ABSTRACT
BACKGROUNDS AND OBJECTIVES: Anemia could adversely affect the cardiovascular condition of the patients suffering with heart failure. This study aimed to elucidate the relationship between anemia and the prognosis of heart failure (HF). SUBJECTS AND METHODS: We enrolled the patients with a diagnosis of CHF who visited to our hospital from January 2000 and January 2001 and they had a left ventricular ejection fraction (EF) less than 40% and a left ventricular end diastolic dimension (LVEDd) larger than 5.7 cm. The hemoglobin (Hb) level was accessed at the time of the initial evaluation. The patients were divided into quartiles of Hb: Hb 14.8 g/dL. RESULTS: A total of 110 patients were enrolled; there were 71 men and 39 women. Anemia was found in 39 (35.5%) patients, and this was significantly more common in the women than in men (p=0.038). The lowest Hb group was more likely to be older and female, and they had severe symptoms (NYHA functional class III or IV), a lower diastolic BP and a wider QRS width. The total mortality was 24.5%. Mortality was higher with lower Hb quartile (46.2%, 28.6%, 17.9% and 7.1% for each quartile, respectively, p=0.002). On the multivariate analysis after adjusting for age, gender, NYHA functional class and the known HF prognostic factors, the lowest Hb level proved to be an independent predictor of mortality (p=0.019). CONCLUSION: In patients with congestive heart failure, anemia is relatively common and the mortality was higher for the lower Hb group. Anemia is an independent negative prognostic factor in patients with congestive heart failure.
Subject(s)
Female , Humans , Male , Anemia , Diagnosis , Heart Failure , Heart , Mortality , Multivariate Analysis , Prognosis , Stroke VolumeABSTRACT
BACKGROUND AND OBJECTIVES: Congenital long QT syndrome (LQTS) is a genetic disease that brings prolongation of the QT interval on an electrocardiogram and leads to syncope and sudden death by a fatal ventricular arrhythmia. In Korea, there have been studies about the clinical characteristics and treatment of LQTS, but there are no studies for the molecular and biological evaluation of its genetic mutation. SUBJECTS AND METHODS: Six nationwide university hospitals and laboratories segregated DNA from the blood of 10 patients diagnosed with LQTS to analyze the genetic mutation. RESULTS: Nine out of ten individuals were female. Eight showed genetic mutations. Three had an abnormality in the KvLQT1, 6 in the HERG and 2 had abnormalities in both KvLQT1 and HERG. None had abnormalities in KCNE1 and 2 showed no abnormalities in KvLQT1, HERG or KCNE1. CONCLUSION: Congenital LQTS shows various genetic mutations, and this indicates the necessity for further organized study in more individuals for confirmation of the relationship between the results of clinical diagnosis and genetic analysis.
Subject(s)
Female , Humans , Arrhythmias, Cardiac , Death, Sudden , Diagnosis , DNA , Electrocardiography , Hospitals, University , Korea , Long QT Syndrome , SyncopeABSTRACT
BACKGROUND AND OBJECTIVES: Many studies have established risk factors for cardiovascular diseases. The Duke treadmill score has gained widespread acceptance for prognosis and diagnosis in cardiac diseases. Recently, changes in heart rate during and after exercise have also been studied to predict the prognosis of cardiac diseases. We examined the relationship between the incidence of cardiovascular events and exercise capacity, achievement of 85% maximal predicted heart rate (MPHR) or heart rate recovery (HRR) after a routine exercise treadmill test. SUBJECTS AND METHODS: We studied 88 patients with chest pain who were over the age of 30. They were referred for exercise treadmill test for assessment of chest pain and underwent symptom-limited, exercise test with a cool down period of 30 seconds. HRR was defined as the difference in heart rate between peak exercise and 1 minute after exercise. Delta heart rate (DHR) was defined as the difference in heart rate between resting and peak exercise. Other parameters in the exercise test were also measured. RESULTS: Cardiovascular events were found in 13 of the 88 patients. In the events group, age, peak heart rate in exercise, ST depression, maximal exercise capacity, HRR, DHR and achievement of 85% MPHR were all significant variables. There was a favorable prognosis in the patients with a value of HRR >22 beats/minute and a value of DHR >83 beats/minute. Even after adjusting for age, sex, ST depression and left ventricular hypertrophy, the parameters of maximal exercise capacity, HRR, DHR, and achievement of 85% MPHR remained predictive prognostic factors in cardiovascular events. CONCLUSION: Parameters in exercise treadmill test, such as maximal exercise capacity, HRR, DHR and achievement of 85% MPHR, appear to provide additional information and are important variables associated with the prediction of risk in cardiac events.
Subject(s)
Humans , Cardiovascular Diseases , Chest Pain , Depression , Diagnosis , Exercise Test , Heart Diseases , Heart Rate , Heart , Hypertrophy, Left Ventricular , Incidence , Prognosis , Risk FactorsABSTRACT
A spontaneous coronary artery dissection is a rare cause of acute myocardial ischemia. However, its precise etiology, pathogenesis, prevalence and treatment is unclear. The clinical presentation of a spontaneous coronary artery dissection can be sudden death or an acute coronary syndrome and sometimes no symptoms are present. We report a case of a 39-year-old man with a spontaneous coronary artery dissection in the right coronary artery. He presented with a history of chest pain persisting for 4 hours. The initial electrocardiogram showed a ST segment elevation in lead II III and aVF. He received intravenous urokinase, but no improvement in his symptoms was observed and the electrocardiographic changes did not resolve. A rescue coronary angiogram was performed, which demonstrated an area of dissection in the distal right coronary artery with resultant TIMI II flow. A 3.5x36 mm MAC stent was deployed across the lesion. After implanting the stent, the remainder of his stay was uncomplicated and he has remained asymptomatic at the time of this review.
Subject(s)
Adult , Humans , Acute Coronary Syndrome , Chest Pain , Coronary Vessels , Death, Sudden , Electrocardiography , Myocardial Infarction , Myocardial Ischemia , Prevalence , Stents , Urokinase-Type Plasminogen ActivatorABSTRACT
BACKGROUND: Prosthetic valve thrombosis is an uncommon but serious complication. Thrombolytic therapy has recently been proposed as an alternative to surgical methods in treating this condition and is used increasingly. However, the indications for thrombolytic treatment in prosthetic valve thrombosis have not been well defined and differential diagnosis of thrombosis is still difficult. METHODS: Four symptomatic patients with prosthetic valve thrombosis underwent 9 thrombolytic sessions for 7 distinct episodes. Transthoracic or transesophageal echocardiography and cinefluoroscopy were performed and repeated after each thrombolytic session. Urokinase or rt-PA (recombinant tissue-type plasminogen activator) was used and repeated dose was given if necessary. Recurrent thrombosis was treated also either with urokinase or rt-PA. RESULTS: All patients were female and mean age was 38.5 years old. Two valves were in mitral position and the other two were in tricuspid position. The anticoagulation status was inadequate in three patients. The initial success after first dose was 43% (3/7), which increased to 54% (4/7) after repeated thrombolytic therapy. Thrombolytic therapy was failed in three episodes; two thromboses and one ingrowths of pannus. Operations were needed in these cases. No complication was seen. CONCLUSION: Thrombolytic treatment can be used as an alternative to surgical therapy with a low risk of complications. But guideline of thrombolytic therapy for the recurrent thrombosis and education for the patients about the adequate anticoagulation were needed.