Contrast-Induced Nephropathy and Oxygen Pretreatment in Patients With Impaired Renal Function.

Introduction: Contrast-induced nephropathy is a complication following coronary angiography and percutaneous coronary intervention. Because contrast-induced nephropathy is a predictor of long-term mortality in patients with ischemic heart disease undergoing percutaneous coronary intervention, preventive strategies are required. We assessed the effects of periprocedural oxygenation on contrast-induced nephropathy among patients with pre-existing renal dysfunction.

Impact of myocardial reperfusion status on QT dispersion after successful recanalization of the infarct-related artery in acute myocardial infarction.

Objective: To determine whether adequate myocardial perfusion status after transluminal recanalization is associated with prompt improvement of QT dispersion (QTd).

Background: Transluminal recanalization of the infarct-related coronary artery in acute myocardial infarction aims to promptly restore myocardial perfusion, to maximize electrical and mechanical recovery. QTd represents the heterogeneity of ventricular repolarization, which may affect electrical stability.

CXC-chemokine receptor 4 antagonist AMD3100 promotes cardiac functional recovery after ischemia/reperfusion injury via endothelial nitric oxide synthase-dependent mechanism.

Background: CXC-chemokine receptor 4 (CXCR4) regulates the retention of stem/progenitor cells in the bone marrow (BM), and the CXCR4 antagonist AMD3100 improves recovery from coronary ligation injury by mobilizing stem/progenitor cells from the BM to the peripheral blood. Thus, we investigated whether AMD3100 also improves recovery from ischemia/reperfusion injury, which more closely mimics myocardial infarction in patients, because blood flow is only temporarily obstructed.

Methods And Results: Mice were treated with single subcutaneous injections of AMD3100 (5 mg/kg) or saline after ischemia/reperfusion injury.

CXCR4 blockade augments bone marrow progenitor cell recruitment to the neovasculature and reduces mortality after myocardial infarction.

We hypothesized that a small molecule CXCR4 antagonist, AMD3100 (AMD), could augment the mobilization of bone marrow (BM)-derived endothelial progenitor cells (EPCs), thereby enhancing neovascularization and functional recovery after myocardial infarction. Single-dose AMD injection administered after the onset of myocardial infarction increased circulating EPC counts and myocardial vascularity, reduced fibrosis, and improved cardiac function and survival. In mice transplanted with traceable BM cells, AMD increased BM-derived cell incorporation in the ischemic border zone.

Percutaneous transluminal coronary angioplasty for postoperative left coronary artery stenosis following surgical reconstruction of congenital atresia of the left main coronary artery.

Congenital atresia of the left main coronary ostium is a rare coronary artery anomaly. A 3-year-old boy who was asymptomatic had a heart murmur because of mitral regurgitation. He underwent reconstruction of the left main coronary artery, but stenosis occurred in the early postoperative period.

Telmisartan induces proliferation of human endothelial progenitor cells via PPARgamma-dependent PI3K/Akt pathway.

Objective: Although recent clinical trials have suggested that angiotensin II type 1 receptor blockers (ARBs) reduced cardiovascular events, the precise mechanisms involved are still unknown. Telmisartan, an ARB, has recently been identified as a ligand of peroxisome proliferator-activated receptor-gamma (PPARgamma). On the other hand, since endothelial progenitor cells (EPCs) are thought to play a critical role in ischemic diseases, we investigated effects of telmisartan on proliferation of EPCs.

Noninvasive prediction of angiographic spasm provocation using trans-thoracic Doppler echocardiography in patients with coronary spastic angina.

Background: In the present study it was examined whether transthoracic Doppler echocardiography (TTDE) would be useful for noninvasive diagnosis of coronary spastic angina (CSA) by assessing coronary arterial tone in the morning.

Methods And Results: The study population comprised 21 CSA patients and 27 control subjects. All diagnoses were angiographically confirmed by provocation test using acetylcholine.

Primary percutaneous coronary intervention vs conservative treatment for acute ST elevation myocardial infarction: short- and long-term follow-up according to disease severity.

Background: Because there is insufficient evidence to support primary percutaneous coronary intervention (PPCI) as the treatment of acute myocardial infarction (AMI), this study elucidated the efficacy of PPCI according to disease severity.

Methods And Results: Between January 1999 and June 2001, 3,021 AMI patients were registered at Tokyo Women's Medical University and 17 affiliated institutions. Of these, 1,994 patients with ST-elevation AMI were admitted within 12 h of onset.

Association of glomerular filtration rate with unsuccessful primary percutaneous coronary intervention and subsequent mortality in patients with acute myocardial infarction: from the HIJAMI registry.

Background: Outcomes after percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) complicated by renal insufficiency have not been well described. The aims of this study were to evaluate the association of estimated glomerular filtration rate (GFR) and risk of unsuccessful PCI for AMI, and to evaluate the prognostic importance of PCI success in patients with renal insufficiency.

Methods And Results: From the Heart Institute of Japan Acute Myocardial Infarction (HIJAMI) registry, 1,706 patients undergoing primary PCI were analyzed.

High P-selectin expression and low CD36 occupancy on circulating platelets are strong predictors of restenosis after coronary stenting in patients with coronary artery disease.

Recent studies have shown that circulating platelets play an important role in the development of restenosis early after coronary stent implantation. We investigated P-selectin expression and CD36 blockade on platelets by flow cytometry in 48 consecutive patients who underwent coronary stenting. P-selectin expression was significantly higher 1 day after stenting in patients who had restenosis (n = 15) than in those who had no restenosis (n = 28), and the odds ratio for restenosis in patients with high P-selectin levels (MFI > 6.

Utility of multislice computed tomography as a strategic tool for complex percutaneous coronary intervention.

Objectives: Multislice computed tomography (MSCT) has been currently utilized as a non-invasive diagnostic modality to detect coronary artery disease. We sought to investigate whether preprocedural lesion assessment by MSCT could offer strategic guidance in the setting of elective complex percutaneous coronary intervention (PCI).

Methods And Results: Twenty-six complex coronary artery lesions in 23 patients were evaluated using 16-row MSCT scanner and an off-line image analysis workstation prior to the PCI.

Impact of post-dilatation with a focal expanding balloon for optimization of intracoronary stenting.

Optimal stenting frequently requires additional stent post-dilatation following initial stent deployment. Stent post-dilatation using a focal expanding balloon (FB) that grows 0.5 mm larger centrally may achieve a larger final stent lumen with fewer stent edge injuries as compared to use of a conventional unidiameter balloon (UB).

Postprocedural resistance of the target lesion is a strong predictor of subsequent revascularization: assessment by a novel lesion-specific physiological parameter, the epicardial resistance index.

Objective evaluation of the functional significance of individual stenosis in patients with multiple lesions is crucial when performing percutaneous coronary intervention (PCI). Here we propose a novel lesion-specific parameter, the epicardial resistance index (ERI), which is derived from intracoronary pressure measurements, and validate its clinical usefulness. The ERI is defined as the ratio of the resistance of an epicardial coronary stenosis to that of downstream myocardium.

Hyper-echoic plaque with high attenuation in intravascular ultrasound may predict slow flow during percutaneous coronary intervention.

One patient with acute inferior wall myocardial infarction underwent percutaneous coronary intervention following intravenous thrombolysis. Intravascular ultrasound (IVUS) before stenting revealed huge plaque burden with high attenuation underneath the hyper-echoic eccentric plaque surface. Stent deployment resulted in slow flow, which was managed with intra-aortic balloon counter-pulsation.

Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome.

There has been growing evidence associating obstructive sleep apnea (OSA) with cardiovascular pathogenesis. We hypothesized that OSA may affect outcomes after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). We performed a sleep study in 89 consecutive patients with ACS who were successfully treated with PCI.

Single administration of cerivastatin, an HMG-CoA reductase inhibitor, improves the coronary flow velocity reserve: a transthoracic Doppler echocardiography study.

HMG-CoA reductase inhibitors (statins) have been shown to improve the endothelial function by lowering lipids. Recent studies also suggest a direct impact of statins on the vascular wall. We assessed the rapid effect of cerivastatin on the coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography (TTDE).

Excessive intrastent plaque volume is the major cause of restenosis after intracoronary bare metal stent implantation: a 3-dimensional intravascular ultrasound and quantitative coronary angiography based study.

Vascular response after percutaneous coronary intervention (PCI) may differ in different ethnic group. Here we show the impact of peri-stent and intra-stent remodeling on coronary stenotic lesions in a group of Japanese patients. Those lesions were evaluated before, after and during follow up, with 3 dimensional intravascular ultrasound (IVUS) (3-D IVUS) and quantitative coronary angiography (QCA) 30 patients with pre, post and follow up IVUS were enrolled.

[Clinical impact of nephropathy induced by contrast medium in patients with acute myocardial infarction undergoing emergent coronary angiography].

Objectives: The incidence of contrast-induced nephropathy (CIN) after coronary angiography and the prognostic value in patients with acute myocardial infarction remains to be determined. This study investigated the frequency, predictors of CIN, and the prognostic significance of CIN in acute myocardial infarction patients undergoing emergent coronary angiography.

Methods: This study included 132 consecutive acute myocardial infarction patients undergoing emergent coronary angiography within 24 hr after the onset between January 1999 and June 2001.

[Prognostic value of C-reactive protein and troponin T level in patients with unstable angina pectoris].

Objectives: The prognosis of unstable angina pectoris may be more accurately predicted by the combination of C-reactive protein (CRP), which is a known inflammation marker, and troponin T (TnT), which is used for risk assessment for the prognosis of acute coronary syndrome. The present study investigated the correlations between pathophysiology and prognosis of severe unstable angina pectoris and CRP and TnT levels.

Methods: The correlation between CRP at admission and the prognosis was studied in 367 patients with severe unstable angina pectoris (Braunwald type II and III) who were admitted to our hospital between January 1998 and December 2000.

Non-invasive assessment of coronary arterial tone using trans-thoracic Doppler echocardiography.

Background: As coronary flow velocity (CFV) is inversely related to the luminal size that exists for the myocardial bed, the elevated arterial tone can be assessed as the higher flow velocity in the epicardial artery. We examined the usefulness of transthoracic Doppler echocardiography (TTDE) for the assessment of coronary arterial tone.

Methods And Results: A total of 32 patients underwent TTDE and angiography.

A large-scale prospective cohort study on the current status of therapeutic modalities for acute myocardial infarction in Japan: rationale and initial results of the HIJAMI Registry.

Background: In Western countries, several multicenter collaborative studies on acute myocardial infarction (AMI) have provided much information about this disease. In Japan, on the other hand, there have been few cohort studies in which a sufficient number of Japanese patients with AMI were registered during a short period. This fact explains the absence of a database from which strategies for treating Japanese patients with AMI could be established.

Clinical characteristics and early outcomes of very elderly patients in the reperfusion era.

Background: Not much data is available regarding "real-world" clinical experience of very elderly patients with acute myocardial infarction (AMI) in the reperfusion era.

Methods: We reviewed 483 patients (26%) between the ages of 75 and 85 from the 1855 patients with AMI. We analyzed 264 patients treated with reperfusion therapy (55%) and 219 patients treated with conservative therapy (45%) on their clinical characteristics and early outcomes.

Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis.

Background: Takayasu arteritis is associated with a low incidence of coronary artery involvement, such as stenosis, obstruction, aneurysm, and coronary steal syndrome, but coronary ischemia can be fatal.

Methods: Between 1972 and April 2001, 81 of 130 patients given a diagnosis of Takayasu arteritis underwent selective coronary angiography, and among them, 31 patients (4 male and 27 female patients; mean age, 41.1 +/- 13.