ABSTRACT
Aims: Brugada syndrome is characterised by ST segment elevation in right precordial leads and associated sometimes with idiopathic ventricular fibrillation leading to sudden cardiac death. Although ECG recording at higher intercostal space unmasks Brugada syndrome, the vectorcardiographic (VCG) mechanisms of this unmasking remain unknown. Place and Duration of Study: Noninvasive ECG laboratory of Heart Center, Kyushu University Hospital, Fukuoka, Japan, from November 2013 to April 2015. Methodology: Twelve-lead digital ECG was recorded at standard (4th) and higher (3rd and 2nd) intercostal space in 5 patients with Brugada syndrome. The ECG data were transformed automatically to the VCG data based on the corrected three orthogonal Frank leads (X, Y and Z) and three vector loops of P, QRS and T waves were constructed and projected to the three (horizontal, frontal and right sagittal) orthogonal planes. Results: ST elevation in the standard right precordial leads (V1 to V3) was augmented by the 12-lead ECG recorded at higher intercostal space. Saddle back ST elevation was often converted to coved type ST elevation by this invent. QRS loop was open in all 5 patients, and the maximum J-point vector showed right anterosuperior direction, whereas T loop showed left anteroinferior direction. The J-point vector faced toward and the maximum T vector faced backward the right precordial ECG electrodes, which was accentuated by shifting them to the higher intercostal space. Conclusion: Unmasking of Brugada ECG was explained well even in this small-sample study by the spatial relationship between the orientations of ST-T vector and the standard right precordial ECG electrodes positioned at the higher intercostal space.
ABSTRACT
Aims: Plasmalogens are unique phospholipid of biological membrane and is considered to play a potent role of intrinsic antioxidant. Atherosclerosis is associated with oxidative stress, but the correlation between plasmalogens and atherosclerosis is debatable. Therefore, this study aimed to assess the plasma and erythrocyte membrane phospholipids profile in patients with coronary heart diseases (CHD) undergoing percutaneous coronary intervention (PCI). Place and Duration of the Study: Vascular laboratory of Heart Center, Kyushu University Hospital, Fukuoka, Japan, from February to August 2016. Methodology: The plasma concentrations and erythrocyte membrane contents of phospholipids were quantified in patients with CHD (n = 30, group A) and age-matched controls (n = 38, group B) using high-performance liquid chromatography with evaporative light scattering detection method. Results: Plasma concentrations of plasmalogens in group A were significantly lower than those in group B. Similar findings were obtained from relative contents of plasmalogens in the erythrocyte membrane. Multiple regression models for plasmalogens yielded phospholipids other than plasmalogen as determinants of plasmalogens. Conclusions: This cross-sectional study indicated that plasma and erythrocyte membrane plasmalogens are reduced in patients with CHD undergoing PCI. Further longitudinal studies are required to elucidate the clinical role of intrinsic plasmalogens as a laboratory marker of oxidative stress and extrinsic plasmalogens as a novel therapy for atherosclerosis.
ABSTRACT
Background: Erythrocyte deformability is a major determinant of microcirculation in vivo. Although this concept was defined as filterability evaluated by flow-pressure curve constructed during a filtration process of erythrocyte suspension through a nickel mesh filter, the behaviours of erythrocytes during the filtration process are unknown. Aim: The present study aimed to obtain the better rheological understanding of the behaviours of erythrocytes passing through the nickel mesh filter. Methods: Blood sample was obtained from 8 apparently healthy subjects after obtaining informed consent. Erythrocyte filterability (%) was calculated as the flow rate of a hematocrit-adjusted erythrocyte suspension relative to that of saline at a filtration pressure of 100 mmH2O in flow-pressure curves obtained by nickel mesh filtration technique. Nickel mesh filters showing specific pore sizes of 6.00 ?m (step 1) and 5.31 ?m (step 2) were chosen, and two-step filtration protocol was performed. Erythrocytes counts (EC) were performed immediately before (ECpre) and after (ECpost) each filtration, and erythrocyte trapping rate (%) was defined as (ECpre – ECpost) / ECpre. Erythrocyte filterability and trapping rate were correlated in each step for data analysis. Results: ECpre was always greater than corresponding ECpost in every subject and in both steps. Erythrocyte filterability in the step 1 (91.8 ± 2.1%) was close to that in the step 2 (90.0 ± 10.3%). Likely, the trapping rate in the step 1 (77.8 ± 2.4%) was close to that in the step 2 (79.4 ± 7.0%). Mean filterability in step 1 did not differ from that in step 2 (p = 0.637), and the same was true with respect to the mean trapping rate (p = 0.516). However, individual comparison between the filterability and the trapping rate of both steps demonstrated no correlation. Conclusions: The present findings indicate that erythrocytes in suspension are trapped substantially by our nickel mesh filter. This trapping rate was not correlated to the erythrocyte filterability obtained by the flow-pressure curve during the nickel mesh filtration. Therefore, the erythrocyte trapping rate should be considered as a hemorheological parameter independent of the erythrocyte filterability.
ABSTRACT
Background: Although the coexistence of atrial fibrillation (AF) and gastroesophageal reflux disorder (GERD) has been reported, the prevalence of GERD in arrhythmic patients remains unknown. This study aimed to investigate the relationship between GERD and several kinds of arrhythmia, and the therapeutic effects of proton pump inhibitors (PPI) on AF. Methods: In Study 1, patients with various kinds of arrhythmia (n=147) including AF (n=98) were administered a GERD-specific questionnaire (F-scale). In Study 2, patients with AF and GERD (n=27) responded to an AF-specific questionnaire (AFQLQ) before and after the additive PPI therapy to explore the effects of PPI on comorbid AF. In Study 3, device memory was assessed as it is related to PPI administration in pacemaker patients with GERD and AF (n=5) to study the effects of PPI on device-documented AF. Results: Left atrial (LA) size and F-scale scores in AF patients were the largest among the arrhythmic patients in Study 1. Logistic regression analysis showed no independent determinants of GERD. F-scale scores and AFQLQ scores showed temporal and partial correlations and significant improvement after starting PPI in Study 2. However, device interrogation confirmed limited AF improvement by starting PPI in Study 3. Conclusions: GERD is prevalent in AF patients. LA size is not an independent determinant of GERD. Symptoms of AF were improved, whereas device-documented paroxysms of AF were not ameliorated by PPI administration. A large-scale prospective study is required to conclude the efficacy of PPI on the comorbid AF.