The effect of acupuncture on the coronary arteries as evaluated by coronary angiography: a preliminary report

The Neiguan acupuncture point (EH-6) of the heart meridian is often used for circulatory disorders. To clarify this effect, we measured coronary diameters in patients with angina pectoris following acupuncture stimulation using cardioangiography. Two kinds of acupuncture stimulation, the leaving needle (LN) and the sparrow pecking method (SPM), were employed for this study. No significant differences were found between LN and SPM. Concerning the pattern of coronary reaction, coronary constriction following acupuncture showed a relationship to patients with vasospastic angina. Coronary dilation following acupuncture showed a relationship to patients with Syndrome X. The mean dilatation with acupuncture was 68.8% of that caused by isosorbide dinitrate. These findings may help to clarify the mechanism of acupuncture treatment.

[Renal cell carcinoma with late skin metastasis: a case report]

An 81-year-old man complaining of appetite loss visited our clinic. Four subcutaneous nodules were visible. One was seen on the right chest, 1 on the left shoulder and 2 on the abdomen. They were soft, dome-like masses and 20 to 30 mm in diameter. Computed tomography revealed multiple metastatic lesions in the brain, lungs, abdomen and skin. The patient had undergone radical nephrectomy for renal cell carcinoma 15 years earlier. The histology of the biopsy specimens obtained at nephrectomy was grade 1 and that of the subcutaneous nodules was grade 2. The patient died 49 days after admission, in spite of interferon-alpha therapy. To our knowledge, this is the 63rd case of skin metastasis of renal cell carcinoma in Japanese literature.

Echocardiographic determination of stroke volume during rapid atrial pacing and volume loading in normal rats

OBJECTIVE

The aim was to validate echocardiographic assessment of acute changes of left ventricular stroke volume in normal rats.

METHODS

By transthoracic use of a 7.5 MHz ultrasonic transducer, the left ventricular dimensions were determined before and during rapid atrial pacing and saline infusion in seven Wistar rats weighing 310-470 g. Left ventricular volume was calculated from short axis dimensions according to a cube function formula. Echo stroke volume (SVE) was then compared with that obtained simultaneously using a pulsed Doppler flow meter placed around the ascending aorta (SVF).

RESULTS

The SVE (ml) was decreased from 0.30(SD 0.12) to 0.13(0.06) by rapid pacing and increased from 0.27(0.12) to 0.63(0.16) by volume loading. Regression analysis showed high correlations between SVE and SVF during both pacing (r = 0.84) and infusion (r = 0.91) studies. Furthermore, correlations between SVE and SVF in individual animals were very close (r = 0.87-0.99 in the pacing study and 0.92-0.99 in the volume study). Interobserver and intraobserver variances were small, with close correlations (r = 0.96-0.99) and modest standard errors of the estimate (0.02-0.04 ml) between the two measurements.

CONCLUSIONS

Echocardiography allows reliable in vivo measurement of cavity dimensions and assessment of acute alterations in stroke volume in normal rats.

Echo/Doppler diagnosis of tetralogy of Fallot, ventricular septal defect, pulmonary valve dysplasia, and hypertrophic cardiomyopathy in WKY/NCrj rats

We examined the hearts of 97 WKY/NCrj rats, a strain which spontaneously develops congenital cardiac malformations, by means of echocardiography with a pulsed Doppler ultrasound, and compared the results with those of 20 WKY/Ta rats and 30 normal Wistar rats. Dissection of these WKY/NCrj rats revealed a ventricular septal defect (VSD) in 20 and pulmonary valve dysplasia (PVD) in 41, both VSD and PVD occurring together in 18. VSD was readily diagnosed in vivo by the jet flow signal derived from the left-to-right shunt near the membranous portion, with a sensitivity of 85% and a specificity of 99%. Ultrasound imaging revealed overriding of the aorta and right ventricular (RV) hypertrophy in 18 of the 20 rats with VSD. Of the 20 rats with VSD, 10 had a systolic high-velocity jet across the RV outflow indicating an infundibular stenosis. PVD was commonly accompanied by a pulmonary regurgitation signal, with severe cases showing intensified echo and low excursion of the cusps. The regurgitation signal showed a good diagnostic value for PVD with a sensitivity of 82% and a specificity of 85%. In the remaining 54 WKY/NCrj rats without VSD or PVD, the ratio of mean left ventricular (LV) wall thickness to cavity dimension, the fractional shortening of the LV dimension, and the septal to LV free wall thickness ratio were all abnormally high, and the motion of the ventricular septum was reduced in most of the cases compared with that of the other two strains. All these features resemble the hypertrophic cardiomyopathy seen in humans, which further promises that the rats should be a useful model for the controversial disease.

Hereditary transmission of tetralogy of Fallot, cardiac hypertrophy, and anomalies of great vessels in WKY/NCrj rats

We examined 78 fetuses on d 21 of gestation (G21) and 83 neonates on d 2 after birth (A2), which were first generation offspring of WKY rats mated with normal Wistar rats (F1). In addition, we examined six groups of fetuses on d 19 of gestation (G19): 65 Wistar rats, 111 WKY rats, 85 F1, 100 F1 X F1, 92 F1 X Wistar, and 97 F1 X WKY progeny. In the F1 at G19, G21, and A2, there were abnormalities of the pulmonary valve, pulmonary outflow tract, architecture of muscle bundle, and pulmonary arterial branch, as well as hypoplastic ductus arteriosus and postnatal cardiac hypertrophy, similarly in males and females but at a lower incidence and to a lesser extent than in the WKY rats. Severe pulmonary valve dysplasia and ventricular septal defect with overriding of the aorta (tetralogy of Fallot), usually associated with a markedly small ductus, were not present or were very rare in the F1 and the F1 X Wistar but were present in the F1 X WKY and in the F1 X F1 less prevalently than in the WKY. The size of the ductus showed a continuous distribution in all of the six groups; there was a large skewing toward lower values in the WKY, the F1 X WKY, and the F1 X F1. These results suggest that cardiovascular anomalies of WKY rats are transmitted as autosomal recessive or incomplete autosomal dominant traits with an incomplete penetrance and variable expressivity or as polygenic traits. Chromosomal analysis of 31 WKY fetuses revealed no aberrations specifically related to the development of cardiovascular malformations.

Visualization of the heart and determination of left ventricular mass in rats by echocardiography

A high-frequency transducer was used to determine the optimal parameters for visualizing the heart in 40 normal Wistar, 15 SHR, and 10 aorta-banded rats. The rats were 5 to 30 weeks old and weighed between 105 and 705 grams. Two-dimensional and M-mode views of the ventricles, atria, valves, and great arteries were obtained by placing the transducer beneath the rats through the left or right parasternal window in either the prone or the right decubitus positions, respectively. Left ventricular (LV) mass was determined on the basis of a spheroid model; these values correlated well with the LV weight for both the Wistar rats (r = 0.94, p less than 0.001) and the rats with cardiac hypertrophy due to pressure load (r = 0.87, p less than 0.001). These results were highly reproducible. This indicates that echocardiography is useful for obtaining quantitative measurements in rats.

Tetralogy of Fallot, cardiac hypertrophy, pulmonary hypertension, and anomalies of great vessels in fetuses and neonates of WKY/NCrj rats

We examined anatomically the hearts, lungs, and great vessels of 269 WKY/NCrj rats at three fetal and three neonatal stages. Severe pulmonary valve thickening was present in 16 and ventricular septal defects with overriding of the aorta in 15 of the 90 near-term fetuses and in 10 and nine, respectively, of the 79 neonates at 2-4 d of age. These abnormalities occurred together (tetralogy of Fallot) in seven of the near-term fetuses and in five of the neonates. A narrow pulmonary outflow tract was present in 55% of the fetuses and in 56% of the neonates. The wall of the pulmonary arterial branch was abnormally thick in 19% of the fetuses and in 26% of the neonates, most of which did not have septal defects. In about 80% of the fetuses, the middle latitudinal muscle bundle of the ventricular septum was not continuous with the left ventricular free wall, but rather with the right; after birth, it was discontinuous with both free walls. The heart was abnormally heavy in 49% of the 79 neonates. In about half of the heavy hearts, there were no septal defects or pulmonary valvular and arterial lesions. There were double aortic arches in four and right aortic arches in six of the total WKY fetuses and neonates; the ductus arteriosus was abnormally small in 47% and the aorta was large in 51% of the near-term fetuses. This constellation of congenital heart disease is genetic in origin, but altered by hemodynamics late in fetal life.

Tetralogy of Fallot, pulmonary valve stenosis, ventricular septal defect, and hypertrophic cardiomyopathy in WKY/NCrj rats

We examined anatomically the hearts of 198 WKY/NCrj rats of 20 litters. There were 51 rats with moderate to severe thickening of the pulmonary valve and 19 rats with a ventricular septal defect; the two lesions occurred together in 16 rats, in 15 of which there were overriding of the aorta, stenosis of the pulmonary outflow tract, and hypertrophy of the right ventricle, fulfilling the criteria for tetralogy of Fallot in man. The papillary muscle of the conus was absent in 65 rats. The heart was abnormally heavy in 18. We analyzed the relationship between cardiac hypertrophy and valvular lesions and septal defects in these rats plus 27 selected WKY rats with abnormally heavy hearts. Of the 151 rats with neither severe valvular lesions nor septal defects, six rats had abnormally heavy hearts and 67 rats had disproportionate ventricular septal thickening. This situation in the rats is similar to hypertrophic cardiomyopathy. The occurrence of these abnormalities, isolated or in association, in rats of an established inbred strain strongly suggests that they are etiologically or genetically linked, and that the rats should be a useful animal model for these diseases in man.

[An attempt of thallium-201 myocardial perfusion imaging during transient coronary arterial occlusion by PTCA]

To evaluate the myocardial perfusion during transient coronary occlusion, we attempted to obtain the myocardial scintigraphy during percutaneous transluminal coronary angioplasty (PTCA). Tl-201 was injected at the last inflation of angioplastic balloon and occlusion was kept on for 60 sec. Planar images or SPECT were obtained immediately after PTCA. With this protocol, myocardial perfusion defects were observed during PTCA and fully redistributed 3 hours after Tl injection. Extent of ischemic lesions were almost same as that observed during exercise in two cases without collateral vessels. In a case with well visualized collateral vessels, perfusion defect was smaller in PTCA images than that in exercise stressed images. We conclude that intravenous injection of Tl-201 during PTCA is useful to assess the alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedure.

[Thallium-201 myocardial perfusion imaging during transient coronary occlusion at the time of PTCA: comparison with stress imaging]

To evaluate myocardial perfusion during transient coronary arterial occlusion, thallium-201 was administered intravenously during percutaneous transluminal coronary angioplasty (PTCA) in 12 patients with effort angina, and the resulting perfusion images were compared with those of exercise stress obtained before PTCA. Thallium-201 was injected at the last inflation of an angioplastic balloon and occlusion was maintained for 60 to 90 sec. Three projections of planar images were obtained immediately after PTCA, using a portable gamma camera in an angiography room. These perfusion images obtained during PTCA and exercise were visually interpreted and compared. Myocardial perfusion defects due to the responsible vessel occlusion were observed at early imaging after PTCA, and were fully redistributed three hrs post injection. In 10 patients without angiographically imaged collateral vessels, there were no significant differences in perfusion between images during PTCA and during exercise. Two patients whose collaterals were observed during coronary angiography before PTCA had higher perfusion scores during PTCA than during exercise. We concluded that intravenous injection of thallium-201 during PTCA is a useful means for assessing alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedures, and that it provides more precise information about the jeopardized myocardium, perfused by antegrade blood flow.

Spontaneously occurring hypertrophic cardiomyopathy in the rat. II. Distribution of, and correlations between, various cardiac abnormalities in the WKY/NCrj and its related strains

We performed gross-anatomic and histologic examinations quantitatively on 18 male and 30 female WKY/NCrj rats, and their 299 first generation off spring. The results were analyzed in comparison with those obtained from 3 other strains of rats. The offspring of the WKY rats showed various cardiac abnormalities quite similar to those in their parents. The cardiac abnormalities in the offspring of the WKY rats were: increased heart weight (in about 10%), left or right atrial hypertrophy (50%), disproportionate septal thickening (50%), small left ventricular cavity (40%), right ventricular hypertrophy (40%), abnormal fiber arrangement greater than 5% in either of the 3 ventricular walls (90%), myocardial fibrosis (70%), and abnormal location of arteries in the ventricular septum (30%). ECG findings of the WHY-F rats such as high QRS complexes and high T waves and axis deviation showed a high sensitivity and specificity in the diagnosis of marked cardiac hypertrophy. Another conspicuous histologic finding observed in the WKY hearts was that the continuity of the latitudinal fiber bundle of the ventricular septum with that of the left ventricular free wall, an important functioning unit for pressure generation in the left ventricle, was markedly disturbed in the area of junction between the 2 walls; the smaller the continuity, the greater the cardiac hypertrophy; the disadvantage of the discontinuity for the pressure generation may be related to the development of cardiac hypertrophy. Also examined were two strains of Wistar rats with the same origin as the WKY/NCrj. These rats also had gross-anatomic and histologic abnormalities of the heart quite similar to those in the 2 generations of WKY/NCrj rats, suggesting that a common factor related to the development of the abnormalities, probably a genetic predisposition, has been transmitted in these 3 strains.

[Evaluation of right ventricular function in severe left ventricular failure: comparison of old myocardial infarction with dilated cardiomyopathy]

To evaluate right ventricular (RV) function in severe left ventricular (LV) failure, we measured RV and LV ejection fractions (EF) in 18 patients with old myocardial infarction (OMI) and in 18 with dilated cardiomyopathy (DCM) using cardiac blood pool scintigraphy. In patients with OMI, RVEF was significantly greater in stage II LV failure than in stage III (functional class of the New York Heart Association, 47 +/- 8% and 28 +/- 12%, respectively: p less than 0.01), and this correlated well with exercise tolerance by bicycle ergometer and mean pulmonary artery pressure (r = 0.83 and r = -0.71, respectively). In patients with DCM, however, there was no correlation between RVEF and these indexes. After the oral administration of denopamine (beta 1 effector), both RVEF and LVEF increased in patients with OMI (35 +/- 13% to 45 +/- 12%, and 27 +/- 9% to 30 +/- 10%: p less than 0.01), but they did not change significantly in patients with DCM. These results indicate that RVEF in patients with OMI correlates well with subjective symptoms, exercise tolerance and RV afterload, but these correlations were not apparent in patients with DCM. We concluded that RV function in cases of severe LV failure has a different meaning between OMI and DCM.