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Background and Objectives@#As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients. @*Methods@#Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]). @*Results@#Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746–42.306). @*Conclusions@#COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.
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Background and Objectives@#As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients. @*Methods@#Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]). @*Results@#Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746–42.306). @*Conclusions@#COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.
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Background@#Implantable loop recorders (ILRs) can provide an enhanced possibility to detect atrial fibrillation (AF), but the accuracy, especially the positive predictive value (PPV), is controversial. This study aimed to evaluate the accuracy of ILRs for detecting AF through a comparison with Holter. @*Method and results@#Thirteen patients who underwent AF ablation were enrolled. ILRs were implanted in all patients, who were scheduled to have Holter monitorings after the procedure. The incidence of AF was compared between the two modalities and analyzed for any correlations. A total of 51 Holters (67,985.5 min) and concomitant ILRs were available for the comparison. The judgment of the presence of AF did not perfectly correlate between the ILR and Holter (Kappa = 0.866, P < 0.001). In the ILR data, the sensitivity of detecting AF on the Holter was 81.6% (95% confidence interval [CI] 0.812–0.820; P < 0.001). The specificity was 99.9% (95% CI 0.998–0.999; P < 0.001). When the ILR detected AF, the PPV was 99.5% (95% CI 0.994–0.995), but the ILR did not detect AF, and the negative predictive value was 94.2% (95% CI 0.941–0.944). A separate analysis of AF/atrial tachycardia (AT) showed that the AT detection rate of the ILR was 2.3%. @*Conclusion@#The ILR had a low false positive value and high PPV for AF events. However, it was limited in identifying AT.
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BACKGROUND@#Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.@*METHODS@#Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).@*RESULTS@#During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).@*CONCLUSION@#In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.
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BACKGROUND: Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.METHODS: Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).RESULTS: During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).CONCLUSION: In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.
Subject(s)
Humans , Asian People , Body Mass Index , Defibrillators, Implantable , Filtration , Follow-Up Studies , Heart , Heart Failure , Korea , Mortality , Primary Prevention , Risk Assessment , Secondary Prevention , ShockABSTRACT
BACKGROUND@#Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.@*METHODS@#Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).@*RESULTS@#During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).@*CONCLUSION@#In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.
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BACKGROUND AND OBJECTIVES: This study was performed to describe clinical characteristics of patients with left ventriculars (LV) dysfunction and implantable cardioverter-defibrillator (ICD), and to evaluate the effect of ICD therapy on survival in Yeongnam province of Korea. SUBJECTS AND METHODS: From a community-based device registry (9 centers, Yeongnam province, from November 1999 to September 2012), 146 patients with LV dysfunction and an ICD implanted for primary or secondary prophylaxis, were analyzed. The patients were divided into two groups, based on the etiology (73 with ischemic cardiomyopathy and 73 with non-ischemic cardiomyopathy), and indication for the device implantation (36 for primary prevention and 110 for secondary prevention). The cumulative first shock rate, all cause death, and type and mode of death, were determined according to the etiology and indication. RESULTS: Over a mean follow-up of 3.5 years, the overall ICD shock rate was about 39.0%. ICD shock therapy was significantly more frequent in the secondary prevention group (46.4% vs. 16.7%, p=0.002). The cumulative probability of a first appropriate shock was higher in the secondary prevention group (p=0.015). There was no significant difference in the all-cause death, cardiac death, and mode of death between the groups according to the etiology and indication. CONCLUSION: Studies from this multicenter regional registry data shows that in both ischemic and non-ischemic cardiomyopathy patients, the ICD shock therapy rate was higher in the secondary prevention group than primary prevention group.
Subject(s)
Humans , Cardiomyopathies , Convulsive Therapy , Death , Defibrillators, Implantable , Follow-Up Studies , Heart Failure , Heart , Korea , Mortality , Primary Prevention , Secondary Prevention , Shock , Ventricular Dysfunction, LeftABSTRACT
In patients with nonvalvular atrial fibrillation (AF), the risk of stroke is five times that of patients with a normal sinus rhythm. Antithrombotic therapy has a pivotal role for the prevention of stroke. With the advent of new oral anticoagulants (NOAC), the strategy of antithrombotic therapy has undergone significant changes due to its better efficacy, safety, and convenience when compared with warfarin or an antiplatelet regimen. Furthermore, new aspects of antithrombotic therapy in the prevention of stroke have revealed that the efficacy of antiplatelet regimens is weak while the risk of major bleeding is not significantly different to that of oral anticoagulant therapy, especially in the elderly. To reflect these pivotal changes, the previous guidelines for use of NOACs have been updated in recent years by various societies and associations. The Korean Heart Rhythm Society (KHRS) summarized the current evidence and updated its recommendations for stroke prevention in patients with nonvalvular AF. First of all, antithrombotic therapy must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient, especially with regard to balancing the benefit of stroke prevention with the risk of bleeding. They recommend using the CHA2DS2-VASc score rather than the CHADS2 score to assess the risk of stroke, and suggest the HAS-BLED score be used to validate bleeding risk. In patients with truly low risks (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas oral anticoagulant (OAC) therapy, including warfarin (INR 2-3) or NOACs, is recommended in patients with a CHA2DS2-VASc score > or = 2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered. When also factoring in the bleeding risk and patient preferences, antiplatelet therapy or no therapy could be the best treatment option.
Subject(s)
Aged , Humans , Anticoagulants , Atrial Fibrillation , Heart , Hemorrhage , Patient Preference , Stroke , WarfarinABSTRACT
BACKGROUND/AIMS: Percutaneous coronary intervention (PCI) is the standard method of treating ST-segment elevation myocardial infarction (STEMI). There is continuing uncertainty as to whether reducing the thrombus burden through catheter aspiration improves the arrhythmogenic structure of the myocardium in STEMI. We compared the changes in electrical instability after thrombus aspiration-assisted primary PCI using conventional primary PCI. METHODS: The study population included 170 consecutive patients with STEMI who underwent primary PCI. The patients were divided into 80 patients who underwent primary PCI only and 90 patients who underwent thrombus aspiration before PCI. The signal-averaged ECG (SAECG) was obtained 5 +/- 2 days after the intervention. RESULTS: There were no significant differences between the groups in terms of sex, age, cardiovascular risk factors, or time from the onset of symptoms to treatment. The duration of the low amplitude signals less than 40 microV (LAS40), duration of the QRS complex (QRSD), and root mean square voltage of the terminal 40 ms of the QRS complex (RMS40) did not differ between the thrombus aspiration and no thrombus aspiration groups. The incidences of QRSD > 114 ms and RMS40 38 ms was significantly higher in the non-thrombus aspiration group (18 vs. 8, p = 0.018). CONCLUSIONS: Among random patients with STEMI, thrombus aspiration improved all of the parameters of SAECG, which is related to ventricular arrhythmogenesis, although the long-term clinical outcomes need to be assessed.
Subject(s)
Humans , Catheters , Electrocardiography , Incidence , Myocardial Infarction , Myocardium , Percutaneous Coronary Intervention , Risk Factors , Thrombectomy , Thrombosis , UncertaintyABSTRACT
BACKGROUND AND OBJECTIVES: Due to recent studies that have shown an association between the genetic variation of SCN5A and sick sinus syndrome (SSS), we sought to determine if a similar correlation existed in Korean patients with SSS. SUBJECTS AND METHODS: We enrolled 30 patients with SSS who showed a sinus pause (longer than 3.0 s) in Holter monitoring, in addition to 80 controls. All exons including the putative splicing sites of the SCN5A gene were amplified by polymerase chain reaction and sequenced either directly or following subcloning. Wild-type and single nucleotide polymorphisms were expressed in human embryonic kidney cells, and the peak sodium current (I(Na)) was analyzed using the whole-cell patch-clamp technique. RESULTS: A total of 9 genetic variations were identified: 7 variations (G87A-A29A, IVS9-3C>A, A1673G-H558R, G3823A-D1275N, T5457C-D1819D, T5963G-L1988R, and C5129T-S1710L) had been previously reported, and 2 variants (A3075T-E1025D and T4847A-F1616Y) were novel; the potential structural effects of F1616Y were analyzed in a three-dimensional model of the SCN5A domain. Patch-clamp studies at room temperature demonstrated that the peak I(Na) was significantly increased by 140% in HEK cells transfected with F1616Y compared with wild-type (-335.13 pA/pF+/-24.04, n=8 vs. -139.95 pA/pF+/-23.76, n=7, respectively). Furthermore, the voltage dependency of the activation and steady-state inactivation of F1616Y were leftward-shifted compared with wild-type (V(h) activation=-55.36 mv+/-0.22, n=8 vs. V(h) activation=-44.21 mV+/-0.17, n=7; respectively; V(h) inactivation=-104.47 mV+/-0.21, n=7 vs. V(h) inactivation=-84.89 mV+/-0.09, n=12, respectively). CONCLUSION: F1616Y may be associated with SSS.
Subject(s)
Humans , Electrocardiography, Ambulatory , Exons , Genetic Variation , Kidney , Patch-Clamp Techniques , Polymerase Chain Reaction , Polymorphism, Single Nucleotide , Sick Sinus Syndrome , SodiumABSTRACT
Atherosclerotic renal artery stenosis (RAS) may result in hypertension, azotemia, and acute pulmonary edema. We report on a renal angioplasty with stent placement for bilateral RAS in a patient with acute decompensated heart failure and acute kidney injury. A 67-year-old female patient was admitted to our hospital with acute shortness of breath and generalized edema. Echocardiography showed left ventricular wall motion abnormality and the follow up electrocardiography showed T wave inversion in the precordial leads. We performed a coronary angiography to differentiate ischemic heart disease from non-cardiac origin for the cause of the heart failure. The coronary angiography showed no significant luminal narrowing, but bilateral RAS was confirmed on the renal artery angiography, therefore, we performed renal artery revascularization. After the procedure, the pulmonary edema was improved and the serum creatinine was decreased. Two weeks later, an echocardiography showed improvement of the left ventricular systolic function.
Subject(s)
Aged , Female , Humans , Acute Kidney Injury , Angiography , Angioplasty , Azotemia , Coronary Angiography , Creatinine , Dyspnea , Echocardiography , Edema , Electrocardiography , Follow-Up Studies , Heart Failure , Heart Failure, Systolic , Heart , Hypertension , Hypertension, Renovascular , Myocardial Ischemia , Phenobarbital , Pulmonary Edema , Renal Artery Obstruction , Renal Artery , StentsABSTRACT
In patients with nonvalvular atrial fibrillation (AF), the risk of stroke varies considerably according to individual clinical status. The CHA2DS2-VASc score is better than the CHADS2 score for identifying truly lower risk patients with AF. With the advent of novel oral anticoagulants (NOACs), the strategy for antithrombotic therapy has undergone significant changes due to its superior efficacy, safety and convenience compared with warfarin. Furthermore, new aspects of antithrombotic therapy and risk assessment of stroke have been revealed: the efficacy of stroke prevention with aspirin is weak, while the risk of major bleeding is not significantly different from that of oral anticoagulant (OAC) therapy, especially in the elderly. Reflecting these pivotal aspects, previous guidelines have been updated in recent years by overseas societies and associations. The Korean Heart Rhythm Society has summarized the new evidence and updated recommendations for stroke prevention of patients with nonvalvular AF. First of all, antithrombotic therapy must be considered carefully and incorporate the clinical characteristics and circumstances of each individual patient, especially with regards to balancing the benefits of stroke prevention with the risk of bleeding, recommending the CHA2DS2-VASc score rather than the CHADS2 score for assessing the risk of stroke, and employing the HAS-BLED score to validate bleeding risk. In patients with truly low risk (lone AF, CHA2DS2-VASc score of 0), no antithrombotic therapy is recommended, whereas OAC therapy, including warfarin (international normalized ratio 2-3) or NOACs, is recommended for patients with a CHA2DS2-VASc score > or =2 unless contraindicated. In patients with a CHA2DS2-VASc score of 1, OAC therapy should be preferentially considered, but depending on bleeding risk or patient preferences, antiplatelet therapy or no therapy could be permitted.
Subject(s)
Aged , Humans , Anticoagulants , Aspirin , Atrial Fibrillation , Heart , Hemorrhage , Patient Preference , Risk Assessment , Stroke , WarfarinABSTRACT
BACKGROUND/AIMS: Combination single-pill therapy can improve cost-effectiveness in a typical medical therapy. However, there is a little evidence about the efficacy and tolerability of combination single-pill antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). METHODS: From June to November 2012, in total, 142 patients who met the following criteria were enrolled: at least 18 years old; successful PCI with DES at least 3 months earlier; and regular medication of aspirin and clopidogrel with no side effects. After VerifyNow P2Y12 and aspirin assays, the combination single pill of aspirin and clopidogrel was given and laboratory tests were repeated 6 weeks later. RESULTS: At baseline, the incidence of aspirin resistance, defined as aspirin reaction unit (ARU) > or = 550, was 9.2%, that of clopidogrel resistance, defined as P2Y12 reaction unit (PRU) > or = 230, was 46.5%, and that of percent inhibition of PRU < 20% was 32.4%. At follow-up, the incidence of resistance by ARU value was 7.0%, 50.0% by PRU value, and 35.9% by percentage inhibition of PRU, respectively. The mean values of ARU (431.5 +/- 63.6 vs. 439.8 +/- 55.2; p = 0.216) and PRU (227.5 +/- 71.4 vs. 223.3 +/- 76.0; p = 0.350) were not significantly different before versus after antiplatelet-combination single-pill therapy. Five adverse events (3.5%) were observed during the study period. CONCLUSIONS: Combination single-pill antiplatelet therapy, which may reduce daily pill burden for patients after PCI with DES, demonstrated similar efficacy to separate dual-pill antiplatelet therapy.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antiplatyhelmintic Agents/administration & dosage , Aspirin/administration & dosage , Drug Combinations , Drug Resistance , Drug-Eluting Stents , Intention to Treat Analysis , Myocardial Ischemia/blood , Percutaneous Coronary Intervention/adverse effects , Platelet Function Tests , Prospective Studies , Tablets , Ticlopidine/administration & dosage , Time Factors , Treatment OutcomeABSTRACT
Platelets play an important role in the development of acute coronary syndrome. Platelet-inhibiting drugs, such as glycoprotein IIb/IIIa inhibitors, can be beneficial when they are administered at the time of primary percutaneous coronary intervention for acute coronary syndrome. Although an increased risk for bleeding complications is well recognized, the risk associated with diffuse alveolar hemorrhage is much less reported. We report a case of diffuse alveolar hemorrhage after using abciximab.
Subject(s)
Acute Coronary Syndrome , Antibodies, Monoclonal , Blood Platelets , Glycoproteins , Hemoptysis , Hemorrhage , Immunoglobulin Fab Fragments , Percutaneous Coronary InterventionABSTRACT
BACKGROUND/AIMS: Several studies have reported an association between antiphospholipid antibodies (APA) and major adverse cardiovascular events (MACE) following acute myocardial infarction (AMI). However, the relationship between APA and the prognosis after drug-eluting stent (DES) implantation in patients with AMI is not known. METHODS: Thus, we investigated the relationship between the incidence of MACE and APA levels in patients with AMI who underwent successful DES implantation. RESULTS: Of 182 patients, 78 (42.9%) tested positive for APA. Lupus anticoagulant was positive in 37.6% (68 of 181) patients, anticardiolipin antibody IgM was positive in 8.3% (15 of 180), and anticardiolipin antibody IgG was positive in 1.7% (3 of 180) patients. At follow up, a MACE had occurred in 11 (14.1%) patients in the APA-positive group and in seven (6.7%) patients in the APA-negative group (p = 0.099). CONCLUSIONS: No significant association was found between the incidence of MACE and the presence of APA in patients with AMI who underwent successful DES implantation.
Subject(s)
Humans , Antibodies, Anticardiolipin , Antibodies, Antiphospholipid , Drug-Eluting Stents , Follow-Up Studies , Immunoglobulin G , Immunoglobulin M , Incidence , Lupus Coagulation Inhibitor , Myocardial Infarction , PrognosisABSTRACT
The incidence and importance of tricuspid valve regurgitation after a blunt chest injury has risen with the increase in the number of automobile accidents and steering wheel traumas. This kind of injury has been reported more frequently in the last decade because of the better diagnostic procedures and understanding of the pathology. However, tricuspid valve regurgitation following a blunt chest injury can still be easily missed because most patients do not show symptoms at the time of the trauma. A 55-year-old male patient presented himself at our facility after suffering a chest injury from an automobile accident. His transthoracic echocardiography (TTE) revealed severe tricuspid valve regurgitation due to the prolapse of his anterior valve leaflet. We report a case of asymptomatic tricuspid regurgitation that developed after a blunt chest injury.
Subject(s)
Humans , Male , Middle Aged , Automobiles , Chordae Tendineae , Echocardiography , Incidence , Pathology , Prolapse , Rupture , Thoracic Injuries , Thorax , Tricuspid Valve Insufficiency , Wounds, NonpenetratingABSTRACT
Recent several studies have shown that the genetic variation of SCN5A is related with atrioventricular conduction block (AVB); no study has yet been published in Koreans. Therefore, to determine the AVB-associated genetic variation in Korean patients, we investigated the genetic variation of SCN5A in Korean patients with AVB and compared with normal control subjects. We enrolled 113 patients with AVB and 80 normal controls with no cardiac symptoms. DNA was isolated from the peripheral blood, and all exons (exon 2-exon 28) except the untranslated region and exon-intron boundaries of the SCN5A gene were amplified by multiplex PCR and directly sequenced using an ABI PRISM 3100 Genetic Analyzer. When a variation was discovered in genomic DNA from AVB patients, we confirmed whether the same variation existed in the control genomic DNA. In the present study, a total of 7 genetic variations were detected in 113 AVB patients. Of the 7 variations, 5 (G87A-A29A, intervening sequence 9-3C>A, A1673G-H558R, G3578A-R1193Q, and T5457C-D1819D) have been reported in previous studies, and 2 (C48G-F16L and G3048A-T1016T) were novel variations that have not been reported. The 2 newly discovered variations were not found in the 80 normal controls. In addition, G298S, G514C, P1008S, G1406R, and D1595N, identified in other ethnic populations, were not detected in this study. We found 2 novel genetic variations in the SCN5A gene in Korean patients with AVB. However, further functional study might be needed.
Subject(s)
Humans , Atrioventricular Block , DNA , Exons , Genetic Variation , Introns , Multiplex Polymerase Chain Reaction , Untranslated RegionsABSTRACT
Recent several studies have shown that the genetic variation of SCN5A is related with atrioventricular conduction block (AVB); no study has yet been published in Koreans. Therefore, to determine the AVB-associated genetic variation in Korean patients, we investigated the genetic variation of SCN5A in Korean patients with AVB and compared with normal control subjects. We enrolled 113 patients with AVB and 80 normal controls with no cardiac symptoms. DNA was isolated from the peripheral blood, and all exons (exon 2-exon 28) except the untranslated region and exon-intron boundaries of the SCN5A gene were amplified by multiplex PCR and directly sequenced using an ABI PRISM 3100 Genetic Analyzer. When a variation was discovered in genomic DNA from AVB patients, we confirmed whether the same variation existed in the control genomic DNA. In the present study, a total of 7 genetic variations were detected in 113 AVB patients. Of the 7 variations, 5 (G87A-A29A, intervening sequence 9-3C>A, A1673G-H558R, G3578A-R1193Q, and T5457C-D1819D) have been reported in previous studies, and 2 (C48G-F16L and G3048A-T1016T) were novel variations that have not been reported. The 2 newly discovered variations were not found in the 80 normal controls. In addition, G298S, G514C, P1008S, G1406R, and D1595N, identified in other ethnic populations, were not detected in this study. We found 2 novel genetic variations in the SCN5A gene in Korean patients with AVB. However, further functional study might be needed.
Subject(s)
Humans , Atrioventricular Block , DNA , Exons , Genetic Variation , Introns , Multiplex Polymerase Chain Reaction , Untranslated RegionsABSTRACT
BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.
Subject(s)
Humans , Angiotensin-Converting Enzyme Inhibitors , Angiotensins , C-Reactive Protein , Enalapril , Heart , Heart Failure , Natriuretic Peptide, Brain , Peptidyl-Dipeptidase A , Plasma , Prospective Studies , Renin-Angiotensin System , Stroke Volume , Tetrazoles , Valine , ValsartanABSTRACT
BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.