Relationship between Abdominal Obesity and Electrocardiographic QTc Interval Prolongation

BACKGROUND: Electrocardiographic QTc interval prolongation can cause serious arrhythmias such as ventricular tachycardia, ventricular fibrillation, torsade de pointes, and even sudden death. Many studies have been performed to clarify whether QTc interval prolongation is related to increasing body mass index (BMI) and abdominal obesity. However, there is no study about the relationship between abdominal obesity and QTc interval prolongation in Korea. We, therefore, studied the relationship between QTc interval prolongation and abdominal obesity among Korean adults. METHODS: The measurement of height, weight, and waist circumference, and standard 12-lead ECG was performed on 3,086 subjects at a health promotion center of a university hospital from March to April, 2003. We excluded: 37 subjects whose ECG or body measurement was not performed, 17 with a past history of cardiac disease or current cardiac medications which can influence QTc interval, 9 taking neuropsychiatric medications, 25 with abnormal serum concentration of potassium or calcium, 1 foreigner and 59 with underweight. First, we studied the correlation between BMI and waist circumference. Then, we analyzed the relationship between QTc interval prolongation and the index of obesity. RESULTS: A total of 2,938 subjects consisted of 2,411 men and 527 women. BMI and waist circumference were shown to have a significant correlation with QTc interval after age was adjusted in men (P<0.01, P<0.01). The odds ratio between QTc interval prolongation and the subjects of normal, overweight, and obesity by BMI were not significant in both men and women. In men with abdominal obesity, the odds ratio between QTc interval prolongation and abdominal obesity by waist circumference was 1.33 (0.99~1.79). CONCLUSION: In men, abdominal obesity was shown a positive correlation with QTc interval prolongation. But these results were not statistically significant.

Factors Associated with Distorted Self-perception of Body Weight in Korean Adults

BACKGROUND: This study was done to examine the relationship between distorted self-perception of body weight and some sociodemographic factors in Korean adults. METHODS: This study was conducted among 14,621 adults (men 10,833, women 3,788), who visited Ulsan University Hospital Health Promotion Center to take a routine health examination. The objective body weight status was classified as underweight, normal, overweight, and obesity by body mass index. We compared the self- perception of body weight with in objective body weight status. We used multiple logistic regression to assess the odds ratio for distorted self-perception of body weight by age, marital status, monthly income, and level of education. RESULTS: Among the total 72.8% of obese men had a distorted self-perception of being slightly excess, 48% of overweight men considered themselves as just about right, and 39.5% of men with normal body weight as underweight. In women, 36.5% with normal body weight had a distorted self-perception of being slightly excess or very excess. In both men and women who were overweight or obesity, the distorted self-perception of being just about right was increased with higher age and lower education. The odds ratio of distorted self-perception in normal as being slightly excess or very excess was higher in women with higher income and higher education. CONCLUSION: In both men and women, many people had a distorted self-perception of Body weight. Some sociodemographic factors were found to be related to the self- perception of body weight.

Initial Experience of Rotational Atherectomy in Coronary Artery Disease

BACKGROUND:Rotational atherectomy has been developed for several years. It is a useful tool in complex coronary lesion morphologies such as diffuse, calcific, ostial and angulated lesion. We report initial experience of the rotational atherectomy in complex coronary artery morphology. METHODS: We included 64 patients who was treated with rotational atherectomy since July 1997 to February 1999. Mean age was 56+/-9 years with 47 male patients. Clinical diagnosis was 12 acute myocardial infarction, 49 unstable angina, and 3 stable angina. Rotational atherectomy was done by transfemoral or transradial approach with adjunctive ballooning and/or stenting in all patients. RESULTS: Ninty-one percent of the treated lesions showed complex lesion morphologies (B2/C lesion) with 43 left anterior descending artery and 19 right coronary artery. Rotational atherectomy was done in 37 de novo lesion (58%) and 27 (42%) restenosis patients. Transradial approach was done in 33 patients (52%). Mean maximal burr size was 1.68 mm and mean burr to reference artery ratio was 0.63. Rotastenting were done in 58% of the patients with higher post-procedure minimal lumen diameter, % diameter stenosis and net gain than rotablator with adjunctive balloon angioplasty. Overall procedural success was 94% (62/64). Complications were one non-Q infarction, one coronary artery perforation, two slow flow, and one guidewire fracture. None of the patients showed inhospital mortality or 30 day cardiac event (death, emergency CABG, Q-infarction, or re-intervention). CONCLUSION: Rotational atherectomy is a useful technique with high success rate without showing major cardiac events during inhospital period and within 30 days.

Congenital Absence of Left Circumflex Coronary Artery: Circumflex Artery Extended from Right Coronary Artery

Nonvisualization of left circumflex coronary artery from the left coronary artery is commonly due to anomalous origin of circumflex artery from the right coronary artery or right sinus of Valsalva. However, complete ostial obstruction of circumflex artery, circumflex artery extended from the right coronary artery, anomalous origin of circumflex artery from the pulmonary artery may be the cause. We report two cases of absent left circumflex artery from the left coronary artery, in which the circumflex artery arose as a terminal extension of the right coronary artery. Angiographic features of absent left circumflex artery from the left coronary artery were described.

Acute Closure of Target and Remote Coronary Arteries Complicated by Balloon Rupture during Primary Stenting of Acute Myocardial Infarction

Primary coronary stenting is one of the established therapeutic options for acute myocardial infarction. The risk of balloon rupture during stenting may be increased after high pressure inflation technique was introduced. Balloon rupture during stenting may cause catastrophic complications such as extensive dissection, acute closure, coronary perforation. We report a case of balloon rupture during primary stenting in acute myocardial infarction, which caused acute thrombotic closure of target and remote coronary arteries simultaneously.

Terson's Syndrome in Aneurysmal Subarachnoid Hemorrhage

Terson's syndrome is the oculocerebral syndrome of retinal and vitreous hemorrhage associated with spontaneous subarachnoid hemorrhage(SAH) or all forms of intracranial bleeding. Recent observations indicate that the patients with spontaneous subarachnoid hemorrhage have an 18% to 20% concurrent incidence of retinal and vitreous hemorrhages and about 4% incidence of viterous hemorrhage alone. Therefore, clinical ophthalmologic findings may have a significant diagnostic and prognostic value for the clinician. Total of 627 consecutive patients with aneurysmal subarachnoid hemorrhage were retrospectively studied by means of indirect fundoscopy to address the question of occur and prognostic implications of vitreous hemorrhage after subarachnoid hemorrhage from January 1993 to December 1996. Among these, we experienced 21 patients with vitreous hemorrhage(Terson's syndrome). The patients with vitreous hemorrhage commonly occurred in anterior communicating and internal carotid artery aneurysm. Twelve patients had intraocular hemorrhage within 48 hours after SAH. There were bilateral involvement in 15 cases, and the 14 experienced complete recovery of vision following massive intravitreal hemorrhage. A favorable surgical outcome was obtained in 14 of 21 patients(66.7%) and a satisfactory result in vision was achieved in 15 cases among 17 survivors(88.2%). From these results, we emphasize the significance of ocular findings in patients with aneurysmal subarachnoid hemorrhage.

Systemic Lupus Erythematosus with Central Nervous System Involvement: Case Report

Systemic lupus erythematosus(SLE) is a disease of unknown cause in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Clinical manifestations which fulfill American Rheumatism Association criteria for a diagnosis of SLE include malar or discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal, neurologic, hematologic or immunologic disorder, and antinuclear antibodies. Central nervous system (CNS) events may be single or multiple. Clinical manifestations of CNS involvement include organic brain syndromes, focal infarcts, headache, transverse myelitis, optic neuritis, cranial nerve palsies, depression, and anxiety. A 34-year-old female presented with generalized seizure. Antinuclear antibody and antibody to Sm were positive, and low levels of C3 and C4 were detected. On MRI, mild, non-enhancing, low signal intensity was seen on T1 weighted images, and illdefined higher intensities on T2 weighted images. On stereotactic biopsy, three pieces of yellowish material were obtained. Microscopically, coagulative necrosis and neutrophilic infiltration were seen, and the patient underwent steroid therapy. Two months later, MRI no longer showed abnormal signal intensity.

Recurrent Cardiac Tamponade Complicated by Coronary Intervention

Coronary perforation is a rare, but potentially catastrophic complication of percutaneous coronary intervention. It rarely results in cardiac tamponade with the use of standard anticoagulant regimens. But spontaneous cardiac tamponade was reported recently during balloon angioplasty under the large dose of heparin infusion, and after stent implantation under powerful antiplatelet therapy including platelet IIb/IIIa receptor inhibitor administration. We report a case of delayed cardiac tamponade complicated by guidewire manipulation under powerful anticoagulant and antiplatelet therapy, which recurred early after the first pericardiocentesis.

Transradial Approach for Coronary Angiography and Interventions: Practical Applicability at a High-volume Laboratory and Safety in Korean Patients

BACKGROUND AND OBJECTIVES: Radial approach was introduced as a route for coronary angiography or interventions. We assessed clinical applicability at a high-volume laboratory and safety. MATERIALS AND METHOD: Procedure-related results were compared between phase I period including learning curve and phase II period in 326 patients, in whom coronary angiography or interventions were performed by radial approach. RESULTS: 1) Success rate was 90% (292/326) in all patients, which significantly increased to 95% (246/259) during phase II compared to 69% (46/67) during phase I. 2) Time from local anesthesia to sheath placement and time for first coronary cannulation were 4.3+/-2.7min, 3.1+/-1.9min, respectively, in all patients, which significantly decreased to 3.8+/-3.6min, 2.7+/-2.4min during phase II compared to 7.0+/-3.2min, 5.7+/-4.7min during phase I. Total examination time was 21.7+/-5.5min in all patients, which significantly decreased to 20.4+/-6.2min during phase II compared to 28.3+/-8.0min during phase I. 3) Overall procedural success rate of coronary interventions was 94% (98/104). Guidewire didn't pass in 5 (5%) patients with chronic total occlusion and stent wasn't delivered in 1 (1%) due to poor guiding backup. 4) During follow-up of 61+/-25 days, weak or absent radial pulse, abnormal reverse Allen test were observed in 13 (5%), 3 (1%), 15 (6%) patients, respectively, but no claudication observed. CONCLUSION: Coronary angiography and interventions by radial approach was safe and performed without more time delay after learning curve.