Effects of Statins on the Epicardial Fat Thickness in Patients with Coronary Artery Stenosis Underwent Percutaneous Coronary Intervention: Comparison of Atorvastatin with Simvastatin/Ezetimibe

BACKGROUND: Epicardial fat is a visceral thoracic fat and known to be related with presence of dyslipidemia and coronary arterial stenosis. We evaluated the effects and differences of statins on epicardial fat thickness (EFT) in patients underwent successful percutaneous coronary intervention (PCI). METHODS: In this retrospective cohort study, we enrolled consecutive patients underwent successful PCI and scheduled six to eight-months follow-up coronary angiography from March 2007 to June 2009. EFT was measured by echocardiography twice at the time of PCI and the follow-up coronary angiography. We included 145 patients (58 females; mean, 63.5 +/- 9.5 years). RESULTS: Of the 145 patients, 82 received 20 mg of atorvastatin (atorvastatin group) and 63 medicated with 10 mg of simvastatin with 10 mg of ezetimibe (simvastatin/ezetimibe group). With statin treatments, total cholesterol concentration (189.1 +/- 36.1 to 143.3 +/- 36.5 mg/dL, p < 0.001), triglycerides (143.5 +/- 65.5 to 124.9 +/- 63.1 mg/dL, p = 0.005), low density lipoprotein-cholesterol (117.4 +/- 32.5 to 76.8 +/- 30.9 mg/dL, p < 0.001) and EFT (4.08 +/- 1.37 to 3.76 +/- 1.29 mm, p < 0.001) were significantly decreased. Atorvastatin and simvastatin/ezetimibe showed similar improvements in the cholesterol profiles. However, atorvastatin decreased EFT more significantly than simvastatin/ezetimibe (EFT change 0.47 +/- 0.65 in the atorvastatin vs. 0.12 +/- 0.52 mm in the simvastatin/ezetimibe group; p = 0.001). CONCLUSION: In this study, the atorvastatin group showed significant reduction in EFT than in the simvastatin/ezetimibe group. This might be originated from the statin difference. More large, randomized study will be needed to evaluate this statin difference.

Usefulness of Mitral Annular Systolic Velocity in the Detection of Left Ventricular Systolic Dysfunction: Comparison with Three Dimensional Echocardiographic Data

BACKGROUND: Although the modified Simpson's method is widely used for the assessment of left ventricular ejection fraction (LVEF), it has limitations including relatively high inter- and intra-observer variability and time consuming nature. We want to evaluate whether assessing mitral annular systolic velocity (S' velocity) by tissue Doppler imaging (TDI) can be used to evaluate LV systolic function with comparing LVEF by three dimensional echocardiography (3DE). METHODS: We examined 3DE and TDI studies of patients between January and August 2008. 3DE LVEF was measured by offline commercial computer software EchoPac PC(R) (GE, Andover, MA, USA). S' velocity was obtained from the medial side with apical four chamber view by pulsed-wave Doppler with TDI. RESULTS: We included 125 patients (78 males (62.4%), mean age: 57.5+/-13.0 years). The mean S' velocity was 7.7+/-1.9 cm/s and the mean LVEF was 57.2+/-10.4%. The S' velocity measured by TDI showed a linear correlation with LVEF measured by 3DE (r=0.688, p<0.001). Study patients were divided into two groups according to the presence of LV systolic dysfunction: Group I (normal LVEF), n=102 and Group II (LVEF <50%), n=23. For prediction of significant LV systolic dysfunction by the receiver operating characteristic curve according to S' velocity, the optimal cutoff value was 6.8 cm/s. At this cutoff value, the sensitivity and specificity were 94.1% and 87%, respectively. CONCLUSION: In this study, S' velocity measured by TDI showed a significant correlation with three dimensional LVEF and can be used to detect patients with LV systolic dysfunction.

Catecholamines May Play an Important Role in the Pathogenesis of Transient Mid- and Basal Ventricular Ballooning Syndrome

The exact pathogenesis of transient mid- and basal ventricular ballooning, a new variant of transient left ventricular (LV) ballooning, remains unknown. We report two cases of transient mid- and basal ventricular ballooning associated with catecholamines. These cases suggest that catecholamine-mediated myocardial dysfunction might be a potential mechanism of this syndrome.