The Prognostic Implication of Metabolic Syndrome in Patients with Heart Failure

BACKGROUND AND OBJECTIVES: Metabolic syndrome (MetS) increases the risk of heart failure (HF). The purpose of this study was to identify the prevalence of MetS in patients with HF and determine the syndrome's association with HF in clinical and laboratory parameters. SUBJECTS AND METHODS: A total of 3200 HF patients (67.6+/-14.5 years) enrolled in a nationwide prospective Korea HF Registry between Jan. 2005 and Oct. 2009. Patients were divided into two groups according to the presence or absence of MetS at admission: group I (presence, n=1141) and group II (absence, n=2059). RESULTS: The prevalence of MetS was 35.7% across all subjects and was higher in females (56.0%). The levels of white blood cells, platelets, creatinine, glucose, and cholesterol were significantly higher in group I than in group II. Left ventricular dimension and volume was smaller and ejection fraction was higher in group I than in group II. An ischemic cause of HF was more frequent in group I. The rates of valvular and idiopathic cause were lower in group I than in group II. The rate of mortality was lower in group I than in group II (4.9% vs. 8.3%, p<0.001). CONCLUSION: Despite the increased cardiovascular risks in MetS, MetS was found to be associated with decreased mortality in HF.

Characteristics, Outcomes and Predictors of Long-Term Mortality for Patients Hospitalized for Acute Heart Failure: A Report From the Korean Heart Failure Registry

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.

Long-Term Effect of Angiotensin Converting Enzyme Inhibitor on Chronic Mitral Regurgitation

BACKGROUND AND OBJECTIVES: Angiotensin converting enzyme inhibitors (ACEI) have been suggested to be beneficial in regurgitant valvular heart disease by reducing both preload and afterload. Moreover their benefits have also been proven in acute mitral regurgitation (MR). However the role of long term administration of ACEI in chronic MR remains in dispute. SUBJECTS AND METHODS: One hundred patients with more than moderate degree MR (rheumatic MR or Mitral valve prolapse [MVP] MR) were identified from patients undergoing cardiac echocardiography between April 1984 and July 2002. Patients with co-morbid valvular heart disease more than mild degree were excluded from the study. The subjects were divided into the study group (who took ACEI) and the control group. Medical records and echocardiographic reports were reviewed and the etiology of MR, left ventricular end-diastolic dimensions (LVEDD), end-systolic dimensions (LVESD), left atrial dimensions, and ejection fraction (EF) changes were studied serially for both groups. RESULTS: The mean duration of follow-up was 5.0+/-3.2 years. There were no significant differences in age, blood pressure, or basal echocardiographic parameters between the rheumatic MR and MVP MR groups. In the MVP MR patients, the ACEI group showed a statistically significant increase in EF (p=0.007), decrease in LVESD (p=0.0014) and decrease in left atrial dimensions (p=0.01). However, in the rheumatic MR patients, the ACEI group showed no significant changes compared to those of the non-ACEI group. CONCLUSION: Long term ACEI therapy seems to be beneficial in mildly symptomatic MR due to mitral valve prolapse.

Effect of Steroid on Impaired Vascular Function Induced by Irradiation

BACKGROUND AND OBJECTIVES: Intracoronary irradiation has been proven to reduce restenosis following percutaneous transluminal coronary angioplasty, however late thrombosis is another recurring problem. We evaluated the sequential changes of vascular dysfunction and morphological changes according to the radiation dosage in rats. The effects of dexamethasone on these changes were also evaluated. MATERICAL AND METHODS: Female Sprague-Dawley rats were randomized into 4 groups (n=20, each group), and were irradiated with 0, 5, 10, 20 Gray (Gy). The rats were sacrificed at 1 hour, 1, 3 and 7 days after irradiation. The physiographic responses and morphologic changes of the arterial rings were evaluated. After the time- and dose-response relationship was determined, an additional 40 rats were pretreated with dexamethasone for 3 days and irradiated with 10 or 20 Gy to evaluate the effects of the dexamethasone. 5 Gy irradiation did not induce endothelial dysfunction. 10 Gy irradiation induced an impairment of endothelium dependent relaxation (EDR) only 7days after irradiation. 20 Gy caused an impairment of EDR from the very time of irradiation, although endothelium independent relaxation (EIDR) was not affected irrespective of dose or time. On immuno-histochemistry of vWF, all irradiated arteries showed mild de-endothelialization in acute phase and subsequent re-endothelialization. However, after 20 Gy irradiation, re-endothelialization did not occur. With dexamethasone treatment, all of these vascular dysfunctions were prevented, and re-endothelialization was promoted. CONCLUSION: Irradiation induced the impairment of EDR as well as de-endothelialization, in a time- and dose-response relationship in rats. Pretreatment with dexamethasone may partly prevent radiation-induced vascular dysfunction and de-endothelialization.

Effect of angiotensin converting enzyme and nitric oxide synthase polymorphisms and the effect of interaction between the polymorphisms on the restensois after coronary angioplasty in Korea / 대한내과학회지

BACKGROUND: Intimal hyperplasia and vascular remodeling are major mechanisms of restenosis after coronary artery angioplasty. Angiotensin II causes restenosis by stimulating cell proliferation and vascular constriction and nitric oxide prevents restenosis by inhibiting cell proliferation and stimulating vascular dilatation. Angiotensin converting enzyme (ACE) and nitric oxide synthase (NOS) are the main determinants of the activity of the angiotensin II and the nitric oxide. In this study, we tested whether the genetic polymorphisms of the ACE and the NOS gene are the risk factors of restenosis and whether the effect of the genetic polymorphisms in stent group is different from that in balloon angioplasty group. We also tested whether there are interactions among the polymorphisms. METHODS: We determined ACE I/D polymorphism and NOS A/B and G/T polymorphism in 219patients (77 patients (81 lesions) in stent group and 142 patients (181 lesions) in balloon angioplasty group) who underwent PTCA and follow up coronary angiography in Seoul national university hospital from January 1996 to May 1999. RESULTS: Restenosis (50% of reference diameter) was observed in 78/262(30%) lesions (18/81(22%) lesions in stent group, 60/181(33%) lesions in balloon angioplasty group). ACE DD genotype is the significant risk factor for increment of late luminal loss and loss index in stent group. In stent group, means of the late luminal loss and loss index of the lesions of the DD genotype are 1.12+/-0.61mm and 74.7+/-38.3% and those of the non-DD genotype are 0.72+/-0.77mm and 44.9+/-67.5% but DD genotype is not the risk factor for restenosis after balloon angioplasty. The restenosis rate, late luminal loss and loss index are not significantly different according to NOS polymorphisms. No significant interaction among the polymorphisms is observed. CONCLUSION: ACE DD genotype is a significant risk factor for restenosis after stent insertion but is not a risk factor for restenosis after balloon angioplasty in Korean. This result reflects the different mechanism of restenosis after stent insertion and balloon angioplasty. NOS polymorphisms are not associated with restenosis and no interaction between the polymorphisms is observed.

Radiofrequency Catheter Ablation of Anteroseptal Accessory Pathways from Right Atrium

BACKGROUND AND OBJECTIVES: Radiofrequency catheter ablation (RFCA) of accessory pathways (AP) has recently become the choice of therapeutic regimen for the patients with atrioventricular (AV) reentrant tachycardia. Among AP, anteroseptal AP is subject to the potential complication of inadvertent AV block during RFCA because of the close proximity to the AV node-His bundle conduction system. This study was conducted to evaluate the efficacy and safety of RFCA of anteroseptal AP at the atrial site by ablation catheter introduced through left subclavian vein. MATERIALS AND METHODS: Seven patients with orthodromic AV reentrant tachycardia mediated by a retrogradely conducting anteroseptal AP were studied. Antidromic AV reentrant tachycardia was also induced in one patient during electrophysiologic study. Mean age was 24+/-10 years (range, 16-42 years) and the male to female ratio was 5:2. APs were manifested in 4 patients and concealed in 3 patients. After diagnosis of anteroseptal AP by electrophysiologic study, temperature guided radiofrequency current was applied in the anteroseptal area at the atrial site of tricuspid annulus by a steerable ablation catheter. RESULTS: All pathways were successfuly ablated. The AV node or His bundle conductions was not impaired in any patients. There were no complications related to the procedure. CONCLUSION: RFCA of the anteroseptal AP at the atrial site by a ablation catheter introduced through superior vena cava is effective and safe with good preservation of the normal conduction system.

Radiofrequency Catheter Ablation of Anteroseptal Accessory Pathways from Right Atrium

BACKGROUND AND OBJECTIVES: Radiofrequency catheter ablation (RFCA) of accessory pathways (AP) has recently become the choice of therapeutic regimen for the patients with atrioventricular (AV) reentrant tachycardia. Among AP, anteroseptal AP is subject to the potential complication of inadvertent AV block during RFCA because of the close proximity to the AV node-His bundle conduction system. This study was conducted to evaluate the efficacy and safety of RFCA of anteroseptal AP at the atrial site by ablation catheter introduced through left subclavian vein. MATERIALS AND METHODS: Seven patients with orthodromic AV reentrant tachycardia mediated by a retrogradely conducting anteroseptal AP were studied. Antidromic AV reentrant tachycardia was also induced in one patient during electrophysiologic study. Mean age was 24+/-10 years (range, 16-42 years) and the male to female ratio was 5:2. APs were manifested in 4 patients and concealed in 3 patients. After diagnosis of anteroseptal AP by electrophysiologic study, temperature guided radiofrequency current was applied in the anteroseptal area at the atrial site of tricuspid annulus by a steerable ablation catheter. RESULTS: All pathways were successfuly ablated. The AV node or His bundle conductions was not impaired in any patients. There were no complications related to the procedure. CONCLUSION: RFCA of the anteroseptal AP at the atrial site by a ablation catheter introduced through superior vena cava is effective and safe with good preservation of the normal conduction system.

Therapy of myocardial infarction after discharge / 대한내과학회지

No abstract available.

Synergistic effect of angiotensin - converting enzyme ( ACE ) & angiotensinogen gene polymorphism on the pathogenesis of acute coronary syndrome but not of chronic stable angina / 대한내과학회지

OBJECTIVES: The renin-angiotensin system(RAS) had an important role in the pathogenesis of ischemic heart disease(IHD). Angiotensinogen(ATG), angiotensin-converting enzyme(ACE), and angiotensin II receptor are key components of RAS and reported to have polymorphisms. We studied to investigate the separate and interactive effects of ACE (I/D) and ATG (M235T) gene polymorphisms on the pathogenesis of IHD, and to compare the genetic influences between on the chronic stable angina(CSA) and on the acute coronary syndrome(ACS). METHODS: We studied total 468 patients who underwent CAG. Control group comprised 159 patients who did not have a significant coronary lesion. IHD group was subgrouped according to clinical manifestation into CSA group(n=90) and ACS group(n=219). To determine the frequency of ACE and ATG genotype, polymerase chain reaction (PCR) and enzyme digestion was done. RESULTS: 1) In ACS group, genotype frequency of ACE(II:ID:DD) was 0.27:0.48:0.25 and ATG (MM:MT:TT) was 0.31:0.59:0.10, which was significantly different from control group (ACE II:ID:DD =0.38:0.45:0.17 and ATG MM:MT:TT =0.51:0.40:0.09) (p<0.05). 2) There was no significant difference in genotype frequency of ACE, ATG gene between CSA group and control. 3) In multiple logistic regression analysis, sex, age, ATG and ACE genotype were independent risk factors for ACS. The relative risk for ACS in ACE DD compared to II genotype was 3.52 (95% CI: 1.52-8.13) and that in ACE ID compared to ACE II genotype was 1.55 (95% CI: 0.82-2.94), which showed that the risk increased with the number of ACE D-allele. In contrast, sex, age, and DM were independent risk factors for CSA, whereas ATG and ACE genotype were not. 4) In combined analysis including both ACE and ATG gene polymorphism, the relative risk for ACS associated with ATG genotype increased with the number of ACE D-allele. CONCLUSION: ACE and ATG gene polymorphism are associated with the development of ACS but not CSA, which suggests that ACE and ATG genes may be involved in the plaque unstabilization or thrombosis rather than the chronic progression of coronary atherosclerosis.

Long-term Follow-up of the Patients with Permanent Antibradycardia Pacemaker

BACKGROUND: Antibradycardia pacemaker is one of the treatment modalities for bradyarrhythmia. We present the clinical results of 440 implantations of permanent pacemaker between August 1984 and December 1997 at Department of Internal Medicine in Seoul National University Hospital. METHOD: We investigated the indication of permanent pacing, the pacing modes, the complications of permanent pacing, and the chronic pacing threshold. RESULT: The study was comprised of 440 patients (M/F : 179/261, mean age : 59+/-12 years, 58+/-14 years, respectively). Indications of the primary pacemaker implantations were sinus node dysfun-ction in 53% and atrioventricular conduction disorders in 47%. Twelve percent of total pacemaker procedures were pulse-generator replacements. Pacing modes were VVI in 59.1%, VVIR in 10.2%, DDD in 30.2%, and others in 0.5%. Complications developed in 21 cases (4.8%) during long-term follow-up. They included 8 cases of pacing failure due to increased pacing threshold, 2 cases of early power depletion, 2 cases of lead dislodgement, 6 cases of lead fracture, 3 cases of skin erosion, 3 cases of hematoma, 3 cases of infection, and 1 case of skeletal muscle stimulation. Chronic pacing thresholds at pacing width of 0.5 msec were 1.9+/-0.4 V for the epicardial ventricular leads (n=11), 1.3+/-0.5 V for the endocardial ventricular leads (n=36), and 1.1+/-0.2 V for the atrial leads (n=4) after 7 to 10 years of implantation. CONCLUSION: Sinus node dysfunction was the more common indication than atrioventricular block for the antibradycardia pacemaker implantation. Long-term follow-up of the pacemaker patients would be very useful to detect the pacing system abnormalities and to maximize the battery longevity by adjustment of pacing output according to the level of chronic pacing threshold.

Long-term Follow-up of the Patients with Permanent Antibradycardia Pacemaker

BACKGROUND: Antibradycardia pacemaker is one of the treatment modalities for bradyarrhythmia. We present the clinical results of 440 implantations of permanent pacemaker between August 1984 and December 1997 at Department of Internal Medicine in Seoul National University Hospital. METHOD: We investigated the indication of permanent pacing, the pacing modes, the complications of permanent pacing, and the chronic pacing threshold. RESULT: The study was comprised of 440 patients (M/F : 179/261, mean age : 59+/-12 years, 58+/-14 years, respectively). Indications of the primary pacemaker implantations were sinus node dysfun-ction in 53% and atrioventricular conduction disorders in 47%. Twelve percent of total pacemaker procedures were pulse-generator replacements. Pacing modes were VVI in 59.1%, VVIR in 10.2%, DDD in 30.2%, and others in 0.5%. Complications developed in 21 cases (4.8%) during long-term follow-up. They included 8 cases of pacing failure due to increased pacing threshold, 2 cases of early power depletion, 2 cases of lead dislodgement, 6 cases of lead fracture, 3 cases of skin erosion, 3 cases of hematoma, 3 cases of infection, and 1 case of skeletal muscle stimulation. Chronic pacing thresholds at pacing width of 0.5 msec were 1.9+/-0.4 V for the epicardial ventricular leads (n=11), 1.3+/-0.5 V for the endocardial ventricular leads (n=36), and 1.1+/-0.2 V for the atrial leads (n=4) after 7 to 10 years of implantation. CONCLUSION: Sinus node dysfunction was the more common indication than atrioventricular block for the antibradycardia pacemaker implantation. Long-term follow-up of the pacemaker patients would be very useful to detect the pacing system abnormalities and to maximize the battery longevity by adjustment of pacing output according to the level of chronic pacing threshold.

Permanent pacemaker implantation via coronary sinus

We report a case of successful ventricular pacing via the coronary sinus in a 34 year-old female patient admitted because of repetitive dizziness and syncope. She had rheumatic valvular disease with mitral valve replacement 14 years earlyer. and the mitral, aortic and tricuspid valves were subsequently replaced with prosthetic mechanical valves 4 years ago. Two years after the triple valve replacement, complete AV block developed with the symptoms of dizziness and syncope. A permanent pacemaker was implanted epicardially. Six months later the epicardial lead was replaced because of increased pacing threshold. A year later the epicardial lead had to be replaced because of increased threshold and capture failure to pace. To avoid further thoracotomy, a 'Medtronic 2188' electrode was implanted in the posterior left ventricular vein via the coronary sinus. Pacing threshold was 1.2 volt/0.4 msec. Five days later, the pacing threshold increased to 3.0 volt/0.4 msec. Prednisolone had been given for 10 months. The new system has been functioning well and the pacing threshold was 1.0 volt/0.4 msec at 11 months after implantation. Ventricular pacing via the coronary sinus can be an alternative to the epicardial pacemaker system in patient whose tricuspid valve have been replaced with mechanical prosthetic valve.

Permanent pacemaker implantation via coronary sinus

We report a case of successful ventricular pacing via the coronary sinus in a 34 year-old female patient admitted because of repetitive dizziness and syncope. She had rheumatic valvular disease with mitral valve replacement 14 years earlyer. and the mitral, aortic and tricuspid valves were subsequently replaced with prosthetic mechanical valves 4 years ago. Two years after the triple valve replacement, complete AV block developed with the symptoms of dizziness and syncope. A permanent pacemaker was implanted epicardially. Six months later the epicardial lead was replaced because of increased pacing threshold. A year later the epicardial lead had to be replaced because of increased threshold and capture failure to pace. To avoid further thoracotomy, a 'Medtronic 2188' electrode was implanted in the posterior left ventricular vein via the coronary sinus. Pacing threshold was 1.2 volt/0.4 msec. Five days later, the pacing threshold increased to 3.0 volt/0.4 msec. Prednisolone had been given for 10 months. The new system has been functioning well and the pacing threshold was 1.0 volt/0.4 msec at 11 months after implantation. Ventricular pacing via the coronary sinus can be an alternative to the epicardial pacemaker system in patient whose tricuspid valve have been replaced with mechanical prosthetic valve.

The Influence of Morphological Characteristics of lesions on the Development of Collateral Circulation in Angina Pectoris

BACKGROUND: It is well known that collateral circulation has important roles in ischemic heart disease. It reduce ventricular remodelingand infarct size to improve ventricular function and survival. Extents and duration of ischemia are critical stimulants of the development of coronary collaterla circulation. We hypothesize that collateral circulation is poor in patients with lisions at branching points because atherosclerosis progress more rapidly not to allow the collateral circulation to develop. METHOD: We studied total 330 coronary angiography, which have more than 50% stenosis in any coronary artery, normal letf ventriculography and no history of myocardial infarction. In each coronary angiography, severity, site, proximity, length of lesions were analyzed, classified, and collaterale circulation was graded. We also observed whether the lesions involve branching point or not. RESULTS: While coronary collateral circulation developed well when stenosis was more than 90% in the severity, it was poor when the lesions involve branching points. Collateral circulation tended to be poor in case of eccentric lesion, but it was statistically insignificant. The above findings support our hypothesis of the accelerated atherosclerosis at branching points. CONCLUSIONS: The facts that the development of coronary collaterals is poor with lesions involving branching points suggest that atherosclerosis is accelerated at these lesions that is characterized by blood stasis, turbulence and lower arterial wall tension.

Fibrinogen as Risk Factors for the Coronary Artery Disease

BACKGROUND: This prospective and cross-sectional study was conducted to assess the risk factors for coronary artery disease in the selected Korean Pateints. METHOD: We analyzed clinical parameters and biochemical parameters in 158 subjects; 98 subjects with significant coronary artery disease as proven by coronary angiography(stable angina pectoris : 55, unstable angina pectoris : 30, post-myocardial infarction angina pectoris : 13) and 58 normal subjects as proven by coronary angiography, from November 1993 to April 1994 in Seoul National University Hospital. RESULTS: 1) Old age, male gender, history of diabetes and smoking, high low density lipoprotein cholesterol level, high lipoprotein (a) level and high fibrinogen level were identified and risk factors for coronary artery disease on simple logistic regression analysis. 2) Lp(a) was positively related to fibrinogen(r=0.23), cholesterol(r=0.23) and low density lipoprotein cholesterol(r=0.28). 3) High fibrinogen level, old age, and male gender were independent risk factors of significant coronary artery disease in the selected Korean Population on multiple stepwise logistic regression analysis. CONCLUSION: High fibrinogen level, old age, and male gender six were independent risk factors of significant coronary artery disease in the selected Korean Population of multiple stepwise logistic regression analysis. These findings could not deny the role of cholesterol in coronary artery disease, but suggested that factors related to thrombosis and fibrinolysis, may play more important role in Korean patients coronary artery disease.

Fibrinogen as Risk Factors for the Coronary Artery Disease

BACKGROUND: This prospective and cross-sectional study was conducted to assess the risk factors for coronary artery disease in the selected Korean Pateints. METHOD: We analyzed clinical parameters and biochemical parameters in 158 subjects; 98 subjects with significant coronary artery disease as proven by coronary angiography(stable angina pectoris : 55, unstable angina pectoris : 30, post-myocardial infarction angina pectoris : 13) and 58 normal subjects as proven by coronary angiography, from November 1993 to April 1994 in Seoul National University Hospital. RESULTS: 1) Old age, male gender, history of diabetes and smoking, high low density lipoprotein cholesterol level, high lipoprotein (a) level and high fibrinogen level were identified and risk factors for coronary artery disease on simple logistic regression analysis. 2) Lp(a) was positively related to fibrinogen(r=0.23), cholesterol(r=0.23) and low density lipoprotein cholesterol(r=0.28). 3) High fibrinogen level, old age, and male gender were independent risk factors of significant coronary artery disease in the selected Korean Population on multiple stepwise logistic regression analysis. CONCLUSION: High fibrinogen level, old age, and male gender six were independent risk factors of significant coronary artery disease in the selected Korean Population of multiple stepwise logistic regression analysis. These findings could not deny the role of cholesterol in coronary artery disease, but suggested that factors related to thrombosis and fibrinolysis, may play more important role in Korean patients coronary artery disease.

The Effect of Heart Rate on Aortic Valve Area Calculated by Continuity Equation

BACKGROUND: Recent investiogations have shown that aortic valve area derived by continuity equation as well as Gorlin formula varied with transvalvular volume flow rate. This study was designed to investigate the effect of heart rate on aortic valve area calculated by continuity equation. METHODS: We studied 10 patients of with cath-proven aortic stenosis. Patients underwent echocardiography recording during right atrial pacing with 80, 100 and 120 beats/min. Flow rate and continuity equation valve area were obtained at each heart rate by doppler echocardiography. RESULTS: Transvalvular flow rates were 194+/-30 ml/sec, 208+/-38 ml/sec and 200+/-39 ml/sec with pacing at 80, 100 and 120 beats/min respectively, and there was no significant change in flow rate with heart rate. Aortic valve areas derived by continuity equation were 0.77+/-0.14cm2, 0.81+/-0.14cm2and 0.86+/-0.15cm2with pacing at 80, 100 and 120 beats/min. There was signifcant increase in aortic valve area between heart rate 120 and 100 beat/min(p=0.02), and between heart rate 120 and 80 beas/min([=0.003). there was no significant change in aortic valve area between heart rate 100 and 80 beat/min. CONCLUSION: Although there was no significant change in transvalvular flow rate with heart rate increase, aortic valve area derived by continuity equation significantly increased with increased heart rate. This relation should be considered when interpretion continuity equation valve area in aortic stenosis.

Antihypertensive Efficacy and Safety of Perindopril Versus Nifedipine in High Salt Intake Essential Hypertensives : A Double-Blind Parallel Group Study

BACKGROUND: To assess the efficacy and safety of perindopril, a new angiotensin-converting enzyme(ACE) inhibitor, perindopril was compaired to nifedipine LP. METHODS: Perindopril(4mg q.d.) was compaired to nifedipine LP(20mg b.i.d.) in the double blind, parallel-group study involving total of 41 hypertensive patients with diatolic blood pressure(DBP) of 95-125mmHg. A 4-week single-blind placebo period preceeded 12 weeks of active tratment. Dose titration was at weeks 4 and 8 if the DBP was >90mmHg. The dose was doubled and, if necessary, a diuretic(hydrochlorthiazide 25mg) was added. The analysis of efficacy was performed on the 36 patients who completed the trial after 12 weeks; active treatment. The analysis of tolerance involved all 41 patients who entered the study. RESULTS: 1) The two groups were homogeneous prior to treatment. 2) The fall in blood pressure(BP) with perindopril was 22/11mmHg(from 160+/-14/101+/-6mmHg to 139+/-15/90+/-6mmHg) and 32/19mmHg(from 164+/-18/104+/-7 to 132+/-17/85+/-10mmHg) for nifedipine. 3) 65% of the perindopril group and 84% of the nifedipine group achived the target BP(diastolic BP or =10mmHg) was similar between two groups(88% cersus 89%). 5) Heart rate was not changed in the perindopril group. but increased in the nifedipine group. 6) Five patients withdrew from the study ; two were attributed to adverse events. one in the perindopril group and one in the nifedipine group. 7) The incidence of side effects in the perindopil group was less than that in the nifedipine group. Cough was reported by 10% of patients of the perindopril group. 8) Both groups did not induce changes in blood glucose and lipid profiles. 9) We could not find any significant relationship between the amount of blood pressure decline and 24 hour urine sodium excretion. 10) There were no clinically significant changes in laboratory parameters. CONCLUSION: Perindopril reduced blood pressure to slightly less extent than nifedipine, but had as similar efficacy as nifedipine. Perindopril had less side effects than nifedipine.

AV Nodal Reentrant Tachycardia with 2:1 AV Block

BACKGROUND: Second degree AV block is occasionally induced during AV nodal reentrant tachycardia by programmed electrical stimulation. This study was performed to determine the incidence, the block site, and the mechanism of AV block during AV nodal reentrant tachycardia. METHODS AND RESULTS: The study population was 67 consecutive patients with AV nodal reentrant tachycardia studied by programmed electrical stimulation. Among these patients, common types(slow pathway for anterograde and fast pathway for retrograde conduction) were 64 patients and uncommon types(fast pathway for anterograde and slow pathway for retrograde conduction) were 3 patients. Among 67 patients with AV nodal reentrant tachycardia 10 patients developed 2:1 AV block during tachycardia. The block site of AV block was infrai bundle in 9 patients and supraHis bundle in patient. There were intermittent aberrancies of RBBB and/or LBBB form during tachycardia in 5 patients with infraHis AV block. CONCLUSION: The occurrence of AV block during AV nodal reentrant tachycardia is not rare and might be related to the prematurity of atrial extrastimulation. The block sites of AV block were infraHis bundle in most cases and this finding suggests that distal common pathway of the reentry circuit is present in the AV node.

Clinical significance of plasma tissue plasminogen activator and plasminogen activator inhibitor-1 in chronic stable angina

BACKGROUND: Impaired fibrinolytic system has been considered to play an important role in the pathogenesis of coronary artery disease, especially associated with thrombus formation. To evaluate the pathogenetic role of fibrinolytic system in coronary artery disease, major determinants of fibrinolytic system, tissue plasminogen activator(t-PA) and palsminogen activator inhibitor-1(PAI-1) levels were measured in control(n=7) and chronic stable angina patients(n=7). METHODS: Blood samplings were done in resting state, venous occlusion and peak exercise. Levels of plasma t-PA antigen and PAI-1 antigen were measured by ELISA method. RESULTS: 1) In resting state, there was no significant difference in plasma level of t-PA(control group : 9.15+/-2.82ng/ml vs, study group ; 9.65+/-3.53ng/ml) and PAI-1(control group ; 20.27+/-9.98ng/ml vs, study group ; 17.43+/-3.53ng/ml) between each group. 2) With venous occlusion test, increment of plasma t-PA level was noted in both groups which was lower in patient group, however, this difference in increment was not statistically significant. 3) Increased plasma t-PA level was noted after exercise in both groups. 4) Plasma level of PAI-1 was not significantly changed after venous occlusion or exercise in both groups. CONCLUSIONS: In patients with chronic stable angina, there was no definite evidence of impaired fibriolytic system although plasma t-PA increased somewhat less after venous occlusion in patients with chronic stable angina than control.