Influence of night shift work on circadian heart-rate rhythm in nurses: using a holter electrocardiogram that can be continuously measured for two weeks.

The influence of night shift work on circadian heart-rate rhythm was examined in nurses engaged in shift work using a Holter electrocardiogram, continuously measured for two weeks, and cosine periodic regression analysis. We enrolled 11 nurses who were engaged in a two-shift system. The R2 value in the cosine regression curve of heart-rate rhythm (concordance rate), indicating the concordance rate between the actual heart rate over 24 h and the cosine regression curve approximated by the least-squares procedure, was significantly lower in the night shift (0.40 ± 0.15) than in the day shift (0.66 ± 0.19; p<0.001). Moreover, the amplitude was significantly lower and the acrophase was significantly delayed in the night shift. Thus, the circadian heart-rate rhythm was disrupted by the night shift work. Although the heart-rate acrophase recovered during the day and two days after the night shift, the concordance rate and amplitude did not recover, indicating that the influence of night shift work on circadian heart-rate rhythm might persist even two days after the night shift. Based on these results, adequate clinical attention should be paid to how to spend the day and two days after the night shift to correct the circadian heart-rate rhythm disruption caused by night shift work.

The relationship between social jetlag and subjective sleep quality: differences in young and middle-aged workers.

Social jetlag is a recent problem that is associated with a wide range of issues in the context of modern life. However, differences in the effects of social jetlag on sleep quality between young and middle-aged workers remain unclear. Accordingly, we aimed to examine the different effects of social jetlag on sleep quality in young (20-39 years) and middle-aged (40-59 years) workers from one factory. We included 106 male full-time workers (average age: 35.8 ± 11.5 years) who worked at the Kobe Factory of Fuji Electric Co., Ltd. Social jetlag was evaluated using the Munich ChronoType Questionnaire Japanese Version. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index Japanese Version. Chronotype was determined using the Morningness-Eveningness Questionnaire Japanese Version (MEQ), while the health-related quality-of-life was evaluated using a revised version of the MOS 36-Item Short-Form Survey. Furthermore, we examined factors related to sleep quality in each age group using multiple regression analysis. Subjective sleep quality in the analysis set was poor; moreover, 39.4% of the participants had social jetlag for ≥ 1 h. Compared with middle-aged workers, young workers showed significantly longer and lower social jetlag and MEQ scores, respectively. Multiple regression analysis revealed that mental health and social jet lag were significantly associated with sleep quality in young participants. Contrastingly, social jetlag was not associated with sleep quality in middle-aged workers. Our findings demonstrate the importance of considering the effects of age-based factors on sleep quality.

Reoccurrence of takotsubo cardiomyopathy induced by osimertinib: A case report.

A patient with lung cancer was administrated osimertinib. She developed symptomatic heart failure due to Takotsubo cardiomyopathy (TC). As her condition improved after discontinuing osimertinib, TC was thought to be caused by osimertinib. Reoccurrence of TC was seen after readministrating half dose of osimertinib.

Do differences in chronotypes affect sleep and health-related quality of life of nursing students? A cross-sectional study.

Nursing students experience higher levels of stress and more sleep-related problems than other students; however, the relationship of chronotype to nursing students' sleep status and health-related quality of life (HRQOL) is unclear. This cross-sectional, observational study investigated whether chronotype affected Japanese nursing college students' sleep and HRQOL. Nursing students completed the Attribute Questionnaire about Subject Background, Japanese Version Morningness‒Eveningness Questionnaire (MEQ), Munich Chrono-Type Questionnaire‒Japanese Version (MCTQ), Japanese Version of the Pittsburgh Sleep Quality Index (PSQI), SF-12v2 Standard, Japanese Version 2.0 (SF-12), Japanese Translation of Profile of Mood States 2nd Edition‒Adult Short (POMS2). Of the 241 students (mean age 20.16 ± 1.80 years; 80.9% female), 80 (33.2%) had evening, 142 (58.9%) had intermediate, and 19 (7.9%) had morning chronotype. The overall total PSQI score was 6.86 ± 2.97. Additionally, 141 students (64.1%) scored ≥ 6, suggesting disturbed sleep. Approximately 80% of the evening chronotype students had a total PSQI score of 8.34 ± 3.11, clearly indicating disturbed sleep. Sleep-related parameters (total PSQI score, bedtime, sleep latency, wake-up time, sleep duration, social jetlag) were worse in evening than in other chronotypes. SF-12 and POMS2 did not differ among chronotypes. Thus, evening chronotype nursing students require sleep-related support from early on.

Preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients.

Postoperative delirium, a common perioperative complication, is frequently observed in elderly surgical patients. Few studies have investigated the life rhythm of preoperative patients, and whether or not the preoperative life rhythm is associated with the development of postoperative delirium. The purpose of this study was to investigate the relationship between the preoperative circadian physical activity rhythm and postoperative delirium in cardiovascular surgery patients. A total of 43 patients who underwent cardiovascular surgery were included in this prospective study between July 2016 and September 2017 at Kobe University Hospital. All subjects used a "Life Microscope" wristband (a wristwatch-type terminal incorporating a 3-axis accelerometer monitoring) for 3-7 days at home before the planned surgery. Hourly mean values were calculated for the metabolic equivalents from the obtained activity amounts, and subsequently evaluated using cosine periodic regression analysis. The circadian rhythm parameters of mesor (24 h time series mean), amplitude (half the peak-trough variation), and acrophase (peak time) for the metabolic equivalents were obtained. The intensive care delirium screening checklist was used to assess for postoperative delirium. The acrophase significantly advanced in the postoperative delirium group (median, 11:55 h [interquartile range, 11:06-12:27 h]) compared to the group without postoperative delirium (median, 13:25 h [interquartile range, 12:52-14:13 h]) (p < .001). Furthermore, binary logistic regression analysis showed that advances in the physical activity phase remained independently associated with postoperative delirium (odds ratio, 0.003 [95% confidence interval, 0-0.63]). These results suggest that misalignment between advanced life rhythm before hospitalization and life rhythm after hospitalization might be associated with risk for developing postoperative delirium. Our results led us to speculate that adequate consideration of the patient's life rhythm before hospitalization is needed to prevent postoperative delirium.

The Influence of Chronotype and Working Condition on Sleep Status and Health Related Quality of Life of Daytime Office Workers.

Several companies in Japan introduced early working conditions (including recommendations on early morning work and prohibitions on nighttime overtime work) to decrease the number of long working hours at night. Nevertheless, individuals possess their own chronotype, i.e., their behavioral timing preference-be it morning or evening-that is associated with worker health. The purpose of this study was to investigate the influence of chronotype and working conditions on sleep and health related quality of life (HRQOL) using 126 daytime office workers who were classified as morning or evening type by their Morningness-Eveningness Questionnaire scores. We then compared morning and evening type workers' sleep variables (sleep onset/offset time and total sleep time), sleep quality (using the Japanese version of the Pittsburgh Sleep Quality Index), and HRQOL scores. Additionally, we compared the same sleep variables, sleep quality, and HRQOL scores of each chronotype category of worker under early and normal working conditions. As the results, evening type workers had late sleep onset/offset time, poor sleep quality, and low HRQOL (role-social component) compared to morning type workers. Furthermore, the evening type workers under early working conditions had earlier sleep onset/offset time and poorer sleep quality compared to those workers under normal working conditions. These results suggest that evening type workers in general have poor sleep and low HRQOL and those same workers under early working conditions, in particular, are associated with poor sleep quality. Therefore, in order to optimize worker health, we suggest that working conditions should be taken account of individual chronotypes.

Postprandial Blood Pressure Decrease in Patients with Type 2 Diabetes and Mild or Severe Cardiac Autonomic Dysfunction.

Background Few reports have evaluated the relationship between changes in postprandial blood pressure and the severity of autonomic dysfunction in patients with type 2 diabetes. This was a cross-sectional study designed to investigate postprandial blood pressure changes in individuals without type 2 diabetes and patients with type 2 diabetes and mild or severe cardiac autonomic dysfunction. Methods Forty patients with type 2 diabetes mellitus and 20 individuals without type 2 diabetes participated in this study. Fifty-two participants underwent a meal tolerance test. Blood pressure (brachial systolic blood pressure (bSBP) and central systolic blood pressure (cSBP)), electrocardiogram recordings, and blood samples were assessed before and after meal ingestion. Patients with diabetes were divided into two groups based on their coefficient of variation of R⁻R intervals (CVRR): a normal or mildly dysfunctional group (mild group, CVRR ≥ 2%; n = 20) and a severely dysfunctional group (severe group, CVRR < 2%; n = 15). Results In the control group, bSBP and cSBP did not significantly change after meal ingestion, whereas both decreased significantly at 60 min after meal ingestion in the mild and severe groups. While blood pressure recovered at 120 min after meal ingestion in the mild group, a significant decrease in blood pressure persisted at 120 min after meal ingestion in the severe group. Conclusions Based on these results, adequate clinical attention should be paid to the risk of serious events related to postprandial decreases in blood pressure, particularly in patients with diabetes and severe cardiac autonomic dysfunction.

Relationship between the Functional Independence Measure and Mann Assessment of Swallowing Ability in hospitalized patients with pneumonia.

AIM: Pneumonia ranks high among the causes of death worldwide. However, the predictive values of activities of daily living, the nutrition index and the aspiration index measured objectively remain unclear. The present study aimed to examine the associations of activity, nutrition and dysphagia with pneumonia. METHODS: We assessed 992 hospitalized patients. Logistic regression analysis was used to examine the predictors of pneumonia. Receiver operating characteristic curve analysis was used to determine the cut-off values of variables. Kaplan-Meier and Cox hazards regression analyses were used to examine the incidence of pneumonia and the factors associated with pneumonia. RESULTS: We finally enrolled 393 inpatients. Of the 393 patients, 102 (26.0%) had pneumonia. On logistic regression analysis, age, Functional Independence Measure (FIM)-motor score and Mann Assessment of Swallowing Ability (MASA) score were independent predictors of pneumonia. The FIM-motor and MASA cut-off values were 19.5 (area under the curve 0.83, P < 0.01) and 170.5 (area under the curve 0.82, P < 0.01), respectively. Kaplan-Meier analysis showed that the no pneumonia rate was significantly lower among patients with FIM-motor scores <20 than among those with FIM-motor scores ≥20 (log-rank test, P < 0.01), and was significantly lower among patients with MASA scores <171 than among those with MASA scores ≥171 (log-rank test, P < 0.01). Cox regression analysis showed that FIM-motor (hazard ratio 0.97, P = 0.009) and MASA scores (hazard ratio 0.99, P < 0.01) were significantly associated with pneumonia. CONCLUSIONS: In addition to the infectious risk, the FIM-motor and MASA scales are useful tools to predict the development of pneumonia in older adults. Geriatr Gerontol Int 2018; 18: 1620-1624.

A Comparison of Quantitative T2 Mapping on Cardiovascular Magnetic Resonance Imaging with Metaiodobenzylguanidine Scintigraphy and Left Ventricular Functional Recovery in Dilated Cardiomyopathy: A Retrospective Pilot Study.

OBJECTIVE: Metaiodobenzylguanidine (MIBG) scintigraphy is used to assess heart failure (HF) severity and to predict cardiac functional recovery. Cardiovascular magnetic resonance (CMR) imaging has recently been used to diagnosis HF. We evaluated CMR T2 mapping and MIBG scintigraphy in dilated cardiomyopathy (DCM) patients. METHODS: Consecutively, 22 DCM patients [aged 56.8 ± 13.4 years; 6 women and 16 men; left ventricular ejection fraction (LVEF), 31.9 ± 10.7%] who underwent T2 mapping and MIBG scintigraphy were retrospectively evaluated. Echocardiography results were recorded at baseline and the 6-month follow-up. Patients with an increased LVEF ≥15% between the 2 measures were considered to be responders. We measured each patient's T2 values and MIBG indices [the heart-to-mediastinum ratio (H/M) in the early phase, H/M in the delayed phase, and the washout rate (WOR)] at baseline. We compared these values between the 12 responders and 10 non-responders. RESULTS: The mean T2 value for all patients was 64.5 ± 6.6 ms. The mean values of early H/M, delayed H/M, and WOR were 2.06 ± 0.25, 1.94 ± 0.35, and 43.5 ± 11.8%, respectively. The T2 values were found to correlate with MIBG indices (p<0.05 for all) and were lower in the responders than non-responders (61.4 vs. 68.1 ms, p=0.013). MIBG indices were not significantly different. CONCLUSION: Our study shows that the T2 values correlated with the MIBG indices and were increased in non-responders. T2 mapping may be useful in assessing the cardiac function and functional recovery in DCM patients.

Predicting the response to cardiac resynchronization therapy using 99mTc-tetrofosmin myocardial scintigraphy in patients with drug-refractory heart failure: additional value of the washout of 99mTc-tetrofosmin.

OBJECTIVE: A lack of response to cardiac resynchronization therapy (CRT) has been reported in 20-40% of heart failure patients with left ventricular (LV) dyssynchrony who underwent treatment based on the established guidelines. The study aimed to investigate the relationship between (99m)Tc-tetrofosmin ((99m)Tc-TF) myocardial scintigraphy and the response to CRT. PATIENTS AND METHODS: Twenty-one patients with drug-refractory heart failure who underwent CRT were evaluated. All patients underwent (99m)Tc-TF myocardial scintigraphy before and after CRT. Single-photon emission computed tomography images of (99m)Tc-TF were acquired at 30 min and 3 h after injection and were used to determine the total defect score (TDS) and washout score (WOS). The change in the LV volume and ejection fraction (ΔLVEF) and relative reduction in left ventricular end-systolic volume (%ΔLVESV) were calculated as an index of LV functional recovery after CRT. Response to CRT was considered to have occurred when ΔLVEF was greater than 15% or when ΔLVEF was greater than 5% and %ΔLVESV was greater than 15%. RESULTS: Significant differences were observed between the patients who responded to CRT (the responder group, 13 patients) and the nonresponder group (eight patients) for both early and delayed TDS and WOS (P<0.05). Moreover, there was a good correlation between early TDS before CRT and both ΔLVEF and %ΔLVESV (P<0.01) and an excellent correlation between WOS before CRT and both ΔLVEF and %ΔLVESV (P<0.01). CONCLUSION: Evaluating the washout of (99m)Tc-TF in addition to myocardial perfusion before CRT using (99m)Tc-TF myocardial scintigraphy might be useful in drug-refractory heart failure patients.

Relationship of decreased accumulation of (99m)Tc-tetrofosmin on myocardial single-photon emission computed tomography images between QRS duration in dilated cardiomyopathy patient with left bundle branch block.

PURPOSE: This study aimed to clarify the relationship between severity of conduction delay in the left ventricle and myocardial uptake of (99m)Tc-tetrofosmin (TF) in dilated cardiomyopathy (DCM) patients with left bundle branch block (LBBB). METHODS AND RESULTS: Thirty-two DCM patients with LBBB underwent electrocardiography and (99m)Tc-TF myocardial single-photon emission computed tomography (SPECT). SPECT images were acquired at 30 min (early images) and 3 h (late images) after injection. We calculated the total defect score (TDS) using a 20-segment model with a 5-point scoring system. The TDS in early and late images was defined as the summed early score (SES) and summed late score (SLS), respectively. On early images, 29 of 32 patients (91%) had decreased tracer uptake in the septum. All patients showed a decreased tracer uptake in the septum on late images. A significant correlation was observed between TDS (both SES and SLS) and QRS duration, with SLS showing an excellent correlation (SES: r = 0.554, P < 0.001; SLS: r = 0.779, P < 0.0001). CONCLUSIONS: These findings suggest that in DCM patients with LBBB, hypoperfusion and myocardial damage in the septum might occur in accordance with an increase in the QRS duration.

Relation between sleep quality and daily physical activity in hemodialysis outpatients.

The purpose of this study was to examine the correlations among objective sleep variables, sleep-wake cycle parameters, and daily physical activity in hemodialysis patients and controls. Twenty-four hemodialysis patients (HD group) were compared with a control group consisting of 24 healthy participants matched for age, height, and weight. Sleep variables (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], and waking after sleep onset [WASO]), sleep-wake cycle parameters (the sleep-wake cycle period and the peak of sleep-wake cycle variance), and daily physical activity (steps per day) for each participant were assessed by objective methods for two weeks. While there was no difference in TST between the two groups, the HD group showed a significantly increased SL (HD: 0:29±0:20 vs control: 0:16±0:13, p < 0.05) and WASO (HD: 2:21±1:00 vs control: 1:35±0:41, p<0.05) and decreased SE (HD: 67.1±13.6% vs control: 77.5±9.7%, p<0.01) compared to the control group. There was no significant difference in sleep-wake cycle period between the HD and control groups. However, the peak of sleep-wake cycle variance in the HD group (0.050±0.028) was significantly lower (t = 2.49, p<0.05) than in the control group (0.068±0.019). The number of daily steps taken in the HD group (4,774± 2,845 steps) was also significantly lower than in the control group (8,696± 3,047). The peak of sleep-wake cycle variance was significantly correlated with SE (r = 0.532, p<0.01), SL (r = -0.501, p<0.01), and WASO (r = -0.436, p<0.01), whereas the number of steps showed a weak correlation only with WASO (r = -0.308, p<0.05) among the objective sleep parameters. Our results suggest that sleep quality in HD patients may be more effectively improved by maintaining the regular 24-hour sleep-wake cycle rather than by increasing the amount of daily physical activity, indicating that intervention such as measures to prevent napping during hemodialysis sessions may prove effective in improving the quality of sleep in HD patients.

Comparison of effects of α-Glucosidase inhibitors and glinide drugs on endothelial dysfunction in diabetic patients with coronary artery disease.

BACKGROUND: Studies have shown that repeated post-prandial hyperglycemia may play an important role in the development of atherosclerosis by suppressing endothelial function. α-Glucosidase inhibitors (α-GIs), which reduce post-prandial hyperglycemia without stimulating insulin secretion, significantly reduce the risk of coronary artery disease (CAD), whereas glinides, which improve post-prandial hyperglycemia through post-prandial insulin secretion, do not appear to affect CAD. METHODS AND RESULTS: A total of 104 diabetic patients with CAD were randomly divided into 2 groups: those treated with miglitol (M-group; n=52) and those treated with nateglinide (N-group; n=52). After 4 months' treatment, although hemoglobin A1c and 1,5-anhydroglucitol were significantly improved in both groups, only the M-group had significant reductions in insulin resistance index and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C; a beneficial index for assessing the presence of small dense low-density lipoprotein, and a marker of atherogenic dyslipidemia). Furthermore, only the M-group had improvement in percentage flow-mediated dilatation (%FMD) and reactive oxygen metabolites. In the M-group, multiple regression analysis showed that improvement in TG/HDL-C, in addition to 1,5-anhydroglucitol, was an independent predictor of improvement in %FMD. CONCLUSIONS: The ameliorating effect of α-GI on post-prandial hyperglycemia without stimulating insulin secretion may improve atherogenic dyslipidemia by reducing insulin resistance. These effects are associated with its beneficial impact on oxidative stress, consequently leading to an improvement in endothelial dysfunction.

Myocardial washout of 99mTc-tetrofosmin and response to steroid therapy in patients with cardiac sarcoidosis.

OBJECTIVE: Early diagnosis and initiating treatment of cardiac sarcoidosis are essential because cardiac involvement is an important prognostic factor. Although there are many reports on the diagnosis of cardiac sarcoidosis, the literature on predicting the efficacy of steroid therapy is very limited. The purposes of this study were to investigate the myocardial washout of (99m)Tc-tetrofosmin (TF), and to evaluate the predictability of left ventricular (LV) functional recovery after steroid therapy in patients with cardiac sarcoidosis. METHODS: We performed TF-gated SPECT and echocardiography for ten patients with cardiac sarcoidosis before and after initiating steroid therapy. SPECT images were acquired at 30 min (early images) and 3 h (delayed images) after injection. We calculated the total defect score (TDS) and left ventricular ejection fraction (LVEF). The washout score (WOS) was considered as the difference between the early and delayed TDS. In addition, we defined DeltaLVEF as the change in LVEF after initiating steroid therapy. Furthermore, we analyzed the regional TF myocardial uptake (%uptake) and the regional LV function (wall thickness, WT) by the 20-segment model on polar maps as regional indices. The regional washout (RWO) was defined as the change in %uptake between the early and delayed images in TF SPECT before the therapy. We calculated the improvement factor of the regional LV function as DeltaWT (WT after initiating therapy - WT before the therapy) and investigated the relationships among the indices. RESULTS: We observed WO in 6 of 10 patients (60%). Decreased WT on echocardiography was observed in only 2 of 6 patients (33.3%) in the WO(+) group and in all 4 patients (100%) in the WO(-) group (p < 0.05). WOS before initiating steroid therapy exhibited a good correlation with DeltaLVEF (r = 0.685, p < 0.05). In the regional analysis, %uptake in the early images and delayed images before therapy did not significantly correlate with DeltaWT. In contrast, RWO before therapy was well correlated with DeltaWT (r = 0.435, p < 0.05). CONCLUSION: Our preliminary study shows that there is a relationship between washout of (99m)Tc-tetrofosmin and the LV functional recovery after steroid therapy in patients with cardiac sarcoidosis.

Effects of aerobic exercise on the circadian rhythm of heart rate and blood pressure.

Although the effects of aerobic exercise on resting heart rate, heart rate variability, and blood pressure have been investigated, there are scant data on the effects of aerobic exercise on the circadian rhythm of such cardiovascular parameters. In this study, we investigated the effects of aerobic exercise on the 24 h rhythm of heart rate and ambulatory blood pressure in the morning, when cardiovascular events are more common. Thirty-five healthy young subjects were randomized to control and aerobic exercise groups. Subjects in the latter group participated in their respective exercise program for two months, while those in the former group did not exercise. Twenty-four-hour electrocardiogram and ambulatory blood pressure monitoring data were obtained at baseline and at the end of the exercise intervention. The control group showed no changes, while the aerobic exercise group showed a significant decrease in heart rate (73.7 +/- 6.6 bpm to 69.5 +/- 5.1 bpm, p < 0.005) and sympathetic activity such as LF/HF ratio (2.0 +/- 0.7 to 1.8 +/- 0.6, p < 0.05) throughout the 24 h period, particularly in the daytime. The decrease in the heart rate was most prominent in the morning. However, heart rate and LF/HF ratio showed no statistical changes during the night. No significant changes were observed in blood pressure. These findings suggest aerobic exercise exerts beneficial effects on the circadian rhythm of heart rate, especially in the morning.

The relationship between reverse redistribution of 99mTc-tetrofosmin in sub-acute phase and left ventricular functional recovery in chronic phase in patients with acute myocardial infarction.

OBJECTIVE: The purpose of this study was to clarify the relationship between reverse redistribution (RRD) of (99m)Tc-tetrofosmin ((99m)Tc-TF) and left ventricular functional recovery in patients with acute myocardial infarction (AMI). METHODS: We studied 21 patients with AMI who underwent direct percutaneous coronary intervention (PCI). (99m)Tc-TF-gated single-photon emission computed tomography (SPECT) was performed at rest in the sub-acute and chronic phases. Imaging data were acquired at 30 min (early images) and 3 h (delayed images) after injection. Defect score, regional relative uptakes of (99m)Tc-TF (%uptake), and regional wall thickening (WT) were calculated using the 20-segment model. We measured left ventricular ejection fraction (LVEF) and defined DeltaLVEF as change in LVEF. Summed defect score was calculated by adding the scores of 20 segments on early and delayed images. Summed washout score (SWS) was derived as the difference between early and delayed scores. We defined that SWS was more than 1 point as individual RRD (I-RRD). In each segment, regional RRD (R-RRD) in the sub-acute phase was calculated as %uptake on early images minus %uptake on delayed images in the sub-acute phase. DeltaWT was defined as change in WT from the sub-acute phase to chronic phase. We defined that R-RRD and DeltaWT were higher than 1SD on the control map as R-RRD (+) and change of WT (+). RESULTS: All patients were divided into two groups according to the presence of I-RRD. DeltaLVEF was significantly higher in I-RRD (+) than in I-RRD (-) (14.5 +/- 12.1 vs. 0.0 +/- 3.9%, p < 0.01). We analyzed 162 segments as at-risk areas among a total of 420 segments. In total of R-RRD (+), 75 of 96 segments (78%) had change of WT (+), while this was observed in only 13 of 66 segments (20%) in total of R-RRD (-) (p < 0.0001). In addition, there was a significant correlation between R-RRD in the sub-acute phase and change in %uptake on delayed images from the sub-acute phase to chronic phase in at-risk areas (r = 0.584, p < 0.001). CONCLUSION: These findings suggested that quantitative evaluation of RRD by gated (99m)Tc-tetrofosmin SPECT in the sub-acute phase can predict recovery of left ventricular function in the chronic phase with higher accuracy in patients with AMI who underwent direct PCI.

Continuous positive nasal airway pressure decreases levels of serum amyloid A and improves autonomic function in obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with the pathogenesis of cardiovascular disease, and inflammation and autonomic dysfunction. We investigated levels of serum amyloid A (SAA), a marker of inflammation, as well as autonomic nervous activity and pulse wave velocity (PWV) before and after nasal continuous positive airway pressure (nCPAP) therapy in patients with obstructive sleep apnea. METHODS AND RESULTS: We separated 116 patients who were diagnosed with OSAS by polysomnography according to the apnea hypopnea index (AHI) into the following groups: Group 1 without or with mild OSAS (AHI<20, n=35), Group 2 with moderate OSAS (20==40, n=46). Serum level of SAA (p<0.05), brachial-ankle PWV (p<0.05) and BP (p<0.005) were significantly higher in Group 3 than in Group 1. Autonomic nervous activity assessed by autoregressive spectral analysis of heart rate variability showed that high frequency (HF) power, an indicator of vagal activity, was decreased in Groups 2 and 3 (p<0.05) and that low frequency/HF, an indicator of sympathetic activity, was increased in Group 3 (p<0.05). After 3 months of nCPAP therapy in Group 3 (n=38), SAA (p<0.05), PWV (p<0.001) and BP (p<0.05) were significantly decreased. CONCLUSION: Markers of inflammation and autonomic dysfunction are increased in patients with OSAS, and nCPAP might help to reduce these risk factors for cardiovascular diseases.

Determinants of heart rate recovery in patients with suspected coronary artery disease.

BACKGROUND: Heart rate recovery after exercise is an independent prognostic indicator for cardiovascular and all-cause mortality. The purpose of this study was to clarify the clinical determinants of heart rate recovery. METHODS AND RESULTS: We examined 114 consecutive male patients who underwent exercise myocardial perfusion single-photon emission computed tomography and echocardiography for the evaluation of suspected coronary artery disease. Heart rate recovery was obtained from the subtraction of heart rate in the first minute of recovery after exercise from maximal heart rate during exercise. Abnormal heart rate recovery was present in 50 patients (43.9%). Patients with abnormal heat rate recovery were more likely to have diabetes mellitus. Patients with abnormal heart rate recovery had a higher heart rate at rest than those with normal heart rate recovery (77.5 +/- 13.6 vs. 72.3 +/- 12.5 (bpm), p<0.05). However, no differences in left ventricular geometry investigated with echocardiography were observed between patients with normal and abnormal heart rate recovery. Furthermore, there was no difference in various scintigraphic variables between patients with normal and abnormal heart rate recovery. A stepwise multivariate analysis showed that heart rate at rest and diabetes mellitus were independent predictor of heart rate recovery (p<0.05). CONCLUSION: Our results suggested that heart rate recovery is associated with clinical factors related to the cardiac autonomic function such as diabetes mellitus and heart rate at rest, but not with other ones such as left ventricular geometry and myocardial ischemia.

Development of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients.

OBJECTIVE: The aim of this study was to assess the reliability and validity of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients (ES-SMBPA-2D). RESEARCH DESIGN AND METHODS: Outpatients with type 2 diabetes (n = 146) completed a self-administered questionnaire supported by a semistructured interview based on a literature review. The content, factor, and concurrent validity and internal consistency and reproducibility of the scale were analyzed. Pearson's correlation coefficients for the ES-SMBPA-2D and International Physical Activity Questionnaire (IPAQ) subscale scores were calculated to evaluate the concurrent validity. RESULTS: The ES-SMBPA-2D was divided into two parts, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-2D correlated with the IPAQ subscales. Cronbach's alpha coefficient was between 0.56 and 0.90, and the intraclass test-retest correlation coefficient of the subscales was between 0.60 and 0.88. CONCLUSIONS: The ES-SMBPA-2D is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction.