Abdominal and Pericardial Fat in Patients with and without Coronary Artery Disease: Computed Tomography Study

OBJECTIVE: There has been a limited investigation looking into the correlation between pericardial fat and abdominal fat with coronary artery disease (CAD) as measured by coronary computed tomographic angiography (CCTA). We proposed that the volume of pericardial fat is larger in patients with CAD than in patients without CAD, and sought to determine which abdominal adiposity index best correlated with pericardial fat volume. METHODS: Participants were examined using CCTA between October 2007 and January 2008. All participants had no previous history of CAD. Pericardial adipose tissue (PAT) volume, abdominal total adipose tissue volume, abdominal subcutaneous adipose tissue volume, and abdominal visceral adipose tissue (AVAT) volume were measured using CCTA. RESULTS: Fifty patients (26.5%) demonstrated CAD, and 139 patients did not demonstrate CAD by CCTA. PAT volume in patients with CAD was larger than that of patients without CAD (173.2+/-64.2 cm3 vs. 147.6+/-50.4 cm3, p<0.01). However, indices of abdominal adiposity were not significantly different between the two groups. Using multivariable analysis, independent predictors of CAD were PAT volume (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.00-1.02, p=0.04), coronary artery calcium score (OR 1.01, 95% CI 1.00-1.01, p<0.01), and typical chest pain (OR 4.88, 95% CI 1.47-16.21, p=0.01). AVAT volume showed a linear correlation with PAT volume. CONCLUSION: PAT volume was an independent predictor of CAD as measured by CCTA. PAT volume was also well correlated with the AVAT volume among the indices of abdominal adiposity.

Balloon-Based Distal Protection Device Improves the Recovery of Left Ventricular Function after Primary Coronary Angioplasty

BACKGROUND AND OBJECTIVES: Despite the high success rate of primary angioplasty in cases of acute myocardial infarction (AMI), myocardial reperfusion can frequently be compromised, mainly due to distal embolization, which can be effectively prevented with the use of distal protection devices. The goal of this study was to see whether PercuSurge(r), a balloon-based distal protection device, could improve myocardial reperfusion and late clinical outcomes after primary coronary angioplasty. SUBJECTS AND METHODS: Between April 2002 and July 2003, 29 patients with AMI, within 12 hours of the onset of symptoms, were scheduled to undergo primary angioplasty using PercuSurge(r) (PS group). Thirty patients were selected as a control group by matching the 5 clinical and angiographic variables; the clinical status and coronary angiograms were also prospectively reviewed and analyzed. RESULTS: There were no significant differences in the baseline clinical and angiographic characteristics, including the left ventricular ejection fraction (LVEF) between two groups. The procedures were successful, without complications, in all patients from both groups. However, the PS group was associated with a significantly higher incidence of myocardial blush score of 3 (PS 58%, control 30%, p=0.001) and early ST-segment elevation resolution (PS 76%, control 47%, p=0.02) compared to the control group. The PS group also showed a greater LVEF at 60 days after the procedure (PS 51+/-5%, control 46+/-8%, p=0.007). There was no significant difference in the incidences of death or myocardial infarction between the two groups during the follow-up period. CONCLUSION: The use of the PercuSurge(r) was found to be safe and feasible during primary angioplasty, and this system also improved the recovery of the left ventricular function as well as myocardial reperfusion following primary coronary angioplasty.

Effect of Vigorous Preload Reduction on Mitral Annulus Velocity in Chronic Renal Failure

BACKGROUND AND OBJECTIVES: The pulsed wave Doppler echocardiography in the mitral inflow is used widely for the assessment of LV diastolic function. The echocardiographic index of LV diastolic function is known to be affected by several factors, such as the loading condition. In the Doppler tissue image (DTI), the mitral annulus velocity is known to be unaffected by the loading condition. The purpose of this study was to investigate the effect of the preload reduction on the mitral annulus velocity. SUBJECTS AND METHODS: We examined the transmitral and pulmonary venous flows, and the mitral annulus velocity in 30 patients with chronic renal failure, but a normal LV systolic function, by echocardiography, both before and after hemodialysis. The study patients were divided into two groups; Group I (preload reduction 2.0 kg, N=20). RESULTS: In the transmitral flow; the E velocity was changed, both before and after hemodialysis, in Group II. < Group I from 97+/-12 cm/s to 86+/-11 cm/s (NS), Group II from 85+/-5 cm/s to 63+/-5 cm/s (p=0.0001)<. The A velocity was also changed in Group II. In the mitral septal annulus velocity by DTI; The E' velocity was changed in both groups, but the A' velocity was only changed in Group II. In the mitral lateral annulus velocity by DTI; all indices remained unchanged in both groups. CONCLUSION: These results suggested that a vigorous preload reduction might change the echocardiographic indices, and either the transmitral flow pattern or the mitral septal annulus velocity. The mitral lateral annulus velocity indices, which are useful for the evaluation of the LV diastolic function, were unchanged by the preload reduction. The preload condition needs to be accounted for when evaluating the LV diastolic function with a Doppler echocardiography.

Intracoronary Ultrasound in Patients with Coronary Vasospasm or Vasoconstriction

BACKGROUND: It has been hypothesized that early atherosclerosis may be related to the pathogenesis of coronary vasospasm. This study was designed to investigate the relationship between early atherosclersosis and coronary vasospasm or vasoconstriction in response to axetylcholine utilizing intravascular ultrasonography. METHOD: Total 43 segments were analyzed from subjects who were composed of 10 patients with and 7 patients without coronary vasospasm in response to intra coronary acetylcholine infusion. Spasm segment(Sp) was defined as total or subtotal occlusion, constriction segment(C) as diameter decrease>/=10%, and normal segment(N) as diameter decrease 0.5mm. RESULTS: The atherosclerotic plaques of spasm segments were significantly thicker than those of normal and constriction segments(spasm segments : 1.19+/-0.21mm, constrict segments : 0.58+/-0.11mm, normal segment : 0.37+/-0.11, p<0.05). Atherosclerosis was present in 90% of spasm segments. Among normal of constriction segments, atherosclerotic plaque thickness of patients with vasospasm was thicker than that of patients without vasospasm, although it was statistically insignificant(patients with vasospasm : 0.65+/-0.51mm, patients without vasospasm 0.36+/-0.39mm, p=0.07). Frequency of atherosclerosis in normal or constriction segments was significantly higher in patients with vasospasm than patients without vasospasm(patients with vasospasm 47%, patients without vasospasm : 11%, p<0.05). CONCLUSION: Atherosclerosis is present at segments of vasospasm in response to intracoronary acetylcholine. Even among normal or constriction segments, the artherosclerotic plaque thickness of patients with vasospasm was thicker than that of patients without vasospasm which may indicates that coronary vasospasm is a diffuse early atherosclerotic disease.

Clinical Effect and Safety of Celiprolol in Patients with Essential Hypertension

BACKGROUND: Celiprolol is a new generation beta-adrenoreceptor blocking agent with intrinsic sympathomimetic activity characterized by selective blockade of beta1 receptors and partial agonist activity at beta2 receptors. This study was designed to investigate the antihypertensive efficacy and safety of celiprolol in patients with essential hypertension. METHODS: The study subjects consisted of 36 patients(mean age : 55 years, 11 males, 25 females). Celiprolol was administered orally in a aily dose of 200-800mg once or two divided dose for 10 weeks after the admimstration of placebo for 2 weeks. RESULTS: Blood pressure was significantly reduced from 171+/-19/106.8mmHg to 153+/-20/92+/-12mmHg(p<0.01) after 2 week of therapy and this effect was maintained throughout the study periods. The efficacy rates were total 94%(marked improve : 53%, moderate improve : 22%, mild improve : 19%). The cumulative efficacy rate was 72% at 200mg/day, 91% at 400mg/day, and 94% at 800mg/day. Heart rate did not change throughout 10 weeks. There were no significant change in hematologic and blood chemistry variables. During the period of medication, headache developed in 3 cases(8%) and each of dry cough, dyspnea, epigastric pain and diarrhea and facial flushing developed in 1 case(2.8%) but they were tolerable. CONCLUSIONS: This results suggest that celiprolol is effective and safe drug in the treament of patients with essential hypertension.

Ventricular Remodeling after Acute Myocardial Infarction

BACKGROUND: Left ventricular dilatation after acute myocardial infarction is caused by infarct expansion and compensatory dilatation of noninfarct area. This study was done to investigate the contributory topographical change of left ventricle to left ventricular dilatation after acute myocardial infarction. METHODS: 24 first acute myocardial infarction was studied with 2-dimensional echocardiography serielly. First study was done at 7days and second study was done 9 months after an infarction attack. Left ventricular volume was measured by Simpson's method in end-diastolic frame and change of end diastolic left ventricular surface area was measured in apical 4 chamber view. Left ventricular surface area was devided by ischemic(noncontraction) and nonischemic(contracting) area by connecting central point of long axis of left ventricle and the junction of dyssynergic motion and normal motion point in outer rim of left ventricle in end diastolic frame of apical 4 chamber view. RESULTS: Mean left ventricular end-diastolic volume at entry was 114+/-23ml and increased to 121+/-27ml at 9 months after acute myocardial infarction in whole group(p=0.02). In a subgroup of anterior infarction, the left ventricular surface area was increaed in 9 cases with increared left ventricular volume(34.8+/-5.1cm2 to 36.4+/-4.1cm2, p=0.02) and ischemic surface area did not change in these group. In 7 patients without increase in left ventricular volume, the left ventricular surface area did not change and ischemic surface area decreased(9.4+/-4cm2 to 8+/-3.2cm2, p=0.03) at 9 months. CONCLUSION: Thus the increase in left ventricular end-diastolic volume between 13 days and 9 months after acute myocardial infarction is considered to be a consequence of noninfarct ventricular area dilatation.

Delapril Monotherapy in the Treatment of Essential Hypertension

BACKGROUND: Delapril, a recently developed nonsulfhydry(SH) angiotensin converting enzyme inhibitor, was known to have more prolonged duration of action. In order to investigate the efficacy and safety of delapril, patients with essential hypertension were studied. METHODS: The study subject consisted of 37 patients(mean age : 50.4 years, 15 male, 22 female). Because 4 of 37 patients dropped out due to side effects of delapril, the antihypertensive efficacy was evaluated in the remaining 33 patients. Delapril was administered orally in a daily dose of 30-120mg in two divided doses for 10 weeks after the administration of a placebo for 2 weeks. RESULTS: Delapril decreased systolic blood pressure significantly from a baseline value of 162.4+/-18.8mmHg to 142.9+/-20.9mmHg(p<0.01) and diastolic blood pressure from 103.2+/-5.0mmHg to 92.8+/-10.4mmHg(p<0.01) after 2 weeks of therapy, and maintained this effect throughout the study period. The efficacy rates were 72% for systolic pressure, 75% for diastolic pressure. The cumulative efficacy rate was 48% at 30mg/day, 66% at 60mg/day, and 73% at 120mg/day. Heart rate did not change until after 8 weeks, when they modestly decreased(p<0.05), through the 10th week(NS). Side effects were noticed in 12 out of 37 cases(32.4%). The main symptoms included dry cough(7 cases, 18.9%), headache(2 cases, 5.4%), dizziness(1 case, 2.7%), dry mouth(1 case, 2.7%) and angioedema(1 case, 2.7%). Six of the 7cases of dry cough were in women, and 3 caes discontinued the drug due to intractable cough. Angioedema in the oropharynx occurred in 1 patient and caused severe dyspnea which was relieved by the discontinuation of the medication. There was no significant change in CBC and biochemical variables. CONCLUSIONS: A daily dose of delapril in two divided doses is effective in decreasing blood pressure in patients with essential hypertension, and safe when an awareness of possible side effects is taken into account.

Life Threatening Hemoptysis in Mitral Stenosis Treated by Emergency Mitral Commissurotomy

A 25-year-old 7 month pregnant woman with mitral stenosis was hospitalized because of life threatening hemoptysis dispite intensive medical treatment. Emergency mitral commissurotomy resulted in prompt cessation of hemorrhage and at nine months follows-up, the hemoptysis has not recurred. Mitral valve surgery appears to be consitently associated with rapid and sustained cessation of hemoptysis. Therefore, surgery should be considered in hemoptysis due to mitral stenosis, particulary when the danger of asphyxiation exists.