Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction.

Objectives: We assessed whether the intravenous administration of nicorandil, an adenosine triphosphate (ATP)-sensitive K+ channel opener, exerts beneficial effect on microvascular function and functional and clinical outcomes in patients with acute myocardial infarction (AMI).

Background: Experimental studies documented that ATP-sensitive K+ channel opener exerts cardioprotection after prolonged ischemia.

Methods: We randomly divided 81 patients with a first anterior AMI into two groups, nicorandil (n = 40) and control groups (n = 41).

Antecedent angina pectoris as a predictor of better functional and clinical outcomes in patients with an inferior wall acute myocardial infarction.

We examined whether angina pectoris (AP) occurring shortly before the onset of acute myocardial infarction (AMI) can render the right ventricle and the conducting tissue resistant to ischemia in 75 patients with an inferior wall AMI. Each patient had total occlusion in the proximal right coronary artery and underwent successful coronary angioplasty < or =24 hours from the onset. We divided patients into 2 groups based on presence or absence of antecedent AP < or =24 hours before the system onset: group 1 (absent) = 57 patients; group 2 (present) = 18 patients.

Efficacy of coronary artery bypass grafting in patients with a dilated left ventricle due to myocardial infarction.

This study was designed to clarify the efficacy of coronary artery bypass grafting (CABG) on left ventricular (LV) function in 16 patients with a dilated LV due to myocardial infarction (LV end-systolic volume index: LVESVI >60 ml/m2). All had attained complete revascularization. To estimate the LV wall motion quantitatively using echocardiography, a wall motion score (WMS) was used (LV was divided into 17 segments with a four-point scale: akinesis=3, severe hypokinesis=2, hypokinesis=1, normal=0 and then summed).

Assessing the relation between coronary reflow and myocardial reflow.

Since the recognition that prompt reperfusion of the infarct-related artery decreases mortality after acute myocardial infarction (MI), we have been interested in optimizing therapeutic regimens to accelerate the establishment of infarct-related artery patency. Although the major endpoint of many angiographic trials has been the acquisition of a patent infarct-related artery, this may not correlate with actual tissue perfusion because of the no-reflow phenomenon. With myocardial contrast echocardiography (MCE), we assessed the success of myocardial reperfusion at the microvascular level in patients with an acute anterior MI.

[Myocardial contrast echocardiography as a potential diagnostic tool for the assessment of myocardial perfusion].

Myocardial contrast echocardiography (MCE) visualizes the spatial distribution of myocardial blood flow with the injection of microbubbles into the coronary artery. With MCE, we can easily assess the perfusion territory of the coronary artery and collateral circulation as positive contrast area and the risk area as contrast defects. In patients with acute myocardial infarction (AMI), we can assess the success of coronary reperfusion at the microcirculation level.

Ultrasonic tissue characterization predicts myocardial viability in early stage of reperfused acute myocardial infarction.

Background: The aim of the present study was to characterize temporal changes in cyclic variation of ultrasonic integrated backscatter (IBS), which reflects intrinsic contractile performance, in patients with reperfused acute myocardial infarction (AMI) and to elucidate the clinical value of tissue characterization in predicting myocardial viability.

Methods And Results: We recorded short-axis IBS images before and 3, 7, and 21 days after reperfusion in 26 patients with AMI and obtained the cyclic variation of IBS in the normal and infarct zones. When cyclic variation showed synchrony and asynchrony, we expressed its magnitude as positive and negative values, respectively, called the phase-corrected magnitude.

Beneficial effect of intracoronary verapamil on microvascular and myocardial salvage in patients with acute myocardial infarction.

Objectives: We assessed the acute effect of intracoronary injection of verapamil on microvascular function after primary percutaneous translumanal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) with myocardial contrast echocardiography (MCE) in relation to functional outcomes.

Background: Recent clinical studies have documented the potential of verapamil for possible increase in coronary blood flow after primary PTCA.

Methods: Forty patients with a first AMI were randomly assigned to the verapamil group (n = 20) or the control group (n = 20).

Assessment of myocardial distribution of retrograde and antegrade cardioplegic solution in the same patients.

Objective: In order to clarify intramyocardial delivery and distribution of retrograde cardioplegic solution in humans, we induced both ante- and retrograde methods in the same patients to compare their respective delivery and distribution using myocardial contrast echocardiography during surgery.

Methods: 15 patients consisting of nine patients with valvular heart diseases and six patients with coronary artery diseases (including two patients with myocardial infarcted areas and two patients with areas supplied by coronary collateral situation associated with totally occluded coronary arteries without myocardial infarction). Induction of cardioplegia was initially accomplished antegradely and thereafter retrogradely.

Alternation in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction.

Background: Experimental and clinical evidence indicates that myocardial ischemia often damages the coronary microvasculature ("no-reflow" phenomenon). In this study, we examined the effect of this phenomenon on the coronary blood flow velocity pattern in patients with reperfused acute myocardial infarction.

Methods And Results: We measured coronary blood flow velocity after coronary angioplasty in 42 patients with acute myocardial infarction using a Doppler guidewire.

Temporal changes in regional end-diastolic wall thickness early after reperfusion in acute anterior myocardial infarction: relation to myocardial viability and vascular damage.

We investigated early temporal changes in end-diastolic wall thickness (EDWT) of the infarcted myocardium in 46 patients with reperfused anterior acute myocardial infarction in relation to myocardial viability. Two-dimensional echocardiography was performed on days 1 and 2 of acute myocardial infarction, and the EDWT of the anterior segment was measured in the short-axis view. Patients were divided into three groups on the basis of day 1 to day 2 ratio of EDWT: the ratio < or = 0.

Myocardial perfusion patterns related to thrombolysis in myocardial infarction perfusion grades after coronary angioplasty in patients with acute anterior wall myocardial infarction.

Background: Epicardial coronary flow is occasionally reduced even after coronary intervention despite the absence of vessel obstruction in patients with acute myocardial infarction. Our aim was to clarify the cause and outcomes of radiocontrast slow filling in patients with reperfused acute anterior myocardial infarction by assessing microvascular damage with the use of myocardial contrast echocardiography (MCE) and functional outcomes.

Methods And Results: We carefully reviewed the cineangiograms of 86 patients who achieved coronary revascularization within 12 hours of the onset and underwent MCE before and soon after recanalization with the intracoronary injection of sonicated microbubbles.

[Clinical characteristics and therapeutic strategy for acute myocardial infarction in the elderly].

Many randomized studies have revealed that reperfusion therapy is an epochmaking treatment for acute myocardial infarction (AMI). However, it is no clear whether it is equally beneficial in the elderly or not. In this study, we elucidated the clinical characteristics and effectiveness of reperfusion therapy and discussed the optimal treatment for AMI in the elderly.

Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction.

Background: Recent studies demonstrated that the "no reflow" phenomenon after coronary reflow implies the presence of advanced myocardial damage. In this study, we verified the prognostic value of the detection of this phenomenon by studying complications, left ventricular morphology, and in-hospital survival after acute myocardial infarction (AMI).

Methods And Results: The study population consisted of 126 patients with a first anterior AMI.

Alterations in the mitral flow velocity pattern induced by acute myocardial infarction. Doppler findings before and after infarction.

Several studies have demonstrated that myocardial infarction (MI) is likely to alter left ventricular diastolic function. However, it is unclear whether MI per se alters Doppler transmitral flow velocity patterns (TMF) clinically. To investigate how myocardial infarction alters TMF clinically, we assessed serial changes in TMF in 13 patients whose TMF patterns were recorded at a mean of 7 months before and after MI in relation to the size of MI.

Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardial infarction: retrospective clinical evidence of "preconditioning".

Objectives: We examined whether angina pectoris occurring shortly before the onset of acute myocardial infarction can actually preserve postischemic left ventricular function in humans.

Background: Experimental studies indicate that brief, transient episodes of ischemia render the heart very resistant to infarction from a subsequent sustained ischemic insult, an effect termed ischemic preconditioning. However, no clinical data are available concerning the implications of angina pectoris shortly before the onset of infarction in humans.

[Direct anastomosis between the left atrium and the right upper pulmonary vein returning anomalously to the superior vena cava].

We report a case of a 24-year-old woman who had atrial septal defect associated with partial anomalous pulmonary venous return. The right upper pulmonary vein returned anomalously to the proximal part of the superior vena cava. Direct anastomosis between the left atrium and the anomalous right upper pulmonary vein was successfully performed.

Temporal changes in myocardial perfusion patterns in patients with reperfused anterior wall myocardial infarction. Their relation to myocardial viability.

Background: Several studies demonstrated ischemic microvascular damage in patients with acute myocardial infarction (AMI). In this study, myocardial contrast echocardiography (MCE) was used to assess the temporal changes in myocardial perfusion after reflow and to investigate the relation between MCE findings and myocardial viability.

Methods And Results: MCE was performed with the intracoronary injection of sonicated microbubbles before and shortly after coronary reflow and 1 month later in 45 patients with anterior wall AMI.

Clinicopathological characterization of cardiac free wall rupture in patients with acute myocardial infarction: difference between early and late phase rupture.

Differences in morphological characteristics have been described in early phase and late phase post-infarction cardiac rupture. In this study, the clinicopathological characteristics of early and late phase rupture have been clarified by reviewing the clinical records of 1450 consecutive patients with acute myocardial infarction (AMI). Rupture of the left ventricular free wall (blow-out type) developed in 27 of the 1450 patients, and these patients were divided into two groups on the basis of the rupture time: early phase (< 72 h) and late phase (> 4 days).

Dobutamine stress echocardiography predicts reversible dysfunction and quantitates the extent of irreversibly damaged myocardium after reperfusion of anterior myocardial infarction.

Objectives: This study was designed to evaluate dobutamine stress echocardiography in identifying reversible dysfunction and assessing the extent of irreversibly damaged myocardium early in acute myocardial infarction.

Background: Several experimental and clinical studies have suggested that dobutamine enhances contractile function of stunned or hibernating, or both, myocardium. It is important for clinical strategy to predict the magnitude of improvement in myocardial function early in acute myocardial infarction.

Incidence and time course of left ventricular dilation in the early convalescent stage of reperfused anterior wall acute myocardial infarction.

The incidence and early process of left ventricular (LV) dilation in 52 patients with reperfused anterior wall acute myocardial infarction (AMI) were assessed. All patients achieved coronary reflow within 24 hours of the onset and had a patent infarct-related artery in the convalescent stage. Left ventriculography was performed at pre-reflow and 25 days (mean) later to determine LV end-diastolic volume (ml) with the area/length method.