Prospective Study to Evaluate the Efficacy and Safety of Pitavastatin in Patients with Risk Factor of Cardiovascular Disease(PEACE Study)

BACKGROUND AND OBJECTIVES: Pitavastatin, a recently approved synthetic 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, is known to effectively treat hypercholesterolemia. The goal of this study was to investigate the efficacy and safety of pitavastatin in hyperlipidemic Korean patients with coronary risk factors. SUBJECTS AND METHODS: This was an 8-week, prospective, multicenter, open-label clinical trial. The study subjects were hyperlipidemic Korean patients (triglyceride 130 mg/dL, age; 45-75 years) with at least two coronary risk factors. After a 2-week wash out period, the eligible subjects were given 2 mg of pitavastatin once daily for 8 weeks. In the case of the patients with LDL-cholesterol > or = 100 mg/dL after the first 4 weeks of treatment, the dose of pitavastatin was increased to 4 mg per day for the remaining 4 weeks. RESULTS: Of the 131 patients initially enrolled, 105 completed the study. Among the lipid profiles, the total cholesterol, triglyceride, and LDL-cholesterol levels showed a significant reduction with mean reduction rates of -30.66%, -23.92%, and -41.06%, respectively, after 8 weeks. Interestingly, the HDL-cholesterol level was significantly increased in the subjects with a low HDL-cholesterol level (HDL-cholesterol < 40 mg/dL) after 8 weeks of therapy (35.28+/-4.38 mg/dL to 40.39+/-6.45 mg/dL, 15.9%, p=0.001). The proportions of patients who achieved the LDL-cholesterol goal of the National Cholesterol Education Program Adult Treatment Panel III were 72.5% (37/51), 93.6% (44/47), and 100.0% (7/7) for the patients with goals of 100 mg/dL, 130 mg/dL, and 160 mg/dL, respectively. Five patients had mild adverse drug events, such as fatigue, itching, myalgia, and anorexia. No significant abnormalities were detected in the laboratory tests, including the liver function test and creatinine kinase level. CONCLUSION: The HMG-CoA reductase inhibitor, pitavastatin, was highly effective and generally well tolerated with an acceptable safety profile in hyperlipidemic Korean patients with coronary risk factors.

A Comparison of Tenecteplase(TNK-tPA) and Alteplase(rt-PA) in Korean Patients with Acute Myocardial Infarction(A Randomized, Multi-Centered Coronary Angiographic Trial)

BACKGROUND AND OBJECTIVES: This is a comparative, randomized, multi-centered, angiographic trial for the comparison of TNK-tPA with rt-PA, in Korean patients with an acute myocardial infarction (AMI). SUBJECTS AND METHODS: Fifty four patients that were eligible for thrombolysis, diagnosed with an AMI, were randomized into two groups:TNK-tPA (single bolus injection, 25-50 mg weight adjusted;n=25) or rt-PA (accelerated intravenous infusion, up to 100 mg;n=29) at the emergency room. The primary endpoint was the percentage of patients with a TIMI (Thrombolysis In Myocardial Infarction) III flow 90 min following the administration of the study drug. The secondary endpoints were an infarct-related artery patency at 90 min, the percentage of patients with ST segment resolution at 60 and 180 min, and at 30 days mortality. RESULTS: The baseline demographic data, including age, sex and body weight, and a medical history of prior myocardial infarction and risk factors were no different between the TNK-tPA and rt-PA groups. The pain-to-needle and door-to-needle times were also no different. The ST segment resolution was no different between the two groups. A TIMI grade 3, on a coronary angiogram, 90 min following the drug administration, was observed in 19 (76.0%) of the TNK-tPA and 17 (58.6%) of the rt-PA (p=0.24) patients. However, a TIMI grade more than 2 was higher in the TNK-tPA (100%;25/25) than in rt-PA group (72.4%;21/29)(p=0.0052). The in-hospital adverse events, and clinical outcomes at 30 days, were no different between the two groups. CONCLUSION: TNK-tPA is more convenient, and may be a preferred thrombolytic agent, for the revascularization of an AMI.

Multicenter Clinical Trial of Atorvastatin in Patients with Hypercholesterolemia

BACKGROUND & OBJECTIVES: The aim of this study was to investigate the efficacy & safety of a new HMG-CoA reductase inhibitor, atorvastatin, to improve serum lipid profiles in patients with primary hypercholesterolemia. MATERIALS AND METHODS: Three hundred and six patients from 21 hospitals, all with total cholesterol level over 240 mg/dl and triglyceride level below 400 mg/dl were enrolled in the study. Following diet therapy for 2 weeks, atorvastatin 10 mg was taken for 6 weeks if the total cholesterol level remained higher than 240 mg/dl. The percent change of total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol from baseline to 6 weeks of treatment were evaluated. Patients were monitored for safety through careful history talking, physical examination, serum sampling for liver and muscle enzyme. RESULTS: 1) The study was completed in a total of 166 patients. The mean age of patients the was 58 1/2 years and the percent of male and female patients was 37%, 37% and 63%, respectively. 2) The baseline mean values of total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol following diet therapy for 2 weeks were 280+/-34 mg/dl, 172+/-77 mg/dl, 190+/-35 mg/dl, 56+/-13 mg/dl, respectively. 3) After 6 weeks treatment, the level of total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol were 195+/-34 mg/d, 150+/-67 mg/dl, 110+/-33 mg/dl, 55+/-12 mg/dl, respectively, and the rates of change were -30%, -7%, -42%, -0.2%, respectively. 4) The level of LDL-cholesterol at the end of treatment was below 100 mg/dl in 44%, 100-130 mg/dl in 33%, 130-160 mg/dl in 14%, over 160 mg/dl in 9% of patients. 5) 77% of total patients achieved the target goal of LDL cholesterol (below 130 mg/dl) according to the NCEP guideline. 6) The reduction rate of LDL-cholesterol was different among the patients. At the end of treatment, the patients with initial LDL-cholesterol below 100 mg/dl achieved a higher reduction rate (52%) as compared with those patient's inithal LDL-cholesterol level were higher. 7) There are was only 1 patient (0.6%) who showed 3 times a three-fold increase of liver enzyme and no patient showed an increase of creatine kinase. CONCLUSION: Atorvastatin is effective and safe in improving the lipid profiles in of patients with hypercholesterolemia without serious side effects. (Korean Circulation J 2001;31 (4):434-441)

Evaluation of Endotheial Function in Normal Korean Adults and in Patients with Essential Hypertension

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been recently proposed as a noninvasive means for assessing endotheial function. This endothelial function is impaired in certain cardiovascular conditions, including essential hypertension. METHODS: The study population included 50 healthy subjects aged 22 to 62 years (mean+/-SD, 42+/-12 years), all normotensive, nondiabetic with cholesterol level 0.05). 4) Flow-mediated dilatation was significantly lower in patients with essential hypertension than in normotensive control subjects (4.2+/-0.8 vs. 7.3+/-1.3 %, p0.05). CONCLUSIONS: The study demonstrated that 1) in men older than 40 years, flow-mediated, endothelium-dependent vasodilation of the brachial artery was declined, 2) longer brachial artery occlusion resulted in more vasodilation despite similar hyperemic responses, 3) using low (30 mm Hg higher than systolic pressure) and high (70-90 mm Hg higher than systolic pressure) pressure, each pressure of occlusion was similar hyperemic response, and 4) in patients with essential hypertension, flow-medeiated vasodilation was significantly impaired and IMT was increased than in normotensive control subjects.

Plasma Concentration of Atrial and Brain Natriuretic Peptides in the Patients with Essential Hypertension

BACKGROUND: Left ventricular hypertrophy(LVH) is one of the complications of hypertension and has been known as an independent risk factor of cardiovascular complications. Recently, it has been reported that hypertensive patients with LVH had the most advanced extracardiac target-organ damage compared with other groups. Previous reports have shown that mean plasma atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) levels in hypertensive patients are higher than in normotensive subjects. Therefore, in this study, we investigated the relationships between the plasma ANP and BNP levels and the degree of LVH in hypertensive patients and in normotensive subjects and also investigated the clinical significance of measurement of plasma ANP and BNP levels. METHODS: In all study subjects, left ventricle mass index(LVMI) and left ventricle geometry were measured by M-mode echocardiography. Measurements were made by the recommendations of the American Society of Echocardiography. Plasma ANP and BNP levels were measured by radioimmunoassay method. RESULTS: 1) 57% of the hypertensive patients had eccentric hypertrophy and 6% had concentric hypertrophy. 2) LV mass and LVMI of normotensive subjects and hypertensive patients were 169+/-53 g, 229+/-64 g and 99+/-27.3 g/m2, 142+/-37.7 g/m2, respectively(P<0.05). 3) There were statistically significant correlations between blood pressure and LVMI in all subjects(r=.43, P<0.05). 4) Plasma ANP levels were significantly increased in hypertensive patients than normotensive subjects (28.2+/-14.3 pg/mL and 42.8+/-26 pg/mL, respectively; P<0.05). 5) Plasma BNP levels were significantly increased in hypertensive patients than normotensive subjects (18.4+/-5.4 pg/mL and 36.5+/-26 pg/mL; respectively, P<0.05). 6) Plasma BNP levels were significantly increased in 63% of the hypertensive patients with LVH(P<0.05). 7) There were statistically significant correlations between blood pressure and plasma ANP and BNP levels(ANP:r=.39, p<0.05, BNP:r=.31, P<0.05). CONCLUSIONS: Plasma ANP and BNP levels were increased in the hypertensive patients but only plasma BNP levels were significantly increased in the hypertensive patients with LVH. Measurement of plasma BNP levels may be useful for early detection of LVH, an independent risk factor of cardiovascular complications. Therefore intensive blood pressure control in these patients may reduce cardiovascular morbidity and mortality.

Korean multicenter clinical trial of simvastatin ( KS-1 study ) / 대한내과학회지

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.

Korean multicenter clinical trial of simvastatin ( KS-1 study ) / 대한내과학회지

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.

Clinical Investigation of P Wave Amplitude and Atrial Synchronous Ventricular Pacing in Different Body Position and Physical Activity with a Single-Pass Lead VDD Pacing

BACKGROUND: Single pass lead VDD pacing preserves atrioventricular synchrony with a single lead system which incorporates floating atrial electrodes. The objectives of this study were to measure whether different body postures and physical activities cause significant changes of the atrial electrogram amplitudes and to evaluate the effectiveness of its atrial sensing, ventricular sensing and pacing. METHOD: Prospective study was done in 7 patients with high degree AV block and normal sinus node function in whom a single lead VDD pacing system was implanted. The P wave amplitude was been measured in different condition during follow-up period. RESULTS: 1) During follow-up period, the P wave amplitude showed variation with changes in posture and respiration, but there was no consistent increase or decrease in amplitude. The lowest P wave amplitude was above the minimal atrial sensing value of 0.2 mV. 2) The percentage of atrial synchronous ventricular pacing recorded in Holter ECG and during Treadmill exercise test was more than 99%. 3) Atrial oversensing or VA cross sensing were not observed in any of the patients. CONCLUSIONS: Despite floating atrial electrode, the single pass lead VDD pacing maintains reliable atrial sensing and ventricular pacing in different body position and physical activity, so it may offer an excellent alternative in patients with high grade AV block and intact sinus node function.

Clinical Investigation of P Wave Amplitude and Atrial Synchronous Ventricular Pacing in Different Body Position and Physical Activity with a Single-Pass Lead VDD Pacing

BACKGROUND: Single pass lead VDD pacing preserves atrioventricular synchrony with a single lead system which incorporates floating atrial electrodes. The objectives of this study were to measure whether different body postures and physical activities cause significant changes of the atrial electrogram amplitudes and to evaluate the effectiveness of its atrial sensing, ventricular sensing and pacing. METHOD: Prospective study was done in 7 patients with high degree AV block and normal sinus node function in whom a single lead VDD pacing system was implanted. The P wave amplitude was been measured in different condition during follow-up period. RESULTS: 1) During follow-up period, the P wave amplitude showed variation with changes in posture and respiration, but there was no consistent increase or decrease in amplitude. The lowest P wave amplitude was above the minimal atrial sensing value of 0.2 mV. 2) The percentage of atrial synchronous ventricular pacing recorded in Holter ECG and during Treadmill exercise test was more than 99%. 3) Atrial oversensing or VA cross sensing were not observed in any of the patients. CONCLUSIONS: Despite floating atrial electrode, the single pass lead VDD pacing maintains reliable atrial sensing and ventricular pacing in different body position and physical activity, so it may offer an excellent alternative in patients with high grade AV block and intact sinus node function.

Study of 24 Hour Ambulatory Blood Pressure Monitoring in Acute Stroke Patients

OBJECTIVE: Appropriate evaluation of hypertension is important in the patients with a stroke because hypertension is a major cause of a stroke. Blood pressure may be falsely elevated or depressed immediately after a stroke, depending on the severity of neurological deficit, mobility, and physical activity, and the level of consciousness. To overcome this problem, ambulatory blood pressure monitoring (ABPM) has been proposed as a method of obtaining a more accurate clinical assessment. SUBJECTS AND METHODS: The present study was performed in an acute stage of stroke patients to assess the manifestation of 24 hour ambulatory blood pressure, to observe the nocturnal blood pressure fall and to evaluate the relationship of blood pressure degree on admission and nocturnal blood pressure dip. Thirty four patients admitted within 24 hours after onset of acute stroke were involved in this study. 24 Hour blood pressure monitoring device was installed on an independent arm by oscillometric method as soon as brain imaging study was performed. ABPM readings were obtained each 30 minutes during daytime and each 1 hour during nighttime with electrocardiography. Each patients were classified as the presence or absence of hypertension. We examined nocturnal blood pressure dip and mean pressure of 24 hour ambulatory blood pressure. RESULTS: 1)This study demonstrated that comparing daytime with nighttime 24 hour ambulatory blood pressure, 20 of 24 patients (83%) with acute stroke with hypertension, did not show nocturnal blood pressure dip, and there was sustained high nocturnal blood pressure in patients with acute stroke with hypertension. 2)There were significant differences between 24 hour ambulatory mean daytime blood pressure and mean nighttime blood pressure in patients with acute stroke without hypertension, so was lower in nighttime (p<0.05). 3)It is likely that in acute stroke patients with hypertension, patients with higher blood pressure on admission had more abnormality of nocturnal blood pressure dip. CONCLUSION: These results suggest that in patients with acute stroke, 24 hour ABPM is useful method to assess diurnal variation and evaluate hypertension in acute stage of stroke patients, and suggest that patients with acute stroke with hypertension trend to loss of nocturnal blood pressure dip.

ST Segment Depression in Lateral Leads in Inferior Wall Acute Myocardial Infarction

BACKGROUND: The electrocardiogram may provide valuable information regarding the identity of the culprit coronary artery and the location of obstructing lesion within the artery, which may be of guidance in selecting the therapeutic modality. Previous studies have concluded that changes in lateral leads (I, aVL, V5, V6) are predictive of left circumflex coronary artery obstruction in inferior wall acute myocardial infarction. Elect-rocardiographic criteria for determining the location of the obstructing lesion, however, have not been well established. The purpose of this study is to investigate the patterns of ST segment depression in lateral leads in inferior wall acute myocardial infarction and the obstruction site of culprit artery according to ST segment depression in lateral leads. METHODS: We examined 78 patients with inferior wall acute myocardial infarction analizing their electrocardiogram and coronary angiography which performed during acute hospitalization. RESULTS: Of the fifty-five patients in which the culprit artery could be determined, 1)in 41 the culprit artery was the right coronary artery (19 proximal to the right ventricular branch and 22 distal), and in 14 the left circumflex coronary artery (7 proximal to the first obtuse marginal branch or involving a high first obtuse marginal branch, and 7 with distal obstruction). 2)Significant ST depression (ST< or =1 mm) in leads I and aVL was more common in right coronary artery obstruction (p<0.05 and p=0.01 respectively) than left circumflex artery. 3)It was difficult to define the location of obstruction with ST segment change of lateral precordial leads (V5, V6). CONCLUSIONS: In acute inferior wall myocardial infarction, ST segment depression in lateral limb leads (I, aVL) can be indicative of the right coronary artery obstruction and the ST segment depression pattern in lateral precordial leads was not indicative of the site of obstruction.

A Case of Congenital Long QT Syndrome Associated with Deafness and Syncope

Congenital long QT syndrome (LQTS) is an inherited disease characterized by prolonged QT intervals and polymorphic ventricular tachycardia. The clinical manifestations vary from sudden cardiac death by ventricular arrhythmia to asymptom throughout life. In 1957, Jervell and Lange-Nielsen reported a syndrome of congen-ital sensory deafness associated with a prolonged QT interval in four children. The affected children had multiple syncopal episodes, and three died suddenly. The mode of inheritance is autosomal recessive. Affected persons are susceptible to recurrent syncope, and they have a high incidence of sudden death and short life expectancy. We report a case and review the literature on long QT syndrome diagnosed in a 30-year-old female with a history of convulsion and loss of consciousness during delivery.

A Case of Complex Cardiac Myxoma Combined with Nipple Myxoma

The majority of cardiac myxoma occur sporadically as isolated lesions in the left atrium of middle-aged women. However, a familial form and a syndrome form of this lesion have also been identified. The syndrome myxoma can present itself with pigmented skin lesions and peripheral or endocrine neoplasms. The familial and syndrome forms of cardiac myxomas can usually be distinguished from the sporadic form by their occurrences at younger ages, their unusual locations, the multicentricity of the lesions, and the presence of rare pathological conditions. In addition, a higher rate of recurrent lesions is usually associated with the familial and syndrome forms of this disease. We present a case of complex cardiac myxoma with pigmented skin lesions and breast myxoma and report it with a review of literature.

The Significance of Serum Cardiac Troponin I Concentration in the Patients with Acute Myocardial Infarction

BACKGROUND: The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interactions between actin and myosin. cTnI is highly sensitive and specific marker for myocardial injury and is useful in diagnosis and detection of reperfusion in acute myocardial infarction (AMI). In this study, we measured the serum concentration of cTnI according to serial time after chest pain in patients with AMI and compared serum concentration of cTnI with CK-MB and echocardiographic data to evaluate the significance of measuring serum concentration of cTnI in AMI. SUBJECTS AND METHODS: The study was carried out on 16 patients with first attack of AMI within 6 hours of chest pain. All patients were performed thrombolytic therapy and reperfusion was confirmed by coronary angiography. Blood samples for measuring of CK-MB and cTnI were collected at 4-h intervals during the first 24 h, 12-h intervals until 48 h, and 24-h intervals until fourth days after hospitalization. Echocardiography were performed before thrombolytic therapy in all patients. RESULTS: 1) The mean age of subjects was 63.6+/-11.5 years (range:44 - 84 years) and 11 patients were men and 5 patients were women. The site of infarction was anterior in 11 patients and inferior in 5 patients. 2) The peak concentrations of CK-MB and cTnI were reached from 4-h to 12-h after admission in all patients (7.3+/-2.6-h, and 9.0+/-3.1-h, respectively), but there was no significant difference in peak time. 3) Serum concentration of CK-MB was normalized at 72-h after admission, but cTnI was remained in increased state until 96-h after admission. The numbers of the patients with above cutoff value of CK-MB and cTnI at different time after admission were significantly different after 72-h (p<0.05). 4) The peak cTnI and sigma cTnI level were significantly correlated with peak CK-MB and sigma CK-MB level, respectively (r 2 =0.7955, p<0.0001 and r 2 =0.6378, p=0.0002, respectively). 5) The ejection fraction was not correlated with peak cTnI concentration (r 2 =0.0948, p=0.2461) and sigma cTnI (r 2 =0.1867, p=0.0946). 6) The wall motion score index was not correlated with peak cTnI concentration (r 2 =0.2135, p=0.0716), but significantly correlated with sigma cTnI (r 2 =0.2540, p=0.0465). CONCLUSION: The serum concentration of cTnI was useful in late diagnosis of AMI and cTnI release in patients with AMI was correlated with myocardial infarct size.

Collateral Circulation and 99m Tc - MIBI Heart SPECT in Patients with Totally Coronary Occlusion / 대한내과학회지

OBJECTIVES: The role of coronary collateral circulation in protecting myocardium after the occlusion of a supplying artery has long been debated. Recent date show that the coronary collateral circulation may partially prevent ischemia and preserve myocardial contractile function. The purpose of this study was to evaluate the relation between the grades of collateral circulation and perfusion scores of 99mTc-Heart SPECT in patients with totally coronary occlusion. METHODS: We studied 44 patients with totally coronary occlusion who had been hospitalized at Kyung Hee University hospital between October, 1989 and May, 1994, Patients were classified into two groups; Group 1: patients with angina pectoris (n=21), Group 2: patients with myocardial infarction (n=23). Angiographic collateral circulation was graded from 0 to 3: 0=none, 1=filling of side branch only, 2=partial filling of the epicardial segment, 3=complete filling of epicardial segment. The perfusion score of dipyridamole stress 99mTc-MIBI Heart SPCET was analyzed with angiographic findings. Resting and stress echocardiography were analyzed to identify left ventricular wall motion abnormalities. RESULTS: 1) When LAD was totally occluded, there were hishevcrgree of collateral circulations from RCA in group 1 and group 2. When RCA was totally occluded, there was higherdesree of collateral circulation from LAD in group 1 and group 2. 2) The degree of collateral development was higher in group 1 than in group 2 (2.5+/-0.7 vs. 1.8+/-1.0, p<0.05). 3) In 99mTc-MIBI Heart SPECT, there was no significant difference of perfusion score at stress but perfusion score was significantly higher in group I than in group 2 at rest. 4) In 99mTc-MIBI Heart SPCET, there was no difference of perfusion score between totally coronary occlusion territories in group 1 and more than 50% coronary artery stenotic territories in group 1 and group 2. 5) In stress echocardiography, ten of the 13 patients showed normal LV wall motion at rest, but 9 of these 10 patients showed LV wall motion abnormalities at stress in group l. In group 2, all 10 patients showed LV wall motion abnormalities at rest and 3 of these patients showed more aggravation of LV wall motion abnormalities. CONCLUSION: Collateral circulation in angina patients can prevent myocardial ischemia and preserve myocardial function at rest, but not at exercise. Collateral circulation in patients with myocardial infarction cannot preserve myocardial function at rest. and exercise. Dipyridamole stress 99mTc-MIBI Heart SPECT is one of the indirect quantification methods to evaluate collateral development and coronary flow reserve.

A Case of Multifocal Cerebral Infarction Associated with Idiopathic Hypereosinophilic Syndrome / 대한내과학회지

The idiopathic hypereosinophilic syndrome represent a heterogenous group of disorders with common features of prolonged eosinophilia of an undetectable cause and organ system dysfunction. Recently, we experienced a case of idiopathic hypereosinophilic syndrome with multifocal cerebral infarction. The patient was 33-year-old male and visited our hospital with right upper extremity weakness and headache. The blood eosinophil counts were 8,316/mma and the marrow showed eosinophils were predominant and in mature forms The two-dimensional echocardiogram showed hyperechoic density at left ventricular apical wall without thrombus formation. Multifocal infarctions were seen at left cerebellar hemisphere, left thalamus, right frontal lobe and left periventricular white matter on brain MRI scan. No cause for hypereosinophilia was found. He was treated with prednisone and hydroxyurea.

Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients without Structural Heart Disease

BACKGROUND: Radiofrequency catheter ablation therapy of idiopathic ventricular tachycardia in patients without obvious structural heart disease has been assessed in a few studies, but the clinical feasibility and efficacy are not certain. This study reports our results of catheter ablation with radiofrequency energy in thirteen patients. METHODS: Thirteen consecutive patients with idiopathic ventricular tachycardia underwent electrophysiologic study, pharmacological interventions and radiofrequency catheter ablation therapy. RESULTS: There were 7 men and 6 women with a mean age of 34+/-11years(13-55 years). The QRS configuration during tachycardia were left bundle branch block and inferior axis in 5 patients, right axis in 1 patient and right bundle branch block configuration with superior axis in 4 patients, right axis in 2 patients, left axis in 1 patients. Mean tachycardia cycle length was 361 +/-20 milliseconds. The focus of ventricular tachycardia were located in the right ventricular outflow tract(six patients) and the left ventricular inferior wall(four patients), posterobasal wall(one patients), anterolateral wall(one patients). Ventricular tachycardias were electrically induced in 9/13 patients. Mapping and radiofrequent catheter ablation was done with standard technique and ventricular tachycardia or VPCs were successfully eliminated in nine patients(69.2%). One patients complicated with transient pleural effusion. During mean follow-up period of 12+/-3months, one patients had a recurrence of symptomatic ventricular tachycardia. CONCLUSION: Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease is effective and safe and may be considered as primary choice of therapy in the patients.

Four Cases of Cystic Nature Adjacent to Right Atrial Wall by Two-Dimensional Echocardiography

Two-dimensional echocardiography is a simple, noninvasive method of evaluating cardiac strucures and pericardiac structures. The diagnosis of pericarial cyst is strongly suggested by the prominent roentgenographic appearance of a round, sharply demarcated mass along the right cardiac silhouette in an asymptomatic patient. Two-dimensional echocardiography is also useful method for diagnosing pericardial cyst, but differential diagnosis is difficult when other mass revealed echo-lucent cystic nature is located adjacent to the right atrial wall. We report the similar two-dimensional echcardiography findings located adjacent to the right atrial wall which are diagnosed different disease entity each oter. We suggest that two-dimensional echocardiography helps diagnosis of mass adjacent to the right atrial wall and may need more extensive investigation for accurate differential diagnosis.

Effects of recombinant human erythropoietin on cardiac function and morphology in patients with chronic renal failure / 대한신장학회잡지

No abstract available.

Cross-Over Comparison of Dilevalol and Nicardipine in Patients with Mild to Moderate Hypertension

The antihypertensive efficacy and safety of Dilevalol, compared with Nicardipine, were evaluated in mild to moderate hypertensive patients in a randomized crossover study. Following a 3 week placebo washout (phase I), the first crossover (phase II) was initiated with 63 patients randomized to dilevalol and 62 to nicardipine. The 6 weeks of treatment was initiated with 100mg of dilevalol once daily or 40mg of nicardipine (20mg B.I.D.). After 2 weeks, patients not achieving a sitting DBP to or =10mmhg were uptitrated to 200mg Dilevalol once daily or 60mg Nicardipine twice daily. A second three week placebo washout (phase III) followed by a second 6 week active treatment phase (phase IV) during which patients were crossed over to the alternative therapy as during phase II if the sitting DBP again met the entrance criteria. 18 patients were only evaluable for the first washout and treatment period because of early discontinuation or protocol violations. They were included in the safety evaluation. phass II patients treated with Dilevalol (n=63) were mean age of 52.9 years, 49% male and 51% mild hypertensives (< or =105mmHg). Phase ??patients treated with Nicardipine (n=62) were mean age of 51.2 years 55% male and 66% mild hypertensives. Both Dilevalol and Nicardipine significantly and equivalently lowered blood pressure relative to baseline (71% versus 67% normalization). Dilevalol slightly but significantly lowered heart rate (-5 beat/min versus -1 beat/min). Dilevalol significantly increased HDL cholesterol (2.1mg/dl, 4.2%) and decreased total cholesterol (9.6mg/dl, 4.2%) while Nicardipine produced only a small but not significant reduction in total cholesterol (3.2mg/dl, 1.2%). The incidence of adverse effects were lower with Dilevalol than with Nicardipine and especially flushing and ankle edema occurred significantly more often with Nicardipine. in conclusion, dilevalol is equally effective but has a superior safety profile to nicardipine in the treatment of mild to moderate hypertension.