Recurrence of angina pectoris after percutaneous coronary intervention is reduced by statins in Japanese patients

Background

Statins have been reported to reduce cardiovascular events in patients with coronary artery disease (CAD). Percutaneous coronary intervention (PCI) is commonly used to relieve ischemic symptoms in patients with CAD. However, there is little information on the effect of statins on cardiovascular events after PCI, even in the era of coronary stent implantation.

Methods

A total of 1019 patients with acute or chronic CAD and modest total cholesterol levels (180–240 mg/dl) were enrolled and randomly assigned to treatment with or without statins. We evaluated the effect of any available statin on the incidence of cardiovascular events after PCI. The primary endpoint was a composite of cardiovascular death, nonfatal acute myocardial infarction (MI), recurrent angina pectoris requiring emergency rehospitalization (rAP), heart failure, and stroke.

Results

Indications for PCI were stable angina in 54%, ST-elevation MI in 41% and non-ST-elevation MI/unstable angina pectoris in 5%. After 2 years of statin treatment, low-density lipoprotein cholesterol (LDL-C) decreased from 133 to 96 mg/dl. Stents were implanted in 84% of all cases. The primary endpoint event rate was 9.5% in the statin group and 14.7% in the non-statin group (p = 0.0292). Of all primary endpoint events, only rAP was significantly suppressed by statins (p = 0.0027). In rAP patients, coronary angiography revealed that statins suppressed restenosis but not new lesions.

Conclusions

For Japanese CAD patients treated with PCI and stent implantation, statin therapy reduced the incidence of recurrent cardiovascular events, particularly rAP. Discretionary statin treatment to achieve LDL-C levels <100 mg/dl effectively reduced restenosis causing rAP.     

Serum Immunoglobulin A Concentration Is an Independent Predictor of Liver Fibrosis in Nonalcoholic Steatohepatitis Before the Cirrhotic Stage

Background and Aims  

The similarity of alcoholic liver disease and nonalcoholic steatohepatitis (NASH) in terms of pathogenic mechanisms suggests that immunoglobulin A (IgA) may play an important role in the pathogenesis of NASH. We aimed to determine whether serum IgA concentrations allow a diagnosis of liver fibrosis in NASH.     

Pancreatoduodenectomy after coronary artery bypass grafting using the right gastroepiploic artery: a case report

We herein report the case of an advanced ampullary cancer developed 80 months after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) and successfully treated by pancreaticoduodenectomy (PD) with revascularization using the great saphenous vein. A 69-year-old Japanese male was admitted for examination with one-month history of nausea and appetite loss. He underwent three vessel CABG, involving bypassing between the right coronary artery and RGEA about 80 months before. The preoperative diagnosis with CT scan and gastric endoscope was carcinoma of the papilla of Vater. Preoperative abdominal angiography showed the RGEA graft remained well patent. He underwent PD with regional lymph node dissection after revascularization of the RGEA. The postoperative clinical course was uneventful. The histopathological examinations of the resected specimen revealed adenocarcinoma of the ampulla, pT2, pN0, M0 stage IB. The patient is currently alive without any further signs of ischemic heart disease several months after his operation. This case report demonstrates that the radical PD with revascularization using other vein graft can be safely performed after CABG using the RGEA.     

Electrophysiological features of atrial tachyarrhythmias after the creation of a left atrial roof line during catheter ablation of atrial fibrillation

Left atrial roof line (LARL) can prevent the perpetuation of atrial fibrillation (AF) by delineation of the arrhythmogenic substrate, but it may be associated with an increased incidence of atrial tachycardia (AT). This study was performed to evaluate the characteristics and clinical implications of inducible AT after LARL.A total of 139 consecutive patients with AF who underwent catheter ablation were prospectively enrolled in this study. LARL was required to prevent the perpetuation of AF in 98 of 139 patients (71%). LARL significantly reduced the incidence of inducible AF (before versus after: 100% versus 44%, respectively, P < 0.01), whereas it significantly increased the incidence of AT (18% versus 63%, P < 0.01). ATs were observed after LARL in 62 of 98 patients (63%), and these circuits were determined in 99 of 112 stable ATs (88%), including tricuspid isthmus-dependent (n = 35), mitral annulus (n = 22), septal (n = 15), surrounding right pulmonary veins (PVs) (n = 12), coronary sinus (CS) ostium (n = 4), upper loop (n = 4), surrounding left PVs (n = 4), and LA anterior wall (n = 3). Catheter ablation (CA) successfully terminated 111 of 122 stable ATs (91%) during CA. The occurrence of AT after CA was significantly higher in patients with than in those without residual AT (26% versus 2%, P < 0.05).Induced AT with a stable circuit after LARL creation could be mapped, and delineation of the induced AT may lead to a favorable outcome.     

Successful treatment of a patient with IgG4-related disease with a paravertebral mass lesion

A 68-year-old woman was admitted with bleary eyes and lacrimal gland swelling. A biopsy specimen from a right paravertebral mass lesion detected by computed tomography showed remarkable IgG4-positive plasma cells. Because serum IgG4 was elevated to 3300 mg/dl, IgG4-related disease was diagnosed, with the assistance of fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT). Administration of 30 mg of oral prednisolone effectively reduced the lacrimal gland swelling and paravertebral mass volume. Nine months after the initiation of prednisolone, serum IgG4 was reduced to 31.4 mg/dl, and there was norecurrence.     

Perioperative short-term pulmonary rehabilitation for patients undergoing lung volume reduction surgery

Although pulmonary rehabilitation is recommended for patients undergoing lung volume reduction surgery, the optimal method of pulmonary rehabilitation is unclear. The aim of this study was to determine the feasibility and safety of perioperative short-term pulmonary rehabilitation. We enrolled candidates for lung volume reduction surgery from 1999 to 2006 and retrospectively evaluated the feasibility and safety of perioperative short-term pulmonary rehabilitation for these patients. The program included the progressive exercise training on a treadmill for approximately 3 weeks. Two primary endpoints, feasibility and safety, were determined by the adherence rates of the program session and the adverse events. Pulmonary function and exercise capacity were evaluated at baseline and the termination of pre- and postoperative short-term pulmonary rehabilitation. Twenty-two patients were enrolled in this study. All patients completed our program without any serious adverse events. The mean values of adherence rates of the preoperative, postoperative, and overall period were, 89.1%, 95.1%, and 92.1%, respectively. All values of pulmonary function tests, except for forced vital capacity, significantly improved at the termination of postoperative short-term pulmonary rehabilitation in comparison to those at the termination of preoperative short-term pulmonary rehabilitation. The values of the 6-minute walk distance, total exercise time, and maximal workload on incremental exercise test were significantly improved by preoperative short-term pulmonary rehabilitation, and their values were maintained until the termination of postoperative short-term pulmonary rehabilitation. The results indicated that it is both feasible and safe to perform perioperative short-term pulmonary rehabilitation.     

Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy

Background  

Adequate blood supply for the reconstructed organ is important for safe esophagogastric anastomosis during esophagectomy. Recently, indocyanine green (ICG) has been used for visualization of the blood supply when anastomosis is performed in vascular surgery. To visualize the blood supply for reconstruction, we employed ICG fluorescence during esophagectomy.     

Modulation of neuromagnetic responses to face stimuli by preceding biographical information

When we encode faces in memory, we often do so in association with biographical information regarding the person. To examine the neural dynamics underlying such encoding processes, we devised a face recognition task and recorded cortical activity using magnetoencephalography. The task included two conditions. In the experimental condition, face stimuli were preceded by biographical information regarding the person whose face was to be memorized, whereas in the control condition, nonsense syllables were presented before face stimuli. Behavioral results indicated that the biographical information about a person facilitated the recognition memory of their face. Magnetoencephalography signals showed clear visually evoked magnetic fields mainly in the occipitotemporal cortex, in response to the face stimuli that were to be encoded. The phasic peak was observed at 100-200 ms after onset of a face stimulus, which was followed by late latency deflections (200-400 ms). Comparison of the signal between conditions revealed that the preceding semantic information does modulate the neuromagnetic responses to the face stimuli. This modulation occurred primarily at the late latency component in the sensors over the occipitotemporal cortex. In addition, the effects of conditions were also observed in the signals from more anterior sensors, which occurred earlier than the effects in the occipitotemporal cortex. These results provide insights into the neural dynamics underlying the encoding of faces in association with their biographical information.