Antiarrhythmic Effect of Artemisinin in an Ex-vivo Model of Brugada Syndrome Induced by NS5806

Background and Objectives@#Brugada syndrome (BrS) is an inherited arrhythmia syndrome that presents as sudden cardiac death (SCD) without structural heart disease. One of the mechanisms of SCD has been suggested to be related to the uneven dispersion of transient outward potassium current (Ito ) channels between the epicardium and endocardium, thus inducing ventricular tachyarrhythmia. Artemisinin is widely used as an antimalarial drug. Its antiarrhythmic effect, which includes suppression of Ito channels, has been previously reported. We investigated the effect of artemisinin on the suppression of electrocardiographic manifestations in a canine experimental model of BrS. @*Methods@#Transmural pseudo-electrocardiograms and epicardial/endocardial transmembrane action potentials (APs) were recorded from coronary-perfused canine right ventricular wedge preparations (n=8). To mimic the BrS phenotypes, acetylcholine (3 μM), calcium channel blocker verapamil (1 μM), and Ito agonist NS5806 (6–10 μM) were used.Artemisinin (100–150 μM) was then perfused to ameliorate the ventricular tachyarrhythmia in the BrS models. @*Results@#The provocation agents induced prominent J waves in all the models on the pseudoelectrocardiograms. The epicardial AP dome was attenuated. Ventricular tachyarrhythmia was induced in six out of 8 preparations. Artemisinin suppressed ventricular tachyarrhythmia in all 6 of these preparations and recovered the AP dome of the right ventricular epicardium in all preparations (n=8). J wave areas and epicardial notch indexes were also significantly decreased after artemisinin perfusion. @*Conclusions@#Our findings suggest that artemisinin has an antiarrhythmic effect on wedge preparation models of BrS. It might work by inhibition of potassium channels including Ito channels, subsequently suppressing ventricular tachycardia/ventricular fibrillation.

Carotid artery intima-media thickness in Behcet's disease patients without significant cardiovascular involvement

BACKGROUND/AIMS: Behcet's disease (BD) is a systemic disorder associated with a characteristic vasculitis that can involve both veins and arteries of all sizes. Endothelial activation or injury is a characteristic feature of BD. Endothelial dysfunction is widely regarded as being the initial lesion in the development of atherosclerosis. The carotid artery intima-media thickness (IMT) is a widely accepted marker of subclinical atherosclerosis. We aimed to determine the carotid IMT in BD patients with using high-resolution B-mode Doppler ultrasonography. METHODS: We studied 40 patients (24 males, mean age: 39.1+/-8.5 years) who were diagnosed by the international diagnostic criteria of Behcet's disease and 20 healthy controls (13 males, mean age: 40.2+/-5.1 years), and the two groups were matched by age and gender. No subject in either group had a history of atherosclerosis or its complications. The clinical data, including the age of onset, the duration of disease, a history of medication, the activity score and the laboratory data were analyzed. RESULTS: The carotid IMT in the BD group was significantly higher than that in the control group (0.71+/-0.22 mm vs. 0.59+/-0.09 mm, respectively, p<0.01). Cardiac and major vessel involvements were not identified in the BD group. However, minor vascular involvements were documented in 2 patients with deep vein thrombosis, in 4 patients with superficial thrombophlebitis and in 2 patients with pseudoaneurysm. The carotid IMT in the patients with posterior uveitis or retinal vasculitis was higher than that of the patients without these findings (0.85+/-0.21 mm vs. 0.64+/-0.10 mm, respectively, p=0.007), but there was no difference of the IMT according to minor vascular involvement. CONCLUSIONS: Despite that there was no significant cardiovascular involvement in the BD patients, the carotid IMT was significantly higher in the BD patients as compared with the healthy controls.

The Clinical Value of Modified Low Density Lipoprotein-Cholesterol in Patients Who Underwent Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: It is well known that atherosclerosis is characterized by chronic inflammation of an injured intima and the pathological processes are initiated by an accumulation of morphologically distinct, modified forms of low density lipoprotein (LDL)-cholesterol. However, it is not well known whether the level of modified LDL-cholesterol has clinical significance for the patients who underwent percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: Eighty seven patients (mean age: 63.0 +/- 11.1 years, 58 men) who underwent PCI were enrolled. The patients with stable or unstable angina pectoris were classified as group I (n=44, mean age: 62.4 +/- 9.3 years), and the patients with acute myocardial infarction were classified as group II (n=43, mean age: 63.6 +/- 12.7 years). Modified LDL-cholesterol was expressed semiquantitatively by agarose gel electrophoresis with using the charge modification frequency (CMF). The clinical and coronary angiographic data was analyzed. RESULTS: The clinical diagnosis was stable angina in 13 patients, unstable angina in 31 patients, non-ST elevation myocardial infarction in 5 patients and ST elevation myocardial infarction in 38 patients. There were no significant differences of the CMF between two groups (3.0 +/- 7.9 vs. 2.1 +/- 10.9, respectively, p=0.671). The diameter stenosis was severe in the patients with a CMF greater than 10 (84.0 +/- 10.4% vs. 78.6 +/- 13.7%, respectively, p=0.047). The six-month major adverse cardio-vascular events (MACEs) had no relationship with the CMF in group I. However, in group II, the 6-month MACEs developed more frequently in the patients with a CMF higher than 10 {2 (28%) for group ll vs. 2 (5%) for group 1, p=0.031}. The patients with acute myocardial infarction and whose CMF was higher than 10 had in-stent restenosis observed on their follow-up coronary angiography (p=0.003). CONCLUSION: A higher level of modified LDL-cholesterol is associated with severe angiographic findings and a poor prognosis for patients with acute myocardial infarction.

The clinical effects of body mass index in patients with acute myocardial infarction after percutaneous coronary intervention / 대한내과학회지

BACKGROUND: Obesity is one of the major risk factors for coronary artery disease. However, the long-term clinical effects of obesity after percutaneus coronary intervention (PCI) in Korean patients with acute myocardial infarction (AMI) have not been sufficiently evaluated. METHODS: A total of 309 patients (mean age 60.5+/-11.3 years, M:F=243:66) that underwent PCI with a diagnosis of AMI between February 2002 and June 2006. Thepatients were divided into two groups according to the body mass index (BMI): group I (n=194; BMI or =25 kg/m2, mean age 58.2+/-11.3 years, M:F=92:23). Clinical characteristics and risk factors, and major adverse cardiac events during a six-month follow-up were compared between patients in the two gropus. RESULTS: The mean age of group I patients was older than that of group II patients (61.7+/-11.1 years vs. 58.6+/-11.5 years, p=0.017). The prevalence of hypertension was higher in group II patients (75/194, 38.7% vs.59/115, 51.3%, p=0.033) and hyperlipidemia was more prevalent in group II patients (75/194, 38.7% vs. 60/115, 52.2%, p=0.024). The levels of total cholesterol (184.3+/-39.9 mg/dL vs. 201.4+/-42.6 mg/dL, p=0.001), triglycerides (121.2+/-61.6 mg/dL vs. 147.1+/-96.2 mg/dL, p=0.005), low-density lipoprotein-cholesterol (120.3+/-35.1 mg/dL vs. 134.1+/-37.8 mg/dL, p=0.002) were lower in group I patients than in group II patients. The restenosis rate on a follow-up coronary angiogram was higher in group II patients (18/69, 26.1%) than in group I patients (14/109, 12.8%, p=0.025). CONCLUSIONS: Obesity is associated with hyperlipidemia and hypertension in patients with AMI. The restenosis rate after PCI was higher in obese AMI patients.

Anti-inflammatory Effect of Abciximab-Coated Stent in a Porcine Coronary Restenosis Model

The aim of this study was to examine the anti-inflammatory effect of abciximab-coated stent in a porcine coronary overstretch restenosis model. Ten abciximab-coated stents, ten sirolimus-eluting stents (SES), and ten paclitaxel-eluting stents (PES) were deployed with oversizing (stent/artery ratio 1.3:1) in porcine coronary arteries, and histopathologic analysis was done at 28 days after stenting. There were no significant differences in the neointima area normalized to injury score and inflammation score among the three stent groups (1.58+/-0.43 mm2, 1.57+/-0.39 mm2 in abciximab-coated stent group vs. 1.69+/-0.57 mm2, 1.72+/-0.49 mm2 in the SES group vs. 1.92+/-0.86 mm2, 1.79+/-0.87 mm2 in the PES group, respectively). In the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations were found between the extent of inflammatory reaction and the neointima area (r=0.567, p<0.001) and percent area stenosis (r=0.587, p<0.001). Significant correlations were found between the injury score and neointimal area (r=0.645, p<0.001), between the injury score and the inflammation score (r=0.837, p<0.001), and between the inflammation score and neointimal area (r=0.536, p=0.001). There was no significant difference in the inflammatory cell counts normalized to injury score among the three stent groups (75.5+/-23.1/microliter in abciximabcoated stent group vs. 78.8+/-33.2/microliter in the SES group vs. 130.3+/-46.9/microliter in the PES group). Abciximab-coated stent showed comparable inhibition of inflammatory cell infiltration and neointimal hyperplasia with other drug-eluting stents in a porcine coronary restenosis model.

Clinical Characteristics and Prognostic Factors of Patients with Severe Pulmonary Hypertension

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the clinical characteristics and predictors of the prognosis for patients with severe pulmonary hypertension (PHT). SUBJECTS AND METHODS: A total of 169 patients with severe PHT (systolic pulmonary arterial pressure > or =70 mmHg by Doppler echocardiogram) were divided into two groups according to the mortality during 2.8+/-2.2 year clinical follow-up period: group I (moribund group, 34 patients, 60.0+/-15.7 years, 18 males) and group II (survived group, 135 patients, 57.2+/-16.9 years, 65 males). The clinical, electrocardiographic and echocardiographic variables were analyzed. RESULTS: The three most common etiologies were valvular heart disease (VHD)(n=55: 32.9%), pulmonary thromboembolism (n=29: 17.2%) and ischemic cardiomyopathy (n=17: 10.1%). The common presenting clinical symptoms were dyspnea on exertion, leg edema, cough and chest discomfort. Among the variables, the WHO functional classification at presentation [95% confidence interval (CI) 2.065-221.168, p=0.010], atrial fibrillation (AF)(95% CI 1.014-10.161, p=0.041) and the left ventricular ejection fraction (LVEF)(95% CI 1.011-4.545, p=0.047) were significantly associated with the prognosis. CONSLUSION: VHD was the most common cause of severe PHT. The WHO functional classification at presentation, the presence of AF and low LVEF at presentation were the significant predictors of mortality for patients with severe PHT.

Increased Inflammatory Markers and Endothelial Dysfunction are Associated with Variant Angina

BACKGROUND AND OBJECTIVES: Endothelial dysfunction and increased vascular inflammation may be associated with variant angina (VA). However, their exact roles remain to be clarified. The aim of the presents study is to investigate whether the level of inflammation markers and the flow-mediated dilation (FMD) are related to VA. SUBJECTS AND METHODS: The study included 46 patients (VA group: 53.9+/-12.0 years, 20 males) with positive spasm provocation tests and they were without significant coronary stenosis, and 14 patients (control group: 46.6+/-13.5 years, 7 males) with negative spasm provocation tests and they were without significant coronary stenosis. The clinical characteristics and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) level, the monocyte count and the von Willebrand factor (vWF) level, and the FMD were compared between the two groups. The FMD and inflammatory markers were measured in the morning before performing the ergonovine provocation coronary angiogram. RESULTS: The level of vWF was significantly higher in the VA group than in the control group (166.5+/-41.9% vs. 118.0+/-65.3%, respectively, p=0.029). The FMD was significantly decreased in the VA group compared with the control group (9.2+/-4.3% vs. 12.4+/-4.2%, respectively, p=0.021). Nitrate-mediated dilation did not differ between the two groups. The levels of the monocyte count, hs-CRP and homocysteine were higher in the VA group than in the control group (554.7+/-261.0/mm3 vs. 440.7+/-136.0/mm3, respectively, p=0.039; 0.3+/-0.4 mg/dL vs. 0.1+/-0.1 mg/dL, respectively, p=0.029; 7.54+/-4.0micronmol/L vs. 5.92+/-1.6micronmol/L, respectively, p=0.033). CONCLUSION: The results of this study suggested that increased inflammatory markers and endothelial dysfunction may be associated with variant angina.

A Case of Metastatic Intracardiac Rhabdomyosarcoma Arising from Malignant Tumor in Other Site

A 29-year old woman was admitted to the hospital with dyspnea and chest pain. She had undergone a craniotomy due to anaplastic astrocytoma 4 months ago and mass excision of right calf and vagina 3 months ago. The histopathological findings of masses were embryonal rhabdomyosarcoma. Echocardiography showed a highly mobile elongated mass in left atrium and the mass protruded through the aortic valve during systole. Histopathological examination of the resected cardiac tumor showed cells of embryonal rhabdomyosarcoma.

Effects of Oxygen Free Radical on Action Potential in Mouse Atrial Myocardium

BACKGROUND AND OBJECTIVES: Reactive oxygen species are known to be produced when atrial fibrillation develops. This study was performed to investigate the effects of hydrogen peroxide (H2O2) on the action potential parameters of the mouse atrium. SUBJECTS AND METHODS: Mouse (ICR) atrial fibers were excised and immersed in cold bicarbonate-containing Tyrode's solution. The preparations were then perfused with oxygenated (95% O2, 5% CO2) Tyrode's solution and driven by an electrical stimuli 1 ms in duration at a frequency of 1 Hz. The transmembrane potentials were recorded at 0, 2.5, 5, 10, 20 and 30 minute, and compared between groups I (control), II (H2O2 0.1 mM), III (H2O2 0.5 mM) and IV (H2O2 1 mM). RESULTS: In group I, the maximal diastolic potential (MDP), action potential amplitude (APA), maximal slope at phase 0 depolarization (Vmax), action potential duration until 50% and 90% of repolarization (APD50, APD90) were unchanged with increasing time. In group II, the MDP and APA were unchanged, but the Vmax was decreased, and the APD50 and APD90 prolonged. In group III, the MDP was increased and the Vmax decreased; the APD50 and APD90 were prolonged, but the APA unchanged. In group IV, the MDP was increased, the Vmax and APA decreased And the APD50 and APD90 prolonged. After-depolarization was observed in 40% (8/20) and 54.5% (12/22) of groups III and IV, respectively, and asystole occurred in 18.2% (4/22) of group IV. CONCLUSION: Hydrogen peroxide changed the action potential parameters in both time and dose dependent manner, and also elicited after-depolarization at higher concentrations. These results suggest reactive oxygen species are involved in the electrical remodeling and arrhythmogenesis in atrial myocardium.

Clinical Features and Long-Term Clinical Outcomes of Adult Atrial Septal Defects

BACKGROUND AND OBJECTIVES : The aim of this study was to investigate the clinical features and long-term outcomes of atrial septal defect (ASD) that presents in adulthood, according to the treatment modalities. SUBJECTS AND METHODS : A total of 134 patients (mean age: 42.7+/-17.7 years, 79 females) with ASD were divided into two groups: group I (the surgical treatment group; 100 patients, mean age: 38.3+/-14.7 years, 65 females) and group II (the medical treatment group; 34 patients, mean age: 55.9+/-19.3 years, 14 females). The clinical characteristics at presentation and the long-term clinical outcomes were analyzed between the groups. RESULTS : The clinical symptoms at presentation were usually mild. Most of the patients had sinus rhythm except for 14 patients (10.4%) who had atrial fibrillation. The defect size, the systolic pulmonary artery pressure (SPAP) and the pulmonary to systemic flow ratio (Qp/Qs) according to echocardiography were 1.8+/-0.8 cm, 41.1+/-14.2 mmHg and 2.7+/-1.4 respectively. The age at presentation showed a significant positive correlation with the New York Heart Association (NYHA) class (r=0.44), the degree of tricuspid regurgitation (TR)(r=0.31), and the severity of pulmonary hypertension (r=0.45). Group I showed an improved NYHA class (from 1.9+/-0.7 to 1.4+/-0.6, respectively, p<0.001), a decreased SPAP (from 39.3+/-12.7 to 27.5+/-6.6 mmHg, respectively, p<0.001) and a decreased degree of TR (from 1.4+/-0.8 to 0.6+/-0.6, respectively, p<0.001) during the follow-up period. However, group II showed no significant changes. The incidence of hospitalization (10.1% in group I and 32.4% in group II, p=0.005) or arrhythmia (17.2% in group I and 35.3% in group II, p=0.011) was more frequent, and the NYHA functional class (1.4+/-0.6 in group I and 2.2+/-0.9 in group II, p<0.001) was more severe in group II than in group I. The mortality rate was higher in group II than in group I (3 patients: 8.8% in group II, 1 patient and 1.0% in group I, p=0.02) by uni-variate analysis. However, bon the multi-variate analysis, the mortality rate was not different between the groups (p=0.48). CONCLUSION : ASD presenting in adulthood showed mild clinical symptoms and a good prognosis. Surgical treatment showed symptomatic improvement, but there was no mortality benefit as compared with medical treatment.

Clinical and Electrophysiologic Characteristics and Efficacy of Radiofrequency Catheter Ablation of the Elderly Patients with Atrioventricular Nodal Reentrant Tachycardia

BACKGROUND AND OBJECTIVES: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular supraventricular tachycardias in both the general population and elderly patients. The aim of this study is to investigate the clinical and electrophysiologic characteristics and efficacy of radiofrequency catheter ablation (RFCA) for treating AVNRT in the elderly. SUBJECTS AND METHODS: This study included 273 consecutive symptomatic AVNRT patients who underwent RFCA for the slow-pathway. The study population was divided into two groups: group I patients were younger than 65 years (n=227, average age: 44.6+/-12.9 years, male : female=89 : 138) and group II patients were older than 65 years (n=46, average age: 69.0+/-3.6, male : female=9 : 37). We compared the baseline clinical, electrocardiographic and electrophysiologic characteristics and the outcomes of RFCA between the two groups. RESULTS: The prevalence of a baseline prolonged PR interval (>200 ms) was not different between the 2 groups (1.8% vs. 6.5%, p>0.05). The baseline sinus cycle length, QT interval and AVNRT cycle length were significantly longer in group II than in group 1 (799.3+/-146.1 ms vs. 864.3+/-159.8 ms, 374.2+/-42.1 ms vs. 397.6+/-40.4 ms, 351.3+/-43.2 ms vs. 384.9+/-57.0 ms, respectively p or =second degree) was not different between the two groups (4.0% vs. 6.5%, p>0.05). One patient in group I required permanent pacemaker implantation. CONCLUSION: RFCA in elderly patients is safe and effective as in younger patients. Therefore, performing RFCA for treating AVNRT should also be considered in the elderly patients.

The Relationship of Inflammatory Reaction with the Mortality of Type B Acute Aortic Syndrome

BACKGROUND AND OBJECTIVES: Systemic activation of the inflammatory system after aortic injury may play a role in the development of complications. The aim of this study was to determine the significance of the inflammatory markers for the mortality of patients suffering with medically treated type B acute aortic syndrome (AAS). SUBJECTS AND METHODS: We analyzed a total of 81 patients who were admitted with AAS within 24 hours from the onset of the symptoms and who were medically treated between January 2000 and December 2004. The patients were divided into two groups: the moribund patients who died within 2 weeks (group I: n=8, mean age: 64.0+/-11.0 years) and the patients who survived over 2 weeks (group II: n=73, mean age: 62.6+/-13.7 years). The serum high-sensitivity C-reactive protein (hsCRP) levels, the white blood cell (WBC) and monocyte counts, and the plasma D-dimer levels were measured on admission. RESULTS: The baseline clinical characteristics were not different between the two groups. The major causes of in-hospital death in group I were extensions or rupture of type B dissection (6 cases) and acute renal failure (2 cases). The multivariate analysis demonstrated that a high monocyte count (>1,250/mm3), and high levels of hsCRP (>11 mg/dL) and D-dimer (>1.2 mg/dL) were independent determinants of the short-term mortality (OR=6.39, 6.14 and 9.00; 95% CI=1.19 to 34.1, 1.14 to 32.9 and 1.20 to 67.4; p=0.02, 0.04 and 0.03, respectively). CONCLUSION: Systemic activation of the inflammatory system in type B AAS patients may be one of the important factors associated with the development of short-term mortality.

Comparison of the Clinical Effect of Cutting Balloon Angioplasty and Drug-Eluting Stent for Treating the Focal Type of In-Stent Restenosis

BACKGROUND AND OBJECTIVES: Treating coronary in-stent restenosis (ISR) has become one of the major challenges for interventional cardiologists. The aim of this study was to compare the clinical effect of performing cutting balloon angioplasty (CBA) with implanting drug eluting stent (DES) for treating the focal type of instent restenosis (ISR). SUBJECTS AND METHODS: We retrospectively analyzed 56 patients who were treated by CBA (Group I: 59.6+/-9.6 years, male : female=46 : 10) and 20 patients who were treated by DES (Group II: 61.0+/-8.5 year, male : female=15 : 5) between January 2002 and December 2004. All the patients had the focal type of ISR (Group I - type IB : IC : ID=23 : 9 : 26, Group II - type IB : IC : ID=10 : 3 : 7). The 6-month angiographically determined late loss and the major adverse cardiac events (MACE) were compared between the two groups. RESULTS: The baseline clinical characteristics were similar between the two groups except for the high proportion of old myocardial infarction [4 (7.1%) and 3 (15%); respectively, p=0.02] and low left ventricular ejection fraction (62.6+/-8.8% vs. 55.2+/-13.8%, respectively, p=0.02) in group II. The acute gain after the procedure was higher in group II (1.86+/-0.53 mm vs. 2.54+/-0.20 mm, respectively, p<0.01). Follow-up angiography at 6 months was achieved in 40 of 56 (71.4%) patients in group I and in 15 of 20 patients (75%) in group II. The late loss was lower in group II than in group I (0.49+/-0.35 mm vs. 0.14+/-0.24 mm respectively, p<0.01). MACE during the 6-month follow-up developed in 8 patients (14.3%) of group I and in 1 patient (5.0%) of group II (p=0.04). CONCLUSION: DES is associated with a better clinical outcome than CBA for the treatment of the focal type of ISR.

The Preventive Effect on In-Stent Restenosis of Overlapped Drug-Eluting Stents for Treating Diffuse Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Diffuse coronary artery disease presents physicians with a therapeutic challenge. The results after the use of bare metal stents (BMS) are limited by the high rate of restenosis. The introduction of drugeluting stent (DES) has prompted interventional cardiologists to treat long diffuse lesions with multiple overlapping stents. The purpose of this study is to determine the safety and efficacy of using multiple overlapping DESs for patients with diffuse coronary artery disease. SUBJECTS AND METHODS: From Jan. 2002 to Dec 2004, 83 consecutive patients suffering with diffuse coronary artery disease who underwent stent implantation with a minimum of 50 mm long BMSs or DESs were analyzed. The patients who had overlapping stents for dissection without diffuse lesion or they had BMS with overlapping DES were excluded from the study. The patients were divided into two group, the BMS group (group I: 29 patients, 63.0+/-8.2 years) and the DES group (group II: 56 patients, 60.6+/-9.3 years). The major adverse cardiac events (MACE), including death, myocardial infarction (MI), target vessel revascularization (TVR) and coronary artery bypass grafting (CABG), were examined. RESULTS: The mean number of stents implanted was 2.19+/-0.4 in group I and 2.08+/-0.2 in group II, whereas the total mean length of the stents was 61.5+/-9.3 mm in group I and 61.4+/-9.1 mm in group II (p=NS). Procedural success was achieved for 89.7% of the patients in group I and for 96.3% of the patients in group II. No acute stent thrombosis was observed in both groups. All the patients underwent clinical follow-up (mean follow-up: 15+/-8.9 months, range: 7-36 months), and 66.2 % had an angiographic follow-up done at six months. During the follow-up, MACE was the cause of two deaths; there were thirteen TVRs and one CABG in group I, and there was one MI and five TVRs in group II. The TVR rate was lower in group II compared with group I (44.8% vs. 9.3%, respectively; p<0.001). Late stent thrombosis developed for one patient in group II. CONCLUSION: The implantation of overlapping DESs in patients with diffuse coronary artery disease is safe and this treatment is associated with better clinical outcomes than that with using BMS.

Acute Myocardial Infarction Induced by Thrombi within the Coronary Artery Aneurysms of a Young Male SLE Patient

We describe the case of a 30-year-old man with systemic lupus erythematosus (SLE) and he was struck with non-ST segment elevation myocardial infarction: this was due to the presence of multiple coronary artery aneurysms those were full of thrombi. A diagnostic coronary angiogram revealed huge dilatations in the proximal three coronary arteries with multiple filling defects and a decreased flow rate, and these were suggestive of thrombi within the coronary artery aneurysms. An intravascular ultrasound (IVUS) examination revealed huge aneurysmal dilatations with movable thrombi in three coronary arteries. He had an uneventful recovery without us having to perform any percutaneous coronary intervention.

The Effect of Alpha Lipoic Acid(Thioctacid HR(R)) on Endothelial Function in Diabetic and Hypertensive Patients

BACKGROUND AND OBJECTIVES: alpha-Lipoic acid (ALA) is known to improve endothelial function in patients with diabetes. However, the effect of ALA on endothelial function in hypertensive patients is unknown. The aim of this study was to investigate whether ALA improves endothelial function in diabetic and hypertensive patients. SUBJECTS AND METHODS: This study included 40 patients who were treated with ALA (Group I: 20 diabetic patients, 54.9+/-10.2 years, Group II: 20 hypertensive patients, 56.5+/-9.0 years). ALA was administered in 600 mg/day doses during the first four weeks, and 1,200 mg/day doses during the second four weeks. Clinical characteristics and endothelial function were assessed at baseline, 4 weeks and 8 weeks after ALA administration. Evaluation of patients included: assessment of the brachial artery for flow mediated vasodilation (FMD) and the inflammatory marker (high sensitive CRP: hsCRP). RESULTS: Clinical characteristics (body mass index, total cholesterol/HDL-cholesterol and hsCRP) were unchanged in each group. However, FMD was significantly improved at 8 weeks after ALA therapy in both groups. Group I-baseline: 4 weeks : 8 weeks = 4.1+/-3.3 : 6.5+/-2.2 : 8.0+/-2.7, Group II-baseline: 4 weeks : 8 weeks = 5.5+/-3.7 : 7.4+/-3.3 : 9.3+/-2.7, p<0.05. The level of fibrinogen was observed to have an inverse correlation with FMD at 8 weeks after ALA therapy in Group I (p<0.05). CONCLUSION: ALA improves endothelial function in both diabetic and hypertensive patients.

The Effect of Alpha Lipoic Acid(Thioctacid HR(R)) on Endothelial Function in Diabetic and Hypertensive Patients

BACKGROUND AND OBJECTIVES: alpha-Lipoic acid (ALA) is known to improve endothelial function in patients with diabetes. However, the effect of ALA on endothelial function in hypertensive patients is unknown. The aim of this study was to investigate whether ALA improves endothelial function in diabetic and hypertensive patients. SUBJECTS AND METHODS: This study included 40 patients who were treated with ALA (Group I: 20 diabetic patients, 54.9+/-10.2 years, Group II: 20 hypertensive patients, 56.5+/-9.0 years). ALA was administered in 600 mg/day doses during the first four weeks, and 1,200 mg/day doses during the second four weeks. Clinical characteristics and endothelial function were assessed at baseline, 4 weeks and 8 weeks after ALA administration. Evaluation of patients included: assessment of the brachial artery for flow mediated vasodilation (FMD) and the inflammatory marker (high sensitive CRP: hsCRP). RESULTS: Clinical characteristics (body mass index, total cholesterol/HDL-cholesterol and hsCRP) were unchanged in each group. However, FMD was significantly improved at 8 weeks after ALA therapy in both groups. Group I-baseline: 4 weeks : 8 weeks = 4.1+/-3.3 : 6.5+/-2.2 : 8.0+/-2.7, Group II-baseline: 4 weeks : 8 weeks = 5.5+/-3.7 : 7.4+/-3.3 : 9.3+/-2.7, p<0.05. The level of fibrinogen was observed to have an inverse correlation with FMD at 8 weeks after ALA therapy in Group I (p<0.05). CONCLUSION: ALA improves endothelial function in both diabetic and hypertensive patients.

The Long-Term Clinical Outcomes of Combination Therapy with Angiotensin II Type 1 Receptor Blocker and Simvastatin after Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Angiotensin II type 1 receptor blocker (ARB) has been to attenuate neointimal formation and vascular smooth muscle cell proliferation, with decreased inflammation. Recent studies have demonstrated that statins may contribute to the beneficial effects of ARB toward vascular diseases. The aim of this study was to evaluate the beneficial effects of the combination therapy of ARB and statin compared to that of angiotensin converting enzyme (ACE) inhibitor and statin in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: 396 patients with ACS, who underwent PCI between June 2002 and December 2003, were divided into two groups: the ARB and simvastatin (n=188, 61.2+/-10.3 years, male 72%) and ACE inhibitor and simvastatin groups (n=208, 60.9+/-10.6 years, male 66%). The major adverse cardiovascular events, including restenosis and repeat PCI, between the two groups were compared. RESULTS: At 6-month after PCI, the levels of total cholesterol, triglyceride and low-density lipoprotein cholesterol were significantly decreased and that of high-density lipoprotein cholesterol significantly increased, and the levels of high-sensitivity C-reactive protein, fibrinogen, white blood cell and monocyte significantly decreased in both groups. A quantitative coronary angiography analysis of stented coronary segments disclosed no differences in the minimum lumen diameter and stent length. At the 6-month follow-up angiogram, there were no significant differences in the incidence of restenosis and repeat PCI, and there was also no difference in late loss between the two groups (ARB and statin group: 20%, 18%, 0.78+/-0.38 mm vs. ACE inhibitor and statin group: 22%, 20%, 0.81+/-0.44 mm). There were no significant differences in the incidence of cardiac deaths, myocardial infarctions, cerebrovascular accidents and bypass grafts at the 1-year clinical follow-up between the two groups. The event-free survival rates at 1 year were 81 and 79% in the ARB and statin and the ACE inhibitor and statin groups, respectively. There were no differences in the late loss and major adverse cardiac events according to the used ARBs or ACE inhibitors. CONCLUSION: The combination therapy of ARB with statin might not show more beneficial effects compared to ACE inhibitor with statin in ACS patients having undergone PCI.

The Relationship between Hemoglobin A1c and Major Adverse Cardiac Events in Nondiabetic Acute Myocardial Infarction Patients Underwent Primary Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Hyperglycemia on hospital admission is a known important risk factor in patients with acute myocardial infarction. The purpose of this study was to investigate the relation between the level of hemoglobin A1c (HbA1c) and major adverse cardiac events (MACE) in non-diabetic acute myocardial infarction patients who underwent primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: Of the 105 acute myocardial infarction patients who underwent primary PCI between January 2002 and December 2002, 68 non diabetic patients were analyzed. The patients were divided into two groups: group I (n=46, 58.7+/-12.5 years, 37 male) with low levels of HbA1c (<6%) and group II (n=22, 64.6+/-13.1 years, 18 male) with elevated levels of HbA1c (6% to 7%). MACE was observed during the six-month clinical follow-up. RESULTS: There were no differences in the risk factors for atherosclerosis and angiographic characteristics between the two groups. Group II had a significantly higher rate of MACE (13% vs. 36%, p=0.026) compared to Group I. Logistic regression analysis disclosed that an elevated level of HbA1c, between 6 and 7%, was a significant independent predictor of MACE. CONCLUSION: An elevated level of HbA1c is a significant prognostic factor in non-diabetic acute myocardial infarction patients after primary PCI.

Is Thyroid Hormone a Risk Factor of Coronary Atherosclerosis in Korean Patients?

BACKGROUND AND OBJECTIVES: Overt and subclinical hypothyroidism is known to be associated with developing atherosclerosis and adverse changes in blood lipid. There has been no data regarding the effects of a normal range of thyroid hormone on the presence of coronary atherosclerosis. SUBJECTS AND METHODS: We studied 1 25 consecutive patients (age: 60.0 +/-11.1 years, male: female=84:41) who underwent diagnostic coronary angiography. The clinical diagnoses on admission were stable angina (32.0%), unstable angina (53.6%), and acute myocardial infarction (14.4%). The thyroid hormones [thyroid stimulating hormone (TSH), free thyroxine and free 3 -iodothyronine], serum lipid levels, high sensitivity C-reactive protein (hsCRP) level, homocysteine and fibrinogen levels were measured. The coronary angiographic results were compared with laboratory findings. RESULTS: The angiographic diagnoses of coronary artery disease were no significant stenosis in 4 1 patients (32.8%), single vessel disease in 47 patients (37.6%) and multivessel disease in 37 patients (29.6%). The serum TSH levels showed a trend toward higher levels in the patients with multivessel disease compared to the patients with no significant stenosis (1.22+/-0.96 uIU/mL vs. 0.73+/-0.53 uIU/mL, respectively, p=0.053). According to the levels of TSH ( or =1.0 IU/mL), the incidence of multivessel disease was significantly higher in the patients with high serum TSH levels (23.1 % vs. 40.0%, respectively, p=0.038). A significant correlation was observed between the levels of TSH and the monocyte count (r=0.251, p=0.005), hsCRP level (r=0.208, p=0.023) and homocysteine level (r=0.279, p=0.002). CONCLUSION: The high level of serum TSH is associated with multivessel disease, abnormal inflammatory markers and high homocysteine levels.