Objective Red blood cell distribution width (RDW) is a numerical measure of erythrocyte size variation. It has been recently reported to be an independent prognostic marker of heart failure (HF). Previous studies on RDW were mostly designed for middle-aged and elderly patients (60-79 years old), therefore, there is no established limit for super-elderly patients (! 80 years old). The purpose of this study was to evaluate RDW as an effective tool to detect fatal HF in super-elderly patients. Methods The medical records and death certificates of 160 consecutive patients admitted to the Department of Cardiology in Juntendo Tokyo Koto Geriatric Medical Center and who died from June 2002 to October 2010 were reviewed. The causes of death were reviewed, and the factors, including RDW, that might have been related to the fatal HF were evaluated using multivariate logistic regression analysis. Results HF was the major cause of death [52 patients (32.5%), 29 females, age 84.0±7.5 years], followed by pneumonia (18.8%, 30/160), and acute myocardial infarction (16.3%, 26/160). The most common cause of HF was atrial fibrillation (36.6%, 19/52), followed by hypertensive heart disease (19.2%, 10/52) and valvular disorders (17.3%, 9/52). The multivariate logistic regression analysis found that a high RDW (! 16.5%) was an independent factor related to fatal HF (OR 2.36, 95% CI 1.10, 5.04, p=0.03). Conclusion HF was the major cause of death, and RDW ! 16.5 was significantly associated with fatal HF in super-elderly patients.

This study demonstrates that the deletion of the FcR gamma chain preserves the endothelial function and attenuates oxidative stress affected by hypercholesterolaemia in FcR gamma(-/-) mice. These results indicate that FcR may play the pivotal role in endothelial dysfunction through oxidative stress induced by hypercholesterolaemia.

Human paraoxonase (PON1) is an high-density lipoprotein (HDL) -associated enzyme that is proposed to protect against the oxidation of lipoproteins. Recently, the association of coronary artery disease (CAD) and PON1 activity was reported. Furthermore, the R/R genotype of PON1 has been related to the risk for CAD. In this study we investigated the PON1 genotype and susceptibility to lipoprotein oxidation to elucidate the contribution of PON1 to atherosclerosis in Japanese subjects. We studied 179 patients who underwent coronary angiography and their PON1 genotypes were determined. Lipoproteins were obtained from a patient's blood after at least 12 hours fasting and were separated with sequential ultracentrifugation. We analyzed the thiobarbituric acid reactive substances (TBARS) and continuously monitored the copper-induced oxidation three genotype groups. Genotype frequencies of Q / Q, Q / R, and R / R were 21.2%, 36.9%, and 41.9%, respectively. PON1 polymorphism clearly determined the lipid oxidation. The R/R genotype of PON1 had significantly lower levels of plasma and HDL TBARS and significantly retarded the initiation of oxidation in HDL and low-density lipoprotein (LDL). The R/R genotype was related to the lower prevalence of CAD. The PON1 genotype clearly determined the oxidative modification of lipoproteins and may play a role in the pathogenesis of atherosclerosis via its protective effect against lipoprotein oxidation in Japanese subjects. J Atheroscler Thromb, 2003; 10: 85-92.

n 1962, Sabiston performed the first case of coronary artery bypass grafting (CABG) to the right coronary artery, using a reversed segment of saphenous vein, but the patient died of a postoperative accident. 1 Green et al used a left internal thoracic artery (LITA), and anastomosed its distal end to the left anterior descending coronary artery (LAD). 2 Favalore established the use of saphenous vein grafts (SVGs) for multivessel bypass. 3 In Japan, CABG is also widely performed; for example, since 1975 in Juntendo University School of Medicine. However, the long-term prognosis and serial angiographic follow-up beyond 10 years in patients who have undergone CABG have not been fully studied in Japan, so we investigated those who underwent CABG before 1992 and performed a clinical and serial angiographic follow-up. Methods Study PatientsWe selected 71 patients who underwent CABG before 1992 and were willing to undergo the long-term clinical and angiographic follow-up. All patients underwent CABG in Juntendo University School of Medicine and were followed in Juntendo Urayasu hospital. Of these patients, 30 had a SVG only, and the remaining 41 had a LITA to LAD graft. We investigated clinical course and prognosis, and coronary risk factors of the patients with SVG alone (SVG group) and compared them with the patients with LITA (LITA group). All patients in the SVG group had a SVG to LAD graft, whereas in the LITA group, all patients had LITA to LAD and SVG to the other coronary vessels. The major adverse cardiac events (MACE) were defined as cardiac death, Q-wave or nonQ-wave myocardial infarction, and congestive heart failure. Hyperlipidemia was defined as requiring antihyperlipidemic drugs or a total cholesterol (TC) >220 mg/dl. Diabetes mellitus (DM) was defined as a requirement for therapy with medication and/or with a fasting blood sugar (FBS) of more than 140 mg/dl, and/or a blood sugar >200 mg/dl on occasion. Baseline clinical and procedural data were collected for all patients. Coronary AngiographyThe patients gave informed consent to undergo serial angiography at 1, 5 and 10 years after CABG, regardless of their symptoms. The films were of good quality and the repeat studies were always compared with the baseline coronary arteriograms. The films were each read by 2 angiographers working together to reach a consensus. Stenosis of the coronary arteries and grafts was defined as the linear percentage of narrowing of the diameter of the vessel compared with the diameter of the nearest normal segment. In this study, patent graft meant widely patent or stenosis less than 99% narrowing. Percutaneous coronary intervention (PCI) to the SVG and native coronary arteries Serial Angiographic Follow-up Beyond 10 Years After Coronary Artery Bypass GraftingMizuhiro Arima, MD* , **; Tatsuji Kanoh, MD**; Takeshi Suzuki, MD**; Kenichi Kuremoto, MD**; Kosei Tanimoto, MD**; Tetsuya Oigawa, MD**; Shigeru Matsuda, MD** Background The long-term prognosis and serial angiographic follow-up beyond 10 years in patients who underwent co...

The patient was a 101-year-old woman whose chief complaints were difficulty of breathing and high fever.The history of the present illness included paroxysmal atrial flutter which was untreated, but she had not developed heart failure.At admission, auscultation of the chest revealed moist rales and systolic murmur but did not clearly show the presence of fixed splitting of S2. X-ray examination of the chest showed a cardiothoracic ratio of 61%, moderate bilateral pulmonary congestion, pleural fluid, and enlarged pulmonary arteries. Electrocardiogram showed atrial flutter with a heart rate of approximately 150 beats/minute. Echocardiographic examination revealed an atrial septal defect (ASD) of the ostium secundum type (left to right shunt) and right ventricular pressure 71 mmHg. The diameter of the ASD was approximately 10 mm.She began receiving an antibiotic and a diuretic immediately after admission, but died on the second day of hospitalization.This case could be the oldest individual with ASD among those reported to date. (Int Heart J 2019; 60: 489-491)