Search

Background: Myocardial perfusion scintigraphy (MPS) plays an important role in the evaluation and quantification of myocardial ischemia, and those with significant ischemia (SI) benefit most from revascularization procedures. This study aimed to identify the clinical factors and anatomical features associated with SI in patients with stable ischemic heart disease (SIHD). Methods and Results: Data were analyzed from 4197 SIHD patients undergoing PCI in The Japan Cardiovascular Database (N = 11,258) between September 2008 and April 2013. MPS was used to evaluate 1070 (25.5%) patients. Significant ischemia (SI) was defined as more than 10% ischemic region. Logistic regression analysis was performed to identify any clinical factors associated with SI. Patients with a history of heart failure, stroke, or anginal symptoms with Canadian Cardiovascular Society class 2 or more were more likely to have SI (odds ratio [OR] 1.63, p = 0.025, OR: 1.85, p = 0.009, and OR: 1.49, p = 0.003, respectively). When angiographic variables were considered, a proximal left anterior descending artery (pLAD) lesion was the sole factor associated with SI (OR: 1.46, p = 0.012) (Table). Importantly, those with SI had more complications (p = 0.006), most notably post-PCI infarcts (p = 0.008) (Figure). Conclusions: Patients’ background data, such as stronger anginal symptoms or a pLAD lesion, were associated with SI. Since patients with SI are necessary to be treated with PCI to improve long-term prognosis, however procedure-related complications happen more frequently than non-SI patients. Physicians must give their full attention to the PCI procedure in SI patients to minimize their complication rate.

Background: Myocardial perfusion scintigraphy (MPS) plays a pivotal role in the evaluation of ischemia. Coronary computed tomography angiography (CTA) is emerging to evaluate anatomical features for stable ischemic heart disease (SIHD). This study aimed to identify the clinical characteristics of ischemia (MPS) or anatomy (CTA)-oriented percutaneous coronary intervention (PCI) patients for SIHD. Methods and Results: Data were analyzed from 4197 SIHD patients undergoing PCI in The Japan Cardiovascular Database (N = 11,258) between September 2008 and April 2013. MPS was used to evaluate 1070 (25.5%) patients. Significant ischemia (SI) was defined as more than 10% ischemic region. CTA was performed in 1433 patients, and patients with ischemia evaluation and unavailable results were excluded. A total of 694 patients (16.5%) were evaluated as CTA group. CTA-oriented PCI patients had milder illness in their background (Table). More than half of patients had multivessel disease (CTA vs non-SI vs SI; 51.6, 66.3, 71.9%). Incomplete revascularization ratio was significantly lower in CTA group (0.6, 2.2, 3.1%, p = 0.003). However, CTA-oriented PCI patients and SI patients had significantly more complications than non-SI patients (6.6, 3.8, 8.2%, p = 0.022), especially post-procedural infarction (2.4, 0.5, 3.0%, p = 0.032) (Figure). Conclusions: Even though CTA-oriented PCI patients had incomplete revascularization less frequently, they experienced more complications. These results indicate that functional assessment is important to predict in-hospital complications, and physicians need to give their attention to CTA-oriented PCI patients as well as SI patients.

Giant cell myocarditis (GCM) is rare and often fatal. Proper diagnosis is crucial, because immunosuppressive therapy has been reported to increase the median transplant-free survival time from 3.0 to 12.3 months.1 Although endomyocardial biopsy plays an essential role in early diagnosis, it may yield false-negative results. Imaging examinations including cardiac magnetic resonance (CMR) may facilitate the diagnosis, but the associations between specific CMR findings and the clinical features and pathological findings remain unclear. We present a patient with characteristic CMR findings, with intriguing associations with the clinical features and pathological findings of the biopsy and autopsy. A 73-year-old woman presented with acute chest pain and dyspnea that had continued for 7 hours. Her medical history was unremarkable, with the exception of uveitis and dyslipidemia. Initial examination showed resting blood pressure 132/83 mm Hg, heart rate 103 bpm, and respiratory rate 17 breaths/min. She required 5 L/min of oxygen via facemask to maintain Spo2>98%. Coarse crackles were heard over both lung fields. X-ray demonstrated mild cardiomegaly with bilateral pulmonary congestion (Figure 1). Electrocardiography, which had been within normal limits 2 years previously, showed changes resembling acute myocardial infarction (Figure I in the online-only Data Supplement). Echocardiography showed global hypokinesis in the left ventricular (LV) wall, and regional akinesis in the septum and inferoseptal wall. Coronary artery angiography revealed no significant stenosis or intracoronary plaque rupture. Her serum creatinine kinase level was high at 2558 IU/L. CMR was performed on day 7. Cine-CMR showed global hypokinesis in …

Background— Bone marrow (BM) cells possess broad differentiation potential and can form various cell lineages in response to pathophysiological cues. The present study investigated whether BM-derived cells contribute to the pathogenesis of cardiac hypertrophy, as well as the possible cellular mechanisms involved in such a role. Methods and Results— Lethally irradiated wild-type mice were transplanted with BM cells from enhanced green fluorescent protein–transgenic mice. The chimeric mice were subjected to either prolonged hypoxia or transverse aortic constriction. BM-derived enhanced green fluorescent protein–expressing cardiomyocytes increased in number over time, emerging predominantly in the pressure-overloaded ventricular myocardium, although they constituted Conclusions— We found that BM-derived cells were involved in the pathogenesis of cardiac hypertrophy via the dual mechanisms of cell fusion and transdifferentiation. Moreover, the present results suggest that BM-derived monocytes accumulating in the perivascular space might play an important role in the formation of perivascular fibrosis via direct differentiation into myofibroblasts.

Background— Hematopoietic cytokines, granulocyte colony-stimulating factor (G-CSF), and stem cell factor (SCF) were reported to show a neuroprotective effect or to support neurogenesis. These cytokines also mobilize bone marrow (BM) cells into the brain, and the BM-derived cells differentiate into neuronal cells. We administered these hematopoietic cytokines after focal cerebral ischemia and assessed their effects and the therapeutic time window for neuronal regeneration. Methods and Results— We induced permanent middle cerebral artery occlusion in mice whose BM had been replaced with BM cells from green fluorescent protein (GFP)-transgenic mice. The occluded mice were treated with G-CSF and SCF in the acute phase (days 1 to 10) or subacute phase (days 11 to 20), and the brain functions and histological changes were evaluated. Separately, we injected bromodeoxyuridine during cytokine treatment to assess cell kinetics in the brain. Six mice were prepared for each experimental group. Administration of G-CSF and SCF in the subacute phase effectively improved not only motor performance but also higher brain function, compared with acute-phase treatment. Acute-phase and subacute-phase treatments identically reduced the infarct volume relative to vehicle treatment. However, subacute-phase treatment significantly induced transition of BM-derived neuronal cells into the peri-infarct area and stimulated proliferation of intrinsic neural stem/progenitor cells in the neuroproliferative zone. Conclusions— Administration of G-CSF and SCF in the subacute phase after focal cerebral ischemia is effective for functional recovery, enhancing cytokine-induced generation of neuronal cells from both BM-derived cells and intrinsic neural stem/progenitor cells. Because G-CSF and SCF are available for clinical use, these findings suggest a new therapeutic strategy for stroke.