Among patients with ST-segment elevation myocardial infarction, slow gait speed was significantly associated with an increased risk of cardiovascular events. (Gait Speed for Predicting Cardiovascular Events After Myocardial Infarction; NCT01484158).

In patients with an implanted DDD pacemaker (PM), the atrial contribution may be interrupted by too short an atrioventricular (AV) delay, and filling time may be shortened by too long an AV delay. The AV delay at which the end of the A wave on transmitral flow coincides with complete closure of the mitral valve may be optimal. The subjects were 15 patients [70.3+/-12.3 (SD) years old] with an implanted DDD PM. Cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) were measured by Swan-Ganz catheter. Transmitral flow was recorded by pulsed Doppler echocardiography. AV delay was prolonged stepwise by 25 msc. When the AV delay was set at 155+/-26 ms, the end of the A wave coincided with complete closure of the mitral valve. When the AV delay was prolonged 25, 50, 75, and 100 ms from this AV delay, the interval between the end of the A wave and complete closure of mitral the valve was prolonged 16+/-5, 39+/-6, 65+/-4 and 88+/-5 ms, respectively (r = 0.97, P<0.0001) and diastolic mitral regurgitation was observed during this period. Thus, the optimal AV delay may be predicted as follows: the slightly prolonged AV delay minus the interval between the end of the A wave and complete closure of the mitral valve. When the AV delay was set at 215 ms, there was a significant positive correlation between the predicted optimal AV delay (166+/-23 ms) and the optimal AV delay (CO: 161+/-26 msec, r = 0.93, P<0.0001, PCWP: 161+/-28 msec, r = 0.95, P<0.0001). In conclusion, optimal AV delay can be predicted by this simple formula: slightly prolonged AV delay minus the interval between end of A wave and complete closure of mitral valve at the AV delay setting.

We investigated the effects of polyethylene glycol-adsorbed superoxide dismutase (PEG-SOD), polyethylene glycol-adsorbed catalase (PEG-CAT), and DMSO on diaphragmatic contractility and malondialdehyde (MDA) concentrations in septic peritonitis in vitro. One hundred eighty-six rats were divided into two groups. One group (CLP group) was treated with cecal ligation and perforation (CLP), and the other (sham group) was treated with laparotomy. PEG-SOD, PEG-CAT, and DMSO were administered intraperitoneally 30 min before and 12 h after CLP. The left hemidiaphragm was removed at 10 h or 16 h after the operation. We assessed the diaphragmatic contractility by twitch characteristics and force-frequency curves in vitro. We measured MDA concentrations, as an index of oxygen-derived free radical-mediated lipid peroxidation, and the activities of two main antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GPx), as an index of antioxidant defenses, after CLP. Diaphragmatic force generation capacity was significantly reduced after CLP. Diaphragmatic MDA levels were significantly elevated after CLP. PEG-SOD, PEG-CAT, and DMSO significantly improved diaphragmatic contractility and prevented the elevation in diaphragmatic MDA concentrations after CLP. Diaphragmatic SOD activities were significantly increased after CLP. These results suggest that several types of oxygen-derived free radicals play a role in the reduction in diaphragmatic contractility after CLP.

n 1992, Brugada et al described 8 cases of aborted sudden death in patients without demonstrable structural heart disease, but with a peculiar electrocardiogram (ECG) pattern consisting of right bundle-branch block (RBBB) and ST-segment elevation in leads V1 to V3. 1 Three of 8 patients in this report were children, and familial occurrence was recognized. Since then, a few case reports have been published on this syndrome in young populations. [2][3][4] Brugada syndrome may cause sudden death in children, even in the first few months of life where it may be misdiagnosed as sudden infant death syndrome. The Brugada-type ECG is not rare in the adult Japanese population (0.14 to 0.70%). [5][6][7] However, the prevalence of this type of ECG in schoolchildren remains unclear. We evaluated the prevalence of Brugada-type ECG, incomplete RBBB (IRBBB) and complete RBBB (CRBBB) in Japanese schoolchildren stratified according to age. Circulation Journal Vol.68, April 2004 Methods ECG DefinitionsAll ECGs were recorded at standard gain (1 mV/10 mm) and paper speed (25 mm/s). An ECG was considered to be Brugada-type when the 12-lead ECG fully met the criteria for the Brugada syndrome as recently published in a consensus report. 8 To compare the prevalence with previous reports of healthy populations, we defined "Brugada-like" ECG as follows. The 12-lead ECG showed RBBB (rsR' or Rsr' pattern in V1 lead) and ST-segment elevation in the right precordial leads. The ST-segment elevation was defined as an elevation of the J point of ≥0.1 mV in leads V1 through V3. According to the configuration, ST-segment elevations were designated as either coved or saddle-back.Complete RBBB was defined as a QRS duration ≥0.12 s, with an RsR' configuration and IRBBB was defined as a QRS duration <0.12 s, with an rSr' configuration in the right precordial leads.The ECG records of all study subjects were reviewed by Yamakawa, without any information about the subjects including age, sex, or family history of sudden death. Ishikawa and Sumita reviewed those records on which judgments had been made, and they concurred with the judgments. Study SubjectsThe study population consisted of 20,387 young We considered right bundle-branch block and ST-segment elevation of the J point of ≥0.1 mV in leads V1 through V3 as Brugada-like ECG, and an ECG was considered to be Brugada-type when the 12-lead ECG fully meet the criteria for the Brugada syndrome as recently published in a consensus report. Only 2 children (0.0098%, 95% confidence interval (CI): 0 to 0.023%) completely conformed to the criteria for Brugada-type ECG. Brugada-like ECG was found in 11 (10 male) of 20,387 children (0.054%, 95% CI: 0.022 to 0.086%). The prevalence in males was significantly higher than that in females, even in children (0.096% vs 0.010%, p=0.012). Stratified according to age, there was tendency for the prevalence of Brugada-like ECG to increase up to puberty (first graders, 0.01%; fourth graders, 0.05%; seventh graders, 0.08%; tenth graders, 0.23%; p=0.068). ConclusionThe pre...

Sympathetic activity is increased in patients with mitral stenosis. Mitral valvuloplasty in such patients results in early and long-lasting normalization of sympathetic nerve activity, possibly because of an improvement in arterial baroreflex sensitivity.