Background Syndrome X has been recognized as a disease that is primarily reflected in the cardiac microvasculature. Myocardial metabolism in this condition has been studied, but not in relation to small vessel pathology. Methods and ResultsIn order to examine the relationship between myocardial metabolism and small vessel pathology, 24 consecutive patients with syndrome X (7 men, 17 women; mean age 58 years) were evaluated by the thallium exercise stress test, positron emission tomography using F-18 fluoro-deoxyglucose (FDG), and an endomyocardial biopsy. All patients showed either diffuse or focal increase in the myocardial uptake of FDG, but only 17 patients (71%) showed hypoperfused areas with partial or complete redistribution in the thallium study. Quantification of myocardial FDG uptake revealed that the value in syndrome X patients was 10-fold higher than in controls (p<0.0001). Histopathological examination revealed that in syndrome X there is an extensive increase in smooth muscle cells and thickening of the vascular wall, even in capillary vessels, and the small vessel lumen was markedly narrowed. There was a significant inverse correlation between FDG myocardial uptake and the microvessel luminal area. Conclusions In syndrome X patients, myocardial FDG uptake is increased extensively, which is strongly associated with narrowed myocardial microvasculature. (Circ J 2004; 68: 220 -226)

A 79-year-old man with unstable angina underwent an emergency coronary angiography, and percutaneous balloon angioplasty was performed for LCX. Left ventriculography showed hypokinesis in the posterior wall, inferior and apical wall immediately after the PCI therapy. The defects on 123I-BMIPP SPECT seen in the inferior, posterior and lateral wall were more extensive than those observed on 99mTc-MIBI SPECT, and a flow-fatty acid metabolism mismatch pattern was observed. The 18F-FDG PET showed reduced uptake in the lateral segment, although 13N-NH3 PET showed normal perfusion, and a reverse flow-glucose metabolism mismatch pattern was observed. Left ventriculography showed significant improve to normal contraction on the 3-month follow up, and there was not significantly reduced uptake in 99mTc-MIBI SPECT, 123I-BMIPP SPECT, 13N-NH3 PET or 18F-FDG PET.

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Background: Arteriolization of varicose veins is well known as its histopathological change. However, histopathological analysis of venous valves less discusses regarding valvular dysfunction. Materials and Methods:We analyzed histopathological change of venous valves in 22 patients (8 men, 14 women; mean age 54 w 15 years), using surgical specimens obtained by stripping of varicose veins of lower legs.Fifty venous valves from 22 patients with varicose veins of lower legs were subjected. Thickening, thinning, thrombus formation, and inflammation of valves were evaluated.Results: All patients had fibrous thickening of the venous valves in the order of the basal (90%), middle (64%), and free edge (60%). Thickened venous valves with dram-stick shape were composed of increment of elastic fiber, collagen fiber and myofibril. Thrombus of venous valve was in a small number (6%). No inflammatory changes were seen in valves. Conclusion:Histopathological changes of varicose vein and venous valve were irregular thickening and thinning. We suggest to pay attention to venous valve, as a marker of regurgitation and venous pressure elevation.