Obesity and Hypertension in Association with Diastolic Dysfunction Could Reduce Exercise Capacity

BACKGROUND AND OBJECTIVES: Empirical evidence is lacking on the cumulative disease burden of obesity and hypertension and its impact on cardiac function and exercise capacity. The purpose of this study was to determine whether the presence of obesity and hypertension together was associated with cardiac dysfunction and exercise capacity. SUBJECTS AND METHODS: Using a retrospective study design, medical records were reviewed for echocardiographic and treadmill exercise stress test data. Subjects were grouped according to four categories: normal control, obese, hypertensive, or obese and hypertensive. RESULTS: Obese, hypertensive persons showed significantly lower Ea and E/A ratio and greater E/Ea ratio, deceleration time, left ventricular (LV) mass, and LV mass index compared to their counter parts (normal control, obese and/or hypertensive) (all p<0.05), after controlling for age and sex. After controlling for age and sex, significant differences in exercise capacity indices were found, with the obese group having shorter exercise time, lower metabolic equivalents, and lower maximal oxygen uptake than the normal control, hypertensive, or both groups (all p<0.05). The hypertensive or obese and hypertensive group had greater maximal blood pressure compared with the normal control group (all p<0.001). Obese and hypertensive persons were approximately three times more likely to have diastolic dysfunction (odd ratio=2.96, p=0.001), when compared to the reference group (normotensive, non-obese, or hypertensive only persons). CONCLUSION: Diastolic dysfunction was associated with obesity and/or hypertension. The cumulative risk of obesity and hypertension and their impact on diastolic dysfunction which could be modifiable could reduce exercise capacity.

Thrombotic Occlusion of Stent Graft Limbs due to Severe Angulation of Aortic Neck in Endovascular Repair of Abdominal Aortic Aneurysm

Endovascular aneurysm repair (EVAR) is a safe alternative to open surgical repair for an abdominal aortic aneurysm. However, unfavorable aortic anatomy of the aneurysm has restricted the widespread use of EVAR. Anatomic limitation is most often related to characteristics of the proximal neck anatomy. In this report, we described a patient with a severely angulated proximal neck who underwent EVAR, but required repeat intervention because of thrombotic occlusion of stent graft limbs.

Erratum: Obesity and Hypertension in Association with Diastolic Dysfunction Could Reduce Exercise Capacity

In the article, the 3rd author's affiliation was misspelled.

A Comparison of Two Brands of Clopidogrel in Patients With Drug-Eluting Stent Implantation

BACKGROUND AND OBJECTIVES: Although generic clopidogrel is widely used, clinical efficacy and safety between generic and original clopidogrel had not been well evaluated. The aim of this study was to evaluate the clinical outcomes of 2 oral formulations of clopidogrel 75 mg tablets in patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) implantation. SUBJECTS AND METHODS: Between July 2006 and February 2009, 428 patients that underwent implantation with DES for CAD and completed >1 year of clinical follow-up were enrolled in this study. Patients were divided into the following 2 groups based on treatment formulation, Platless(R) (test formulation, n=211) or Plavix(R) (reference formulation, n=217). The incidence of 1-year major adverse cardiovascular and cerebrovascular event (MACCE) and stent thrombosis (ST) were retrospectively reviewed. RESULTS: The baseline demographic and procedural characteristics were not significantly different between two treatment groups. The incidence of 1-year MACCEs was 8.5% {19/211, 2 deaths, 4 myocardial infarctions (MIs), 2 strokes, and 11 target vessel revascularizations (TVRs)} in Platless(R) group vs. 7.4% (16/217, 4 deaths, 1 MI, 2 strokes, and 9 TVRs) in Plavix(R) group (p=0.66). The incidence of 1-year ST was 0.5% (1 definite and subacute ST) in Platless(R) group vs. 0% in Plavix(R) group (p=0.49). CONCLUSION: In this study, the 2 tablet preparations of clopidogrel showed similar rates of MACCEs, but additional prospective randomized studies with pharmacodynamics and platelet reactivity are needed to conclude whether generic clopidgrel may replace original clopidogrel.

Right Coronary Cusp Prolapse Resembling Subpulmonic Stenosis in an Old Adult Patient with Ventricular Septal Defect

Ventricular septal defect (VSD) can be associated with various complications such as aortic regurgitation (AR). AR in VSD come from a deficiency or hypoplasia of the conal septum which leads to abnormal apposition in diastole and prolapse of the poorly supported noncoronary or right coronary cusp through the VSD into the right ventricle resembling subpulmonic stenosis and subsequently results in distortion of the aortic valve and progressive AR. AR often increases in severity with age and it indicates a worse prognosis. Therefore, appropriate timing of surgical repair in progressive AR in VSD might be important. Until now, many earlier experiences about surgical repair of AR complicating VSD were on adolescents or young adults. We reported a case of AR in 48-year-old male patient with right coronary cusp prolapse complicating the subarterial type of VSD which was properly assessed by echocardiography and was successfully treated with surgical repair. Right coronary cusp or noncoronary cusp prolapse should be suspected in AR complicating VSD through proper echocardiographic assessment and the surgical repair on VSD and distorted aortic valve should be considered in the old patient, as well as the young.

Clinical characteristics of lung cancer diagnosed from 2006 to 2008: Data from Gachon University Gil Hospital / 대한내과학회지

BACKGROUND/AIMS: This study examined the clinical characteristics of patients with lung cancer who were diagnosed at the Gachon University of Medicine and Science Gil Hospital from January 2006 to December 2008. METHODS: The lung cancer data were downloaded from the hospital medical information system using cancer registration information. The patient clinical characteristics were analyzed retrospectively. RESULTS: A total of 713 patients were diagnosed with lung cancer. Their median age was 69 years, 78.1% were over 60 years old, and 73.1% and 58.2% were men and smokers, respectively. Adenocarcinoma (32.7%) was the most common histologic type, followed by squamous carcinoma (25.9%), unclassifiable non-small-cell lung cancer (NSCLC) (17.3%), and small-cell carcinoma (SCLC) (15.0%). In the NSCLC group, the stage at diagnosis was IA (1.5%), IB (5.6%), IIA (1.3%), IIB (4.3%), IIIA (5.4%), IIIB (23.1%), IV (47.7%), and unknown (11.1%). In the SCLC group, 20.6% of the patients were in the limited stage, 76.6% were in the extensive stage, and 2.8% were unknown. The patients were treated by surgery (9.8%), concurrent chemoradiotherapy (6.7%), radiotherapy only (5.9%), chemotherapy (32.4%), or best supportive care only (29.7%). The median overall survival was 15.3 months (95% CI, 11.5~19.1). The median survival based on histology was adenocarcinoma (35.0 months), squamous (13.5 months), NSCLC (14.2 months), and SCLC (11.8 months) (p=0.0445). CONCLUSIONS: Adenocarcinoma was the most common histologic type at our institute. Most patients were over 60 years of age (78.1%) and had stage III/IV (76.3%) cancer. The survival of patients with adenocarcinoma was longer than that for the other histological types.