Bilateral Occipital Lobe Infarction Presenting as Bilateral Inferior Altitudinal Defects

PURPOSE: Horizontal visual field defects are generally caused by lesions before the optic chiasm, but we report a case with bilateral inferior altitudinal defects secondary to bilateral occipital lobe infarction. CASE SUMMARY: A 57-year-old male with a history of diabetes and hypertension presented with a month of blurring in the inferior visual field. His corrected visual acuity was 1.0 in the right eye and 0.63 in the left eye, and the intraocular pressure was normal in each eye. Pupillary response, ocular movement, and color vision tests were normal in both eyes. There was no specific finding of the optic disc and macula on fundus examination. Visual field examination revealed an inferior congruous homonymous hemianopia with horizontal meridian sparing and a left incongruous homonymous quadrantanopia. Optical coherence tomography for peripapillary retinal nerve fiber layer thickness revealed a mild decrease in the inferior disc of both eyes. Brain magnetic resonance imaging confirmed the presence of an acute infarction confined with upper medial calcarine fissures of bilateral occipital lobe and the right splenium of the corpus callosum, which were consistent with inferior altitudinal hemianopia and left superior incongruous quadrantanopia, respectively. Brain magnetic resonance angiography showed multiple stenosis of bilateral posterior cerebral arteries. CONCLUSIONS: The altitudinal visual field defects could be caused by the occipital lesion medial to the calcarine fissure, and unusual visual defects could be due to a combination of multiple lesions.

An Intra-procedural Stent Thrombosis in a Prasugrel Resistant Patient Treated with Ticagrelor / 계명의대학술지

Stent thromboses due to multifactorial causes including hypercoagulable conditions and high on treatment platelet reactivity (HTPR), which means a low response to anti-platelet therapy, especially clopidogrel. Prasugrel is a third generation thienopyridine and inactive pro-drug requiring metabolic activation in vivo, which improves the rate of HTPR with clopidogrel. This drug is mostly effective, with a potent, fast, and consistent anti-platelet action, but rare cases of inadequate platelet inhibition with prasugrel have been reported. Here we describe the case of a 47-year-old man who presented with a recurrent acute myocardial infarction and ST during an intravascular ultrasound pullback and was resistant to prasugrel, was successfully treated with ticagrelor.

Comparison of Sirolimus and Paclitaxel-Eluting Stents for Complex Coronary Lesions: An Intravascular Ultrasound Study

BACKGROUND/AIMS: Recent intravascular ultrasound (IVUS) studies of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have demonstrated a significant reduction in neointimal hyperplasia (NIH) based on simple coronary lesions. In this study, we evaluated the efficacy of SES and PES using IVUS in complex coronary lesions. METHODS: Eighty-seven patients in whom 95 drug-eluting stents (66 SES and 29 PES) were implanted in complex coronary lesions were enrolled in this study. Case selection was based on the availability of IVUS and quantitative coronary angiographic (QCA) examinations at the index procedure and at follow-up. The neointimal volume index (volume/length: NIVI) and percent neointimal volume (% NIV) were calculated. The longitudinal length of stented segments without IVUS-detectable NIH was also evaluated. RESULTS: The baseline patient demographics were similar between the SES and PES groups. At follow-up, no significant differences were observed in the vessel, plaque, or stent volume indices between the two groups. However, the NIVI and % NIV were significantly lower in the SES group (p<0.01). The longitudinal length of stented segments without IVUS-detectable NIH was significantly higher in the SES group (p<0.01). The net gain was significantly larger in the SES group (2.3+/-0.7 vs. 2.0x0.6 mm, p=0.025), while the rate of major adverse cardiac events was similar between the two groups. CONCLUSIONS: Although SES showed significantly greater suppression of NIH at follow-up, both stents were highly effective at inhibiting NIH in complex coronary lesions.

Similar Degree in Mechanical Left Ventricular Dyssynchrony Between Right Ventricular Outflow Tract and Right Ventricular Apical Pacing: A Strain Doppler Imaging Study

BACKGROUND AND OBJECTIVES: Long-term right ventricular (RV) apex pacing has been associated with left ventricular (LV) systolic dysfunction. However, pacing in the RV outflow tract (RVOT) is associated with a narrower QRS duration and may have a more normal LV activation in comparison to RV apical (RVA) pacing. We hypothesized that RVOT pacing is associated with less mechanical dyssynchrony compared to RVA pacing and that it also more closely resembles mechanical activation in normal controls with a narrow QRS. SUBJECTS AND METHODS: We studied 9 patients with RV pacing, 9 with left bundle branch block (LBBB), and 15 normal controls with a narrow QRS. In the RV pacing group, we paced from the RVA and RVOT. At the end of each pacing train, we obtained echocardiographic images in the apical 4- and 2-chamber views and obtained the following parameters: the compression/expansion crossover point (CEP) for myocardial strain and the time from QRS onset to the CEP in the strain image. The degree of dyssynchrony was evaluated using the dispersion and standard deviation of CEP times in 12 segments of the LV. RESULTS: Significant dyssynchrony was observed in the RVOT pacing group compared to the group with normal QRS. No significant difference was observed in LV mechanical dyssynchrony among the RVOT pacing, RVA pacing, and LBBB groups. CONCLUSION: RVOT pacing is associated with significant LV dyssynchrony. Although the RVOT has been recommended as an alternative site for pacing, this approach may have adverse effects on long-term LV function.

Loeffler's Endocarditis due to Idiopathic Hypereosinophilic Syndrome

Loeffler's endocarditis, a rare cardiac manifestation of hypereosinophilic syndrome (HES), is characterized by fibrous thickening of the endocardium of both ventricles, leading to apical obliteration and heart failure. We report a case of a 41-year-old male with slowly progressive right-sided heart failure symptoms. The complete blood count showed hypereosinophilia and the echocardiogram revealed that the both ventricles were filled with large amount of thrombus. His symptoms and typical echocardiographic findings markedly improved within several weeks after steroid and anticoagulation therapy.

A Case of Stent Strut Fracture of a Paclitaxel-Eluting Stent at the Time of Stent Implantation in a Complex Coronary Lesion

Several cases of stent strut fractures (SSFs) have recently been reported following drug-eluting stent (DES) implantation Although SSF is a rare complication, it has been suggested to be a cause of restenosis. To date, a number of cases of stent fracture have been associated with sirolimus-eluting stents and they occurred from 2 days to about 2 years after the initial procedure. We report here on a case of paclitaxel-eluting stent fracture at the time of stent placement in a calcified coronary lesion.

A case of aortoesophageal fistula after NSAID use / 대한내과학회지

Aortoesophageal fistula secondary to thoracic aortic aneurysm is an uncommon cause of gastrointestinal bleeding and is uniformly fatal without surgical intervention. We report a case of aortoesophageal fistula in an 83-year-old male who presented with massive hematemesis after 4 days of NSAID use. Endoscopy showed a kissing esophageal ulcer with a pulsating mass lesion in the mid esophagus. HRCT showed a fusiform aortic aneurysm in the descending aorta that was affecting the mid esophagus.

Early and Delayed Myocardial Enhancement in Myocardial Infarction Using Two-Phase Contrast-Enhanced Multidetector-Row CT

OBJECTIVE: The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. RESULTS: After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). CONCLUSION: Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.

Impact of Optimal Stent Expansion on Late Outcomes after Sirolimus-Eluting Stent Implantation: An Intravascular Ultrasound Study

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SESs) have a considerably lower optimal minimal stent area (MSA) threshold compared to bare metal stents (BMSs). In the SIRIUS IVUS sub study, the absolute optimal stent expansion (OSE) of SESs was described as > or =5.0 mm2. The purpose of this study was to evaluate the impact of the OSE on long-term outcomes following SES implantation using absolute IVUS criteria. SUBJECTS AND METHODS: The study included 157 patients (BMS: 57; SES; 100), who underwent 6-month follow-up angiography and 18-month clinical follow-up after bare metal stent or drug-eluting stent (DES) implantation. According to the absolute measurement IVUS criteria, patients were divided into two groups: OSE and non-OSE. The IVUS criteria for OSE were MSA > or =6.5 mm2 for BMS implantation and MSA > or =5.0 mm2 for SES implantation. RESULTS: Angiographic binary restenosis was higher in the non-OSE than the OSE group with BMS (33.3% vs. 11.4%; p<0.039), but the rates were similar between the two groups with SES (4.5% vs. 3.2%; p=1.00). With the BMS, the MACE rates were 5.7% and 30% in the OSE and non-OSE group, respectively (p=0.017). However, with the SES, the MACE rates were similar between the two groups (OSE group, 3.2% vs. non-OSE group, 4.5%, p=1.00). CONSLUSION: After SES implantation, there were no significant differences in the late outcomes in relation to the achievement of absolute OSE. A variety of restenosis related factors should be considered for better outcomes after DES implantation. Therefore, the concept of OSE in the era of DESs might need to be revisited.

Clinical and Angiographic Outcome of Sirolimus-Eluting Stent for the Treatment of Very Long Lesions

BACKGROUND AND OBJECTIVES: Compared to bare metal stent, drug-eluting stent has improved the clinical and angiographic outcomes for de novo, simple lesions. In real world clinical practice, we often encounter more complex, long lesions, which increase the rate of restenosis and cardiovascular events. The aim of this study was to evaluate the clinical and angiographic outcome of sirolimus-eluting stent (SES) for the treatment of very long lesions in real world clinical practice. SUBJECTS AND METHODS: We implanted multiple SESs (>40 mm in total length) in 113 de novo lesions in 113 patients. The average length of the implanted stents was 58+/-14 mm (range: 41-112 mm) and a mean of 2.2 stents were implanted in each lesion and the average stent diameter was 3.0+/-0.3 mm. RESULTS: Procedural and angiographic success were achieved in all the patients without death or coronary artery bypass surgery. Non-Q wave MI (CK-MB > or = 3 times the normal value) developed in 13 patients (11.5%). Two patients experienced late stent thrombosis after discharge (1.8%). The major adverse cardiac events (MACE)-free survival was 94% at 12 months. There were two sudden cardiac deaths. Six months follow up angiography was performed on 76 patients (67%) and angiographic binary restenosis developed in 7 patients (9.2%). All of them were the focal type in-stent restenosis and these were found to be located at the distal stents. CONCLUSIONS: In conclusion, long lesion coverage with SESs is feasible with a favorable mid-term outcome in real world clinical practice.

The Incidence of Gastro-Esophageal Disease for the Patients with Typical Chest Pain and a Normal Coronary Angiogram

BACKGROUND: Although patients may present with typical chest pain and exhibit ischemic changes on the cardiac stress test, they are frequently found to have a normal coronary angiogram. Thus, we wanted to determine which procedures should be performed in order to make an adequate diagnosis of the cause of chest pain. METHODS: 121 patients (males: 42, 34.7%) who had a normal coronary angiogram with typical chest pain were included in this study. All the patients underwent upper endoscopy, Bernstein's test and esophageal manometry. RESULTS: Among the 121 patients, clinically stable angina was noted in 107 (88.4%). Stress testing was done in 82 (67.8%); it was positive in 52 (63.4%). Endoscopic findings were erosive gastritis in 18 (14.8%), gastric ulcer in 4 (3.3%), duodenal ulcer in 5 (4.1%), and reflux esophagitis in 16 (13.2%). Positive results were observed on Berstein's test for 68 patients (56.2%); 59 (86.8%) of them had non-erosive reflux disease. On the esophageal manometry, 35 (28.9%) of these patients had motility disorders. Nutcracker esophagus was observed in 27 patients (22.3%), nonspecific esophageal motility disorder was observed in 5 (4.1%), and hypertensive lower esophageal sphincter was observed in 3 (2.5%). Among the 52 patients with positive cardiac stress testing and a negative coronary angiogram (this clinically corresponded to microvascular angina), 46 patients (85.1%) showed abnormal findings on the gastro-esophageal studies. CONCLUSIONS: In our study, 85.1% of the patients with microvascular angina revealed positive results of gastric or esophageal disease. In spite of any existing evidence of microvascular angina or cardiac syndrome X, it would be more advisable to perform gastro-esophageal studies to adequately manage chest pain.

Clinical Implication of Carotid-Radial Pulse Wave Velocity for Patients with Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Arterial stiffness assessed non-invasively with the aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to determine whether arterial stiffness may predict the severity of coronary artery disease (CAD). SUBJECTS AND METHODS: We enrolled 106 consecutive, symptomatic patients (males: 71 (67%), mean age: 57.0+/-10.5 years) who underwent coronary angiography. The extent of the CAD was defined by single or multiple vessel disease according to the number of coronary vessels with a > or = 50% narrowing, the lesion type according to the AHA/ACC guidelines, and a modified stenosis scoring system. Arterial stiffness was characterized by measurement of the carotid-radial PWV. In addition, such cardiovascular risk factors as the body mass index, hypertension, smoking, LDL-and HDL-cholesterol, ejection fraction (EF), left ventricle mass index (LVMI), pulse pressure, plasma homocysteine and C-reactive protein (CRP) were evaluated. RESULTS: The carotid-radial PWV in multiple vessel CAD was faster than in single vessel CAD and the normal arteries (10.33+/-1.46 vs. 8.76+/-1.65 m/sec, respectively, p<0.001). On the univariate analysis, the extent of the CAD, as expressed as a modified stenosis score, was associated with the total cholesterol, LDL-cholesterol, the EF and the PWV. However, on the multivariate analysis, the extent of CAD was associated with the carotid-radial PWV (p<0.001). CONCLUSION: Arterial stiffness identified by carotidradial PWV may predict the severity of the CAD after adjusting for other cardiovascular risk factors.

Clinical Implication of Carotid-Radial Pulse Wave Velocity for Patients with Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Arterial stiffness assessed non-invasively with the aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to determine whether arterial stiffness may predict the severity of coronary artery disease (CAD). SUBJECTS AND METHODS: We enrolled 106 consecutive, symptomatic patients (males: 71 (67%), mean age: 57.0+/-10.5 years) who underwent coronary angiography. The extent of the CAD was defined by single or multiple vessel disease according to the number of coronary vessels with a > or = 50% narrowing, the lesion type according to the AHA/ACC guidelines, and a modified stenosis scoring system. Arterial stiffness was characterized by measurement of the carotid-radial PWV. In addition, such cardiovascular risk factors as the body mass index, hypertension, smoking, LDL-and HDL-cholesterol, ejection fraction (EF), left ventricle mass index (LVMI), pulse pressure, plasma homocysteine and C-reactive protein (CRP) were evaluated. RESULTS: The carotid-radial PWV in multiple vessel CAD was faster than in single vessel CAD and the normal arteries (10.33+/-1.46 vs. 8.76+/-1.65 m/sec, respectively, p<0.001). On the univariate analysis, the extent of the CAD, as expressed as a modified stenosis score, was associated with the total cholesterol, LDL-cholesterol, the EF and the PWV. However, on the multivariate analysis, the extent of CAD was associated with the carotid-radial PWV (p<0.001). CONCLUSION: Arterial stiffness identified by carotidradial PWV may predict the severity of the CAD after adjusting for other cardiovascular risk factors.

A case of acute myocardial infarction with plaque rupture in patient with hyperthyroidism / 대한내과학회지

Hyperthyroidism has been reported to be associated with cardiac complication, such as heart failure, atrial fibrillation, heart block and acute coronary syndrome. Acute coronary syndrome in hyperthyroidism has been known mainly due to coronary spasm, but plaque rupture of atherosclerotic lesion has been rare. We reported a case of acute myocardial infarction associated with hyperthyroidism which had been confirmed plaque rupture by intravascular ultrasound.

A case of huge thrombi in right atrium for taking bed rest after percutaneous coronary intervention / 대한내과학회지

After percutaneous coronary intervention through femoral artery, patient must take a bed rest for a long time. Immobility is a risk factor that increase venous thromboembolism. We report 74-years old female who experienced with huge thrombi in right atrium after taking a bed rest, which was related with percutaneous coronary intervention.

Acute Effects of Caffeine on Arterial Stiffness in Young Healthy Subjects

BACKGROUND AND OBJECTIVES: Coffee is one of the most popular beverages in the world. Caffeine is one of the substances contained in coffee and it is well known to increase blood pressure and the peripheral vascular resistance, in part because it stimulates the sympathetic nervous system. Arterial stiffness is an important factor for the performance of the cardiovascular system and it is an independent prognosticator of cardiovascular disease. We investigated the acute effect of caffeine on arterial stiffness in young healthy subjects. SUBJECTS AND METHODS: We enrolled 20 young healthy subjects, who were randomly divided two groups. The caffeine group (10 subjects, 4 males, mean age: 23.3+/-1.1 years) received 520 mL caffeinated coffee and the control group (10 subjects, 4 males, mean age: 23.1+/-1.3 years) received 520 mL water. The arterial stiffness was evaluated by the carotid-radial pulse wave velocity and the augmentation index as corrected by heart rate (75 bpm), and all the hemodynamic measurements were obtained at baseline, 30, 60, 120 and 180 minutes after ingestion of the coffee or water. RESULTS: Arterial stiffness measured by carotid-radial pulse wave velocity increased progressively from 9.4+/-1.2 m/sec at baseline to 11.5+/-1.6 m/sec (p<0.05) at 30 minutes after the coffee intake. In addition, peripheral systolic pressure increased progressively from 107.1+/-10.2 mmHg at baseline to 114.4+/-12.9 mmHg (p<0.05) at 60 minutes after the coffee intake. Such changes were not seen in control group. CONCLUSION: Caffeine affects increased the pulse wave velocity and systolic blood pressure. This means that coffee might have an adverse effect on arterial stiffness.

A Comparison of the Intravascular Ultrasound Findings before and after Coronary Stent Implantation in Patients with Small Vessel Disease(2.5-2.75 mm) by Quantitative Coronary Angiography

BACKGROUND AND OBJECTIVES: From a clinical standpoint, coronary artery disease in blood vessels measuring 2.5 mm to 2.75 mm, as accessed by quantitative coronary angiography (QCA), has been classified as a small vessel disease, and it is treated with percutaneous coronary intervention (PCI). The aim of this study was to evaluate the discrepancy of vessel size between intravascular ultrasound (IVUS) and QCA, and its late outcome before and after stent implantation in patients with small coronary artery disease (2.5-2.75 mm). SUBJECTS AND METHODS: We enrolled 135 patients having 143 lesions who underwent IVUS-guided PCI. Twenty-three patients (26 lesions) were in the small vessel (SV, 2.75 mm) group. We evaluated the IVUS and QCA parameters' association with mortality, acute myocardial infarction (AMI) and target vessel revascularization (TVR) at the 1 year follow-up. RESULTS: On QCA, the pre-interventional reference vessel diameters and post-stent minimal lumen diameters in the SV group were smaller than those in the LV group. The discrepancy of vessel size between IVUS and QCA at the reference site was larger in the SV group than that in the LV group (1.44 mm vs. 0.92 mm, respectively p<0.05). This discrepancy was significantly associated with the plaque area in both groups (p<0.001). Despite of having larger stents implanted in the SV group than the LV group, there was no difference in mortality, AMI and TVR after 1 year between the 2 groups. CONCLUSION: A coronary artery disease measuring 2.5 mm to 2.75 mm by QCA revealed large vessels with a high percentage of plaque. The bigger stent implantation using IVUS did not show more complications after PCI and there were favorable clinical outcomes at 1 year for patients with this condition.

Moleculogenetic Characteristics of the Patient with Long QT Syndrome in Korean

BACKGROUND AND OBJECTIVES: Congenital long QT syndrome (LQTS) is a genetic disease that brings prolongation of the QT interval on an electrocardiogram and leads to syncope and sudden death by a fatal ventricular arrhythmia. In Korea, there have been studies about the clinical characteristics and treatment of LQTS, but there are no studies for the molecular and biological evaluation of its genetic mutation. SUBJECTS AND METHODS: Six nationwide university hospitals and laboratories segregated DNA from the blood of 10 patients diagnosed with LQTS to analyze the genetic mutation. RESULTS: Nine out of ten individuals were female. Eight showed genetic mutations. Three had an abnormality in the KvLQT1, 6 in the HERG and 2 had abnormalities in both KvLQT1 and HERG. None had abnormalities in KCNE1 and 2 showed no abnormalities in KvLQT1, HERG or KCNE1. CONCLUSION: Congenital LQTS shows various genetic mutations, and this indicates the necessity for further organized study in more individuals for confirmation of the relationship between the results of clinical diagnosis and genetic analysis.

The Relationship between Progression of Coronary Artery Stenosis and Serum Adiponectin, ICAM(Intercellular Adhesion Molecule)-1 Level

BACKGROUND AND OBJECTIVE: Adiponectin is an adipocyte derived plasma protein that is known to have an anti-atherogenic effect. Low plasma adiponectin concentrations are found in obesity, diabetes and coronary artery disease. The measurement of the plasma adiponectin level is helpful in the assessment of the risk for coronary artery disease. The intercellular adhesion molecule (ICAM)-1 is associated with the atherosclerotic inflammatory response. An elevated ICAM-1 concentration is associated with increased risk of future coronary events, independent of other risk factors. The relationships between serum adiponectin and ICAM-1 levels and the progression of coronary artery stenosis with instent restenosis of previous stent sites were analyzed. SUCJECTS AND METHODS: 83 patients who had percutaneous transluminal coronary angioplasty and stent insertion were enrolled. The initial angiographic finding was compared with that at the 6 month follow up. The serum adiponectin and ICAM-1 level were measured with the plasma lipid profiles prior to percutaneous coronary intervention. These biochemical parameters were analyzed according to the progression of coronary artery stenosis (> or =10%) and instent restenosis (> or =50%). RESULTS: In the coronary artery stenosis progression group, there were significantly lower adiponectin (3.91+/-1.24 microgram/mL vs. 4.66+/-1.36 microgram/mL, p=0.03) and higher ICAM-1 levels (199.16+/-79.13 ng/mL vs. 150.54+/-63.65 ng/mL, p=0.03). The instent restenosis group also showed lower adiponectin (3.99+/-1.22 microgram/mL vs. 4.33+/-1.38 microgram/mL) and higher ICAM-1 (195.17+/-68.45 ng/mL vs. 171.47+/-80.48 ng/mL) levels, but without statistical significance. CONCLUSION: The serum adiponectin and ICAM-1 levels are related to the progression of coronary artery stenosis. However, further study will be required to confirm the relationships between the serum adiponectin and ICAM-1 levels and instent restenosis.

The Change of Arterial Stiffness According to Dialysis in Patients with End-Stage Renal Disease

BACKGROUND AND OBJECTIVE: In dialysis patients, the cardiovascular mortality is 10 to 20 times higher than that in the general population. The increased arterial stiffness in patients with end-stage renal disease (ESRD) is an independent predictor of all-cause mortality. The arterial stiffness and atherosclerotic markers were evaluated in patients with ESRD treated with and without hemodialysis (HD) or peritoneal dialysis (PD). SUCJECTS AND METHODS: 14 hemodialysis (mean dialysis duration 19.6 months), 14 peritoneal dialysis (mean dialysis duration 26.1 months) and 14 patients with ESRD prior to initiation of dialysis, and 27 age-sex matched controls were enrolled. The calculated central pulse pressure, plasma homocysteine, serum C-reactive protein, left ventricular mass index and aortic pulse wave velocity (PWV) were measured. RESULTS: Patients with ESRD treated with and without dialysis had greater increases in their arterial stiffness and advanced atherosclerosis compared with the controls. However, there was no difference in the arterial stiffness and atherosclerotic markers before and after the dialysis treatment, or in the dialysis modality (HD, PD) of patients with ESRD. In a multiple regression model, PWV in patients with ESRD was explained by the level of plasma homocysteine (beta=0.396;p=0.027). CONCLUSION: Atherosclerosis and arterial stiffness in patients with ESRD may not be affected by dialysis treatment or modality. In patients with ESRD, the level of plasma homocysteine is independently associated with arterial stiffness.