The Effects of Macrophage on Neointimal Formation after Balloon or Stent Injury in Hypercholesterolemic Rabbits

BACKGROUND AND OBJECTIVES: The present study investigated differences in the effects of macrophages between neointimal formation after balloon (BI) and that after stent injury (SI) in hypercholesterolemic rabbits. We also studied the relationship between advanced glycation end products (AGE), the receptor for AGE (RAGE), and S100A8/A9 in the inflammatory reaction mediated by macrophages. MATERIALS AND METHODS: Male New Zealand White rabbits fed with a 1% cholesterol diet for 2 weeks underwent balloon dilatation to one iliac artery, and stenting to the contralateral artery. Arteries were harvested at 7, 14, and 28 days after injury. RESULTS: Sizes and cell numbers of neointima were higher in SI than in BI (p0.05). Sizes and cell numbers of neointima in BI and SI increased significantly till 14 days (p0.05). Macrophage numbers increased until 28 days in the media of BI (p=0.003). Macrophage numbers increased at 14 days in the neointima of SI (p=0.001), but decreased at 28 days (p=0.014). Macrophage numbers were not changed in the media of SI. Cell numbers and area were significantly correlated with macrophage numbers in the neointima and media of BI, and in the neointima of SI (p<0.05). RAGE expression was strong in cells adjacent to lumen at 7 and 14 days, and in cells of neointima and media adjacent to internal elastic lamina at 28 days. Expression of RAGE was increased in both macrophage and smooth muscle cells. Macrophages were the predominant cells observed with AGE accumulation. S100A8/A9 was not found. CONCLUSION: There seems to be a difference in effect of macrophages on the formation of neointima after injury between BI and SI. The effects of macrophages appears to be more significant in the neointima of BI. Mechanical arterial injury induces the formation of AGE and overexpression of RAGE in macrophages.

A simple oscillometric measurement of pulse wave velocity: Comparison with conventional tonometric measurement / 대한내과학회지

BACKGROUND: We compared brachial-ankle pulse wave velocity (baPWV) measured by a simple oscillometric method with heart-carotid (hc) and heart-femoral (hf) PWVs measured by a conventional tonometic method. METHODS: Using an automatic waveform analyzer, we measured hcPWV, hfPWV and baPWV simultaneously. The subjects comprised 82 healthy subjects (normal group), 229 subjects without coronary artery disease (CAD) but with hypertension, diabetes, hypercholesterolemia, low HDL-cholesterol, smoking, or obesity (risk group), and 106 patients with coronary artery disease (CAD group). In 30 subjects, reproducibility of PWVs were determined. RESULTS: Pearson's correlation coefficients of intraobserver reproducibility of hcPWV, hfPWV and baPWV were r=0.855, r=0.912 and r=0.976, respectively (p<0.001 for all). The corresponding coefficients of variation (CV) were 4.5%, 4.5% and 2.6%. Pearson's correlation coefficients of interobserver reproducibility of hcPWV, hfPWV and baPWV were r=0.751, r=0.802 and r=0.972, respectively (p<0.001 for all). The corresponding CV were 7.8%, 5.8% and 3.3%. baPWV correlated well with hcPWV and hfPWV (r=0.457 and 0.640, respectively, p<0.001 for both). In normal and risk groups, age, sex and hypertension were major independent factors affecting hcPWV, hfPWV and baPWV. PWVs were increased according to the number of risk factors (p<0.001 for all). In CAD group, hfPWV was higher in patients with 3 vessel disease than those with 1+2 vessel disease (p=0.024). hcPWV, hfPWV and baPWV did not differ between risk and CAD groups in the age of 50 to 69 (p=NS for all). CONCLUSION: baPWV has good reproducibility and correlates acceptably with hcPWV and hfPWV. This simple measurement of baPWV is useful for screening of arterial stiffness.

Do Acute Changes in Heart Rate by Isoproterenol Affect Aortic Stiffness in Patients with Hypertension?

BACKGROUND: Increased aortic stiffness is a independent risk factor of cardiovascular disease in patients with hypertension. Acute changes of the heart rate (HR) have been reported not to affect the aortic stiffness in pacing. However, it is unknown whether acute changes in HR caused by sympathomimetics can affect the aortic stiffness in patients with hypertension. We investigated the effect of acute changes in HR produced by isoproterenol on the aortic stiffness in 17 hypertensive patientss (mean age: 59 +/- 9 years). METHODS: All vasoactive drugs were discontinued at least 3 days before the study. The carotid-tofemoral pulse wave velocity (PWV) was measured by the foot-to-foot method. The pulse waves were recorded at the baseline and at every increase of HR by 5 to 10 bpm with a gradual increase of the dose of isoproterenol. The blood pressures and HR were measured simultaneously. For the analysis, HR, PWV, compliance (C), and compliance index (Ci) were converted as percent changes (delta) from the baseline values. Percent changes of the parameters of the aortic stiffness, i.e., delta PWV, delta C, and delta Ci, were grouped by every 10% increase in delta HR. RESULTS: There was no significant difference among groups in delta PWV, delta C and delta Ci (p> 0.05 for each of the group). The regression analysis showed no significant correlation of delta HR with delta PWV and delta C (r=0.18, 0.13 respectively, p> 0.05 for each). delta Ci had a poor correlation with delta HR (r=0.22, p< 0.05). However, only 4.6% of delta Ci could be referred to delta HR (r2=0.046). CONCLUSION: Aortic stiffness was not affected by acute changes in HR produced by isoproterenol which suggests that it is not necessary to consider acute changes in HR when measuring aortic PWV.

Vasculo-Behcet's Disease Developing in a Patient with Ebstein Anomaly / 대한류마티스학회지

Behcet's disease (BD) is a chronic inflammatory disease, involving several organs. It is well known that there are the marked regional differences in the disease expression of BD. In case of the vascular involvement in BD, the frequency rate has been described in 25~30% among the patients from the MiddLe East, whereas it has been noted in 5~15% in our country. In general, BD associated with large vessel lesions is named vasculo-BD. On the other hand, the cardiac involvement in BD has rarely been reported in the literature. Ebstein anomaly is a kind of malformation that is characterized by a downward displacement of the tricuspid valve into the right ventricle. We reported a 54-year-old male patient with vasculo-BD who had inferior vena cava obstruction and Ebstein anomaly. The association of Ebstein anomaly with vasculo-BD is considered to be coincidental. To the best of our knowledge, this is the first case of Ebstein anomaly associated with BD.

Fibrocalcific Embolism of Right Coronary Artery Combined with Aortic Valvular Stenosis / 대한흉부외과학회지

The main cause of ischemic heart disease combined with aortic valve disease is the systemic atherosclerotic process. Coronary artery embolism by a particle from the calcified aortic valvular tissue is very rare. A 73-year-old female patient was admitted due to chest tightness of recent onset. Two dimensional echocardiogram showed severe calcific aortic valve stenosis. Preoperative coronary angiogram exhibited a stenotic lesion at the distal right coronary artery, which seemed to be embolic in origin. The coronary embolus was removed through the coronary arteriotomy and then the arteriotomy site was repaired by onlay patch angioplasty technique. Aortic valve was replaced by a bioprosthetic valve. The embolus was reported as a fibrocalcified particle of diseased valve.

Does changes in heart rate by isoproterenol affect aortic stiffness in patients with hypertension? / 대한내과학회지

BACKGROUND: Increased aortic stiffness (AS) is an independent risk factor of cardiovascular disease in patients with hypertension. Elevation of blood pressure (BP) or sympathetic tone increases AS. It was reported that acute changes in heart rate by artificial pacemaker did not affect AS. However, it is unknown whether changes in HR by sympathomimetics can affect AS in patients with hypertension. We investigated the effect of changes of HR by isoproterenol (ISO) on AS in 17 hypertensives (mean age: 59+/-9 years). METHODS: All vasoactive drugs were discontinued at least 3 days before the study. Carotid-to-femoral pulse wave velocity (PWV) was measured by foot-to-foot method. Pulse wave recordings were done at baseline and at every increase of HR by 5 to 10 bpm with gradual increase of dose of ISO. BPs were measured simultaneously by the fluid-filled manometer system through the side arm of arterial sheath of femoral artery. HR was measured by electrocardiography. Compliance (C) and compliance index (Ci) were calculated from PWV, pulse pressure, systolic and diastolic blood pressure by established formulas. For analysis, HR, PWV, C and Ci were converted as percent changes (delta) from the baseline values. Percent changes of parameters of AS, i.e., deltaPWV, deltaC, and deltaCi, were grouped by every 10% increase in HR. RESULTS: There was no significant difference among groups in deltaPWV, deltaC and deltaCi (p>0.05 for each). With simple regression analysis, deltaPWV and deltaC showed no significant correlation with deltaHR (r=0.18, 0.13 respectively, p>0.05 for each). deltaCi was weakly correlated with deltaHR (r=0.22, p<0.05). However, only 4.6% of deltaCi could be referable to deltaHR (r2=0.046). CONCLUSION: AS was not affected by changes in heart rate by isoproterenol, suggesting that it is not necessary to consider changes of HR when measuring aortic PWV.

A Case of Severe Bradyarrhythmia after Ingestion of Rhododendron Brachycarpum

Rhododendron brachycarpum has been known as a panacea in Korean folk medicine, and is used to treat various diseases including hypertension. Excessive ingestion can cause intoxication by grayanotoxin. We experienced a 59 year-old man suffering of grayanotoxin intoxication following excessive ingestion of Rhododendron brachycarpum. The patient presented dizziness, weakness, and chest discomfort with cold sweats. Electrocardiography showed marked sinus bradycardia with atrio-ventricular dissociation. With intravenous saline and atropine, the patient recovered. This case calls attention to the potential cardiotoxicity of Korean folk medicine Rhododendron brachycarpum.

Exercise Provocation Test in Patients with Vasospastic Angina: Graded vs. Non-Graded Exercise Test

BACKGROUND AND OBJECTIVES: We investigated in patients with coronary vasospastic angina whether the exercise ECG test results are influenced by the different modes of exercise load and compared the clinical characteristics including coronary risk factors between patients with positive and negative exercise tests. MATERIALS AND METHODS: This study comprised 34 patients with documented coronary artery spasm without significant stenosis (coronary artery luminal diameter narrowing 50%, <70% of luminal diameter) or total cholesterol level between patients with positive and negative results. In 18 typical variant angina patients by clinical history, 8 of 10 patients with high disease activity (5 times or more attack per week) manifested positive result by GET or NGET, whereas 4 of 8 patients with low disease activity (80 vs. 50%, P=NS). CONCLUSION: In patients with coronary vasospastic angina, sudden rapid exercise could induce more frequently coronary artery spasm than multistage exercise. The result of an exercise test may not be correlated with coronary risk factors, coronary anatomy, effort chest pain, and the disease activity.

Short-term Treatment with Angiotensin II Antagonist in Essential Hypertension:Effects of Losartan on Left Ventricular Diastolic Function, Left Ventricular Mass, and Aortic Stiffness

BACKGROUND AND OBJECTIVES: Even short-term treatment with angiotensin converting enzyme inhibitor in essential hypertension has been known to improve left ventricular (LV) diastolic function, LV hypertrophy (LVH), and aortic stiffness. The purpose of this study was to examine the effects of angiotensin II receptor antagonist (Losartan) on LV diastolic function, LVH, and aortic stiffness in essential hypertension. MATERIALS AND METHODS: Twenty-three hypertensive patients who were aged over 50 years, previously untreated, and without cardiac, renal, neurologic disease, or diabetes, were studied. Before and 12 weeks after monotherapy with Losartan 50 mg q.d., (1) supine arterial blood pressure by sphygmomanometry, (2) interventricular septum and LV posterior wall thickness, and LV end-diastolic dimension by M-mode echocardiography, (3) mitral peak E and A wave velocity by doppler echocardiography, (4) pulse wave velocity (PWV) in the descending aorta from aortic arch to the bifurcation by doppler echocardiography, were done. RESULTS: Twelve weeks after treatment, systolic blood pressure was lowered from 168.2+/-3.5 mmHg to 142.9+/-2.9 mmHg (p0.05), compliance (from 1.31+/-0.04 to 1.34+/-0.12, p>0.05), and compliance index (from 0.16+/-0.01 to 0.15+/-0.01, p>0.05). CONCLUSION: Short-term treatment with Losartan decreases blood pressure, improves LV diastolic function and LVH, but not aortic stiffness.