A total of 349 patients with vasospastic angina were followed in eight centers in Japan for a period of 3.4 + 0.1 years (mean ± SE). Ninety-eight percent of patients were treated with calcium blockers. Twenty-one episodes of myocardial infarction occurred in 18 patients (5%), including two fatal myocardial infarctions. The rate of myocardial infarction was higher (p < .01) in patients with a fixed stenosis of 90% or greater than in patients with a fixed stenosis of less than 90% or normal coronary arteries. Myocardial infarctions occurred predominantly during hospital stays or at a time when the frequency of vasospastic angina increased. There were five sudden deaths (2%). Only one patient suffering sudden death had a fixed stenosis of 75% or greater. Serious arrhythmias were noted in 49 patients (14%). The risk of arrhythmias did not depend on the presence of a fixed stenosis of 75% or greater. These results suggest that cardiac events are rather infrequent in Japanese patients with vasospastic angina who are receiving treatment with calcium blockers and that the presence of a severe fixed stenosis markedly increases the risk of myocardial infarction but not the risk of arrhythmias.

he left ventricular (LV) myocardium consists of obliquely oriented muscle fibers that vary from a right-handed helix at the endocardium (Endo) to a left-handed helix at the epicardium (Epi), with most myofibers in approximately circumferential orientation. 1 This 3-dimensional myocardial structure results in rotation of the LV apex with respect to the base, which accompanies contraction and relaxation, and this LV rotational deformation is thought to generate LV torsion while also equalizing fiber stress and sarcomere length across the LV wall. 2 Many methods have been used to describe and quantify LV torsion, including cineangiography with radioopaque markers, 3-7 magnetic resonance imaging (MRI) 8-11 and 2-Circulation Journal Vol.71, May 2007 dimensional (2D) echocardiography. [12][13][14] The cineangiography technique requires implantation at the time of cardiac operation, thus limiting the population available for the study of LV torsion to patients with significant cardiac disease. MRI using myocardial tagging remains expensive and its temporal resolution is not sufficient to assess the time course of LV torsion in detail. 2D echocardiography is limited to measuring the rotation of a small number of identifiable structures such as the papillary muscles.We have developed a 2D echocardiographic tissue tracking system (2DTT) for tracking the locus of the LV myocardium to calculate myocardial strain without Doppler angle dependency. [15][16][17] The technique is based on a patternmatching algorithm, which enables tracking of selected points automatically during the whole cardiac cycle using digital image files.Using 2DTT, we tried to assess LV rotational deformation by calculating the rotation angles between the apex and base of the LV. 18-20 LV torsion of the Endo has been previously reported to be greater than that of the Epi according to tagged MRI analyses, [8][9][10] which suggests that shear occurs between the Endo and Epi (circumferentialradial shear) and this may play an important role in systolic Circ J 2007; 71: 661 -668 (Received December 4, 2006; revised manuscript received January 17, 2007; accepted January 29, 2007 Background The difference in the left ventricular (LV) torsion of the endo-and epicardium (Endo, Epi) with inotropic stimulation and its relation to radial strain (RS) remain unclear. Methods and Results LV basal and apical short-axis images were recorded in 13 normal subjects at rest and during dobutamine infusion (5, 10 g·kg -1 ·min -1 ). A total of 8 points (anterior, lateral, posterior and septum in both Endo and Epi) were manually placed by 2-dimensional tissue tracking technique and the movement of these points during a cardiac cycle was tracked, after which the rotation angles and RS were calculated. LV torsion was defined as the net difference between the basal and apical rotations. In the LV apex, Endo-rotation increased (7.8±2.7 to 14.1±4.6 degrees, p<0.01), whereas Epi-rotation was unchanged, with dobutamine. The apical Endorotation was significantly greater than the Ep...

No abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp nalysis of the transmitral inflow (TMF) and of the tissue Doppler imaging (TDI)-derived mitral annular velocities is commonly used for evaluating left ventricular (LV) filling pressure, 1,2 and these measures provide valuable information for the management of patients with heart failure (HF) and sinus rhythm. In particular, the ratio of the early transmitral peak velocity to the early mitral annular velocity (E/e'), which is used for evaluating LV filling pressure, is widely used in the clinical setting. The E/e' range from 8 to 15 is recognized as a gray or indeterminate zone for the estimation of LV filling pressure. 2,3 Furthermore, the measurement of the time interval between the onset of E and the onset of e' (TE-e') has been proposed as another calculation using E and e' that can predict LV filling pressure. 4-9 In addition, the clinical utility of TE-e' in patients with normal systolic function and an indeterminate E/e' has been reported. 10 In contrast, the utilization of TMF and TDI pattern analysis in patients with atrial fibrillation (AF) has not been established because of the lack of atrial contraction and variability of the heart rate. Recently, the usefulness of the simultaneous recording of the ratio of early transmitral peak velocity to flow propagation velocity (E/Vp) and E/e', using a dual Doppler system, for the assessment of LV filling pressure in patients with AF was reported. 11-13 The usefulness of TE-e' obtained by simultaneous recording of the onset of E and e' for the assessment of LV filling pressure in patients with AF, however, was not evaluated.The purpose of the present study was therefore to investigate the following: (1) the usefulness of TE-e' in patients with AF for the assessment of LV filling pressure using the simultaneous recording of TMF and TDI with a dual Doppler system; and (2) the added benefit of using TE-e' to predict LV filling pressure, in addition to the measurement of E/e'. The time interval between the onset of early transmitral flow velocity (E) and that of early diastolic mitral annular velocity (e') (TE-e') is a good predictor of elevated left ventricular (LV) filling pressure in patients with sinus rhythm. Although the evaluation of LV filling pressure using E/e' has been challenging in atrial fibrillation (AF), the usefulness of TE-e' is unknown.

Two-dimensional Doppler scanning revealed a significant increase in the mean and peak velocities in the soleal and popliteal veins with SFC-IPC but not with IF-IPC in patients with CHF. These results indicate that SFC-IPC could have favorable effects in preventing DVT in patients with CHF.