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Objectives: Diabetes mellitus is associated with the risk of restenosis and mortality after coronary stenting, but the relation between glycosylated hemoglobin (hemoglobin A1c) and prognosis has not yet been fully elucidated in patients with diabetes mellitus. The purpose of this study was to evaluate whether hemoglobin A1c is associated with a risk of major adverse cardiac events (MACE) after successful drug-eluting stent (DES) implantation in patients with diabetes mellitus. Methods: In a retrospective study with a prospective follow-up, 206 patients with diabetes mellitus undergoing successful DES implantation were enrolled in this study. Hemoglobin A1c levels were measured within 1 month before coronary stenting. Results: During a period of 4,811 person-months, we confirmed 40 cases of MACE. Higher hemoglobin A1c levels increased the incidence of MACE. Based on multivariate analysis, hemoglobin A1c was a significant predictor of MACE. The multiple-adjusted hazard ratio for a 1% increase in hemoglobin A1c levels was 1.40 (95% CI: 1.13–1.74, p = 0.002) for MACE after adjustment for age, gender, ejection fraction, chronic renal failure on hemodialysis, and statins. Conclusions: Hemoglobin A1c is associated with an increased risk of MACE after successful DES implantation in patients with diabetes mellitus.

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Coronary artery calcium (CAC) is associated with the presence of coronary artery disease (CAD) and cardiovascular risk factors. However, the relation between cardiovascular risk factors and CAD has not yet been fully elucidated in patients with a zero or low coronary artery calcium score (CACS). The purpose of this study was to evaluate the relation of cardiovascular risk factors and angina status to obstructive CAD according to categorical CACS. A total of 753 patients were enrolled in this study. CAC scoring and coronary computed tomographic angiography (CCTA) were performed with dual-source 64-slice CT scanners. The number of patients with a CACS ≤10 and ≤100 were 358 and 528, respectively. Patients with a higher CACS were older and more frequently male, and had a greater frequency of hypertension, diabetes, and hypercholesterolemia. The prevalence of obstructive CAD increased with the CACS. Among patients with a CACS ≤100, age, male gender, diabetes, hypercholesterolemia, and typical angina pectoris were related to obstructive CAD. The presence of hypercholesterolemia was relatively strongly associated with obstructive CAD (OR 6.67, 95% CI 2.91-15.3, p < 0.001) on multivariate analysis. Among patients with a CACS ≤10, men, hypercholesterolemia, and typical angina pectoris were significantly more frequent in patients with than in those without obstructive CAD (p < 0.01). Our data suggest that neither the absence nor low of coronary calcium burden may reliably exclude obstructive CAD in typical symptomatic male patients with hypercholesterolemia. This result may be useful to interpret the relation of CACS to obstructive CAD.

Methods Study PopulationThe present retrospective study was performed on 53 consecutive patients with HCM (mean age 66 years; range 37-91 years) who underwent an initial assessment, including phonocardiography, echocardiography, LGE-MRI, and biomarker measurements, in Matsushita Memorial Hospital. All patients were clinically stable without symptoms of heart failure, such as dyspnea, fatigue, and edema. Although these initial examinations were not necessarily performed on the same day, there were no patients with clinical conditions that changed over the period of the assessments. The diagnosis of HCM was based on the conventional echocardiographic demonstration of LV end-diastolic thickness ≥15 mm and LV end-diastolic diameter (LVEDD) ≤55 mm in the absence of any cardiac or systemic disorder that may cause LV hypertrophy, such as severe hypertension, defined as blood pressure ≥160/100 mmHg, or aortic stenosis, defined as an aortic valve area <1.5 cm 2 . Exclusion criteria were non-sinus rhythm, a previous history of myocardial T he 4th heart sound (S4) is commonly heard in patients with hypertrophic cardiomyopathy (HCM) with a sinus rhythm. 1,2 The derivation of S4 may be the result of a forceful left atrial contraction into a noncompliant left ventricle (LV). 3,4 The third heart sound (S3) is also heard, although less frequently than S4, in patients with HCM regardless of the presence or absence of heart failure. 1,2 The exact mechanism responsible for S3 in HCM patients remains unclear, reduced LV compliance due to myocardial hypertrophy has been proposed. 5 Patients with HCM often develop LV myocardial fibrosis, which may be assessed non-invasively using late gadolinium enhancement (LGE) magnetic resonance imaging (MRI). 6,7 In addition to myocardial hypertrophy, myocardial fibrosis can alter LV compliance, which leads to the development of S4 and S3; however, limited information is available on the effects of myocardial fibrosis on these extra heart sounds in patients with HCM. Thus, the aims of the present study were to examine the relationships between myocardial fibrosis, as assessed by LGE-MRI, and S3 and S4 in patients with HCM.

Ultrasonic tissue characterization using CV-IB separately in the right and left halves of the ventricular septum, but not late gadolinium enhancement on magnetic resonance imaging, provided useful information in detecting subendocardial ischaemia in patients with HCM. Ultrasonic tissue characterization may be useful in selecting patients who will benefit from medications to relieve chest symptoms.

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Objectives: Limited data are available regarding Holter monitoring for cardiovascular events except for ventricular tachycardia as a risk marker for sudden death in hypertrophic cardiomyopathy (HCM). We aimed to examine Holter findings in relation to the long-term prognosis in patients with HCM. Methods: Ambulatory Holter monitoring was performed in 106 HCM patients with sinus rhythm. All were prospectively followed for the composite endpoint of sudden death, cardiovascular death, and hospitalization for heart failure or stroke associated with atrial fibrillation. Results: Cardiovascular events occurred in 19 patients during a mean follow-up of 10.1 years. Neither arrhythmia information nor autonomic information as assessed by heart rate variability and turbulence significantly differed between HCM patients with and without cardiovascular events. Average heart rates were lower in HCM patients with cardiovascular events (64.7 ± 11.2 beats/min) than in those without (73.7 ± 10.2 beats/min, p = 0.001). Multivariate Cox proportional hazards regression analysis after adjustment for baseline characteristics showed that lower average heart rate remained an independent predictor of cardiovascular events (HR: 0.47 per 10 increase; 95% CI: 0.25–0.87; p = 0.016). Conclusion: Average heart rate on Holter monitoring predicted long-term prognosis in our cohort. Further multicenter studies are needed to confirm our results.