Long-term Follow up in Patients with Vasospastic Angina in Relation to Medication Period and Disease Activity / 대한내과학회지

OBJECTIVES: Clinical course of vasospastic angina is variable : spontaneous remission, persistent angina and progression of disease or death. Several studies from western institutes have been performed on the clinical characteristics and long-term prognosis of patient with coronary vasospasm. In these reports, 53-82% of patients had spontaneous remission. These results may be assumed differ from that of Korean patients with vasospastic angina, but no detailed studies have been reported in Korea. Currently, in patients with vasospastic angina, treatment with calcium antagonists and/or nitrates are effective in reducing the frequency of anginal attacks. And, clinical course and outcome of vasospastic angina may be different from previous western reports thereafter. The purpose of this study is to describe the disease activities and the factors influencing the clinical course of vasospastic angina in relation to medication-period; age, sex, risk factors, extents of coronary vasospasm, initial ischemic events and significance of fixed lesion. Also we tried to determine if clinical or angiographic variables might be useful in predicting the possibility of spontaneous remission for an each patient. METHODS: Eighty-seven patients with vasospastic angina(M/F ; 58/29, mean age ; 53+/-9 years) were included and all documented coronary vasospasm on the coronary angiogram, spontaneous spasm in 35, positive ergonovine or acetylchoine provocation in 52. Coronary artery spasm was declined as more than 75% reduction in coronary luminal diameter and ST segment changes on electrocardiogram, or typical anginal symptoms together and then narrowed coronary arteries were recovered after intracoronary nitroglycerin. The patients were treated with calcium antagonists(nifedipine, diltiazem, amlodipine and felodipine) and nitrates single or both and were divided into 3 groups according to angina activity : group I, which anginal attacks less than one time monthly, group II, which anginal symptoms occurred in 24-48 hours after withdrawal of medication, group III, which symptoms recurred frequently with the incidence of over one time weekly. After discharge, each patient returned to a medical out-patient department at every 1-2 months. RESULTS: Age, gender, other coronary risk factors, disease activity of vasospastic angina, initial clinical presentation at admission, coronary angiographic findings, fixed lesion and alcohol-induced anginal attacks were not statistically different among the 3 groups. But admission frequency of group II and III, which had a high anginal activities, were more than that of group I significantly. CONCLUSION: In the present study, it is concluded that medical treatment in patients with vasospastic angina in Korea may be taken long duration during follow-up period if the patient of group II and III considered to persistent angina group. To assess the prevalence of spontaneous remission, we consider that systematic attempts to taper medication may be done for patient of group I(angina free-on treatment) after absence of anginal attacks for at least one year medication-period.

TEE Detection of Aortic Atheroma in Patients with Cerebral Infarction

BACKGROUND: The atheroma in aorta has been emphasized as a potential source of cerebral embolism after the wide use of TEE. But in Korea there has been no report on the frequency of the aortic atheroma in patients with cerbral infarctions. METHODS: Using transesophageal echocardiography, we evaluated aortic atheroma in the thoracic aorta of 44 patients with cerbral infarctions. The aortic atheroma was defined as a raised lesion with an irregular surface of echo shadow. RESULTS: The aortic atheromas were detected in 7 patients(16%) out of 44 patients with cerebral infarction. However, it were detected in only 3 patients out of 71 patients without cerebral infarction. The size of the lesions reaged from 6mm to 16mm(mean 10+/-3.5) and mobility were seen in 2 patients. The lesions were distributed throughout the thoracic aorta. CONCLUSION: Aortic atheroma is a potential source of cerebral infarction. TEE is a useful procedure for the evaluation of the patients with an undetermined cause of cerebral infarction.