The T30 value could be a specific index for vagally mediated heart rate recovery. Vagally mediated heart rate recovery after exercise is accelerated in well trained athletes but blunted in patients with chronic heart failure.

Advanced age is associated with decreased angiographic presence of collaterals to the IRA in patients with AMI. This abnormality may contribute to the poor prognosis of elderly patients with AMI.

No abstract

Although PCI was associated with a favorable long-term mortality, it remains underused in subsets of patients and increased use may further reduce the long-term mortality rate in Japanese AMI patients.

he combination of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) has been reported to offer more complete blockade of the effect of angiotensin II than treatment with ACEI alone, while retaining the benefits of bradykinin potentiation obtained from ACEI treatment. 1,2 In the clinical setting, the combination of ACEI and ARB is more beneficial in preventing left ventricular remodeling and decreasing the plasma concentrations of aldosterone and brain natriuretic peptide (BNP) than either ACEI or ARB alone. 3,4 In addition, the combination therapy has recently been proved to improve prognosis to a greater extent than the monotherapy. 4,5 However, the doses of ACEI and ARB in large-scale trials performed in the USA and Europe have been 3-4-fold higher than the standard doses prescribed in Japan. The aim of this study was to Circulation Journal Vol.68, April 2004 investigate the effects of the combination of ACEI and ARB at the standard doses prescribed in Japan on left ventricular remodeling and neurohumoral factors in patients with chronic heart failure. Methods Study DesignThis is a multicenter, randomized, open-labeled trial to compare the clinical effects of ACEI or ARB monotherapy and their combination for 6 months. All the patients treated in the 26 institutes gave their written informed consent to participate in the trial, which was approved by the institutional review board of the National Cardiovascular Center, Osaka, Japan. EligibilityMen and women, 18 years old or older, with stable chronic heart failure for at least 3 months before the screening were eligible to participate in this study. In addition, they had to have documented left ventricular (LV) systolic dysfunction with an LV ejection fraction (EF) equal to or less than 45%, determined by echocardiography or LV venCirc J 2004; 68: 361 -366 (Received November 13, 2003; revised manuscript received January 20, 2004; accepted January 27, 2004) The institutes particpating in the study are listed in Appendix 1. Background The present multicenter study investigated whether the combination of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) is more beneficial for preventing left ventricular remodeling and suppressing neurohumoral factors than either ACEI or ARB alone. Methods and ResultsOne hundred and six patients with mild-to-moderate congestive heart failure treated in 26 Japanese institutes were randomly assigned to the combination therapy or monotherapy. Changes in physical activity (New York Heart Association functional classes, Specific Activity Scale (SAS)), concentrations of neurohumoral factors (plasma renin activity, angiotensin II, aldosterone, and brain natriuretic peptide (BNP)), and cardiac function for 6 months were compared between the 2 groups. It was found that the combination therapy, which was administered at doses standard in Japan, increased the SAS score (4.5±1.5 to 4.9±1.5, p<0.05) and decreased the plasma BNP concentration (183±163 to 135±1...