Low-Dose Erythropoietin in Patients With ST-Segment Elevation Myocardial Infarction (EPO-AMI-II) - A Randomized Controlled Clinical Trial.

Background: Erythropoietin (EPO) has antiapoptotic and tissue-protective effects, but previous clinical studies using high-dose EPO have not shown cardioprotective effects, probably because of platelet activation and a lack of knowledge regarding the optimal dose. In contrast, a small pilot study using low-dose EPO has shown improvement in left ventricular function without adverse cardiovascular events.

Methods and results: We performed a multicenter (25 hospitals), prospective, randomized, double-blind, placebo-controlled, dose-finding study to clarify the efficacy and safety of low-dose EPO in patients with ST-segment elevation myocardial infarction (STEMI) under the Evaluation System of Investigational Medical Care of the Ministry of Health, Labor and Welfare of Japan.

Reconstruction of semiautomated cardiac regions of interest using iodine-123 metaiodobenzylguanidine myocardial scintigraphy.

Introduction: Analysis using cardiac iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy with regions of interest (ROIs) is useful for assessing myocardial sympathetic activity. However, manual placement of the cardiac ROI is sometimes difficult because myocardial MIBG uptake is reduced in patients with heart failure. A new method was developed to reconstruct the semiautomated cardiac ROI in a sympathetic denervated heart.

Angioscopic assessment of peri-stent contrast staining following drug-eluting stent implantation.

Background: Peri-stent contrast staining (PSS) has been recognized as a predictor of late stent thrombosis following drug-eluting stent (DES) implantation. However, the intravascular conditions at PSS sites remain unclear.

Methods And Results: We evaluated 10 patients (median age 72 years, 80% male) with stable angina pectoris by coronary angioscopy.

Usefulness of scintigraphy to predict electrical storms in severe idiopathic dilated cardiomyopathy.

Background: Although several predictors of an electrical storm (ES) are indicated in patients with idiopathic dilated cardiomyopathy (IDCM), whether the severity of the myocardial tissue damage (SMTD) evaluated by myocardial perfusion SPECT (MPS) has an association with an ES remains unclear. The purpose of this study was to elucidate the clinical significance of SMTD for the prediction of ES in IDCM patients with an ICD.

Methods: Thirty-seven (27 men, mean age 58 ± 15 years) IDCM patients receiving ICD implantations for secondary prevention with preoperative MPS were enrolled in this study.

Arterial repair 4 months after zotarolimus-eluting stent implantation observed on angioscopy.

Background: Arterial repair in the early phase following implantation of a zotarolimus-eluting stent (ZES) remains unknown.

Methods And Results: Following implantation of 49 Endeavor ZES in 33 patients, follow-up angioscopy was performed in 13 patients (26 ZES) in the early phase (EP; 123±24 days) and in 20 patients (23 ZES) in the middle phase (MP; 247±17 days). Neointimal coverage (NIC) was graded as follows: grade 0, stent struts exposed; grade 1, struts bulging into the lumen, although covered; grade 2, struts were embedded by the neointima but were seen translucently; grade 3, struts fully embedded and invisible.

Successful outside-the-stent stenting for in-stent chronic total occlusion in the common iliac artery.

Several studies showed durable long-term clinical benefit of endovascular therapy with stenting in aorto-iliac occlusive disease. Although in-stent restenosis is easily treated in routine practice, we experienced an uncommon case of failed reconstitution of in-stent total occlusion at the common iliac artery (CIA). The case was treated with nitinol stent implantation outside of the in-stent occlusion site, and good vessel patency was observed at 14 months after the procedure.

Novel algorithm for quantitative assessment of left ventricular dyssynchrony with ECG-gated myocardial perfusion SPECT: useful technique for management of cardiac resynchronization therapy.

Objectives: Cardiac resynchronization therapy (CRT) is the established treatment for patients with chronic and severe heart failure, and it has been reported that the presence of left ventricular (LV) dyssynchrony is one of the most important factors which predict positive response of this therapy. In the present study, we developed new software algorithm for quantitative assessment of LV dyssynchrony from ECG-gated myocardial perfusion SPECT (GMPS), and evaluated its utility for the management of CRT.

Methods: Thirty-three patients with chronic severe heart failure were studied.

Angioscopic assessment of arterial repair following biodegradable polymer-coated biolimus A9-eluting stent implantation. - Comparison with durable polymer-coated sirolimus-eluting stent-.

Background: Second-generation drug-eluting stents (DES) are expected to show better arterial repair than older DES. We angioscopically compared the biodegradable polymer-coated biolimus A9-eluting stent (BES) and durable polymer-coated sirolimus-eluting stent (SES) to explore differences in arterial repair.

Methods And Results: Angioscopy was performed 9 ± 1 months after 15 BES and 16 SES were implanted initially in the native coronary artery.

Transient constrictive pericarditis diagnosed by cardiac magnetic resonance, 67Ga scintigraphy, and positron emission tomography.

Constrictive pericarditis occurs following pericardial fibrosis and often leads to refractory right side heart failure. Surgical relief is often required for correction of hemodynamic abnormalities. Two recent reports described a transient form of constrictive pericarditis that resolved without surgical intervention.

Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan.

Background: Prediction of left ventricular functional recovery is important after myocardial infarction. The impact of quantitative perfusion and motion analyses with gated single-photon emission computed tomography (SPECT) on predictive ability has not been clearly defined in multi-center studies.

Methods: A total of 252 patients with recent myocardial infarction (n = 74) and old myocardial infarction (n = 175) were registered from 25 institutions.

Creation and characterization of Japanese standards for myocardial perfusion SPECT: database from the Japanese Society of Nuclear Medicine Working Group.

Objective: Standards for myocardial single-photon emission computed tomography (SPECT) adapted for a Japanese population were not available. The purpose of this study was to create standard files approved by the Japanese Society of Nuclear Medicine and to make known the characteristics of the myocardial perfusion pattern of this population.

Methods: With the collaboration of nine hospitals, a total of 326 sets of exercise-rest myocardial perfusion images were accumulated from subjects with a low likelihood of cardiac diseases.

Myocardial scintigraphy after pacemaker implantation for congenital complete atrioventricular block.

Patients with isolated congenital complete atrioventricular block (CCAVB) occasionally develop dilated cardiomyopathy (DCM), despite early pacemaker implantation. However, the etiology of the DCM and its relationship to permanent ventricular pacing are not fully understood. Twenty-five patients with CCAVB underwent (99m) technetium (Tc) myocardial perfusion scintigraphy.

[Clinical evaluation of cellular pathophysiology in cardiovascular diseases with radionuclide biochemical imaging].

Myocardial imaging with radionuclide biochemical tracers has provided advanced diagnostic approaches for patients with coronary artery disease and heart failure. Since the biochemical information includes cellular events such as metabolism, inflammation, and sympathetic drive, it can be regarded as one of 'Molecular Imaging'. In this chapter, I introduce topics on clinical evaluation of cellular pathophysiology in cardiovascular diseases with radionuclide biochemical imaging: detection of coronary vulnerable plaque to predict the occurrence of acute coronary syndrome and estimation of altered myocardial metabolism and sympathetic drive to estimate the severity of myocardial failure.

Detection of aortic graft infection by fluorodeoxyglucose positron emission tomography: comparison with computed tomographic findings.

Objective: Radionuclide imaging with fluorodeoxyglucose (FDG) and positron emission tomography (PET) has been proposed for the identification of vascular graft infection; however, its accuracy has not been determined. We performed this prospective study to compare the usefulness of FDG-PET in the assessment of vascular graft infection relative to computed tomography (CT).

Methods: FDG-PET was performed for 33 consecutive patients with a suspected arterial prosthetic graft infection.

Increased gene expression of collagen Types I and III is inhibited by beta-receptor blockade in patients with dilated cardiomyopathy.

Aims: To elucidate the cellular mechanisms of cardioprotection of beta-blockers in patients with heart failure, we investigated the effects of beta-blockers on collagen synthesis in patients with dilated cardiomyopathy (DCM).

Methods And Results: We examined the gene expression before and 4 months after the administration of a beta-blocker in 17 DCM patients. The messenger ribonucleic acid expression of collagen Types I and III (Col I and III) and transforming growth factor-beta(1) (TGF-beta(1)) of right ventricular tissues obtained by the endomyocardial biopsy were assessed by quantitative reverse transcriptase-polymerase chain reaction.

Rationale and design of a randomized trial to assess the effects of beta-blocker in diastolic heart failure; Japanese Diastolic Heart Failure Study (J-DHF).

Background: Heart failure consists of two phenotypes: systolic heart failure and diastolic heart failure (DHF). A growing body of evidence demonstrated benefits of beta-blocker, angiotensin-converting enzyme inhibitor, and angiotensin II receptor blocker in systolic heart failure; however, evidence leading to therapeutic strategy of DHF is lacking.

Methods And Results: The Japanese Diastolic Heart Failure Study (J-DHF) is a multicenter, prospective, randomized trial designed to assess effects of beta-blocker in patients with DHF.

[Value of cardiac nuclear imaging in clinical care of patients with ischemic heart disease].

Coronary revascularization with PTCA or by means of CABG surgery is frequently used in the care of patients with ischemic heart disease. Before revascularization is performed, stress myocardial perfusion imaging may assist in management decisions by demonstrating the presence of myocardial ischemia and viability, and delineating the severity and extent of coronary artery disease. The presence of myocardial ischemia may provide an indication for revascularization, even in asymptomatic persons.

Cardiac tumor as an initial manifestation of acquired immunodeficiency syndrome.

A cardiac tumor was the first manifestation of acquired immunodeficiency syndrome (AIDS) in a female patient in a state of severe immunodeficiency caused by human immunodeficiency virus (HIV) infection. The extensive cardiac and extracardiac involvement shown by various imaging modalities, including echocardiography and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), suggested that she was in the critical stage of non-Hodgkin's lymphoma (NHL). AIDS was treated by highly active-antiretroviral therapy and the NHL was treated by a combination of rituximab-cyclophosphamide-vincristine-doxorubicine-predonisolone.