Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp arly primary percutaneous coronary intervention (PCI) gives the higher rate of recanalization, contributing to decrease in prevalence of cardiac events and improvement of left ventricular (LV) contractility and survival prognosis. 1-3 Although additional therapies have been reported for cardioprotection after acute myocardial infarction (AMI), 4-6 LV remodeling after AMI is complicated by cardiac failure accompanying enlargement of LV chamber to worsen long-term prognosis. 7, 8 We have often noticed that patients with AMI develops remarkable LV remodeling in the chronic phase in spite of the early recanalization by PCI. Editorial p 2290Erythropoietin (EPO), which controls erythropoiesis, is a glycoprotein hormone with a molecular weight of 34,000 consisting of 165 amino acid residues, and is secreted from the kidney in response to hypoxic stimuli. 9 EPO is expressed by hypoxic-ischemic vascular endothelial cells and myocytes, 10 whose EPO receptors make them potential targets of EPO-mediated endocrine and autocrine/paracrine actions, such as anti-apoptosis and pro-angiogenic properties, resulting in the observation that high-dose EPO reduces infarct size and preserves ventricular function in animal models of reper-
. 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
ifferentiation of mesodermal cells to angioblasts and subsequent endothelial differentiation was believed to exclusively occur in embryonic development, 1 but this dogma was overturned when human adult peripheral blood mononuclear cells (PBMNCs) were demonstrated to differentiate into the endothelial lineage. 2 These cells named "endothelial progenitor cells" (EPCs) expressed endothelial markers, and were incorporated into Circulation Journal Vol.71, August 2007 the sites of ischemia. 3,4 We have recently demonstrated that bone marrow mononuclear cells (BMMNCs) contain EPCs in the CD34 + cell fraction and various proangiogenic factors, such as basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and angiopoietin 1 in the CD34 -cell fraction, and that implantation of BMMNCs into the site of ischemia enhances angiogenesis via harmonic supply of EPCs and angiogenic factors. 5,6 This technique has been used clinically and developed as a useful therapeutic option for human critical limb ischemia. 7 The concept of the heart as an organ composed of terminally differentiated myocytes incapable of regeneration is also being challenged. [8][9][10] Although attempts to replace necrotic tissue by transplanting other cells (eg, fetal cardiac myocytes or skeletal myoblasts) succeeded in reconstituting heart muscle, these cells failed to completely integrate structurally and to display characteristic physiological function. [11][12][13] In contrast, bone marrow cells (BMCs) have the ability to differentiate into various tissue and are likely to Circ J 2007; 71: 1199 -1207 (Received January 17, 2007 revised manuscript received March 28, 2007; accepted April 24, 2007 Background Transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) enhances neovessel formation in ischemic myocardium and limbs by releasing angiogenic factors. This study was designed to examine whether intracoronary transplantation of PBMNCs improves cardiac function after acute myocardial infarction (AMI). Methods and ResultsAfter successful percutaneous coronary intervention (PCI) for a ST-elevation AMI with occlusion of proximal left anterior descending coronary artery within 24 h, patients were assigned to either a control group or the PBMNC group that received intracoronary infusion of PBMNCs within 5 days after PCI. PBMNCs were obtained from patients by COBE spectra-apheresis and concentrated to 10 ml, 3.3 ml of which was infused via over-the-wire catheter. The primary endpoint was the global left ventricular ejection fraction (LVEF) change from baseline to 6 months' follow-up. The data showed that the absolute increase in LVEF was 7.4% in the control group and 13.4% (p=0.037 vs control) in the PBMNC group. Cell therapy resulted in a greater tendency of ∆Regional ejection fraction (EF) or significant improvement in the wall motion score index and Tc-99m-tetrofosmin perfusion defect score associated with the infarct area, compared with controls. Moreover, intracoronary administration of PBMNCs did not ex...
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...
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