The Expression of Transforming Growth Factor-beta1 and alpha-Smooth Muscle Actin is Increased in the Human Myxomatous Valve

BACKGROUND: In vitro experimental studies have reported that transforming growth factor-beta1 (TGF-beta1) stimulates the production of alpha-smooth muscle actin (alpha-SMA) in porcine valves. However, the relation between TGF-beta1 and alpha-SMA in myxomatous valves has not been elucidated. METHODS: We classified 27 subjects into two groups: 1) myxomatous group (M:F=11:12, mean age=55+/-15 years) and 2) rheumatic group (M:F=3:1, mean age=41+/-17 years) according to preoperative echocardiographic and postoperative histologic findings. Twenty-seven valve specimens from the patients who underwent valve replacement were obtained. Tissue samples were analyzed by immunohistochemistry for TGF-beta1 and alpha-SMA. The positively stained areas were measured using an image analysis program (Image Pro-Plus 4.5), and then the TGF-beta1 volume fraction (TGF-VF) and alpha-SMA volume fraction (alpha-SMA-VF) were calculated. RESULTS: TGF-VF in myxomatous valves was higher than in rheumatic valves (2,759+/-2,294 vs 864+/-276, p=0.04). alpha-SMA-VF in myxomatous valves was higher than in rheumatic valves (4,122+/-2,275 vs 2,421+/-844, p=0.002). There was a significant correlation between TGF-beta1 and alpha-SMA in myxomatous valves (r=0.38, p=0.04). There was no significant correlation between TGF-beta1 and alpha-SMA in rheumatic valves (r=-0.50, p=0.67). CONCLUSIONS: TGF-beta1 and alpha-SMA may be related to the pathogenesis of myxomatous valves. The activation of TGF-beta1 might increase the expression of alpha-SMA in human myxomatous valves.

Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Patients Following Ablation of Atrial Fibrillation

BACKGROUND AND OBJECTIVES: It is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation. SUBJECTS AND METHODS: One hundred fifty-two patients (mean age, 57+/-10 years; M : F=94 : 58) who underwent catheter ablation due to drug-refractory paroxysmal (mean age, 57+/-10 years; M : F=58 : 43) or persistent AF (mean age, 56+/-10 years; M : F=36 : 15) were enrolled. We compared the recurrence rates between the groups with and without ACEIs or ARBs use in paroxysmal and persistent AF. The mean duration of follow-up was 18+/-14 months. RESULTS: The overall recurrence rate after ablation therapy was 26% (n=39). The recurrence rate was significantly decreased in the patients with persistent AF with the use of ACEIs or ARBs (12.1% vs. 61.1%, p<0.01), but this difference was not observed in the patients with paroxysmal AF (24.2% vs. 22.9%, p=0.87). In patients with persistent AF with and without recurrence, the size of the left atrium (44.2+/-8.4 mm vs. 44.3+/-5.8 mm, respectively, p=0.45) and the ejection fraction (62+/-6.5% vs. 61.5+/-6.2%, respectively, p=0.28) were not significantly different. In multivariate analysis, the use of ACEIs or ARBs was independently associated with recurrence after adjusting for the size of the left atrium and the ejection fraction {odds ratio (OR)=0.078, 95% confidence interval (CI)=0.02-0.35, p<0.01}. CONCLUSION:ACEIs and ARBs were shown to be effective in preventing AF recurrence after catheter ablation in patients with persistent AF.

Endomyocardial Biopsy: One Center's Report About Its Role

BACKGROUND AND OBJECTIVES: Cardiomyopathy is a common cause of heart failure, yet it is sometimes difficult to determine its exact etiology. Endomyocardial biopsy (EMBx) has been considered to be one of the important diagnostic modalities for unexplained cardiomyopathy. The aim of this study was to analyze the diagnostic value of EMBx. SUBJECTS AND METHODS: 30 patients (M : F=26 : 4, mean age: 41+/-11 yrs) who underwent EMBx since 1992 at St. Mary's hospital were enrolled. The patients were classified into 4 groups by their clinical manifestations as follows: Group I: 11 patients with left ventricular hypertrophy (LVH) of an unknown etiology and suspicious of having infiltrative disease on their non-invasive tests, Group II: 15 patients with heart failure of an unknown etiology and rapid progression, Group III: 2 patients with heart failure and peripheral eosinophilia, Group IV: 2 patients with suspicious arrhythmogenic right ventricular dysplasia and cardiac mass. RESULTS: EMBx confirmed the diagnosis in 8 of 30 cases (26.7%). In Group I, 3 patients were confirmed to have amyloidosis (27.3%). In Group II, 2 patients were diagnosed as having lymphocytic myocarditis (13.3%). In Group III, all of 2 patients (100%) were diagnosed as eosinophilic myocarditis. In Group IV, 1 patient was confirmed to have cardiac metastasis from esophageal cancer. The diagnostic rate was higher for Group III than for Group II (p=0.007). There were no complications related with EMBx. CONCLUSION: EMBx may be a useful tool to confirm the causes of cardiomyopathy in selected patients.

Erratum: The usefulness of ischemia modified albumin as an early ischemic marker to detect coronary artery disease in patients with chest pain presenting to the emergency department / 대한내과학회지

No abstract available.

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3- dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up.

Clinical features and prognostic factors in Korean patients hospitalized for coronary artery disease (Catholic Heart Care Network Study) / 대한내과학회지

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.

Inhibition of Neointima Formation by Anti-Vascular Endothelial Growth Factor and Receptor-1 Peptides in a Balloon-Injured Rat Carotid Artery

BACKGROUND AND OBJECTIVES: Vascular endothelial growth factor (VEGF) is a potent endothelial cell-specific mitogen. This study was undertaken to test the hypothesis that the neointima hyperplasia induced by a balloon injury is inhibited by blocking VEGF and VEGF receptor-1 (VEGFR-1) with anti-VEGF peptides. Materials and Methods: Anti-VEGF RRKRRR peptide (dRK6) and anti-VEGFR-1 peptide (anti-flt-1) were synthesized at Pohang University of Science and Technology, Korea. Male Sprague-Dawley rats, weighing 300-350 g, were subcutaneously injected 0.5 mg/kg of dRK6 or 0.5 mg/kg of anti-flt-1, dissolved in phosphate buffer solution, 2 days before induction of a carotid balloon-injury, and then daily in the same manner post carotid balloon injury for 2 weeks. RESULTS: Neointima formation was suppressed in both the dRK6 and anti-flt-1 groups compared to that in the untreated controls at 2 weeks post carotid balloon-injury (neointimal area; control group 0.44+/-0.09 mm2, dRK6 group 0.25+/-0.05 mm2, anti-flt-1 group 0.19+/-0.05 mm2, p<0.01). Anti-flt-1 peptide and dRK6 reduced the numbers of proliferative bromodeoxyuridine-labeled cells in the neointima (control group 16.4+/-10.6%, dRK6 group 3.7+/-2.1%, anti-flt-1 group 5.9+/-3.4%, p<0.05). In addition, an inflammatory response, as determined by monocyte chemoattractant protein-1 and interleukin-6 upregulation, which was evident in the controls, was inhibited by both dRK6 and anti-flt-1. CONCLUSION: This study suggests anti-vascular endothelial growth factor peptides can reduce the inflammation and neointima formation in balloon injured rat carotid arteries.

Comparison of the Long-Term Prognosis between Coronary Vasospasm and Intermediate Vasoconstriction Induced by the Administration of Acetylcholine

BACKGROUND AND OBJECTIVES: The degree of coronary vasoconstriction induced by acetylcholine administeration can vary. We compared the prognosis between coronary vasospasm and intermediate vasoconstriction, which were both induced by acetylcholine administration. SUBJECTS AND METHODS: The subjects were 156 patients with the coronary vasospasm or intermediate vasoconstriction, as observed on the acetylcholine provocation tests that were performed from January, 2000 to January, 2004. The patients with a spasm showing greater than 90% reduction of vessel diameter along with chest pain or ST changes or both were classified as having 'strong positive vasospasm' (n=113). The patients with 70-90% reduction of diameter were classified as having 'intermediate vasoconstriction' (n=43). The mortality, frequency of chest pain and clinical events were then analyzed. RESULTS: A smoking history (p<0.001) and multivessel involvement (p=0.02) were more frequent in the strong positive group. We compared the mortality and clinical events due to chest pain during the average 26.4+/-14.1 months of follow-up. There were 5 patients (4.4%) who incurred cardiac death in the strong positive group as compared with none in the intermediate group. The total clinical events were more frequent in the strong positive group (p<0.001). Also, the strong positive group showed a significantly higher frequency of chest pain (p<0.001). CONCLUSION: The long-term prognosis of the intermediate vasoconstriction was better than that of strong positive vasospasm. Thus, the intermediate vasoconstriction must be ruled out by strict application of the positive criteria for the acetylcholine provocation test.

Is Systemic Inflammation Associated with Passive Smoke Exposure? A Population-Based Observational Study

BACKGROUND AND OBJECTIVES: Passive smoking increases the risk of cardiovascular disease, but the factors responsible for this association remain largely unknown. We sought to determine whether passive smoke exposure is associated with systemic inflammation in a dose-dependent fashion, which is a known risk factor for cardiovascular events. SUBJECTS AND METHODS: We analyzed the data of self-reported non-smokers, > or =40 years of age, who were from the Third National Health and Nutrition Examination Survey (n=6,595). We quantified the passive nicotine exposure by dividing the non-smokers into quartiles, as based on the serum cotinine values. We used multiple linear and logistic regression models to determine the independent relationship between serum cotinine and the levels of C-reactive protein, fibrinogen and leukocytes, and the platelet expression. RESULTS: After adjustments were done for age, gender, body mass index and race, the participants in the highest serum cotinine quartile (quartile 4) had circulating platelet, fibrinogen and homocysteine levels that were 6,893/microliter higher (95% confidence interval [CI]: 1,886 to 11,900/microliter, p=0.007), 8.74 mg/dL (95% CI: 2.63 to 14.84 mg/dL, p=0.005) and 0.90 micromol/L (95% CI: 0.36 to 1.43 (micromol/L, p=0.001), respectively, than in those in the lowest quartile of serum cotinine (quartile 1). There was a dose-dependent increase in the circulating fibrinogen, homocysteine and platelet levels across the quartiles of cotinine. CONCLUSION: These findings indicate that even among nonsmokers, elevated serum cotinine is an independent risk factor for systemic inflammation. This suggests that passive smoke exposure promotes systemic inflammatory response in a dose-dependent fashion. These observations may explain why passive smoking is a risk factor for atherosclerosis and cardiovascular events.

Plasma Osteoprotegerin Level, a New Biochemical Marker of Atherosclerosis, is Associated with Diabetes Mellitus and Age in Coronary Artery Disease

BACKGROUND AND OBJECTIVES: There have been reports of an association between osteoprotegerin (OPG) and cardiovascular disease. Therefore, the aims of this study were to evaluate the association between the plasma OPG level and the severity of atherosclerosis, as well as search for conventional cardiovascular risk factors associated with the plasma OPG level in patients with coronary artery disease (CAD). SUBJECTS AND METHODS: Plasma OPG levels were measured in 583 consecutive patients (mean age: 62+/-10 yrs, M:F=398:185), using an ELISA method, with CAD confirmed from the coronary angiogram. The intima media thickness (IMT) of the common carotid artery was also measured in 252 patients. RESULTS: The plasma OPG level was correlated with the IMT (r=0.184, p=0.003), with the median level found to be elevated in accordance with the severity of CAD (2704 in 1VD vs. 2914 in 2VD vs. 3046 pg/mL in 3VD, p=0.024). Median plasma OPG levels were significantly higher in female (3024 vs. 2828 pg/mL, p=0.003) and DM patients (3098 vs. 2711 pg/mL, p<0.001), and positively correlated with age (r=0.340, p<0.001) and the HbA1C level (r=0.102, p=0.035), but showed an inverse correlation with BMI (r=-0.199, p<0.001). No correlation was found between high sensitive C reactive protein (hs-CRP) and the plasma OPG level, and no relation was found between CRP and the severity of CAD or the IMT. From a multivariate logistic regression analysis, increasing age (odds ratio, 1.053 [95% confidence interval, 1.034-1.073]), DM (odds ratio 1.664 [95% confidence interval, 1.149-2.410]) and a BMI less than 25 kg/mm2 (odds ratio, 1.625 [95% confidence interval, 1.142-2.314]) were associated with the supramedian OPG level (2831 pg/mL). CONCLUSION: The plasma OPG level might be a biochemical marker of atherosclerosis, and is associated with cardiovascular risk factors, especially DM and age.

Chlamydia Pneumoniae Infection Initiates the Development of Atherosclerosis in OLETF and LETO Rats: The Role of Platelet-derived Growth Factor-B

BACKGROUND AND OBJECTIVES: Chlamydia pneumoniae (CP) has been linked with atherosclerosis. While several studies have shown that CP contributes to the acceleration of atherosclerotic lesions, any studies on the initiation of atherosclerosis are sparse. The present study investigated whether CP infection could initiate atherosclerotic lesions in rats that are known to be resistant to atherosclerosis; further, we investigated if these lesions do form, then how does the CP participate in this and develop of atherosclerosis in these rats. MATERIALS AND METHODS: Thirty 11-week-old Otsuka Long-Evans Tokushima Fatty (OLETF) rats, thirty type 2 diabetic rats and thirty age-matched Long-Evans Tokushima Fatty (LETO) rats that were maintained on a high-cholesterol diet were either mock-inoculated or inoculated intranasally 3 times at 11, 13 and 15 weeks of age. The serum levels of the lipid profiles, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1) and C-reactive protein (CRP) were measured by performing ELISA at 24 weeks and 40 weeks of age. The atherosclerotic lesion areas were analyzed, and immunohistochemical staining using chlamydia genus-specific monoclonal antibody and PDGF-B was performed in the ascending aorta at 40 weeks of age. RESULTS: Immunohistochemical staining with using specific monoclonal antibody demonstrated CP infection in the vessel walls. The serum PAI-1 level of the OLETF rats was higher than that of the LETO rats (p<0.05) regardless of the state of the CP infection, but there were no differences in the serum MCP-1 and CRP levels between the OLETF rats and the LETO rats. While no atherosclerotic lesion was observed in the mock-infected LETO rats, early-to-advanced atherosclerotic lesions were found in the other rat groups. CP-infected OLETF rats showed more advanced atherosclerotic lesions and greater mean lesion areas than the other rat groups (LT-N, 0 mm2; LETO-CP, 3.29+/-1.23 mm2; OT-N, 4.91+/-2.11 mm2; OT-CP, 9.20+/-4.62 mm2)(p<0.05). The characteristics of the atherosclerotic lesions in the rats were intimal thickening that was mainly composed of smooth muscle cells. The atherosclerotic lesion area positively correlated with the presence and the extent of PDGF-B staining in the aortic wall (p<0.01). CONCLUSION: Chronic infection of CP in the vessel walls initiated the development of atherosclerosis in the LETO rats and it accelerated the atherosclerosis in the OLETF rats. CP-induced smooth muscle proliferation and the resultant intimal thickening may be mediated by PDGF-B in these atherosclerotic lesions.

Association between the Serum Osteoprotegerin Level and Target Lesion Calcium in Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Osteoprotegerin (OPG) is a decoy receptor for receptor nuclear factor-kB ligand (RANKL). We sought to evaluate the association between the serum OPG level and the target lesion calcium (TLC) in those patients suffering with coronary artery disease (CAD). SUBJECTS AND METHODS: We assayed the serum OPG levels in 65 CAD patients (mean age: 62+/-10 yrs, M : F=46 : 19) with using enzyme immunoassay, and these patient underwent intravascular ultrasound (IVUS) examinations of their target lesions. The degree of TLC was estimated by the maximum arc of calcium and also the calcified plaque surface area that was calculated from the serial cross-section IVUS images. RESULTS: The median serum OPG levels were greater in the subjects with TLC than in the subjects without TLC (1.36 vs 0.95 ng/mL, respectively, p<0.05). Significant correlation was noted between the serum OPG levels and the maximum arc of calcium (r=0.274, p=0.027). The median serum OPG levels were significantly increased more in the subjects who had a maximum arc of calcium ranging from 90 to 180 degrees than in those subjects who had a maximum arc of calcium less than 90 degrees (1.63 vs 1.14 ng/mL, respectively, p<0.05) and the median serum OPG levels were also increased more in the subjects who fell within the second tertile of the calcified plaque surface area than that in those subjects who fell within the first and third tertile (0.96, 1.53, 1.40 ng/mL for the first, second, third tertile, respectively, p<0.05). On the stepwise multivariate logistic regression analysis, the serum OPG level remained a risk factor for TLC after adjustment was made for the other risk factors such as age, diabetes mellitus, HbA1C and a smoking history (p=0.019, odds ratio 5.208 [95% confidence interval: 1.308-20.744]). CONCLUSION: In patients with CAD, an increased serum OPG level is associated with target lesion calcification.

Hemodynamic Effects of Simulated Ventricular Tachycardia and Supraventricular Tachycardia in Dogs

BACKGROUND AND OBJECTIVES: Tachycardias have various clinical features according to the heart rate, the left ventricular systolic function, the site of origin and the mechanisms of the tachycardias. The primary purpose of this study was to evaluate the role of the origin site and cycle length on the ventricular tachycardia (VT) hemodynamics. Our secondary purpose was to explore the possible hemodynamic differences between the two common supraventricular tachycardias (SVT). MATERIALS AND METHODS: VT was simulated in 18 dogs that had there chests opened by using ventricular pacing (VP) at 3 different sites: the left ventricular apex (LVA), the right ventricular outflow tract (RVOT), and the right ventricular apex (RVA). The mean arterial pressure (MAP), the mean left atrial pressure (MLAP) and the mean pulmonary artery pressure (MPAP) were monitored during VP. To simulate SVT, the right atrial appendage and the right ventricular basal septum were stimulated at different cycle lengths with different ventriculo-atrial (VA) time intervals in another 11 dogs that had their chests opened. The arterial pressure, the pulmonary capillary wedge pressure and the cardiac output was observed during simulated atrial tachycardia (Group I), AVRT (Group II) and AVNRT (Group III). RESULTS: In the VT study, at the same pacing site as of the VP, the MAP was significantly decreased with the VP, and the deltaMAP was significantly increased as the length of the VP cycle shortened. At the same pacing cycle length of the VP, the deltaMAP was significantly greater at the RVA or RVOT than at the LVA. At the same pacing site of the VP, the MLAP and the deltaMLAP were significantly increased as the VP cycle length shortened. In the SVT study, MAP was highest in Group I and it decreased with the decreasing VA interval, but this was not significant. The systolic arterial pressure was significantly higher in Group II than in Group III. The CO was higher in Group I than in the other two groups, with a significant difference, and the CO decreased with shortening of the VA interval, but this was not significant. CONCLUSION: The above results suggest that in addition to the tachycardia rate, the origin site could be an independent factor of the VT hemodynamics. Episodes of AVRT and AVNRT may have a different hemodynamic impact that probably originates from the different timing of the ventricular and atrial contraction.

Predictability of the Left Ventricular Systolic and Diastolic Function according to the QRS Duration for Left Bundle Branch Block Patients

BACKGROUND AND OBJECTIVES: Left bundle branch block (LBBB) is an ECG finding that suggests a poor prognosis for patients suffering with cardiovascular disease. The aim of this study was to elucidate the relation between the QRS duration and the left ventricular function in the patients with LBBB. SUBJECTS AND METHODS: 95 patients (M : F=35 : 60, mean age: 69+/-13 yrs) with LBBB observed on ECG were recruited for this study. The relations among the QRS duration, the demographic.clinical findings and the conventional echocardiographic findings, including the LV systolic and diastolic function, were analyzed for these subjects. RESULTS: The QRS duration was closely related to the LV ejection fraction (r=-0.613, p or =158 msec showed a sensitivity of 73% and a specificity of 77% for predicting a LV EF <35%. CONCLUSION: The QRS duration is an important predictor that reflects the disease progression in patients with LBBB. Therefore, the QRS duration should be closely monitored in symptomatic patients with LBBB.

A Case of Intramural Hematoma Coexisting with Autosomal Dominant Polycystic Kidney Disease and Intracranial Aneurysm

Autosomal dominant polycystic kidney disease(ADPKD) is one of the most common hereditary diseases, and frequently has well defined extrarenal manifestations. Among the fatal vascular complications associated with ADPKD, ruptured intracerebral aneurysm and ruptured abdominal aortic aneurysm are widely known. Intramural hematoma(IMH) is a rare but potentially disastrous complication, and clinicians should always consider this when dealing with patients with ADPKD who present with acute dyspnea or chest pain. We report a case of a 67-year-old woman with the IMH as a fatal complication of ADPKD and intracranial aneurysm.

Prospective, Randomized, Preliminary Clinical Trial with Low-Molecular-Weight Heparin or Unfractionated Heparin as Periprocedural Anticoagulant during Elective Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: LMWH as a periprocedural anticoagulant during PCI has not yet been extensively studied. The aim of this study is to compare the clinical outcomes of enoxaparin to those of unfractionated heparin (UH) during elective PCI. SUBJECTS AND METHODS: The eligible patients were randomized 1:1 into two treatment arms, either a single IV bolus of enoxaparin (75 IU/kg) or UH (100 IU/kg). The patients who had received any anticoagulants at therapeutic doses were excluded in this study. Data on patient characteristics, angiographic complications, laboratory variables and the in-hospital and 1-month clinical outcomes were compared between the two groups. RESULTS: Of the 139 patients enrolled in this study, 68 received enoxaparin and 71 received UH. The patients' demographic and angiographic characteristics (gender, weight, creatinine and the PCI target vessel) were not different except for age between the groups. Multi-vessel angioplasty was performed in 59 (42.4%) patients. At least one stent was implanted in 130 (93.5%) patients. The sheath was removed immediately after PCI, except for one case, and then a collagen plug was applied in all the cases. There were no significant differences in angiographic complications like no reflow, thrombus at the treated lesion site, occlusion of collateral branches, distal embolism, dissection, coronary rupture or abrupt closure. Cardiac markers including CK (6 [8.8%] in the LMWH group vs 8 [11.3%] in the UH group), CK-MB (6 [8.8%] vs 8 [11.3%], respectively), and troponin-I (6 [8.8%] vs 10 [14.1%], respectively) were slightly increased after PCI compared to the last value obtained before the procedure in both groups, but the differences were not statistically significant. One patient in the enoxaparin arm and 2 patients in the UH arm developed NSTEMI during their admission. Four patients from the UH arm and 3 from the enoxaparin arm experienced hematoma at the puncture site. After discharge, no other events were reported at the 1-month follow-up. CONCLUSION: The use of enoxaparin (75 IU/kg) during elective PCI was effective and safe as using UH. Enoxaparin could be used like UH as a periprocedural anticoagulant in the elective PCI setting.

Prospective, Randomized, Preliminary Clinical Trial with Low-Molecular-Weight Heparin or Unfractionated Heparin as Periprocedural Anticoagulant during Elective Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: LMWH as a periprocedural anticoagulant during PCI has not yet been extensively studied. The aim of this study is to compare the clinical outcomes of enoxaparin to those of unfractionated heparin (UH) during elective PCI. SUBJECTS AND METHODS: The eligible patients were randomized 1:1 into two treatment arms, either a single IV bolus of enoxaparin (75 IU/kg) or UH (100 IU/kg). The patients who had received any anticoagulants at therapeutic doses were excluded in this study. Data on patient characteristics, angiographic complications, laboratory variables and the in-hospital and 1-month clinical outcomes were compared between the two groups. RESULTS: Of the 139 patients enrolled in this study, 68 received enoxaparin and 71 received UH. The patients' demographic and angiographic characteristics (gender, weight, creatinine and the PCI target vessel) were not different except for age between the groups. Multi-vessel angioplasty was performed in 59 (42.4%) patients. At least one stent was implanted in 130 (93.5%) patients. The sheath was removed immediately after PCI, except for one case, and then a collagen plug was applied in all the cases. There were no significant differences in angiographic complications like no reflow, thrombus at the treated lesion site, occlusion of collateral branches, distal embolism, dissection, coronary rupture or abrupt closure. Cardiac markers including CK (6 [8.8%] in the LMWH group vs 8 [11.3%] in the UH group), CK-MB (6 [8.8%] vs 8 [11.3%], respectively), and troponin-I (6 [8.8%] vs 10 [14.1%], respectively) were slightly increased after PCI compared to the last value obtained before the procedure in both groups, but the differences were not statistically significant. One patient in the enoxaparin arm and 2 patients in the UH arm developed NSTEMI during their admission. Four patients from the UH arm and 3 from the enoxaparin arm experienced hematoma at the puncture site. After discharge, no other events were reported at the 1-month follow-up. CONCLUSION: The use of enoxaparin (75 IU/kg) during elective PCI was effective and safe as using UH. Enoxaparin could be used like UH as a periprocedural anticoagulant in the elective PCI setting.

A Case of Patent Ductus Arteriosus Associated with Pulmonary Valve Endocarditis

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.

A Case of Patent Ductus Arteriosus Associated with Pulmonary Valve Endocarditis

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.

The Prediction of High Echogenicity of Intimal Area in Carotid Artery for the Plaque Burden of Culprit Lesion in Coronary Artery Disease

BACKGROUND AND OBJECTIVES: The intima-media thickness (IMT) of the common carotid artery has been widely used as a good index of atherosclerosis. The aim of this study was to test the correlation between the thickness of the high echogenicity intimal area (HELIT) on carotid ultrasound and the plaque burden of the culprit lesion on coronary intravascular ultrasound (IVUS). SUBJECTS AND METHODS: In 33 patients (M:F=20:13, mean age 63+/-8 yrs) that underwent coronary angiogram, the HELIT and IMT from carotid ultrasound were compared with the plaque burden of the culprit vessel on IVUS. The high echogenic layer of the intimal area (HELIA) on carotid ultrasound was defined as a thickened echogenic superficial layer at the far wall of the common carotid artery using 15 MHz linear array transducer. The plaque burden was defined as the maximal percent plaque area of the culprit lesion on IVUS. The HELIT and IMT ration was defined as the percent ratio of HELIT on IMT. RESULTS: The mean HELIT, carotid IMT, ratio of HELIT/IMT and maximal percent plaque area of the culprit lesion were 0.27+/-0.03 mm, 0.85+/-0.22 mm, 0.33+/-0.07 and 68.43+/-11%, respectively. The HELIT was closely related to the maximal percent plaque area on IVUS (r=0.34, p<0.05), but not to the other IVUS parameters or risk factors of CAD. CONCLUSION: Our data suggest that the high echogenic layer of the intimal area on carotid ultrasound is predictive of the plaque burden in the culprit vessel.