Erratum

For the article: Park CG, Ahn JC, Hong SJ, et al. Efficacy of Irbesartan on Left Ventricular Mass and Arterial Stiffness in Hypertensive Patients. Korean J Intern Med 2006;21:103-108. The 6th author's name was misspelled as Sung Mi Park. The correct spelling is Seong Mi Park.

Efficacy of Irbesartan on Left Ventricular Mass and Arterial Stiffness in Hypertensive Patients

BACKGROUND: Increased aortic stiffness measured by pulse wave velocity (PWV) and left ventricular hypertrophy (LVH) are independent risk factors of cardiovascular events in hypertensive patients. We have conducted a prospective study to examine the effects of the angiotensin II receptor antagonist (irbesartan) on PWV and LVH in hypertensive patients. METHODS: A total of 52 untreated hypertensive patients (age:53.3+/-8.0 yrs) were enrolled; they had no evidence of associated cardiovascular complications. Blood pressure, heart rate, aortic PWV and left ventricular mass index (LVMI) by 2-D echocardiography were measured at baseline and after irbesartan treatment (150 mg or 300 mg/day) at 12 weeks and 24 weeks. RESULTS: Blood pressure was significantly decreased after 12 weeks and 24 weeks of treatment compared to baseline (SBP: 134.6+/-13.3 mmHg, 134.0+/-11.0 mmHg vs 163.7+/-13.8 mmHg p<0.001, DBP: 86.0+/-10 mmHg, 83.07 mmHg vs 102.4+/-9.6 mmHg p<0.001, respectively) without significant change in heart rate. LVMI decreased at 12 weeks and at 24 weeks after treatment compared to baseline (from 145.5+/-35.1 g/m2 at baseline to 137.5+/-35.4 g/m2 at 12 weeks, p=0.017 and 135.3+/-35.4 g/m2 at 24 weeks, p=0.008). Aortic PWV was decreased after irbesartan treatment at 12 weeks (from 9.6+/-2.8 m/sec to 8.7+/-3.1 m/sec at 12 weeks, p=0.064) and at 24 weeks (from 9.6+/-2.9 m/sec to 7.7+/-2.1 m/sec at 24 weeks, p=0.007). CONCLUSIONS: Long-term treatment with irbesartan may reduce arterial stiffness and regression of LVH in hypertensive patients. The pleiotropic effects of irbesartan, further decreasing PWV without change of BP between 12 and 24 weeks of treatment, may have favorable vascular effects on arterial stiffness and LVH.

The Source of Inflammatory Response and Platelet Activation in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Studies on the stability of atheromatous plaques, as a determinant of the cause of complications, have been reported. Among the functional features of plaques related with vulnerability, inflammation has emerged as a leading cause of clinical presentation. The purpose of this study was to find the source of the inflammatory response in the patients with acute myocardial infarction (AMI). SUBJECTS AND METHODS: Patients with AMI, whose lesion of in either the left anterior descending artery (LAD group, n=13) or the right coronary artery (RCA group, n=11), were selected. The levels of interleukin-6 (IL-6) and P-selectin were measured in blood from the aortic root (A), great cardiac vein (G) and peripheral vein (V). The control group (n=15) included patients with either stable or variant angina. RESULTS: The levels of IL-6 were 4.77+/-6.0 (A), 11.32+/-7.8 (G) and 4.39+/-5.0 pg/mL (V) in the LAD group, and 3.64+/-2.1 (A), 6.05+/-4.9 (G) and 3.84+/-3.2 pg/mL (V) in the RCA group. Unrelated to the infarction related artery, the level of IL-6 in the great cardiac vein was significantly increased in patients with AMI. The percentages of platelet expressed P-selectin were 6.03+/-7.0 (A), 8.14+/-8.1 (G) and 8.83+/-7.9 (V) in the LAD group and 6.46+/-8.4 (A), 5.80+/-6.0 (G) and 5.91+/-6.9 (V) in the RCA group. CONCLUSION: These findings suggest that the generalized inflammatory response is activated across the coronary vascular bed in patients with AMI, regardless of the infarction related artery site. Therefore, systemic therapy, as well as local management for vulnerable plaque, would be required.

Anomalous Origin of the Right Coronary Artery from the Diagonal Branch of the Left Anterior Descending Coronary Artery

Anomalous origin of the right coronary artery (RCA) is uncommon in patients undergoing cardiac catheterization. Most RCA anomalies are usually found incidentally. However, some anomalies may be associated with malignant courses such as myocardial ischemia, syncope or sudden cardiac death. We present a previously unreported case of a 55-year-old female who had anomalous RCA arising from the diagonal branch of LAD, a variant of L-II Lipton classification, which caused chest pain.

Relation of Blood Pressure Components to Left Ventricular Hypertrophy and Coronary Heart Disease with Aging

BACKGROUND AND OBJECTIVES: There is still uncertainty regarding the relative importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) in predicting the risk of cardiovascular disease. The relative importance of the BP components, as markers of left ventricular hypertrophy (LVH) and coronary artery disease (CAD), were examined in relation to age. SUBJECTS AND METHODS: In 257 subjects receiving no antihypertensive medication, LVH was determined using the M-mode echocardiography when left ventricular mass index (LVMI) was >or =129 g/m2 in men or >or =118 g/m2 in women. In a further 265 subjects, CAD was determined using the coronary angiography when stenosis of the coronary arterial diameter was >or =70%. The most important BP component was determined using a logistic regression analysis. RESULTS: With respect to LVH, in the group 0.10) for DBP, SBP and PP respectively. In the group 50 to 59 years of age, ORs were 1.65, 1.35, 1.36 (all por =60 years of age, ORs were 1.56 (p0.10), 1.07 (p>0.10), 1.21 (por =60 years of age, no BP component had a statistical significance. CONCLUSION: With increasing age, there was a gradual shift from DBP to SBP and then to PP as the marker with the greatest relation to LVH. In all age group, PP was the strongest marker of CAD.

Initiation and Maintenance Mechanism of Atrial Fibrillation Assessed by 3-Dimensional Non-Contact Mapping System

BACKGROUND AND OBJECTIVES: We undertook this study to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). SUBJECTS AND METHODS: Thirty-seven patients (33 men, mean age 50, range 25-68 years) with paroxysmal AF (n=29) and persistent AF (n=8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were enrolled. The multielectrode array and ablation catheter were positioned in the LA via the double transseptal approach. Atrial premature beats (APBs) which triggered initiation of AF that lasted longer than 1 min were mapped and the activation sequence was analyzed on isopotential color maps. Wave front dynamics and the relationship with the underlying structures were assessed. RESULTS: More than half, 56.4%, of APBs from PV were related to the initiation of AF, but not related to the maintenance of AF. A quarter, 25.6%, of APBs from PV not only initiated AF, but also maintained AF without continuous triggering. Mixed type and indeterminate type of AF was 5.0% and 12.8%, respectively. During AF, the mean number of wavelets was 1.45 (maximum 3 in 76.5%). Anatomical structures showing slow conduction and wavebreaks were mostly located at the septopulmonary bundle (86.5%) and the posterior roof of the LA between the left superior PV and right superior PV (54.1%). CONCLUSION: Focal repetitive activity from PV played an important role in both the initiation and maintenance of AF. Specific anatomical structures such as septopulmonary bundle or posterior roof of the LA were related to the heterogeneous conduction delay and spontaneous wavebreak, which was also important in the maintenance of AF.

The Relationship between Serum Adiponectin, Essential Hypertension, LV Mass Index, and LV Diastolic Function

BACKGROUND AND OBJECTIVES: Adiponectin is known for its anti-inflammatory and anti-atherogenic effects. The purpose of this study is to characterize the relationships among serum adiponectin, essential hypertension (EH), left ventricular mass index (LVMI), and LV diastolic function. SUBJECTS AND METHODS: Serum adiponectin by RIA and body mass index were measured in 275 patients (M: F=137: 138). We calculated LVMI, E/A ratio, deceleration time (DT), and isovolumetric relaxation time (IVRT) by using echocardiograms. RESULTS: The serum adiponectin level of the hypertensive group was significantly lower than that of the non-hypertensive group (9.9+/-9.8 ug/mL vs. 12.9+/-9.5 ug/mL, p<0.05). Plasma adiponectin was negatively correlated with LVMI (r=-0.329, p<0.001), BMI (r=-0.290, p<0.001), and IVRT (r=-0.485, p<0.05), but was positively correlated with E/A (r=+0.359, p<0.001). CONCLUSION: These results suggest that a decrease in serum adiponectin is associated with an increase in blood pressure and BMI, progress of LVH, and decrease in LV diastolic function.

The Comparison of Serum Lipid Levels and Risk Factors according to the Status of Coronary Atherosclerosis in Koreans

BACKGROUND AND OBJECTIVES: The aims of this study were to compare the lipid distributions and risk factors in an angiographically normal coronary artery group to those of microvascular and coronary artery diseased groups of Koreans, and to find the effects of the variable risk factors on the serum lipid levels according to the coronary atherosclerosis status. SUBJECTS AND METHODS: A total of 1,198 patients (563 males and 635 females), having undergone a coronary angiography (CAG) using Judkins method, were included. According to their coronary angiographic findings, they were divided into normal CAG (n=568), microvascular disease (n=230) and coronary atherosclerosis (n=400) groups. RESULTS: The mean value of the total cholesterol in the patients with normal coronary artery was 175 mg/dl, which progressively increased to 182 mg/dl and 198 mg/dl in the patients with microvascular disease and coronary atherosclerosis, respectively. The frequencies of the risk factors for coronary atherosclerosis also progressively increased in the patients with microvascular disease and coronary atherosclerosis. The mean values of the serum total cholesterol, LDL-cholesterol and lipoprotein(a), progressively increased from the patients with normal angiographic findings to those with microvascular disease and coronary atherosclerosis, and the results were statistically significant. The results for the patients with microvascular disease were in between those of the patients with normal angiographic findings and those with coronary atherosclerosis. CONCLUSION: The correlation between coronary atherosclerosis and the serum cholesterol levels has, until now, been studied epidemiologically, and this is the first study to angiographically elucidate the positive relationship between coronary artery disease and the serum cholesterol levels. Our data showed lower ranges of lipid distributions compared to those of the ATP III guideline.

Two cases of spontaneous bacterial peritonitis in adults with nephrotic syndrome / 대한내과학회지

Spontaneous bacterial peritonitis is one of the important complication of childhood nephrotic syndrome which occurs not infrequently but this complication in adults with nephrotic syndrome is ,however, very rare. The fact that ascites formation is more frequently seen in childhood nephrotic syndrome and that minimal change disease, the commonest pathology found in childhood is associated with impairment in both cellular and humoral immunities may be an explanation for the discrepancy. We have experienced two cases of spontaneous bacterial peritonitis complicated in adults with nephrotic syndrome. The age of patients is 23 and 68 years respectively. The serum IgG level of younger patient is markedly decreased (375 mg/dL) and that of elderly patient is lower normal limit (765 mg/dL). Peritonitis was complicated during relapse in the younger patient. Both of the patients were receiving steroid therapy before complicated by peritonitis. Both patients recovered from peritonitis by antibiotic therapy but, elderly patient died from nosocomial pneumonia.

Development of peripheral T-cell lymphoma in the course of chronic myelogenous leukemia / 대한내과학회지

Lymphoid malignancies have been reported in association with chronic myelogenous leukemia, but the development of chronic myelogenous leukemia and T-cell lymphoma in the same patients is rare. We experienced a case of peripheral T-cell lymphoma developed in the course of chronic myelogenous leukemia. In December 1993, a diagnosis of chronic myelogenous leukemia was made. The patient was treated with hydroxyurea and busulphan. In June 1999, the patient was admitted because of a swelling in right submandibular area and throat pain. He underwent right tonsilectomy. The histologic and immunologic examination of tonsil revealed a peripheral T-cell lymphoma. This case is additional one to a few previously reported cases of concurrence of chronic myelogenous leukemia and T-cell lymphoma.

Effect of Parathyroid Hormone on Left Ventricular Hypertrophy in Aged Ovariectomized Rats

BACKGROUND: It has been well known that the bone and kidney are the principle organs of parathyroid hormine (PTH) actions. Although patients with primary hyperparathyroidism show a high incidence of LVH and trophic effects of PTH on adult rat ventricular cardiomyocytes were investigated in vitro, effect of PTH on the cardiac tissue in vivo is unknown. METHODS: We examined the effects of PTH on the cardiomyocyte and interstitial tissue using adult rat heart. Twenty-two female Sprague-Dawley rats were ovariectomized bilaterally at three months old and weighing in 250 - 300 gm in order to exclude the trophic effect of estrogen. We administrated human parathyroid hormone (20 ug subcutaneously 5 times per week) to 12 rats for 4 weeks after raising for 8 weeks (PTH group):the remaining 10 rats received only normal saline (control). We measured left ventricular thickness [IVS+LVPW)/2] and number of cardiomyocytes and interstitial fibrosis on LM (H & E and Masson's trochrome stain) and EM. RESULTS: 1) LV wall thickeness tended to increase in PTH group as compared with control (2.16+/-0.31 vs 1.12+/-0.21 mm, p=0.099). 2) The number of cardiomyocyte in PTH group was significantly less than that of control (61.2+/-13.1 vs 70.5+/-14.9, p=0.003, Magnification x 400). 3) There was no significant change of interstitial fibrosis between PTH group and control. CONCLUSION: These results shggest that PTH may produce left ventricular hypertrophic effects in aged ovariectomized rat that resulted form hypertrophy of cardiomyocyte without increase of interstitial connetive tissue.

A Case of Amiodarone Keratopathy

Amiodarone hydrochloride is a benzofuran derivative used for the treatment of cardiac arrhythmias. It is associated with a number of side effects, including thyroidopathy, neuropathy, cutaneous pigmentation, photosensitivity, pulmonary toxicity, hepatotoxicity and keratopathy. Amiodarone keratopathy hasbeen classified into four stages. Corneal pigmentation varies from stage 0, which is a clear cornea without pigment deposition, to stage 3, that is, corneal pigmentation encroaching upon the pupil. We present a case of amiodarone induced keratopathy of stage 3 who received low dose oral amiodarone maintain therapy.

The Efficacy and Safety of Outpatient Coronary Angiography

BACKGROUND: Coronary angiography have become important and integral components in the investigation of patients with cardiovascular disease. Technical improvement combined with an increased need of coronary angiography, and efforts to decrease the length of inpatient hospital stay have prompted the development of outpatient coronary angiography. In this study, we compared the procedure-related complications and costs of inpatient and outpatient coronary angiography when performed at the same institution. In addition, we attempted the coronary angiography as outpatient setting in patients with unstable angina, old age, and anticoagulation therapy, who have been regarded as contraindication for outpatient procedure. METHODS: Diagnostic coronary angiography was performed in 199 cases as inpatient setting, and 225 cases as outpatient setting at Korea University Guro Hospital From January through July 1996. There was no significant difference in sex, age, risk factor, blood pressure, cholesterol level, and ejection fraction. We did not give the heparin during the procedure and, use the Judkins' method in all patients. After the procedure, pressure dressing was done with compressor device for 15 minutes, then sandbag was applied on the puncture site. In outpatient, they took bed rest for 6 hours in one-day care room. RESULTS: 1) In the inpatient group, there were 6 cases(3.0%) of catheterization-related complication, and there were 7 cases(3.1%) of complication in the outpatient group. There was no major complication in both groups, such as death, myocardial infarction, stroke, and perforation of heart and great vessels. In the inpatient group, 2 cases of arrhythmia, 3 cases of hematoma at puncture site, and 1 case of femoral artery pseudoaneuryrsm occurred. In the outpatient group, 2 cases of arrhythmia, 1 case of hematoma at puncture site, 2 cases of skin rash, 1 case of acute febrile reaction, and 1 case of femoral artery dissecting aneurysm developed. There was no significant difference in the rate of complications between two groups(p=0.947). 2) In the outpatient group, there were 28 cases of unstable angina, 6 cases of old age more than 75 years, and 5 cases of anticoagulant has been taken. No catheterization-related complication occurred in those groups. 3) The costs and duration of hospital stay in the inpatient group were won480,230+/-86,800 and 50.3+/-12.3 hours and those in the outpatient group were won276,870+/-32,050 and 8.3+/-1.2 hours. There was significant difference between two groups in the costs and duration of hospital stay(p<0.01, p<0.01). CONCLUSIONS: Outpatient coronary angiography could be done safely with low complication rate, and could reduce the costs and hospital stay. For high risk group such as unstable angina, old age, and anticoagulation therapy, there was no complication in this study, but more experiences and available data should be accumulated to be accepted as a general guideline.

A Case of D-Penicillamine Induced Iga Nephropathy in a Patients with Scleroderma / 대한류마티스학회지

IgA nephropathy can occur rarely as a complication of D-penicillamine treatment, but it is exact pathogenesis remains unclear. If a patients has gross or microscopic hematuria during D-penicillamine treatment, D-penicillamine induced IgA nephropathy should be suspected as a cause of hematuria. In those cases, renal biopsy should be taken for diagnosis and proper management. We experienced a case of IgA nephropathy confirmed by renal biopsy in a 39-years-old female patient with scleroderma during D-penicillamine therapy and report this case with a review of literature.