Gene Expression Profile of Volume-Overloaded Human Ventricular Myocardium Prior to Developing Heart Failure

BACKGROUND AND OBJECTIVES: Left ventricle burdened by longstanding volume-overload, undergoes various structural and functional alterations. Accordingly, the expressions of multiple classes of genes are likely to be altered. However, the profile of gene expressions, specifically in a volume-overloaded left ventricle in humans, has not been explored. SUBJECTS AND METHODS: The pattern of gene expression was studied, using a cDNA microarray, in myocardium from 4 normal subjects and 5 patients with chronic regurgitant valvular heart disease whose end-diastolic left ventricular dimension measures 65 mm or more, but whose systolic function remained preserved. RESULTS: We identified 58 differentially expressed genes that were functionally classifiable in the volume-overloaded myocardium. Those genes involved in cell cycle/growth (up/down-regulation: 9/1), signal transduction (4/1) were mostly overexpressed in the volume-overloaded myocardium. The distributions of the gene expressions were variable for those involved in transcription/translation (up/down-regulation: 6/7) and apoptosis (2/2). The genes related to the myocyte structure (troponin T3, tropomyosin, etc)(up/down-regulation: 1/10), as well as those related to metabolism (2/5), were underexpressed. The gene expression patterns from RT-PCR and Western blot, with randomly selected genes, were similar to those from the cDNA microarray. CONCLUSION: Altered expression was identified in multiple genes in the volume-overloaded human left ventricle prior to the development of heart failure. The genes related to cell growth and signal transduction were mostly overexpressed, while those related to cellular structure and metabolism appeared to be underexpressed. These results might help in the elucidation of cellular mechanisms for the remodeling process associated with chronic volume-overloading.

Modes of Cell Death and Survival in Cardiomyocytes Under Various Type of Ischemic Injury

BACKGROUND AND OBJECTIVES: The dominant mode of cell death in cardiomyocytes under acute ischemic insult, either necrosis or apoptosis, remains to be clearly shown. MATERIALS AND METHODS: Cultured neonatal rat ventricular myocytes (NRVM) were incubated under hypoxic (mixture gas of 95%N2/5%CO2 in glucose containing media), ischemic (hypoxia plus glucose depletion in the media), ischemic and acidic conditions (ischemia with media pH 7.1). The level of cell death was assessed by trypan blue staining. To differentiate the mode of cell death, genomic DNA extraction and electrophoresis, Annexin V/propodium iodide staining, western blot for caspase activation and transmission electron microscopy were employed. RESULTS: The number of cell deaths in the NRVM cultured under hypoxic conditions was similar to that of the controls. The rate of cell death was significantly increased in the NRVM cultured under ischemic conditions, and was accelerated further in an acidic milieu, which simulated the accumulation of metabolic byproducts in ischemia. No signs of apoptotic cell death were observed in the NRVM cultured under ischemic conditions. The morphological examination of the cells in ischemia mostly revealed necrotic death. CONCLUSION: The presence of glucose protected the cardiomyocytes from cell death under hypoxic conditions. Incubation of the NRVM in ischemia resulted in increased cell deaths, which was accelerated in an acidic milieu. In our model of acute ischemia, without reoxygenation, the cardiomyocyte cell deaths appeared to be primarily induced via necrosis rather than apoptosis.

A Development of Intelligent Picture Archiving Communication System that Embedded Computer-Aided Diagnosis and Speech Recognition / 대한의료정보학회지

The rapid technological progress in the fields of computer and engineering has accelerated the medical society to introduce a new advanced paradigm in handling medical information. This paper describes a fully integrated Computer Aided Diagnosis, Speech Recognition/PACS system running on a single platform. We feel that the combination of Computer Aided Diagnosis, Speech Recognition and PACS in a fully integrated single platform has created a tremendous synergy, with process improvements that maximize the advantage s of three systems. The Computer Aided Diagnosis and the Speech Recognition included marked improvement in experiments turnaround time and cost saving for departments because of decreased transcription costs. Proposed system should help others complete the task of digitalizing a hospital information system and may be adaptable to other systems as well.

Removal of Dislodged Stent by Using 8 Fr Sheath and Forcep during Transradial Coronary Stenting

Stent dislogement or migration is not a rare complication. Its incidence varies from 1.4% to 8% of the cases. When stent migration occurs, the usual treatment or management is to implant stent in the distal peripheral artery or proximal coronary artery. But, probably the best treatment is safe retrieval of the dislodged stent. During the transfemoral coronary intervention, undeployed stent can be more easily retrieved into the guiding catheter with relatively larger guiding catheter luminal space. Also, larger sheath can be changed more easily when the retrieval of stent is difficult. In the transradial coronary stenting, usual size of guiding catheter is 6 Fr, makes it difficult to retrieve relatively bulky stent when deployment of stent fails. We report 2 cases of stent dislodgment during transradial coronary stenting which can be successfully removed by using myocardial biopsy forcep through 8 Fr sheath. These combination could be one of the valuable methods, especially during transradial stenting.

Usefulness of Deep Seating Technique for Transradial Coronary Intervention

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.

Usefulness of Deep Seating Technique for Transradial Coronary Intervention

BACKGROUND: Smaller guiding catheter had a problem with poor backup support during the transradial coronary intervention which resulted in higher failure rate. This study sought to prove the usefulness of deep seating technique which improves the backup support of the guiding catheter required to deliver interventional materials during the transradial coronary intervention. METHODS: Thirthy-five patients(23 males) were included in this study since March 1998 to August 1999. Clinical presentation of these patients were stable angina(7 patients), unstable angina(17 patients), acute myocardial infarction(11 cases). The mean age was 68+/-8 years. The treated vessel was left anterior descending artery in 22, left circumflex artery in 2 and right coronary artery in 11 of 35 vessels. RESULT: Twenty-six lesions were treated with stents, 3 with PTCA, and 6 with rotablator. Procedural success were achieved in 33 out of 35 cases(94%). Guiding catheters were used mostly with 6 Fr(30/35). In the left coronary system, usual Judkins left type was used in most of the patients(24/26, 92%), and in right coronary Judkins, Amplatz and multipurpose catheters were used similiarly. Hypotension and sinus bradycardia was encountered in one case without clinical significance and there was no dissection in all patients. CONCLUSION: Deep seating technique is a safe and effective technique without major adverse event during the transradial coronary intervention in selected cases.

Outpatient Cardiac Catheterization and Angiography: Safety and Experience with Transradial Approach

BACKGROUND AND OBJECTIVES: The safety and efficacy of outpatient cardiac catheterization was established. We evaluated our patient population and complications selected for outpatient procedures and our experience with transradial approach. MATERIALS AND METHODS: A total of 346 outpatient cardiac catheterization (31% of all diagnosticprocedures),performed with transradial approach, was compared with 788 in patient diagnostic procedures in terms of patient population, clinical and angiographic features, complications of examinations. RESULTS: 1) Indications of outpatient coronary angiography were as follows: follow-up of coronary interventions or bypass surgery (41.6%), recent-onset or aggravated angina (31.2%), atypical chest pain (19.4%), stable angina (3.8%), recent myocardial infarction (2.9%), variant angina (0.9%), preoperative evaluation of valvular or congenital heart disease (0.3%). 2) Significant coronary lesions were found in 216 (62.5%) patients and left main disease in 1 2 (3.5%). Coronary spasm test, internal mammary artery or saphenous vein graft angiography, aorto-ileofemoral angiography, and bilateral carotid angiography were safely performed as indicated. 3) Success rate of examination by primary approach was 94.5%, similar to 94.9% of inpatients. Alternative brachial or femoral approaches were needed in 19 (5.5%) patients. 4) No death, cerebral thromboembolism or myocardial infarction were observed and one-day admission was required in 13 (3.7%) patients. Initial 254 patients (33%) showed good radial pulse (94%), weak or absent radial pulse (6%), abnormal reverse Allen test (6%) up to 61+/-25 days. However, no claudication was observed. CONCLUSION: Cardiac catheterization and angiography was safely performed in the outpatient population selected using much extended inclusion criteria. Transradial approach is useful to set up outpatient procedures with less facilities and personnels and makes it available in the daytime with low readmission rate.

Evaluation of Left Internal Mammary Artery during Right Transradial Coronary Angiography: A New, Fast and Reliable Technique

BACKGROUND: The technique to evaluate left internal mammary artery (LIMA) is not well established during right transradial coronary angiography. MATERIALS AND METHODS: Following coronary angiography via right radial artery, LIMA angiography was performed using 5 French (F) Judkins JL-3.5 catheter in 110 patients (56+/-9 years [range: 46-81], 77 males). Eleven (10%) patients had grafted LIMAs. Subclavian and innominate arteries were moderately tortuous in 14 (13%) patients and aortic arches elongated and more vertically oriented in 16 (15%). The catheter, standing in the ascending aorta with its natural curve, was withdrawn slowly while being rotated clockwise to engage its tip in the proximal left subclavian artery. After the tip portion was adjusted, contrast material was injected while sphyngomanometer cuff inflation applied to the left upper arm. RESULTS: Nonselective LIMA angiography was successfully performed in 108 (98%) patients. The catheter was engaged in the subclavian artery in a mean of 11+/-8 seconds (range: 3-136) from the time when the catheter was withdrawn from the ascending aorta. The image quality of LIMA was satisfactory in 103 (95%) patients and not satisfactory in 5 (5%) in whom the catheter tip was not placed near the origin of LIMA. In ten (91%) of the 11 patients with grafted LIMA, the anastomosis site and distal coronary vessels were well visualized. There were no complications, including arterial dissection and thromboembolism. CONCLUSION: Nonselective technique using 5 F Judkins JL-3.5 catheter is easy, fast, safe and reliable for evaluating LIMA during right transradial coronary angiography.

Outpatient Cardiac Catheterization and Angiography: Safety and Experience with Transradial Approach

BACKGROUND AND OBJECTIVES: The safety and efficacy of outpatient cardiac catheterization was established. We evaluated our patient population and complications selected for outpatient procedures and our experience with transradial approach. MATERIALS AND METHODS: A total of 346 outpatient cardiac catheterization (31% of all diagnosticprocedures),performed with transradial approach, was compared with 788 in patient diagnostic procedures in terms of patient population, clinical and angiographic features, complications of examinations. RESULTS: 1) Indications of outpatient coronary angiography were as follows: follow-up of coronary interventions or bypass surgery (41.6%), recent-onset or aggravated angina (31.2%), atypical chest pain (19.4%), stable angina (3.8%), recent myocardial infarction (2.9%), variant angina (0.9%), preoperative evaluation of valvular or congenital heart disease (0.3%). 2) Significant coronary lesions were found in 216 (62.5%) patients and left main disease in 1 2 (3.5%). Coronary spasm test, internal mammary artery or saphenous vein graft angiography, aorto-ileofemoral angiography, and bilateral carotid angiography were safely performed as indicated. 3) Success rate of examination by primary approach was 94.5%, similar to 94.9% of inpatients. Alternative brachial or femoral approaches were needed in 19 (5.5%) patients. 4) No death, cerebral thromboembolism or myocardial infarction were observed and one-day admission was required in 13 (3.7%) patients. Initial 254 patients (33%) showed good radial pulse (94%), weak or absent radial pulse (6%), abnormal reverse Allen test (6%) up to 61+/-25 days. However, no claudication was observed. CONCLUSION: Cardiac catheterization and angiography was safely performed in the outpatient population selected using much extended inclusion criteria. Transradial approach is useful to set up outpatient procedures with less facilities and personnels and makes it available in the daytime with low readmission rate.

Evaluation of Left Internal Mammary Artery during Right Transradial Coronary Angiography: A New, Fast and Reliable Technique

BACKGROUND: The technique to evaluate left internal mammary artery (LIMA) is not well established during right transradial coronary angiography. MATERIALS AND METHODS: Following coronary angiography via right radial artery, LIMA angiography was performed using 5 French (F) Judkins JL-3.5 catheter in 110 patients (56+/-9 years [range: 46-81], 77 males). Eleven (10%) patients had grafted LIMAs. Subclavian and innominate arteries were moderately tortuous in 14 (13%) patients and aortic arches elongated and more vertically oriented in 16 (15%). The catheter, standing in the ascending aorta with its natural curve, was withdrawn slowly while being rotated clockwise to engage its tip in the proximal left subclavian artery. After the tip portion was adjusted, contrast material was injected while sphyngomanometer cuff inflation applied to the left upper arm. RESULTS: Nonselective LIMA angiography was successfully performed in 108 (98%) patients. The catheter was engaged in the subclavian artery in a mean of 11+/-8 seconds (range: 3-136) from the time when the catheter was withdrawn from the ascending aorta. The image quality of LIMA was satisfactory in 103 (95%) patients and not satisfactory in 5 (5%) in whom the catheter tip was not placed near the origin of LIMA. In ten (91%) of the 11 patients with grafted LIMA, the anastomosis site and distal coronary vessels were well visualized. There were no complications, including arterial dissection and thromboembolism. CONCLUSION: Nonselective technique using 5 F Judkins JL-3.5 catheter is easy, fast, safe and reliable for evaluating LIMA during right transradial coronary angiography.

Quadricuspid Aortic Valve: Report of Two Cases

Quadricuspid aortic valve is an uncommon congenital anomaly and cause of aortic regurgitation. We report two cases of quadricuspid aortic valve with aortic regurgitation. Case 1, a 51-year-old woman was admitted to our hospital for fatigue and chest tightness. She had to and fro murmur along the left sternal border. Transthoracic echocardiography and transeso- phageal echocardiography showed grade 2-3 aortic regurgitation with quadricuspid aortic valve. The aortic valve consisted of four cusps of equivalent size(Hurwitz type a). Case 2, a 35-year-old man was admitted to our hospital for exertional dyspnea and chest tightness. He had grade 4/6 to and fro murmur along the left sternal border. Transthoracic echocardiography showed grade 4 aortic regurgitation with suggested quadricuspid aortic valve. The aortic valve consisted of two equal larger cusps and two equal smaller cusps and a supernumerary cusp located between the right and noncoronary cusps(Hurwitz type c). He was performed aortic valve replacement with a 21 mm On-X valve.

Coronary Flow Patterns in the Coronary Artery Narrowings

BACKGROUND: Coronary blood flow shows phasic and diastolic dominant flow pattern in normal coronary artery, which can be changed in coronary artery stenosis. We measured and analysed coronary blood flow velocity by Doppler-tipped guidewire to clarify the change of flow pattern in the proximal and distal segments of coronary narrowings. METHODS: Coronary flow velocity were measured by 0.018 or 0.014 inch Doppler-tipped guidewire in 14 paients, 17 sites(LCS 11, RCA 6) in the proximal and distal segment of coronary narrowings, during coronary angiography or coronary angioplasty after bolus intracoronary infusion of 20microg nitroglycerine. Coronary flow reserve also measured after adenosine intracoronary infusion(LCA 12gmicrog, RCA 6microg). Perent stenosis of coronary artery was measured by digital cailper in 2 different projections and averaged. RESULTS: 1) The was no significant correlation between percent stenosis and proximal distal velocity ratio(P/D) ration(r=0.56. P>0.05). 2) Average peak velocity(APV, cm/sec) and diastolic artery, respectively(p0.01). 3) Coronary flow reserve(CFR) was significantly lower in significant coronary stenotic patients compared to insignificant stenotic patients(1.8 vs 3.6, P<0.01). CONCLUSION: Coronary flow velocity measurement by Doppler dipped guidewire gave us physiologic information. We think it could be used as an important tool to assess the significance of the intermediate coronary narrowings and the effect of conorary angioplasty.

Recanalization of Acute Coronary Closure during Cardiopulmonary Resuscitation : Guiding Catheter Induced Embolization during PTCA Procedure

Acute coronary closure occurs 2-10% during the procedure of PTCA, 50-80% of those events are in the catheterization room. The causes of acute coronary closure are mainly due to dissection, thrombosis or spasm. We recently experienced a case of acute left main coronary artery closure due to guiding catheter induced embolization in the 56 year-old female, unstable angina patient complicated by diabetes mellitus and chronic renal failure. The patient received cardiopulmonary resuscitation shortly after acute closure because of cardiac arrest. During the resuscitation, we performed PTCA at the site of acute closure. The blood pressure maintained normaly after successful recanalization. And then we inserted IABP(intraaortic balloon pump) balloon and did PTCA of original stenosis sites. The patient removed IABP 24 hours later and discharged a month later without complication.

Intravascular Ultrasonographic Detection of Atherosclerotic Lesions in Spastic Segments of the Coronary Arteries in Patients with Variant Angina

Coronary artery spasm plays an important role for evoking myocardial ischemia and infarction as well as sudden cardiac death in patients with variant angina. The coronary anatomy in patients with variant angina has been defined both at autopsy and during coronary arteriography. Severe porximal coronary atherosclerosis of at least one major vessel occurs in 3/4 of patients and the remainder have normal coronary arteries. Coronary angiography is a relatively insensitive diagnostic tool especially in the early stages of coronary artery disease. Due to arterial remodelling, angiographic luminogram may show little or no narrowing even though a large part of the total vessel area is occupied by plaque. Intravascular ultrasonography(IVUS) enables accurate determination of vessel dimensions and wall characteristics and is more sensitive in delineating early intimal changes than angiography. We experienced 2 cases that IVUS showed focal or diffuse atherosclerosis in spastic segments of the coronary arteries, even though they appeared angiographically normal.

Efficacy of Interavascular Ultrasound in the Palmaz-Schatz Stent Implantation: Clinical Experience of 3 Coronary Artery Disease Patients

Intravascular ultrasound is a usful too to assess the adequate stent strut expansion after stent implantation and nowadays it can bo also used as a dicision making method about omitting anticoagulant therapy. We used intravascular ultrasound before and after Palmz-schatz stent implantation in 3 patients with coronary artery narrowings and analysed serial post porcedure lumen diameter, cross sectional area. We think it is a useful tool to assess the effect of stent implantation and post stent balloon dilatation.

The study of the left ventricular diastolic function in the patients with dilated cardiomyopathy / 대한내과학회지

No abstract available.

Therapeutic efficacy of trimetazidine on angina pectoris

BACKGROUND: Trimetazidine 1(2, 3, 4 trimethoxybenzyl)-piperazine dihydrochloride has shown improved exercise tolerance and delayed ischemic threshold in patients with effort angina. But, unlike other classical antianginal drugs, it netiher reduces oxygen consumption nor increases the blood supply. Its effects could be attributed to protection of the myocardial cell function during ischemia, preventing the fall of ATP, reducing intracellular acidosis and subsequently preventing the accumulation of sodium and calcium in the myocyte. METHODS: We investigated the antianginal efficacy of trimetazidine(Vastinan) in 36 patients(22 males, 14 females, mean age of 56.5 year) who had positive exercise stress test among those with typical effort anginal symptoms from Feb, 1992 to Oct, 1992. These patients received 60mg trimetazidine per day(20mg tid) for 1 month and then exercise stress test, routine hematologic examination and urinalysis were performed at the beginning and at the end of therapeutic examination and urinalysis were performed at the beginning and at the end of therapeutic period. The results were as follows. RESULTS: In exercise parameters, there were 19.2% increase in total work, 30.3% increase in exercise duration and 13% shortening in the normalization time of depressed ST-segment and these were no significant change in hemodynamic parameters(heart rate, blood pressure and maximum Rpp(rate pressure product)(p>0.05). The characters of chest pain were changed in the 19 patients, complete disappearance in 4 patients, reduction of intensity or frequency in 12 patients and aggravation in 3 patients. 2 patients complained of mild epigastric discomfort. There were no significant changes in hematologic findings and urinalysis. CONCLUSIONS: Trimetazidine 60mg per day was efficient in patients with angina and more observations are necessary in assessing the long-term therapeutic efficacy and side effects of this drug.