Volume 82, Number 1 July 1990

CirculationEl Research Advances SeriesUnderstanding the Coronary Circulation Through Studies at the Microvascular Level

Melvin L. Marcus, William M Chilian, Hiroshi Kanatsuka, Kevin C. Dellsperger, Charles L. Eastham,and Kathryn G. Lamping . .............................................................. 1

CLINICAL INVESTIGATIONDetection of Enterovirus RNA in Myocardial Biopsies From Patients With Myocarditis andCardiomyopathy Using Gene Amplification by Polymerase Chain Reaction

Ou Jin, MD, Michael J. Sole, MD, Jagdish W Butany, MD, Wah-Kiam Chia, MSc,Peter R. McLaughlin, MD, Peter Liu, MD, and Choong-Chin Liew, PhD .......... ................. 8

Clinical TrialAntiplatelet Treatment With Ticlopidine in Unstable Angina: A Controlled Multicenter Clinical Trial

Francesco Balsano, MD, Paolo Rizzon, MD, Francesco Viol, MD, Domenico Scrutinio, MD,Claudio Cimminiello, MD, Franco Aguglia, MD, Carlo Pasotti, MD, Giusi Rudelli PhD, andthe Studio della Ticlopidina nellAngina Instabile Group ............ ............................... 17

5-Year Incidence of Atherosclerotic Vascular Disease in Relation to General Risk Factors, InsulinLevel, and Abnormalities in Lipoprotein Composition in Non-Insulin-Dependent Diabetic andNondiabetic Subjects

Matti I.J. Uusitupa, MD, Leo K Niskanen, MD, Onni Siitonen, MD, Erkki Voutilainen, MD,and Kalevi Pybrild, MD . .............................................................. 27

Insulin-Dependent Diabetes Mellitus Mortality: The Risk of Cigarette SmokingClaudia Scala Moy, PhD, Ronald E. LaPorte, PhD, Janice S. Dorman, PhD, Thomas J. Songer, MPH,Trevor J. Orchard, MMBCh, MMedSci, Lewis H. Kuller, MD, DrPH,Dorothy J. Becker, MMBCh, MMedSci, FCP, and Allan L. Drash, MD ....... ..................... 37

Comparison of ST Segment/Heart Rate Index to Standard ST Criteria for Analysis of ExerciseElectrocardiogram

Bruce Lachterman, MD, Kenneth G. Lehmann, MD, Robert Detrano, MD, PhD, Joel Neutel, MD, andVictor F. Froelicher, MD . ............................................................. 44

Clinical Features of Amiodarone-Induced Pulmonary ToxicityRaymond E. Dusman, MD, Marshall S. Stanton, MD, William M Miles, MD, Lawrence S. Klein, MD,Douglas P. Zipes, MD, Naomi S. Fineberg, PhD, and James J. Heger, MD ....... .................. 51

Effect of Atrioventricular Interval During Pacing or Reciprocating Tachycardia on Atrial Size,Pressure, and Refractory Period: Contraction-Excitation Feedback in Human Atrium

Lawrence S. Klein, MD, William M. Miles, MD, and Douglas P. Zipes, MD ....... ................. 60

Coronary Atherectomy: Clinical, Angiographic, and Histological Findings and ObservationsRegarding Potential Mechanisms

Robert D. Safian, MD, Joseph S. Gelbfish, MD, Raymond E. Emy, MD, Stuart J. Schnitt, MD,Dwayne A. Schmidt, MD, and Donald S. Baim, MD ............. ............................... 69

Diagnosis of Coronary Artery Disease by Controlled Coronary Vasodilation With Adenosine andThallium-201 Scintigraphy in Patients Unable to Exercise

Mario S. Verani, MD, John J. Mahmarian, MD, Judy B. Hixson, RN, Tem M Boyce, BS, CNMT, andRichard A. Staudacher, MD ............................................................. 80

Restrictive Diastolic Abnormalities Identified by Doppler Echocardiography in Patients WithThalassemia Major

Paolo Spirito, MD, Gabriele Lupi, MD, Caterina Melevendi, MD, and Carlo Vecchio, MD ..... ....... 88

Assessment of Abnormal Systolic Intraventricular Flow Patterns by Doppler Imaging in PatientsWith Left Ventricular Dyssynergy

Paul J. Garrahy, MB, BS, Oi Ling Kwan, BS, David C. Booth, MD, and Anthony N. DeMaria, MD .... 95

Salt and Water Retention and Calcium Blockade in UremiaGerard M. London, MD, Sylvain J. Marchais, MD, Alain P. Guerin, MD, Fabien Metivier, MD,Michel E. Safar, MD, Francoise Fabiani, MD, and Loetizia Froment, MD ......................... 105

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Effect of Age on the In Vitro Reflection Coefficient of the Aortoiliac Bifurcation in HumansS.E. Greenwald, PhD, A.C. Carter, BSc, and C.L. Beny, MD, PhD .............................. 114

Preoperative Risk Evaluation and Stratification of Long-term Survival After Valve Replacement forAortic Stenosis: Reasons for Earlier Operative Intervention

Ole Lund, MD ........ 124

Granulocyte Activation After Coronary Angioplasty in HumansStefano De Servi, MD, Antonino Mazzone, MD, Giovanni Ricevuti, MD, Angela Fioravanti, BSc,Ezio Bramucci, MD, Luigi Angoli, MD, Ghio Stefano, MD, and Giuseppe Specchia, MD ..... ....... 140

Attenuated Forearm Vasodilative Response to Intra-Arterial Atrial Natriuretic Peptide in PatientsWith Heart Failure

Yoshitaka Hirooka, MD, Akira Takeshita, MD, Tsutomu Imaizumi MD, Satoshi Suzuki, MD,Megumu Yoshida, MD, Shin-ichi Ando, MD, and Motoomi Nakamura, MD ....................... 147

Left Ventricular Volume Measurement Using Cardiac Axis Nuclear Magnetic Resonance Imaging:Validation by Calibrated Ventricular Angiography

Gregory B. Cranney, MBBS, FRACP, Chaim S. Lotan, MD, Lany Dean, MD, William Baxley, MD,Alain Bouchard, MD, and Gerald M. Pohost, MD .............. ............................... 154

LABORATORY INVESTIGATIONInhibition of Clot-Bound a2-Antiplasmin Enhances In Vivo Thrombolysis

Guy L. Reed III, MD, Gary R. Matsueda, PhD, and Edgar Haber, MD .. ......................... 164

Acceleration of Recombinant Tissue-Type Plasminogen Activator-Induced Thrombolysis and Pre-vention of Reocclusion by the Combination of Heparin and the Arg-Gly-Asp--Containing PeptideBitistatin in a Canine Model of Coronary Thrombosis

Ronald J. Shebuski, Inez J. Stabilito, Gary R. Sitko, and Mark H. Polokoff ...... .................. 169

Dietary Fish Oil Accelerates the Response to Coronary Thrombolysis With Tissue-Type PlasminogenActivator: Evidence for a Modest Platelet Inhibitory Effect In Vivo

Gregory A. Braden, MD, Howard R. Knapp, MD, PhD, Desmond J. Fitzgerald, MD, andGarret A. FitzGerald, MD . ........................................................... 178

Threshold Concentrations of Endothelin-1 Potentiate Contractions to Norepinephrine and Seroto-nin in Human Arteries: A New Mechanism of Vasospasm?

Zhihong Yang, MD, Vincent Richard, PhD, Ludwig von Segesser, MD, Erwin Bauer, MD, Peter Stulz, MD,Marko Turina, MD, and Thomas F. Luscher, MD ............... .............................. 188

Cardiorenal Actions of Neutral Endopeptidase Inhibition in Experimental Congestive Heart FailurePatricia G. Cavero, MD, Kenneth B. Margulies, MD, Joseph Winaver, MD, Andrea A. Seymour, PhD,Norma G. Delaney, PhD, and John C. Burnett Jr., MD ............ ............................. 196

Determination of Right Ventricular Mass in Humans and Dogs With Ultrafast Cardiac ComputedTomography

Zina D. Hajduczok, MD, RobertM Weiss, MD, William Stanford, MD, and Melvin L. Marcus, MD ... 202Premature Escape Beats: A Model for Triggered Activity in the Intact Heart?

Marc A. Vos, PhD, Anton P.M. Gorgels, MD, Bram de Wit, MD, Joost P.H. Drenth, MD,Ronald T.A.M. van Deursen, MS, Jet D.M Leunissen, and Hein J.J. Wellens, MD ...... ............ 213

a-Adrenoceptor Stimulation and Blockade Modulates Cesium-Induced Early Afterdepolarizationsand Ventricular Tachyarrhythmias in Dogs

Joseph Ben-David, MD, and Douglas P. Zipes, MD ............ ................................ 225

Premature Escape Beats Induced by Overdrive Pacing in Canine Purkinje Fibers: Evidence for theRole of Normal Automaticity as an Underlying Cellular Mechanism

Victor A. Molina Viamonte, MD, and Michael R. Rosen, MD ........ ........................... 234

Mechanism of Cardiac Defibrillation in Open-Chest Dogs With Unipolar DC-Coupled SimultaneousActivation and Shock Potential Recordings

Francis X Witkowski, MD, Patricia A. Penkoske, MD, and Robert Plonsey, PhD ...... ............. 244

Inhibition of Platelet Adhesion to Surfaces of Extracorporeal Circuits by Disintegrins: RGD-Containing Peptides From Viper Venoms

Jacek Musial, MD, Stefan Niewiarowski, MD, PhD, Boguslaw Rucinski, MD, PhD,Gwendolyn J. Stewart, PhD, Jacquelynn J. Cook, PhD, Janice A. Williams, PhD,and L. Henry Edmunds Jr., MD ............................................................ 261

Effects of Flecainide and Quinidine on Human Atrial Action Potentials: Role of Rate-Dependenceand Comparison With Guinea Pig, Rabbit, and Dog Tissues

Zhiguo Wang, MSc, L. Conrad Pelletier, MD, Mario Talajic, MD, and Stanley Nattel, MD ..... ...... 274

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Point of ViewToward a New Understanding of the Mechanism and Prevention of Sudden Death in Coronaiy Heart Disease

Sidney Goldstein, MD ..................... .............................................. 284

Brief Rapid CommunicationBlock ofDelayed Rectifier Potassium Current, 'K, by Flecainide and E-4031 in Cat Ventricular Myocytes

Christopher H. Follmer, PhD, and Thomas J. Colatsky, PhD .................................... 289

Editorial CommentsOf Molecules and Myocardium: PCR Diagnosis of Viral Myocarditis in Cardiac Biopsies

Robert S. Ross, MD, and Kenneth R. Chien, MD, PhD ......................................... 294Ticlopidine in Unstable Angina: A More Expensive Aspirin?

Garret A. FitzGerald, MD ................... .............................................. 296The Compelling Case for Smoking Cessation in Diabetics

Barbara V Howard, PhD, and Wm. James Howard, MD ....................................... 299The Academic Life Cycle of a Noninvasive Test

David B. Pryor, MD . ..................................................................... 302Efficacy and Safety of Coronary Balloon Angioplasty and Directional Atherectomy

L. David Hillis, MD . ...................................................................... 305Vasodilator Myocardial Imaging

Bertram Pitt, MD . ....................................................................... 308Timing of Valve Replacement for Aortic Stenosis

E. William Hancock, MD .................. ............................................... 310Inhibitors of ANF Metabolism: Potential Therapeutic Agents in Cardiovascular Disease

Joey P. Granger, PhD . ..................................................................... 313

Letters to the EditorThe Patient's Right to Know

Charles Fisch, MD . ...................................................................... 316Reply

George J. Klein, MD, E.N. Prystowsky, MD, R. Yee, MD, A.D. Sharma, MD, A. Laupacis, MD ...... 316A New Method for Estimating Left Ventricular dP/dt by Continuous Wave Doppler Echocardiography

James J. Sheridan, MB, MRCPI ................ ............................................ 316Reply

Gian Siro Bargiggia, MD, Carla Bertucci, MD, Franco Recusani MD, Arturo Raisaro, MD,Stefano de Servi, MD, Lilliam M. Valdes-Cruz, MD, David J. Sahn, MD, and Luigi Tronconi, MD ... 317

INSTRUCTIONS TO AUTHORS ................ ............................................ A15ANNOTATED TABLE OF CONTENTS ...................................................... A19ABSTRACT FILE CARDS. ................................................................... A47NEWS FROM THE AMERICAN HEART ASSOCIATION ..................................... A80MEETINGS CALENDAR

Domestic ................................................................................ A89Abroad ........................................A3

HYPERTENSION TABLE OF CONTENTS ................ ........................ A101STROKE TABLE OF CONTENTS ........................................ A105INDEX TO ADVERTISERS ........................................ A108

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Volume 82, Number 2 August 1990

Circulation

Research Advances SeriesGenetic Mechanisms That Determine Oxidative Capacity of Striated Muscles: Control of GeneTranscription

R Sanders Williams, MD .................... .............................................. 319Role of Neural Crest in Congenital Heart Disease

Margaret L. Kirby, PhD, and Karen L. Waldo, MS ........................................... 332

CLINICAL INVESTIGATIONAssessment and Follow-up of Pediatric Survivors of Sudden Cardiac Death

Michael J. Silka, MD, Jack Kron, MD, Charles G. Walance, BS, Joel E. Cutler, MD,and John H. McAnulty, MD ................ ............................................... 341

Electrophysiological Testing and Nonsustained Ventricular Tachycardia: Use and Limitations inPatients With Coronary Artery Disease and Impaired Ventricular Function

David J. Wilber, MD, Brian Olshansky, MD, John F. Moran, MD, and Patrick J. Scanlon, MD ..... ..... 350Determinants of Hemodynamic Compromise With Severe Right Ventricular Infarction

James A. Goldstein, MD, Benico Barzilai, MD, Thomas L. Rosamond, MD, Paul R. Eisenberg, MD,and Allan S. Jaffe, MD . .................................................................. 359

Cardiac Abnormalities in Systemic Lupus Erythematosus: Association With Raised AnticardiolipinAntibodies

Petros Nihoyannopoulos, MD, Patricia M. Gomez, MD, Jayshree Joshi, BSc (Hon), Sozos Loizou, MSc,Mark J. Walport, PhD, MRCP, and Celia M. Oakley, MD, FRCP ................................ 369

Clinical TrialIntravenous Recombinant Tissue-Type Plasminogen Activator in Patients With Unstable AnginaPectoris: Results of a Placebo-Controlled, Randomized Trial

David 0. Williams, MD, Eric J. Topol, MD, Robert M Califf, MD, Robert Roberts, MD,G.B. John Mancini, MD, John M. Joelson, MD, Stephen G. Ellis, MD, Neal S. Kleiman, MD,and Coinvestigators . ....................................................................... 376

Attenuated Vasodilator Responses to Mg2` in Young Patients With Borderline HypertensionToshiro Fujita, Yasushi Ito, Katsuyuki Ando, Hiroshi Noda, and Etsuro Ogata ..... ................ 384

A Hemodynamically Responsive Antitachycardia System: Development and Basis for Design in HumansTodd J. Cohen, MD, and L. Bing Liem, DO ................................................. 394

Sites of Conduction Block in Accessory Atrioventricular Pathways: Basis for Concealed AccessoryPathways

Karl-Heinz Kuck MD, Karen J. Friday, MD, Klaus-Peter Kunze, MD, Michael Schluter, PhD,Ralph Lazzara, MD, and Warren M Jackmnan, MD ............................................ 407

Catheter Ablation of Mahaim Fibers With Preservation of Atrioventricular Nodal ConductionMichel Haissaguerre, MD, Jean-Franqois Warin, MD, Philippe Le Metayer, MD, Luc Maraud, MD,Luc De Roy, MD, Paul Montserrat, MD, and Jean-Paul Massiere, MD ............................. 418

Vascular Prostacyclin Is Increased in Patients Ingesting w-3 Polyunsaturated Fatty Acids BeforeCoronary Artery Bypass Graft Surgery

Raffale DeCaterina, MD, Daniela Giannessi, DSc, Annamaria Mazzone, MD, Walter Bemini,Guido Lazzerini, Stefano Maffei, MD, Maurizio Cerni, MD, Leonardo Salvatore, MD,and Babette Wekler, MD . ................................................................ 428

Automated Quantitation of Indexes of Coronary Lesion Complexity: Comparison Between PatientsWith Stable and Unstable Angina

Steven J. Kalbfieisch, MD, Mark J. McGillem, BS, Sandra B. Simon, MA, Scott F. DeBoe, BS,Ibraim M.F. Pinto, MD, and G.B. John Mancini, MD, FACC ................................... 439

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Prediction of Successful Outcome in 130 Patients Undergoing Percutaneous Balloon Mitral ValvotomyVivian M Abascal, MD, Gerard T Wilkins, MBChB, John P. O'Shea, MBBS,Christopher Y Choong, MBBChir, PhD, Igor F. Palacios, MD, James D. Thomas, MD, Emma Rosas, MD,John B. Newell, BS, Peter C. Block MD, and Arthur E. Weyman, MD .............................. 448

Noninvasive Evaluation of Sympathetic Nervous System in Human Heart by Positron EmissionTomography

Markus Schwaiger, MD, Victor Kalff MD, Karen Rosenspire, PhD, Michael S. Haka, PhD, Edgar Molina,BS, Gary D. Hutchins, PhD, Michael Deeb, MD, Edwin Wolfe Jr., MS, and Donald M. Wieland, PhD ... 457

Muscle Blood Flow During Forearm Exercise in Patients With Severe Heart FailureJ. Malcolm 0. Amold, MD, Jorge P. Ribeiro, MD, DSc, and Wilson S. Colucci, MD ..... ........... 465

Effect of 3-Adrenergic Blockade on Myocardial Function and Energetics in Congestive HeartFailure: Improvements in Hemodynamic, Contractile, and Diastolic Performance With Bucindolol

Eric J. Eichhom, MD, John B. Bedotto, MD, Craig R. Malloy, MD, Barbara A. Hatfield, RN,David Deitchman, PhD, Marilyn Brown, RN, BSN, John E. Willard, MD, and Paul A. Graybum, MD .. 473

Natural History of Left Ventricular Size and Function After Acute Myocardial Infarction: Assess-ment and Prediction by Echocardiographic Endocardial Surface Mapping

Michael H. Picard, MD, Gerard T. Wlkins, MB, ChB, Patricia A. Ray, BS, and Arthur E. Weyman, MD .. 484

Atherogenic Lipoprotein Phenotype: A Proposed Genetic Marker for Coronary Heart Disease RiskMelissa A. Austin, PhD, Mary-Claire King PhD, Karen M Vranizan, MA, and RonaldM Krauss, MD .... 495

Isolated Noncompaction of Left Ventricular Myocardium: A Study of Eight CasesThomas K Chin, MD, Joseph K Perloff, MD, Roberta G. Williams, MD, Kenneth Jue, MD,and Renee Mohrmann, MD ................. ............................................... 507

Doppler-Derived Rate of Left Ventricular Pressure Rise: Its Correlation With the Postoperative LeftVentricular Function in Mitral Regurgitation

Ramdas G. Pai, MD, MRCP, Ramesh C. Bansal, MD, and Pravin M. Shah, MD ..... .............. 514Long QT Syndrome: New Electrocardiographic Characteristics

Jesaia Benhorin, MD, Mario Merri, PhD, Michela Alberti, MS, Emanuela Locati, MD, Arthur J. Moss, MD,WJ. HalL PhD, and L. Cui, A4 ............... ............................................. 521

LABORATORY INVESTIGATIONRelative Roles of Ca2+-Dependent and Ca2`-Independent Mechanisms in Hypoxic ContractileDysfunction

Yukihiro Koretsune, MD, PhD, and Eduardo Marban, MD, PhD ................................. 528

Intermittent Perfusion of Ischemic Myocardium: Possible Mechanisms of Protective Effects onMechanical Function in Isolated Rat Heart

Masato Tani, MD, and James R. Neely, PhD ................................................. 536

In Vivo Induction of "Focal" Triggered Ventricular Arrhythmias and Responses to Overdrive Pacingin the Canine Heart

Tetsushi Furukawa, MD, Shinichi Kimura, MD, Agustin Castellanos, MD, Arthur L. Bassett, PhD, andRobert J. Myerburg, MD ................... ................................................ 549

Adjuvant Therapy for Intracoronary Stents: Investigation in Atherosclerotic SwineGeorge P. Rodgers, MD, Steven T Minor, MD, Keith Robinson, PhD, Douglas Cromeens, DVM,Samuel C. Woolbert, MD, L. Clifton Stephens, DVM, PhD, John R. Guyton, MD, Kenneth Wright, PhD,Gary S. Roubin, MD, PhD, and Albert E. Raizner, MD ......................................... 560

Heparin-Resistant Thrombus Formation by Endovascular Stents in Baboons: Interruption by aSynthetic Antithrombin

William C. Krupski, Arie Bass, Andrew B. Kelly, Ulla M Marzec, Stephen R. Hanson,and Laurence A. Harker .................................................................. 570

Inhibition of Thrombus Formation by Activated Recombinant Protein C in a Primate Model ofArterial Thrombosis

Andrds Gndber, MD, Stephen R Hanson, PhD, Andrew B. Kelly, DVM, Betty S. Yan, PhD, Nils Bang, MD,John H. Gniffin, PhD, and Laurence A. Harker, MD ............................................ 578

Ischemia-Reperfusion Impairs Endothelium-Dependent Relaxation of Coronary Microvessels butDoes Not Affect Large Arteries

James E. Quillen, MD, Frank W Sellke, MD, Leonard A. Brooks, and David G. Harrison, MD ....... 586

Combined Adenosine and Lidocaine Administration Limits Myocardial Reperfusion InjuryJonathon W Homeister, BA, Paul T. Hoff;MS, David D. Fletcher, BA,and Benedict R. Lucchesi, PhD, MD ................ ........................................ 595

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Myocardial Protection With PreconditioningGeorge C. Li MD, Juan A. Vasquez, BS, Kim P. Gallagher, PhD,and Benedict R. Lucchesi, PhD, MD .. 609

Brief Rapid CommunicationMyocardial Catecholamine Content After Heart Transplantation

Vera Regitz, MD, Claus Bossaller, MD, Rudolf Strasser, MD, Stephan Schuiler, MD, Roland Hetzer, MD,and Eckart Fleck MD . ................................................................... 620

EditorialCardiovascular Effects of Fish Oils: Beyond the Platelet

Alexander Leaf MD. ...................................................................... 624

Editorial CommentsSudden Cardiac Death in Children

Thomas S. Klitzner, MD, PhD . .............................................................. 629The Approach to Nonsustained Ventricular Tachycardia After a Myocardial Infarction

Hein J. Wellens, MD ..................................................................... 633Antiphospholipid Antibodies: A Marker of Lupus Carditis?

Robert A. O'Rourke, MD .................................................................. 636Another Piece of the Fish Oil Puzzle

Gregory J. Dehmer, MD, FACC, FACP ................ ...................................... 639Percutaneous Mitral Balloon Valvulotomy or Balloon Valvuloplasty? It's Not Just SemanticsAnymore

Mark L. Smucker, MD .................................................................... 643False Adrenergic Transmitters and Positron Emission Tomographic Imaging of MyocardialSympathetic Innervation

Irwin J. Kopin, MD ....................................................................... 646New Lipoprotein Profiles and Coronary Heart Disease: Improving Precision of Risk

P.J.Nestel, MD ..............649Mechanical Dysfunction of the Heart During and After Ischemia: Unraveling the Causes

William H. Bany, MD .............. 652Prevention of Thrombosis and Rethrombosis: New Approaches

Marschall S. Runge, MD, PhD. .................................................... 655The Surgically Denervated, Transplanted Human Heart

Michael R Bristow, MD, PhD. ................................................... 658

Letters to the EditorMaximal Exercise Testing Safety

Lawrence P. Cahalin, PT, CCS and Raymond L. Blessey, PT, MA4 ......... ...................... 661Robert Roberts, MD .................................................... 661Christer Sylve MD, PhD and Bo Lagerquist, MD. ............................................. 662

ReplyFilippo Crea, MD, FACC and Attilio Maseri, MD, FRCP, FACC .......... ...................... 663

Circulation (ISSN 0009-7322) Published monthly at the Scientific Publishing Office, American Heart Association, 7320 Greenville Avenue,Dallas, TX 75231-4599. Annual subscriptions accepted at any time. For European rates and subscription information, contact us directly:Scientific Publishing, American Heart Association, 7320 Greenville Avenue, Dallas, TX 75321-4599. Telephone: (214) 706-1310. Fax: (214)691-2704. All orders for Japan must be sent to Nankodo Co., Ltd., 42-6 Hongo 3-chome, Bunkyo-ku, Tokyo 113, Japan. Individuals maysubscribe to Circulation for their personal use at the following rates: $84 in the United States; $133 for all other countries except Japan. Interns,residents, and medical students (United States, Canada, or Mexico only) are eligible for a reduced rate if payment is accompanied by a letterfrom the department chairman verifying post held and completion date. Special reduced rates are $42 in the United States, $66.50 in Canadaand Mexico. Contact AlA for subscription rates for libraries, reading rooms, and other multiple-use institutions. Prepayment is required. Makechecks, drafts, post office or express money orders payable to the American Heart Association in U.S. dollars drawn on U.S. bank, withCirculaiion on the face of the check. We accept VISA or MasterCard. Please include account number, expiration date, and name as it appearson card. Issues will be mailed after payment is received. Prices are subject to change without notice. Singfe copy rates are available on request.Second class postage paid at Dallas, Texas, and additional mailing offices. POSTMASTER: Send address changes to Circulation, AmericanHeart Association, Scientific Publishing, 7320 Greenville Avenue, Dallas, TX 75231-4599, or call (214) 706-1310. Fax: (214) 691-2704. Pleaseadvise the Scientific Publishing Department of address changes as soon as possible. To expedite delivery, provide both old and new addresses.

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Special ReportACC/AHA Guidelines for the Early Management of Patients With Acute Myocardial Infarction

Subcommittee Members Rolf M. Gunnar, MD, FACC, Chairman; Patrick D.V. Bourdillon, MD,FACC; Donald W. Dixon, MD, FACC; Valentin Fuster, MD, FACC; Robert B. Karp, MD, FACC;J. Ward Kennedy, MD, FACC; Francis J. Klocke, MD, FACC; Eugene R. Passamani, MD, FACC;Bertram Pitt, MD, FACC; Elliot Rapaport, MD, FACC; T. Joseph Reeves, MD, FACC;Richard 0. Russell Jr., MD, FACC; Burton E. Sobel, MD, FACC;and William L. Winters Jr., MD, FACCTask Force Members Charles Fisch, MD, FACC, Chairman; George A. Beller, MD, FACC;Roman W. DeSanctis, MD, FACC; Harold T. Dodge, MD, FACC; J. Ward Kennedy, MD, FACC;T. Joseph Reeves, MD, FACC; and Sylvan Lee Weinberg, MD, FACC ......................... 664

INSTRUCTIONS TO AUTHORS ................ ............................................ A15ANNOTATED TABLE OF CONTENTS ............ .......................................... A19ABSTRACT FILE CARDS. ................................................................... AS1NEWSFROM THE AMERICAN HEART ASSOCIATION ..................................... A78

MEETINGS CALENDARDomestic ............................................................................. A81Abroad ..................................................................... ........ A85CIRCULATION RESEARCH TABLE OF CONTENTS .......................................... A88

HYPERTENSION TABLE OF CONTENTS .................................................... A93INDEX TO ADVERTISERS . ................................................................ A96

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Volume 82, Number 3 September 1990

CirculationU Clinical Progress SeriesClinical Applications of Transesophageal Echocardiography

Masunori Matsuzaki, MD, Yoichi Toma, MD, and Reizo Kusukawa, MD .......................... 709

S Research Advances SeriesMechanism of Myocardial "Stunning"

Roberto Bolli, MD . ....................................................................... 723

CLINICAL INVESTIGATIONIncidence and Consequences of Periprocedural Occlusion: The 1985-1986 National Heart, Lung,and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry

Katherine M. Detre, MD, DrPH, David R. Holmes Jr., MD, Richard Holubkov, MS, Michael J. Cowley, MD,Martial G. Bourassa, MD, David P. Faxon, MD, Gerald R. Dorros, MD, Lamberto G. Bentivoglio, MS, MD,KennethM Kent, MD, RichardK Myler, MD, and coinvestigators of the National Heart, Lung, and BloodInstitute's Percutaneous Transluminal Coronary Angioplasty Registry ............................... 739

Double-Umbrella Closure of Atrial Defects: Initial Clinical ApplicationsJonathan J. Rome, MD, John F. Keane, MD, Stanton B. Perny, MD, Philip J. Spevak; MD,and James E. Lock, MD .................................................................. 751

Early Diagnosis of Acute Myocardial Infarction Based on Assay for Subforms of CreatineKinase-MB

Peter R. Puleo, MD, Philip A. Guadagno, MS, Robert Roberts, BSc, MD, Mary V. Scheel, BS,Ali J. Marian, MD, David Churchill, MD, andM Benjamin Pertyman, PhD ...... ................. 759

Clinical TrialsPrevention of Early Aortocoronary Bypass Occlusion by Low-Dose Aspirin and Dipyridamole

Gines Sanz, MD, Antonio Pajaron, MD, EduardoAlegria, MD, Ignacio Coello, MD, Mariona Cardona, MD,Juan Antonio Fournier, MD, Manuel Gomez-Recio, MD, Javier Ruano, MD, Ricardo Hidalgo, MD,Alfonso Medina, MD, Gloria Oller, MD, Thieny Colman, MD, Felix Malpartida, MD, Xavier Bosch, MD,and the Grupo Espafzol para el Seguimiento del Injerto Coronario (GESIC) ...... ................. 765

Multicenter Trial of Oral Enoximone in Patients With Moderate to Moderately Severe CongestiveHeart Failure: Lack of Benefit Compared With Placebo

Bany F. Uretsky, MD, ManellJessup, MD, MarvinA. Konstam, MD, G. Wlliam Dec, MD, Carl V Leier, MD,Joseph Benotti, MD, Srinivas Murali MD, Howard C. Herrmann, MD, and JamesA. Sandberg, MD, forthe Enoximone Multicenter Trial Group ...................................................... 774

Consequences of Reocclusion After Successful Reperfusion Therapy in Acute Myocardial InfarctionE. Magnus Ohman, MB, RobertM Calif MD, Eric J. Topol, MD, Richard Candela, MD,Charles Abbottsmith, MD, Stephen Ellis, MD, Kristina N. Sigmon, MA, Dean Kereiakes, MD,Barny George, MD, Richard Stack, MD, and the TAMI Study Group ............................. 781

Atrial Enlargement as a Consequence of Atrial Fibrillation: A Prospective Echocardiographic StudyAnthony J. Sanfilippo, MD, Vivian M. Abascal4 MD, Mary Sheehan, RN, Lynn B. Oertel, RN,Pamela Hamgan, RDCS, RobertA. Hughes, MD, and Arthur E. Weyman, MD ...... ................. 792

Left Ventricular Ejection Performance, Wall Stress, and Contractile State in Aortic RegurgitationBefore and After Aortic Valve Replacement

Kazuhiro Taniguchi, MD, Susumu Nakano, MD, Yasunaru Kawashima, MD, Kei Sakat, MD,Tomohide Kawamoto, MD, Shigehiko Sakaki, MD, Junjiro Kobayash4 MD, Shizuo Morimoto, MD,and Hikaru Matsuda, MD . ................................................................. 798

An Evaluation of Right and Left Ventricular Function After Anatomical Correction and Intra-AtrialRepair Operations for Complete Transposition of the Great Arteries

Robin P. Martin, MRCP, Shakeel A. Qureshi, MRCP, Jose A. Ettedgui, MD, Edward J. Baker, MD,Bemie J. O'Brien, PhD, Philip B. Deverall, FRCS, Alan K. Yates, FRCS, Michael N. Maisey, FRCP,Rosemary Radley-Smith, FRCP, Michael Tynan, FRCP, and Magdi H. Yacoub, FRCS ..... ......... 808

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Modification of Human Atrioventricular Nodal Function by Selective Atrioventricular Nodal ArteryCatheterization

Paul J. Wang, MD, Guillenno Sosa-Suarez, MD, and Peter L. Friedman, MD, PhD ..... ............ 817

Spontaneous Variability in Ventricular Ectopic Activity During Chronic Antiarrhythmic TherapyJeffrey L. Anderson, MD, Maria I. Anastasiou-Nana, MD, Ronald L. Menlove, PhD, Fidela Ll. Moreno, MD,John N. Nanas, MD, and Allan H. Barker, MD ............................................... 830

Fibrinopeptide A Levels Indicative of Pulmonary Vascular Thrombosis in Patients With PrimaryPulmonary Hypertension

Paul R. Eisenberg, MD, MPH, Charles Lucore, MD, Lisa Kaufinan, RN, Burton E. Sobel, MD,Allan S. Jaffe, MD, and Stuart Rich, MD .................................................... 841

A Comparison of the Pathological Spectrum of Hypertensive, Diabetic, and Hypertensive-DiabeticHeart Disease

KH. van Hoeven, MD, and Stephen M Factor, MD ........................................... 848

Baroreflex Control of Muscle Sympathetic Nerve Activity in Borderline HypertensionRobert F. Rea, MD, and Mohamed Hamdan, MD ............................................. 856

Altered Cardiovascular and Neurohumoral Responses to Head-up Tilt AfterHeart-Lung Transplantation

Nicholas R. Banner, BM, MRCP, TD. Meurig Williams, MD, MRCP, Naina Patel, BSc,Julie Chalmers, BSc, Stafford L. Lightman, FRCP, and Magdi H. Yacoub, FRCS ..... .............. 863

Left Ventricular Diastolic Function: Doppler Echocardiographic Changes Soon After CardiacTransplantation

Frederick G. St. Goar, MD, Rebecca Gibbons, RDMS, Ingela Schnittger, MD, Hannah A. Valantine, MD,MRCP, and Richard L. Popp, MD .............. ............................................ 872

Body Surface Mapping of Ectopic Left and Right Ventricular Activation: QRS Spectrum in PatientsWithout Structural Heart Disease

Ame SippensGroenewegen, MD, Hans Spekhorst, MD, NorbertM van Hemel, MD, J. Herre Kingma, MD,Richard N. W. Hauer, MD, Michiel J. Janse, MD, and Arend J. Dunning, MD ...... ................. 879

Circadian Variation of Acute Myocardial Infarction and the Effect of Low-Dose Aspirin in aRandomized Trial of Physicians

PaulM Ridker, MD, JoAnn E. Manson, MD, Julie E. Buring, ScD, James E. Muller, MD,and Charles H. Hennekens, MD ............................................................ 897

Perioperative Myocardial Infarction After Coronary Artery Bypass Surgery: Clinical Significanceand Approach to Risk Stratification

Thomas Force, MD, Patrcia Hibberd, MD, Gary Weeks, MD, AndrewJ. Kemper, MD, Peter Bloomfield, MB,Donald Tow, MD, Miguel Josa, MD, Shukri Khuri, MD, and Alfred F. Parisi, MD .................. 903

Reversal of Segmental Hypokinesis by Coronary Angioplasty in Patients With Unstable Angina,Persistent T Wave Inversion, and Left Anterior Descending Coronary Artery Stenosis: AdditionalEvidence for Myocardial Stunning in Humans

Jean Renkin, MD, William Wijns, MD, Zaqui Ladha, BS, and Jacques Col, MD ..... .............. 913

Activation and Decreased Deformability of Neutrophils After Intermittent ClaudicationFranz-Josef Neumann, MD, Wolfgang Waas, MD, Curt Diehm, MD, Thomas Weiss, MD,Heide-Marlen Haupt, Rainer Zimmermann, MD, Harald Tillmanns, MD, and Wolfgang Kubler, MD ... 922

LABORATORY INVESTIGATIONThrombolytic Activity of a Novel Plasminogen Activator, LY210825, Compared With RecombinantTissue-Type Plasminogen Activator in a Canine Model of Coronary Artery Thrombosis

Charles V Jackson, PhD, V: Gail Crowe, BS, Trelia J. Craft, BS, Jackie L. Sundboom, MS,Brian W. Grinnell, PhD, J. Lee Bobbitt, PhD, Philip J. Burck, PhD, John F. Quay, PhD,and Gerald F. Smith, PhD . ............................................................... 930

Incidence of Sudden Cardiac Death Associated With Coronary Artery Occlusion in Dogs WithHypertension and Left Ventricular Hypertrophy Is Reduced by Chronic f-Adrenergic Blockade

Kevin C. Dellsperger, MD, PhD, James B. Martins, MD, Jennifer L. Clothier, BA,and Melvin L. Marcus, MD . ............................................................... 941

Morphological and Electrophysiological Correlates of Atrioventricular Nodal Response to IncreasedVagal Activity

Shotaro Imaizumi, MD, Todor Mazgalev, PhD, Leonard S. Dreifus, MD, Eric L. Michelson, MD,Akihiko Miyagawa, MD, Saroja Bharati, MD, and Maurice Lev, MD ............................. 951

Ventricular Refractory Period Extension Caused by Defibrillation ShocksRobert J. Sweeney, PhD, RobertM Gill, BS, Mitchell I. Steinberg, PhD, and Philip R. Reid, MD ...... 965

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Elastase-Induced Experimental Aneurysms in RatsSamy Anidjar, Jean-Loup Salzmann, Dianiele Gentric, Pierre Lagneau, Jean-Pierre Camilleri,and Jean-Baptiste Michel .................................................................. 973

Immunosuppression With High Doses of Cyclophosphamide Reduces the Severity of Myocarditis butIncreases the Mortality in Murine Coxsackievirus B3 Myocarditis

Chiharu Kishimoto, MD, PhD, Kathryn A. Thorp, BA, and Walter H. Abelmann, MD ...... ......... 982

Assessment of Regional Myocardial and Renal Blood Flow With Copper-PTSM and PositronEmission Tomography

Marc E. Shelton, MD, Mark A. Green, PhD, Carla J. Mathias, BA, Michael J. Welch, PhD,and Steven R Bergmann, MD, PhD ........................................................ g90

Technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile and Thallium-201 Extraction, Washout,and Retention at Varying Coronary Flow Rates in Rabbit Heart

Robert C. Marshall, MD, Edwin M Leidholdt Jr., PhD, Dan-Ya Zhang, BA, and Charles A. Bamett, MD 998

Pericardial Prostaglandin Biosynthesis Prevents the Increased Incidence of Reperfusion-InducedVentricular Fibrillation Produced by Efferent Sympathetic Stimulation in Dogs

Toshihisa Miyazaki, MD, and Douglas P. Zipes, MD .......................................... 1008

Does Reperfusion Extend Necrosis?: A Study in a Single Territory of Myocardial Ischemia-HalfReperfused and Half Not Reperfused

William Ganz, MD, CSc, Ikuyoshi Watanabe, MD, Ken Kanamasa, MD, Juliana Yano, BS,Dong-Sun Han, MD, and Michael C. Fishbein, MD .......................................... 1020

Brief Rapid CommunicationsObservations on Electrode-Tissue Interface Temperature and Effect on Electrical Impedance DuringRadiofrequency Ablation of Ventricular Myocardium

David E. Haines, MD, and Anthony F. Verow, BA ........................................... 1034

Editorial CommentsAcute Coronary Occlusion After Percutaneous Transluminal Coronary Angioplasty: EvolvingStrategies and Implications

Daniel L. Kulick, MD, and Shahbudin H. Rahimtoola, MB, FRCP .1039Transcatheter Closure of Atrial Septal Defects: Past, Present, and Future

Albert P. Rocchini, MD .1044

Antiplatelet Therapy to Prevent Coronary Artery Bypass Graft OcclusionJulie E. Buring, DSc, and Charles H. Hennekens, MD, DrPH.1046

Enoximone in Chronic Heart FailureH.J.C. Swan, MD, PhD .1049

Aortic Regurgitation: A Lesion With Similarities to Both Aortic Stenosis and Mitral RegurgitationBlase A. Carabello, MD .............................................. .. ... .......... 1051

A Tale of the Spontaneous Variability of Premature Ventricular ContractionsKoonlawee Nademanee, MD. 1054

Baroreceptors and HypertensionRonald G. Victor, MD, and Barbara J. Morgan, PhD . 1057

Inverted T Waves: An Electrocardiographic Marker of Stunned or Hibernating Myocardium in Man?Robert A. Kloner, MD, PhD . 1060

Molecular Biologic Modification of Plasminogen Activators: An Artful ScienceJoseph Loscalzo, MD, PhD ............................................................... 1062

Refractoriness Prolongation by Defibrillation ShocksFrancis X. Witkowski, MD, and Patricia A. Penkoske, MD . 1064

Technetium-99m MIBI As a Myocardial Perfusion AgentJames T. Willerson, MD. 1067

Does Reperfusion Induce Myocardial Necrosis?Tetsuji Miura, MD, PhD . 1070

Is Diagnostic Certainty Essential for the Use ofThrombolytic Therapy During Myocardial Infarctionin the 1990s?

E. Magnus Ohman, MD, Kristina N. Sigmon, MA, and Robert M. Califf, MD ....... .............. 1073

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Letters to the EditorCoronary Excimer Laser Angioplasty

Karl R. Karsch, MD .............. ........................................ 1076

Positron Emission TomographyMalcolm R Bell, MBBS, FRACP, and John A. Rumberger, PhD, MD ....... .................... 1076

dP/dt and Isovolumic Pressure DeclineMichael A. Fifer, MD .............. ....................................... 1076

ReplyWalter J. Paulus, MD, PhD, and Stanislas U. Sys, PhD ............. ........................... 1077

ERRATA ..................................................... 1078

AHA Medical/Scientific StatementSpecial Report:The Healthy American Diet .................. ................................... 1079

INSTRUCTIONS TO AUTHORS. ..................................................... A19ANNOTATED TABLE OF CONTENTS ..................................................... A24ABSTRACT FILE CARDS ............... ...................................... A59NEWS FROM THE AMERICAN HEART ASSOCIATION ........ ............................. A91MEETINGS CALENDAR

Domestic ............................................. A99Abroad .............................................. A103

HYPERTENSION TABLE OF CONTENTS. ............................................. A107CIRCULATION RESEARCH TABLE OF CONTENTS ......................................... AlllINDEX TO ADVERTISERS ............................................. A116

Circulation (ISSN 0009-7322) Published monthly at the Scientific Publishing Office, American Heart Association, 7320 Greenville Avenue,Dallas, TX 75231-4599. Annual subscriptions accepted at any time. For European rates and subscription information, contact us directly:Scientific Publishing, American Heart Association, 7320 Greenville Avenue, Dallas, TX 75321-4599. Telephone: (214) 706-1310. Fax: (214)691-2704. All orders for Japan must be sent to Nankodo Co., Ltd., 42-6 Hongo 3-chome, Bunkyo-ku, Tokyo 113, Japan. Individuals maysubscribe to Circulation for their personal use at the following rates: $84 in the United States; $133 for all other countries except Japan. Interns,residents, and medical students (United States, Canada, or Mexico only) are eligible for a reduced rate if payment is accompanied by a letterfrom the department chairman verifying post held and completion date. Special reduced rates are $42 in the United States, $66.50 in Canadaand Mexico. Contact AHA for subscription rates for libraries, reading rooms, and other multiple-use institutions. Prepayment is required. Makechecks, drafts, post office or express money orders payable to the American Heart Association in U.S. dollars drawn on U.S. bank, withCirculation on the face of the check. We accept VISA or MasterCard. Please include account number, expiration date, and name as it appearson card. Issues will be mailed after payment is received. Prices are subject to change without notice. Single copy rates are available on request.Second class postage paid at Dallas, Texas, and additional mailing offices. POSTMASTER: Send address changes to Circulation, AmericanHeart Association, Scientific Publishing, 7320 Greenville Avenue, Dallas, TX 75231-4599, or call (214) 706-1310. Fax: (214) 691-2704. Pleaseadvise the Scientific Publishing Department of address changes as soon as possible. To expedite delivery, provide both old and new addresses.

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82 (1)

Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 1990 American Heart Association, Inc. All rights reserved.

is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231Circulation 1990;82:1-317Circulation. 

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