Explore the vast range of titles available.

Despite its recommendation by the current guidelines, the role of long-term oral beta-blocker therapy has never been evaluated by randomized trials in uncomplicated ST-segment elevation myocardial infarction (STEMI) patients without heart failure, left ventricular dysfunction or ventricular arrhythmia who underwent primary percutaneous coronary intervention (PCI). In a multi-center, open-label, randomized controlled trial, STEMI patients with successful primary PCI within 24 hours from the onset and with left ventricular ejection fraction (LVEF) ≥40% were randomly assigned in a 1-to-1 fashion either to the carvedilol group or to the no beta-blocker group within 7 days after primary PCI. The primary endpoint is a composite of all-cause death, myocardial infarction, hospitalization for heart failure, and hospitalization for acute coronary syndrome. Between August 2010 and May 2014, 801 patients were randomly assigned to the carvedilol group (N = 399) or the no beta-blocker group (N = 402) at 67 centers in Japan. The carvedilol dose was up-titrated from 3.4±2.1 mg at baseline to 6.3±4.3 mg at 1-year. During median follow-up of 3.9 years with 96.4% follow-up, the cumulative 3-year incidences of both the primary endpoint and any coronary revascularization were not significantly different between the carvedilol and no beta-blocker groups (6.8% and 7.9%, P = 0.20, and 20.3% and 17.7%, P = 0.65, respectively). There also was no significant difference in LVEF at 1-year between the 2 groups (60.9±8.4% and 59.6±8.8%, P = 0.06). Long-term carvedilol therapy added on the contemporary evidence-based medications did not seem beneficial in selected STEMI patients treated with primary PCI. CAPITAL-RCT (Carvedilol Post-Intervention Long-Term Administration in Large-scale Randomized Controlled Trial) ClinicalTrials.gov.number, NCT 01155635.

Objectives The purpose of this study was to estimate the myocardial area at risk (MAAR) using coronary computed tomography angiography (CTA) and Voronoi algorithm-based myocardial segmentation in comparison with single-photon emission computed tomography (SPECT). Methods Thirty-four patients with coronary artery disease underwent 128-slice coronary CTA, stress/rest thallium-201 SPECT, and coronary angiography (CAG). CTA-based MAAR was defined as the sum of all CAG stenosis (>50 %) related territories (the ratio of the left ventricular volume). Using automated quantification software (17-segment model, 5-point scale), SPECT-based MAAR was defined as the number of segments with a score above zero as compared to the total 17 segments by summed stress score (SSS), difference (SDS) score map, and comprehensive SPECT interpretation with either SSS or SDS best correlating CAG findings (SSS/SDS). Results were compared using Pearson's correlation coefficient. Results Forty-nine stenoses were observed in 102 major coronary territories. Mean value of CTA-based MAAR was 28.3 ± 14.0 %. SSS-based, SDS-based, and SSS/SDS-based MAAR was 30.1 ± 6.1 %, 20.1 ± 15.8 %, and 26.8 ± 15.7 %, respectively. CTA-based MAAR was significantly related to SPECT-based MAAR ( r  = 0.531 for SSS; r  = 0.494 for SDS; r  = 0.814 for SSS/SDS; P  < 0.05 in each). Conclusions CTA-based Voronoi algorithm myocardial segmentation reliably quantifies SPECT-based MAAR. Key points • Voronoi algorithm allows for three-dimensional myocardial segmentation of coronary CT angiography • Stenosis-related CT myocardial territories correlate to SPECT based area at risk • CT angiography myocardial segmentation may assist in clinical decision-making

A 51-year-old woman was diagnosed as severe stenosed tricuspid bioprosthetic valve. She had developed an encephalopathy due to elevated serum ammonia concentration caused by congestive hepatic failure. Re-tricuspid valve replacement was deemed too risky, and balloon bioprosthetic valvuloplasty was instead planned. This procedure was successfully performed using a standard mitral valvuloplasty protocol. The 30-mm INOUE-BALLOON was inflated five times. The mean pressure gradient across the bioprosthetic valve decreased from 7.8 to 3.5 mmHg, and the tricuspid valve orifice area increased from 1.09 to 3.13 cm 2 , without worsening of the tricuspid valve regurgitation. Finally, her hepatic encephalopathy was dramatically improved.

The germylenes bis[bis(trimethylsilyl)amido]germanium ( 1a ) and bis[ t -butyl-trimethylsilyl]amido]germanium ( 1b ) were reacted with N -phenyl- p -quinoneimine ( 2 ) to give copolymers ( 3a and 3b ) with alternating tetravalent germanium and p -aminophenol units. The copolymerization took place smoothly at 0°C without added catalyst or initiator. 1 acted as a reductant monomer, and 2 acted as an oxidant monomer (oxidation-reduction alternating copolymerization). Product copolymers were obtained in very high yields and had high molecular weights. The copolymers were soluble in toluene, benzene, n -hexane and chloroform, whereas they were insoluble in acetonitrile and acetone. Additionally, they were stable toward hydrolytic degradation. Electron spin resonance (ESR) spectroscopic studies of the reaction suggested a structure of a stable germyl radical and a plausible mechanism of biradical copolymerization. Germylenes ( 1a and 1b ) reacted with p -quinoneimine ( 2 ) to give copolymers ( 3a and 3b ) having a tetravalent germanium unit and a p -aminophenol unit, alternatively. The copolymerization took place at 0°C smoothly without added catalyst or initiator. 1 acted as a reductant monomer whereas 2 as an oxidant monomer (oxidation-reduction alternating copolymerization). Soluble copolymers were obtained in very high yields, having high molecular weight. ESR spectroscopic studies of the reaction suggested a structure of stable germyl radical and a biradical copolymerization mechanism.

Abstract Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors offer clinical benefits by reducing low-density lipoprotein cholesterol levels and have emerged as valuable therapeutic agents for the management of cardiovascular diseases. Although their effectiveness in treating coronary artery plaques and abdominal aortic aneurysms has been reported, data on their effects on coronary artery aneurysms are limited. Herein, we report the case of a 43-year-old man with familial hyperlipidemia who presented with angina pectoris caused by a giant right coronary artery aneurysm accompanied by extensive plaques and severe stenosis. The patient underwent coronary artery bypass grafting at 6 anastomotic sites, and a PCSK9 inhibitor was initiated postoperatively. Five years after surgery, imaging demonstrated a gradual reduction in the size of the coronary artery aneurysm, and 8 years later, the size was further reduced. This case report illustrates the rare clinical course of a coronary artery aneurysms. The major causes of coronary artery aneurysms are Kawasaki disease in children and atherosclerotic disease in adults.

Cardiac angiosarcoma is a rare, diagnostically elusive disease with a poor prognosis. Herein, we describe the case of a 61-year-old man who presented with cardiac tamponade caused by perforation of the right atrial wall resulting from an invasive angiosarcoma. The tumour, which had spread throughout the entire right atrial free wall, was resected under cardiopulmonary bypass. Subsequent reconstruction of the right atrial wall involved the use of both autologous and bovine pericardial patches. Cardiac wall rupture due to invasive cardiac angiosarcoma is an extremely rare complication, with only a few cases reported. Therefore, we also review the relevant literature herein. Cardiac angiosarcomas usually affect middle-aged men and are located in the right atrium in the two-thirds of affected patients.

We report a surgical case of dextrocardia complicated with annuloaortic ectasia (AAE) and mitral regurgitation, which induced congestive heart failure. Preoperative electrocardiography-gated multidetector-row computed tomography (MDCT) showed the following complex cardiovascular abnormalities without motion artifacts: dextrocardia, situs inversus, polysplenia, AAE, absence of the inferior vena cava, azygos vein continuation, drainage of the hepatic vein into the right atrium, and bilateral superior venae cavae. On the basis of the MDCT data, we established a cardiopulmonary bypass; and a modified Bentall procedure (Piehler method) and mitral valve replacement were performed without complications.

Background. Noninvasive assessment of acute myocardial infarction (AMI) requires information about both myocardial perfusion and left ventricular (LV) function. The automated quantification of electrocardiographic-gated myocardial scintigraphy with technetium-99m tetrofosmin (QGS) can provide this information. Methods and Results. Coronary arteriography, QGS, and left ventriculography (LVG) were performed in 229 patients with reperfused AMI within 2 days after onset. All infarcted vascular territories (229 segments) were visualized with scintigraphic perfusion images. The mean wall motion score (WMS) was 15.9 ± 2.8 by means of QGS and 16.3 ± 2.9 by means of LVG. The correlation between WMS obtained by means of QGS and that obtained by means of LVG was close (y = 0.913x + 1.016, r = 0.94, P < .001), but that obtained by means of QGS was significantly lower than that obtained by means of LVG (P < .0001). Total agreement for the assessment of regional wall motion reached 75% (kappa, 0.66). Although the LV values obtained by means of QGS and LVG correlated well (end-diastolic volume, r = 0.67, P < .0001; end-systolic volume, r = 0.79,P < .0001; ejection fraction, r = 0.78, P < .0001), end-diastolic volume and ejection fraction tended to be underestimated with QGS. Conclusion. QGS data were considered to be useful in detecting infarcted vascular territory and LV function, even in AMI, within 2 days after onset. (J Nucl Cardiol 2000;7:569-74.)

Irreversible inhibition of disease-associated proteins with small molecules is a powerful approach for achieving increased and sustained pharmacological potency. Here, we introduce α-chlorofluoroacetamide (CFA) as a novel warhead of targeted covalent inhibitor (TCI). Despite weak intrinsic reactivity, CFA-appended quinazoline showed high reactivity toward Cys797 of epidermal growth factor receptor (EGFR). In cells, CFA-quinazoline showed higher target specificity for EGFR than the corresponding Michael acceptors in a wide concentration range (0.1–10 μM). The cysteine adduct of the CFA derivative was susceptible to hydrolysis and reversibly yielded intact thiol but was stable in solvent-sequestered ATP-binding pocket of EGFR. This environment-dependent hydrolysis can potentially reduce off-target protein modification by CFA-based drugs. Oral administration of CFA quinazoline NS-062 significantly suppressed tumor growth in a mouse xenograft model. Further, CFA-appended pyrazolopyrimidine irreversibly inhibited Bruton’s tyrosine kinase with higher target specificity. These results demonstrate the utility of CFA as a new class warheads for TCI. Discovery and exploitation of inherent reaction features of chlorofluoroacetamide (CFA) as a warhead such as low off-target activity and reversible reactivity with cysteine enable specific covalent inhibition of targeted kinases.