Background: The pathophysiological role and metabolic pathway of Lp(a) have not been clearly defined. An association between Lp(a) and oxidative low-density lipoprotein (LDL) were recently reported. And small dense LDL (sd-LDL) were associated with circulating malondialdehyde-modified LDL. We investigated the relationships between serum Lp(a) level and LDL particle size in coronary artery disease (CAD) patients. Further, we investigated the relationships of sd-LDL and Lp(a) with the extent and severity of CAD. Methods: A total of 490 patients (mean: 60.5 ± 11.5 years old) who underwent coronary angiography to evaluate chest pain were investigated. Patients were classified into two groups, a CAD group (n = 256), who had significant stenosis observed by coronary angiogram, and a control group (n = 234), who had normal, or minimal coronary arteries. CAD severity was measured by Gensini scores. The distribution of the LDL subfraction was analyzed using a Quantimetrix Lipoprint LDL System. Results: The serum Lp(a) concentration was correlated with the fraction of sd-LDL (r = 0.193, p < 0.001) and mean LDL size (r = 0.160, p = 0.003). The Lp(a) level and mean LDL particle size were significantly correlated with a high Gensini score. LDL particle size in the CAD group was smaller than in the control group (26.74 ± 0.64 vs. 26.43 ± 0.93 nm, p < 0.001). The Gensini score was significantly higher in small LDL with high Lp(a) level groups. Conclusion: The positive correlation of the level of Lp(a) and sd-LDL fraction were demonstrated. The mechanism of this association is not clearly defined; we can suggest that it may stem from the individual atherogenic condition that linked to increased oxidative stress. Both increased Lp(a) and sd-LDL fraction were correlated with the severity of CAD.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he development of left ventricular (LV) hypertrophy in essential hypertension is associated with an increase of LV afterload and severity and duration of the disease process. 1-3 Patients with essential hypertension are exposed to long-lasting pressure overload with enough time for development of pathologic changes in LV structure and function. The morphologic and functional LV changes induced by essential hypertension are well known. 4 Gestational hypertension (GH) is a systemic hypertension that develops during gestation in young women with previously normotensive hearts. Estimation of diastolic dysfunction is usually based on conventional indices that represent the global status. 5 An easily measured Doppler index of myocardial performance, however, combining systolic and diastolic time intervals, has been reported to be simple, reproducible, and independent of heart rate and blood pressure (BP). 6 Moreover, altered segmental contraction based on strain echocardiography may be a sensitive method to evaluate the changes in LV function in GH because it is evident before global conventional indices of systolic dysfunction become definitely informative. 7 Editorial p 1055In the present study we measured and compared LV structure and function in normotensive pregnant women (NPW) with those in patients with GH. The purpose of the present study was to assess the impact of GH on the systolic and diastolic performance and structure of the left ventricle in the previously normotensive young heart.

Advanced glycation endproducts (AGEs)-induced vascular smooth muscle cell (VSMCs) proliferation and formation of reactive oxygen species (ROS) are emerging as one of the important mechanisms of diabetic vasculopathy but little is known about the antioxidative action of HMG CoA reductase inhibitor (statin) on AGEs. We hypothesized that statin might reduce AGEs-induced intracellular ROS of VSMCs and analyzed the possible mechanism of action of statin in AGEs-induced cellular signaling. Aortic smooth muscle cell of Sprague-Dawley rat (RASMC) culture was done using the different levels of AGEs stimulation in the presence or absence of statin. The proliferation of RASMC, ROS formation and cellular signaling was evaluated and neointimal formation after balloon injury in diabetic rats was analyzed. Increasing concentration of AGEs stimulation was associated with increased RASMC proliferation and increased ROS formation and they were decreased with statin in a dose-dependent manner. Increased NF-κB p65, phosphorylated ERK, phosphorylated p38 MAPK, cyclooxygenase-2, and c-jun by AGEs stimulation were noted and their expression was inhibited by statin. Neointimal formation after balloon injury was much thicker in diabetic rats than the sham-treated group but less neointimal growth was observed in those treated with statin after balloon injury. Increased ROS formation, subsequent activation of MAPK system and increased VSMC proliferation may be possible mechanisms of diabetic vasculopathy induced by AGEs and statin may play a key role in the treatment of AGEs-induced diabetic atherosclerosis.

mong the many markers used to assess successful myocardial reperfusion after primary percutaneous coronary intervention (PCI) or thrombolysis therapy, the extent of resolution of ST-segment elevation is a simple noninvasive indicator of the outcome of infarcted myocardium. 1 Previous studies using myocardial contrast echocardiography 2,3 or radioisotope scintigraphy [4][5][6] have demonstrated that early ST-segment elevation resolution (STR) after primary PCI or thrombolysis is associated with better salvage of reperfused myocardium. However, both the pathologic correlates and the mechanisms of early STR are relatively unknown. Recent advances in cardiac magnetic resonance imaging (CMRI) allow relatively precise assessments of myocardial perfusion, infarct size, left ventricular (LV) remodeling and function, with excellent correlation with histology in animal models of acute and chronic myocardial infarction (MI). 7,8 However, there are little data on the CMRI findings related to early STR after successful Circulation Journal Vol.72, October 2008 primary PCI. Therefore, we performed CMRI serially in the early and late phases after successful revascularization by primary PCI for treatment of MI. We sought to determine whether the morphologic and functional parameters of CMRI correlated with early STR after primary PCI for ST-elevation myocardial infarction (STEMI). Method SubjectsWe investigated 45 patients with acute STEMI in whom primary PCI was performed successfully within 12 h of symptom onset. Diagnosis of acute MI (AMI) was based on the presence of acute ischemic chest pain, electrocardiogram (ECG) findings (ST-segment elevation ≥0.1 mV in 2 or more contiguous leads), elevated serum cardiac biomarkers (cardiac troponin T >0.1 g/L, creatine kinase-MB (CK-MB) fraction enzyme level >10 g/L), and angiographic significant stenosis (≥50%) of a coronary artery. Exclusion criteria were unstable hemodynamic status, any history of previous MI, or contraindications to CMRI (eg, pacemaker implantation or claustrophobia). We also excluded patients with recurrent chest pain or anginal equivalent associated with ST-segment changes during the time period between primary angioplasty and second CMRI. All participants gave written informed consent to the study protocol. ECG AnalysisA 12-lead ECG was performed before and 90 min after primary PCI. The sum of ST-segment elevation was mea- Correlation of Serial Cardiac Magnetic Resonance Imaging Parameters With Early Resolution of ST-Segment Elevation After Primary Percutaneous Coronary InterventionJung-Sun Kim, MD, PhD; Young-Guk Ko, MD; Se-Jung Yoon, MD, PhD*; Jae-Youn Moon, MD; Young Jin Kim, MD, PhD**; Byoung Wook Choi, MD, PhD**; Donghoon Choi, MD, PhD; Yangsoo Jang, MD, PhDBackground The aim of the present study was to determine whether the parameters of cardiac magnetic resonance imaging (CMRI) might correlate with early ST-segment resolution (STR) after primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI

BackgroundPregnancy induces dramatic cardiovascular changes in order to meet the increasing metabolic needs. Adaptive change of left ventricle (LV) might be modified in pregnancy complicated by hypertension.MethodsData from 193 consecutive pregnant women were analyzed. Clinical and echocardiographic data were compared in normotensive and hypertensive women.ResultsSignificantly higher LV mass indexed by height was observed in hypertensive women compared with normotensive women (84 ± 21 g/m vs. 97 ± 20 g/m, p = 0.001). Diastolic function measured by the ratio of peak velocity of early diastolic transmitral blood flow to early diastolic mitral annular velocity was impaired in hypertensive women (11.0 ± 3.0 vs. 9.2 ± 2.5, p < 0.001). Such change was more prominent in women with gestational hypertension (GH) than those with chronic hypertension (CH). Heavy maternal weight was an independent factor associated with LV hypertrophy (LVH) in both normotensive and hypertensive women. Overt eccentric LVH was more frequent than concentric remodeling/hypertrophy (24% vs. 8.4%) in GH, while the opposite result was observed in CH (14% vs. 23%).ConclusionHypertensive pregnancy is associated with significant LVH and diastolic dysfunction. CH seems to induce different LV remodeling pattern from GH. Heavy maternal weight during pregnancy might intensify the unfavorable remodeling of LV, particularly in hypertensive pregnancy.

itral stenosis (MS) is known to comprise 2 stenotic lesions: the mitral valve itself and pulmonary arteriolar stenosis, anatomically or functionally. 1,2 MS initially produces pulmonary venous hypertension and subsequently, pulmonary arterial hypertension develops because of the combined effect of back pressure, pulmonary arteriolar constriction and obliterative changes in the pulmonary vascular bed. 1,2 Pulmonary vascular resistance (PVR), representing pre-capillary resistance, reflects pulmonary arteriolar stenosis or pulmonary vascular reactivity, and is a major determinant of exercise capacity and right ventricular (RV) afterload in MS. 3 Net-atrioventricular compliance (Cn), a determinant of pressure decay across the stenotic mitral valve, is related to post-capillary resistance and is also a major determinant of inappropriate elevation of pulmonary arterial pressure during exercise. 4 could be related to increased PVR or direct RV involvement in rheumatic heart disease. 5 RV function significantly affects symptoms, exercise capacity, peri-operative mortality and postoperative results; 6 however, measurement of PVR or RV function has limitations because of the invasiveness of the procedure and the geometric complexity of the RV. Development of the Doppler technique has enabled measurement of new parameters representing PVR and RV function, 7,8 and the major advantage of these Doppler-derived parameters is that they are highly reproducible. Based on this, we aimed to determine if echo-Doppler derived PVR (PVRecho), Cn and peak systolic tricuspid annular velocity (Sa) as parameters of RV function are relevant in predicting the cardiopulmonary exercise (CPX) capacity of patients with MS. Methods Study PopulationThirty-two consecutive patients (25 females, age 52.0± 9.4 years) with moderate or severe MS (mitral valve area (MVA) by 2-dimensional (2D) planimetry: 0.7-1.5 cm 2 ) were studied. Exclusion criteria included patients with left ventricular (LV) systolic dysfunction (ejection fraction (EF) <50%), mitral regurgitation more than grade I, history of underlyng ischemic heart disease or exercise-induced ST segment change on 12-lead electrocardiogram (ECG) suggeting myocardial ischemia, valvular heart disease other Background The present study sought to determine if echo-Doppler-derived pulmonary vascular resistance (PVRecho), net-atrioventricular compliance (Cn) and tricuspid peak systolic annular velocity (Sa), as parameters of right ventricular function, have value in predicting exercise capacity in patients with mitral stenosis (MS). Methods and ResultsThirty-two patients with moderate or severe MS without left ventricular systolic dysfunction were studied. After comprehensive echo-Doppler measurements, including PVRecho, tricuspid Sa and left-sided Cn, supine bicycle exercise echo and concomitant respiratory gas analysis were performed. Measurements during 5 cardiac cycles representing the mean heart rate were averaged. Increment of resting PVRecho (r= -0.416, p=0.018) and decrement of resting Sa (r=0.43...

The percutaneous transfemoral approach has been routinely used for cardiac catheterization and coronary angioplasty. Local vascular complications following angioplasty are seen in 5% to 10% of patients, especially in those who need prolonged anticoagulation. Transradial access for coronary procedures dramatically reduces access site complications. We report a rare case of radial arteriovenous fistula, which developed after coronary angiography perfomed using the transradial approach.

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