Background: The purpose of the present paper was to clarify the etiologic and pathophysiologic bases of periventricular lucency (PVL). Methods: The relationship between PVL severity and hemodynamic variables derived by second‐derivative finger plethysmography (SD‐PTG) was studied. A total of 307 consecutively examined outpatients 60 years or older (mean age: 77.7 years; 149 men, 158 women) was enrolled. On the basis of brain computed tomography, PVL was classified into four grades (0–3) according to a modification of the classification of van Swieten. The grade of PVL was assessed at two points in each patient: anterior and posterior. The heights of the a, b, and d waves on the SD‐PTG waveform were measured from baseline. The b/a ratio, indicating distensibility of the aorta, and the d/a ratio, indicating peripheral resistance, were calculated. Results: An anterior PVL of grade 3 had a significantly higher b/a ratio and a significantly lower d/a ratio than that of grade 0 or grade 1 (both P < 0.05). For posterior PVL, the b/a ratio and the d/a ratio were similar for all four grades. The anterior PVL grade was compared with the posterior PVL grade in individual subjects. This comparison yielded six groups: four in which PVL grade was similar (0, 1, 2 or 3) in both regions, one in which the grade for anterior PVL was higher than that for posterior PVL (predominantly anterior group), and one in which the grade for posterior PVL was higher than that for anterior PVL (predominantly posterior group). In patients with predominantly anterior PVL, the b/a ratio and incidence of lacunae were significantly higher than that in patients with predominantly posterior PVL. Conclusion: These findings indicate that the frontal white matter is susceptible to hemodynamic stress. It is suggested that decreased aortic distensibility may promote fibrohyaline thickening of the medullary arteries, increasing the risk of PVL.
To clarify current changes in the patterns of carotid atherosclerosis in Japan, carotid ultrasonographic findings in Japanese male patients with aortic aneurysm were compared between two groups examined in different periods. The first group was recruited from 42 consecutively examined patients in 1997, while the second group consisted of 40 consecutive patients from September, 2001 to January, 2002. Carotid lesions were analyzed by computer, and classified into three types based on the texture: echolucent, hyperechoic, and heterogeneous types. The mean age of the first group was 72 years, similar to that of the second group. In the first group, cigarette smoking was frequently noted, while the mean BMI was greater and IHD and CVD were frequent in the second group. Fifty carotid lesions were seen in each group. Severe stenosis and hypoechoic type lesions were more frequent in the second group than in the first group. These findings indicated that hypoechoic-type lesions, which are considered to be lipid deposition, hemorrhage, or loose fibrous tissue, and severe stenosis, were increased in the more recent group. This predicted that circulatory disturbance due to unstable atherosclerotic lesions may increase in the future among the elderly because carotid lesions reflect vascular change in other organs. J Atheroscler Thromb, 2003; 10: 13-18.
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Background Although the patient's characteristics and outcome of acute myocardial infarction (AMI) have been sufficiently investigated and primary percutaneous coronary intervention (PCI) has been recognized as established treatment strategy, those of recent myocardial infarction (RMI) have not been fully evaluated. Purpose The purpose of the present study was to clarify clinical characteristics and in-hospital outcomes of RMI patients from the database of the Tokyo CCU network multicenter registry. Methods In Tokyo CCU network multicenter registry database from 2013 to 2016, 15788 consecutive patients were registered as AMI (within 24 hours from onset) and RMI (within 2–30 days from onset). However 1246 patients were excluded because of inadequate data. And we excluded 66 cases because of out of onset period and 129 cases that strongly suspected of involvement of vasospastic events. Therefore, remaining 14347 patients were categorized to RMI group (n=1853) and AMI group (n=12494), and analyzed. Results Compared with AMI group, average age was older (70.4±12.9 vs 68.0±13.4 years, p<0.001), male was less (72.4 vs 76.4%, p<0.001), chest pain as chief complaint was less (75.2 vs 83.6%, p<0.001), prevalence of diabetes mellitus was higher (35.9 vs 31.0%, p<0.001), multi-vessel coronary disease was more (54.7 vs 44.6%, p<0.001), patients undergoing PCI was less (79.0 vs 91.2%, p<0.001), and the incidence of mechanical complication was more in RMI group (3.0 vs 1.5%, p<0.001). Although 30-day mortality was equivalent between 2 groups (5.3 vs 5.8%, p=0.360), the major cause of death in AMI group was cardiogenic shock, while in the RMI group it was a mechanical complication. On Kaplan-Meier analysis, the 2 groups had significantly different cumulative incidence of death due to cardiogenic shock (p=0.006, Log-rank test) and mechanical complication (p=0.021, Log-rank test). Furthermore death due to mechanical complication in AMI group was plateau after about 1 week from hospitalization, whereas in RMI group it continued to increase. Kaplan-Meier analysis Conclusions RMI patients had distinctive clinical features in backgrounds and treatment strategies compared with AMI patients, and the major cause of death of RMI patients was different from that of AMI patients. Furthermore, even though treatment during hospitalization of RMI patients was well done, death due to mechanical complications continued to increase.
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