The present study was conducted to evaluate the validity and reproducibility of noninvasive brachial-ankle pulse wave velocity (baPWV) measurements and to examine the alteration of baPWV in patients with coronary artery disease (CAD). Simultaneous recordings of baPWV by a simple, noninvasive method and aortic pulse wave velosity (PWV) using a catheter tip with pressure manometer were performed in 41 patients with CAD, vasospastic angina, or cardiomyopathy. In 32 subjects (15 controls and 17 patients with CAD), baPWV was recorded independently by two observers in a random manner. In 55 subjects (14 controls and 41 patients with CAD), baPWV was recorded twice by a single observer on different days. baPWV were compared among 172 patients with CAD (aged 62 +/- 8 years); 655 age-matched patients without CAD but with hypertension, diabetes mellitus, or dyslipidemia; and 595 age-matched healthy subjects without these risk factors. baPWV correlated well with aortic PWV (r=0.87, p<0.01). Pearson's correlation coefficients of interobserver and intraobserver reproducibility were r=0.98 and r=0.87, respectively. The corresponding coefficients of variation were 8.4% and 10.0%. baPWV were significantly higher in CAD patients than in non-CAD patients with risk factors, for both genders (p<0.01). In addition, baPWV were higher in non-CAD patients with risk factors than in healthy subjects without risk factors. Thus, the validity and reproducibility of baPWV measurements are considerably high, and this method seems to be an acceptable marker reflecting vascular damages. baPWV measured by this simple, noninvasive method is suitable for screening vascular damages in a large population.

To determine why upper limb blood pressure measurement underestimates the vasodilator effects of nitroglycerin on lowering ascending aortic systolic pressure, we studied 24 patients (58 +/- 11 years, mean +/- SD). Ascending aortic pressure and radial artery pulse calibrated by cuff blood pressure measurement at the brachial artery were recorded simultaneously before and 5 minutes after sublingual administration of 0.3 mg nitroglycerin. Waves were analyzed by a signal processor, and the fourth derivative wave was used to find the early (S1) and late (S2) systolic shoulders (S1 corresponds to the second zero crossing and S2 to the third zero crossing). Before nitroglycerin administration, maximal systolic pressure in the ascending aorta (141 +/- 21 mm Hg) coincided with the late systolic peak in all patients, and in most patients (21 of 24) maximal systolic pressure in the radial artery (140 +/- 19 mm Hg) coincided with the early systolic peak. Maximal systolic pressure decreased more in the ascending aorta than in the radial artery (22 +/- 13 and 11 +/- 11 mm Hg, respectively; P < .001). However, the reduction in the shoulder of late systolic pressure in the radial artery (24 +/- 13 mm Hg) clearly indicated the reduction in maximal systolic pressure (late systolic peak) in the ascending aorta. The augmentation index of the ratio of the height of late systolic pressure to early systolic pressure fell proportionally (r = .74, P < .001) in the radial artery (from 0.88 +/- 0.13 to 0.60 +/- 0.11) and in the ascending aorta (from 1.57 +/- 0.25 to 1.26 +/- 0.24), which indicated the reduction in late systolic pressures.(ABSTRACT TRUNCATED AT 250 WORDS)

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Age was independently correlated with LV concentric/functional changes regardless of LV hypertrophy, suggesting that ageing is independently involved in the progression of LV remodelling.

To assess the coronary flow velocity - pressure relationship distal to a stenosis, and to evaluate the influence of microvascular abnormalities on this relationship, coronary flow velocity and coronary pressure were measured simultaneously in 38 patients (42 vessels). The instantaneous peak coronary flow velocity was plotted against the simultaneous measured distal coronary pressure, and the slope of the relation in the phase of diastolic flow decrease was calculated as the flow - pressure slope index (FPSI) and the X-intercept of the slope was calculated as zero-flow pressure (Pzf). The slope of the curve increased from 2.0+/-2.6 to 4.5+/-4.1 (p<0.001) and the X-intercept decreased from 42+/-16 to 27+/-13 mmHg (p<0.001) after papaverine injection. After successful coronary intervention, Pzf increased from 23+/-10 to 35+/-11 (p<0.01) and FPSI decreased from 6.8+/-5.1 to 3.5+/-1.8 (p<0.05). Pzf was higher in patients with an old myocardial infarction. It is feasible to assess the relationship between coronary flow and pressure distal to a stenosis in the clinical setting, and the relationship may provide additional information regarding coronary microcirculation. Microvascular abnormalities may play an important role in the coronary flow - pressure relationship distal to stenosis.

Streptococcus agalactiae (Group B streptococcus, GBS) is the major pathogen encountered in the perinatal period, although the incidence of GBS infection has recently increased among non-pregnant adults. Nevertheless, GBS infective endocarditis (IE) is uncommon and often accompanies aortic embolism. We experienced two cases of GBS IE. In Case 1, mobile vegetation of the aortic valve caused an infective cerebral aneurysm. In Case 2, the patient experienced an acute aortic embolic episode. Generally, early surgery for large mobile sites of vegetation is recommended as a class IIb therapy in the guidelines. GBS IE often exhibits a severe clinical course and specificity of vegetation. Therefore, early surgery should be considered in such cases.

We encountered a case of drug-resistant hypertension and hypokalemia. Laboratory data suggested primary aldosteronism (PA)

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