The Differences of Left Ventricular Geometry in Acute Myocardial Infarction and the Effects on Short Term Mortality / 이화의대지

OBJECTIVES: This study designed to find the differences of left ventricular (LV) geometry in acute myocardial infarction (AMI) between ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) and the occurrences of adverse outcome according to the LV geometry. METHODS: Comprehensive echocardiographic analyses were performed in 256 patients with AMI. The left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated. LV geometry were classified into 4 groups based on RWT and LVMI: normal geometry (normal LVMI and normal RWT), concentric remodeling (normal LVMI and increased RWT), eccentric hypertrophy (increased LVMI and normal RWT), and concentric hypertrophy (increased LVMI and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LV geometry and clinical outcomes. RESULTS: Patients with NSTEMI were more likely to have diabetes mellitus, hypertension, heart failure, stroke and previous myocardial infarction. By the geometric type, patients with NSTEMI were more likely to have eccentric hypertrophy (n=51, 34.7% vs. n=24, 22.0%, P=0.028). There was no significantly different adverse outcome between STEMI and NSTEMI patients. Fifteen patients (5.9%, 7 female [46.7%]) died and the median duration of survival was 10 days (range, 1 to 386 days). Concentric hypertrophy carried the greatest risk of all cause mortality (hazard ratios, 5.83; 95% confidence interval, 1.04 to 32.7). CONCLUSION: NSTEMI patients had more likely to have eccentric hypertrophy but adverse outcome after AMI was not different between STEMI and NSTEMI patients. Concentric hypertrophy had the greatest risk of short term mortality.

Leptin is Associated with Endothelial Dysfunction in Healthy Obese Premenopausal Women

BACKGROUND AND OBJECTIVES: Previous studies have demonstrated that adipokines can have positive and/or negative effects on vascular function. In this study, we attempted to characterize the association of adipokines with endothelium-dependent vasodilation in healthy premenopausal women. SUBJECTS AND METHODS: Noninvasive pulse wave analysis coupled with provocative pharmacological testing with salbutamol was used to measure endothelium-dependent vasodilation in 60 healthy premenopausal women [37 obese women; body mass index (BMI) > or = 25 kg/m2, 23 age-matched non-obese women; BMI<25 kg/m2]. The lipid profile, fasting insulin, glucose, and C-reactive protein (CRP) concentrations in each patient were assessed via standard laboratory techniques, and plasma concentrations of various adipokines, such as adiponectin, leptin, resistin and TNF-alpha, were measured via enzyme immunoassays. RESULTS: In the obese group, higher leptin concentrations were significantly associated with impairments in endothelium-dependent vasodilation (r=-0.371, p=0.005). This association remained significant, even after adjustment for other risk factors (beta=-0.39, p=0.006). However, we determined that there was no significant correlation between endothelium-dependent vasodilation and these variables in the obese group and the control group. CONSLUSION: Increased plasma concentration of leptin was associated with impairment in endothelial function in obese premenopausal women, regardless of the metabolic and inflammatory disturbances associated with obesity.

Clinical Outcomes Following Sirolimus-Eluting Stent Implantation in Patients with End-Stage Renal Disease: Korean Multicenter Angioplasty Team (KOMATE) Registry

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES), as opposed to bare metal stents (BMS), have been shown to markedly reduce restenosis. However, many clinical trials have excluded the subset of patients (pts) with end-stage renal disease (ESRD). The aim of this study was to evaluate the clinical outcomes following SES implantation in ESRD pts. SUBJECTS AND METHODS: We analyzed the clinical outcomes in 50 pts from our registry following SES implantation, and compared the outcomes between those with ESRD receiving SES (SES-ESRD) and BMS (BMS-ESRD), and with non-ESRD pts following SES implantation (SES-non ESRD). RESULTS: A comparison of the SES-ESRD (50 pts, 72 lesions) with BMS-ESRD groups (42 pts, 45 lesions); those in the SES-ESRD group included; diabetes 78%, hypertension 94% and age 62+/-10 years. Those in the SES-ESRD group were more likely to have diabetes (diabetes of BMS-ESRD, 57%; p=0.04). The reference vessel diameters (RVD) of the SES-ESRD group were smaller (2.76+/-0.50 mm vs. 3.05+/-0.46 mm, p<0.001), but the lesion length was longer (25.6+/-7.0 mm vs. 19.1+/-8.8 mm, p<0.001) than those of the BMS-ESRD group. The SES-ESRD group had a lower 1-year major adverse cardiac events (MACE) rate than the BMS-ESRD group (6.0% vs. 33.3%; p<0.001). There were no differences in mortality and incidence of myocardial infarction between the two groups. The incidence of target vessel revascularization decreased significantly in the SES-ESRD group (2.0% vs. 19.0%, p=0.01). From a multivariate regression analysis, the use of SES was the only significant independent predictor of MACE (OR=0.054, 95% confidence interval 0.01 to 0.26, p<0.001). A comparison with SES-non ESRD group in our total registry (644 pts, 758 lesions); MACE in the SES-ESRD group (6.0%) was higher than in the SES-non ESRD group (3.1%), but there was no statistical significance (p=0.23). CONCLUSION: Compared with BMS, SES caused an improvement in the clinical outcomes in pts with ESRD.

A Case of Myocardial Stunning in Hyperthyroidism

Although myocardial stunning occurs in coronary artery disease, it has rarely been reported with hyperthyroidism. A 72-year-old woman presented with general weakness, shortness of breath and febrile sensation of 10 days duration. The serum thyroid hormone level was elevated. Serial EKGs showed significant ST elevation suggesting transmural ischemia, but coronary angiography was not significant. Echocardiography showed regional wall motion abnormality of apical hypokinesia, which was improved after medication for hyperthyroidism. We report this case as an example of myocardial stunning associated with hyperthyroidism.

A Case of Myocardial Stunning in Hyperthyroidism

Although myocardial stunning occurs in coronary artery disease, it has rarely been reported with hyperthyroidism. A 72-year-old woman presented with general weakness, shortness of breath and febrile sensation of 10 days duration. The serum thyroid hormone level was elevated. Serial EKGs showed significant ST elevation suggesting transmural ischemia, but coronary angiography was not significant. Echocardiography showed regional wall motion abnormality of apical hypokinesia, which was improved after medication for hyperthyroidism. We report this case as an example of myocardial stunning associated with hyperthyroidism.

CT Coronary Angiography Using Multidetector Computed Tomography in Coronary Artery Disease : A Comparative Study to Quantitative Coronary Angiography

BACKGROUND AND OBJECTIVES: The purpose of the present study was to investigate the diagnostic accuracy of coronary stenoses in patients with ischemic heart disease using multidetector CT coronary angiography (MDCT) in the assessment of coronary artery disease. SUBJECTS AND METHODS: Forty-three patients (49-72yrs) undergoing conventional coronary angiography (CCA) were included in this study. All patients were premedicated with oral propranolol, 40-80 mg, to achieve an acceptable heart rate of less than 65 bpm, 1hr before the MDCT. All coronary arteries, including the distal segments and side branches, were assessed with respect to assessability and the presence of significant stenosis (>50%) and the results compared with those of CCA. RESULTS: Of the 645 coronary artery segments scanned, 540 were assessable (84%). A total 44 significant stenoses were detected by CCA and 49 lesions by MDCT. The overall sensitivity and specificity were 77 and 97%, respectively. The overall accuracy for the LAD, RCA and LCX was 94, 98 and 95%, respectively, and there were no differences in the accuracies in each vessel. The sensitivity in the proximal segments was much higher than in the distal segments. A total 15 segments were overestimated by the MDCT due to calcification and the small vessel size. CONCLUSION: MDCT, with improved spatial and temporal resolutions, and pre-treated with oral beta-blocker, permits the detection of coronary artery stenoses with a high degree of accuracy.

The Outcome of Percutaneous Intervention of the Superficial Femoral Artery and the Predictors of its Patency

BACKGROUND AND OBJECTIVES: Percutaneous intervention has become an established technique in the treatment of peripheral arterial obstructive disease. This study was performed to evaluate the procedural success and long-term outcome of percutaneous intervention of the superficial femoral artery (SFA), and to determine the factors that influence the long-term outcome. SUBJECTS AND MEHTODS: Eighty-eight consecutive lesions, in 76 subjects (mean age 65) with chronic lower limb ischemia and SFA obstruction, diagnosed with angiography were included in this study. The angiographic success was defined as residual stenosis <30% and the clinical success as an improvement by at least one clinical category. The clinical patency was defined as an absence of symptom recurrence and target lesion revascularization during the follow up period. The predictors of the outcome were also determined. RESULTS: Balloon angioplasty only was performed in 39 lesions and thrombolysis only in 2, whereas stenting was performed in 47 lesions. Seventy four of the 88 attempts (84%) at recanalization were angiographically successful, while 73 (83%) experienced clinical improvement. The twelve month patency was 67%. Critical ischemia (versus intermittent claudication)(relative risk 4.2, p=0.020) and renal failure (relative risk 4.1, p=0.016) were independent negative predictors of the patency. CONCLUSION: Percutaneous intervention of the SFA yielded a high procedural success rate, with an acceptable long-term outcome. Symptoms of critical ischemia and renal failure were predictive of a low long-term patency.

Relationship of Adiponectin to Body fat Distribution, Insulin Sensitivity and Plasma Lipoproteins: in Healthy Premenopausal Women

BACKGROUND AND OBJECTIVES: The precise mechanism linking obesity and vascular disease is still unclear. Previous studies have demonstrated that the plasma levels of adiponectin, an adipose-derived hormone, decrease in obese subjects, and that hypoadiponectinemia are associated with ischemic heart disease. In this study, we investigated the determinant factors of plasma adiponectin concentration in healthy premenopausal women. SUBJECTS AND METHODS: We analyzed the plasma adiponectin concentrations in healthy, obese premenopausal women (n=37, BMI> or =25 Kg/m2) and in age-matched, healthy, non-obese premenopausal women (n=23, BMI<25 Kg/m2). The visceral and subcutaneous fat areas were measured by CT scan. RESULTS: Plasma levels of adiponectin in the obese subjects were lower than those in the non-obese subjects (3.24+/-1.08 vs. 4.90+/-2.06 microgram/ml, p<0.01). Significant, univariate, inverse correlations were observed between plasma adiponectin levels and visceral fat areas (r=-0.643, p<0.001), and between adiponectin levels and subcutaneous fat areas (r=-0.407, p<0.01). In univariate analysis, adiponectin was directly related to insulin sensitivity, hsCRP, triglyceride, HDL and LDL cholesterol. In multivariate analysis, visceral fat areas (beta=-0.483, p=0.001) and HDL cholesterol remained significantly related to plasma adiponectin concentrations (beta=0.283, p<0.05). CONCLUSION: These results suggest that HDL cholesterol and visceral fat mass were independently associated with plasma concentrations of adiponectin.

Hematuria in Renal Transplant Patients: Causes and Diagnostic Algorithm / 대한이식학회지

PURPOSE: Hematuria is a frequently encountered clinical problem in kidney graft recipients. The causes are variable, may be benign or malignant, but imperative to affect long- term graft function and survival. We have evaluated renal recipients who had hematuria using a newly defined algorithm. METHODS: We evaluated 1060 renal transplant recipients from March 1, 1992 to February 28, 2000. In 93 recipients, hematuria was transitory and spontaneously resolved within 3 months. We tried to identify the cause of persistent hematuria in 126 recipients. Patients were evaluated with plain x-ray, sonography, cystoscopic examination and/or graft biopsy. RESULTS: The mean duration of hematuria onset after transplantation was 17.81+/-14.6 months (4-70 months). The causes of gross hematuria were urolithiasis (n= 15), benign bladder mucosal bleeding (n=3), bladder cancer (n=2) and kidney cancer from an original kidney (n=1). Graft kidney biopsies were performed in 96 patients and the results were as follows: chronic rejection in 18, IgA nephropathy in 16, cyclosporine toxicity in 8, acute rejection in 5, focal segmental glomerulosclerosis in 3, the other glomerulonephritis in 2, and tubular atrophy and interstitial fibrosis in 19 patients. Combined pathologic findings were detected in 15 patients. In 8 patients, no pathological diagnoses were made. We were unable to evaluate 9 patients due to patient's refusal. CONCLUSION: The causes of hematuria after kidney transplantation are variable from benign to malignant disease. If the cause of hematuria is uncertain on ultrasonographic examination, cystoscopic examination and/or graft biopsy should be performed for making a definite diagnosis.

Expression of osteopontin in calcified coronary atherosclerotic plaques

Advanced atherosclerosis is often associated with dystrophic calcification and remodeling of extracellular matrix of vascular wall. Recently many studies have documented a general relationship between calcification and severity of coronary disease, and discussed the feasibility of electron beam computed tomography for detecting and quantifying the coronary artery calcification in the patients. The present study investigated the expression and the localization of osteopontin, one of noncollagenous bone matrix protein, within the calcified coronary arteries. Autopsy-derived coronary artery specimens were scanned and reconstructed to visualize the pattern of coronary calcification using a novel microscopic computed tomography technique. The localization of the osteopontin were evaluated by immunohistochemial stain with LF7. The present study showed that the pattern of coronary calcification is variable and the expression of osteopontin is localized mainly to calcified lesion. The smooth muscle cells in addition to macrophage expressed osteopontin protein in human coronary atherosclerotic plaques. Soluble osteopontin released near to the sites of vascular calcification may represent an adaptive mechanism aimed at regulating the process of vascular calcification.