Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry

Background and Objectives@#The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. @*Methods@#We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. @*Results@#Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. @*Conclusions@#Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.

Doppler Tei Index for Assessment of Subclinical Right Ventricular Dysfunction Associated with Inferior Wall Acute Myocardial Infarction

BACKGROUND: Recognition of ischemic right ventricular (RV) dysfunction in the course of inferior wall left ventricular (LV) acute myocardial infarction is important in clinical practice. The Doppler Tei index is useful for estimating global cardiac function. However, the clinical usefulness of RV Tei index to diagnose subclinical RV dysfunction has not been investigated. The purpose of this study was to assess the clinical value of RV Tei index for diagnosis of subclinical RV dysfunction associated with inferior wall acute myocardial infarction who did not have definite ECG changes at right precordial leads. METHODS: The study population consisted of 22 consecutive patients (male 10, average age 57+/-12) with acute inferior myocardial infarction who did not have specific ST segment changes at right precordial leads. RV Tei index was measured by Doppler echocardiography and RV ejection fraction (EF) was measured by multigated blood pool (MUGA) SPECT. We defined subclinical RV dysfuntion as estimated RA pressure was > or =10 mmHg (group 1) by right heart catheterization. RESULTS: In patients with RV dysfunction, RV Tei index was significantly increased compared with those who did not have RV dysfunction (0.51+/-0.22 vs 0.35+/-0.18, p<0.05). RVEF by MUGA blood pool SPECT was significantly decreased in patients with RV dysfunction (35+/-11% vs 47+/-12, p<0.05). CONCLUSION: RV Tei index is simple and useful non-invasive method for diagnosis of subclinical RV dysfunction associated with inferior wall acute myocardial infarction who did not have typical ECG changes at right precordial leads.

Change of Electrical Restitution Kinetics and Ventricular Fibrillation Threshold during Direct Autonomic Stimulation in Canine Heart

BACKGROUND AND OBJECTIVES: It is known that ventricular fibrillation (VF) can be enhanced by sympathetic activity and antagonized by vagal activity, and that the kinetics of electrical restitution is a key determinant of VF induction or maintenance. However, little is known about the effects of autonomic stimulation on electrical restitution. Therefore, we studied the effect of sympathetic (SS) and vagus nerve stimulation (VS) on the electrical restitution and VF induction. MATERIALS AND METHODS: A monophasic action potential (MAP) was simultaneously recorded from the endocardium and epicardium of the left ventricle in 12 open chest canine hearts. The restitution kinetics were studied using a single ventricular extra-stimuli (S2), following a 15 beat drive train (300 ms), down to the effective refractory period (ERP). S2-MAPD was plotted against the preceding diastolic intervals, fitted to exponential curves and the maximum restitution slope (Smax) measured. The VF threshold (VFT) was determined as the minimum current that would induce VF with rapid pacing (50x50 ms). Parameters were studied at the baseline (control) and separately during VS and SS. RESULTS: SS increased the Smax of the endocardium (1.14+/-0.37 vs. 0.80+/-0.25, p<0.001), but not that of the epicardium, and also increased the transmural dispersion of Smax and decreased the VFT (1.8+/-1.3 mA vs. 3.4+/-1.6 mA, p<0.05), even without significant shortening of the ERP, but VS had the opposite effects. There was a significant correlation between the endocardial Smax, transmural dispersion of the Smax and the VFT, respectively (r=-0.64, p<0.001 and r=-0.531, p=0.003). CONCLUSION: The role of the autonomic nervous system in ventricular arrhythmogenesis is by means of electrical restitution kinetics modulation.

Parkinsonism Associated with Frontal Lobe Meningioma: A Report of Two Cases

Parkinsonism is not commonly associated with intracranial tumors. The most common brain tumor causing parkinsonism is meningiomas. We are presenting two cases of meningiomas whose major manifestations included parkinsonism. In one, parkinsonian symptoms initially partially responded to L-dopa and bromocriptine. A CT scan taken for a stroke-like episode revealed a meningioma of left frontal convexity. After neurological sequelae of CO poisoning, the patient poorly responded to antiparkinsonian drugs. Surgical treatment of meningioma did not result in satisfactory control of extrapyramidal symptoms. In the other with a parasagittal meningioma, parkinsonian symptoms were postoperatiYely improved. Because no curative treatment is available for the majority of parkinsonian patients, early detection of an underlying neoplasm may result in a most rewarding outcome. It would be desirable to perform CT or MRI in cases of parkinsonism with other associated neurological manifestation. Unilaterality of parkinsonian symptoms may also be indication.

A Case Report of the "Top of the Basilar" Syndrome with Peduncular Hallucinosis

We report a case of the top of the basilar syndrome with peduncular hallucinosis in a 58 year old man who showed visual, oculomotor, and behaviorai symptoms and signs. Angiography revealed atherosclerotic stenosis at the junction of vertebral and basilar arteries. Mri showed high-signal lesions in various vertebrobasilar territories including thaiamus and midbrain.

MRI Findings in Wernicke's Encephalopathy with Hyperemesis Gravidarum

A 25 year old female patient with hyperemesis gravidarum developed mental confusion, gait disturbance and diplopia. MRI of this patient showed high-signal lesions in thalamus, floor of the fourth ventricle, periaqueductal gray matter, mammillary body, and corpora quadrigemina, The high signal areas correlated well with the anatomical distribution of pathologic lesions in wernicke's encephalopathy previously described.

A Case with the Alien Hand Sign

We report a 60 year-old right-handed woman with left anterior cerebral artery territory infarction who showed the alien hand sign. The patient exhibited a severe disturbance of the right arm motor control characterized by forced grasping. Motor perseveration. And the presence of intermanual conflict that at times the right hand interfered with tasks performed by the left hand. Also, features of a transcortical motor aphasia signs of callosal interruption, urinary incontinence, and weakness of right leg were noted. MRI showed high signal areas in the left medial frontal cortex and anterior corpus callosum.