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SUMMARY Twenty-four-hour ambulatory ECG recording was performed in 26 patients with variant angina to evaluate the diurnal distribution of ST-segment elevation in relation to chest pain and the incidence of arrhythmias during the episodes. During a recording period of 52 days, 364 ST-segment elevations of 1 mm or greater were observed and 79% were asymptomatic. ST-segment elevation frequently occurred between 0:00 and 9:00 hours (72%) and most frequently between 5:00 and 6:00 hours (13%). Only a few episodes occurred between 10:00 and 18:00 hours. Premature atrial contractions, premature ventricular contractions (PVCs), ventricular tachycardia (VT) and complete atrioventricular block occurred during 12% of the episodes and were more common during painful episodes (32%) than during painless ones (6%). However, VT and severe forms of PVCs (couplets and bigeminy) appeared eight times during painless episodes and nine times during painful ones. Arrhythmias occurred more frequently when the elevated ST segment started to return or was returning to the control level (n = 38) than when the ST segment was rising (n = 8). The incidence of arrhythmias was lower when the daily frequency of ischemic episodes was high. This study shows that episodes of asymptomatic coronary artery spasm predominantly occur early in the morning as symptomatic episodes; complex dysrhythmias appear during the asymptomatic episodes; arrhythmias occur predominantly during a "reperfusion period;" and more arrhythmias accompany infrequent daily episodes of ischemia than frequent ones.IN PATIENTS with variant angina, anginal attacks occur more frequently at midnight or early in the morning, and arrhythmias, including life-threatening ones, are common during the attack. 1-3 To our knowledge, however, no quantitative data have been reported on the diurnal distribution of ischemic episodes, such as chest pain and ECG changes, in variant angina except for a preliminary report by Kuroiwa,4 which showed a higher frequency of recurrent ST-segment elevations early in the morning. It is important to clarify the diurnal distribution of the episodes for the evaluation of pathophysiology of variant angina as well as for treatment.ST-segment elevation without pain has been observed in variant angina and recently proved to be due to coronary vascular spasm resulting, like painful STsegment elevations, in myocardial ischemia.5-7 Twenty-four-hour ambulatory ECG monitoring is a good tool for evaluating ST-segment elevation in variant angina, especially that without chest pain,2' 8.9 and can also be used to evaluate arrhythmias during the episodes.In the present study, we studied the diurnal distribution of ischemic episodes with or without chest pain and the incidence of arrhythmias during the episodes using 24-hour ambulatory ECG recordings. Materials and Methods Twenty-six consecutive patients with variant angina admitted to our clinic from June 1976 to December 1981 were studied. Twenty-five were males and one was female, ages 44-72 years old. None of these patie...

BACKGROUND: Hypertension is an important risk factor of coronary heart disease. A new guidelines for hypertension prevention and management in The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in the United States recommended lifestyle modification or medical treatment for subjects with prehypertension. However, whether prehypertension increases the risk of coronary atherosclerosis in the Japanese population is still unknown. METHODS: A cross-sectional study in a clinical setting was conducted. The subjects were 705 patients (417 males and 288 females) aged 30 years and older who underwent a first-time coronary angiography for suspected or known coronary heart disease at 5 major cardiology departments in the Fukuoka metropolitan area between September 1996 and August 1997. RESULTS: Compared to subjects with normal blood pressure, those with prehypertension had an increased risk of coronary atherosclerosis even after adjusting for other factors. CONCLUSION: Prehypertension may be an important clinical entity which requires treatment in the Japanese population.

OBJECTIVE:To investigate the relation of the obesity and body-fat distribution with angiographically de®ned coronary atherosclerosis. DESIGN: Cross-sectional study in a clinical setting. SUBJECTS: Three hundred and twenty men (median age, 59 y) and 212 women (median age, 67 y) who underwent coronary angiography for suspected or known coronary heart disease at 5 cardiology departments between September 1996 and August 1997. Patients with disease duration b1 y were excluded. MEASUREMENTS: The body mass index (BMI) and the waist to hip circumference ratio (WHR) were used as main exposure variables, and either the presence of signi®cant coronary stenosis or the Gensini's score ( 10 vs`10) as an outcome variable, in a sex-speci®c multiple logistic regression analysis controlling for age, hospital, and other coronary risk factors. RESULTS: Among male patients, BMI was progressively higher with an increasing number of vessels involved (P trend 0.05); the adjusted odds ratios for the presence of signi®cant stenosis across quartiles of BMI were 1.0 (reference), 1.1, 1.9 and 2.5 (P trend 0.02), and the positive association was more pronounced for younger patients. Among females, however, such associations were not evident. Employing the Gensini's score as an outcome gave similar results. WHR was not signi®cantly associated with either outcome regardless of sex. CONCLUSION: These results suggested that BMI was predictive of coronary stenosis among male patients, but not among female patients. Unlike most previous studies, this study failed to detect a positive association with WHR.