Influence of Metabolic Syndrome on Hypertension-related Target Organ Damage: Diagnosis of Metabolic Syndrome Is Still Necessary

BACKGROUND: The value of metabolic syndrome (MetS) evaluation in predicting cardiovascular disease is recently criticized. We investigated, in hypertensive patients without diabetes mellitus, the influence of MetS on the target organ damage. METHODS: Data from the fourth Korean National Health and Nutrition Examination Survey performed in 2008 were analyzed. Metabolic syndrome is defined by the 2001 National Cholesterol Education Program-Third Adult Treatment Panel guideline. The category of hypertension is defined following the seventh report of the Joint National Commitee-7 guideline. RESULTS: The prevalence of target organ damage (TOD), defined as history of myocardial infarction/angina/stroke/chronic renal disease as well as the presence of macroalbuminuria, was increased according to blood pressure; 8.5% in the population of normal blood pressure, 12.5% in those of prehypertensive range, and 20.5% in hypertensive population. Hypertensive population associated with MetS showed greater prevalence of TOD than those without MetS even excluding diabetic population. The presence of MetS in hypertensive population showed 2.2 fold increased risk for TOD. Any single parameter of MetS diagnostic criteria as well as obesity did not show the comparable range of risk prediction as MetS. CONCLUSIONS: These results indicate a strong relationship of Mets with TOD in hypertensive population. Evaluating the metabolic components in hypertensive population is necessary in establishing management strategies for overall risk.

Proteomic Analysis of the Serum in Patients with Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Proteomics is a new technology that allows the detection and identification of several proteins at a given time in a sample. There are currently few reports concerned with the proteomic study of serum from patients during acute coronary syndrome. We performed proteomics to analyze the modifications in the serum protein map of patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: We investigated the serum from 12 patients who suffered with acute myocardial infarction (AMI), 12 patients with unstable angina (UA) and 13 age- and sex-matched patients as the control group. Two-dimensional electrophoresis, Coumassie staining and image analysis were performed. Mass spectrometry was performed to identify the selected spots. RESULTS: For the two-dimensional electrophoresis with using a pH range of 3 to 10, two different areas within the serum protein map were observed, and this showed differences between the groups. In area 1, three fibrinogen gamma chain isoforms were identified. All of them were increased in the serum from the AMI and UA patients when compared with the control group. In area 2, four fibrinogen beta chain isoforms were identified. Three isoforms of them were increased in the serum from the AMI and UA patients. CONSLUSION: Three fibrinogen gamma chain isoforms were identified and they were increased in the serum from ACS patients. Four fibrinogen beta chain isoforms were identified and three isoforms of them were increased in the serum from ACS patients.

A Case of Coronary Arteriovenous Fistula Associated with Pulmonary Artery Aneurysm Confirmed by Multi Detector-Row Helical CT

A congenital coronary arteriovenous fistula is a rare condition, which is an abnormal communication of the coronary artery with the right or left ventricle, the right or left atrium or the pulmonary artery. A coronary arteriovenous fistula, complicated with a pulmonary aneurysm, is quite uncommon. A case of 68-year-old woman, complaining of resting chest pain for 1 week, is reported. The coronary arteriovenous fistula associated, with a pulmonary aneurysm, was confirmed by coronary angiography and multidetector-row helical CT (MDCT), and was surgically ligated.

Case of Left Atrium Myxoma with Inferior Vena Caval Thrombus and Pulmonary Embolism Complicated with Budd-Chiari Syndrome

Primary tumors of the heart are rare, three-quarters of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, but, only 3 to 4 percent of myxoma are detected in the left ventricle. Cardiac myxoma is histologically benign, but may be lethal because of their position. We reported a case of 65-year-old man with left atrium myxoma associated with inferior vena caval thrombi and pulmonary embolism. After the operation of myxoma, the Budd-Chiari syndrome developed and the patient died due to hepatic failure.

A Case of Embolism of Left Posterior Tibial Artery after Successful Pregnancy and Delivery in a Patient with a Mechanical Valve Replacement Using Subcutaneous Injection of Low Molecular Weight Heparin

Low molecular weight heparin (LMWH) demonstrated the safety and efficacy in patients with valve prosthesis and successfully prevented or treated venous thromboembolic events in large series of pregnant women. Subcutaneous injection of LMWH at home was done for whole gestational period (39 weeks) in 29 year-old female patient with mechanical prosthetic valves in the aortic (St. Jude 21 mm) and mitral (St. Jude 29 mm) position. aPTT and echocardiography were regularly monitored once a month. Dosage of LMWH was used in a steady state. On delivery day, use of LMWH was stopped and full-term vaginal delivary of a healthy baby could be obtained without fetal loss, thromboembolic episodes. Warfarin was combined with LMWH for 3 days after delivery. One week later, left posterior tibial artery embolism developed.