Long-term Follow-up Results of Tilt Training in Patients with Neurocardiogenic Syncope

BACKGROUND AND OBJECTIVES: Tilt training as a non pharmacological therapy was recently introduced to treat the patients with neurocardiogenic syncope. Tilt training has been known to prevent neurocardiogenic syncope by desensitizing abnormal autonomic reflex. Herein, the early effect of tilt training and the preventive effect on the relapse of syncope were studied during a long-term follow-up period. SUBJECTS AND METHODS: Fifteen patients (11 males) who experienced recurrent syncope, despite drug treatment or were intolerant to drug treatment, among those diagnosed as neurocardiogenic syncope by the head-up tilt test at Samsung Medical Center between March 2000 and May 2003 were recruited. Each patient underwent tilt training after admission and was educated to continue self-tilt training after discharge. Data for recurrences after discharge were obtained via questionnaires on outpatient visits or by telephone interviews. RESULTS: Eleven (73%) of the 15 who underwent tilt training on admission showed therapeutic effects. The mean follow-up period was 21+/-10 months (5-40 months). Only one patient was excluded due to follow-up loss. Ten of the above patients underwent training by themselves for an average of 4 months after discharge, and experience no relapse of syncope during the follow-up period. CONCLUSION: Tilt training maintained its therapeutic effect during long-term follow-up. This could be a new treatment for patients non responsive or intolerant to medical therapy.

N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Marker in Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Biochemical markers are useful for the prediction of cardiac events in patients with acute coronary syndrome (ACS). The N-terminal fragment of the BNP prohormone (NT-proBNP), which is synthesized by cardiac ventricles in response to increased wall stress, may be a prognostic marker in ACS. The relation between the NT-pro BNP levels on admission and major adverse cardiovascular events (MACEs) were assessed in a cohort of patients with ACS. SUBJECTS AND METHODS: Between October 2002 and April 2004, blood samples for the determination of NT-proBNP level were obtained on admission from 78 patients with ST-elevation myocardial infarction (STEMI), 32 with non-ST elevation MI(NSTEMI) and 66 with unstable angina (UA). Patients were followed concerning MACEs (death, MI, heart failure, stroke and revascularization) for a median of 7 months in median. RESULTS: 22 patients (13%) had events. The mean NT-proBNP level was significantly lower in the event-free survivors than in those with events (1342+/-1598 versus 6129+/-6522 pg/mL, p<0.0001). The optimal cut-off value of the NT-proBNP level using a receiver-operating-characteristic curve was 1445 pg/mL. The unadjusted risk ratio of patients with an NT-proBNP level greater than the threshold was 7.0 (95% confidence interval, 2.6 to 19.0). In a multivariate Cox regression model, including clinical background factors and other biochemical markers, the NT-proBNP level was the most powerful indicator of MACEs (risk ratio, 8.0 [95% confidence interval, 1.7 to 37.1]). The coronary angiographic Gensini score was also a predictor of prognosis in ACS (risk ratio, 3.8 [95% confidence interval, 1.0 to 14.0]). CONCLUSION: A single measurement of the NT-proBNP level on admission appears to be useful as a prognostic factor in the prediction of MACEs in patients after ACS.

Age-Associated Changes in Parameters of Left Ventricular Diastolic Function Assessed by Pulsed Doppler Myocardial Imaging of Mitral Annulus in Healthy Korean Adults

BACKGROUND AND OBJECTIVES: Left ventricular (LV) diastolic function can be evaluated by obtaining parameters from Doppler analysis of the mitral inflow, which are known to change with increase in age. Pulsed Doppler myocardial imaging (DMI) analysis of mitral annular velocity has been proposed as a more accurate method for evaluation of LV diastolic function. This study sought to find out the age-associated changes in parameters of LV diastolic function acquired from pulsed DMI analysis of the mitral annulus in a large group of heathy Korean adults. MATERIALS AND METHODS: Two hundred and eighty-nine apparently healthy Korean subjects who visited the Center for Health Promotion for routine health checkup were studied. All went through pulsed DMI by echcardiography for acquisition of velocities in the septal, lateral, anterior, and inferior annuli of the mitral valve. Peak early diastolic velocity (Em), peak late diastolic velocity (Am), and their ratio (Em/Am) were obtained and their correlation with age was evaluated. Doppler flow analysis of mitral inflow was also performed. Peak early and late diastolic flow velocity (E and A), deceleration time (DT) and isovolumic relaxation time (IVRT) were assessed and their relationship with increase in age was also evaluated. RESULTS: Mean age of the subjects was 55.7+/-10.9. Em velocities of all portions of mitral annulus showed good correlation with age, showing continuous decline with increase in age (R=-0.60, -0.58, -0.59, -0.58 for septal, lateral, anterior and inferior annuli, respectively, p<0.01). Am velocities showed a significant but minimal increase with increase in age in all of the sampled positions. Em/Am ratio also showed a significant decline similar to the change in Em velocities. The A velocity and E/A ratio obtained from mitral inflow Doppler analysis showed a significant decline and DT and IVRT showed a significant increase with increase in age. CONCLUSION: Parameters of left ventricular diastolic function evaluated by pulsed DMI show significant changes that correlate well with increase in age. This supports the finding that left ventricular diastolic function continuously declines with increase in age.

Effect of Local Administration of Lovastatin on Preventing Neointimal Hyperplasia in the Rat Carotid Artery Injury Model

BACKGROUND AND OBJECTIVES: ovastatin, a HMG-CoA reductase inhibitor, is known to show antiproliferative effects on VSMC after vessel injury, but a large amount of the drug is needed orally for this purpose. This study investigated the effects of lovastatin given locally to injured carotid arteries of rats on reducing neointimal hyperplasia. MATERIALS AND METHOD: Lovastatin was given perivascularly to balloon-injured carotid arteries of 21 rats in 1 microM to the low-dose group, and 30 microM to the high-dose group. The control group was treated with pluronic gel only. Two weeks later, the lumen area, neointimal areas and the number of actively proliferating cells were obtained and compared. RESULTS: eointimal area was 0.113+/-0.032 mm2, 0.065+/-0.017 mm2, 0.072+/-0.017 mm2 in the control, low-dose and high-dose groups respectively. The area was significantly smaller in the treatment groups (p<0.05), but no significant difference was observed between the treatment groups. The number of actively proliferating cells per mm2 of neointimal area were 714.5+/-227.4, 688.4+/-333.7, and 1526.3+/-744.0 in the groups respectively, and the number was significantly high in the high-dose group (p<0.05). CONCLUSION: Local administration of lovastatin is effective in reducing neointimal hyperplasia after vascular injury, but extremely high doses are not needed locally for this purpose.