No abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he number of patients with severe angina pectoris without indications for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is rapidly increasing worldwide and their prognosis still remains poor. 1,2 Thus, it is crucial to develop new therapeutic strategies for these patients. We have previously demonstrated that extracorporeal cardiac shock wave (SW) therapy with low-energy SW (≈10% of the energy density used for urolithiasis) ameliorates myocardial ischemia and dysfunction in a porcine model of chronic myocardial ischemia in vivo. 3, 4 We subsequently demonstrated in an open trial that our SW therapy effectively improved chest pain symptoms and exercise tolerance without any adverse effects in 9 patients with severe angina pectoris. 3,5 In the present study, to further confirm the effectiveness and safety of our SW therapy, we performed a double-blind placebo-controlled trial in patients with severe angina pectoris. MethodsWe enrolled 8 consecutive patients with severe angina pectoris who already had undergone CABG or PCI, but who no longer had further indications for these therapies even though they still suffered from stable effort angina under intensive medication (M/F, 5/3; age, 70±3 years) (Table).The patients were treated with one series of placebo and the SW therapy in a double-blind and cross-over manner with an interval of 3 months. One series of therapy comprised 3 sessions per week. Throughout the study, the patient and the doctor in charge were not informed of the type of therapy. We performed the SW therapy (200 shoots/spot at 0.09 mJ/mm 2 for 40-60 spots per session; Modulith SLC, Storz Medical, Kreuzlingen, Switzerland) as described previously. 3,5 As placebo, the patients underwent the procedure of SW therapy but without irradiation. The patients were followed-up for 3 months after completion of the therapy. We evaluated symptoms using the Canadian Cardiovascular Society (CCS) class score, the patient's requirement for nitroglycerin, 5 exercise tolerance in a 6-min walk, and a cardiopulmonary exercise test, and cardiac function assessed by MRI (Achieva 1.5 T, Philips, Eindhoven, Netherlands). The left ventricular ejection fraction (LVEF) was measured using contiguous short-axis slices obtained by cine MRI; end-diastolic and end-systolic endocardial traces were used to determine end-diastolic and end-systolic left ventricular (LV) volumes, respectively. We also evaluated the number of circulating progenitor cells in peripheral blood by FACS analysis 2 days before the 1 st session and 1 h after the 3 rd session in 7 of the 8 patients Background: Low-energy shock wave (SW) therapy has improved myocardial ischemia in both a porcine model and in patients with severe angina pectoris.

These results provide the first evidence that coronary spasm is associated with inflammation of coronary adventitia and PVAT, where F-FDG PET/CT could be useful for disease activity assessment. (Morphological and Functional Change of Coronary Perivascular Adipose Tissue in Vasospastic Angina [ADIPO-VSA Trial]; UMIN000016675).

years since 1979, where almost all AMI patients in the Miyagi Prefecture have been prospectively registered. [18][19][20] In a previous report, we demonstrated the trend for increasing incidence and decreasing in-hospital mortality of AMI from 1979 Since then, we have been facing rapid social aging in Japan, where such aging should affect the actual situation of cardiovascular diseases, including AMI. Thus, in the present study, we examined the temporal age-specific trends in the incidence and inhospital mortality of AMI during the past 30 years (from 1985 to 2014) in our Miyagi AMI Registry. MethodsThe present study was approved by the Institutional Review Board of Tohoku University Graduate School of Medicine A cute myocardial infarction (AMI) is a leading cause of death and a serious public health problem worldwide, especially in developed countries. 1-3 In Western countries, decreasing trends in the incidence and mortality of AMI have been reported since the 1980 s, 4-8 in association with public efforts to reduce coronary risk factors and improved critical care for AMI (e.g., reperfusion therapies). 9-11 In contrast, in Asian countries, including Japan, Taiwan and Korea, AMI has become more common because of prolonged life expectancy, rapid socioeconomic advances, and westernization of life style and diet. 12, 13 In Japan, there have been a few registry studies of AMI and most of them included a relatively small number of patients and/or a relatively short study period. 14-17 In order to elucidate the accurate trend of AMI in Japan, we have been conducting the Miyagi AMI Registry Study for 37 Background: We are now facing rapid population aging in Japan, which will affect the actual situation of cardiovascular diseases. However, age-specific trends in the incidence and mortality of acute myocardial infarction (AMI) in Japan remain to be elucidated.

These results indicate that Rho-kinase activity in circulating neutrophils is enhanced in patients with VSA and may be a useful biomarker for diagnosis and disease activity assessment of the vasospastic disorder.