ong-lasting tachyarrhythmia can result in wall motion abnormality, which is reversible if the culprit arrhythmia is treated. 1-3 Frequent isolated premature ventricular complexes (PVCs) in the absence of tachycardia can cause left ventricular (LV) dysfunction, 4,5 but this phenomenon has rarely been documented. We report resolution of apparent dilated cardiomyopathy (DCM) in a patient after the focal source of PVCs was eliminated by radiofrequency catheter ablation (RF-CA). Case ReportA 53-year-old man presented with palpitations and exertional fatigue, but without clinical or laboratory evidence of ischemic heart disease. He was diagnosed by echocardiography as having DCM with fractional shortening (FS) of the left ventricle of 25%. All 4 chambers were dilated: LV diastolic diameter 65 mm, LV systolic diameter 49 mm, and left atrial diameter 46 mm. The chest X-ray showed mild cardiomegaly (cardio thoracic ratio) (CTR) 54%, and the serum brain natrinvetic peptide (BNP) level was mildly elevated to 54 pg/ml. The electrocardiogram (ECG) did not record any abnormal findings other than frequent PVCs. Repeated Holter recordings revealed about 50,000 isolated or couplet PVCs in a 24-h period, the majority with a uniform left bundle branch block (LBBB) pattern and inferior-axis morphology. PVCs bigeminy appeared constantly throughout the day. During an exercise test, the number of PVCs decreased with the loading of exercise and increased again after the test. Tl-myocardial scintigraphy showed a mildly decreased uptake in the apicoanteroseptal wall. Cardiac magnetic resonance imaging did not show evidence of infiltration of fatty tissue.

. Of these, the clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI) and in-hospital outcomes for 27 young patients <40 (young group), and 338 non-young patients 60≤, <70 years old (non-young group) were retrospectively compared. The young AMI patients were all male. Current smoking, hypercholesterolemia and family history were the most common risk factors in young patients, while hypertension and diabetes mellitus were more prevalent in non-young patients. Young patients had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as a culprit lesion. The young group had high acquisition rates of Thrombolysis In Myocardial Infarction 3 flow just after primary PCI (95.8%) and no in-hospital deaths, which was not significantly different from the non-young group. Conclusions These results suggest that young AMI patients have different clinical characteristics from those in non-young AMI patients, and acute results of primary PCI and in-hospital prognosis in young AMI patients are comparable to those in non-young AMI patients in Japan. (Circ J 2005; 69: 1454 -1458

SummaryCardiorenal anemia syndrome has recently been receiving greater attention; however, data regarding the relationship between chronic kidney disease (CKD)/anemia on presentation and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still limited in Japan.A total of 1,447 primary PCI-treated AMI patients were classified into 4 groups according to the presence of CKD and/or anemia on hospital admission (with CKD/with anemia n = 222, with CKD/without anemia n = 299, without CKD/with anemia n = 151, without CKD/without anemia n = 775). Angiographic acute results of primary PCI were similar among the 4 groups. The patients with CKD had a significantly higher in-hospital overall mortality rate than the patients without CKD, and in the presence or absence of CKD, patients with anemia tended to have a higher in-hospital mortality rate than the patients without anemia. According to a multivariate analysis, anemia on admission was found to be an independent predictor of in-hospital mortality, whereas admission CKD and admission eGFR were statistically not independent predictors. Moreover, the multivariable adjusted odds ratio of in-hospital death in AMI patients with CKD alone was 1.855 (95% CI 0.929-3.706), and that in AMI patients with CKD/with anemia was 3.384 (95% CI 1.697-6.748).These results suggest that among real-world, unselected Japanese AMI patients undergoing primary PCI, the combination of CKD and anemia on admission confers significant adverse effects on in-hospital mortality. (Int Heart J 2014; 55: 301-306)

rimary percutaneous coronary intervention (PCI) is now established as a first-line therapeutic strategy for patients with acute myocardial infarction (AMI). Several reports from the US and France regarding patients undergoing primary PCI have demonstrated an inverse relationship between the hospital volume of primary PCI and in-hospital mortality. [1][2][3][4] According to the guidelines for PCI published by the American Heart Association (AHA), the American College of Cardiology (ACC), and the Circulation Journal Vol.72, July 2008Society for Cardiovascular Angiography and Interventions (SCAI) in 2005, primary PCI for ST-segment elevation AMI should be performed in centers with an annual volume of at least 400 elective and 36 primary PCI procedures. 5 In contrast, another recent report from Tsuchihashi et al demonstrated that low-volume hospitals and high-volume hospitals had similar in-hospital outcomes for primary PCI. 6 However, detailed data on the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis are still lacking in Japan. It is also uncertain whether the AHA/ACC/SCAI guidelines for primary PCI are appropriate in Japan. The AMI-Kyoto Multi-Center Risk Study, a large multicenter observational study in which 16 collaborating hospitals in Kyoto Prefecture collected demographic, procedural, and outcome data on AMI patients, was established in 2000 in order to analyze such data and establish an emergency-hospital network for heart diseases in Kyoto. [7][8][9] The purpose of the present study was to compare angiographic results and in-hospital outcomes in AMI patients undergoing primary PCI at low-volume hospitals with those at high-volume hospitals, using data from the AMI-Kyoto Multi-Center Risk Study. Background Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan. Methods and ResultsUsing the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as lowvolume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n=1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate anal...

besity is a risk factor for coronary heart disease (CHD) among adults 1 and is increasing in prevalence among young adults, as well as adults. 2,3 A recent report indicated a significant association of obesity with coronary atherosclerosis in young male adults, particularly in those with a central pattern of adiposity, and little association of obesity with coronary atherosclerosis in young female adults. 4 Still another recent report points out that adiposity and its metabolic disturbances (ie, metabolic syndrome) are associated with early atherosclerotic change in adolescents. 5 Recently we demonstrated that young Japanese patients with acute myocardial infarction (AMI) have a higher body mass index (BMI) compared with older patients, 6 but it remains uncertain whether obesity is a CHD Circulation Journal Vol. 70, December 2006 risk factor in young adults as well as older adults in Japan.The AMI-Kyoto Multi-Center Risk Study, a large multicenter observational study in which 16 collaborating hospitals in Kyoto Prefecture have collected demographic, procedural, and outcome data on AMI patients, was established in 2000 in order to analyze these data and establish an emergency-hospital network for heart diseases in Kyoto. 6,7 The Kyoto Citizen's Health and Nutrition Study was performed among residents in Kyoto Prefecture, in order to examine behavior and lifestyle habits and develop effective public health intervention. 8,9 In the present study we used cases from the AMI-Kyoto Multi-Center Risk Study, and controls from the Kyoto Citizen's Health and Nutrition Study, respectively, to assess obesity as a risk factor for AMI in subgroups of 20-year age bands of each gender separately, based on a multi-center case -control study. Methods Case and Control SubjectsFrom January 2000 to June 2004, 1,651 consecutive patients with a diagnosis of AMI, who were admitted to AMIKyoto Multi-Center Risk Study Group Hospitals within 1 week after the onset of AMI, were enrolled in the present Background It remains uncertain whether obesity is an independent risk factor for coronary heart disease in young adults, as well as adults, in Japan. Methods and ResultsIn the present study, 1,260 cases of acute myocardial infarction (AMI) and 3,775 community controls were recruited from the AMI-Kyoto Multi-Center Risk Study and Kyoto Citizen's Health and Nutrition Study, respectively. Obesity and other risk factors were retrospectively examined between cases and controls in each subgroup of young males (20-40 years), middle-aged males or females (40-60 years), older males or females (60-80 years), and very old males or females (80-100 years). In young, middle-aged, and older males, as well as in older females, cases had a higher body mass index (BMI) than controls. In young males, as well as in middle-aged and older females, cases had a higher prevalence of smoking than controls. Except for very old males, the prevalences of hypercholesterolemia, hypertension, and diabetes mellitus were higher in each subgroup of cases than in controls. M...

These results suggest that admission SBP 141-158 mmHg might be correlated with better in-hospital prognosis, whereas admission SBP<105 mmHg was associated with in-hospital death in Japanese AMI patients undergoing primary PCI.

SummaryA J-shaped or U-shaped curve phenomenon might exist between systolic blood pressure (SBP) or pulse pressure (PP) at admission and in-hospital mortality in Japanese patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). However, data regarding a relationship between mean blood pressure (MBP) at admission and in-hospital outcome in AMI patients undergoing primary PCI are still lacking in Japan.A total of 1,413 primary PCI-treated AMI patients were classified into quintiles based on admission MBP (< 79 n = 283, 79-91 n = 285, 92-103 n = 285, 104-115 n = 279, and ≥ 116 mmHg n = 281). Patients with MBP < 79 mmHg had a significantly higher in-hospital mortality, while mortality was not significantly different among the other quintiles: 16.6% (< 79), 4.9% (79-91), 3.9% (92-103), 3.2% (104-115), and 5.0% (≥ 116 mmHg). On multivariate analysis, Killip class ≥ 3 at admission, LMT or multivessels as culprit lesions, admission MBP < 79 mmHg, and age were independent positive predictors of in-hospital mortality, whereas hypercholesterolemia and TIMI 3 flow before/after PCI were negative predictors, while the other MBP categories were not.These results suggest that admission MBP < 79 mmHg might be associated with in-hospital death, and the in-hospital prognostic effects of MBP, the steady component of blood pressure, at admission might be different from those of SBP or PP, the pulsatile component of blood pressure, at admission in Japanese AMI patients undergoing primary PCI. (Int Heart J 2016; 57: 547-552) Key words: Systolic blood pressure, Pulse pressure, Prognosis, J-curve phenomenon B ased on numerous reports from Western countries, an inverse relationship between systolic blood pressure (SBP) at admission and in-hospital mortality in acute myocardial infarction (AMI) patients has largely been established, [1][2][3][4] and indeed admission SBP is involved in several riskscoring methods for AMI patients.5-7) In addition to major blood pressure indexes, such as SBP and diastolic blood pressure (DBP), blood pressure is characterized by its pulsatile and steady components, which correspond to pulse pressure (PP) and mean blood pressure (MBP), respectively. We have already shown that admission SBP or PP in a certain interval between an extremely low subset and extremely high subset might be associated with a lower in-hospital mortality in Japanese AMI patients undergoing primary percutaneous coronary intervention (PCI), which followed a J-or U-shaped curve pattern. 8,9) However, sufficient data regarding the effects of the steady component of blood pressure, MBP, at admission on the prognosis in AMI patients are still lacking.

lthough young adults are a relatively small proportion of those having acute myocardial infarction (AMI), they are an important group to examine with regard to risk factor modification and secondary prevention. Previous studies have indicated that patients less than 40 years old comprise between 2% and 6% of all AMIs 1-3 and that AMI in young patients has different characteristics from that in older patients. Young AMI patients are characterized by a relatively high incidence of normal coronary arteries, non-obstructive stenosis, or single-vessel disease, 1,4,5 and high prevalence of current smoking, hyperlipidemia, and family history. 6,7 In addition, non-classical risk factors, such as vasospastic tendency, thrombophilic conditions, and past history of Kawasaki disease, have also been proposed as the cause of AMI in young patients. [8][9][10][11][12] Recently we demonstrated that young Japanese patients with AMI are usually male and have a high prevalence of cigarette smoking, hypercholesterolemia, and family history, a higher frequency of single-vessel disease, and a lower frequency of left circumflex coronary artery as the culprit lesion. 13 As to the short-and long-term prognosis, most previous reports have shown a favorable prognosis after discharge in young AMI patients, 1,14,15 and we have already shown that initial results of primary percutaneous coronary intervention (PCI) and in-hospital outcome in young patients with AMI are comparable to those in non-young patients with AMI in Japan. 13 However, the data on the medium-and long-term prognosis of young Japanese patients with AMI, aged <40 years, are still lacking. The AMI-Kyoto MultiCenter Risk Study, a large multicenter observational study in which 15 collaborating hospitals in Kyoto Prefecture have collected demographic, procedural, and outcome data on AMI patients, was established in 2000 in order to analyze these data and establish an emergency-hospital network for heart disease in Kyoto. The purpose of the present study is therefore to examine retrospectively the medium-term outcome in young adults with AMI in Japan. Methods Patient PopulationFrom January 2000 to Background Data on the medium-and long-term prognosis of young Japanese patients with acute myocardial infarction (AMI) are still lacking. Methods and ResultsIn the present study, 1,458 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2003. Of these, clinical characteristics and medium-term prognosis were retrospectively compared in 21 young patients <40 years (young group), and 190 non-young patients 60-70 years old (non-young group) who could be followed after hospital discharge. The young group was all male and had higher prevalence of current smoking and greater body mass index, but previous myocardial infarction (MI) and hypertension were more prevalent in the non-young group. The young group had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as the culprit lesion. The acquis...