiitis with renal dysfunction and pulmonary hemorrhage: A case report.

Corticosteroids and cyclophosphamide are the mainstay of the treatment of microscopic polyangiitis involving pulmonary hemorrhage or rapidly progressive glomerulonephritis. However, patients with advanced age are unable to tolerate this combined therapy, because of a relatively high incidence of side effects including infection, hemorrhagic cystitis, and bone marrow suppression. The authors encountered an 80-year-old patient with pulmonary hemorrhage and renal dysfunction ascribed to microscopic polyangiitis and achieved successful treatment by employing gabexate mesilate in addition to corticosteroids. The present case suggests that gabexate mesilate may be a therapeutic option for microscopic polyangiitis with progressive renal failure and pulmonary hemorrhage.

[Clinical usefulness of 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT program using low-dose dobutamine loading in assessment of myocardial viability in patient with acute myocardial infarction--a case report].

An 86-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed 99% stenosis of the mid segment of the left anterior descending coronary artery, therefore, a coronary stent was implanted. Immediately after the stent implantation, 99% stenosis occurred at the proximal site of the 1st diagonal artery because of stent jeal. On the 4th hospital day, ECG-gated 201TL/99mTc-PYP dual myocardial quantitative gated SPECT was performed at rest and during low-dose dobutamine loading. The 201Tl scintigraphy revealed moderately reduced uptake in the anterior, septal and apical walls, and 99mTc-PYP uptake was observed in the mid-anterior wall. A three-dimensional surface display of gated 201Tl SPECT images showed severe hypokinesis in the anterior, septal and apical walls at rest. On the other hand, during low-dose dobutamine loading, improved wall motion was observed in the basal anterior and septal walls, while no change was observed in the midanterior and apical wall movements. Three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed similar patterns of wall motion as those of gated 201Tl SPECT images at rest. During low-dose dobutamine loading, on the other hand, a three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed improved wall motion in the basal anterior, septal and apical walls, but worsened wall motion of the mid-anterior wall. After 6 months, a follow-up coronary angiography revealed no re-stenosis of the stent, but 99% stenosis at the proximal aspect of the 1st diagonal artery. Left ventriculography revealed improved wall motion in the apex and akinesis of the mid-anterior wall. These wall motion findings were similar to those visualized in the three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images during low-dose dobutamine loading in the acute phase. These results suggest that 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT using low-dose dobutamine loading could be useful for the assessment of myocardial viability after reperfusion therapy in patients with acute myocardial infarction.

[A case of takotsubo cardiomyopathy provoked by taking a new quinolone antibiotic drug and a non-steroidal anti-inflammatory drug].

A 97-year-old woman was provoked a convulsion after taking a new quinolone antibiotic drug Levofloxacin and a non-steroidal anti-inflammatory drug Loxoprofen. At a later time, she was suffered from severe chest pain. An electrocardiogram showed ST segment elevation in leads II, III and aVF, and T-wave inversion in leads V1 to V4. Coronary angiography demonstrated no organic stenosis, however biventriculography revealed apical ballooning akinesis and basal hyperkinesis. Positron emission tomography was also performed to assess the uptake of 18F-fluorodeoxyglucose (FDG) after 75 g oral glucose loading for evaluating myocardial glucose metabolism at 10th day. Severely reduced uptake of FDG was observed in the apical ballooning region. Left ventriculography showed normal wall motion at 19th day. Thallium-201 myocardial single-photon emission computed tomography (SPECT) to determine the status of myocardial perfusion at the 20th hospital day showed normal perfusion. Iodine-123-beta-methyl-p-iodophenyl penta-decanoic acid myocardial SPECT to evaluate myocardial fatty acid metabolism at the 23rd day revealed severely reduced uptake in the apical ballooning region. These findings suggested that the coronary microcirculation was impaired in the apical ballooning region.

[Clinical usefulness of 1231I-BMIPP myocardial SPECT in patient with microvascular spasm: a case report].

This patient was a 64-year-old man with chest pain at rest. An electrocardiogram showed depression of the ST segment in V2-V5 leads during chest pain. 123I-BMIPP myocardial SPECT revealed reduced uptake in the apex. Coronary angiographies revealed severely delayed filling of contrast medium without narrowing of epicardial coronary arteries. An intracoronary infusion of isosorbide dinitrate did not improve the delayed filling of contrast medium or the ST segment depression. After an intracoronary infusion of nicorandil, coronary arterial flows were remarkably improved, chest symptoms disappeared, and electrocardiographic findings were improved. Left ventriculography showed severe hypokinesis in the apex. After the medication with nicorandil, reduced 123I-BMIPP myocardial uptake and reduced wall motion on echocardiography were improved. These findings suggest that myocardial ischemia in this case might be explained as having been caused by microcirculation disturbance.

Sustained cavity obliteration and apical aneurysm formation in apical hypertrophic cardiomyopathy.

OBJECTIVES: In patients with apical hypertrophic cardiomyopathy (ApHCM), we estimated the severity of cavity obliteration (CO) in the apical potion of the left ventricle and correlated it with various clinical findings including apical aneurysm. BACKGROUND: Apical hypertrophic cardiomyopathy sometimes develops apical aneurysm. The apical CO is often exhibited in ApHCM along with apical hypertrophy and ischemia. It remains unclear, however, how the CO and others are related to aneurysm. METHODS: In 46 patients with ApHCM, we measured CO time on M-mode echocardiography and corrected it by the R-R interval (cCOT). We divided the 46 patients into the following groups: 17 with cCOT 200 to 350 ms (severe CO group). We then compared apical aneurysm, hypertrophy, ischemia, QT interval, and the like between the three groups. RESULTS: The severe CO group exclusively comprised 11 patients having apical aneurysm and paradoxic jet flow. Of the 11 patients, 10 exhibited irreversible defects on exercise single photon emission computed tomography with thallium-201. All with moderate CO showed reversible defects, and none with no/mild CO showed any defects. Left ventricular hypertrophy and the corrected QT interval (QTc) were largest in the severe CO group. There were high correlations between the cCOT, hypertrophy, ischemia, and QTc. Of the 11 patients with severe CO, 6 had nonsustained ventricular tachycardia and 1 had mural thrombus. CONCLUSIONS: In ApHCM, sustained CO is an important pathophysiologic condition as well as hypertrophy, ischemia, and prolonged QTc, which are considered jointly related to the development of aneurysm through interactions.

Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy.

OBJECTIVES: We measured plasma atrial/brain natriuretic peptide (ANP/BNP) levels at rest and during exercise and correlated the results with various clinical findings, particularly with myocardial ischemia, in asymptomatic hypertrophic cardiomyopathy (HCM). BACKGROUND: In patients with HCM, ANP and BNP levels are elevated and exercise-induced myocardial ischemia is common. However, it has not yet been elucidated how these levels at rest and their change with dynamic exercise are related to ischemia. METHODS: Levels of ANP and BNP were measured at rest and at peak exercise during (99m)Tc-tetrofosmin scintigraphy in 31 asymptomatic patients with non-obstructive HCM and in 10 control subjects. RESULTS: Levels of ANP and BNP at rest and the change of ANP and BNP levels (PG/ML) from rest to exercise were significantly greater in HCM than in control subjects (ANP: rest, 53.2 +/- 31.8 vs. 11.6 +/- 6.1; exercise, 114.5 +/- 74.8 vs. 28.3 +/- 23.4. BNP: rest, 156.7 +/- 104.1 vs. 9.8 +/- 9.6; exercise, 201.6 +/- 131.5 vs. 13.2 +/- 14.5). Septal perforator compression (SPC) and exercise-induced ischemia were observed, respectively, in 20 (64.5%) and in 19 (61.3%) patients with HCM. The increment of ANP during exercise was similar between HCM subgroups with or without inducible ischemia. However, BNP levels at rest and BNP increments during exercise were significantly greater in the HCM subgroup with inducible ischemia than in the subgroup without (rest, 190.5 +/- 116.2 vs. 103.1 +/- 48.3; exercise, 250.5 +/- 142.2 vs. 124.2 +/- 58.6). Multiple logistic regression analysis revealed that SPC and BNP levels at rest were independently associated with exercise-induced ischemia. CONCLUSIONS: Measurement of plasma BNP levels at rest may be useful in predicting silent myocardial ischemia in HCM.

Heart rate variability in adult patients with isolated left ventricular noncompaction.

BACKGROUND: Isolated left venticular noncompaction (IVNC) is a rare congenital heart disease charactrized by a pattern of an excessively prominent trabecular meshwork with deep intertrabecular recesses. Heart rate variability (HRV) has been reported to be impaired in various heart diseases, though little is known regarding HRV in adult patients with IVNC. METHODS: We measured spectral components of HRV using fast Fourier transformation of 24-h Holter recordings in 10 adult patients with IVNC, 40 patients with myocardial infarction (MI), 40 patients with hypertrophic cardiomyopathy (HCM) and 40 healthy controls. RESULTS: The low frequency component and the high frequency component of HRV were lower in IVNC patients tahn those in controls (265 +/- 213 ms(2) vs. 469 +/- 195 ms(2), p < 0.01; 80 +/- 51 ms(2) vs. 185 +/- 126 ms(2), p < 0.01). Furthermore, 3 IVNC patients with a previous history of heart failure exhibited more decreased HRV (low frequency, 75 +/- 56 ms(2); high frequency, 39 +/- 18 ms(2)). Contrary, the ratio of low frequency to high frequency component was higher in patients with IVNC than controls (3.5+/-0.5 vs. 3.2 +/- 0.3, p < 0.05). The degree of impaired HRV was severest in MI patients, intermediate in IVNC patients and mildest in HCM patients compared with controls. CONCLUSIONS: HRV is impaired in adult patients with IVCN, especially in patients with a previous history of heart failure, suggesting vagal withdrawal or sympathetic enhancement. HRV in IVNC adults is less impaired than in MI patients, and more impaired than in HCM patients of our cohort.

Short-term fluctuations in sinus cycle length after premature ventricular beats in patients with hypertrophic cardiomyopathy and myocardial infarction.

BACKGROUND: Sinus cycle length has been reported to fluctuate after a ventricular premature beat (VPB). The purpose of this study was to assess the short-term fluctuations of sinus cycle length in patients with hypertrophic cardiomyopathy (HCM) and prior myocardial infarction (MI). METHODS: The relative deviation of RR intervals from the mean of the last two RR intervals preceding a VPB were calculated during the 20 subsequent beats following the VPB from Holter recordings in 92 patients with non-obstructive HCM, 57 patients with prior MI and 54 healthy controls. RESULTS: In controls, the deviations of the RR intervals were negative for several beats after a VPB and subsequently changed to positive before returning to the baseline. Similar changes in RR intervals following a VPB were exhibited in HCM patients; however, the late positive deviations of RR intervals were more marked than in controls. By contrast, in patients with prior MI, the early negative deviations of RR intervals were smaller compared with controls, and the deviations returned to the baseline without incidence of the positive changes. CONCLUSIONS: Short-term fluctuations in sinus cycle length after a VPB differed exclusively among HCM patients, prior MI patients, and healthy controls.

Unexpected abnormal extra-cardiac mediastinal accumulation of technetium-99m-tetrofosmin in patient with acute pericarditis.

A 58-year old woman had felt some chest pains on effort for several days. She was admitted to the emergency room with severe and refractory chest pain after exercise. Electrocardiogram showed marked ST-segment elevations in II, III, aVF and V1-6 electrodes. Echocardiogram revealed neither wall motion asynergy in the left ventricle nor abnormal pericardial effusion. Chest X-ray showed normal findings, and mild elevation of C-reactive protein was observed in the blood chemistry data. Her chest pain was relieved by nitroglycerin administration. Emergent technetium-99m-tetrofosmin myocardial imaging did not show any abnormal perfusion in the left ventricle. However, an abnormal extra-cardiac mediastinal accumulation was detected in the planar image. Contrast-enhanced chest CT scanning also demonstrated an inhomogeneously enhanced tumor in the anterior superior mediastinum. The tumor was surgically removed and was finally diagnosed as an invasive thymoma. Technetium-99m-tetrofosmin scintigraphy happened to provide useful information for diagnosing acute pericarditis with mediastinal tumor.

Assessment of Takotsubo cardiomyopathy (transient left ventricular apical ballooning) using 99mTc-tetrofosmin, 123I-BMIPP, 123I-MIBG and 99mTc-PYP myocardial SPECT.

UNLABELLED: We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT. METHODS: We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4). RESULTS: Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase. CONCLUSIONS: Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.