The Role of Preoperative NT-proBNP in Elderly Orthopedic Patients with Normal Left Ventricular Systolic Function / 대한내과학회지

BACKGROUND/AIMS: Preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful predictor of postoperative cardiovascular complications. The present study investigated whether blood NT-proBNP values are suitable for predicting postoperative cardiovascular complications after non-cardiac surgery in elderly patients showing normal left ventricular (LV) function on preoperative echocardiograms. METHODS: This study was performed by analyzing the medical records of elderly patients referred to the cardiology department for the purpose of assessing their cardiac function before orthopedic surgery. Of the patients who underwent echocardiography and NT-proBNP assessment simultaneously, 275 patients aged > or = 70 years and with an LV ejection fraction of > or = 55% were included in the study. RESULTS: Major adverse cardiac and cerebrovascular events (MACCEs) occurred in 33 (12%) of the 275 patients, and the NT-proBNP concentration was higher in patients with complications than in those without complications (1,904.20 +/- 2,300.23 vs. 530.58 +/- 882.27 pg/mL, p 80 years (odds ratio, 2.313; p = 0.047) and an increased blood NT-proBNP concentration (odds ratio, 3.189; p = 0.009) were independent risk factors for the prediction of MACCEs. CONCLUSIONS: Although elderly patients scheduled to undergo non-cardiac surgery may show normal LV systolic function on echocardiography, measurement of their preoperative blood NT-proBNP concentration is useful for predicting MACCEs occurring after non-cardiac surgery.

Fatal Delayed Coronary Artery Perforation After Coronary Stent Implantation

Most type I and II perforations are predominately caused by hydrophilic and stiff wires, often presented in the delayed form, and do not require pericardial drainage or surgical interventions. However, we report a type III delayed coronary artery perforation at the site of stent implantation after intervention without any evidence of immediate perforations. To the best of our knowledge, this is the first case report of angiographic documentation and treatment of delayed coronary perforation at the site of stent, presented as a cardiac arrest.

Percutaneous Cardiopulmonary Support-Supported Percutaneous Coronary Intervention: A Single Center Experience

BACKGROUND AND OBJECTIVES: Percutaneous cardiopulmonary support (PCPS) has proven to be a valuable technique in high-risk coronary patients undergoing percutaneous coronary intervention (PCI). However, there have been few studies on PCI associated with PCPS in Korea. We summarized our experience with PCPS-supported PCI. SUBJECTS AND METHODS: We retrospectively reviewed 19 patients with PCPS-supported PCI between August 2005 and June 2009. PCPS was used as an elective procedure for 10 patients with at least two of the following conditions: left-ventricular ejection fraction <35%, target vessel(s) supplying more than 50% of the viable myocardium, high risk surgical patients, and patients who refused coronary bypass surgery. In the remaining 9 patients PCPS was used as an emergency procedure, to stabilize and even resuscitate patients with acute myocardial infarction and cardiogenic shock, in order to attempt urgent PCI. RESULTS: Among the 19 patients who were treated with PCPS-supported PCI, 11 (57.9%) survived and 8 (42.1%) patients did not. ST elevation myocardial infarction with cardiogenic shock was more prevalent in the non-survivors than in the survivors (75% vs. 27.3%, p=0.04). The elective PCPS-supported PCI was practiced more frequently in the survivors than in the non-survivors (72.7% vs. 25%, p=0.04). In the analysis of the event-free survival curve between elective and emergency procedures, there was a significant difference in the survival rate (p=0.025). Among the survivors there were more patients with multi-vessel disease, but a lower Thrombolysis in Myocardial Infarction grade in the culprit lesions was detected in the non-survivors, before PCI. Although we studied high-risk patients, there was no procedure-related mortality. CONCLUSION: Our experience suggests that PCPS may be helpful in high risk patients treated with PCI, especially in elective cases. More aggressive and larger scale studies of PCPS should follow.

The Inhibition of Insulin-stimulated Proliferation of Vascular Smooth Muscle Cells by Rosiglitazone Is Mediated by the Akt-mTOR-P70S6K Pathway

PURPOSE: Thiazolidinediones (TZDs) are known to inhibit the proliferation of vascular smooth muscle cell (VSMC) by increasing the activity of p27(Kip1) and retinoblastoma protein (RB). However, the upstream signaling mechanisms associated with this pathway have not been elucidated. The Akt-mTOR-P70S6 kinase pathway is the central regulator of cell growth and proliferation, and increases cell proliferation by inhibiting the activities of p27(Kip1) and retinoblastoma protein (RB). Therefore, we hypothesized in this study that rosiglitazone inhibits VSMC proliferation through the inhibition of the Akt-TOR-P70S6K signaling pathway. MATERIALS and METHODS: Rat aortic smooth muscle cells (RAoSMCs) were treated with 10microM of rosiglitazone 24 hours before the addition of insulin as a mitogenic stimulus. Western blot analysis was performed to determine the inhibitory effect of rosiglitazone treatment on the Akt-mTOR-P70S6K signaling pathway. Carotid balloon injury was also performed in Otsuka Long-Evans Tokushima Fatty (OLETF) diabetic rats that were pretreated with 3 mg/kg of rosiglitazone. RESULTS: Western blot analysis demonstrated significant inhibition of activation of p-Akt, p-m-TOR, and p-p70S6K in cells treated with rosiglitazone. The inhibition of the activation of the p-mTOR-p-p70S6K pathway seemed to be mediated by both the upstream PI3K pathway and MEK-ERK complex. CONCLUSION: The inhibitory effect of rosiglitazone on RAoSMC proliferation in vitro and in vivo is mediated by the inhibition of the Akt-mTOR-P70S6K pathway.

Levels of Serum Antioxidant Minerals and Enzyme Capacities of Korean Male Patients with Coronary Artery Disease / 대한지역사회영양학회지

Increased oxidative stress contributes to the progression of atherosclerosis. We measured serum antioxidant mineral concentrations, capacities of serum antioxidant enzymes and fasting lipid profile in 97 male patients with coronary artery disease (CAD) and 21 male controls. Nutrient intake was assessed by the semi-quantitative food frequency method. CAD patients were divided into single-vessel disease (SVD, n = 66) and multi-vessel disease (MVD, n = 31) groups on the coronary angiography. The ratio of serum LDL- to HDL-cholesterol elevated with an increasing number of diseased vessels compared to the control (control < SVD

Clinical Fate of Reversible Non-Ischemic Left Ventricular Systolic Dysfunction and Its Influencing Factors

BACKGROUND AND OBJECTIVES: About 25% of the patients with non-ischemic left ventricular (LV) systolic dysfunction will improve spontaneously. However, little has been known about the fate of the patients stricken with heart failure after recovery from LV dysfunction. We hypothesized that the patients who recovered from non-ischemic LV dysfunction have a substantial risk for recurrent heart failure. SUBJECTS AND METHODS: Fifty patients (32 males, mean age: 54.9+/-12.4 years) who recovered from systolic heart failure (LV ejection fraction; an EF of 28.8+/-7.2% at the initial presentation) to near-normal (LVEF > 40% and a 10% or more increase in the absolute value) were monitored for the recurrence of heart failure. Patients with significant coronary artery disease were excluded. The etiologies of heart failure were idiopathic dilated cardiomyopathy (n=39), alcoholic cardiomyopathy (n=7), adriamycin-induced cardiomyopathy (n=2), and tachycardia-induced cardiomyopathy (n=2). After recovery of LV dysfunction, the patients were followed up for a mean of 41.0+/-26.3 months. RESULTS: In 9 patients (18%), the LV systolic dysfunction recurred during follow-up (LVEF 32.6+/-7.3%). There was no significant difference in the baseline clinical and echocardiographic variables between the patients with and without recurrent heart failure. However, cessation of anti-heart failure medication was more frequently observed in the patients with recurrent LV systolic dysfunction (55.6% vs 4.9%, respectively, p<0.05). CONCLUSION: Recurrent heart failure may ensue in the patients with reversible non-ischemic LV systolic dysfunction. The maintenance of anti-heart failure medication in these patients may be a significant influencing factor for their clinical prognosis.

Comparison of Long-Term(Over 10 Years) Outcome of Percutaneous Mitral Balloon Valvuloplotomy between Moderate and Severe Mitral Stenosis

BACKGROUND AND OBJECTIVES: Percutaneous mitral balloon valvuloplotomy (PMV) is a safe and effective procedure for the treatment of mitral stenosis (MS); however, its long-term results according to the severity of MS remain unknown. The aim of this study was to compare the long-term results of PMV between moderate and severe MS. SUBJECTS AND METHODS: The immediate and long-term outcomes of 786 patients (198 male, mean age; 43 years) who underwent PMV at a single referral center, between 1988 and 2000, were analyzed. The clinical and echocardiographic data were compared between moderate (n=357) and severe MS (n=429). RESULTS: Optimal results were gained in 618 (79%) patients, including 80 and 76% moderate and severe MS cases, respectively (p=0.13). Acute complications occurred in 85 patients (11%), but without significant difference between the two groups. After a mean follow-up period of 94 months (range, 6 to 210 month), the 5 year event-free survival rate was better in moderate (88%) than in severe MS (79%), but the 10 year event-free survival rates were no different (65% vs. 65%). Independent predictors for better prognosis were a lower echo score ( or =1.7 cm2)(p=0.002, HR=0.65), less mitral regurgitation (

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Diabetics with Multivessel Coronary Artery Disease: The Korean Multicenter Revascularization Registry (KORR)

This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years between two groups. Among diabetic patients, the three-year mortality rate in PCI group was 1.9-fold higher than that of CABG group, although it was not statistically significant (PCI 19.8%, CABG 11.4%, p=0.14). The three-year mortality rate was similar between the two groups in non-diabetics (PCI 8.3%, CABG 10.0%, p=0.50). The 30-day rate of cerebrovascular event was higher in CABG group, for both diabetic (CABG 3.6%, PCI 0.0%, p<0.001) and non-diabetic patients (CABG 2.4%, PCI 0.0%, p<0.001). Short- and long-term revascularization rates were higher in PCI group than in CABG group. As a conclusion, this Korean registry demonstrates that PCI was associated with comparable survival rates and lower short-term morbidity, but a greater requirement for repeated revascularization compared with CABG in Korean diabetics.

The Utility of Multi-detector Row Spiral CT for Detection of Coronary Artery Stenoses

Contrast-enhanced multi-detector row spiral computed tomography (MDCT) was introduced as a promising noninvasive method for vascular imaging. This study examined the accuracy of this technique for detecting significant coronary artery stenoses. Both MDCT (Sensation 16, Siemens, Germany, 12 x 0.75 mm collimation and 0.42 sec rotation speed, 120 kV, 500 effective mA, and 2.7 mm/rotation table-feed) and invasive coronary angiography (CAG) were performed on 61 patients (mean age 59.2 +/- 10, 44 men) who were suspected of having coronary artery disease. All patients were treated with atenolol (25 - 50 mg) prior to imaging and the heart rate was maintained below 65 beats per minutes during image acquisition. The images were reconstructed in the diastole around TI - 400 ms with a 0.5 mm increment and a 1.0 mm thickness. All coronary arteries with a diameter of 2.0 mm or more were assessed for the presence of a stenosis (> 50% luminal narrowing). Two independent radiologists who were unaware of the results of the invasive CAG evaluated the MDCT data, and the results were compared with those from the invasive CAG (interval 1- 27, mean 11 days). An evaluation of the CT coronary angiogram (CTCA) was possible in 58 of the 61 patients (95%). Image acquisition of the major coronary arteries including the left main trunk was available in 229 out of 244 arteries. Invasive CAG showed that 35 out of 58 patients had significant coronary artery stenoses by. patient analysis of those who could be evaluated showed that CT coronary angiography correctly classified 30 out of 35 patients as having at least 1 coronary stenosis (sensitivity 85.7%, specificity 91.3%, positive predictive value 93.8%, negative predictive value 80.8%). By analyzing each coronary artery, CAG found 62 stenotic coronary arteries in the 229 coronary arteries that could be evaluated. MDCT correctly detected 50 out of 62 stenotic coronary arteries and an absence of stenosis was correctly identified in 156 out of 167 normal coronary arteries (sensitivity 80.6%, specificity 93.4%, positive predictive value 81.9%, negative predictive value 92.8%). The non-invasive technique of MDCT for examining the coronary artery appears to be a useful method for detecting coronary artery stenoses with a high accuracy particularly with the proximal portion and large arteries.

Pulmonary Arteriovenous Malformations

No abstract available.

Incidence and Predictors of Late Secondary Tricuspid Regurgitation after Mitral Valve Replacement

BACKGROUND: Severe tricuspid regurgitation (TR) may develop later after mitral valve replacement (MVR) in the absence of prosthetic mitral valve (MV) dysfunction and other causes of left heart failure. The aim of this study was to investigate the incidence and predictors of severe TR late after MVR for rheumatic MV disease. METHODS: From 309 patients who underwent MVR between 1995 and 1997 at Yonsei Cardiovascular Hospital, we selected 193 patients (M:F=52:141; mean age 48.5+/-11.3) who underwent MVR for rheumatic valvular disease [concomitant TAP (Tricuspid annuloplasty) group: 56, No TAP group: 137]. The mean follow up duration was 83.2+/-26.4 months. Primary end point was time to clinical events, such as death, reoperation for tricuspid valve, admission due to right heart failure and the development of severe TR without left side heart failure. Patients were classified into 3 groups based on the degree of TR at the time of MVR: Group I; patients with coexisting mild TR (Grade 0, trivial), Group II; mild to moderate TR (Grade I-II), Group III; severe TR (Grade III-IV). RESULTS: Twenty-one patients (10.9%) developed clinical events [Group I: 2/78 (2.6%), Group II: 8/76 (10.5%), Group III: 11/39 (28.2%)]. Event free survival rate was different during the follow-up period between groups. By Cox regression analysis, initial severe TR (Hazard Ratio: 5.2, 95%CI 2.2-12.3), old age (Hazard Ratio: 4.3, 95%CI 1.4-12.8), and TAP (Hazard Ratio: 4.3, 95%CI 1.8-10.5) were the risk factors for the development of late severe TR. CONCLUSION: The incidence of severe TR or right heart failure in the absence of prosthetic MV dysfunction was 10.9% in MVR patients. Despite of successful TAP, the severity of TR at the time of MVR was the most important factor for prediction of late severe TR. It can be suggested that initial TR grade and RV function rather than TAP, is the important factor for the recurrence of severe TR after MV surgery.

Atherosclerotic Obstruction of Lower Limb Arteries in Diabetic Foot: Effectiveness of Percutaneous Intervention

BACKGROUND AND OBJECTIVES: Peripheral arterial disease is a risk factor for foot ulcers and amputation in diabetic patients. Percutaneous intervention of an obstructed lower limb artery is one of the treatments for diabetic foot;however, few data are available on this treatment and its effectiveness. The aim of this study was to investigate atherosclerotic obstruction in lower limb arteries and to evaluate the feasibility and effectiveness of percutaneous intervention in salvaging a lower limb with diabetic foot. SUBJECTS AND METHODS: Fifty-two consecutive subjects (mean age:64) with diabetic foot underwent angiography of the lower limbs. In patients with significant narrowing (diameter stenosis >50%), percutaneous intervention was performed. Angiographic success was defined as restoration of distal blood flow with residual stenosis less than 30%. During follow-up, bypass surgery was performed when clinically indicated in some patients and the state of diabetic foot was evaluated. RESULTS: Forty-nine patients (94%) showed atherosclerotic narrowings in lower limb arteries and 34 of them (65%) had significant lesions. Among those 34 subjects, interventions were carried out in 30 cases (balloon angioplasty in 11, stenting in 18, and intra-arterial thrombolytic therapy in 1). In the other 15, intervention was not indicated. Twenty-six (86%) of the 30 procedures were angiographically successful. During the follow-up (7+/-6 months), 12 subjects (57%) experienced wound healing with or without forefoot amputation or bypass surgery, whereas 3 had major amputation. Four patients died during the period. CONCLUSION: The majority of patients with diabetic foot had atherosclerotic obstruction in lower limb arteries. Percutaneous intervention may salvage limbs and reduce the rate of major amputation in patients with diabetic foot.

The Prognostic Significance of ST Segment Depression Score in Acute Non ST Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: A significant ST segment depression is known to be an independent risk factor for acute coronary syndrome (ACS). Defining high risk groups in non ST elevation myocardial infarction (NSTEMI) is especially important due the poor long term prognosis of these patients. The purpose of this study was to determine the prognostic significance of the degree of ST depression on admission, as determined by a novel ST depression scoring system. SUBJECTS AND METHODS: 68 patients, admitted to Yonsei Cardiovascular Hospital between Jan 2001 and Aug 2002, and diagnosed with acute non ST elevation myocardial infarction were included in this study. Analysis of the initial ECG on admission was retrospectively performed. RESULTS: ST depression scores > or =1 and <1 were present in 36 (Group I) and 32 (Group II) patients, respectively. The rate of multivessel disease was significantly higher in group I than II (76.7 vs. 50%, p=0.032), the use of glycoprotein IIb/IIIa inhibitors was more frequent in group I than II (25 vs. 6.3%, p=0.041) and the left ventricular ejection fraction was significantly lower in group I than II (44.6+/-14.5 vs. 54.5+/-11.6%, p<0.05). The one-year survival rates were 68.9 and 93.7% for Groups I and II, respectively; p=0.0095), with Group I having a significantly higher early in-hospital mortality rate compared to group II.( 27.8 vs. 3.1%, p=0.0058) The event free survival rate in group I was lower than that in group II (55 vs. 90.6%, p=0.001). CONCLUSION: The ST depression score may be useful as an objective prognostic factor in acute NSTEMI, which may be especially useful for prediction of the early in hospital prognosis.

The Impact of the Preoperative Severity of Target-Vessel Stenosis on the Short-Term Patency of Radial Artery Grafts

The fate of a grafted radial artery remains unknown. The purpose of this study was to determine whether the preoperative severity of stenosis of the target vessel influence short-term patency of radial artery (RA) grafts used as coronary artery bypass conduits. In 54 patients who had coronary artery bypass grafting (CABG) with RA grafts, RA patency was determined with multi-slice computed tomography (MSCT) 1 year after CABG. These patients were divided into three groups on the basis of the percentage of the target vessel stenosis: mild ( or = 80%, n=18). MSCT was also performed 1 week later to exclude early occlusion of RA grafts. In 3 patients, the MSCT failed to adequately discriminate the status of the RA graft due to poor image resolution. The overall incidence of RA occlusion was 23.5% (12 of 51) at 1 year in the entire population. The mild stenosis, moderate stenosis and severe stenosis group showed an occlusion rate of 50% (8 of 16), 23.5% (4 of 17) and 0% (0 of 18), respectively. The severe stenosis group had significantly lower rate of RA graft occlusion compared to the mild stenosis group (p< 0.001) and moderate stenosis group (p< 0.05). No difference in occlusion between grafts used for the different coronary artery branches could be demonstrated. Preoperative severity of the target coronary artery significantly affected the short-term RA grafts patency. Correct indication is the key factor for short-term RA patency.

Association of the Gene Polymorphisms of Platelet Glycoprotein Ia and IIb/IIIa with Myocardial Infarction and Extent of Coronary Artery Disease in the Korean Population

Platelet membrane receptor glycoproteins (GP) are essential for the platelet activation process, and the genetic polymorphisms in the genes that encode platelet glycoproteins have been proposed to influence the risk of acute coronary syndrome and atherosclerosis. In this study, we investigated the role of GPIa, HPA-1 and HPA-3 polymorphisms as putative risk factors for myocardial infarction (MI) and the extent of coronary artery disease. We selected 1, 073 subjects who underwent coronary angiography; 242 had normal or minimal coronary atherosclerosis, and 831 patients had significant coronary artery disease (CAD). The genotype was determined by the methods of single base extension for C807T/G873A polymorphisms of GPIa, and restriction fragment length polymorphism for HPA-1 and HPA-3. The C807T and G873A polymorphisms of GPIa showed complete linkage in the Korean population. For HPA-1 gene polymorphism, only the HPA-1a/a (PlA1/A1) genotype was observed in 192 selected subjects from our study population. The distribution of GPIa (C807T/G873A) and HPA-3 genotypes did not differ significantly between normal subjects and CAD subjects. No significant association between MI and both gene polymorphisms was present. However, for the subgroup analysis of young male patients whose age was less than 56 years, the genotype frequency of HPA-3b/b was significantly lower in patients with MI compared to patients without a history of MI (7.5% vs. 20.0%, p=0.04). The odds ratio for HPA-3 b homozygosity versus the HPA-3a carrier was 0.32 (95% CI, 0.10- 0.99, p=0.04). Conclusively, HPA-3 polymorphism was associated with MI in Korean individuals younger than 56 years of age, but other polymorphisms of GP, which we studied, were not associated with both the extent of coronary atherosclerosis or MI.

Clinical and Echocardiographic Characteristics of Pericardial Effusion in Patients Who Underwent Echocardiographically Guided Pericardiocentesis: Yonsei Cardiovascular Center Experience, 1993-2003

Percutaneous pericardiocentesis guided by two-dimensional echocardiography was introduced in 1983 as an alternative to electrocardiographically or fluoroscopically guided puncture for the management of pericardial effusion. The objective of this study was to investigate echocardiographically (echo) - guided pericardiocenteses performed at Yonsei Cardiovascular Center from January 1, 1993 to December 31, 2003, and also to determine whether patient profiles, etiology, and practice patterns have changed over this 11-year period. The medical records of 272 patients were examined and a follow-up survey was conducted. Patient clinical profiles, etiology, echocardiographic findings, and procedural details were determined for 2 periods: January, 1993 through December, 1997 (period 1) ; and January 1998 through December, 2003 (period 2). During the 11-year study period, 291 therapeutic, echo-guided pericardiocenteses with pericardial catheter drainage were performed in 272 patients. The number of pericardiocentesis in period 2 was increased compared with period 1 (191 cases vs. 100 cases). The mean age at pericardiocentesis increased from 49 +/-17 years in period 1 to 55+/-16 years in period 2 (p< 0.05). The procedural success rate was 99% overall with a major complication rate of 0.7% (2 cases of right ventricular free wall perforation which required emergency operation). Only one procedure-related mortality (< 30 days) was noted. Malignancy was the leading cause of a pericardial effusion requiring pericardiocentesis (45.6%). The incidence of pericardial effusion following cardiothoracic surgery and percutaneous coronary intervention procedures accounted for nearly 20% of all pericardiocenteses performed. Echo-guided pericardiocentesis has become a safe, standard practice for clinically significant pericardial effusion, in line with the changes of patients profiles over the 11 years of the study.

The Relationship between Q-wave Regression and Improvement in the Left Ventricular Systolic Function after an Anterior Wall Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: An abnormal Q wave, after an acute myocardial infarction, has been considered an indicator of myocardial necrosis. However, in some cases this Q wave partially or completely disappears during the evolution of the myocardial infarction. The clinical significance of Q wave regression remains to be established. Accordingly, this study was conducted to evaluate the relationship between Q wave regression, after an anterior wall acute myocardial infarction, and the improvements of the regional wall motion abnormality and left ventricular ejection fraction in echocardiography. SUBJCETS AND METHODS: A total of 80 patients, who presented with a first anterior wall acute myocardial infarction, managed successfully with direct intervention, were divided into two groups according to the regression (group A) or presence (group B) of abnormal Q waves. Regression of an abnormal Q wave was defined as the disappearance of the Q wave and reappearance of the R wave > or =0.1 mV, in at least two of the I, aVL, and V1 to V6 leads. RESULTS: Of the 80 patients, 26 (32.5 %) had an abnormal Q wave regression within 12 months. The peak creatine kinase-MB activity was lower in group A than B (277.3+/-202.6 vs. 521.3+/-284.4 ng/dL, pc<0.01). Group A had better left ventricular regional wall motion than group B in the initial echocardiograms. The degree of improvement of the left ventricular ejection fraction and regional wall motion between the initial and follow-up echocardiographies were significantly greater in group A than B. CONCLUSION: Patients with an anterior wall acute myocardial infarction, showing Q wave regression, tended towards a smaller amount of necrotic myocardium and a significantly larger amount of stunned myocardium.

The Relationship between Q-wave Regression and Improvement in the Left Ventricular Systolic Function after an Anterior Wall Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: An abnormal Q wave, after an acute myocardial infarction, has been considered an indicator of myocardial necrosis. However, in some cases this Q wave partially or completely disappears during the evolution of the myocardial infarction. The clinical significance of Q wave regression remains to be established. Accordingly, this study was conducted to evaluate the relationship between Q wave regression, after an anterior wall acute myocardial infarction, and the improvements of the regional wall motion abnormality and left ventricular ejection fraction in echocardiography. SUBJCETS AND METHODS: A total of 80 patients, who presented with a first anterior wall acute myocardial infarction, managed successfully with direct intervention, were divided into two groups according to the regression (group A) or presence (group B) of abnormal Q waves. Regression of an abnormal Q wave was defined as the disappearance of the Q wave and reappearance of the R wave > or =0.1 mV, in at least two of the I, aVL, and V1 to V6 leads. RESULTS: Of the 80 patients, 26 (32.5 %) had an abnormal Q wave regression within 12 months. The peak creatine kinase-MB activity was lower in group A than B (277.3+/-202.6 vs. 521.3+/-284.4 ng/dL, pc<0.01). Group A had better left ventricular regional wall motion than group B in the initial echocardiograms. The degree of improvement of the left ventricular ejection fraction and regional wall motion between the initial and follow-up echocardiographies were significantly greater in group A than B. CONCLUSION: Patients with an anterior wall acute myocardial infarction, showing Q wave regression, tended towards a smaller amount of necrotic myocardium and a significantly larger amount of stunned myocardium.

Risk Factors of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention with Stent Implantation

BACKGROUND AND OBJECTIVES: No-reflow is an important phenomenon for limiting the prognosis of patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Coronary stenting is the current standard procedure for primary PCI in AMI. However, stenting is suspected to cause more microembolization, and no-reflow phenomenon. This study was performed to elucidate the risk factors for the no-reflow phenomenon following primary PCI with stenting, in patients with AMI. SUBJCETS AND METHODS: The clinical, angiographic and procedure related parameters were reviewed in patients with AMI that had undergone primary PCI, with stent implantation, within 12 h of the onset of chest pain, at Seoul National University Hospital, Yonsei University Hospital Cardiovascular Center and Chungbuk National University Hospital (n=183). RESULTS: 29 patients (16%) showed no-reflow phenomenon (final TIMI flow grade less than 3). Conventional risk factors for coronary artery disease were not significant risk factors for the no-reflow phenomenon. In a univariate analysis, a high initial CK-MB level (>50 IU) (8.45% vs. 21.9%, p=0.04), low left ventricular ejection fraction (LV EF) (30 sec) (31% vs. 15%, p=0.04) were significant risk factors of the no-reflow phenomenon. A low LV EF and long pre-dilatation balloon inflation time were significant risk factors in a multivariate analysis. CONCLUSION: LV dysfunction at presentation and a long pre-dilatation balloon inflation time were independent risk factors for the no-reflow phenomenon following primary PCI with stenting for AMI. Preventive measures against the no-reflow phenomenon should be considered in patients with these risk factors.

Risk Factors of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention with Stent Implantation

BACKGROUND AND OBJECTIVES: No-reflow is an important phenomenon for limiting the prognosis of patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Coronary stenting is the current standard procedure for primary PCI in AMI. However, stenting is suspected to cause more microembolization, and no-reflow phenomenon. This study was performed to elucidate the risk factors for the no-reflow phenomenon following primary PCI with stenting, in patients with AMI. SUBJCETS AND METHODS: The clinical, angiographic and procedure related parameters were reviewed in patients with AMI that had undergone primary PCI, with stent implantation, within 12 h of the onset of chest pain, at Seoul National University Hospital, Yonsei University Hospital Cardiovascular Center and Chungbuk National University Hospital (n=183). RESULTS: 29 patients (16%) showed no-reflow phenomenon (final TIMI flow grade less than 3). Conventional risk factors for coronary artery disease were not significant risk factors for the no-reflow phenomenon. In a univariate analysis, a high initial CK-MB level (>50 IU) (8.45% vs. 21.9%, p=0.04), low left ventricular ejection fraction (LV EF) (30 sec) (31% vs. 15%, p=0.04) were significant risk factors of the no-reflow phenomenon. A low LV EF and long pre-dilatation balloon inflation time were significant risk factors in a multivariate analysis. CONCLUSION: LV dysfunction at presentation and a long pre-dilatation balloon inflation time were independent risk factors for the no-reflow phenomenon following primary PCI with stenting for AMI. Preventive measures against the no-reflow phenomenon should be considered in patients with these risk factors.