著者

Hiroshi Imamura Yukio Sekiguchi Tomomi Iwashita Hiroshi Dohgomori Katsunori Mochizuki Kazunori Aizawa Shin-ichi Aso Yuichi Kamiyoshi Uichi Ikeda Jun Amano Kazufumi Okamoto

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.75, no.1, pp.59-66, 2011 (Released:2010-12-24)

参考文献数

37

被引用文献数

45 66 29

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Background: Acute aortic dissection (AAD) classically presents as sudden, severe chest, back, or abdominal pain. However, there have been several documented cases presenting with atypical features. The clinical characteristics and outcomes of patients with painless AAD were investigated. Methods and Results: The study group comprised 98 patients (53 males, 45 females; 66±12 years) with AAD admitted to hospital from 2002 to 2007: 16 patients (17%) had no pain (Painless group) and 82 patients had pain (Painful group). In 81% of the Painless group and 70% of the Painful group there was a type A dissection. The Painless group more frequently had a persistent disturbance of consciousness (44% vs. 6%, P<0.001), syncope (25% vs. 1%, P<0.001) and a focal neurologic deficit (19% vs. 2%, P=0.006) as presenting symptoms. Imaging study findings were not significantly different. Cerebral ischemia (50% vs. 1%, P<0.001) and cardiac tamponade (38% vs. 13%, P=0.01) were more frequent complications in the Painless group. In-hospital mortality was not significantly different (19% vs. 15%). However, the Painless group had a more unfavorable functional outcome on overall performance category (P<0.001). Conclusions: Painless AAD may be more frequent than previously reported. Painless AAD patients often present with a disturbance of consciousness or a neurologic deficit, and have a higher morbidity than painful AAD patients. (Circ J 2011; 75: 59-66)

著者

Mafumi Owa Kazunori Aizawa Nobuyuki Urasawa Hiroyuki Ichinose Kazuya Yamamoto Koji Karasawa Mitsuru Kagoshima Jun Koyama Shu-ichi Ikeda

出版者

日本循環器学会

雑誌

JAPANESE CIRCULATION JOURNAL (ISSN:00471828)

巻号頁・発行日

vol.65, no.4, pp.349-352, 2001 (Released:2001-06-01)

参考文献数

13

被引用文献数

66 105

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Four patients had the clinical features of `ampulla cardiomyopathy', consisting of acute-onset transient left ventricular apical akinesis with basal normokinesis, normal coronary angiogram, ST-segment elevation and subsequent giant T wave inversion, which mimicked acute coronary syndrome, the onset of which occurred shortly after extreme mental stress. Myocardial necrosis was minimal, although 2 patients showed elevated serum catecholamine levels in the acute phase. Each patient underwent serial cardiac radionuclide single-photon emission computed tomography of myocardial functional sympathetic innervation, fatty acid metabolism and perfusion using I-123-metaiodobenzyl-guanidine (MIBG), I-123-β-metyl-iodophenyl pentadecanoic acid (BMIPP) and thallium-201 (201Tl), respectively. In the acute phase, MIBG and BMIPP imaging showed an uptake defect in the apical region, whereas 201Tl uptake was mildly decreased. When assessed semi-quantitatively, the MIBG images had higher defect scores from the acute phase throughout the year of observation compared with BMIPP, and 201Tl. These observations suggest that the primary cause of ampulla cardiomyopathy is related to a disturbance of the cardiac sympathetic innervation. (Jpn Circ J 2001; 65: 349 - 352)