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In this research, the characteristics of a viscoelastic material under high strain rate are evaluated by use of a Split-Hopkinson pressure bar method. Tests are performed under several strain rates at various temperatures. A high-speed camera at the speed of one million frames per second is used to observe the strains. The validity of the experimental results is evaluated by comparing with the results obtained from digital image correlation. In addition, the time-temperature superposition principle is verified by comparing the impact and static experiments at the various temperatures.

A real-time system large-scale-integrated circuit (LSI) for digital video cassette recorder (DVCR) encoding/decoding and MPEG-2 decoding is implemented on a dual-issue RISC processor (DRISC) with dedicated hardware optimized for video-block processing. The DRISC achieves 972-MOPS software performance and can execute fixed-length data processing at the block level as well as processing at the macro-block level and above for the DVCR/MPEG-2. The dedicated hardware for variable-length coding/decoding can encode and decode codes for both the DVCR and the MPEG-2 by changing translation tables. The dedicated hardware for video-block loading can process video-block data transfers with half-pel operations. The LSI size is 7.7/spl times/7.2 mm/sup 2/ in a 0.25-/spl mu/m CMOS process.

High density lipoprotein (HDL) with and without apolipoprotein (apo) E was quantified and characterized in subjects with three genotypes of cholesteryl ester transfer protein (CETP) deficiency: the nonsense mutation in intron 14 (10 homozygotes and 5 heterozygotes); the missense mutation in the exon 15 (3 homozygotes and 9 heterozygotes); and the Int14A/D442G in 6 compound heterozygotes. ApoE-poor and apoE-rich HDL-cholesterol levels were elevated significantly in all genotypic groups with the decrease in CETP activity, indicating that both types of HDL-cholesterol can be a substrate for CETP. However, an unchanged or only slightly increased serum apoA-II level in each genotype indicated that the HDL particles with apoA-II are relatively resistant to CETP-mediated lipid transfer. Serum apoE-rich HDL level was considerably higher in the Int14A homozygotes than in the compound heterozygotes, in spite of similar apoE-poor HDL-cholesterol levels, which may indicate that apoE-rich HDL is a better substrate for CETP than apoE-poor HDL. Although the apoE-rich and apoE-poor HDL subclasses were similar in the accumulation of cholesteryl ester and depletion of triglyceride, the accumulation of free cholesterol was unique to apoE-rich HDL, indicating inhibited cholesterol esterification on this lipoprotein. Clinical laboratories should be aware of the discrepancy in HDL-cholesterol measurements that comes from the different recoveries of apoE-rich HDL using commercial reagents. In conclusion, CETP deficiency causes considerable quantitative and compositional changes in HDL subclasses, reflecting a significant physiological role for CETP in HDL metabolism.

Cholesteryl ester transfer protein regulates high-density lipoprotein cholesterol (HDL-C) level, and genetic deficiency causes hyperalphalipoproteinemia (HALP). The G to A mutation in the intron 14 splice donor (I14A) has been known to be a common mutation in HALP. Recently, another mutant, D442G (Asp 442 to Gly), was ascertained. The allelic frequencies of I14A and D442G were investigated using 226 unrelated patients with HDL-C of 1.03 mmol/L (40 mg/dL) or greater. Of these, 44 had a mutation I14A and/or D442G. The I14A was found in 15, including 4 compound heterozygotes (I14A/D442G) in patients with HDL-C of 2.05 mmol/L (80 mg/dL) or greater. All I14A homozygotes (n = 5) were present in the group with HDL-C of 3.08 mmol/L (120 mg/dL) or greater, and the allelic frequency paralleled the increase in HDL-C level. D442G was identified in 33, including the 4 compound heterozygotes. Its allelic frequency appeared as two clusters, one at HDL-C around 1.79-2.03 mmol/L (70-79 mg/dL) and the other at HDL-C of 2.82 mmol/L (110 mg/dL) or greater; the latter consisted exclusively of compound heterozygotes. Allelic frequency in the general population for I14A and D442G was 0.81% and 4.62%, respectively. These data suggest that D442G is a common mutation and that, although I14A is responsible for the most severe HALP, D442G leads to a relatively smaller increase in HDL-C.

The M32R/D is a 32-bit microprocessor with a large-capacity on-chip DRAM. It consists of a 32-bit RISC CPU, a 32-bit/spl times/16-bit multiply and accumulator (MAC), either 1-Mbyte or 2-Mbyte DRAM, 4-Kbyte cache memory, and a memory controller. The CPU, DRAM, and cache memory are connected via a 128-bit 66.6 MHz internal bus yielding high performance and low power dissipation. The chip is capable of coping with a with range of applications and thus provides the system designer with great flexibility. For instance, a portable multimedia system can be realized by only three chips: an M32R/D chip, an I/O ASIC chip, and programming ROM. This means that a total system solution can be achieved at a lower cost with higher performance. Personal digital assistants (PDAs) and digital still cameras are such examples.

A wide range motion estimation with exhaustive search is the best approach for high quality encoding applications. To perform the required computational power, a 165 GOPS (giga operations per second) exhaustive motion estimation processor ME3 has been developed. The ME3 is powerful enough to realize a range of -64/+63 pixels horizontally and -32/+31 pixels vertically with a single chip. A dual-array architecture supports not only high calculation power but also luminance and chrominance based search to increase picture quality. Also, the ME3 outputs extra vectors as candidates to enhance the picture quality. Using a multi-chip configuration, the exhaustive search range can be easily expanded to meet the requirements of MP@HL encoder. It is implemented using 0.35 /spl mu/m CMOS technology and contains 1.9 million transistors in an area of 8.5/spl times/8.5 mm/sup 2/.

Cardiac (123)I-labeled metaiodobenzylguanidine (MIBG) activity has significant incremental prognostic value, but the difference between the long-term prognostic value of MIBG imaging for ischemic cardiomyopathies and the long-term prognostic value of MIBG imaging for idiopathic cardiomyopathies is not clear. This study aimed to determine whether assessment of cardiac (123)I-MIBG activities in ischemic and idiopathic cardiomyopathies have equally prognostic values and whether the kinetics are different because of the underlying etiologies.After quantitative (123)I-MIBG imaging, 76 ischemic and 56 idiopathic cardiomyopathy patients were prospectively followed up for 54 mo. In addition to conventional parameters, cardiac (123)I-MIBG activity was quantified as a heart-to-mediastinum ratio (H/M) for early and late images and the washout kinetics were calculated using tomographic imaging. The data were compared with those obtained from 16 healthy volunteers.During follow-up, 29 deaths from heart failure, 11 sudden cardiac deaths, 2 deaths from arrhythmia, and 5 deaths from acute myocardial infarction were documented. Multivariate discriminant analysis using the Cox proportional hazards model showed that, in comparison with other variables, late H/M was the most powerful independent predictor of a lethal clinical outcome in ischemic (Wald chi(2) = 18.6502; P = 0.0000) and idiopathic (Wald chi(2) = 5.3394; P = 0.0208) groups. When patients with left ventricular ejection fraction (LVEF)40% were considered, late H/M had the greatest statistical power in both groups. Kaplan-Meier analysis showed late H/M to have an identical threshold (1.82) for both groups for identifying patients at risk of cardiac death. Likewise, when analysis was restricted to patients with an LVEF40%, the upper cutoff value of late H/M was 1.50 (P = 0.0358; log rank = 4.41) for ischemic patients and 2.02 (P = 0.0050; log rank = 7.86) for idiopathic patients. For patients with an LVEF40% and a late H/M less than the identified threshold of late H/M, the annual rate of cardiac death was greatest, 18.2%/y for the ischemic group and 11.9%/y for the idiopathic group.Cardiac (123)I-MIBG activity has the most powerful independent long-term prognostic value for both ischemic cardiomyopathy patients and idiopathic cardiomyopathy patients, indicating that both disease processes have common pathophysiologic and prognostic implications of impaired cardiac sympathetic innervation. Although combined testing of cardiac function and (123)I-MIBG activity is most likely to identify patients at increased risk of cardiac death, the underlying etiology of cardiac dysfunction may affect the threshold of (123)I-MIBG activity for the differentiation of high-risk patients.

To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study.Only several case presentations have been reported with regard to this syndrome.We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies.Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 months, two patients showed recurrence, and one died suddenly.A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.

Despite the diagnostic efficacy of stress myocardial perfusion imaging, the correlation between the actual perfusion tracer activity and diseased state of a coronary artery has not been studied in detail. We estimated exercise-related perfusion augmentation in relation to disease states of a coronary artery in diabetic and non-diabetic patients by a newly developed quantitative technetium (Tc)-99m-tetrofosmin myocardial imaging technique. Tc-99m-tetrofosmin tomographic imaging with an exercise-rest protocol was performed in 26 stable coronary patients and in 8 age-matched controls. Percent increase (%IR) in myocardial count during symptom-limited submaximal exercise-stress was calculated in 16 non-infarcted polar map segments and in each coronary territory by a subtraction technique with corrections for physical decay and injected tracer doses, and the results were compared with those of angiographically quantified coronary diameter stenosis (%DS). Percent IR and peak heart rate during exercise showed a positive linear correlation both in coronary territories with significant stenosis (%DSor = 75%) and in control or nonstenotic (%DS75%) territories. The regression line in stenotic regions was, however. significantly (p0.01) shifted downward compared to that in non-stenotic regions. Percent IR in stenotic regions showed a significant inverse correlation with %DS. Coronary stenosis of 75% or more was identified by a %IR cutoff value of 40% with 77% sensitivity, 70% specificity, and an accuracy of 72%. In coronary territories with a %DS of less than 75%, %IR in diabetic patients was significantly lower (46+/-15%) than that in nondiabetic patients (61+/-25%). Thus, blunted exercise-related augmentation of myocardial uptake of Tc-99m-tetrofosmin correlates with the severity of coronary narrowing and diabetic state.

Left ventricular Doppler index (LVDI) is believed to be a useful echocardiographic index of systolic and diastolic ventricular function. However, the usefulness of right ventricular Doppler index (RVDI) remains uncertain, especially in dilated cardiomyopathy. The predictive value of RVDI for estimating long-term cardiac events, including cardiac death, was investigated.Fifty-nine consecutive patients with dilated cardiomyopathy (41 males and 18 females, mean age 52 +/- 15 years) were enrolled in this follow-up study. RVDI and LVDI were calculated as follows: DI = (isovolumic contraction time + isovolumic relaxation time)/ejection time.During a follow-up period of 3.7 +/- 3.0 years, 27 (46%) of the patients exhibited cardiac events, including cardiac death (n = 9), heart failure (n = 16) and tachyarrhythmias (n = 2) requiring in-hospital treatment. Patients with these cardiac events had higher LVDI and RVDI at the initial follow-up examination, and RVDI had a significant linear correlation with LVDI (LVDI = 0.550 + 0.452 x RVDI, r = 0.530, p = 0.0001). The 6-year survival rate was significantly lower in patients with both LVDIor = 0.78 and RVDIor = 0.49 than in other patients (50% vs 75%, respectively, p = 0.009). Cox proportional hazards model analysis showed that RVDIor = 0.49 was the independent predictor of cardiac events (p = 0.0153) and cardiac death (p = 0.0003).RVDI is clinically useful for estimating the outcome of patients with dilated cardiomyopathy.

The mortality and morbidity associated with residual intracardiac floating thrombi in patients with acute pulmonary thromboembolism remain uncertain. Thirteen patients (2 men and 11 women, mean age 56 +/- 15 years) with pulmonary thromboembolism underwent echocardiography within 24 hours from onset of symptoms. Four patients (31%) had floating intracardiac thrombi in the right heart: 3 in the right atrium and one in the inferior vena cava. The time to evaluation by echocardiography was shorter than in the patients without thrombi. The thrombi disappeared shortly (3.2 +/- 2.4 hr) after thrombolysis without adverse effects in these patients. After thrombolysis, clinical symptoms improved and pressure gradient between the right ventricle and right atrium decreased significantly (p0.01) from baseline 47 +/- 6 to 26 +/- 5 mmHg. Major bleeding complications occurred in 3 (43%) of the patients who underwent thrombolysis. Right-side intracardiac floating thrombus was easily detectable by early echocardiography. Thrombolytic agents are likely to be effective in patients with intracardiac floating thrombi.

To elucidate the effect of a modification of ceramide on antigenicity of the carbohydrate of ganglioside, the reactivity of O-acetyl GM3 having 3-O-acetyl ceramide, which has been characterized as a glioma-related ganglioside, with monoclonal antibody M2590 was examined in comparison to that of non-acetylated GM3, by means of quantitative enzyme-linked immunosorbent assay, TLC-immunostaining and liposome immune lysis assay. In all these assay systems, O-acetyl GM3 showed less activity than GM3 as follows: GM3 was detected till 0.1 nmol in TLC-immunostaining, whereas O-acetyl GM3 could not be detected even at 0.25 nmol; the GM3 reaction was approximately twofold that of O-acetyl GM3 at each diluted point in the enzyme-linked immunosorbent assay; and 20% of the liposomes containing GM3 were lysed at 6 mol%, while liposomes containing O-acetyl GM3 did not lyse at that concentration. The lesser antigenicity of the sugar moiety of O-acetyl GM3 could be ascribed to the presence of an acetyl group in the ceramide at the 3-position of sphingosine.

Insulin resistance is known to be important in the aggravation of established coronary risk factors, but it is unclear whether insulin resistance might cause coronary artery disease as diabetes mellitus. To evaluate the relationship between insulin resistance and coronary atherosclerosis, the angiographic semiquantitative score of coronary atherosclerosis was investigated in 216 patients (175 males, 41 females) with coronary artery disease and the varying degrees of glucose metabolism including insulin resistance. Insulin resistance was estimated by plasma insulin level at 120 min after the 75g oral glucose tolerance test. Patients were divided into 3 groups according to the levels of glucose metabolism: 37 patients with treated diabetes mellitus, 48 with glucose intolerance and non-treated diabetes, and 131 with normal glucose tolerance. Multivessel disease was more frequently seen in the treated diabetes group (67.6%) than in the glucose intolerance and non-treated diabetes groups (43.8%) and in the normal glucose tolerance group (40.5%). The severity of coronary artery stenosis (8.5 +/- 3.9 vs 7.6 +/- 3.7 vs 6.6 +/- 3.7) and calcification (6.5 +/- 6.3 vs 3.3 +/- 3.3 vs 4.0 +/- 4.8) were significantly higher in the treated diabetes group than in other groups. Distal coronary lesions were significantly more frequent in the treated diabetes group (61.1% vs 17.6% vs 27.4%) than in other groups. Half of the patients in the normal glucose tolerance group had hyperinsulinemia. Multivessel disease was significantly more frequent in the insulin resistant subgroup than in the insulin non-resistant subgroup (59.4% vs 25.0%, p = 0.011). The severity of coronary artery stenosis was significantly higher in the insulin resistant subgroup than in the insulin non-resistant subgroup (8.6 +/- 3.9 vs 5.6 +/- 3.0, p0.001), but the severity of coronary artery calcification was not significant. Distal coronary lesions showed a tendency to increase in the insulin resistant subgroup (37.5% vs 12.0%, p = 0.081). These results suggest that insulin resistance is an important risk factor for coronary artery disease in patients with normal glucose tolerance, and is related to the severity and multiplicity of coronary atherosclerosis as in patients with diabetes.

The relevance of brief antecedent ischemia to preservation of myocyte viability and cardiac function is still controversial in humans. Dysfunctioning but viable myocardium shows impaired fatty acid metabolism despite restored coronary perfusion. We asked whether preinfarction angina might be related to preservation of cell viability and better functional recovery in comparison with impaired fatty acid metabolism.Tomographic imagings with thallium and beta-methyl-p-iodophenyl penta-decanoic acid (BMIPP) were performed in 32 patients with first acute myocardial infarction who received primary coronary angioplasty: 20 patients with preexisting angina before infarction (Group A) and 12 without (Group B). Thallium and BMIPP abnormalities were quantified as a severity index by a polar map. Regional function was quantified by ventriculography and followed up.Despite no significant difference in coronary risk factors, cardiac function and angiographic findings, the thallium severity index was significantly lower than that of BMIPP (62+/-45 versus 96+/-59) in Group A but not in Group B (104+/-65 versus 115+/-68); the thallium severity index in Group A was significantly lower than that in Group B, but there was no significant difference in BMIPP abnormality between them. The BMIPP severity index correlated significantly with that of thallium in both groups. However, the regression line in Group A shifted downward and was statistically different compared with that in Group B. Regional function at an acute stage was significantly improved from 107+/-31 to 70+/-31 s.d./chord during follow-up in Group A but not in Group B (109+/-62 versus 106+/-52). The ratio of the thallium severity index to that of BMIPP at an acute stage was significantly related to improved regional wall motion during follow-up in the reperfused patients (y=-53x + 65, r=0.667).Preinfarction angina preserves myocyte viability relative to fatty acid metabolism, resulting in augmented perfusion-metabolism mismatch and functional improvement in patients undergoing successful reperfusion, indicating cardioprotective effects of preinfarction angina.

To determine O-esterified positions, a rapid and complete acetalization to prepare an intermediate was established using ethyl vinyl ether as a new reagent. The new method was applied to O-esterified glycolipids followed by GC-MS analysis of the monosaccharide derivatives after methylation and methanolysis, revealing the derivatives with correctly substituted positions. This method was superior in terms of its shorter reaction time and complete acetalization, particularly of the N-glycolyl hydroxyl residue, to previously reported methods using methyl vinyl ether.

To clarify the significance of the serum levels of tumor necrosis factor-alpha (TNF-alpha) in the mechanism of insulin resistance, we studied 12 obese patients with noninsulin-dependent diabetes mellitus (NIDDM). We evaluated the relationship of TNF-alpha levels with the visceral, subcutaneous, and total fat areas measured by computed tomography (CT), and with insulin resistance evaluated by the glucose infusion rate (GIR) observed during an euglycemic hyperinsulinemic clamp study. Controls consisted of 12 normal subjects and 12 nonobese patients with NIDDM. TNF-alpha levels were measured using a high sensitivity enzyme-linked immunosorbent assay. Following admission, all patients with NIDDM participated in a 4-week program of diet and exercise. After this treatment, we evaluated the relationship of the serum levels of TNF-alpha with the area of body fat, the GIR, and the resultant change in the TNF-alpha level. Serum levels of TNF-alpha in the obese patients with NIDDM significantly exceeded those observed in normal subjects (P0.01) or in the nonobese patients with NIDDM (P0.01). Serum levels of TNF-alpha in obese NIDDM patients showed a significant positive correlation with the area of visceral fat before (r = 0.662, P0.03) and after (r = 0.508, P0.05) the treatment; similar correlation was observed in all patients with NIDDM before (r = 0.537, P0.02) and after (r = 0.430, P0.05) the treatment. Serum levels of TNF-alpha in obese NIDDM patients showed a significant negative correlation with GIR after the treatment (r = -0.595, P0.05). Serum levels of TNF-alpha were significantly reduced in the obese patients with NIDDM after the treatment (P0.01), while those in the nonobese NIDDM patients were unchanged. These results suggest that serum TNF-alpha levels may play an important role in mechanism of insulin resistance associated with obesity.

To investigate an appropriate hematocrit (Hct) for managing renal anemia complicated by angina pectoris at rest.Nonrandomized, retrospective and prospective observational study.Sapporo Medical University Hospital, Sapporo, Japan.Thirty-two anemic patients (aged 62 +/- 10 years, range 40 to 78) with rest angina in end-stage renal failure.Serial changes of exercise tolerance (estimated metabolic equivalents [METs] on stress electrocardiography produced by improvement of patients' Hct, using recombinant human erythropoietin (rHuEPO). Adverse effects, such as deteriorating systemic hypertension, were investigated with regard to the severity of coronary arteriographic findings (Leaman's score) and cardiac events within a six-month period.Higher Hct was clearly correlated with better estimated METs: when Hct was less than 20%, MET was 1.4 +/- 0.5; with 20%or = Hct25% 2.1 +/- 1.4; with 25%or = Hct30% 3.1 +/- 1.6; and with 30%or = Hct35% 4.9 +/- 1.1. Patients with cardiac events (elective balloon angioplasty [n = 5], bypass surgery [n = 1], myocardial infarction [n = 2] and hospital death from congestive heart failure [n = 3]) had advanced coronary lesions compared with patients without coronary events (Leaman's score 15.9 +/- 9.3 versus 7.3 +/- 4.4, respectively, P0.01) and lower exercise capacity at 25%or = Ht30% (estimated METs 2.4 +/- 1.2 versus 3.9 +/- 1.9, respectively, P0.05). Moreover, there was an inverse linear correlation between estimated METs and Leaman's score only when Hct was over 25%. In prospectively examined subjects (n = 16), Hct 35% or greater without systemic hypertension was obtained in only seven (44%), and no additional effect on exercise tolerance was expected when Hct was 35% or greater.Managing renal anemia with 30%or = Hct35% with rHuEPO is considered an appropriate therapy in patients with end-stage renal failure complicated by rest angina.

Little is known concerning therapeutic modification of left atrial thrombus in mitral stenosis and its formation after successful balloon valvuloplasty (percutaneous transvenous mitral commissurotomy [PTMC]).To test the roles of the clinical use of anticoagulant therapy and PTMC, serial changes in left atrial thrombus were examined by transesophageal echocardiography in 80 patients with mitral stenosis.No difference in embolic history, New York Heart Association functional class, cardiac rhythm, left atrial size or mitral valve area was found between patients with (n=23) and without (n=57) left atrial thrombus. Diuretic use was the prevalent factor for left atrial thrombi, which were dissolved completely in seven (30.4%) and partially in eight (34.7%) of the patients by adequate warfarin. However, after PTMC (n=53), newly formed thrombus was observed in four of 51 (7.8%) patients, which correlated with left atrial size (at least 50mm), atrial fibrillation and poorly controlled warfarin (thrombo test: 63.8 +/- 18.8% versus 35.9 +/- 17.7%, P0.005). The newly formed thrombi were dissolved within several weeks.Left atrial thrombus in symptomatic mitral stenosis exhibits elusive characteristics and should be strictly monitored even after successful PTMC by transesophageal echocardiography in order to achieve adequate anticoagulation.

Exposing the myocardium to brief ischemia followed by reperfusion enhances myocardial resistance to infarction from a subsequent sustained ischemia. This phenomenon, termed preconditioning, is most likely to be triggered by adenosine A1 receptor activation, and the dependence of the preconditioning effect on the duration of preconditioning ischemia and the number of its repetition is probably through the interstitial adenosine level achieved by each preconditioning protocol. Our studies support the theory that activation of protein kinase C subsequent to stimulation of the A1 receptor enhances myocardial ischemic tolerance. The ATP-sensitive potassium channel may be involved in preconditioning, but its relation with protein kinase C is unclear, and the relative importance of this channel might be species dependent. The mechanism of preconditioning needs to be further elucidated in animal models and preconditioning in the human heart needs to be further characterized before we can adapt its biochemical basis to clinical therapy.

The relationships between myocardial perfusion, fatty acid metabolism, and cardiac function were investigated using dual single photon emission computed tomography (SPECT) with thallium and iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid (123I-BMIPP) during the acute (10 +/- 1 days) and recovery (60 +/- 14 days) phases in 29 patients with acute myocardial infarction. There were 18 patients who underwent successful primary coronary angioplasty (PTCA group) and 11 patients who received conservative therapy (non PTCA group). Thallium and BMIPP uptakes were scored visually by a 4-point system and left ventricular ejection fraction (LVEF) was calculated by radionuclide ventriculography. Although significant positive correlations between thallium and 123I-BMIPP scores were observed during both phases, BMIPP scores were significantly lower than thallium scores in both acute and recovery phases in the PTCA group. No significant difference in thallium and 123I-BMIPP scores was observed at the recovery phase in the non PTCA group. LVEF significantly correlated with thallium and 123I-BMIPP scores in both phases in the PTCA group. Furthermore, the difference between thallium and 123I-BMIPP scores during the acute phase significantly correlated with the improvement of LVEF during the follow-up period in the PTCA group (y = 0.92x-0.77, r = 0.65, p0.005). These findings suggest that mismatch of perfusion and metabolism in infarcted myocardium assessed by thallium and 123I-BMIPP SPECT is increased by reperfusion therapy and persists at least until the recovery phase of myocardial infarction. The recovery of left ventricular function depends on the extent of the mismatched uptake, indicating a predictor for functional recovery following acute myocardial infarction.

Exercise-stress thallium (Tl) scintigraphy is a reliable diagnostic tool for evaluating the reversibility of injury to the myocardium; however, overestimation of infarcted volume has been considered as a clinical limitation, both in recent and in old myocardial infarctions. To reveal the clinical efficacy of reinjection modification, infarcted and ischemic myocardium were quantitatively evaluated by stress, reinjection, and resting image with 201Tl SPECT in 43 patients with myocardial infarction. A quite significant correlation was found in severity scores from reinjection and resting images (87 +/- 12 vs. 81 +/- 10, r = 0.85, p0.001), these were significantly lower than the scores from post-exercise (124 +/- 13) and 4-hour delayed (103 +/- 11) images. The fractions of reversible ischemic myocardium predicted by reinjection and resting images also correlated with each other (r = 0.55, p0.05) and were significantly larger than those from 4-hour delayed images. Furthermore, the degree of redistribution of myocardial perfusion observed in reinjection image showed a significant positive linear correlation with improved myocardial perfusion after coronary revascularization (r = 0.80, p0.001), while that from the 4-hour delayed image did not. These results suggest that the severity score of thallium reinjection method is useful for quantifying both labile and non-labile myocardium after myocardial infarction and contributes to predicting the effect of coronary revascularization therapy.

Little is known about exercise-induced electrocardiographic ST segment shift in right-sided precordial leads, especially elevated ST in patients with subacute inferior myocardial infarction.To test the clinical significance of exercise-induced STV1 deviation with special regard to right ventricular function and right ventricular involvement.Sixty-eight patients with recent inferior myocardial infarction (without having a left descending arterial lesion) aged 30 to 73 years (mean +/- SD, 59.1 +/- 10.0) were investigated with respect to biventricular function observed in radionuclide ventriculography and treadmill stress electrocardiographic findings.STV1 shift during exercise (delta STV1) had a negative linear logarithmic relationship only with the right ventricular ejection fraction (RVEF) and no correlation with the left ventricular ejection fraction (delta STV1 = 6.7604-1.7528xlnRVEF, r = 0.709, P = 0.0001). Significant STV1 elevation (delta STV1 of 0.5 mm or more) predicted right ventricular dysfunction (RVEF of 40% or less) and right ventricular infarction with sensitivities of 76% and 77%, specificities of 88% and 92%, and accuracies of 84% and 77%, respectively. Twenty patients with STV1 elevation (0.5 mm or more) showed nearly identical rest and exercise electrocardiographic findings, exercise capacities and similar stenotic lesions on coronary angiography, to 43 patients without significant STV1 elevation. Elective balloon angioplasty reduced the delta STV1 during exercise in only three of six patients (50%) with right ventricular infarction.Exercise-induced STV1 elevation may be a useful indicator of global right ventricular dysfunction and/or right ventricular infarction in the subacute phase of myocardial inferior infarction.

The binding of a galactosylceramide (GalCer) analog to proteins in normal human cerebrospinal fluid (CSF) was examined by photo-affinity labeling using a radioiodolabeled 2-(p-azido-salicylamido) ethyl-1,3-dithiopropionate (ASD) derivative of galactosylsphingosine (GalSph) as a probe. The affinity-bound peptides appeared at 66, 36 and 28 kDa as radiolabeled bands. The latter two peptides, 36 and 28 kDa, were independently identified by immunostaining of the isolated peptides using biotinylated GalSph, and immobilized Avidin, and by immunoprecipitation of the photolabeled peptide, to apolipoproteins (ALPs) E and A-I, respectively. The direct binding of the GalCer analog to these apo-peptides suggested that the existence in the body fluids or the transfer between the fluids and cells of the glycolipid was related to high density lipoprotein (HDL) constructions.

Reversible myocardial perfusion abnormality was quantified by bull's eye and unfolded surface mapping methods in exercise thallium SPECT before and after coronary revascularization in 47 patients with angina pectoris, including 34 patients with previous myocardial infarction (PMI) and 13 with effort angina (AP). There was no difference in the incidence or extent of myocardial ischemia between the 2 groups before revascularization. However, the ischemic scores were significantly smaller in PMI group preoperatively than the reductions of the ischemic scores after revascularization. The ischemic scores, preoperatively estimated reversible perfusion abnormality was 32%, 69% and 48% of the improvement of the ischemic score (extent score, severity score, and ischemic area, respectively). Using the 3 ischemic scores, the improvement of perfusion abnormality was well predicted in 70-89% of AP patients but 35-57% of PMI patients. Thus, quantitative analysis in stress thallium SPECT is useful for detecting myocardial ischemia and evaluating the effect of coronary revascularization. However, about a half of myocardial viability was underestimated in one third of PMI patients by the conventional exercise-stress thallium SPECT study.

Fatty acid metabolic and perfusion abnormalities associated with cardiac hypertrophy were investigated using dual tracer tomography with thallium and a cardiac metabolic tracer, 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP), in eight patients with hypertrophic cardiomyopathy (HCM) and in three with hypertension (HT). Thallium and BMIPP uptakes were scored and analyzed in 143 segments (13/heart) by comparison with the left ventricular wall thickness measured by two-dimensional echocardiography. Complete agreement of both scores in HT patients was significantly higher than that in HCM patients (64% vs 24%, p0.001), while a lower BMIPP uptake compared to that of thallium (mismatching) was observed more frequently in HCM than in HT patients (65% vs 31%, p0.001). The wall thickness significantly (p0.005) correlated with BMIPP uptake score. HCM patients showed a low BMIPP uptake in 22 hypertrophic segments (59%) and 15 non-hypertrophic segments (41%), and reduced BMIPP uptake in 29% hypertrophic segments, while HT patients showed just five segments with decreased BMIPP uptake of which 4 were non-hypertrophic and only one hypertrophic. The left ventricular ejection fraction assessed by radionuclide ventriculography was normal and no regional wall motion abnormality was detected in any patient by echocardiographic and scintigraphic studies. Metabolic abnormalities detected by the iodine-123-beta-methyl fatty acid analog in hypertrophic cardiomyopathy may be independent of thallium myocardial perfusion, regional wall motion, or the magnitude of cardiac hypertrophy, suggesting that fatty acid imaging may be useful in investigating the pathogenesis and subclinical abnormality of hypertrophic cardiomyopathy, and differentiation from secondary, induced cardiac hypertrophy.

A 26-year-old male with about a ten-year history of smoking was admitted to our hospital for evaluation of ischemic symptoms including numbness, easy fatigability on exercise and lack of pulse in his left arm. His left axillary, brachial and radial pulse could not be palpated and a needle reaction was negative on physical examination. Laboratory data showed no diabetes mellitus or hyperlipidemia. C-reactive protein, Wassermann's reaction, rheumatoid reaction, anti-nuclear factor, anti-DNA antibody, hypocomplementemia and circulating immune complex were negative. Invasive arteriography using contrast medium revealed segmental occlusion with multiple collateral arteries showing a typical "corkscrew" appearance at the left subclavian artery. However, no stenotic and aneurysm-like lesions suggesting aortitis syndrome, vasculo-Beçhet disease and giant arteritis were found on the aorta or other arteries including the pulmonary artery. Although no pathological study could be carried out, the angiographic and laboratory findings strongly suggested Buerger's disease as a possible cause of solitary stenosis of the left subclavian artery in this patient.

In order to investigate the correlation between cardiac fatty acid metabolism and regional wall motion, dual-isotope tomography using thallium-201 and iodine-123 labeled 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (BMIPP), was performed in 15 patients with coronary artery disease (CAD), hypertension, or hypertrophic cardiomyopathy (HCM). The uptake of thallium and BMIPP was scored and compared with left ventricular regional wall motion assessed by 2-dimensional echocardiography and radionuclide ventriculography. The incidence of a complete agreement of thallium and BMIPP scores was significantly higher in hypertension (64%) and CAD (63%) groups compared to HCM patients (24%), while a lower BMIPP uptake compared to that of thallium (mismatching) was observed more frequently in HCM (65%) than in hypertension (31%) or CAD (33%). Only 3 infarct patients had regional wall motion abnormality which was detected in 20 (95%) of 21 segments with a low BMIPP uptake. Furthermore, compared to thallium perfusion, decreased BMIPP uptake much more corresponded to reduced wall motion in 8 of 11 segments with mismatching. Thus, metabolic abnormality assessed by BMIPP is well associated with asynergy in CAD patients, whereas the discrepancy of fatty acid metabolism and contraction is more dominant in HCM, suggesting that the combined assessment of thallium perfusion, BMIPP uptake, and regional wall motion might contribute to better understanding the pathogenesis of various cardiac disorders.

Cardiac function and myocardial perfusion were assessed by exercise-stress thallium SPECT and resting gated blood pool SPECT techniques before and after 47 successful coronary angioplasties. Thallium perfusion was analyzed visually and quantitatively in stress and resting studies. Left ventricular ejection fraction (LVEF) and peak filling rate (PFR) were calculated and regional wall motion was scored by amplitude and phase images in radionuclide planar and tomographic imagings. The thallium redistribution in delayed or resting SPECTs was more sensitive (87%) for detecting myocardial ischemia compared to symptoms (36%) and ECG changes (60%). An exercise capacity, LVEF, PFR, and the scores of perfusion and regional wall motion were improved significantly after coronary angioplasty. Stress thallium and gated blood pool SPECTs showed the improvements of myocardial perfusion in 159 (79%) of 201 segments and regional wall motion in 47 (51%) of 92 segments, respectively. These results suggest that the combined use of stress thallium SPECT, gated blood pool planar and SPECT techniques can contribute not only to the assessment of the efficacy of coronary angioplasty but also to detecting the mismatching of myocardial perfusion and contraction ("myocardial hibernation") in infarct-related myocardial lesions.

The clinical implications of isolated late recovery ST depression were tested in patients with scintigraphically defined ischemia (coronary artery disease [CAD], n = 18) compared with patients without ischemia (n = 25). Spontaneous (78.4 versus 12.0%, P0.008) and exercise-induced angina (44.4 versus 0%, P0.0001) were more frequently seen in patients with CAD. Histories of unstable angina (33.3%), prior myocardial infarction (27.8%), ST elevated angina (22.2%) and significant stenosis in the left anterior descending artery (17 of 18, 94.4%) were almost exclusively seen in the CAD group. There was no significant difference between the two groups in capacity for exercise, maximum deviation of ST level or TV2 amplitude. Balloon angioplasty abolished late recovery ST changes in 63.6% of CAD patients. These results suggest that isolated late recovery ST depression, when accompanied with typical chest pain, may be considered as an indicator of myocardial ischemia, but this phenomenon is difficult to distinguish electrocardiographically.

Infarct-related coronary lesions and collaterals were assessed by the bull's eye view and the unfolded surface map derived from thallium-201 myocardial tomography (Tl-201 SPECT) in 25 patients with anterior myocardial infarction. The patients were categorized in six groups according to their cine-angiographic findings: locations of stenosis (proximal or distal portions of the first diagonal branch or distal site of the first septal branch), and the presence or absence of collaterals. The anterior half of the left ventricle on the bull's eye view map was divided into eight regions from the anterior septum to the lateral wall and from the apex to the cardiac base. Tl-201 SPECT images were expressed as functional maps using maximum-count circumferential profile analysis: an "extent image" showing the extent of perfusion defect, and a "severity image" demonstrating the degree of hypoperfusion. The following results were obtained: 1. Perfusion defect of the "extent image" at the basal portion of the anterior septum reflected poor collaterals, with a sensitivity of 81.3%, a specificity of 77.8%, and a diagnostic accuracy of 80.0%. 2. Coronary stenosis at segment 6 (AHA classification) was differentiated from that at segment 7 by detecting hypoperfusion at the basal septum on the "severity image", with a sensitivity of 71.4%, a specificity of 77.8%, and a diagnostic accuracy of 75.0%. 3. Perfusion defect at the basal section of the proximal portion of the anterior wall on the "extent image" indicated stenosis at the proximal segment 6, with a sensitivity of 57.1% and a specificity of 88.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

A 63 year old woman with chronic heart failure was admitted to our hospital for palpitation attack on 26th Apr 1988. The patient was died by cardiogenic shock and recurrent ventricular fibrillation 12-hours after admission. The autopsy revealed diffuse myocardial fibrosis and disarray which was compatible with dilated cardiomyopathy. The electrocardiogram on admission showed a peculiar wide QRS tachycardia with atrioventricular dissociation. After intravenous injection of 400 mg of procainamide, the QRS was separated into two types. The one type was left bundle branch block (LBBB) type with right axis deviation (type A), which was similar as that documented on Jan 1985, and the other was LBBB with normal axis (type B). Each wide QRS tachycardias were sustained independently and simultaneously either with RR 440 msec. or with RR 600 msec as if they were dissociated intraventricularly. The different wide QRS tachycardia documented on Feb 1986 was suspected as the fusion beats with type A and the QRS resembling type B. Although ventricular tachycardia with beat-to-beat changes of QRS morphology was generally regarded as bidirectional tachycardia, double foci were considered as origins of the two types of wide QRS tachycardia simultaneously observed in this patient.