Prevalence of Diabetes Mellitus and Prediabetes in Dalseong-gun, Daegu City, Korea

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.

Incidence of Hypertension in Korea: 5-Year Follow-up Study

Limited data are available about the incidence of hypertension over the 5-yr in non-hypertensive subjects. The study subjects were 1,806 subjects enrolled in a rural area of Daegu, Korea for a cohort study from August to November 2003. Of them, 1,287 (71.3%) individuals had another examination 5 yr later. To estimate the incidence of hypertension, 730 non-hypertensive individuals (265 males; mean age = 56.6 +/- 11.1 yr-old) at baseline examination were analyzed in this study. Hypertension was defined as either a new diagnosis of hypertension or self-reports of newly initiated antihypertensive treatment; prehypertension was if the systolic blood pressure was 120-139 mmHg and/or diastolic blood pressure was 80-89 mmHg. During the 5-yr follow-up, 195 (26.7%) non-hypertensive individuals developed incident hypertension. The age-adjusted 5-yr incidence rates of hypertension were 22.9% (95% confidence interval [CI] = 19.9-29.0) in overall subjects, 22.2% (95% CI = 17.2-27.2) in men, and 24.3% (95% CI = 20.4-28.2) in women. The incidence rates of hypertension significantly increased with age. In the multivariate analysis, prehypertension (Odds ratio [OR] 2.25; P < 0.001) and older age (OR 2.26; P = 0.010) were independent predictors for incident hypertension. In this rapidly aging society, population-based preventive approach to decrease blood pressure, particularly in subjects with prehypertension, is needed to reduce hypertension.

The Impact of Circadian Variation on 12-Month Mortality in Patients With Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Although circadian variation in the onset of acute myocardial infarction (AMI) has been reported in a number of studies, not much is known about the impact of circadian variation on 12-month mortality. The aim of this study was to investigate the impact of circadian variation on 12-month mortality in patients with AMI. SUBJECTS AND METHODS: Eight hundred ninety two patients (mean age 67+/-12; 66.1% men) with AMI who visited Kyungpook National University Hospital from November 2005 to December 2007 were included in this study. Patients were divided into groups based on four 6-hours intervals: overnight (00:00-05:59); morning (06:00-11:59); afternoon (12:00-17:59) and evening (18:00-23:59). RESULTS: Kaplan-Meier survival curves showed 12-month mortality rates of 9.6%, 9.1%, 12.1%, and 16.7% in the overnight, morning, afternoon, evening-onset groups, respectively (p=0.012). Compared with the morning-onset AMI group, the serum creatinine levels (p=0.002), frequency of Killip class > or =3 (p=0.004), and prescription rate of diuretics (p=0.011) were significantly higher in the evening-onset AMI group, while the left ventricular ejection fraction (p=0.012) was significantly lower. The proportion of patients who arrived in the emergency room during routine duty hours was significantly lower in evening-onset groups irrespective of the presence or absence of ST-segment elevation (p<0.001). According to univariate analysis, the 12-month mortality rate in the evening group was significantly higher compared to the morning group (hazard ratio 1.998, 95% confidence interval 1.196 to 3.338, p=0.008). CONCLUSION: Patients with evening-onset AMI had poorer baseline clinical characteristics, and this might affect the circadian impact on 12-month mortality. Further studies are needed to clarify the role of circadian variation on the long-term outcome of AMI.

Electrocardiography Patterns and the Role of the Electrocardiography Score for Risk Stratification in Acute Pulmonary Embolism

BACKGROUND AND OBJECTIVES: Data on the usefulness of a combination of different electrocardiography (ECG) abnormalities in risk stratification of patients with acute pulmonary embolism (PE) are limited. We thus investigated 12-lead ECG patterns in acute PE to evaluate the role of the ECG score in risk stratification of patients with acute PE. SUBJECTS AND METHODS: One hundred twenty-five consecutive patients (63+/-14 years, 56 men) with acute PE who were admitted to Kyungpook National University Hospital between November 2001 and January 2008 were included. We analyzed ECG patterns and calculated the ECG score in all patients. We evaluated right ventricular systolic pressure (RVSP) (n=75) and RV hypokinesia (n=80) using echocardiography for risk stratification of acute PE patients. RESULTS: Among several ECG findings, sinus tachycardia and inverted T waves in V(1-4) (39%) were observed most frequently. The mean ECG score and RVSP were 7.36+/-6.32 and 49+/-21 mmHg, respectively. The ECG score correlated with RVSP (r=0.277, p=0.016). The patients were divided into two groups {high ECG-score group (n=38): ECG score >12 and low ECG-score group (n=87): ECG score < or =12} based on the ECG score, with the maximum area under the curve. RV hypokinesia was observed more frequently in the high ECG-score group than in the low ECG-score group (p=0.006). Multivariate analysis revealed that a high ECG score was an independent predictor of high RVSP and RV hypokinesia. CONCLUSION: Sinus tachycardia and inverted T waves in V(1-4) were commonly observed in acute PE. Moreover, the ECG score is a useful tool in risk stratification of patients with acute PE.

Association Between Gamma-Glutamyltransferase and Hypertension Incidence in Rural Prehypertensive Adults / 예방의학회지

OBJECTIVES: Prehypertension is associated with a higher risk of developing hypertension compared with normotension. Yet, factors predicting the development of hypertension among prehypertensive people are ill-understood. This prospective cohort study was performed to examine if serum gamma-glutamyltrasferase (GGT) within a normal range can predict the future risk of hypertension among prehypertensive adults. METHODS: Study subjects were 293 prehypertensive persons >30-years-of-age who participated in a community-based health survey in 2003 and who were followed up in 2008. Sex-specific quartiles of baseline serum GGT were used to examine association with 5-year hypertension incidence. RESULTS: Baseline serum GGT within normal range predicted the risk of developing hypertension for 5 years only in prehypertensive women. Adjusted relative risks were 1.0, 3.7, 3.6, and 6.0 according to quartiles of baseline serum GGT (P for trend <0.01). This pattern was similarly observed in non-drinkers. However, serum GGT was not associated with incident hypertension in men. Different from serum GGT, baseline serum alanine aminotransferase, another well-known liver enzyme, did not predict the risk of incident hypertension in both genders. CONCLUSIONS: Even though baseline serum GGT within normal range strongly predicted the future risk of hypertension, it was observed only in women, Although underlying mechanisms of this association are currently unclear, serum GGT can be used to select a high risk group of hypertension in prehypertensive women.

Examining the Relationship Between Triggering Activities and the Circadian Distribution of Acute Aortic Dissection

BACKGROUND AND OBJECTIVES: There are limited data examining triggering activities and circadian distribution at the onset of acute aortic dissection (AAD) in the context of diagnostic and anatomical classification. The aim of this study was to further investigate this relationship between triggering activities and circadian distribution at the onset of AAD according to diagnostic and anatomic classification. SUBJECTS AND METHODS: A total of 166 patients with AAD admitted to Kyungpook National University Hospital between July 2001 and June 2009 were included. To assess the influence of diagnostic and anatomical classification, we categorized the patients into intramural hematoma (IMH) group (n=67)/non-IMH group (n=99) and Stanford type A (AAD-A, n=94)/type B (AAD-B, n=72). To evaluate circadian distribution, the day was divided into four 6-hour periods: night (00-06 hours), morning (06-12 hours), afternoon (12-18 hours), and evening (18-00 hours). RESULTS: Most (72%) AAD episodes were related to physical (53%) and mental activities (19%), with about one-third occurring during the afternoon, and only 12% occurring at night. No differences in triggering activities or circadian distribution were observed among the groups. Waking hours including morning, afternoon, and evening correlated with triggering activities (p=0.003). These relationships were observed for the non-IMH (p=0.008) and AAD-B (p=0.003) cases. The remaining categories had similar relationships, but did not reach statistical significance. CONCLUSION: Our findings suggest differences in the relationship between triggering activities and the circadian distribution of the onset of AAD according to diagnostic and anatomical classification.

Recurrent Catecholamine-Induced Cardiomyopathy in a Patient With a Pheochromocytoma

Pheochromocytomas presents with variable clinical manifestations. Cardiomyopathy caused by a pheochromocytoma is well known. We report the case of a 62-year-old woman with recurrent left ventricular dysfunction, who was subsequently found to have a pheochromocytoma. The patient had two different patterns of cardiomyopathy. Patients with a cardiomyopathy, of non-specific origin, should have a pheochromocytoma ruled out.

Gender Differences Among Korean Patients With Coronary Spasm

BACKGROUND AND OBJECTIVES: The gender differences among Korean patients with coronary spasm have not been defined. We thus determined the gender differences among Korean patients with coronary spasm. SUBJECTS AND METHODS: Patients with chest pain and/or syncope who were admitted to Kyungpook National University Hospital between January 2001 and August 2008 were included. Provocation of coronary vasospasm with intracoronary ergonovine maleate was performed when baseline coronary angiography showed no significant stenosis or there was a strong clinical suspicion of coronary spasm. The clinical characteristics were analyzed from 104 consecutive patients (56+/-9 years of age; 21 females) who were diagnosed with coronary spasm. RESULTS: Female patients were younger (52+/-7 vs. 57+/-10 years, p=0.046) with lower rates of smoking and alcohol consumption histories than male patients (19% vs. 65%, p<0.001; and 43% vs. 89%, p<0.001, respectively). The other clinical characteristics were not significantly different, except for the triglyceride levels. CONCLUSION: The majority of patients with coronary spasm were males who were smokers and alcohol consumers. The female patients had lower rates of smoking and alcohol consumption, and they were younger than the male patients. Further studies are needed to investigate the relevance of gender differences in the pathogenesis of coronary spasm.

Prognosis and Natural History of Drug-Related Bradycardia

BACKGROUND AND OBJECTIVES: The prognosis and natural history of bradycardia related to drugs such as beta-blockers and non-dihydropyridine calcium channel blockers are not well known. SUBJECTS AND METHODS: We retrospectively analyzed 38 consecutive patients (age 69+/-11, 21 women) with drug-related bradycardia (DRB) between March 2005 and September 2007. A drug-associated etiology for the bradycardia was established based on the medical history and patient response to drug discontinuation. The mean follow-up duration was 18+/-8 months. RESULTS: The initial electrocardiogram (ECG) showed sinus bradycardia (heart rate < or =40/min) in 13 patients, sinus bradycardia with junctional escape beats in 18 patients, and third-degree atrioventricular (AV) block in seven patients. Drug discontinuation was followed by resolution of bradycardia in 60% of patients (n=23). Among them, five (17.8%) patients resumed taking the culprit medication after discharge and none developed bradycardia again. Bradycardia persisted in 10 (26.3%) patients despite drug withdrawal, and a permanent pacemaker was implanted in seven of them. Third-degree AV block, QRS width, and bradycardia requiring temporary transvenous pacing were significantly associated with the bradycardia caused by drugs. CONCLUSION: Beta-blockers were the most common drugs associated with DRB. However, in one quarter of the cases the DRB was not associated with drugs; in these patients permanent pacemaker implantation should be considered.

Relationship between serum gamma-glutamyltransferase and metabolic syndrome among Korean non-diabetic adults / 한국역학회지

PURPOSE: This study was conducted to investigate the association of gamma-glutamyltransferase (GGT) with metabolic syndrome among non-diabetic adults. METHODS: This study was conducted in a rural area, South Korea from August, 2003 to November, 2003. The study subjects were 1,023 sampled persons aged from 40 years and older (male 377, female 646). We analyzed the association between GGT with metabolic syndrome by multiple logistic regression analysis using SAS 9.1 version. RESULTS: The prevalence of metabolic syndrome in this study was 28.8%. The prevalence of metabolic syndrome was increased by quartiles of serum GGT level (P for trend <0.05). The prevalence of metabolic alterations fitting the criteria of the metabolic syndrome by quartiles of serum GGT level were almost significantly increased except for the criterion of low high density lipoprotein (HDL) cholesterol with adjustment for age and alcohol intake. Among 5 components of metabolic syndrome, the criterion of high serum triglyceride was most powerfully associated with serum GGT level in both gender. CONCLUSIONS: This study shows that serum GGT level was significantly associated with metabolic syndrome even after excluding diabetic adults.

Serum gamma-glutamyl transferase activity has no prognostic value in patients with acute myocardial infarction / 대한내과학회지

BACKGROUND: Serum gamma-glutamyl transferase activity (GGT) is able to catalyse low-density lipoprotein oxidation in coronary atherosclerotic plaques and has a role in the pathogenesis of atherosclerosis. GGT has been shown to be an independent risk factor for cardiac mortality in patients with a previous myocardial infarction. The purpose of this study is to determine the prognostic value of GGT within its normal range at an acute stage in patients with acute myocardial infarction. METHODS: In a retrospective study, GGT and other cardiac risk factors were evaluated in 192 patients (M/F=143/49; mean age: 60.8+/-11.8 years) who were diagnosed with an acute myocardial infarction at the emergency room. We compared the serum GGT values for each patient with or without a cardiac event, including cardiac death, non-fetal myocardial infarction and unstable angina, after an acute myocardial infarction for a mean follow-up of 16.5+/-10.8 months. RESULTS: During the follow-up period, 17 patients underwent cardiac death and experienced an acute myocardial infarction and 23 patients had unstable angina. Although the mean GGT values were significantly different from patients with cardiac events (29.5+/-10.0 U/L vs 25.0+/-11.2 U/L, p=0.024), serum GGT was not an independent cardiac risk factor for a cardiac event based on multivariate analysis adjusted for age, sex, alcohol and known cardiovascular risk factors. CONCLUSIONS: Serum GGT within its normal range at an acute stage in patients that experienced an acute myocardial infarction is not an independent prognostic marker.

A Case of Carney Complex: Diagnosed 11 Years after Resection of Recurrent Cardiac Myxomas

Carney complex (CNC) is a rare disease characterized by myxoma, spotty skin pigmentation, and multiple neuroendo crine tumors. Here, we present a case of CNC, diagnosed 11 years after resection of recurrent cardiac myxomas. We had previously reported a 37-year-old woman in 1984 as biatrial myxomas and in 1994 as recurrent left atrial and ventricular myxomas, and at those times, she did not have any other myxomas and skin lesions. On her present admission, she had skin pigmentation and myxomatosis of breast, nostril and forearm. Upon the examination of her relatives, no characteristics of CNC were found on them. She was diagnosed as a sporadic form of CNC. If cardiac myxomas tend to be multiple and recurrent, we should consider the possibility of CNC, even other characteristics of CNC except cardiac myxomas are not present at diagnosis.

Blood Pressure Response during the Exercise Treadmill Test and the Risk of Future Hypertension and Cardiovascular Disease

BACKGROUND AND OBJECTIVES: Many studies had established the risk factors for cardiovascular disease. The Duke treadmill score has gained widespread acceptance for making the prognosis and diagnosis for patients with cardiac disease. Recently, the changes in blood pressure during and after exercise have also been studied to predict the prognosis of cardiac disease. We examined the relationship between the incidence of hypertension or cardiovascular disease and the changes of blood pressure during a routine exercise treadmill test. SUBJECTS AND METHODS: 256 men were screened, and they performed exercise treadmill tests from March to May, 2000. Those subjects with histories of hypertension and ischemic heart disease or who were newly diagnosed with ischemic heart disease were excluded. 109 subjects were selected for the final analysis. The follow up period was 78 months. Review of medical records and telephone interviews were used for follow up. We defined clinical events as new onset hypertension, ischemic heart disease, congestive heart failure, cerebrovascular accident, diabetes and atrial fibrillation. The peak systolic blood pressure of 182.5mmHg had the highest specificity and sensitivity on the receiver operating characteristic (ROC) curve of the systolic blood pressure for prediction of clinical events. We defined a hypertensive response as a peak systolic blood pressure over 180 mmHg. RESULTS: 43 (39.4%) of the subjects had a hypertensive response on their exercise treadmill test. The mean exercise capacity was higher in the hypertensive response group. No significant differences were found between the hypertensive and non-hypertensive response groups, in terms of age, gender, body weight, height, body mass index and resting blood pressure. 18 (41.8%) of the hypertensive response subjects had clinical events, while only 11 (16.6%) of the non-hypertensive response subjects had clinical events. The hypertensive response group had more clinical events (p=0.006). 14 (32.5%) of the hypertensive response subjects had hypertension, while only 10 (15.1%) of the non-hypertensive response group had hypertension. The hypertensive response group had more hypertension (p=0.044). On the multivariate analysis, the hypertensive response on the exercise treadmill test was an independent risk factor for hypertension and clinical events (odds ratio=3.990, 95% confidence interval; 1.473-10.808, p=0.006). CONSLUSION: These results indicate that the exercise blood pressure response seems to be a risk factor for hypertension and clinical events. Careful medical care and close follow up may be needed for subjects with a hypertensive blood pressure response on the exercise treadmill test. Further study is needed to understand the significance of an exaggerated blood pressure response on the exercise treadmill test.

Influences of Perfusion Defect on the Measurement of Left Ventricular Ejection Fraction and Volumes in Gated Myocardial Perfusion SPECT

BACKGROUND AND OBJECTIVES: The left ventricular ejection fraction (LVEF) and volume (LVV) are important variables in patients with coronary artery disease. Quantitative gated myocardial SPECT (QGS) permits the simultaneous assessment of perfusion, LVEF and LVV. However, the presence of a perfusion defect may influence the LVEF and LVV measured by QGS. SUBJECTS AND METHODS: 67 subjects (M/F=47/20; mean age: 60.2+/-12.4 years) underwent both QGS with Tc-99m MIBI and 2-D echocardiography (Echo) at less than 7 days apart. The LVEF and LVV were measured by Echo, using the modified Simpson's method, and by QGS, using the automatic software, AutoQUANT(TM). The QGS rest images were used to compare with the Echo. RESULTS: The correlations between the QGS and Echo for LVEF, LVEDV and LVESV were good in all 67 subjects (r=0.781, 0.754 and 0.906, respectively, p<0.0001). In patients with no perfusion defect (n=34), the correlations between the QGS and Echo for LVEF, LVEDV and LVESV were good (r=0.689, 0.593 and 0.586, p<0.0001). In patients with a perfusion defect (n=33), the LVEF between the QGS and Echo was well correlated (r=0.777, p<0.0001), but the LVEF was higher by 7.1+/-8.7% from the Echo results. The LVEDV and LVESV by both QGS and Echo were also well correlated (r=0.804 and 0.929, respectively, p<0.0001), but the LVEDV and LVESV were higher from QGS by 17.9+/-34 and 16.9+/-25 mL, respectively. A Bland-Altman analysis showed the agreement between the QGS and Echo in patients without perfusion defect was better than for those with a perfusion defect. CONCLUSION: The perfusion defect from QGS might affect the measurements of the LVEF and LVV; therefore, the QGS and Echo values are not interchangeable.

Complications of 2-D Echocardiography Guided Transfemoral Right Ventricular Endomyocardial Biopsy

Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.

Complications of 2-D Echocardiography Guided Transfemoral Right Ventricular Endomyocardial Biopsy

Endomyocardial biopsy (EMBx) is a useful tool for diagnosing various cardiac pathologies. However, the routine use of EMBx has not gained widespread acceptance due to the possible complications related to the EMBx. Thus, not much information is available on the complications related to the EMBx. We prospectively evaluated 90 consecutive patients who underwent 2-D echocardiography guided transfemoral right ventricular EMBx at Kyungpook National University Hospital between March 2002 and November 2005 to determine the incidence, nature and subsequent management of complications related to EMBx. The clinical diagnoses before the EMBx were arrhythmogenic right ventricular dysplasia in 54, dilated cardiomyopathy in 19, Brugada syndrome in 9, myocarditis in 6 and miscellaneous in 2 patients. The overall major complication rate was 5.6% and no procedure-related mortality occurred. Myocardial perforation (n=3), which was the most frequent complication, did not progress to cardiac tamponade requiring pericardiocentesis in any patient. Hemodynamically unstable ventricular tachycardia occurred in 1 patient. New and persistent right bundle branch block occurred in another. Our findings suggest that 2-D echocardiography guided transfemoral right ventricular EMBx is a relatively safe procedure.

Anemia is Associated with Higher Mortality in Severe Heart Failure

BACKGROUNDS AND OBJECTIVES: Anemia could adversely affect the cardiovascular condition of the patients suffering with heart failure. This study aimed to elucidate the relationship between anemia and the prognosis of heart failure (HF). SUBJECTS AND METHODS: We enrolled the patients with a diagnosis of CHF who visited to our hospital from January 2000 and January 2001 and they had a left ventricular ejection fraction (EF) less than 40% and a left ventricular end diastolic dimension (LVEDd) larger than 5.7 cm. The hemoglobin (Hb) level was accessed at the time of the initial evaluation. The patients were divided into quartiles of Hb: Hb 14.8 g/dL. RESULTS: A total of 110 patients were enrolled; there were 71 men and 39 women. Anemia was found in 39 (35.5%) patients, and this was significantly more common in the women than in men (p=0.038). The lowest Hb group was more likely to be older and female, and they had severe symptoms (NYHA functional class III or IV), a lower diastolic BP and a wider QRS width. The total mortality was 24.5%. Mortality was higher with lower Hb quartile (46.2%, 28.6%, 17.9% and 7.1% for each quartile, respectively, p=0.002). On the multivariate analysis after adjusting for age, gender, NYHA functional class and the known HF prognostic factors, the lowest Hb level proved to be an independent predictor of mortality (p=0.019). CONCLUSION: In patients with congestive heart failure, anemia is relatively common and the mortality was higher for the lower Hb group. Anemia is an independent negative prognostic factor in patients with congestive heart failure.

The clinical significance of the differernce in left ventricular ejection fraction between rest and stress on gated myocardial perfusion SPECT / 대한내과학회지

BACKGROUND: Gated myocardial perfusion SPECT improved diagnostic accuracy of coronary artery disease and enabled us to observe motion and thickening of myocardial walls, ejection fraction as well as myocardial perfusion. Many studies suggested that there was a decrease of left ventricular ejection fraction (LVEF) at post-stress compared with that at rest gated myocardial perfusion SPECT (stunning). The objective of this retrospective study is to evaluate the clinical significance of the decrease of LVEF at post-stress gated myocardial perfusion SPECT by correlating with coronary angiographic finding. METHODS: Authors selected 41 patients who underwent exercise electrocardiography and gated myocardial perfusion SPECT between May, 2001 and May, 2002. The patients underwent coronary angiography within 6 months. The patients were divided into two groups, 16 patients in whom post-stress LVEF was >or=5% lower than rest (stunning group) and 25 patients in whom LVEF was not >or=5% lower than rest (non-stunning group). RESULTS: The number of patients with hyperlipidemia was higher in stunning group than in non-stunning group (50% vs 4%, p=0.001). The number of patients with angiographic stenoses >90% was significantly higher in stunning group than in non-stunning group (75% vs 28%, p=0.04). The number of patients with multi-vessel disease was also significantly higher in stunning group than in non-stunning group (75% vs 36%, p=0.015). CONCLUSION: The patients who had a decreased LVEF after stress (stunning) showed more severe coronary artery stenosis. This finding suggests that stunning may be an important additional indicator of underlying myocardial ischemia.

Prevalence rate and triggering factors of syncope in medical students / 대한내과학회지

BACKGROUND: Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous. The most frequently identified causes of syncope are neurocardiogenic, cardiac, cerebrovascular and side effects of drugs. However, in many cases, it is not easy to make a diagnosis of syncope. The prevalence rate of syncope also is variable according to the nature of the study. We investigated the prevalence rate, characteristics and triggering factors of syncope in young medical students. METHODS: We contacted 400 medical students of Kyungpook National University, Daegu, Korea, and a questionnaire on the prevalence, triggering factors, and recurrence rate of syncope was handed out. The data from 379 medical student (male 168, female 211, mean age 22.3 years) were included for further analysis. RESULTS: Fifty-eight students (15.3%) experienced syncope and female students reported higher prevalence rate than male students (20.4 versus 8.9%, p=0.002). Among 58 students with syncopal history, 22 students (male 2, female 20) experienced recurrent syncope. The students who experienced recurrent syncope were younger at first syncope than those without recurrent syncope (15.0 versus 17.3 years, p=0.039). The triggering factors of syncope were prolonged standing, warm environment, immediate standing, tiredness, emotional upset, menstruation, and so on. CONCLUSION: The prevalence rate of syncope was 15% in medical student with mean age of 22.3 years. As the syncope in female and early onset syncope showed higher rate of recurrence, more attention may prevent recurrent syncope in these cases.

Changes in Heart Rate during and after Exercise Treadmill Test as Prognostic Factor in Cardiovascular Disease

BACKGROUND AND OBJECTIVES: Many studies have established risk factors for cardiovascular diseases. The Duke treadmill score has gained widespread acceptance for prognosis and diagnosis in cardiac diseases. Recently, changes in heart rate during and after exercise have also been studied to predict the prognosis of cardiac diseases. We examined the relationship between the incidence of cardiovascular events and exercise capacity, achievement of 85% maximal predicted heart rate (MPHR) or heart rate recovery (HRR) after a routine exercise treadmill test. SUBJECTS AND METHODS: We studied 88 patients with chest pain who were over the age of 30. They were referred for exercise treadmill test for assessment of chest pain and underwent symptom-limited, exercise test with a cool down period of 30 seconds. HRR was defined as the difference in heart rate between peak exercise and 1 minute after exercise. Delta heart rate (DHR) was defined as the difference in heart rate between resting and peak exercise. Other parameters in the exercise test were also measured. RESULTS: Cardiovascular events were found in 13 of the 88 patients. In the events group, age, peak heart rate in exercise, ST depression, maximal exercise capacity, HRR, DHR and achievement of 85% MPHR were all significant variables. There was a favorable prognosis in the patients with a value of HRR >22 beats/minute and a value of DHR >83 beats/minute. Even after adjusting for age, sex, ST depression and left ventricular hypertrophy, the parameters of maximal exercise capacity, HRR, DHR, and achievement of 85% MPHR remained predictive prognostic factors in cardiovascular events. CONCLUSION: Parameters in exercise treadmill test, such as maximal exercise capacity, HRR, DHR and achievement of 85% MPHR, appear to provide additional information and are important variables associated with the prediction of risk in cardiac events.