Hypertension, a Low Ejection Fraction and Severe Angiographic Findings are Associated with Smooth Muscle Dysfunction in Patients with Coronary Atherosclerosis

BACKGROUND AND OBJECTIVES: Nitroglycerin-mediated arterial dilation (NMD) was shown to be preserved in most previous studies, and this is possibly due to using a single high dose of nitroglycerin (NTG), which causes maximal arterial dilation. We sought to evaluate the clinical factors of flow-mediated dilation (FMD) and NMD at different doses of NTG in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: Thirty-two consecutive patients (mean age: 61 years old, 18 males) with angiographically proven CAD underwent FMD and NMD at total cumulative doses of 25microgram, 175microgram and 325microgram with using high-resolution ultrasound for the imaging. RESULTS: The FMD, NMD (25microgram), NMD (175microgram) and NMD (325microgram) were 4.72+/-1.82%, 7.08+/-3.02%, 13.33+/-6.14% and 15.89+/-7.24%, respectively (p<0.001 compared with each other). Univariate analysis showed that the FMD is associated with the serum homocysteine level, the NMD (25microgram) is associated with the body mass index, the NMD (175microgram) is associated with the fasting blood sugar and the ejection fraction, and the NMD (325microgram) is associated with the fasting blood sugar, while there was no significant difference of the FMD and NMD according to the presence of CAD risk factors. Multivariate analysis disclosed that the independent factors of FMD were the serum homocysteine and triglyceride levels, and those of NMD (25microgram) were hypertension, a low ejection fraction and severe coronary angiographic findings, while there was no independent factor for NMD (175microgram) and NMD (325microgram). CONCLUSION: This study suggests that hypertension, a low ejection fraction and significant stenotic coronary lesion may be associated with endothelium-independent smooth muscle dysfunction at low dose NTG, while the serum homocysteine and triglyceride levels are associated with endothelium-dependent endothelial dysfunction in the patients with CAD. Using low-dose NTG is important when measuring the NMD.

A Case of a Successful Percutaneous Coronary Intervention Using Percusurge(r) System in a Massive Intracoronary Thrombi Patient

A massive intracoronary thrombus, during percutaneous coronary intervention (PCI), implies a high risk of major adverse cardiac events. We experienced a case of successful PCI, using Percusurge(r), in an acute myocardial infarc-tion patient, with massive intracoronary thrombi. The TIMI 3 coronary flow could not be restored during a primary PCI of the right coronary artery, despite repeated ballooning, intracoronary urokinase injection, parenteral abciximab and heparin. However, successful PCI, with stenting, was performed by aspiration of the large intracoronary thrombi, with the Percusurge(r) system, 5 days after the primacy PCI.

A Case of a Successful Percutaneous Coronary Intervention Using Percusurge(r) System in a Massive Intracoronary Thrombi Patient

A massive intracoronary thrombus, during percutaneous coronary intervention (PCI), implies a high risk of major adverse cardiac events. We experienced a case of successful PCI, using Percusurge(r), in an acute myocardial infarc-tion patient, with massive intracoronary thrombi. The TIMI 3 coronary flow could not be restored during a primary PCI of the right coronary artery, despite repeated ballooning, intracoronary urokinase injection, parenteral abciximab and heparin. However, successful PCI, with stenting, was performed by aspiration of the large intracoronary thrombi, with the Percusurge(r) system, 5 days after the primacy PCI.

Correlation between Intima-Media Thickness in Carotid Artery and the Extent of Coronary Atherosclerosis

BACKGROUND AND OBJECTIVES: We performed this study to elucidate whether there were significant correlations 1) between intima-media thickness (IMT) of carotid artery and the extent of coronary atherosclerosis and 2) between carotid IMT and risk factors of atherosclerosis in patients with coronary atherosclerosis. SUBJECTS AND METHODS: All study subjects (n=326, 200 males, 59+/-10 years) had chest pain and underwent coronary angiography. IMT was measured in the far wall of the internal and common carotid arteries and the carotid bulb using high-resolution ultrasound with a 3-11 MHz linear probe. We also evaluated the presence of plaque in the carotid artery. The extent of coronary atherosclerosis was divided into 4 groups (0, 1, 2, and 3) according to the number of coronary arteries narrowed more than 50% of the diameter. RESULTS: In patients with one or more diseased coronary vessels, IMT of the common carotid artery was thicker (0.81+/-0.15 mm vs. 0.91+/-0.28 mm, p<0.05) and plaques were more frequently found (16% vs. 40%, p<0.05). There was also a significant correlation between the extent of coronary artery atherosclerosis and IMT of the common carotid artery (r=0.217, p<0.001) and the internal carotid artery (r=0.177, p<0.01). Multiple regression analysis revealed hypertension and smoking, among the atherosclerosis risk factors, as independent factors in the IMT of the common carotid artery and carotid bulb. CONCLUSION: We concluded that there was a significant correlation between the extent of coronary artery disease and IMT of the carotid artery;and that hypertension and smoking, of all atherosclerosis risk factors, were independent factors in the IMT of the carotid artery.

Effects of Ramipril on Vascular Response in Patients with Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Angiotensin-converting enzyme (ACE) inhibitors have been shown to improve the endothelial dysfunction and prevent the development of atherosclerosis in animal models. We performed this study to investigate the effects of the ACE inhibitor, ramipril, on carotid atherosclerosis and endothelial dysfunction of the brachial artery in patients with coronary artery disease (CAD). SUBJECTS AND METHODS: We studied 69 subjects with a mean age of 59yrs, and divided them into two groups according to ramipril use (39 patients with ramipril and 30 without). Using a double-blind, randomized, prospective design, we measured the flow-mediated vasodilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the carotid artery, prior to, and 1, 3 and 6 months following coronary angiograms in CAD patients. RESULTS: The FMD was significantly increased in the ramipril group from 4.6+/-2.2% baseline to 5.3+/-2.5% at the 1 month follow-up (p<0.05), but at the 3 and 6 month follow-ups no significant changes were found. There were no significant differences in the FMD between the two groups at any of the follow-up periods, and no changes in the IMT were found in relation to time for either group. CONCLUSION: Ramipril improved the endothelial dysfunction in patients with CAD for the first month; however this effect did not persist 3 or 6 months after taking ramipril. Ramipril had no effect on the atherosclerotic vascular changes to the IMT of carotid arteries.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Two Patients with Persistent Left Superior Vena Cava

We report two cases of radiofrequency catheter ablation (RFCA) with atrioventricular nodal reentrant tachycardia (AVNRT) in patients associated with persistent left superior vena cava (PLSVC). AVNRT with PLSVC differs in terms of catheter positioning and location of slow AV nodal pathway as compared with AVNRT alone. In our two patients, a coronary sinus electrode catheter was easily introduced through the PLSVC and directly into the coronary sinus. Successful RFCA was performed with the energy delivery at the bed of the proximal portion of the markedly enlarged coronary sinus without any complications in the two patients.

Differential Endothelial Function According to the Presence of Restenosis in Patients Having Undergone Percutaneous Transluminal Coronary Angioplasty

BACKGROUND AND OBJECTIVES: e undertook this study to determine whether there is any difference in endothelial function according to the presence of restenosis in patients who had undergone percutaneous transluminal coronary angioplasty (PTCA), although it is well known that endothelial dysfunction is present in patients with coronary artery disease. SUBJECTS AND METHODS: he study population comprised 39 patients (mean age:1 years old, male:0 patients) who underwent PTCA a mean 12 months before follow-up coronary angiogram (CAG). We measured the flow-mediated brachial artery dilation (FMD) using high-resolution ultrasound 1 day before taking the follow-up CAG in an overnight fasting state. We also analyzed the risk factors of atherosclerosis, lipid and glucose levels, the presence of chest pain, and the types of drug taken by patients according to the presence of restenosis. RESULTS: MD was significantly lower in patients with restenosis (n=19) than without restenosis (7.5+/-3.7% vs 10.2+/-2.5%, p=0.013). However, there were no significant differences in other variables according to the presence of restenosis. CONCLUSION: ndothelial dysfunction was more pronounced in patients with restenosis than without restenosis following PTCA. However, we do not yet know whether the severity of endothelial dysfunction is a predictor for restenosis as the FMD was taken just prior to the follow-up coronary angiogram.

Long-term clinical outcomes in patients with angina and insignificant coronary artery stenosis

BACKGROUND: We performed this study to evaluate the long-term clinical prognosis, the effects of anti-anginal medicines on angina, and the factors on recurrence of angina in patients with angina and insignificant coronary artery stenosis (CAS). METHODS: The study population was consisted of 372 patients with angina and normal or minimal (less than 50 % stenosed) CAS out of 2475 consecutive patients who were performed coronary angiogram for 3.5 years. We reviewed the medical record of the study population. RESULTS: Myocardial infarction was developed in 2 cases (0.5%), recurrence of angina 59 cases (16%), and no death during mean 19 months follow-up period out of 372 patients. Patients with normal coronary artery (n=66) were younger (mean 54 yrs vs 59 yrs, p<0.001), had less incidence of diabetes (5% vs 13%, p<0.01), hypertension (19% vs 29%, p<0.05), recurrent angina (15% vs 18%, not significant), and myocardial infarction (0.4% vs 0.9%, not significant) than patients with minimal lesion (n=06). Anti-anginal medicine did not show benefits in relieving recurrent angina. Furthermore, in case of taking nitrates in patients with normal coronary artery, there was more frequent recurrence of angina (23% vs 13%, p<0.01) than not taking nitrates. There were no affecting factors to the recurrent angina among age, sex, ischemic changes on electrocardiogram, smoking, hypertension, diabetes, and hyperlipidemia. CONCLUSION: The long-term clinical outcomes in patients with insignificant CAS were good. Although there were no definite factors for recurrence of chest pain, administration of nitrates may cause more frequent angina in patients with normal coronary angiography.

Comparison of the Endothelial Function between Healthy Subjects and Patients with Coronary Artery Disease or Risk Factors of Atherosclerosis

BACKGROUND: We performed this study to evaluate the lower limit of the normal endothelial function, which can differentiate normal values from abnormal ones and to evaluate the changes of the endothelial function according to ages. MATERIALS AND METHODS: Study populations were consisted of four groups: patients (group A) with coronary artery disease (CAD) (n=2, mean age: 55 yrs), patients (group B) with one or more risk factors of atherosclerosis (n=3, mean age: 54 yrs), age- and sex-matched healthy subjects (group C, n=5, mean age: 54 yrs), and healthy young subjects (group D, n=3, mean age: 26 yrs). We measured the flow-mediated endothelium-dependent dilation (FMD) of brachial artery using a high-resolution ultrasound in all subjects. We analyzed the receiver operating characteristic (ROC) curve. RESULTS: The FMD of the A and B group were significantly lowered (8.6+/-3.7% vs 9.9+/-4/5% than C (14.3+/-3.3%, p<0.001) or D group (18.0+/-3.5%, p<0.001). The FMD level of 11.5% had 76.3% of sensitivity and 76% of specificity to differentiate normal endothelial function from abnormal one. The spearman correlation coefficient between ages and FMD in groups C and D was -0.543 (p<0.001). CONCLUSIONS: The endothelial function was decreased in patients with CAD or risk factors of atherosclerosis. We observed the age-related declining tendency of endothelial function in healthy subjects. 11.5% FMD) may be used to identify the person at risk of atherosclerosis.