Left Ventricular Apical Aneurysm: Atypical Feature of Cardiac Sarcoidosis Diagnosed by Multimodality Imaging

no abstract available.

A Close Relationship between Non-Alcoholic Fatty Liver Disease Markerand New-Onset Hypertension inHealthy Korean Adults

Background and Objectives@#Nonalcoholic fatty liver disease (NAFLD) is an excessiveaccumulation of fat into the liver as a result of increased inflammation and insulin resistance.Although there can be common pathogenic mechanisms for NAFLD and hypertensionassociated with the development of cardiovascular diseases, little data are showing theassociation between NAFLD and hypertension in a large-scale cohort study. Thus, weevaluated the ability of the fatty liver index (FLI), a surrogate marker of NAFLD, to predict thedevelopment of hypertension in healthy individuals. @*Methods@#We included 334,280 healthy individuals without known comorbidities whounderwent the National Health check-ups in South Korea from 2009 to 2014. Theassociation between the FLI and hypertension was analyzed using multivariate Coxproportional-hazards models. @*Results@#During a median of 5.2 years' follow-up, 24,678 subjects (7.4%) had new-onsethypertension. We categorized total subjects into quartile groups according to FLI (range: Q1,0–4.9; Q2, 5.0–12.5; Q3, 12.6–31.0; and Q4, >31.0). The incidence of hypertension was higherin subjects with the highest FLI than in those with the lowest FLI (Q4, 9,968 [11.9%] vs. Q1,2,277 [2.7%]; p<0.001). There was a significant correlation between the highest FLI and anincreased risk of new-onset hypertension (adjusted hazard ratio between Q4 and Q1, 2.330;95% confidence interval, 2.218–2.448; p<0.001). FLI was significantly associated with anincreased risk of new-onset hypertension regardless of baseline characteristics. @*Conclusions@#Higher FLI was independently associated with increased risk of hypertension ina healthy Korean population.

Impact of Diabetes Control on Subclinical Atherosclerosis: Analysis from Coronary Computed Tomographic Angiography Registry

Background@#There are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis. @*Methods@#We analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively. @*Results@#Compared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; p=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; p=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; p<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; p<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (p=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (p=0.023). @*Conclusion@#Asymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.

Trends, Characteristics, and Clinical Outcomes of Patients Undergoing Percutaneous Coronary Intervention in Korea between 2011 and 2015

BACKGROUND AND OBJECTIVES@#We sought to evaluate nationwide trends, characteristics, and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) in Korea.@*METHODS@#From National Health Insurance claims data in Korea, 81,115 patients, who underwent PCI for the first episode of coronary artery disease between 2011 and 2015, were enrolled. Patients were categorized into angina (n=49,288) or acute myocardial infarction (AMI, n=31,887) groups and analyzed.@*RESULTS@#The mean age of patients was 64.4±12.2 years and 56,576 (69.7%) were men. Diabetes, hyperlipidemia, and hypertension were observed in 27,086 (33.4%), 30,675 (37.8%), and 45,389 (56.0%) patients, respectively. There was a 10% increase in the number of patients undergoing PCI for angina between 2011–2012 and 2014–2015 (11,105 vs. 13,261; p=0.021). However, the number of patients undergoing PCI for AMI marginally decreased between 2011–2012 and 2014–2015 (8,068 vs. 7,823; p=0.052). In procedures, drug-eluting stent was the most frequently used device (93.2%), followed by balloon angioplasty (5.5%) and bare metal stents (1.3%). The mean number of stents per patient was 1.39±0.64. At discharge, dual-anti platelet therapy, statin, beta-blockers, and angiotensin converting enzyme inhibitor or angiotensin receptor blocker were provided to 76,292 (94.1%), 71,411 (88.0%), 57,429 (70.8%), and 54,418 (67.1%) patients, respectively. The mean in-hospital and 1-year total medical costs were 8,628,768±4,832,075 and 13,128,158±9,758,753 Korean Won, respectively. In-hospital mortality occurred in 2,094 patients (2.6%).@*CONCLUSIONS@#Appropriate healthcare strategies reflecting trends, characteristics, and clinical outcomes of PCI are needed in Korea.

Trends, Characteristics, and Clinical Outcomes of Patients Undergoing Percutaneous Coronary Intervention in Korea between 2011 and 2015

BACKGROUND AND OBJECTIVES: We sought to evaluate nationwide trends, characteristics, and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) in Korea. METHODS: From National Health Insurance claims data in Korea, 81,115 patients, who underwent PCI for the first episode of coronary artery disease between 2011 and 2015, were enrolled. Patients were categorized into angina (n=49,288) or acute myocardial infarction (AMI, n=31,887) groups and analyzed. RESULTS: The mean age of patients was 64.4±12.2 years and 56,576 (69.7%) were men. Diabetes, hyperlipidemia, and hypertension were observed in 27,086 (33.4%), 30,675 (37.8%), and 45,389 (56.0%) patients, respectively. There was a 10% increase in the number of patients undergoing PCI for angina between 2011–2012 and 2014–2015 (11,105 vs. 13,261; p=0.021). However, the number of patients undergoing PCI for AMI marginally decreased between 2011–2012 and 2014–2015 (8,068 vs. 7,823; p=0.052). In procedures, drug-eluting stent was the most frequently used device (93.2%), followed by balloon angioplasty (5.5%) and bare metal stents (1.3%). The mean number of stents per patient was 1.39±0.64. At discharge, dual-anti platelet therapy, statin, beta-blockers, and angiotensin converting enzyme inhibitor or angiotensin receptor blocker were provided to 76,292 (94.1%), 71,411 (88.0%), 57,429 (70.8%), and 54,418 (67.1%) patients, respectively. The mean in-hospital and 1-year total medical costs were 8,628,768±4,832,075 and 13,128,158±9,758,753 Korean Won, respectively. In-hospital mortality occurred in 2,094 patients (2.6%). CONCLUSIONS: Appropriate healthcare strategies reflecting trends, characteristics, and clinical outcomes of PCI are needed in Korea.

Non Sinus Focal Atrial Tachycardia

Non sinus focal atrial tachycardia (AT) is an uncommon arrhythmia. Electrocardiograms (ECGs) can be used to diagnose the condition. ECGs can also be used to pinpoint the origin of the focal AT; however, the precise location is ultimately confirmed by electrophysiology. Automaticity, triggered activity, and micro-reentry are possible underlying mechanisms for focal AT. Pharmacological therapy is recommended for symptomatic patients. Radiofrequency catheter ablation is a viable alternative, especially in patients intolerant to drugs, or patients with drug-refractory focal AT. This review describes the epidemiology, clinical features, diagnosis, and mechanisms of focal AT, as well as possible therapeutic approaches for this condition.

A Case of Perimembranous Ventricular Septal Defect Associated with Sinus of Valsalva Aneurysm Mimicking Membranous Septal Aneurysm

Sinus of Valsalva aneurysms are rare. Sinus of Valsalva aneurysms are frequently associated with ventricular septal defect (VSD) and aortic regurgitation. They often remain asymptomatic until abruptly presenting with acute chest pain and heart failure secondary to rupture. Here, we describe a case of 20-year-old man who presented with chest pain with a history of VSD. Initial work-up concluded that the patient had VSD associated membranous septal aneurysm. Four years later, the patient presented with symptoms of heart failure. Work-up showed that the ruptured sinus of Valsalva aneurysm was the cause of symptoms. Due to its close proximity to the aortic annulus, sinus of Valsalva aneurysm should be differentiated from membranous septal aneurysm.

Changes in Carotid Intima-media Thickness and Left Ventricular Mass by Control of Blood Pressure and Hyperlipidemia in Hypertensive Patients

BACKGROUND: Hypertensive patients often present with carotid atherosclerosis, and especially those with left ventricular hypertrophy (LVH) are known to have twice the prevalence of carotid atheroma. The aims of this study were to evaluate the changes in the severity of carotid atherosclerosis and left ventricular (LV) mass by control of blood pressure (BP) and hyperlipidemia in hypertensive patients. METHODS: A total of 87 treated hypertensive patients who had been diagnosed as stage 2 hypertension on Joint National Committee 7 classification in past 1 year or LVH on electrocardiographic criteria were enrolled. Both at baseline and the end of study, repetitive measurements of carotid intima-media thickness (IMT) and LV mass indexed by body surface area were performed. Measurement of carotid IMT was conducted at bilateral sides of distal common carotid artery. RESULTS: After the follow-up period of mean 16-months, there were significant lowering in systolic and diastolic BP, respectively (144.6 +/- 19.2 to 131.3 +/- 13.6 mm Hg, p < 0.001; 87.5 +/- 11.3 to 79.6 +/- 9.4 mm Hg, p < 0.001). Carotid IMT showed no significant change (0.75 +/- 0.18 to 0.76 +/- 0.18 mm, p = 0.310). Although there was significant reduction in LV mass index (107.9 +/- 22.0 to 101.0 +/- 18.4 g/m2, p < 0.001), it was not correlated with the changes in carotid IMT (r = 0.141, p = 0.197). CONCLUSIONS: Anti-hypertensive therapy combined with statin if indicated did not show significant reduction in atherosclerotic burden of carotid artery, but it seemed to prevent further progression in hypertensive patients. Decrement in LV mass achieved by BP control was not correlated with changes in carotid IMT.

A Case of Anaphylaxis to Oral Minocycline

Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. To date, there has been only one case report of anaphylaxis to minocycline. We report here a case of anaphylaxis to oral minocycline. A 56-yr-old woman visited our hospital after three episodes of recurrent anaphylaxis. We performed an oral challenge test, the standard method for diagnosing drug allergies, with minocycline, one of the drugs she had taken previously. She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid. However, she presented similar symptoms at 50 min and at 110 min. In prescribing oral minocycline, physicians should consider the possibility of serious adverse reactions, such as anaphylaxis.

Recurrent Postoperative Effusive-Constrictive Pericarditis Associated with Steroid Discontinuation

Transient effusive-constrictive pericarditis is a rare complication of open-heart surgery, but is increasingly recognized. For patients with both pericardial effusion and constrictive physiology soon after uneventful open-heart surgery, proper treatment remains to be established. We experienced a case of transient effusive-constrictive pericarditis in a 50-year-old woman who underwent aortic valve replacement due to infective endocarditis. Initially, she was treated with both prednisolone and ibuprofen, which resulted in dramatic relief of symptom. However, she suffered from a relapse of pericaridis after rapid steroid discontinuation and was stabilized by re-treatment with steroid.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A Case of Miliary Tuberculosis in a Patient with Behcet's Disease and Uveitis Receiving Infliximab / 결핵및호흡기질환

Infliximab, a TNF-alpha antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis, Crohn's disease and Behcet's disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet's disease and uveitis. We report this case with a review of the relevant literature.

A Case of Miliary Tuberculosis in a Patient with Behcet's Disease and Uveitis Receiving Infliximab / 결핵및호흡기질환

Infliximab, a TNF-alpha antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis, Crohn's disease and Behcet's disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet's disease and uveitis. We report this case with a review of the relevant literature.

Echocardiographic Diagnosis of Right Atrial Perforation due to Primary Cardiac Angiosarcoma Using Hand-Agitated Saline Contrast

Primary cardiac angiosarcoma is a rare and rapidly progressing tumor characterized by high predilection for right-sided heart involvement and a very poor prognosis. In this report, we present a case of angiosarcoma involving right atrium and ventricle in 61-year old woman with clinical presentation of repeated bloody pericardial effusion. Right atrial perforation was confirmed by contrast echocardiography using hand-agitated saline contrast. Primary cardiac angiosarcoma was confirmed by histological and immunohistochemical studies.