In many cases, the diagnosis of eosinophilic myocarditis is suggested by an elevated peripheral blood eosinophil count. However, no detailed studies have been performed on the sequential changes in the initial peripheral blood eosinophil count over the course of the disease. We measured the peripheral blood eosinophil count at the time of presentation in eight patients with eosinophilic myocarditis proven by endomyocardial biopsy and intermittently thereafter. The eosinophil count at the time of onset was <500/mm(3) in four patients, >500/mm(3) but <1,000/mm(3) in three patients, and > or =1,000/mm(3) in one patient. In three of the four patients with an initial eosinophil count of <500/mm(3), an increase to > or =500/mm(3) occurred 7-12 days after the onset. The remaining patient did not develop peripheral eosinophilia. In conclusion, in the early stage of eosinophilic myocarditis, peripheral hypereosinophilia is not present initially in some patients, and may not develop during the course of the illness in a subset of these patients.
Objective The present study was undertaken to establish a useful range for the B-type natriuretic peptide (BNP) level, with the ultimate goal of determining a cut-off BNP level that will make it possible to identify patients with clinically important organic heart disorders among patients encountered in clinical practice. Methods A total of 11,967 outpatients were evaluated for this study, and, after applying the exclusion criteria, 361 patients were finally recruited for the analysis. Compared to the factors of gender and body mass index, aging was considered to be an indispensable factor in this analysis. The 'median' plasma BNP level was found to increase slowly with age, but remained lower than 30 pg/mL, even in patients aged 60 years or older. In contrast, the overall '95th percentile' of the plasma BNP level in the patients younger than 60 years was 41 pg/mL, which increased to 139.8 pg/mL in the patients aged 60 years or older. Conclusion These findings suggest that the lower range of the BNP level allowing for identification of patients with clinically important organic heart disorders increases with age; however, it might be appropriate to adopt a level of approximately 40 pg/mL, even in elderly patients, in order to avoid any possible age-related effects of diastolic dysfunction or other factors.
ransient thickening of the ventricular wall sometimes develops in patients with acute myocarditis, 1-17 and we have shown that it is the result of interstitial edema. 1 However, the influence of the ventricular wall thickening per se on left ventricular function in acute myocarditis has not been elucidated, so we reviewed serial echocardiograms of patients with acute myocarditis and attempted to determine the relationship between ventricular wall thickening and left ventricular function. Methods Study PatientsDuring the 12-year period from 1987 to 1998, 60 patients at Fujita Health University Hospital or Nagoya Dai-ni Red Cross Hospital were diagnosed as having acute myocarditis based on clinical symptoms and endomyocardial biopsy findings. Echocardiography and right ventricular endomyocardial biopsies were performed during both the acute (≤2 weeks after onset) and convalescent (≥1 month after onset) phases in 29 of the patients. Of these, 9 patients with second or third degree atrioventricular block were excluded, and the remaining 20 patients comprised the current study group (12 men, 8 women; mean age, 36.5±16.1 years) ( Table 1). In addition to the conventional pharmacological therapies, steroids, catecholamines, and diuretics were being taken by 5, 13, and 16 patients, respectively. Percutaneous cardiopulmonary support and intraaortic balloon pumping were used in 2 patients each. Endomyocardial BiopsiesRight ventricular endomyocardial biopsies were performed, and at least 3 tissue fragments were obtained in each patient. The samples were fixed immediately in 10% buffered formalin, and multiple sections were stained with hematoxylin-eosin, Azan-Mallory, and elastica van Gieson stains for light microscopic examination. The histologic sections were analyzed by 3 observers, and a diagnosis of myocarditis was reached by consensus. The final diagnosis of lymphocytic myocarditis [18][19][20] was based on the Dallas criteria. 18 Only patients with histologic evidence of "active" myocarditis were included.Eosinophilic myocarditis [21][22][23][24] was defined as the development of cardiac symptoms in the presence of peripheral blood eosinophilia and endomyocardial biopsy evidence of eosinophilic infiltration, degranulation, and myocyte necrosis. Using the Azan-Mallory-stained specimens, myocardial
At 4 and 6h postprandially, TG levels were decreased (p<0.01) after 4 weeks of ezetimibe treatment, and the AUC for TG was also decreased (p<0.01). Apolipoprotein B48 (apo-B48) levels at 4 and 6h postprandially were significantly decreased after ezetimibe treatment (p<0.01 and p<0.001, respectively), and the AUC for apo-B48 was also significantly decreased (p<0.01). Blood glucose and insulin levels at 2h postprandially were significantly decreased by ezetimibe (p<0.05). The AUCs for blood glucose and insulin were also significantly decreased (p<0.05 and p<0.01, respectively). Since ezetimibe improved postprandial lipid and glucose metabolism, this drug is likely to be beneficial for dyslipidemia in patients with postprandial metabolic abnormalities.
The lipid-lowering and anti-atherosclerotic effects of atorvastatin (10 mg/day) were investigated by measuring changes in the levels of oxidized low-density lipoprotein (LDL), serum lipids (total cholesterol [TC], LDL-cholesterol [LDL-C] and triglycerides [TG]), and in the protein adiponectin. This was undertaken in 22 patients with ischaemic heart disease and serum LDL-C levels > 100 mg/dl. After 3 months of therapy, atorvastatin significantly decreased serum lipids, oxidized LDL was reduced from 457.0 ± 148.6 to 286.9 ± 88.5 nmol/l, and adiponectin increased from 9.7 ± 7.4 to 13.9 ± 9.98 mg/ml. No significant correlation was observed between adiponectin and LDL-C, TG and high-density lipoprotein cholesterol. Atorvastatin therapy was not associated with side-effects, such as myalgia and gastrointestinal disorders, and did not give abnormal laboratory test results. It is concluded that atorvastatin decreases serum lipid and oxidized LDL levels, and increases adiponectin levels in patients with ischaemic heart disease.
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