The Relationship between Left Ventricle Diastolic Dysfunction and Carotid Plaques in Elderly Patients with Ischemic Stroke

BACKGROUND: Atherosclerotic plaques in the carotid artery have been considered a potential source of cerebrovas- cular events. Carotid plaques are associated with an increased risk of ischemic stroke. We performed this study to evaluate the relationship between atherosclerotic carotid plaques and cardiac function measured by echocardiography in elderly patients with ischemic stroke. METHODS: A total of 415 patients aged >60 yrs with acute ischemic stroke were divided into two groups according to the presence(groups I, n=195, 140 males) or absence(group II, n=220, 112 males) of carotid plaques. We evaluated the asso ciation of the presence of plaques with age, sex, potential vascular risk factors, other carotid images, and cardiac function by echocardiography. RESULTS: Of the 415 patients, carotid plaques were found in 195 cases. Mean plaque size was 2.44+/-0.7mm on the right side and 2.32+/-0.75mm on the left. Plaques were located more frequently in the carotid bulb(68%) than in the common carotid artery(32%). 57% were calcified plaques and 72%, multiple plaques. Group I(with carotid plaques) had a significantly higher percentage of males(73.6%, p<0.001), hypertension(68.5%, p=0.043), diabetes(28.7%, p=0.029), and dyslipidemia(60.1%, p=0.008). In addition, group I had thicker carotid IMT than group II(Right: 0.86 vs. 0.70mm, p<0.001, Left: 0.90 vs. 0.73mm, p<0.001), lower common carotid artery end diastolic flow velocity(Right: 13.37 vs. 15.73m/s, p=0.002, Left: 14.46 vs.17.24m/s, p=0.004), and higher E/E'level(11.57 vs. 9.36, p=0.001). Old age, dyslipidemia, and diastolic dysfunction were independently associated with carotid plaques. CONCLUSION: Our results indicated that old age, male gender, diabetes, hypertension, and dyslipidemia are more com- mon in patients with carotid plaques than in those without. Old age, male gender, dyslipidemia, and diastolic dysfunc- tion are independent risk factors of carotid plaques in elderly patients with ischemic stroke. We further concluded that though left ventricle systolic function is not associated with carotid plaques in elderly patients with ischemic stroke, left ventricle diastolic dysfunction is.

A Case of Myocardial Abscess Mimicking Acute Myocardial Infarction

Myocardial abscess, a rare and life-threatening disease, occurs as a complication of infective endocarditis, acute myocardial infarction, or other infections in the setting of debilitating condition. We report a case of myocardial abscess mimicking acute myocardial infarction (AMI), not a following consequence of AMI. We can diagnose the disease with the aid of transthoracic echocardiography and cardiac computed tomography.

Papillary Fibroelastoma of Pulmonary Valve Mimicking Infective Endocarditis

In this report, we describe a case of previous undiagnosed masses of the pulmonary valve mimicking infective endocarditis that were incidentally found during the work-up of a 62-year-old woman, who was presented with abdominal discomfort and dyspepsia. The pathologic findings were characteristics of a papillary fibroelastoma. Although benign, papillary fibroelastomas have the potential to cause lethal embolic events such as stroke, myocardial infarction, and pulmonary embolism are reported in some cases. Tumor identification and surgical excision are important to prevent such complications.

The Effects of the Heparin-Coated Maximum Arterial Re-Creation (MAC) Stent on Porcine Coronary Stent Restenosis

BACKGROUND: Stent thrombosis and late restenosis are still major limitations in the clinical use of coronary stenting. Heparin-coated stent may reduce the incidences of stent thrombosis and restenosis. Heparin-coated stents were compared with control stents in a porcine coronary stent restenosis model in order to evaluate the effects of heparin-coated stent on stent restenosis. METHODS: Heparin was coated on a stent by deposition of an ultra-thin polymeric film containing amine groups by means of plasma polymerization. And then stent was immersed in heparin solution. Stent overdilation injury (stent:artery=1.3:1.0) was performed with bare (Group I, n=4) and heparin-coated (Group II, n=5) MAC stents in porcine coronary arteries. Follow-up quantitative coronary angiography (QCA) was performed at 4 weeks after stenting. The histopathologic assessments (KERN=*)of stented porcine coronary arteries were compared in between 2 groups. RESULTS: 1)Luminal area of stented artery was 7.05+/-1.25 mm2 in Group I and 7.67+/-2.85 mm2 in Group II, which were not different between two Groups. 2)Histopathologic stenosis of Group I was 35.7+/-13.2%, which was higher than 28.6+/-14.7% of Group II (p<0.05). Ratio of neointima/media was 1.16+/-0.52 in Group I and 0.87+/-0.31 in Group II and neointimal area was higher in Group I than in Group II (3.81+/-1.78 mm2 vs. 2.82+/-1.11 mm2, p<0.05 respectively). 3)PCNA (Proliferating cell nuclear antigen) index of GroupI was 10.0+/-2.2%, which was higher than in Group II (6.8+/-4.0%). CONCLUSIONS: Heparin-coated MAC stent may be effective in the inhibition of neointimal proliferation in a porcine stent restenosis model.

The Incidence of Dual Atrioventricular Nodal Pathways and the Differences of Their Electrophysiologic Properties According to the Inducibility of Atrioventricular Nodal Reentrant Tachycardia / 대한내과학회지

OBJECTIVES: Refractory period and conduction time of the slow and fast pathways in the atrioven-tricular node are known to be the most important determinant of the inducibility of atrioventricular nodal reentrant tachycardia (AUNRT) but their relationship has not been determined in Korean. METHODS: Two hundred and ten patients under-gone electrophysioiogic study. One hundred twenty two patients with dual AV nodal pathways were divided into two groups (group I, 77 patients with no inducible AVNRT; group II, 45 patients with inducible AVNRT). RESULTS: Antegrade dual AV nodal pathways were documented in 77 patients (47%) out of 165 patients on whom AVNRT was not induced, Antegrade ERP of slow pathway in paced rhythm (600 msec) was shorter in group II than in group I (331 +/- 14 msec vs 269 +/- 47 msec, p<0.05). Ventriculoatrial block cycle length (VABCL) and retrograde ERP of the AV conduction system were significantly shorter in group 2 than in group 1 (p<0.001). Maximum slow pathway conduction times in sinus rhythm and paced rhythm (600msec) in group 2 were significantly longer than in group 1 (sinus rhythm: 332 +/- 68msec vs. 379 +/- 88msec, p<0.005; paced rhythm: 332 +/- 69msec vs. 392 +/- 85msec, p<0.005). The ERP gaps of two AV nodal pathways of group 2 in sinus rhythm and in paced rhythm were also significantly longer than those of group 1 (sinus rhythm 41 +/- 3msec vs. 78 +/- 50msec, p<0.001; paced rhythm 36 +/- 32 msec vs. 72 +/- 19msec, p<0.005). The incidence of intact ventriculoatrial conduction was significantly higher in group 2 than in group 1 (p<0.05). Antegrade slow pathway conduction time (A2H2 interval) at the time of AVNRT induction with single atrial premature depolarization (APD) with a coupling interval over 10 msec less than that of an APD producing AH jump were not correlated with VABCL (r=0.193, p<0.05). CONCLUSION: Dual AV nodal pathways were observed in 47% of patients with no-inducible AVNRT group. The inducibility of AVNRT appears to be closely ralated to the some conduction characteristics of the dual pathways and the refractoriness, i.e. maximum slow pathway conduction time, the ERP gap of two pathways, retrograde fast pathway ERP, VABCL.

Coronary angiographic morphology of unstable angina / 대한내과학회지

No abstract available.