The Effect of Individualized Exercise Parameters Applied to Two Patients Recovering from Implanted Left Ventricular Assist Devices in Korea / 대한스포츠의학회지

Left ventricular assist devices (LVADs) are a treatment option for patients with severe chronic heart failure. These patients are referred to an inpatient cardiac rehabilitation after implantation to improve an aerobic capacity and quality of life (QOL). Several studies have reported that an exercise therapy, which is a component of cardiac rehabilitation, improves exercise capacity and QOL. The LVADs were implanted successfully in a destination therapy in two Korean patients, and these patients were enrolled in the cardiac rehabilitation. After an individualized intervention, they were discharged from improved exercise functional capacity and QOL. This is the first report showing a benefit of the individualized exercise therapy using different parameters after LVADs implantation in Korea.

Prevalence, Treatment Pattern and Resource Use in Patients with Mixed Dyslipidemia Using Lipid Modifying Agents in Korea (PRIMULA): An Observational Study

OBJECTIVE: Limited information is available on the effectiveness of lipid-modifying therapy (LMT) for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) in the Korean population. The objective of this study was to describe the prevalence of different types of lipid disorders in Korean patients using LMT. METHODS: Eight hundred seventy-one dyslipidemia patients, who were LMT-naive for >1 year prior to retrospective enrollment, were included for analysis. Serum levels of LDL-C, HDL-C, TG and total cholesterol (TC) were assessed after >1 year of LMT. We also analyzed the therapeutic effects of LMT in the subjects with high cardiovascular risk factors (n=629), atherosclerotic cardiovascular disease (ASCVD) (n=296) or diabetes without ASCVD (n=316). RESULTS: The rates of elevated LDL-C without other abnormal lipids levels, elevated TG or decreased HDL-C (with normal LDL-C levels) and high LDL-C combined with elevated TG and/or decreased HDL-C were 33.4%, 13.0% and 53.6%, respectively. After at least one year on LMT (statin alone: 81%, statin and cholesterol absorption inhibitor: 10%, fibrates alone: 3%, others: 3%), 61% of patients had at least one lipid abnormality, with 3.4% failing to reach the therapeutic LDL-C target level or a normal level of HDL-C and TG. After LMT, 64.9% of patients with high cardiovascular risk factors, 64.5% of those with ASCVD or and 64.2% of those with diabetes without ASCVD also had at least one lipid abnormality. CONCLUSION: Approximately two-thirds of patients did not reach the target or normal lipid profile after taking LMT, irrespective of combining disease and high cardiovascular risk factors. Tight lipid control is required, especially in patients with dyslipidemia and high cardiovascular risk factors or comorbid diseases.

Exercise Therapy for an Older Patient With Left Ventricular Assist Device

A left ventricular assist device (LVAD) is a mechanical circulation support implanted for patients with end-stage heart failure. It may be used either as a bridge to cardiac transplantation or as a destination therapy. The health of a 75-year-old man with a medical history of systolic heart failure worsened. Therefore, he was recommended to have implanted a LVAD (Thoratec Corp.) as a destination therapy. After the surgery, he was enrolled in patient cardiac rehabilitation for the improvement of dyspnea and exercise capacity. In results, there is an improvement on his exercise capacity and quality of life. For the first time in Korea, we reported a benefit of exercise therapy after being implanted with a LVAD.

Treatment of Dyslipidmia

Treatment of dyslipidemia is apparently one of the most important measures for prevention of atherosclerotic cardiovascular diseases. Recent trend reflecting several study results after publication of the ATP-III guideline in 2001 recommends more aggressive target LDL goals in very high risk patients. On the other hand, public health approaches, such as life style modification, to low risk group should not be neglected for primary prevention to avoid life-long medication in undesirably large number of people. Intensity of the treatment must be adjusted after a careful consideration of each patient's global risk, not just by lipid level alone. More attention to dyslipidemia management is needed for both clinical and public health perspectives.

Correlation Between Levels of N-terminal Pro-B-Type Natriuretic Peptide and Degrees of Heart Failure

BACKGROUND: The N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized in the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between the NT-pro BNP levels and the New York Heart Association function class (NYHA Fc) of dyspnea and echocardiographic findings for the patients who visited our cardiology departments. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients who visited the Samsung Medical Center and the Jong Koo Lee Heart Clinic. RESULTS: The NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p< 0.001 by ANOVA), the increase in the systolic left ventricular internal dimension (p< 0.05), and the decrease in the ejection fraction (p< 0.01). For the NYHA Fc I patients, the NT-pro BNP levels were positively correlated with age (p< 0.001) and left atrial size (p< 0.001). For the patients with ischemic heart disease, the NT-pro BNP levels were also positively correlated with the NYHA Fc (p< 0.001 by ANOVA). The NT-pro BNP levels were increased with the increase in the systolic (p< 0.001) and diastolic pressure (p=0.017), the left ventricular internal dimension as well as the decrease in the ejection fraction (p< 0.001). The area under the receiver operating characteristic (ROC) curve for the NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level for the NT-pro BNP was 293.6 pg/mL. CONCLUSION: The NT-pro BNP levels were positively correlated with the NYHA Fc of dyspnea and the systolic dysfunction for the patients who visited our cardiology departments. A 300 pg/mL value for the NT-pro BNP cut-off point appears to be a sensitive level to differentiate dyspnea originating from an ailing heart or not for the patients who visited our cardiology departments.

Safety of One-Day Admission Transradial Coronary Intervention

BACKGROUND: Recent advances of percutaneous coronary intervention (PCI) and transradial coronary intervention (TRI) have made it possible to reduce the local complication rate and the time until a return to ambulation. The aim of this study is to assess the safety and the patient satisfaction of the TRI-based one-day admission program for PCI. METHODS: Total 230 consecutive patients underwent TRI on the day of admission, according to pre-determined inclusion criteria, from May 2001 to October 2003. The subjects were examined for clinical and angiographic characteristics. The patients having a same-day discharge were telephone-interviewed one day and seven days after discharge to assess late complications and the patients' satisfaction. RESULTS: The mean age of the subjects was 59+/-9 years and 77.4% were male patients. 169 (73.4%) had stable angina and 37 (16.1%) had unstable angina. Stents were implanted in 178 cases (69.3%). Of the 230 patients who underwent TRI, 206 patients (89.6%) could discharge on the same day after the procedure. The procedure was successful in 98.5%. The average hospital stay for them was 9.4+/-1.4 hours. Two subjects reported hematoma near the puncture site within 24 hours after discharge, and one reported this problem 7 days after discharge. During the follow-up, there were no cases reporting chest pain needing rehospitalization or such complications as subacute vessel closure. No deaths, myocardial infarctions or revascularization were noted during the follow-up period. The majority of the patients (n=197, 95.6%) were satisfied with the same-day admission and discharge. CONCLUSIONS: Same day admission and discharge after TRI seems to be safe as well as satisfactory for not low-risk patients.

Correlation between levels of n-terminal pro-b-type natriuretic peptide and degrees of heart failure / 대한내과학회지

BACKGROUND: N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized from the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between NT-pro BNP levels and New York Heart Association function class (NYHA Fc) and echocardiographic findings in patients, who visited cardiology department. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients, who visited Samsung Medical Center and Jong Koo Lee Heart Clinic. RESULTS: NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p<0.001 by ANOVA) as well as with the increase in systolic left ventricular internal dimension (p<0.05) and the decrease in ejection fraction (p<0.01). In NYHA Fc I patients, NT-pro BNP levels were positively correlated with age (p<0.001) and left atrial size (p<0.001). In patients with ischemic heart disease, NT-pro BNP levels were also positively correlated with NYHA Fc (p<0.001 by ANOVA). NT-pro BNP levels were increased with the increase in systolic (p<0.001) and diastolic (p=0.017) left ventricular internal dimension as well as the decrease in ejection fraction (p<0.001). The area under the receiver operating characteristic (ROC) curve for NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level of NT-pro BNP was 293.6 pg/mL. CONCLUSION: NT-pro BNP levels were positively correlated with NYHA Fc of dyspnea and systolic dysfunction in patients, who visited cardiology department. A 300 pg/mL of NT-pro BNP level appears to be a sensitive level to differentiate dyspnea of heart origin or not in patients, who visited cardiology department.

afety and Feasibility in Trans-radial Coronary Interventions for Chronic Total Occlusion

BACKGROUND AND OBJECTIVES: Recent advances in trans-radial coronary intervention (TRI) have shown a reduction in patient's morbidity. However, the role of TRI for a chronic total occlusion (CTO) is not well established. The aim of this study was to assess the safety and feasibility of TRI for a CTO. SUBJECTS AND METHODS: Sixty-three successive CTO lesions of more than 2 months duration were prospectively included in this registry between April 2002 and November 2003. Guiding catheters with strong back-up, stiff guide wires and supportive infusion catheters were actively used. The angiographic and procedural characteristics were prospectively evaluated. RESULTS: There were 45 male and 18 female patients, with a mean age of 59.8+/-9.5 years. The most common clinical diagnosis was stable angina (95.2%). The mean duration of the occlusions was 10.3+/-1.6 months. Procedural success was achieved in 53 lesions (84.1%). No cases were crossed over to transfemoral procedure. The most common cause of procedural failure was guide wire passage failure (7 lesions). The mean duration of occlusions was significantly longer in the failure group (7.5+/-1.1 versus 24.8+/-6.5 months, p<0.001). Bridging collateral vessels, long occlusions, calcification at lesion sites, a side branch at the occlusion site and blunt entry morphology were also statistically significant predictors for procedural failure. Procedure-related complications were noted in 6 patients (9.8%), which included coronary perforations (3.3%), severe dissections (3.3%), arrhythmia (1.6%) and branch artery occlusion (1.6%). No patients suffered from local complications, such as hematoma or radial artery occlusion. CONCLUSION: TRI for a CTO seems to be safe and feasible, with acceptable success and complication rates.

Long-term Follow-up Results of Tilt Training in Patients with Neurocardiogenic Syncope

BACKGROUND AND OBJECTIVES: Tilt training as a non pharmacological therapy was recently introduced to treat the patients with neurocardiogenic syncope. Tilt training has been known to prevent neurocardiogenic syncope by desensitizing abnormal autonomic reflex. Herein, the early effect of tilt training and the preventive effect on the relapse of syncope were studied during a long-term follow-up period. SUBJECTS AND METHODS: Fifteen patients (11 males) who experienced recurrent syncope, despite drug treatment or were intolerant to drug treatment, among those diagnosed as neurocardiogenic syncope by the head-up tilt test at Samsung Medical Center between March 2000 and May 2003 were recruited. Each patient underwent tilt training after admission and was educated to continue self-tilt training after discharge. Data for recurrences after discharge were obtained via questionnaires on outpatient visits or by telephone interviews. RESULTS: Eleven (73%) of the 15 who underwent tilt training on admission showed therapeutic effects. The mean follow-up period was 21+/-10 months (5-40 months). Only one patient was excluded due to follow-up loss. Ten of the above patients underwent training by themselves for an average of 4 months after discharge, and experience no relapse of syncope during the follow-up period. CONCLUSION: Tilt training maintained its therapeutic effect during long-term follow-up. This could be a new treatment for patients non responsive or intolerant to medical therapy.

Effect of Cardiac Rehabilitation on Physiologic and Inflammatory Markers in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: here are several reports of cardiac rehabilitation (CR) having beneficial effects on the reduction of cardiovascular mortality and in the prevention of recurrent coronary events in patient with myocardial infarction (MI). An 8-week CR program was investigated to see if it affected the prognostic factors, such as inflammatory markers, after acute MI. SUBJECTS AND METHODS: 33 male and 5 female patients, with a mean age of 55+/-10 yrs, were consecutively assigned to the CR (n=19) and the control (n=19) groups three weeks after acute MI. The 8-week CR program consisted of life style modification and aerobic exercise training. At the baseline, and after 8 weeks, the symptom limited exercise test and peripheral blood sampling were performed to measure the physiologic capacity, the serum levels of high sensitive C-reactive protein (hs-CRP) and the plasma levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha. The interval changes of each parameter were compared between the two groups. RESULTS: The interval increments of the maximal oxygen uptake (14.3% vs. 10.6%, CR vs. control group, p=0.014), anaerobic threshold (18.8% vs. 7.0%, CR vs. control group, p=0.044) and exercise duration (9.4% vs. 3.1%, CR vs. control group, p=0.009) were larger in the CR than in the control group. The magnitudes of the interval changes in hs-CRP, IL-6 and TNF-alpha, as inflammatory markers, did not differ between the two groups (p>0.05). CONCLUSION: This 8-week CR program demonstrated an improved exercise capacity for MI patients, but a larger clinical trial, with modified exercise intensity and duration, will be necessary to detect any possible effect on the inflammatory markers.

N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Marker in Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Biochemical markers are useful for the prediction of cardiac events in patients with acute coronary syndrome (ACS). The N-terminal fragment of the BNP prohormone (NT-proBNP), which is synthesized by cardiac ventricles in response to increased wall stress, may be a prognostic marker in ACS. The relation between the NT-pro BNP levels on admission and major adverse cardiovascular events (MACEs) were assessed in a cohort of patients with ACS. SUBJECTS AND METHODS: Between October 2002 and April 2004, blood samples for the determination of NT-proBNP level were obtained on admission from 78 patients with ST-elevation myocardial infarction (STEMI), 32 with non-ST elevation MI(NSTEMI) and 66 with unstable angina (UA). Patients were followed concerning MACEs (death, MI, heart failure, stroke and revascularization) for a median of 7 months in median. RESULTS: 22 patients (13%) had events. The mean NT-proBNP level was significantly lower in the event-free survivors than in those with events (1342+/-1598 versus 6129+/-6522 pg/mL, p<0.0001). The optimal cut-off value of the NT-proBNP level using a receiver-operating-characteristic curve was 1445 pg/mL. The unadjusted risk ratio of patients with an NT-proBNP level greater than the threshold was 7.0 (95% confidence interval, 2.6 to 19.0). In a multivariate Cox regression model, including clinical background factors and other biochemical markers, the NT-proBNP level was the most powerful indicator of MACEs (risk ratio, 8.0 [95% confidence interval, 1.7 to 37.1]). The coronary angiographic Gensini score was also a predictor of prognosis in ACS (risk ratio, 3.8 [95% confidence interval, 1.0 to 14.0]). CONCLUSION: A single measurement of the NT-proBNP level on admission appears to be useful as a prognostic factor in the prediction of MACEs in patients after ACS.

Clinical Aspects of Coronary Artery Perforation during Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Coronary artery perforation is a rare, but potentially deadly, complication of percutaneous coronary intervention (PCI). The purpose of this study was to analyze the clinical characteristics, and outcome, of coronary artery perforation. SUBJECTS AND METHODS: We retrospectively reviewed 3,782 consecutive PCIs, performed between January, 1994 and May, 2002 at the Samsung Medical Center, from the database records. The medical records and angiograms of the patients were also reviewed. The coronary artery perforations were classified according to Ellis' classification. RESULTS: A coronary artery perforation was noted in 24 patients (0.6%). It was most commonly observed during PCI of the right coronary artery (46%) and a chronic total occlusion intervention (42%). The number of the patients with Ellis'classes I, II and III were 11, 8 and 5, respectively. The most frequent causes of the perforation were guidewire, followed by balloon (11 and 8 cases, respectively). The interventional modality with the highest risk of perforation in this study was rotational atherectomy, (4 out of 157, 2.6%). Five patients had cardiac tamponade, of which four occurred during a rotablator procedure. Pericardiocentesis was performed in 5 patients, while 3 patients with class III perforations received emergent coronary artery bypass surgery. There were no in-hospital mortalities, although the duration of the hospital stay for the class III patients was longer than those with classes I or II perforations. CONCLUSION: A coronary artery perforation during percutaneous coronary intervention is a potentially serious complication. However, the immediate and adequate management results in a fairly good prognosis.

Clinical Manifestation of Novel Stress-induced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Prospective Registry

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.

Impact on Long-term Adverse Cardiac Events of Troponin T or Creatine Kinase-MB Release after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND AND OBJECTIVES: The impact on long-term adverse cardiac events of troponin T (TnT) or creatine kinase-MB (CK-MB) release after percutaneous transluminal coronary angioplasty (PTCA) is not well defined. The purpose of the study is to evaluate the effect of elevated TnT or CK-MB on the late major adverse cardiac events [MACE ; Q wave myocardial infarction (MI), revascularization, or cardiac death]. SUBJECTS AND METHODS: Study population were 207 consecutive patients (M : F=148 : 59, mean 60.8+/-9.2 years) who underwent PTCA. Patients with acute MI, unstable angina with abnormal levels of TnT or CK-MB, or newly developed Q MI after PTCA were excluded. Cardiac enzyme levels were measured before and 8, 24 hours after PTCA for CK-MB, and before and 16 hours after PTCA for TnT. Group I (n=181, 87.4%) had normal levels of both after PTCA. Group II (n=26, 12.6%) had abnormal levels of CK-MB (>or=16 U/L) and/or TnT (>or=0.2 ng/mL). 1-year follow-up was available in 201 (97.1%) patients. RESULTS: Incidence of non-Q MI after PTCA was 26/207 (12.6%). Major complications such as acute coronary occlusion, side branch occlusion, and major dissection were significantly associated with elevation of TnT or CK-MB after PTCA (p=0.01). However, elevation of CK-MB or TnT was not significantly associated with late MACE by Kaplan-Meier survival curve (p=0.46). During 1-year follow-up, event free rate of group I and II were 76.6% and 69.2%, respectively. CONCLUSION: Acute coronary occlusion, side branch occlusion, or major dissection can increase the level of TnT or CK-MB after PTCA. But, elevation of CK-MB or TnT after PTCA dose not significantly influence on late MACE.

Vitamin C is additive to statin in improving the endothelial function in hypercholesterolemic patients / 대한내과학회지

BACKGROUND: Hypercholesterolemia is firmly established as a risk factor for the development of atherosclerosis. However the exact mechanism of hypercholesterolemia-related damage to the arterial wall and its relation to the atherosclerotic process are not well known. The endothelium plays an important role for the regulation of vascular tone and the endothelial function is impaired in the presence of risk factors early in the process of atherosclerosis. Assessment of endothelial function appears to be a valuable tool for the diagnosing and therapeutic monitoring of coronary artery disease. Lipid lowering agents and anti-oxidants are known to improve endothelial dysfunction in hypercholesterolemic patients, respectively. The purpose of this study is to investigate whether vitamin C has additional benefit on endothelial function of statin-treated hypercholesterolemic patients. METHODS: The endothelial function was estimated using venous occlusion plethysmography (VOP) in 9 hypercholesterolemic patients and 11 healthy volunteers. The strain guage was connected to plethysmograph to record the forearm volume change. A rapid cuff inflator was used to inflate the arm cuff to 40 mmHg instantaneuosly thus occluding venous return from the forearm. The measurement of forearm volume change was repeated for 7 times each stage. The patients in the hypercholesterolemic (HC) group were treated with the statin, then examined again. The change of the forearm blood flow (FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. RESULTS: Endothelium-dependent vasodilatation was significantly impaired in the HC group compared to the control group (15.9+/-0.9 mL/min/100mL forearm tissue, vs 8.9+/-0.6 mL/min/100mL forearm tissue, mean+/-standard error of mean, p<0.05). The FBF increased significantly after statin therapy (8.9+/-0.6 vs 25.2+/-1.4 mL/min/100mg forearm tissue, p<0.05). Vitamin C infusion in these patients results in additional improvement in FBF (25.2+/-1.4 vs 31.9+/-2.1, p<0.05). CONCLUSION: Endothelium-dependent vasodilatation was significantly impaired in the HC group compared to the control group. The FBF increased significantly after statin therapy. Vitamin C seems to have additional benefit on the endothelial function of statin-treated hypercholesterolemic patients.

Effect of lipoprotein lipase gene polymorphism on lipid profile and body mass index in healthy Korean adult / 대한내과학회지

BACKGROUND: Lipoprotein lipase(LPL) plays a pivotal role in triglyceride-rich lipoprotein metabolism. It removes TG-rich lipoprotein from circulation by hydrolysing TG and produces active form of HDL. It also affects the development and maintenance of obesity by regulating the fatty acid metabolism of the adipose tissue. Many studies about the association of the genetic variation of LPL and dyslipidemia have been performed, but the results were not consistent. We tried to characterize the phenotypes of the LPL genetic variation in Korean. METHODS: Healthy Korean adults (n=110) were genotyped for Hind III/Pvu II RFLP and Ser447Ter mutation of the LPL gene by PCR-digestion method. We investigated the association of the genetic variations with the lipids, the lipoprotein concentrations and the body mass index(BMI). RESULTS: The allele frequencies of Hind III RFLP, Pvu II RFLP and Ser447Ter mutation were H1:H2=33%:67%, P1:P2=40%:60% and Ser447: Ter447=90%:10%. Ser447Ter mutation carriers had higher HDL cholesterol level than non-carriers (59+/-10mg/dl versus 53+/-11mg/dl, p=0.049) and the Pvu II RFLP is associated with increased body mass index. (P1P1:P1P2:P2P2 = 22.1+/-2.0 kg/m2: 23.5+/-2.7 kg/m2: 24.5+/-2.6 kg/m2, p=0.003) CONCLUSION: The genetic variations of the LPL gene in healthy Korean adult resulted in increased HDL cholesterol and increased BMI. These results were different from previous studies. This difference may reflect the racial difference from the diet and the linkage disequilibrium

Long Term Survival Rate and Prognostic Factors of Acute Myocardial Infarction

BACKGROUND AND METHODS: To identify the long term survival rate and prognostic factors of acute myocardial infarction (AMI) in Korea, total 1139 patients who presented between Jan. 1980 and Dec. 1997 at Seoul National University Hospital were followed for an average of 115 months. 321 patients died during follow up periods, 238 patients were lost and 580 patients are alive till the end point of the study. RESULTS: Overall survival rates (+/-standard error) were 88.2+/-1%, 86.8+/-1%, 85.3+/-1.1%, 82.1+/-1.2%, 79.6+/-1.3%, 75.6+/-1.5%, 73.1+/-1.6%, 70.3+/-1.7%, 67.4+/-1.8%, 64.5+/-1.9%, 60.0+/-2.2%, 56.3+/-2.5% at 1,6,12,24,36,48,60,120 months. In univariate analysis, older, history of diabetes, higher degree of Killip class, higher peak creatine kinase level, residual ischemia on treadmill test or MIBI scan, lower ejection fraction on echocardiography or gated blood pool scan, more severe extent of coronary artery disease, lower HDL-cholesterol level at least 3 months after AMI proved as poor long term prognostic factors of AMI with statistical significance (p0.05). In mltivariate analysis, old age and Killip class III versusIproved as independent poor long term prognostic factors of AMI with statistical significance (p<0.05) at combinations of age, sex, Killip class, existence of Q-wave, history of diabetes, ejection fraction on gated blood pool scan. CONCLUSION: The morthality of AMI is composed of two components. At acute phase, within 1 month, the mortality reaches to about 12%, and at chronic phase, after 1 month from AMI, mortality increases by 3% a year for 10 years. The other conclusion is old patients who have poor left ventricular functions show poor prognosis.

Radiofrequency Catheter Ablation of Anteroseptal Accessory Pathways from Right Atrium

BACKGROUND AND OBJECTIVES: Radiofrequency catheter ablation (RFCA) of accessory pathways (AP) has recently become the choice of therapeutic regimen for the patients with atrioventricular (AV) reentrant tachycardia. Among AP, anteroseptal AP is subject to the potential complication of inadvertent AV block during RFCA because of the close proximity to the AV node-His bundle conduction system. This study was conducted to evaluate the efficacy and safety of RFCA of anteroseptal AP at the atrial site by ablation catheter introduced through left subclavian vein. MATERIALS AND METHODS: Seven patients with orthodromic AV reentrant tachycardia mediated by a retrogradely conducting anteroseptal AP were studied. Antidromic AV reentrant tachycardia was also induced in one patient during electrophysiologic study. Mean age was 24+/-10 years (range, 16-42 years) and the male to female ratio was 5:2. APs were manifested in 4 patients and concealed in 3 patients. After diagnosis of anteroseptal AP by electrophysiologic study, temperature guided radiofrequency current was applied in the anteroseptal area at the atrial site of tricuspid annulus by a steerable ablation catheter. RESULTS: All pathways were successfuly ablated. The AV node or His bundle conductions was not impaired in any patients. There were no complications related to the procedure. CONCLUSION: RFCA of the anteroseptal AP at the atrial site by a ablation catheter introduced through superior vena cava is effective and safe with good preservation of the normal conduction system.

Radiofrequency Catheter Ablation of Anteroseptal Accessory Pathways from Right Atrium

BACKGROUND AND OBJECTIVES: Radiofrequency catheter ablation (RFCA) of accessory pathways (AP) has recently become the choice of therapeutic regimen for the patients with atrioventricular (AV) reentrant tachycardia. Among AP, anteroseptal AP is subject to the potential complication of inadvertent AV block during RFCA because of the close proximity to the AV node-His bundle conduction system. This study was conducted to evaluate the efficacy and safety of RFCA of anteroseptal AP at the atrial site by ablation catheter introduced through left subclavian vein. MATERIALS AND METHODS: Seven patients with orthodromic AV reentrant tachycardia mediated by a retrogradely conducting anteroseptal AP were studied. Antidromic AV reentrant tachycardia was also induced in one patient during electrophysiologic study. Mean age was 24+/-10 years (range, 16-42 years) and the male to female ratio was 5:2. APs were manifested in 4 patients and concealed in 3 patients. After diagnosis of anteroseptal AP by electrophysiologic study, temperature guided radiofrequency current was applied in the anteroseptal area at the atrial site of tricuspid annulus by a steerable ablation catheter. RESULTS: All pathways were successfuly ablated. The AV node or His bundle conductions was not impaired in any patients. There were no complications related to the procedure. CONCLUSION: RFCA of the anteroseptal AP at the atrial site by a ablation catheter introduced through superior vena cava is effective and safe with good preservation of the normal conduction system.

Predicting Factors of Multivessel Coronary Artery Disease in Dobutamine Stress Echocardiography

BACKGROUND: Dobutamine stress echocardiography(DSE) is useful detection of coronary artery disease as a noninvasive test. The purpose of this study is to find predicting factors of multivessel disease (MVD) in DSE. METHODS: Sixty-five patients suspicious of coronary artery disease excluding myocardial infarction on clinical base had undergone DSE and coronary arteriography. We divided the patient group into normal group (22 patients), single vessel disease(SVD) group(25 patients) and multivessel disease (MVD) group (18 patients) according to the findings of the findings of coronary angiogram. DSE findings and hemodynamic change during stress were analyzed and compared in these groups. We defined MVD on DSE as findings of new or aggravating regional wall motion abnormalities in 2 or more coronary artery territories, and significant stenosis on coronary angiogram as stenosis of 50% or more. RESULTS: 1) The numbers of diseased vessel evaluated by DSE showed significant correlation with those evaluated by coronary angiogram. 2) Resting, low-dose and peak-dose wall motion scores were significantly different among 3 groups, being higher in MVD group than in SVD and normal group. 3) Total administered dose of dobutamine in MVD group was significantly lower than that of normal group. 4) Heart rate at peak-dose showed significant difference among 3 groups, but product of heart rate and systolic blood pressure at peak-dose was not significantly different. 5) Frequency of ST segment change was significantly higher in multicessel disease group CONCLUSION: DSE reflects severity of coronary artery disease. and frequency of resting regional wall motion abnormally. wall motion score in low-dose and paak stress seems to be useful as a predictor of multivessel disease. Value of total administered dose of dobutamine, hemodynamic changes and ST segment changes as a MVD remains to be proved.