Biomedical subjects
Publications and source records attributed to K Niki.
The purpose of this study was to examine the assumption of similarity between pressure and diameter-change waveforms in humans. We measured carotid arterial pressure and diameter change, simultaneously, in six patients with heart disease. In all patients, the carotid arterial pressure-diameter relationship could, in practice, be regarded as being linear.
A 54-year-old woman was admitted to our hospital complaining of dyspnea due to hypertrophic obstructive cardiomyopathy. On admission, she was treated with 4 antiarrhythmic drugs and 2 beta-blockers. After 4 of these 6 drugs were withdrawn, the left ventricular outflow pressure gradient markedly increased and then she fell into cardiogenic shock. Therefore, disopyramide(600 mg/day) was administered by continuous intravenous drip infusion to reduce the left ventricular outflow pressure gradient. After intravenous administration of disopyramide, the left ventricular outflow pressure gradient markedly decreased from 100 to 16 mmHg and the cardiogenic shock could be improved. Continuous intravenous drip infusion of disopyramide is effective for the treatment of cardiogenic shock due to severe left ventricular outflow obstruction in patients with hypertrophic obstructive cardiomyopathy.
A theoretical equation was derived based on the time-varying elastance model to predict theoretically the relationship between the delay in the onset of left ventricular outflow obstruction and the reduction in peak left ventricular pressure (LVP) caused by treatment in hypertrophic obstructive cardiomyopathy (HOCM). ECG, LVP, and other hemodynamic parameters were measured during catheterization at a constant heart rate with atrial pacing in 16 patients with HOCM before and after intravenous administration of disopyramide (1 mg/kg). After disopyramide administration, the duration between the R wave of the ECG and the onset of obstruction (T1) was prolonged significantly (from 117 +/- 30 to 155 +/- 32 ms, P < 0.0001), and peak LVP was reduced significantly (from 222 +/- 42 to 177 +/- 39 mmHg, P < 0.0001). The relation between the prolongation of T1 and the percent reduction in peak LVP was predicted well by the theoretical equation (coefficient of determination R2 = 0.926). Our model simplifies the therapeutic strategy for reducing the left ventricular outflow pressure gradient in patients with HOCM, which is to delay the time of onset of obstruction by some methods.
Wave intensity (WI) is a new hemodynamic index, which is defined as (dP/dt)(dU/dt) at any site of the circulation, where dP/dt and dU/dt are the time derivatives of blood pressure and velocity, respectively. Arterial WI in normal subjects has two positive sharp peaks. The first peak occurs during early systole when a forward-traveling compression wave is generated by the left ventricle. The magnitude of this peak increases markedly with an increase in cardiac contractility. The second peak, which occurs towards the end of systole, is caused by generation of a forward-traveling expansion wave by the ability of the left ventricle to actively stop aortic blood flow. The interval between the R wave of the ECG and the first peak of WI (R-1st peak interval) and the interval between the first and second peaks (1st-2nd interval) are approximately equal to the preejection period and left ventricular ejection time, respectively. Using a combined Doppler and echo-tracking system, we obtained carotid arterial WI noninvasively. We examined the characteristics of WI in 11 patients with mitral regurgitation (MR) before and after surgery, and 24 normal volunteers. In the MR group before surgery, the second peak was decreased and the (1st-2nd interval)/(R-R interval) ratio was reduced, compared with the normal group (140 +/- 130 vs 750 +/- 290mmHg m/s3. P < 0.0083; 20.7% +/- 3.4% vs 26.7% +/- 2.8%, P < 0.083). There were no significant differences in the first peak between the normal group and the MR group before and after surgery. The second peak in the MR group was increased significantly (P < 0.016 vs before surgery) to 1,150 +/- 830mmHg m/s3 in the early period after surgery (stage I), and to 1,090 +/- 580mmHgm/s3 in the late period after surgery (stage II). These values did not differ significantly from that of the normal group. At stage I, the (R-1st peak interval)/ (R-R interval) ratio was increased from 13.4% +/- 2.7% to 20.6% +/- 5.6% (P < 0.016 vs before surgery). At stage II, this ratio decreased to 16.2% +/- 2.8% (P < 0.016 vs stage I). but was still significantly higher than that before surgery. The (1st-2nd interval)/(R-R interval) ratio increased significantly after surgery (P < 0.016 vs before surgery) to values (27.0% +/- 4.5% at stage I and 28.9% +/- 2.6% at stage II) which did not differ significantly from that of the normal group. The recovery of the second peak after surgery suggests that the left ventricle had recovered the ability to actively stop aortic blood flow. Wave intensity is useful for analyzing changes in the working condition of the heart.
Surface-enhanced resonance Raman scattering and electroreflectance voltammetry were used to investigate the effect of electrode surface modification on the structure and redox properties of cytochrome c3 immobilized on Ag surfaces. It is shown that the redox reactions of cytochrome c3 are more reversible at an 11-mercaptoundecanoic acid modified Ag electrode as compared to a bare metal surface. The heme of cytochrome c3 is in a mixed low and high spin state when adsorbed at the bare electrode, whereas only the low spin form is present on the 11-mercaptoundecanoic acid modified electrode, suggesting that the native conformation is maintained in the latter case. The reduction potential is close to that of the most positive macroscopic potential as determined by electroreflectance spectroscopy. In contrast, the reduction potential as determined by SERRS undergoes a large positive shift in the presence of 4,4'-bipyridine, the magnitude of which is dependent upon the concentration of 4,4'-bipyridine. These results indicate that the effect of the cytochrome c3 interaction with the 4,4'-bipyridine-modified surface is significantly different as compared to its interaction with the 11-mercaptoundecaodoic acid modified surface. Moreover, the results emphasize that electrode modifiers can have dramatically different effects on the redox properties of different proteins. It is well known that 4,4'-bipyridine acts as a redox promoter in the case of cytochrome c, whereas no electrochemical or electroreflectance response was observed in the case of cytochrome c3.
The effect of ionic strength on the macroscopic and microscopic redox potentials and the heme environment of cytochrome c3 from Desulfovibrio vulgaris Miyazaki F have been investigated by NMR and electrochemical methods. The redox potentials of this tetraheme protein are found to be ionic strength-dependent. Especially, the microscopic redox potentials of hemes 2 and 3 at the fourth reduction step increase significantly with increasing ionic strength, which is in contraction to the theoretical expectation. The coordinated imidazole proton signals are unaffected by ionic strength. However, the methyl and propionate proton signals of hemes 1 and 4 showed significant ionic strength dependencies that are distinct from those for hemes 2 and 3. This heme classification is the same as that found in the ionic strength dependencies of the microscopic redox potentials at the fourth reduction step. Furthermore, the effect of ionic strength on the electrostatic potentials at the heme irons has been examined on the theoretical basis. The electrostatic potential at heme 4 changes up to 1 M ionic strength, which was not expected from the observations reported on cytochromes so far. These results are discussed in connection with the reported anomalous ionic strength dependency of the reduction rate of cytochrome c3.
We evaluated the effects of disopyramide in terms of the balance between myocardial oxygen supply and demand in patients with hypertrophic obstructive cardiomyopathy (HOCM). The myocardial oxygen supply was evaluated by measuring coronary flow velocity and the myocardial oxygen demand was assessed by the pressure-volume area (PVA). The time velocity integral of coronary flow did not change significantly (20 +/- 6 to 21 +/- 8 cm), but the peak left ventricular pressure and left ventricular external work decreased significantly (206 +/- 44 to 157 +/- 37 mmHg, P < 0.001; 1.09 +/- 0.33 to 0.80 +/- 0.23 J/beat, P < 0.001) after disopyramide administration. From theoretical analysis using these data, we concluded that disopyramide improves the myocardial oxygen supply-demand balance in patients with HOCM.
OBJECTIVES: The aim of the present study was to test two hypotheses: (1) the momentum of the blood flowing out of the left ventricle toward the aorta (inertia force) plays an important role in the initiation of decay and the maximum rate of decay (peak (-dP/dt)) of left ventricular pressure (P); (2) a normal heart itself generates the inertia force which enhances its function. METHODS: The contribution of the inertia force to (-dP/dt) was theoretically given as rho c alpha, where rho is the blood density, c the pulse wave velocity, and alpha the deceleration rate of aortic blood flow. The correlations of peak (-dP/dt) with rho c alpha and with the time constant (tau) of the pressure decay during isovolumic relaxation, which was considered to represent myocardial relaxation characteristics, were compared in seven dogs. We developed a method of grading the strength of the inertia force, using the phase loop of left ventricular pressure (dP/dt vs. P relation). The method was applied to the records of 25 patients with ischemic heart disease, from which high fidelity left ventricular pressure recordings were available. RESULTS: The correlation of peak (-dP/dt) with rho c alpha was much higher than with tau (0.75 vs. -0.46). 16 of the 25 patients showed evidence of the inertia force. However, other patients showed no inertia force. The strength of the inertia force showed a significant (P < 0.05) correlation with left ventricular end-diastolic pressure (r = -0.46), cardiac index (r = 0.62), stroke volume index (r = 0.69), ejection fraction (r = 0.46), and peak (-dP/dt) (r = 0.56). CONCLUSION: The inertia force of late systolic aortic flow contributed to ventricular relaxation in the normal heart.
The diagnostic value of transesophageal echocardiography was investigated in heart transplant recipients, i.e., four patients who received orthotopic heart transplantation and one patient who received total heart transplantation. Donor-recipient atrial anastomosis was identified in the four patients with orthotopic heart transplantation, but not in the patient with total heart transplantation. Transthoracic and transesophageal echocardiography detected no thrombus or spontaneous echo contrast in any of the patients. Color Doppler transesophageal echocardiography showed trivial mitral regurgitation in all patients. Total heart transplantation resulted in no protruding suture line and normal atrial cavity size. The patient with total heart transplantation showed some difference in the peak flow velocity of the right and left pulmonary veins (left superior pulmonary vein: 48 cm/sec; right superior pulmonary vein: 86 cm/sec), possibly due to stenosis at the suture line between the left atrium and right superior pulmonary vein, or compression of the right superior pulmonary vein by the anastomosis between the superior vena cava and right atrium. Transesophageal echocardiography was helpful for detecting thrombus in the left atrium and left atrial appendage after heart transplantation, and allowed evaluation of the flow pattern in the pulmonary veins and left atrial appendage as well as abnormal flow in the atrium. In conclusion, transesophageal echocardiography is useful in the follow-up of heart transplant recipients.
The assignment of 1H-NMR signals of the heme methyl and propionate groups of cytochrome c3 of D. vulgaris Miyazaki F was performed. The heme assignment was revised for hemes 2 and 3 (sequential heme numbering). Namely, heme 4 is mainly reduced at first with hemes 1, 2 and 3 following it in this order. The p2H titration of heme methyl signals in four macroscopic oxidation states was performed in the p2H range of 5.2 to 9.0. While the heme methyl resonances in the fully oxidized state showed just small changes with p2H, most resonances in the intermediate oxidation states revealed clear p2H dependence. In particular, the methyl resonances of heme 1 shifted significantly in the acidic region. Then, the chemical shifts of beta-CH2 (next to the carboxyl group) of all propionate groups in the fully oxidized state were observed at various p2H in the range of 4.5 to 9.0. Only the propionate group at C-13 (IUPAC-IUB nomenclature) of heme 1 showed a clear change in this p2H range, its titration curve being similar to those of the methyl resonances of heme 1 in the intermediate oxidation states. pKa of the propionate group was 5.95 +/- 0.05. Analysis of the microscopic formal redox potentials was carried out for the observations at p2H 5.2, 7.1 and 9.0. The redox potentials of heme 1 showed the most remarkable p2H dependence, resulting in the change of the order of the redox potentials of four hemes. A significant change was also found in the interacting potential between hemes 1 and 2. In the light of the p2H-titration experiments, the propionate at C-13 of heme 1 was identified as the most plausible ionizable group responsible for the p2H dependence of microscopic redox potentials of heme 1 in the acidic region.
The purpose of this study was to clarify the clinical significance of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in patients with left ventricular pressure-overload diseases. MIBG scintigraphy was applied to 10 pts with aortic valve stenosis (AS group), 11 pts with hypertrophic obstructive cardiomyopathy (HOCM group), 17 pts with hypertrophic non-obstructive cardiomyopathy (HCM group) and 6 control cases (C group). Mean pressure gradient in AS and HOCM groups was 62 +/- 21 mmHg and 38 +/- 18 mmHg, respectively. Initial myocardial uptake of MIBG (MU) was higher in the AS (1.92 +/- 0.46%) and HOCM (2.27 +/- 0.47%) groups than those in the HCM (1.61 +/- 0.29%) and C (1.50 +/- 0.23) groups. Myocardial clearance of MIBG (MC) was higher in the AS (39 +/- 11%), HOCM (37 +/- 19%) and HCM (28 +/- 17%) groups than that in the C (14 +/- 6%) groups. Heart/mediastinum count ratio (H/M) of AS, HOCM, HCM and C groups was 1.87 +/- 0.29, 2.09 +/- 0.19, 1.98 +/- 0.26, and 2.20 +/- 0.10, respectively. In the cases of AS, positive correlation was observed between mean pressure gradient and MU (r = 0.618, p < 0.05). In conclusion, MU was increased in the case of left ventricular pressure-overload state (AS and HOCM).
Leakage from the composite graft at the site of coronary anastomosis into the perigraftal space (pseudoaneurysm) is an important complication of Bentall's operation. The clinical value of transesophageal echocardiography (TEE) for detecting this graft failure was evaluated in 30 patients who underwent Bentall's operation or Piehler's modification. Three patients (10%) had perigraftal leakage (pseudoaneurysm). TEE demonstrated the leakage site which was not clearly showed by computed tomography (CT) scan and aortography. The detection rate of the anastomosed native coronary artery was 89% (left: 100%, right: 67%). Interposition graft by Pichler's modification method was detected in 96% (left: 100%, right: 92%) of cases by TEE, but only in 43% (left: 57%, right: 29%) by CT scan (left: p < 0.005, right: p < 0.0001). The detection rate of the right coronary artery, interposition graft to right coronary artery, and their color signals were lower than those of the left coronary artery. TEE has considerable diagnostic value in evaluating patients after Bentall's operation.
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A gene encoding a novel FMN-binding protein from Desulfovibrio vulgaris (Miyazaki F) was cloned, and its expression system was constructed in Escherichia coli. The 1.4-kilobase pair DNA fragment isolated from D. vulgaris (Miyazaki F) by double digestion with KpnI and SmaI was found to express a protein binding FMN as a prosthetic group under control of the lac promoter in E. coli. This DNA fragment contained several putative open reading frames. The partial amino acid sequence of the polypeptide portion of the purified FMN-binding protein and its tryptic peptides were completely consistent with those deduced from the nucleotide sequence of the third open reading frame in the cloned SmaI-SmaI fragment of D. vulgaris (Miyazaki F) DNA, which may include promoter and regulatory sequences. The nucleotide sequence of FMN-binding protein indicated that the protein is composed of 122 amino acids including an initiator Met residue and lacks a signal peptide for secretion. The main redox potential of the FMN-binding protein was measured as -325 mV using direct current cyclic and differential pulse voltammetric techniques and an electroreflectance method, suggesting that this FMN-binding protein functions as a redox protein like other FMN-binding proteins. Immunoblot analysis of the whole proteins from D. vulgaris (Miyazaki F) clearly indicated that this protein is expressed in this bacteria. However, the protein was found to have a primary structure distinct from those of other FMN-binding proteins and to be the smallest FMN-binding protein yet reported.
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Site-specific heme assignment of the 1H-NMR spectrum of cytochrome c3 of D. vulgaris Miyazaki F, a tetraheme protein, was established. The major reduction of the heme turned out to take place in the order of hemes I, III, IV and II (numbering in the crystal structure). The hemes with the smallest and greatest solvent accessibility were reduced at the highest and lowest potentials on average, respectively. A cooperative interheme interaction was attributed to a pair of the closest hemes, namely, hemes III and IV. This assignment can provide the physiochemical basis for the elucidation of electron transfer of this protein.