Ventricular late potentials measured by signal‑averaged electrocardiogram in young professional soccer players

Background and objectives@#Athlete’s heart is characterized by structural cardiac changes, including enlargement and hypertrophy. However, exercise-induced cardiac electrical remodeling is not well known in Asian athletes. We sought to evaluate the association between vigorous exercise and the development of abnormal late potential on signal-averaged electrocardiogram (SAECG).Method: We analyzed 48 Korean professional soccer players and 71 healthy sedentary controls who underwent SAECG and transthoracic echocardiography at Kyung Hee University Hospital. An SAECG was considered abnormal (positive for ventricular late potential) when any one of the three following criteria was met: filtered QRS dura‑ tion > 114 ms, root-mean-square voltage in the terminal 40 ms 114 ms (7.0% vs. 22.9%, P = 0.013) and lower terminal QRS rootmean-square voltage < 20 uV (5.6% vs. 20.8%, P = 0.012). Ventricular late potential on SAECG was significantly more frequent in athletes (15.5% vs. 35.4%, P = 0.012). Regarding echocardiographic parameters, the athletes had larger cardiac chamber size; however, these differences became non-significant after adjustment for body surface area, except left ventricular mass index (65.7 ± 12.7 g/m2 vs. 84.7 ± 17.7 g/m2 , P < 0.001). @*Conclusion@#Abnormal SAECG findings were significantly more common in athletes than in controls. Further study is needed to determine the clinical impact of these abnormal SAECGs in athletes and cardiac outcomes in the long term.

Ventricular late potentials measured by signal‑averaged electrocardiogram in young professional soccer players

Background and objectives@#Athlete’s heart is characterized by structural cardiac changes, including enlargement and hypertrophy. However, exercise-induced cardiac electrical remodeling is not well known in Asian athletes. We sought to evaluate the association between vigorous exercise and the development of abnormal late potential on signal-averaged electrocardiogram (SAECG).Method: We analyzed 48 Korean professional soccer players and 71 healthy sedentary controls who underwent SAECG and transthoracic echocardiography at Kyung Hee University Hospital. An SAECG was considered abnormal (positive for ventricular late potential) when any one of the three following criteria was met: filtered QRS dura‑ tion > 114 ms, root-mean-square voltage in the terminal 40 ms 114 ms (7.0% vs. 22.9%, P = 0.013) and lower terminal QRS rootmean-square voltage < 20 uV (5.6% vs. 20.8%, P = 0.012). Ventricular late potential on SAECG was significantly more frequent in athletes (15.5% vs. 35.4%, P = 0.012). Regarding echocardiographic parameters, the athletes had larger cardiac chamber size; however, these differences became non-significant after adjustment for body surface area, except left ventricular mass index (65.7 ± 12.7 g/m2 vs. 84.7 ± 17.7 g/m2 , P < 0.001). @*Conclusion@#Abnormal SAECG findings were significantly more common in athletes than in controls. Further study is needed to determine the clinical impact of these abnormal SAECGs in athletes and cardiac outcomes in the long term.

Long-Term Clinical Effects of Carotid Intraplaque Neovascularization in Patients with Coronary Artery Disease

Objective@#To investigate the predictive value of intraplaque neovascularization (IPN) for cardiovascular outcomes. @*Materials and Methods@#We evaluated 217 patients with coronary artery disease (CAD) (158 men; mean age, 68 ± 10 years) with a maximal carotid plaque thickness ≥ 1.5 mm for the presence of IPN using contrast-enhanced ultrasonography. We compared patients with (n = 116) and without (n = 101) IPN during the follow-up period and investigated the predictors of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, coronary artery revascularization, and transient ischemic accident/stroke. @*Results@#During the mean follow-up period of 995 ± 610 days, the MACE rate was 6% (13/217). Patients with IPN had a higher maximal thickness than those without IPN (2.86 ± 1.01 vs. 2.61 ± 0.84 mm, p = 0.046). Common carotid artery-peak systolic velocity, left ventricular mass index (LVMI), and ventricular-vascular coupling index were significantly correlated with MACE. However, on multivariate Cox regression analysis, increased LVMI was independently related to MACE (p < 0.05). The presence of IPN could not predict MACE. @*Conclusion@#The presence of IPN was related to a higher plaque thickness but could not predict cardiovascular outcomes better than conventional clinical factors in patients with CAD.

Embolic Myocardial Infarction in a Patient with Massive Pulmonary Thromboembolism

No abstract available.

PCI or CABG, That is the Question!

No abstract available.

A Case of Recovered Atrioventricular Conduction in Behcet Disease after Immunotherapy / 대한내과학회지

Atrioventricular conduction disturbance is a rare clinical manifestation of Behcet disease. We describe a case in which a 48-year-old man complaining of dyspnea on exertion presented with complete atrioventricular block with junctional escape rhythm caused by Behcet disease. He also had moderate aortic regurgitation and mitral regurgitation. MRI and PET scan revealed inflammatory changes involving the ventricular septum and the ascending aorta. Recovery of atrioventricular conduction and improvement of valvular regurgitation were achieved with immunotherapy. Timely diagnosis and treatment of cardiac Behcet disease can prevent unnecessary pacemaker implantation.

Rosuvastatin Does Not Affect Fasting Glucose, Insulin Resistance, or Adiponectin in Patients with Mild to Moderate Hypertension / 전남의대학술지

The effects of statins on insulin resistance and new-onset diabetes are unclear. The purpose of this study was to evaluate the effects of rosuvastatin on insulin resistance and adiponectin in patients with mild to moderate hypertension. In a randomized, prospective, single-blind study, 53 hypertensive patients were randomly assigned to the control group (n=26) or the rosuvastatin (20 mg once daily) group (n=27) during an 8-week treatment period. Both groups showed significant improvements in systolic blood pressure and flow-mediated dilation (FMD) after 8 weeks of treatment. Rosuvastatin treatment improved total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglyceride levels. The control and rosuvastatin treatment groups did not differ significantly in the change in HbA1c (3.0+/-10.1% vs. -1.3+/-12.7%; p=0.33), fasting glucose (-1.3+/-18.0% vs. 2.5+/-24.1%; p=0.69), or fasting insulin levels (5.2+/-70.5% vs. 22.6+/-133.2%; p=0.27) from baseline. Furthermore, the control and rosuvastatin treatment groups did not differ significantly in the change in the QUICKI insulin sensitivity index (mean change, 2.2+/-11.6% vs. 3.6+/-11.9%; p=0.64) or the HOMA index (11.6+/-94.9% vs. 32.4+/-176.7%; p=0.44). The plasma adiponectin level increased significantly in the rosuvastatin treatment group (p=0.046), but did not differ significantly from that in the control group (mean change, 23.2+/-28.4% vs. 23.1+/-27.6%; p=0.36). Eight weeks of rosuvastatin (20 mg) therapy resulted in no significant improvement or deterioration in fasting glucose levels, insulin resistance, or adiponectin levels in patients with mild to moderate hypertension.

Rosuvastatin Does Not Affect Fasting Glucose, Insulin Resistance, or Adiponectin in Patients with Mild to Moderate Hypertension / 전남의대학술지

The effects of statins on insulin resistance and new-onset diabetes are unclear. The purpose of this study was to evaluate the effects of rosuvastatin on insulin resistance and adiponectin in patients with mild to moderate hypertension. In a randomized, prospective, single-blind study, 53 hypertensive patients were randomly assigned to the control group (n=26) or the rosuvastatin (20 mg once daily) group (n=27) during an 8-week treatment period. Both groups showed significant improvements in systolic blood pressure and flow-mediated dilation (FMD) after 8 weeks of treatment. Rosuvastatin treatment improved total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglyceride levels. The control and rosuvastatin treatment groups did not differ significantly in the change in HbA1c (3.0+/-10.1% vs. -1.3+/-12.7%; p=0.33), fasting glucose (-1.3+/-18.0% vs. 2.5+/-24.1%; p=0.69), or fasting insulin levels (5.2+/-70.5% vs. 22.6+/-133.2%; p=0.27) from baseline. Furthermore, the control and rosuvastatin treatment groups did not differ significantly in the change in the QUICKI insulin sensitivity index (mean change, 2.2+/-11.6% vs. 3.6+/-11.9%; p=0.64) or the HOMA index (11.6+/-94.9% vs. 32.4+/-176.7%; p=0.44). The plasma adiponectin level increased significantly in the rosuvastatin treatment group (p=0.046), but did not differ significantly from that in the control group (mean change, 23.2+/-28.4% vs. 23.1+/-27.6%; p=0.36). Eight weeks of rosuvastatin (20 mg) therapy resulted in no significant improvement or deterioration in fasting glucose levels, insulin resistance, or adiponectin levels in patients with mild to moderate hypertension.

Percutaneous Coronary Intervention for Acute Myocardial Infarction in Elderly Patients with Renal Dysfunction: Results from the Korea Acute Myocardial Infarction Registry

This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFR<60 mL/min) received either medical (n=439) or PCI (n=1,019) therapy. Primary end point was in-hospital death. Secondary end point was MACE during a 1 month and 1 yr follow-up. PCI group showed a significantly lower incidence of in-hospital death (20.0% vs 14.3%, P=0.006). Short-term and long-term MACE rates were higher in medical therapy group (31.9% vs 19.0%; 57.7% vs 31.3%, P<0.001), and this difference was mainly attributed to cardiac death (29.3% vs 17.6%; 51.9% vs 25.0%, P<0.001). MACE-free survival time after adjustment was also higher in PCI group on short-term (hazard ratio, 0.67; confidence interval, 0.45-0.98; P=0.037) and long-term follow-up (hazard ratio, 0.61, confidence interval, 0.45-0.83; P=0.002). In elderly AMI patients with renal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.

Acute regional myocarditis with normal ventricular wall motion diagnosed by two-dimensional speckle tracking imaging

No abstract available.

Combined Assessments of Biochemical Markers and ST-Segment Resolution Provide Additional Prognostic Information for Patients With ST-Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: The prognostic value of biochemical markers and the resolution of ST-segment elevation on electrocardiogram are well established. However, how a combination of these two tools affects the evaluation of risk stratification has not yet been evaluated. SUBJECTS AND METHODS: Between January 2006 and June 2008, 178 consecutive patients treated with primary percutaneous coronary interventions after ST-segment elevation myocardial infarctions (STEMI) were analyzed at two coronary care units. Patients were divided into the following three groups according to ST-segment resolution: complete (> or =70% depression of the elevated ST-segment, n=63), partial (30% to 70%, n=90), and incomplete (<30%, n=25). Demographic data, including history, electrocardiography, biochemical markers, initial ejection fraction, and angiographic findings were also evaluated. RESULTS: There were 7 deaths, 3 repeated myocardial infarctions, and 17 readmissions for worsening heart failure during six months of follow-up. In a multivariate analysis to predict clinical outcomes, ejection fraction {hazard ratio (HR): 0.83 (0.76-0.91), p<0.01}, high-sensitivity C-reactive protein {HR: 1.15 (1.05-1.26), p<0.05}, and the degree of ST-segment resolution {HR: 0.96 (0.93-0.09), p<0.05} were independently associated with clinical outcomes. According to the Cox-proportional hazards model, the addition of ST-segment resolution markedly improved the prognostic utility of the model containing biochemical markers and ejection fraction. CONCLUSION: Assessment of biomarkers upon admission and ST-segment resolution are strong predictors of clinical outcomes. The combination of these data provides additive information about prognosis at an early point in the disease progression and further improves risk stratification for STEMI.

A Dual (Brachial and Contralateral Femoral) Approach for Subintimal Angioplasty of Long Ilio-Femoral Occlusive Disease Including the Iliac Ostium

As techniques and device technology have improved, the success rates and long patency of ilio-femoral occlusive disease have also improved. In the case of extensive iliac occlusive disease, however, wire passage and handling remain a challenge due to the relatively weak guiding catheter backup support with the contralateral femoral approach. There has been no report on methods to overcome this problem. We performed a successful percutaneous translunimal angioplasty for long ilio-femoral occlusive disease including the iliac ostium by a dual approach including simultaneous brachial and contralateral femoral arteries for subintimal angioplasty.

Updates in the management of patients with acute coronary syndrome / 대한내과학회지

Acute coronary syndrome (ACS) represents a broad spectrum of ischemic myocardial events, including unstable angina, non-ST elevation myocardial infarction, and acute ST elevation myocardial infarction, which are associated with high morbidity and mortality. Early diagnosis and risk stratification are essential for initiation of optimal medical and invasive management. Randomized clinical trials over the past decade have revolutionized the care of patients with ACS. Therapeutic measures consist of administration of aggressive antiplatelet, antithrombotic, and antiischemic agents. In addition, patients with high-risk features, notably positive troponin, ST segment changes, and diabetes, benefit from early invasive intervention as compared to conservative strategies. Lifestyle interventions, modification of risk factor profile, and long-term medical treatment are of pivotal importance in reducing the long-term risk of recurrence.

A case of aseptic meningoencephalitis in adult-onset Still's disease / 대한내과학회지

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology, affecting mainly young adults,characterized by a high spiking quotidian fever, arthralgia or arthritis, evanescent salmon-colored maculopapular rash. It affects almost all organs, but neurological manifestations of AOSD are rare and could be responsible for a delay in diagnosis. We describe a case of AOSD who developed aseptic meningoencephalitis without any infectious cause. A 23-year-old woman was admitted because of high quotidian fever, arthralgia, maculopalpular rashes, leukocytosis with increased ferritin. During treatment by prednisolone, she suddenly developed status epilepticus. The brain image, electroencephalogram, and cerebrospinal fluid analysis did not show any abnormality including evidence of infection. After methyprednisolne pulse therapy, her clinical symptoms and laboratory tests including ferritin dramatically improved, and she could be discharged. To our knowledge, this is the first reported case of aseptic meningoencephalitis in a patient with AOSD in Korea.

Cases of IgA Nephropathy Associated with Psoriasis Vulgaris / 대한신장학회지

IgA nephropathy is recognized worldwide as one of the most common form of primary glomerulonephritis. Clinical manifestations vary, ranging from microscopic hematuria to nephrotic syndrome. Most cases of IgA nephropathy are idiopathic. A variety of additional disorders have been associated with IgA nephropathy, some of which shed light on possible pathogenetic mechanism. Association with psoriasis has been debated for a long time. Secondary renal amyloidosis in psoriatic arthropathy and drug-induced renal lesions secondary to methotrexate or cyclosporine are accepted accompaniments of psoriasis. We report 3 cases of IgA nephropathy which was diagnosed by renal biopsy in a patient with psoriasis.

A case of non-small cell lung cancer that metastasized to the gingiva / 대한내과학회지

About 5% of all malignancies involve the oral cavity. Metastatic cancers to the oral cavity from distant sites are very rare, and only a few cases have been reported in the clinical literature. The most common tumors that metastasize to the oral cavity originate in the breast, lung, and kidney. We recently experienced a patient who had a non-small cell lung cancer that metastasized to the gingiva. The patient was 56-year-old man. The disease status was a progressive condition, although the patient had received third-line chemotherapy. The patient had multiple bony metastases including vertebral bodies, femurs, and clivus as well as the gingival metastasis. The gingival tumor was histopathologically diagnosed as a poorly differentiated adenocarcinoma. The metastatic gingival tumor had the same pathology as the primary lung cancer.

Pancreatitis from Metastatic Small Cell Lung Cancer: Successful Treatment with Endoscopic Intrapancreatic Stenting

Lung cancer metastases can occur in almost any organ. However, metastasis of small cell lung cancer to the pancreas is rare. Moreover, not all cases present with clinically diagnosed pancreatitis. We recently treated a patient with small cell lung carcinoma that invaded the pancreatic duct causing acute pancreatitis. Generally, the treatment for tumor-induced acute pancreatitis is initially supportive followed by aggressive chemotherapy or surgery. If the patient can tolerate the insertion of an endoscopic intrapancreatic stent, this is performed in addition to chemotherapy and surgery; this approach offers a safe and effective treatment modality for such patients.