Abstract Rotational atherectomy (RA) has been widely used for percutaneous coronary intervention (PCI) to severely calcified lesions. As compared to other countries, RA in Japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). IVUS has been used to understand the guidewire bias and to decide appropriate burr sizes during RA, whereas OCT can also provide the thickness of calcification. Owing to such abundant experiences, Japanese RA operators modified RA techniques and reported unique evidences regarding RA. The Task Force on Rotational Atherectomy of the J apanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document to summarize the contemporary techniques and evidences regarding RA.
In recent years, the potential of oral care in preventing aspiration pneumonia has been recognized.Consuming drinks is thought to be an easy and effective method of oral care, and the antibacterial activities of various drinks have been examined.However, the side effects associated with, for example, caffeine as an ingredient in tea (e.g.sleep disorders) need to be taken into consideration.As yet, a safe caffeine-free tea to be taken orally to prevent aspiration pneumonia has not been reported.Thus, in the present study we evaluated the antibacterial effects of hot water extracts of four teas, namely Hypericum erectum, Crataegus cuneata, Rosa canina, and Matricaria rectita, thought to be caffeine-free.The effects of the extracts against 19 bacteria and 1 fungus were investigated by the dilution plate technique.In addition, the components of the teas were analyzed by HPLC analysis.The strongest antibacterial activity was observed for the hot water extract of H. erectum, which exhibited signi cant activity against oral bacteria, including Streptococcus oralis.However, the H. erectum extract did not kill microbiota, such as Escherichia coli and Lactobacillus casei.Neither hypericin nor caffeine, both of which have notable side effects, were detected in the H. erectum extract following HPLC analysis.These results suggest that H. erectum tea may be a good candidate for simple, safe oral care to prevent aspiration pneumonia in the elderly.
First-generation drug-eluting stents (DESs) have reduced angiographic and clinical restenosis rates compared to bare-metal stents (BMSs). Zotarolimus-eluting stents (ZESs) are second-generation drug-eluting stents: however, the clinical efficacy of ZES implantation is unclear because late loss associated with ZESs is reportedly higher than that observed for other DESs. The aim of this study was to evaluate the clinical efficacy of ZESs compared to paclitaxel-eluting stents (PESs). We retrospectively evaluated the angiographic and clinical outcomes of 431 lesions in 342 patients treated with PESs and 153 lesions in 121 patients treated with ZESs in our hospital between May 2007 and December 2010. Follow-up angiographic examinations were performed eight months post-treatment and clinical outcomes were assessed one year after the procedure. Quantitative coronary angiographic analyses showed that late loss was significantly higher for ZESs than PESs (0.82 ± 0.73 mm vs 0.47 ± 0.68 mm; P = 0.003). However, there was no significant difference in target lesion revascularization (TLR) between the two groups (ZES: 15 lesions, 9.8% vs PES: 25 lesions, 5.8%; P = 0.092). When comparing stents according to the American College of Cardiology/American Heart Association (ACC/AHA) lesion type, the TLR rate in the ZES group was significantly lower than in the PES group (0% vs 7.0%; P = 0.038) for Type A/B1 lesions, but the TLR rate for type B2/C lesions in the ZES group was significantly higher than in the PES group (15.8% vs 5.3%; P = 0.009). Multivariate logistic regression analysis showed that dialysis (OR: 35.54; 95% CI: 3.15-400.67; P = 0.039) and pre-minimal lumen diameter (OR: 0.036; 95% CI: 0.002-0.541; P = 0.016) were independent predictors of TLR in ZES-treated lesions. However, no factors predicted TLR in PES-treated lesions. Our study demonstrated excellent outcomes with ZESs for simple lesions, but it is necessary to carefully implant ZESs in complex lesions, such as ACC/AHA type B2/C lesions..
Hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) are endothelial cell-specific growth factors, but the production of these growth factors in cardiomyocytes has also been demonstrated. However, there have been no reports focusing their attention on the changes in these growth factors after coronary intervention. We investigated the time-course changes of the serum VEGF and HGF levels in angina pectoris (AP) and acute myocardial infarction (AMI).The serum HGF and VEGF levels were measured in 60 patients with AP, in 62 patients with AMI (AP, before heparin administration, and at 24 and 48 hours, and one week after intervention; AMI, before heparin, and at 48 and 72 hours, and one, two, three and four weeks) and in 56 patients with neurocirculatory asthenia as controls. We defined the patients with remodelling who showed an increase in left ventricular end-diastolic volume index (LVEDVI) in the sub-acute phase of AMI.Hepatocyte growth factor levels in the AP and AMI were significantly higher than that in the control (p<0.0001). The AMI level was also significantly higher than AP (p<0.001). In the AMI and AP, HGF peaked at 48 hours. Vascular endothelial growth factor level in the AMI was significantly higher than that in the control and AP (p<0.0001). In the AMI, VEGF peaked at two weeks. There was a significant positive correlation between the peak VEGF and LVEDVI in the sub-acute phase of AMI (p=0.0089, r=0.436). Peak VEGF in the remodelling (+) group was significantly higher than that in the remodelling (-) group (p<0.001). In the AP, VEGF was unchanged.While both myocardial and vascular damage contribute to an increase in HGF level, vascular damage is not associated with the increase in VEGF. Vascular endothelial growth factor might be related to left ventricular remodelling in the sub-acute phase of myocardial infarction.
Background— Left atrial (LA) remodeling is a factor in atrial fibrillation (AF) recurrence after pulmonary vein catheter ablation (CA), but right atrium (RA) remodeling has not been investigated for possible associations to AF recurrence. Methods and Results— Using 64-slice multidetector computed tomography, RA and LA volumes were measured 3-dimensionally before CA in 65 patients with initially proven idiopathic paroxysmal AF (mean age, 60±10 years, 81.5% men). The CA procedure was guided by CARTO Merge atrial electroanatomic mapping. Sixteen patients (24.6%) had AF recurrence within the 6-month period after the CA. The recurrence was associated with a large RA volume [odds ratio, 1.04; 95% confidence interval (CI), 1.02 to 1.07, P <0.0001], a large LA volume with 1.04 [95% CI, 1.01 to 1.06, P =0.002], and low LA mean voltage with 1.03 [95% CI, 1.01 to 1.05, P =0.002]. After adjustment for potential confounding variables, RA and LA volumes remained predictive of AF recurrence. Large atrial volumes (mL) (RA ≥87 or LA ≥99) predicted AF recurrence (sensitivity of RA volume: 81.3% in 13 of 16 patients with AF recurrence; specificity: 75.5% in 37 of 49 patients without AF recurrence; sensitivity of LA volume: 81.3% in 13 of 16 patients with AF recurrence; specificity: 69.4% in 34 of 49 patients without AF recurrence), and the combined estimate of both atrial volumes was incremental and additive prognostic power (sensitivity: 75% in 12 of 16 patients with AF recurrence; specificity: 93.9% in 46 of 49 patients without AF recurrence). Conclusions— Both LA and RA remodeling are equally associated with post-CA AF recurrence.
Abstract The incidence of coronary ectasia (CE) and the relationship between CE and coronary spasm that was said not to be apt to occur in patients with CE were studied. The study consisted of 1,373 patients (including 1,008 patients with ischemic heart disease) who underwent cardiac catheterization. In 74 patients with CE, coronary spasm was tested in 33 patients subjected to acetylcholine (ACh) provocation and in 17 patients subjected to ergonovine (Ergo) provocation. CE was found in 74 patients (5.4%), and its incidence was significantly higher (6.7%) in patients with ischemic heart disease. In addition, ACh and Ergo provocation tests gave positive results in 12 (36%) and 4 patients (24%), respectively. Spasm was not provoked as frequently in the ectatic portion as elsewhere. In addition, spasm was often found at the borders of the ectatic portion in both provocation tests. The incidence of coronary ectasia was higher than that described in previous reports, and coronary spasm was more often observed at the borders between ectatic and normal portions than elsewhere.
Biomarkers of atherothrombosis can predict the risk of cardiovascular events. However, it is difficult to predict second adverse events using these biomarkers at the point in time when the first cardiovascular event occurs. Therefore, we evaluated atherothrombosis-related biomarkers to determine their associations with prognosis after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. A total of 309 AMI patients were enrolled in this study. The patients had undergone successful coronary interventions and the levels of various atherothrombosis-related biomarkers were assessed within the first postoperative hour. Biomarkers other than those assessed by routine biochemical tests were analyzed, including defined endothelial cell damage markers such as thrombomodulin (TM), inflammatory markers such as C-reactive protein (CRP), and coagulation and fibrinolysis system markers such as D-dimer, prothrombin fragment F1+2 (F1+2) and plasminogen activator inhibitor-1 (PAI-1). Major adverse cardiac events (MACEs) occurred in 98 patients during the follow-up period (872.6±579.8 days). Multivariate analysis revealed that clinical parameters such as decreased levels of left ventricular ejection fraction and elevated levels of brain natriuretic peptide, hemoglobin A1c and TM were significantly associated with MACEs. The association between TM and MACEs was especially high (OR: 3.65, 95% CI; 1.75–7.68). Neither dyslipidemia, hypertension, smoking, advanced age, a history of cardiac events nor the type of AMI were associated with MACEs. TM is independently associated with MACEs and may be predictive of second events following PCI in patients with AMI.
Coronary spasm can be induced by acetylcholine (ACh) in many patients without a past history of rest angina. However, the low specificity of ACh for diagnosing coronary spastic angina is a controversial aspect of the ACh stress test. We investigated the clinical significance of the ACh stress test following isosorbide dinitrate (ISDN) administration. In addition, to elucidate the relationship between coronary vasospasm and endothelin (ET), we determined plasma ET-1 levels in patients with vasospastic angina pectoris. Twenty-six (81.3%) out of thirty-two patients (Group P) who developed vasospasm induced by ACh following administration of ISDN, had rest angina, while only seventeen (37.8%) out of forty-five patients (Group N ) who did not develop vasospasm induced by ACh following administration of ISDN, had rest angina. The frequency of subjective chest pain at rest was significantly higher in Group P than in Group N (81.3% vs. 37.8%: p<0.01) . Therefore, the post-ISDN ACh stress test may be useful in detecting true vasospastic angina pectoris. Plasma ET-1 levels in the coronary sinus increased significantly from a basal value of 3.13 to 3.78 pg/ml in patients who developed ACh induced vasospasm following injection of ISDN (p<0.05) . These patients exhibited symptoms to the clinical symptoms of rest angina, but there was no change in the other patients. Elevated plasma levels of ET-1 might directly or indirectly increase the level of vascular smooth muscle contraction. This study suggests that the development of ACh-induced vasospasm following administration of ISDN might be due not only to injury of vascular endothelial cells but also to the increased contractility of vascular smooth muscle cells.
