Regeneration of Recurrent Laryngeal Nerve using Polycaprolactone (PCL) Nerve Guide Conduit Coated with Conductive Materials / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: Recurrent laryngeal nerve (RLN) damage commonly occurs from a thyroid surgery and causes communication impairment, aspiration and dysphagia. The purpose of this study is to develop a polycaprolactone (PCL) nerve guide conduit (NGC) coated with conductive materials for facilitating regeneration from the RLN defects and to evaluate the usefulness of the PCL NGC coated with conductive materials in a rabbit model. MATERIALS AND METHODS: The PCL NGCs coated with conductive materials were fabricated for this study. The types of conductive materials were single-walled carbon nanotubes (SWNTs) and poly (3,4-ethylenedioxythiophene): polystyrene sulfonate (PEDOT:PSS) which were coated on the PCL NGCs by layer-by-layer (LBL) assembly techniques. An 8-mm segment of left RLN was resected in 24 New Zealand white rabbits. Three different NGCs (PCL and PCL with two conductive materials) were interposed between both stumps and fixed with suture. For the assessment of functional regeneration, the vocal cord mobility was observed using endoscopic system after RLN stimulation, and the motion change was analyzed. The atrophies of thyroarytenoid muscle and nerve growth were evaluated by Hematoxylin-Eosin (H-E) and toluidine blue (T-B) staining, respectively. Immunohistochemical study using anti-neurofilament, S-100 staining was further performed to evaluate the nerve regeneration. RESULTS: In endoscopic evaluation, the group with conductive PCL NGCs showed an improved tendency of vocal cord mobility compared to that of the other group. Nerve growth was observed with the time for 8 weeks in all groups and immunohistochemical staining revealed the expression of neurofilament and S-100 in regenerated nerve in all groups. The atrophies of thyroarytenoid muscle in the group with conductive PCL NGCs was also shown to be decreased compared to that of the nonconductive PCL NGC group. CONCLUSION: The study shows that PCL NGC coated with conductive materials appears to be a good alternative option for the repair and regeneration of RNL damages.

A Case of Huge Thrombus in the Aortic Arch with Cerebrovascular Embolization

Pedunculated thrombus in the aortic arch that is associated with cerebral infarction is very rare requires prompt diagnosis and treatment to prevent occurrence of another devastating complication. Transesophageal echocardiography is useful for detecting source of embolism including aortic thrombi. The treatment options of aortic thrombi involves anticoagulation, thrombolysis, thromboaspiration, and thrombectomy. Here we report a case of huge thrombus in the aortic arch, resulting in acute multifocal cerebellar embolic infarct in patient without any risk factors for vascular thrombosis. Thrombi in the aortic arch were diagnosed by transesophageal echocardiography and treated with anticoagulants successfully.

Aberrant right coronary artery from the left coronary sinus with an interarterial course detected using 128-multidetector coronary CT angiography / 대한내과학회지

No abstract available.

Correlation between inflammatory markers and the progression of atherosclerosis in patients with coronary artery disease / 대한내과학회지

BACKGROUND/AIMS: Inflammation plays a key role in the pathogenesis and progression of cardiovascular disease (CAD). A small number of recent studies reported anti-inflammatory therapy achieved a reduction of CAD progression. The aim of the present study was to explore the roles of inflammatory markers and the conventional risk factors for CAD progression. METHODS: One hundred and fifty patients (58+/-10 years, 112 men) who underwent percutaneous coronary intervention and follow-up angiography (mean duration, 7.5+/-2.0 months) were enrolled in this study. On comparison of the coronary angiographic findings, the patients were divided into the progression and non-progression groups. The serologic inflammatory markers were angiography measured at the time of follow up. The clinical characteristic and inflammatory markers were compared between the two groups and the independent predictors of CAD progression were analyzed. CAD progression was defined as more than 30% diameter reduction of a pre-existing luminal stenosis. RESULTS: CAD progression occurred in 32 patients (21.3%). The frequency of diabetes mellitus (37.5% versus 19.5%, respectively, p=0.033) and the number of the disease vessels (p=0.003) were higher in the CAD progression group. In terms of the inflammatory markers, the progression patients had higher hsCRP (p=0.023), MCP-1 (p=0.036), sVCAM-1 (p=0.000), sP-selectin (p=0.000) and sCD40L (p=0.001) levels. Multiple logistic regression analysis of the variables showed that the logCRP (relative risk (RR) 5.016, CI=1.384-18.177, p=0.014) logVCAM-1 (RR 11.854, CI=1.883-74.614, p=0.008) and triple vessel disease of the coronary arteries (RR 5.037, CI=1.550-16.350, p=0.007) were independent predictors of CAD progression. CONCLUSION: In the present study, the extent of coronary artery disease and inflammatory markers like hsCRP and VCAM-1 were independent predictors for the progression of atherosclerotic lesions.

Giant aneurysm and fistula fed by multiple arteries and draining into the pulmonary artery: detection by 64-multidetector coronary CT angiography / 대한내과학회지

No abstract available.

The Estimated Glomerular Filtration Rate With Using the Mayo Clinic Quadratic Equation as a New Predictor for Developing Contrast Induced Nephropathy in Patients With Angina Pectoris

BACKGROUND AND OBJECTIVES: The Mayo clinic quadratic (MCQ) glomerular filtration rate (GFR) equation accurately estimates the GFR when the presence of kidney disease is unknown. The aim of this study is to evaluate the usefulness of the MCQ GFR equation for predicting contrast-induced nephropathy (CIN) in patients with angina pectoris and who are undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: One hundred seven patients diagnosed with stable or unstable angina and who had normal serum creatinine levels (SCr or =250 mL (OR 17.1, p=0.002), a CRP level > or =0.5 mg/dL (OR 4.7, p=0.037) and a left ventricular ejection fraction < or =40% (OR 1.7, p=0.020) were the independent risk factors for CIN. CONCLUSION: The pre-coronary angiography MCQ GFR is a useful predictor for the development of CIN. Strong preventive strategies are needed to avoid developing CIN in these high-risk patients.

Risk Factors Associated with Hemodynamic Instability during Stent Implantation in Unprotected Left Main Lesions without Routine IABP: Identification of the High Risk Patients

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) stenosis is a promising approach during this era of drug-eluting stents. However, there is no available hemodynamic data on these type patients during the performance of LMCA stenting. The purpose of this study was to determine the risk factors affecting hemodynamic stability during LMCA stenting, and to evaluate whether hemodynamic support such as inotropics or intra-aortic balloon pump (IABP) is needed, based on the risk factors. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 92 study patients (Male=55) who had visited Yeungnam University Hospital, Keimyung University Dongsan Hospital and InJe University Baik Hospital in Busan and they were all were diagnosed with angiographically detected unprotected LMCA stenosis. Group 1 (n=69) included those patients who did not need hemodynamic support during PCI. Group 2 (n=23) included patients who needed hemodynamic support during PCI. All patients had stents deployed in the LMCA lesions without hemodynamic support; the clinical, angiographic and procedural outcomes were compared between the two groups after the procedure. RESULTS: The baseline patient characteristics were not statistically different between the two groups. On univariate analysis, Group 2 had more patients diagnosed with acute myocardial infarction (AMI) than Group 1 (40% vs. 15%, respectively, p=0.014). Group 1 had a greater frequency of an increased left ventricular (LV) ejection fraction than Group 2 (60+/-10 vs. 47+/-11, respectively, p=0.01). Regarding the lesion location in the LMCA, Group 2 had relatively more lesions at bifurcated locations than Group 1 (44% vs. 78%, respectively, p=0.004). Group 2 required more complex techniques to repair lesions, such as kissing or crush stenting, than did Group 1 (19% vs. 48%, respectively, p=0.006). Multivariate logistic regression analysis showed that the presence of AMI (Odds Ratio (OR)=3.74, p=0.014), a complex stenting procedure such as kissing or crushing (OR=3.99, p=0.006), a bifurcated lesion (OR=4.58, p=0.004) and poor LV function (OR=9.95, p=0.0001) were independent risk factors for hemodynamic instability during LMCA stenting. CONCLUSION: The most important risk factor for hemodynamic instability during LMCA stenting was LV function. Therefore, preparation for hemodynamic support, including IABP before the procedure, is necessary for the high risk patients.

Thrombolytic Therapy during Cardiopulmonary Resuscitation in a Patient with Cardiac Arrest

Thrombolytic therapy during cardiopulmonary resuscitation is not routinely recommended, but 50-70% of cardiac arrests are caused by either acute myocardial infarction or massive pulmonary embolism. Thrombolytic therapy can be a reasonable treatment modality for a patient suffering with cardiac arrest in an emergency situation and whose diagnosis is not known. We report here on a case with cardiac arrest and the diagnosis was not known. The patient was refractory to conventrional cardiopulmonary resuscitation, and he was treated with a bolus injection of a thrombolytic agent. He recovered completely without complications.

Diffuse Alveolar Hemorrhage due to Acute Mitral Regurgitation

Diffuse alveolar hemorrhage occurs from a variety of causes and mitral stenosis has been well known to cause hemoptysis. However, mitral regurgitation rarely can cause hemoptysis at presentation. A 38-year-old man who has been healthy was admitted to the hospital with massive hemoptysis. The patient underwent fiberoptic bronchoscopy which showed fresh blood throughout the bronchus of both lung and transbronchial biopsy showed chronic inflammation. All serologic and microbiologic markers were negative. On auscultation, grade 4 holosystolic murmur was incidentally heard at apex, the patient was examined by transthoracic 2-dimensional Doppler echocardiography which showed severe mitral regurgitation. Transesophageal echocardiography showed severe mitral regurgitation with A2 portion chordae rupture of anterior mitral leaflet. The patient was done with emergency mitral valve repair surgery and complete resolution of symptom and radiographic abnormalities thereafter.

Hypertrophic Cardiomyopathy Complicated by Left Ventricular Apical Necrosis and Aneurysm in a Young Man: FDG-PET Findings

A 29-year old male was transferred to our hospital with an abnormal chest X-ray finding diagnosed as hypertrophic cardiomyopathy with apical necrosis and aneurysm formation. Four years after the initial hospitalization, we confirmed the aneurysm and necrosis using both integrated positron emission tomography (PET) and computed tomography (CT) scanning. The F-18 2-fluoro-2-deoxy-D-glucose (FDG) PET/CT enabled precise localization of the aneurysm, which was found to be composed of semi-lunar calcification of non-metabolic myocardium. A contrast-enhanced CT angiography showed an hour-glass appearance of the left ventricular cavity. The integrated PET/CT fusion scanner is a novel multimodality technology that allows for a comprehensive analysis of the anatomical and functional status of complex heart disease. Based on these findings, long standing mechanical and physiologic abnormalities may have led to chronic ischemia in the hypertrophied myocardium, induced necrosis and calcification at the cardiac apex.

Effect of Left Atrial Decompression by Percutaneous Balloon Mitral Commissurotomy on the Atrial Electrophysiologic Properties

BACKGROUND AND OBJECTIVES: Atrial dilatation contributes to the inducibility of atrial fibrillation (AF) by changing the atrial electrophysiological properties. There has been no report regarding the electrophysiologic data of the left atrium (LA), where the most significant electrophysiological impact might be expected to occur in case of mitral stenosis (MS). We investigated the electrophysiological changes after reduction of the LA pressure in patients who were undergoing percutaneous balloon mitral commissurotomy (PBMC). SUBJECTS AND METHODS: We studied 26 patients (21 women, age range: 50+/-12 years) with MS, including 7 sinus rhythm (SR) patients. The effective refractory period (ERP), the monophasic action potential duration (MAPD90), and the conduction time (CT) were measured simultaneously in both atriums at 600, 500, 400 and 300 ms of drive cycle length (DCL). The restitution slope (RS) was also calculated by the S1S2 method. The atrial fibrillation cycle length (AFCL) and dominant frequency (DF) for the cases of AF were also calculated. All the measurements were repeated after PBMC. RESULTS: The mean LA pressure was significantly reduced after PBMC in both the AF and SR patients (17.0+/-5.5 mmHg vs 10.4+/-4.0 mmHg, respectively, p<0.01, 17.6+/-7.1 mmHg vs 9.0+/-2.8 mmHg, respectively, p<0.01). A significant increase of ERP was observed in the LA after PBMC, but not in the right atrium (RA). The increase of MAPD90 after PBMC was significant in the LA at all the tested DCLs, but not in the RA. The CT was also significantly decreased at all the tested DCLs after PBMC. The RS of the LA decreased from 1.71+/-0.82 to 0.76+/-0.33 after PBMC (p=0.056). However, no significant changes of the AFCL or DF after PBMC were observed in the AF group. CONCLUSION: Chronic atrial stretch altered the atrial electrophysiological milieu, especially in the LA, which was partially reversible in SR patients. This result supports the theoretical basis for the beneficial effects of early intervention to reduce the atrial pressure overload in MS patients.

Optimal resting heart rate in adult population: factors related to the heart rate / 대한내과학회지

BACKGROUND: The resting heart rate (HR) or HR recovery after exercise is one of the important predictors of cardiovascular disease mortality. However, few studies have addressed the ideal range of the HR. We sought to define the normal HR of healthy adults who have no evidence of cardiovascular or systemic illness, and none of the component of metabolic syndrome (MS). METHODS: We analyzed a total of 20,162 asymptomatic adults, who were referred for a general health evaluation. All participants underwent careful clinical evaluation, including a detailed history, physical examination and laboratory workup. The mean HR for 30 seconds in the morning after an overnight fast was obtained. There were 7,823 subjects who were free of any component of MS. There were 935 MS patients, and 10,492 patients had > or =1 component of MS. RESULTS: The HR was faster in women. The resting HR of healthy men was 59.9+/-8.2 bpm, and that of healthy women was 63.7+/-8.5 bpm. There was significant correlation between the HR and the age of healthy adults (r=-0.008, p<0.001). The mean resting HR was higher in the MS patients than that of their healthy counterparts (67.4+/-10.6 bpm vs 62.0+/-8.6 bpm, respectively, p=0.000). A significant gradual increase of HR was observed as the numbers of MS component increased (r=0.127, p<0.001). The systolic blood pressure, fasting blood sugar, HbA1c, triglyceride, gamma GTP, uric acid and CRP were significantly correlated with HR. CONCLUSIONS: We herein newly define the optimal HR in a healthy adult population. Follow-up study is needed to clarify the role of HR as a risk stratifier.

Correlations of C-reactive protein levels and Framingham coronary risk score / 대한내과학회지

BACKGROUND: The Framingham coronary risk score is a simplified coronary prediction tool developed to enable clinicians to estimate cardiovascular risk. C-reactive protein (CRP), a marker of low-grade inflammation, has been extensively studied in several large, prospective, epidemiological studies. However, few studies are available that have directly compared CRP levels with the Framingham coronary risk score. METHODS: A total of 13,052 individuals that visited our hospital for comprehensive medical tests between January 2002 and June 2003, were enrolled in the study (7,978 men, 5,074 women, mean age 44.8+/-11.0 years). Plasma samples were assayed for determination of CRP level by using a clinically validated high-sensitive assay. The Framingham coronary risk score was calculated by using previously published algorithms that used baseline cardiac risk factors including age, HDL cholesterol level, total cholesterol level, smoking status, blood pressure, and history of diabetes. Pearson correlation coefficients relating these individual risk factor scores and a total score were calculated. The CRP levels were divided into different categories; into 4 groups based on the quartiles of the CRP levels and 3 groups based on the baseline CRP levels of 0.3 mg/dL. The CRP levels were compared with the Framingham coronary risk score and the Framingham 10-year coronary heart disease risk according to each group. RESULTS: CRP levels significantly correlated with the Framingham coronary risk score (rtotal=0.373, p<0.01; rmen=0.351, p<0.01; rwomen=0.378, p<0.01). The CRP levels also correlated with individual components of the Framingham coronary risk score, which included age (rtotal=0.302, p<0.01; rmen=0.330, p<0.01; rwomen=0.287, p<0.01), blood pressure (rtotal=0.275, p<0.01; rmen=0.214, p<0.01; rwomen=0.270, p<0.01) and HDL-cholesterol level (rtotal=0.221, p<0.01; rmen=0.198, p<0.01; rwomen=0.221, p<0.01). Furthermore CRP levels correlated with calculated the Framingham 10-year coronary heart disease risk (rtotal=0.366, p<0.01, rmen=0.301, p<0.01, rwomen=0.420, p<0.01). The Framingham coronary risk score and calculated Framingham 10-year coronary heart disease risk increased with each increasing CRP level category(quartiles and risk, p<0.01). CONCLUSIONS: The CRP level correlated well with the Framingham coronary risk score and is a useful factor for predicting cardiovascular risk in Korean patients.

Lesion Location: Its Impacts on the Procedural and Postprocedural Outcomes of Unprotected Left Main Coronary Stenting

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) stenosis is a promising technique in the drug-eluting stent era. However, there is a lack of data as to the impact of the lesion location in the LMCA on the procedural and postprocedural outcomes. The aim of this study is to evaluate the effect of lesion location on the procedural and postprocedural outcomes. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 82 patients (Males: n=49), who underwent PCI for unprotected LMCA stenosis at Yeungnam University Medical Center, Keimyung University Dong-san Hospital and In-je University Baik Hospital in Busan. The patients were divided into two groups according to the lesion location. Group 1 (n=38) was defined as those patients who had a significant stenosis in the ostium and/or body. Group 2 (n=44) was defined as those patients had a left main coronary lesion involving a bifurcation. All the patients had a sirolimus eluting stent (Cypher, Cordis) deployed into the LMCA stenosis. Stenting techniques such as the T, crush and kissing stent techniques for treating the LMCA were used at the discretion of the operator and according to the characteristics of the lesion location. The in-hospital outcomes were compared between the two groups and follow-up coronary angiography was performed after 6 months; the major adverse cardiac events (MACE) and restenosis were analyzed between the two groups. RESULTS: The baseline characteristics between the two groups were not statistically different. The procedural outcomes showed that for the stenting methods, the conventional stent technique was the only one used in all cases of Group 1, but the kissing, T stenting and Crush techniques were also used in Group 2 (p=0.001). The clinical outcomes showed that that there was no statistical difference for the in-hospital MACEs between the two groups, but for the out-of hospital MACEs at 6 month, the target lesion revascularizatin rates, including PCI or bypass graft operation, in Group 1 were higher than those in Group 2 (0% vs 13.6%, respectively p=0.043). Both groups had one cardiac death each (2.3% vs 2.6% respectively) and there was 1 MACE in Group 1 and 7 MACEs in Group 2 (2.6% vs 16%, respectively, p=0.045). The angiographic outcomes at 6 month showed that all 8 significant restenosis cases were included in Group 2 (18%, 9.7% in the total population); the restenosis site was the left circumflex artery in all cases. CONCLUSION: PCI with using drug eluting stents in the left main lesion showed favorable short term outcomes in selected patients. The lesion location is also an important factor for the clinical and angiographical outcomes.

The Usefulness of Intracoronary Electrocardiography during Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Measurements obtained using an intracoronary electrocardiogram (IC-ECG) reflect the electrical activity in various regions of the myocardium. This technique can be easily used in the catheterization laboratory during percutaneous coronary intervention (PCI) procedures. Furthermore, IC-ECG could be used to evaluate myocardial viability in patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the usefulness of IC-ECG in predicting the microvascular integrity and late improvement of left ventricular (LV) function after primary PCI in patients with AMI. SUBJECTS AND METHODS: A total of 78 patients (62 male, 16 female) who underwent primary PCI with stent implantation were enrolled in this study. After the implantation of the stent, IC-ECG was recorded from the tip of an insulated angioplasty guidewire before and after balloon occlusion of the infarct-related artery. The IC-ECG was obtained from the inferior and inferolateral areas in inferior wall MI, or apex and apical anterior wall regions in anterior wall MI. Significant ST segment elevation was defined as a further ST segment elevation of > or =0.2 mV at 80 msec after the J-point in comparison to the baseline value. The microvascular integrity of the myocardium was evaluated by myocardial contrast echocardiography (MCE) one day after the PCI was performed. Six months later, all of the patients were followed up by echocardiography and the wall motion score index (WMSI) and ejection fraction (EF) were measured. RESULTS: Significant ST elevation was noted in 47 patients (Group A) after coronary occlusion. There was no significant change in the other 31 patients (Group B). MCE showed microvascular perfusion in 41 patients in group A (87%) and in four patients in group B (13%) (p<0.05). The six-month follow-up echocardiography showed that group A had a lower WMSI (1.20+/-0.18 vs 1.56+/-0.34, p<0.05) and higher EF (57.6+/-7 vs 47+/-11, p<0.05) than group B. The LV end diastolic dimension (LVEDD) in group B was increased compared to group A (p=0.021). The LV end systolic dimension (LVESD) was also increased in group B; however, the LVESD in group A was decreased after six months (p=0.002). CONCLUSION: IC-ECG during PCI is a simple and useful method for assessing the microvascular integrity of the myocardium and for predicting the long-term improvement of LV function.

The Significance of Cardiac Sympathetic Nerve Imaging with 123I-Metaiodobenzylguanidine for Predicting the Occurrence of Ventricular Tachycardia in Patients with Idiopathic Dilated Cardiomyopathy

BACKGROUND AND OBJECTIVE: Ventricular arrhythmia is an important cause of death in patients suffering with idiopathic dilated cardiomyopathy (IDCM). The decreased uptake or increased "washout" of 123I-metaiodobenzylguanidine (MIBG)-derived radioactivity is associated with a worse prognosis or severe disease in patients with cardiac diseases. SUBJECTS AND METHODS: Forty patients (28 men, mean age: 56.5+/-13.0 years) with angiographically proven IDCM were studied and divided into 2 groups: the patients with clinically documented ventricular tachycardia (VT) and IDCM (group A; 17 patients), and the patients without VT, but with IDCM (group B; 23 patients). The normal control group (7 men, mean age 62.4+/-7.9) was compared theses patients. 123I-MIBG was evaluated by the early (15 min) and delayed (3hours) uptake, the heart to mediastinum uptake (H/M) ratio and the global and regional washout ratio (WOR) that was defined as the [early H uptake-delayed H uptake]/early H uptake. The clinical variables, echocardiographic parameters and 123I-MIBG-derived parameters were compared among three groups. RESULTS: There were no significant differences in age and the echocardiographic parameters between the groups A and B. A significant negative correlation was present between the early inferior wall H/M ratio and the LVEDD (Spearman's correlation, r=-0.412, p=0.08), and the early inferior H/M ratio and the LVESD (Spearman's correlation, r=-0.463, p=0.03). Only the delayed lateral wall uptake was significantly lower in group A than that in group B (23.3+/-5.3 versus 27.8+/-8.4, respectively p=0.042). The regional WOR was not statically different among the three groups. CONCLUSION: Cardiac 123I-MIBG SPECT partially reflects the vulnerability for the occurrence of VT in patients suffering with IDCM. These results support the feasibility of using cardiac 123I-MIBG SPECT as a prognostic tool in IDCM patients.

Successful Treatment of Ischemic Dysfunction of the Sinus Node with Thrombolytic Therapy: A Case Report

We report on a case of ischemic dysfunction of the sinus node as a complication after percutaneous transluminal coronary angioplasty of the distal left circumflex artery. After local thrombolytic therapy in the sinus node artery, sinus node arterial flow was re-established and sinus node function normalized over the period of a week. Our experience suggests that immediate reperfusion of a totally occluded nodal artery can be re-established. Ischemic dysfunction of the sinus node, as a complication of angioplasty, is generally transient and requires a prolonged period for recovery. Therefore the decision to implant a permanent pacemaker should be delayed for at least one week after the ischemic insult.

Fractal and Complexity Measures of Heart Rate Dynamics in Patients with Normal and Left Ventricular Dysfunction: The Role of New Noninvasive Markers for Cardiac Risk Stratification

BACKGROUND AND OBJECTIVES: The traditional indexes of heart rate (HR) variability may lack the ability to detect subtle, but important changes in HR behavior. Nonlinear heart rate variability (HRV) analysis methods that are based on chaos theory can reveal subtle abnormalities in the HR dynamics of patients with cardiovascular diseases. Therefore, we tested the validity of nonlinear analysis methods as markers to differentiate normal and abnormal HR dynamics in the cardiovascular disease state. SUBJECTS AND METHODS: One-hundred patients were studied: 70 patients with left ventricular dysfunction (LVD), including 40 post-myocardial infarct patients (PMI) and 30 dilated cardiomyopahty patients (DCM), and 30 age and gender-matched controls. One-hour, 6-hours (day and night each) and 24 hours of R-R interval data from 24-hour Holter recordings were subjected to the conventional time and frequency-domain analysis. The ApEn, short-term (alpha1) and long-term (alpha2) scaling exponents of the detrended fluctuation analysis (DFA) and the power-law exponent (beta) were also measured. RESULTS: Conventional linear measures did not show a significant difference except for the VLF, lnLF and the LF/HF ratio between the controls and the LVD patients. Among the analyzed parameters, beta, beta2 and alpha1 were the most powerful discriminators. The beta of the normal and LVD patients was -1.10+/-0.29 and -0.70+/-0.40, respectively (p<0.001), and the alpha1 was 1.08+/-0.23 and 0.81+/-0.28, respectively (p<0.001). The beta, beta2 and alpha1 can discriminate the etiologic cause of LVD. The length of the R-R interval data did not affect the result, and a significant correlation was observed. The individual values of the fractal and complexity measures were more stable than those of the conventional linear measures. CONCLUSION: We conclude that the measures derived from fractal and complexity methods are useful for detecting altered HR dynamics of LVD and for improving the shortcomings of the conventional measures.

Clinical and Angiographic Outcome of Sirolimus-Eluting Stent for the Treatment of Very Long Lesions

BACKGROUND AND OBJECTIVES: Compared to bare metal stent, drug-eluting stent has improved the clinical and angiographic outcomes for de novo, simple lesions. In real world clinical practice, we often encounter more complex, long lesions, which increase the rate of restenosis and cardiovascular events. The aim of this study was to evaluate the clinical and angiographic outcome of sirolimus-eluting stent (SES) for the treatment of very long lesions in real world clinical practice. SUBJECTS AND METHODS: We implanted multiple SESs (>40 mm in total length) in 113 de novo lesions in 113 patients. The average length of the implanted stents was 58+/-14 mm (range: 41-112 mm) and a mean of 2.2 stents were implanted in each lesion and the average stent diameter was 3.0+/-0.3 mm. RESULTS: Procedural and angiographic success were achieved in all the patients without death or coronary artery bypass surgery. Non-Q wave MI (CK-MB > or = 3 times the normal value) developed in 13 patients (11.5%). Two patients experienced late stent thrombosis after discharge (1.8%). The major adverse cardiac events (MACE)-free survival was 94% at 12 months. There were two sudden cardiac deaths. Six months follow up angiography was performed on 76 patients (67%) and angiographic binary restenosis developed in 7 patients (9.2%). All of them were the focal type in-stent restenosis and these were found to be located at the distal stents. CONCLUSIONS: In conclusion, long lesion coverage with SESs is feasible with a favorable mid-term outcome in real world clinical practice.

The Effect of Attenuation Correction with CT on the Interpretation of Myocardial Perfusion SPECT: in Patients with Normal Coronary Angiogram / 대한핵의학회잡지

PURPOSE: There has been many reports for the effect of attenuation correction on myocardial perfusion SPECT. We studied the effect of attenuation correction with CT (computed tomography) in patients with normal coronary angiography. MATERIALS AND METHODS: Fifteen patients with normal coronary artery on angiography and low likelihood of coronary artery disease were enrolled in this study (male: 6, female: 9, mean age: 58+/-8 year). Myocardial perfusion SPECT was done with Millennium VG with Hawkeye device (GE, SPECT/CT camera). A visual analysis and polar map quantification (Emory tool box) was performed. In quantitative analysis, percent uptake of each myocardial wall on polar map (percent of maximal uptake) was compared between non-corrected (NC) and corrected (AC) images. RESULTS: Visual analysis showed AC images led to an increase of uptake in the inferior wall, but decrease of uptake in the anterior wall, apex and septum. Liver activity is also increased in AC images. In quantitative analysis, the percent uptake is decreased in the anterior wall, apex and septum, but increased in the inferior wall. It is helpful to interpret the images in the inferior wall after AC, but difficult in the apex and anterior wall after AC. CONCLUSION: AC is helpful in the inferior wall. But in the apex or anterior wall, AC must be carefully applied to normal perfused myocardium.