Our findings indicate that beta-blockers have an important immunoregulatory role in modifying the dysregulated cytokine network in DCM. This effect of beta-blockers may be partly responsible for the efficacy of therapeutic drugs for heart failure.

These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function.

ontrast enhanced multislice spiral computed tomography (CE-MSCT) has been proposed as a means of evaluating coronary artery stenoses. [1][2][3] In just a few years, technological advances have progressively improved the temporal resolution. Recent studies showed that CE-MSCT allows for a noninvasive assessment of coronary artery disease (CAD) in a clinical setting. [4][5][6][7][8][9][10] In addition to coronary artery assessment, CE-MSCT can also provide information about myocardial perfusion. Koyama et al reported that CE-MSCT could describe acute myocardial infarction (AMI) as a perfusion defect after the injection of a bolus of contrast medium. 11 Their data showed myocardial viability and function after AMI.No attempt to detect myocardial ischemia using pharmacological stress MSCT has been reported previously. Adenosine triphosphate (ATP) is widely used as a coronary vasodilator to detect myocardial ischemia in the fields of magnetic resonance imaging, 12 nuclear imaging 13 and echocardiography. 14 We hypothesized that CE-MSCT can describe myocardial ischemia as a hypo-perfusion area (HPA) using the ATP provocation test. The present study was designed to: (i) to test our hypothesis; and (ii) to evaluate the potential of the ATP stress CE-MSCT in a clinical setting. Methods Study ProtocolThe study protocol necessitated that the enrolled patients underwent both ATP-provocation/non-provocation CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS), and received conventional coronary angiography (CAG) as required. All patients gave their informed consent and the protocol was approved by the hospital's ethics committee.The entry criteria were as follows: (i) de novo effort or rest stable angina (documented ST-T change on electrcardiogram (ECG), or relieved by administration of nitroglycerin); (ii) no history of coronary angiography; and (iii) asymptomatic patients with a high probability of CAD (ie, multiple coronary risk factors) or abnormal findings in exercise ECG.The exclusion criteria included: (i) acute myocardial infarction (within 3 months); (ii) unstable angina (recent onset of angina within a month, severe and worsening clinical symptom); (iii) chronic atrial fibrillation; (iv) deteriorated renal function (serum creatinine >1.5 mg/dl); (v) pregnancy, hyperthyroidism or a known allergic reaction to Background The present study was designed to: (i) detect myocardial ischemia in contrast enhanced multislice spiral computed tomography (CE-MSCT) using adenosine triphosphate (ATP) pharmacological stress test; and (ii) evaluate the potential of ATP stress CE-MSCT in a clinical setting. Methods and ResultsTwelve patients underwent ATP stress CE-MSCT and stress thallium-201 myocardial perfusion scintigraphy (MPS) and 9 of the patients received conventional coronary angiography (CAG). Dual CE-MSCT scans were performed for stress and rest images, with and without intravenous infusion of ATP (0.16 mg·kg -1 ·min -1 ) at intervals of 20 min. Myocardial perfusion and coronary artery were visually eval...

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To elucidate whether there is a difference in the progression of target-organ damage between primary aldosteronism and essential hypertension, we compared left ventricular hypertrophy and extracardiac target-organ damage in 23 patients with primary aldosteronism and 116 patients with essential hypertension. The severity of hypertensive retinopathy and the renal involvement in primary aldosteronism were subclinical and similar to those in essential hypertension without left ventricular hypertrophy but significantly milder than those in essential hypertension with left ventricular hypertrophy. There was a strongly significant correlation between the degree of left ventricular mass index and the severity of hypertensive retinopathy and renal involvement independent of office blood pressure in essential hypertension. In contrast, left ventricular hypertrophy markedly progressed despite the mild extracardiac target-organ damage in primary aldosteronism. Left ventricular end-diastolic dimension index in primary aldosteronism (3.16+/-0.50 cm/m2) was significantly larger than in essential hypertension without (2.87+/-0.23) and with (2.88+/-0.22) left ventricular hypertrophy. On the other hand, there was no difference in extracardiac target-organ damage between 13 primary aldosteronism patients with eccentric left ventricular hypertrophy and the 26 essential hypertensive patients with eccentric left ventricular hypertrophy. The results suggest that predominantly volume load, be it due to aldosteronism or other mechanisms, resulting in eccentric left ventricular hypertrophy is less likely to cause extracardiac target-organ damage than hemodynamic or nonhemodynamic mechanisms resulting in concentric left ventricular hypertrophy.

Both hyperuricemia and echocardiographically determined left ventricular (LV) mass have a well-determinedassociation with cardiovascular morbidity and mortality. However, whether or not there is a sex difference in the association of serum uric acid level with LV mass has never been systematically explored. We examined the sex-specific relation of serum uric acid level and echocardiographic indexes of LV structure in never-treated patients with essential hypertension. We enrolled 160 never-treated hypertensive patients (89 men and 71 women) to assess the possible relationship between LV mass and serum uric acid levels. LV measurements were performed according to the recommendations of the American Society of Echocardiography and the Penn Convention. LV mass was indexed by height, body surface area and height raised to the 2.7th power. A positive significant correlation between LV geometry (LV mass, indexed LV mass and relative wall thickness) and serum uric acid level was found in male hypertensive patients but not in female hypertensive patients. Independent determinants of serum uric acid levels in male hypertensive patients were LV mass and serum creatinine levels. In addition, male hypertensive patients with concentric hypertrophy showed the highest serum uric acid levels. In comparison, independent determinants of serum uric acid levels in female hypertensive patients were age and serum creatinine levels. In conclusion, these findings indicate a sex difference in the association of uric acid with LV geometry in Japanese hypertensive patients. In addition, the finding that the highest levels of serum uric acid were observed in our male hypertensive patients with concentric hypertrophy confirmed the previous reports that these patients have the highest risk for cardiovascular morbidity and mortality. (Hypertens Res 2005; 28: 133-139)

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These results suggest that strain-based LV radial dyssynchrony and E/e' as well as LV torsion are related to diastolic untwisting behaviour in patients with DCM.