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Biomedical subjects

M Hiroe

Publications and source records attributed to M Hiroe.

At least 181 records · Page 10Linked to original sources
PubMed1986

Clinical validation of fully-automated contour detection for gated radionuclide ventriculography with a slant-hole collimator.

A new fully-automated method for processing gated blood-pool images is presented and its clinical validity and performance for images with various noise levels are investigated using data obtained from a slant-hole collimator. The optimal preprocessing conditions are evaluated for the images with various noise levels to obtain the accurate ejection fraction, end-diastolic and end-systolic counts. This new method has successfully detected left ventricular contour in 92% of the 61 patients. The left ventricular ejection fraction obtained by the method related closely to that of contrast ventriculography (correlation coefficient r = 0.90). The end-diastolic volume also had a good correlation with contrast ventriculography (r = 0.90).

Filtration↗
PubMed1986

Age-associated myocardial changes in various heart diseases. A clinicopathologic analysis in biopsied and autopsied myocardium.

Age-associated changes in histopathologic and ultrastructural aspects of cardiac myocytes were systematically compared with clinical problems. The study material consisted of 1,515 endomyocardial biopsies; 150 normal and 50 diseased cardiac myocytes from pediatric autopsy specimens; 34 intraoperative endomyocardial biopsy specimens from the left ventricle and 28 surgical biopsy specimens from the right or left atrium. The following results were obtained: The myocytes developed to adult size by the age of 15 years. Thereafter, the size did not change up to the age of 59. Short-term hemodynamic overloading to the ventricle caused reactive hyperfunction and hypertrophy of myocytes. Stable hypertrophy resulted in long-term overloading. In cardiomyopathy, compensated or stable hypertrophy occurred, but progression to decompensated or gradual exhaustion and progressive cardiosclerosis (Meerson) took place. Progress of endocardial thickening was often observed during the course of the disease. In the right and left atrial myocardium, extremely advanced pathology was observed and changes were related to the duration of the disease rather than to the severity of the hemodynamics.

Aging↗
PubMed1986

Analysis of histopathologic findings in cases with dilated cardiomyopathy with special reference to formulating diagnostic criteria on the possibility of postmyocarditic change.

From our study employing serial endomyocardial biopsy in patients with acute viral or idiopathic myocarditis, we were able to construct histopathologic criteria for acute, subacute and convalescent myocarditis. We realize that it is difficult for the inexperienced observer to make an appropriate diagnosis of myocarditis or postmyocarditic changes in patients with dilated cardiomyopathy (DCM). In order to overcome this problem, each finding was graded and the scores obtained were analyzed statistically and compared with those from hypertrophic cardiomyopathy (HCM) and chronic right ventricular overloading (CRVO). The scores were obtained by summing the gradings for each of the following findings: increase of fibrocytes, increase of fibroblasts in the interstitium, hypertrophy of myocytes, fragmentation of muscle bundles, interstitial fibrosis, disarrangement of muscle bundles, abnormal branching, variation in size, increased glycogen deposition in the sarcoplasm, scarcity of myofibrils, and nuclear degeneration of myocytes and endocardial thickening. Since the increase in number of fibrocytes was considered important, its value was doubled. Scores in each group were as follows: convalescent myocarditis: 17.1 +/- 4.7 (n = 10), DCM: 13.2 +/- 3.3 (n = 47), HCM: 9.7 +/- 2.4 (n = 20), CRVO: 7.0 +/- 3.6 (n = 21). It was found that the scores for cases with myocarditis in the convalescent stage and in DCM were higher than those found for cases with either HCM and CRVO (p less than 0.05). In summary, the high score for postmyocarditis in DCM could suggest that prior myocarditis is an important causative factor of this disease.

Biopsy↗
PubMed1986

[Prognosis of dilated cardiomyopathy: an integrated study using a prognostic index].

A ten year follow-up study of 111 patients with dilated cardiomyopathy (DCM) was conducted. The five year survival rate after onset of subjective symptoms was 53%; the ten year survival rate, 22%. To evaluate the prognosis of DCM, the cardiothoracic ratio (CTR), ECG, hemodynamics, and histopathological contractility failure index (HCFI) which we constructed via a right ventricular endomyocardial biopsy, were compared. Patients having malignant arrhythmias with mildly impaired cardiac status, mild cardiomegaly and low HCFI were more prone to sudden death. In patients with progressively deteriorating cardiac status, refractory cardiomegaly, supraventricular arrhythmias, left axis deviation, prolongation of QRS interval, low voltage and high HCFI, the cause of death was more likely refractory heart failure. A prognostic index of DCM was then constructed through cardiac status, CTR, ECG, hemodynamics and HCFI. The mortality rate of the group with a prognostic index of seven points or below was 5.0%; the group with eight points or above was 82.1%. The prognostic index of DCM was thus shown to be a useful prognostic indicator.

Adult↗
PubMed1985

Prognosis of dilated cardiomyopathy. An integrated analysis including endomyocardial biopsy findings.

A long-term prognostic study of up to 15 years of dilated cardiomyopathy (DCM) was carried out in 65 cases. The 5-year survival rate after the onset of subjective symptoms was 40%, and the 10-year survival rate 22%. To evaluate the prognostic factor of DCM, the cardiothoracic ratio (CTR), ECG, hemodynamics, and histopathological contractility failure index (HCFI), which we constructed through right ventricular endomyocardial biopsy, were compared. Patients having malignant arrhythmias, such as short runs or multifocal ventricular premature beats with mild impaired cardiac status, mild cardiomegaly, and low HCFI, were more prone to sudden death. In patients with progressively deteriorating cardiac status, refractory cardiomegaly, supraventricular arrhythmias, left axis deviation, prolongation of QRS interval, low voltage, and high HCFI, the cause of death is more likely to be refractory heart failure.

Adult↗
PubMed1985

Double nuclei in endomyocardial biopsy: a comparative study of the incidence in myocarditis and chronic right ventricular overloading.

The incidence of double nuclei in myocarditis and in cases with right ventricular overloading (CRVO) was histopathologically assessed in a minimum of 100 longitudinally cut myocytes in specimens obtained at right ventricular endomyocardial biopsy. In myocarditis, the incidence of double nuclei was shown to be 5.8 +/- 1.8 and in CRVO and in normal heart tissue it was seen in 3.0 +/- 0.8 and 3.2 +/- 0.9% (m +/- S.D.), respectively, of the population of myocytes. It is concluded that double nuclei result from either the activity or the reparative process of myocarditis and that it is not the expression of chronic right ventricular overloading. It is suggested that quantitative assessment of the frequency of double nuclei is an useful method in the interpretation of myocardial biopsy.

Biopsy↗
PubMed1985

Recent trends in cardiac sarcoidosis research in Japan.

Our recent survey of the Japanese literature, actual case experience, and previous studies revealed the following results. Fifty-three cases were reported in which the main cause of death in sarcoidosis was congestive heart failure (11 of 17 cases, 64.7%) and not sudden death as was previously believed. ECG analysis revealed that third degree AV block, bundle branch block, and ventricular arrhythmias were the most frequent findings indicating the presence of cardiac sarcoidosis. It was recognized that in the Japanese population fatal myocardial sarcoidosis or clinical diagnosed cardiac sarcoidosis occurred most frequently in females over the age of 40 years. It is suggested that myocardial changes progress independently of granulomatous changes. This is due to the detection of a high incidence of basal lamina layering of myocardial capillaries (14 of 18 cases, 77.8%) and is considered to play a significant role in the progression of this disease. Radionuclide studies showed that thallium scintigraphy or technetium ventriculography were positive in those cases where ECG abnormalities are prominent, indicating the presence of myocardial disease. Previous therapeutic studies of cardiac sarcoidosis have shown a decrease in the incidence of sudden death; death due to congestive heart failure occurred more frequently despite pacemaker implantation. Control of congestive heart failure is thus regarded as the most important aspect of improved treatment and prognosis.

Adolescent↗
PubMed1985

Histopathologic and ultrastructural observations of acute and convalescent myocarditis: a serial endomyocardial biopsy study.

Serial endomyocardial biopsy findings were analyzed in ten cases with acute myocarditis of possible viral origin. The histopathologic findings were analyzed at the acute (0-10 days after the onset), subacute (11-21 days), and convalescent stages (22-167 days). The incidence and severity of various cardiac myocyte and interstitial changes were compared at each stage of the disease. The time-course changes of the histopathologic findings in acute myocarditis were as follows. At the acute stage, we observed: interstitial cell infiltration composed of fibroblasts, macrophages, and lymphocytes, fragmentation of the muscle bundles, myocytolytic changes, swelling and scarcity of the cytoplasm and swelling of nuclei, variation in size of the myocytes, disarrangement of the muscle bundles, interstitial edema, increased glycogen deposition in the myocytes, abnormal branching of the myocytes, and interstitial fibrosis. At the convalescent stage, most of the above findings could still be seen except for myocytolytic changes, swelling of myocytes, and interstitial edema. At the subacute and convalescent stages, an increase in abnormal branching and in double nuclei in the myocytes and nuclear degeneration became observable. A further control study comparing the changes at the convalescent stage of myocarditis and the myocardial changes in cases with chronic right ventricular overload in 58 cases revealed that in the former fragmentation of the muscle bundles, abnormal branching, size variation, glycogen deposition, and large mononuclear cell infiltrations were significantly more frequent. Ultrastructural observation of the myocytes revealed that they have a great potentiality for regeneration; myocytes showing severe myocytolytic changes may recover to regain an architecture of almost normal appearance.

Acute Disease↗
PubMed1985

A comparative ultrastructural study on the nature of interstitial cell constituents in idiopathic myocarditis and myocardial infarction.

In order to observe the characteristics of interstitial cellular proliferation in cases with myocarditis of possible viral origin, a systematic ultrastructural analysis of the cell components in the interstitium was made employing endomyocardial biopsy at the acute (0-10 days after onset), subacute (11-25 days), and convalescent stages (26-167 days) of the disease in ten cases. For comparison, myocardial specimens from cases with myocardial infarction were taken from early autopsy cases or from tissue obtained during surgery. The dominant interstitial cells observed in the acute stage of myocarditis were fibroblasts (38.3% +/- 17.5%, mean +/- SD), macrophages (23.3% +/- 12.1%), and lymphocytes (18.0% +/- 18.1%); at the convalescent stage, fibrocytes (44.6% +/- 20.2%) and fibroblasts (22.5% +/- 8.0%) were commonly seen. In myocardial infarction, the dominant cells were macrophages (35.0% +/- 16.0%) and neutrophils (26.0% +/- 13.9%) at the acute stage, and lymphocytes (30.0% +/- 17.8%), plasma cells (27.1% +/- 20.0%), and macrophages (26.4% +/- 11.4%) at the late stage. Thus, some differences between the two diseases could be recognized.

Acute Disease↗
PubMed1985

A clinicopathologic study on a cause of idiopathic cardiomyopathy and arrhythmia and conduction disturbance employing endomyocardial biopsy.

A comparative study of right ventricular histopathologic findings and clinical profiles in 174 cases with hypertrophic cardiomyopathy (HCM), 145 cases with dilated cardiomyopathy (DCM), and 241 cases with idiopathic arrhythmia and/or conduction disturbance with significant myocardial pathology [Electric disturbance type of cardiomyopathy (ECM)], totaling 560 cases, was made in order to clarify the role of viral myocarditis in these conditions. Postmyocarditis change (PMC) was defined by assessing serial biopsy findings in nine cases with acute myocarditis. The PMC was observed in three cases with HCM (1.7%), 22 with DCM (15%), and 21 with ECM (8.7%). The incidence of PMC was significantly higher in DCM and ECM than in HCM (P less than 0.001). The typical pattern of onset of acute myocarditis, i.e., high fever, upper respiratory infection, and gastrointestinal symptoms preceding cardiac symptoms within 10 days, was recognized in one case with HCM, eight with DCM, and 6 of 123 cases with ECM. The incidence was higher in DCM and ECM than in HCM (P less than 0.05). Of 46 cases with PMC, 12 (26%) showed this pattern, on the other hand only 3 of 377 cases (0.8%) without PMC did so (P less than 0.0001). Familial occurrence was not found in any of the 46 cases with PMC but was found in 38 of the 377 cases without PMC (P less than 0.01). This study indicates that viral myocarditis may often be the causative agent of idiopathic cardiomyopathy, especially DCM and ECM. It is also noticed that familial occurrence of the cases with PMC was never seen.

Acute Disease↗
PubMed1985

Hemodynamic studies and response to a combined therapy of nitroglycerin ointment and dopamine in patients with acute myocarditis.

Left ventricular performance was assessed in ten patients with acute myocarditis during the acute stage (within the first 3 days after the onset of cardiac symptoms) and during the convalescent phase (3-5 weeks later). In nine, the diagnosis was confirmed by endomyocardial biopsy during the acute stage, when left ventricular function was markedly reduced, i.e., cardiac index 1.53 +/- 0.33 l/min/m2 (mean +/- SD), left ventricular stroke work index 14.1 +/- 3.9 g/beat/m2, pulmonary capillary pressure 25.9 +/- 4.3 mm Hg, and systemic vascular resistance 27.9 +/- 9.4 R units. During convalescence, seven patients improved clinically with normal cardiac function and in three it remained impaired. Cardiovascular response to nitroglycerin ointment in three patients and a combination of dopamine and nitroglycerin ointment in five were compared. Nitroglycerin ointment reduced pulmonary capillary pressure by an average of 28.5% (P less than 0.05) and systemic vascular resistance by 26.8%, while the cardiac index increased by 34.1% (P less than 0.05) and left ventricular stroke work index by 30.3% (P less than 0.01). The combined therapy was more effective, with a reduction of pulmonary capillary pressure by 30.4% (P less than 0.05) and systemic vascular resistance by 27.5% (P less than 0.05), accompanying an increase in cardiac index by 53.5% (P less than 0.005) and left ventricular stroke work index by 63.5% (P less than 0.01), with little change in the double products. This study suggests that serial hemodynamic monitoring accurately evaluates cardiac function, selection of appropriate therapy, and the hemodynamic effects of treatment in patients with acute myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

Long follow-up study in patients with prior myocarditis by radionuclide methods.

Ten patients with previous myocarditis were evaluated to determine cardiac conditions by T1-201 myocardial perfusion imaging and stress radionuclide ventriculography during the follow-up of 18-102 (average 56) months; the results were compared with those from ten sex- and age-matched controls. Exercise capacity by supine bicycle ergometer was reduced in patients with myocarditis. Their resting left ventricular ejection fraction (LVEF) was 57.5% +/- 3.9%, similar to that of controls. LVEF response to stress in myocarditis was abnormal with an increment of end-systolic volume, while in the controls LVEF increased significantly during stress. Seven of the eight patients with an abnormal ejection fraction response had constant T1-201 perfusion defects. This study indicates that latent left ventricular dysfunction is present in patients with prior myocarditis and that nuclear study is useful for long-term follow-up.

Adult↗
PubMed1985

Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease.

Fourteen cases of heart disease with hypereosinophilia were analyzed employing conventional cardiologic methods, including echocardiography, cardiac catheterization, and endomyocardial biopsy. The cases were divided into four types: Acute carditic (endocarditis, myocarditis, pericarditis; five cases); ventricular dilation (three cases); restrictive (three cases); electric disturbance (three cases). Biopsy revealed significant changes in all cases. In one case of the ventricular dilation type, endomyocardial fibrosis with myocardial degeneration was seen, and in another case mural thrombus formation was shown to be present. In three cases of the restrictive type, endomyocardial fibrosis (EMF) was observed. In two cases of the electric disturbance type, minor right ventricular myocardial degeneration was observed. In two of the three cases of the carditic type and in three of eight cases in other categories, postmyocarditic changes were observed. The course of the disease compared with the type of disorder revealed a short course in the carditic type and a longer course, ranging from 2 to 24 years, with one exception, in the other types. It is also confirmed that the various histopathologic changes can be related to particular clinical presentations. We have shown that the basic changes in eosinophilic heart disease are not restricted to the endomyocardium and that they occur in various parts of the heart causing more widespread manifestations. The more comprehensive term "eosinophilic heart disease" is a preferable description.

Adolescent↗