Clinical Outcomes in Patients with Intermediate Coronary Stenoses: MINIATURE Investigators (Korea MultIceNter TrIal on Long-Term Clinical Outcome According to the Plaque Burden and Treatment Strategy in Lesions with MinimUm Lumen ARea lEss Than 4 mm2 Usin

BACKGROUND AND OBJECTIVES: We evaluated the two-year clinical outcomes in patients with angiographically intermediate lesions according to the plaque burden and treatment strategy. SUBJECTS AND METHODS: We prospectively enrolled patients with angiographically intermediate lesions (diameter stenosis 30-70%) with an intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm2 with 50-70% plaque burden of 16 Korean percutaneous coronary intervention centers. Patients were divided into medical therapy group (n=85) and zotarolimus-eluting stent group (ZES; Resolute) group (n=74). We evaluated the incidences of two-year major adverse cardiovascular events (MACE). RESULTS: A two-year clinical follow-up was completed in 143 patients and MACE occurred in 12 patients. There were no significant differences in the incidences of death (1.3% vs. 3.0%, p=0.471), target vessel-related non-fatal myocardial infarction (0.0% vs. 0.0%, p=1.000) and target vessel revascularizations (7.8% vs. 4.5%, p=0.425) between medical and ZES groups. Independent predictors of two-year MACE included acute myocardial infarction {odds ratio (OR)=2.87; 95% confidence interval (CI) 1.43-6.12, p=0.014}, diabetes mellitus (OR=2.46; 95% CI 1.24-5.56, p=0.028) and non-statin therapy (OR=2.32; 95% CI 1.18-5.24, p=0.034). CONCLUSION: Medical therapy shows comparable results with ZES, and myocardial infarction, diabetes mellitus and non-statin therapy were associated with the occurrence of two-year MACE in patients with intermediate lesion with IVUS MLA <4 mm2 with 50-70% of plaque burden.

The Comparative Clinical Effects of Valsartan and Ramipril in Patients With Heart Failure

BACKGROUND AND OBJECTIVES: Angiotensin II receptor blocker (ARB) has emerged as an alternative to angiotensin converting enzyme inhibitor (ACEI) for the treatment of heart failure. This study aimed at comparing the effectiveness and safety of valsartan with ramipril in patients with heart failure, and these patients were hospitalized at Chonnam National University Hospital, Wonkwang University Hospital, Gunsan Medical Center, Presbyterian Medical Center, Seonam University Hospital and Gwangju Christian Hospital. SUBJECTS AND METHODS: Between March 2005 and March 2007, 82 patients (60.5+/-12.4 years, 59 males) who complained of class II to IV dyspnea, according to the New York Heart Association (NYHA) classification, and who had low left ventricular ejection fraction (LVEF) less than 50% were randomly allocated to valsartan or ramipril. After 6 months, the clinical symptoms, vital signs, biochemical tests and echocardiography were compared between the two groups. RESULTS: The NYHA class was improved in both groups (the valsartan group: 2.31+/-0.51 vs. 1.46+/-0.58, p<0.001; the ramipril group: 2.21+/-0.55 vs. 1.61+/-0.50, p<0.001). The incidence of cough, as measured by the cough index, was significantly lower in the valsartan group than in the ramipril group (p=0.045). The LVEF was improved in both groups (the valsartan group: 36.4+/-8.5% vs. 46.9+/-12.9%, p<0.001; the ramipril group: 35.1+/-8.5% vs. 45.3+/-11.2%, p<0.001). The improvements of the left ventricular end-systolic dimension (p=0.754) and end-diastolic dimension (p=0.998) were not different between the two groups. N-terminal Pro-B-type natriuretic peptide level was improved in both groups (the valsartan group: 2619.6+/-4213.5 vs. 995.4+/-2186.0 pg/mL, p=0.012; the ramipril group: 3267.9+/-4320.0 vs. 828.1+/-1232.8 pg/mL, p=0.009), and there was no difference between the groups (p=0.877). CONCLUSION: Both valsartan and ramipril were effective treatments, with relatively low adverse events, in patients with heart failure.

A Case of Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus in a 15-year-old Boy Suffered from Exertional Syncope

We report a case of an anomalous origin of the left coronary artery from the right aortic sinus in young boy with exertional syncope. A 15-year-old boy was admitted to the hospital because of severe retrosternal chest pain followed by syncope during exertion. He had a similar history of syncope during exercise previously. On site transthoracic echocardiography showed that abnormal color mosaics course between aorta and pulmonary artery, suggesting the anomalous left coronary artery originated from the right aortic sinus, and the definite diagnosis was made by multidetector computed tomography (MDCT) thereafter. Coronary angiography showed anomalous origin of the left main coronary artery (LMCA) from the right coronary sinus. The right coronary artery was normal. Mid portion of the LMCA was angulated and narrowed significantly. Surgical correction of the left coronary artery by reimplantation of the ostium to the left aortic sinus and augmentation of the ostium using oval vein patch was performed successfully.

A Case of Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus in a 15-year-old Boy Suffered from Exertional Syncope

We report a case of an anomalous origin of the left coronary artery from the right aortic sinus in young boy with exertional syncope. A 15-year-old boy was admitted to the hospital because of severe retrosternal chest pain followed by syncope during exertion. He had a similar history of syncope during exercise previously. On site transthoracic echocardiography showed that abnormal color mosaics course between aorta and pulmonary artery, suggesting the anomalous left coronary artery originated from the right aortic sinus, and the definite diagnosis was made by multidetector computed tomography (MDCT) thereafter. Coronary angiography showed anomalous origin of the left main coronary artery (LMCA) from the right coronary sinus. The right coronary artery was normal. Mid portion of the LMCA was angulated and narrowed significantly. Surgical correction of the left coronary artery by reimplantation of the ostium to the left aortic sinus and augmentation of the ostium using oval vein patch was performed successfully.

Papillary Muscle Rupture Complicating a Papillary Muscle Abscess

Spontaneous rupture of a papillary muscle from a papillary abscess is extremely rare. Most cases of papillary muscle ruptures are due to myocardial infarction or trauma. We describe the clinical course of a 68-year-old man who died from a papillary muscle rupture as a complication of a papillary muscle abscess due to Streptococcal pyogenes septicemia.

A Case of Non-Functioning Huge Adrenocortical Carcinoma Extending Into Inferior Vena Cava and Right Atrium

Primary adrenocortical carcinoma (ACC) is a rare tumor and its usual sites of metastasis are the lung (71%), lymph node (68%), liver (42%), and bone (26%). However, intracaval invasion extending into the right atrium is very rare and spontaneous regression of tumor burden in adrenal carcinoma is also rare. We report a case of ACC with direct invasion of the inferior vena cava and right atrium. A 34-yr-old male patient presented with progressive dyspnea, weight loss, and poor oral intake over 3 months. Non-functioning ACC with direct invasion of the inferior vena cava and right atrium was confirmed by imaging, pathologic, and hormonal study. Chemo-radiotherapy was attempted. However, tumor burden was not changed, but rather toxic hepatitis and thrombocytopenia were developed. His subjective symptoms and general conditions were improved after 1 month of conservative management and the patient was discharged. During clinical follow-up, this tumor showed spontaneous regression.

The Relationship between Hemoglobin A1c and Major Adverse Cardiac Events in Nondiabetic Acute Myocardial Infarction Patients Underwent Primary Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Hyperglycemia on hospital admission is a known important risk factor in patients with acute myocardial infarction. The purpose of this study was to investigate the relation between the level of hemoglobin A1c (HbA1c) and major adverse cardiac events (MACE) in non-diabetic acute myocardial infarction patients who underwent primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: Of the 105 acute myocardial infarction patients who underwent primary PCI between January 2002 and December 2002, 68 non diabetic patients were analyzed. The patients were divided into two groups: group I (n=46, 58.7+/-12.5 years, 37 male) with low levels of HbA1c (<6%) and group II (n=22, 64.6+/-13.1 years, 18 male) with elevated levels of HbA1c (6% to 7%). MACE was observed during the six-month clinical follow-up. RESULTS: There were no differences in the risk factors for atherosclerosis and angiographic characteristics between the two groups. Group II had a significantly higher rate of MACE (13% vs. 36%, p=0.026) compared to Group I. Logistic regression analysis disclosed that an elevated level of HbA1c, between 6 and 7%, was a significant independent predictor of MACE. CONCLUSION: An elevated level of HbA1c is a significant prognostic factor in non-diabetic acute myocardial infarction patients after primary PCI.

Clinical Values of the Posterior Chest Leads for Patients with Myocardial Infarction

BACKGROUND AND OBJECTIVES: The standard 12 lead electrocardiography (ECG) is very valuable in the evaluation of myocardial infarction (MI), but it has many limitations for the diagnosis of posterior wall MI. We investigated the ECG patterns of the posterior chest leads in the normal population and we also investigated the values of the posterior chest leads when evaluating the involvement of the posterior wall in patients with MI. SUBJECTS AND METHODS: To determine the normal ECG patterns of the posterior chest leads (V7-9), 52 healthy young men undergoing military service and 60 patients with MI (acute MI: 50 patients, old MI: 10 patients) were enrolled. We compared the sensitivity and specificity between the leads V1-2 and V7-9 for diagnosing posterior wall MI. RESULTS: In the normal population, the prevalence of the pathologic Q wave was 0% in leads V7 and V8, and 7.5% in lead V9. None of the controls had an ST elevation more than 0.5 mm. For diagnosing posterior wall MI, the sensitivity was 36.4% for leads V1-2 and 72.7% for leads V7-9 and the specificity was 84.2% for leads V1-2 and 86.8% for leads V7-9. The left circumflex coronary artery lesions were more common in patients with concomittent inferior and posterior MI than in patients with isolated inferior wall MI (20.0% vs 6.6%, respectively, p=ns). All the patients with lateral wall MI or pure posterior wall MI had a lesion only in the left circumflex coronary artery. However, posterior wall involvement in patients with inferior wall MI did not exert any significant influence on the in-hospital course. CONCLUSION: Our results suggest that the recording of posterior chest leads (V7-9) is a simple and valuable method for evaluating posterior wall involvement in patients with MI.

Is Thyroid Hormone a Risk Factor of Coronary Atherosclerosis in Korean Patients?

BACKGROUND AND OBJECTIVES: Overt and subclinical hypothyroidism is known to be associated with developing atherosclerosis and adverse changes in blood lipid. There has been no data regarding the effects of a normal range of thyroid hormone on the presence of coronary atherosclerosis. SUBJECTS AND METHODS: We studied 1 25 consecutive patients (age: 60.0 +/-11.1 years, male: female=84:41) who underwent diagnostic coronary angiography. The clinical diagnoses on admission were stable angina (32.0%), unstable angina (53.6%), and acute myocardial infarction (14.4%). The thyroid hormones [thyroid stimulating hormone (TSH), free thyroxine and free 3 -iodothyronine], serum lipid levels, high sensitivity C-reactive protein (hsCRP) level, homocysteine and fibrinogen levels were measured. The coronary angiographic results were compared with laboratory findings. RESULTS: The angiographic diagnoses of coronary artery disease were no significant stenosis in 4 1 patients (32.8%), single vessel disease in 47 patients (37.6%) and multivessel disease in 37 patients (29.6%). The serum TSH levels showed a trend toward higher levels in the patients with multivessel disease compared to the patients with no significant stenosis (1.22+/-0.96 uIU/mL vs. 0.73+/-0.53 uIU/mL, respectively, p=0.053). According to the levels of TSH ( or =1.0 IU/mL), the incidence of multivessel disease was significantly higher in the patients with high serum TSH levels (23.1 % vs. 40.0%, respectively, p=0.038). A significant correlation was observed between the levels of TSH and the monocyte count (r=0.251, p=0.005), hsCRP level (r=0.208, p=0.023) and homocysteine level (r=0.279, p=0.002). CONCLUSION: The high level of serum TSH is associated with multivessel disease, abnormal inflammatory markers and high homocysteine levels.

The Relationship between Microalbuminuria and Coronary Artery Stenosis or Inflammatory Markers in Patients with Angina Pectoris

BACKGROUND AND OBJECTIVES: Microalbuminuria is associated with increased cardiovascular risk factors and mortality. The aims of this study were to clarify the relationship between the spot urine albumin-creatinine ratio (ACR) and coronary artery stenosis on diagnostic coronary angiograms and to investigate its association with inflammatory markers. SUBJECTS AND METHODS: One hundred thirteen consecutive patients, who underwent a diagnostic coronary angiogram, between April 2004 and July 2004, were divided into two groups: group I (n=89, 58+/-1 2 years, 6 1 male, no microalbuminuria) and group II (n=24, 65+/-10 years, 14 male, microalbuminuria). Microalbuminuria was diagnosed when the ACR was between 30 and 300 mg/g.cr. RESULTS: The mean age was higher in group II than group I (58+/-1 2 vs. 65+/-1 0 years, p=0.013), and group II also showed higher levels of white blood cell (7.0+/-2.4 vs. 9.5+/-4.1 x 103/mm3, p=0.009), monocyte (0.4+/-0.2 vs. 0.5+/-0.2 x 103/mm3, p=0.039), homocysteine (8.8+/-3.5 vs. 10.8+/-4.1 micro mol/L, p=0.02) and fasting plasma glucose (126.1+/-33.6 vs. 183.7+/-75.3mg/dL, p=0.001), and more frequent higher value of high sensitivity C-reactive protein (>0.5mg/dL) (16.9 vs. 66.7%, p<0.001 ) compared with those of group I. There was a correlation between the ACR and all the inflammatory markers tested. Significant coronary lesions, requiring percutaneous coronary intervention, were more frequently detected in group II than in group I (50.6 vs. 75%, p=0.032). CONCLUSION: The ACR was associated with significant coronary artery disease and the inflammatory markers.

Predictive factor of the third coronary stent restenosis / 대한내과학회지

BACKGROUND: Percutaneous coronary intervention (PCI) has been established as one of the effective therapeutic methods in the treatment of ischemic heart disease. A coronary artery stent is the most promising device in PCI, however in-stent restenosis (ISR) remains a major problem to be overcome. METHODS: Follow-up coronary angiograms (CAG) three times after stenting were performed in 107 out of 3,816 stented patients at Chonnam National University Hospital between August 1992 and July 2004. The patients were divided into four groups: forty eight patients (Group I: 58.7+/-9.5 years, 35 Males) had no incident ISR on three follow-up CAG. Fourteen patients had three times of ISR and underwent four PCIs (Group II : 54.5+/-9.51 years, 12 Males), 15 had two times of ISR and underwent three PCIs (Group III : 53.9+/-5.9 years, 11 males), 30 had one time of ISR and underwent two PCIs (Group IV : 59.6+/-9.5 years, 27 males). Each group was analysed according to clinical characteristics, coronary angiographic findings, and therapeutic modalities for ISR. RESULTS: There was no differences in clinical diagnosis, lesion location, multi-vessel lesion and TIMI flow. Risk factors for atherosclerosis were not different except for diabetes mellitus. The incidence of diabetes mellitus was more common in Group II than in Group I (Group I: 22%, Group II: 57%, Group III: 46%, Group IV: 20%, Group I vs. Group II: p =0.023). Stent length and diameter were not different among four groups. CONCLUSION: The only predictor of recurrent coronary stent restenosis more than three times is diabetes mellitus.

Usefulness Of The Measurement Of The Plasma NT-ProBNP Level For The Prediction Of The Postoperative Cardiac Risk In Elderly Patients / 대한내과학회지

BACKGROUND: The prediction of the postoperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to predict the outcome, but their usefulness has neither been evaluated nor been widely used. The purpose of this study was to assess the NT-proBNP as a prognostic factor for the prediction of the postoperative cardiac risk as compared with the existing cardiac indices in elderly patients undergoing orthopedic surgery. METHODS: From September 2003 to January 2004, we examined 50 patients older than 60 years, who were scheduled to undergo orthopedic surgery. The plasma NT-proBNP concentration, clinical cardiac indices and left ventricular ejection fraction were measured prior to the operation. The postoperative outcomes were followed and predictors for postoperative cardiac risk were identified. RESULTS: Cardiac complications occurred in 22% of the patients. A statistically significant increase in the cardiac complications was observed in the patients with higher plasma concentration of NT-proBNP (p<0.001), higher original cardiac index score (p<0.001), higher revised cardiac index score (p=0.004) and that fell into the major group of the American college of cardiology/American heart association guidelines (p=0.018). The NT-proBNP concentrations were positively correlated with the original cardiac index score (r=0.666, p<0.001), revised cardiac index score (r=0.429, p=0.002) and grouping by the ACC/AHA guidelines (r=0.497, p<0.001). The area under the receiver-operating characteristic curve for the plasma NT-proBNP (0.946, 95% CI) was superior to the other cardiac indices. The optimal cut-off point for the prediction of postoperative cardiac complications occurred at a plasma NT-proBNP, concentration of 539.3 pg/mL and provided a 90.9% sensitivity, 92.3% sensitivity, 79.9% positive predictive value and 97.3% negative predictive value. The independent predictors for postoperative adverse cardiac event were age and Goldman index. CONCLUSION: The plasma NT-proBNP level may be a useful parameter for the prediction of postoperative cardiac complications.

The Clinical Effects of Drug-Eluting Stents for the Treatment of Coronary In-Stent Restenosis

BACKGROUND AND OBJECTIVES: Treating coronary in-stent restenosis (ISR) has become one of the major challenges for the interventional cardiologist. The aim of this study was to determine the feasibility and safety of treating ISR with drug eluting stents (DESs), and we also wanted to determine the effect of DESs on the prevention of recurrent restenosis. SUBJECTS AND METHODS: Eighty patients (age range: 60.9+/-6.4 year-old, males:females=63:17) with 82 ISR lesions that were treated successfully with DES (sirolimus- and paclitaxel-eluting stents) were enrolled in our study. Five patients received 2 stents for a total mean of 1.1+/-0.3 stents per lesion. The major adverse cardiac events (MACEs) during hospitalization, at 30 days and at 6 months after the stenting were analyzed along with the coronary angiographic findings. RESULTS: At the time of DES implantation, the mean number of ISRs was 1.4+/-0.9, and the patterns of ISR according to the Mehran classification were IB in 9 lesions (10.5%), IC in 3 lesions (3.7%), ID in 6 lesions (7.3%), II in 19 lesions (23.2%), III in 30 lesions (36.7%), and IV in 15 lesions (18.3%). The mean stent length was 27.1+/-5.6 mm and the mean acute gain was 2.58+/-0.67 mm. No in-hospital MACE was observed. During the 30-day clinical follow-up, one patient developed acute myocardial infarction due to a subacute stent thrombosis. Forty two patients with 43 lesions underwent a 6-month follow-up coronary angiogram. The mean late loss at 6 months was 0.30+/-0.74 mm. The binary restenosis rate was 9.3% (4/43 lesion). The restenosed lesions were treated by balloon angioplasty in three lesions and by additional DES implantation in one lesion. CONCLUSION: Our results demonstrated that DES was a safe and very effective method for the treatment of ISR.

The Acute Effects of Cigarette Smoking on the Heterogeneity of Ventricular Repolarization in Healthy Subjects: The Relationship between QT Dispersion and Coronary Flow Reserve

BACKGROUND AND OBJECTIVES: Although cigarette smoking is a known risk factor for sudden cardiac death, little is known about the effects of smoking on the heart. The QT interval and QT dispersion prolongation have been associated with a lower ventricular fibrillation threshold and the occurrence of sudden cardiac death. Smoking has an unfavorable influence on the autonomic balance and myocardial blood flow. The objective of the current study was to evaluate the relationship between the QT dispersion and coronary flow reserve (CFR) in healthy young male subjects. SUBJECTS AND METHODS: The study included a sample of 30 healthy young male cigarette smokers. The catecholamines level, QTc dispersion, heart rate variability and myocardial blood flow were measured, immediately before and 5 minutes after and during the smoking of 3 cigarettes. RESULTS: Short-term smoking caused significant increases in the serum cortisol (10.9+/-4.9 vs. 15.0+/-7.0 microgram/dL, p<0.01), serum epinephrine (0.038+/-0.026 vs. 0.046+/-0.026 ng/mL, p=0.044), heart rate (78+/-9 vs. 85+/-8 beats/min, p<0.01), maximal QTc interval (412+/-22 vs. 435+/-20 ms, p<0.01), QTc dispersion (43+/-14 vs. 62+/-17 ms, p<0.01), LFnu (68+/-9 vs. 78+/-6%, p<0.01), LF/HF (3.25+/-2.15 vs. 5.22+/-1.89, p<0.01) and peak diastolic velocity (21.7+/-3.9 vs. 23.9+/-5.5 cm/sec, p=0.005), and a decrease in the CFR (3.71+/-0.56 vs. 3.42+/-0.76, p=0.024). The change in the QTc dispersion was closely related to the change in the CFR (r=-0.357, p=0.043). CONCLUSION: The present study is the first to demonstrate that the impaired coronary flow reserve after smoking may contribute to the increased inhomogeneity of ventricular repolarization in healthy young male smokers.

The Effects of Abciximab(ReoPro(r))-Coated Stents on Extracellular Matrix Synthesis and Apoptosis

BACKGROUND AND OBJECTIVES: The most important mechanism of coronary stent restenosis is neointimal hyperplasia (NIH). In addition to neointimal cell proliferation, synthesis of the extracellular matrix (ECM) may be important for the induction of NIH. The effects of the abciximab (ReoPro(r))-coated stent on the ECM synthesis and cellular apoptosis in coronary stent restenosis were observed. MATERIALS AND METHODS: Twenty one abciximab-coated stents and 21 control stents were placed in porcine coronary arteries and histopathologic analyses were performed at 14 days, 28 days and 56 days after the stenting procedures, respectively. Each specimen was analyzed by hematoxylin and eosin staining, modified Movat, immunohistochemical staining and TUNEL analysis. RESULTS: The area of neointima in the abciximab-coated stents was reduced by 45.7% and 45.5% of the control stents at 28 days and 56 days after stenting, respectively (1.9+/-0.5 vs. 3.5+/-0.7 mm2, 2.4+/-0.5 vs. 4.4+/-0.6 mm2, p=0.012, 0.001, respectively). The content ratio of the proteoglycan of the abciximab-coated stents was reduced by 23% at 14 days (12.4+/-4.4 vs. 16.1+/-4.3%, respectively, p=0.041) and the content ratio of collagen in the abciximab-coated stents was reduced by 19.7% and 25% at 28 days and 56 days, respectively (27.7+/-5.0 vs. 34.5+/-8.7%, 36.6+/-10.5 vs. 48.8+/-12.7%, p=0.021, 0.001, respectively). The proliferating cell nuclear antigen index of neointima for the abciximab-coated stents was reduced by 22.2% at 14 days (10.5+/-5.4 vs. 13.5+/-8.4%, respectively, p=0.022). There was no significant difference in the apoptosis, as was determined by TUNEL analysis between the two groups on the 56-day follow-up after stenting. CONCLUSION: The Abciximabcoated stent inhibits ECM synthesis, but it does not inhibit apoptosis in a porcine stent restenosis model.

The Combined Use of Adenosine Stress Echocardiography and Myocardial Perfusion Imaging for Diagnosis of Coronary Artery Stenosis in Angina Patients

BACKGROUND AND OBJECTIVES: Adenosine, a myocardial stressor and a potent vasodilator, has a short half life and few side effects. The purpose of this study was to clarify the safety and clinical usefulness of combined adenosine stress echocardiography with adenosine stress myocardial perfusion imaging for the detection of coronary artery stenosis in angina patients. METHODS: The study population consists of 78 patients who had no history of previous infarction or coronary intervention. Adenosine stress echocardiography and adenosine stress myocardial perfusion imaging were done in the same protocol several hours to one day prior to coronary angiography. Adenosine was infused under hemodynamic, ECG, and echocardiographic monitoring in dose of 0.14 mg/Kg/min, and stopped when new or worsening wall motion abnormality was developed or intolerable side effects were occurred. After three minutes of adenosine infusion, Tc-99m tetrofosmin (Myoview(R)) of 20 mCi was injected and perfusion imaging was taken 4 hours later. RESULTS: For the diagnosis of significant coronary artery disease in the angina patients, the sensitivity of adenosine stress echocardiography was 750%, that of adenosine stress myocardial perfusion imaging 71.4%, and that of combined use of both methods was increased to 91.7%. The specificity was 76.1%, 92.9%, and 66.7%, respectively. Forty seven patients (60.3%) had some side effects. They were chest discomfort (29.8%), dyspnea (23.4%), headache (17.0%), chest pain (14.9%), neck discomfort, and palpitation in descending order. The study was stopped because of severe chest pain in only one case. CONCLUSION: Although adenosine stress echocardiography and adenosine stress myocardial perfusion imaging showed similar levels of less sensitivity for diagnosis of coronary artery stenosis in the angina patients, the combined use and interpretation of both methods showed relatively higher sensitivity in comparison with either adenosine stress echocardiography or myocardial perfusion imaging alone.

The Usefulness of Color M-mode Doppler Echocardiographic Indices in the Assessment of Left Ventricular Diastolic Function

BACKGROUND AND OBJECTIVES: Early color M-mode Doppler flow propagation (Vp) has been used to distinguish pseudonormal from normal diastolic filling patterns. However, the role of other indices, including the late diastolic propagation velocity (Ap) and time delay of mitral flow propagation (VpTD and ApTD), is not clear. SUBJECTS AND METHODS: Doppler echocardiographic examinations were performed in 89 patients (60.6+/-9.9 years, male 59.6%), with an ejection fraction > or =40%, who were admitted for diagnostic coronary angiography. The clinical diagnoses on admission were stable angina (41.6%), unstable angina (30.3%), old myocardial infarction (24.7%) and atypical chest pain (3.3%) The diastolic filling patterns, as confirmed by mitral inflow and pulmonary venous flow, were compared with the Ap, VpTD and ApTD indices using color M-mode Doppler echocardiography. RESULTS: The age, left ventricular ejection fraction, left ventricular end diastolic and end systolic dimensions, the left atrial size, and the E'and A'velocities of the mitral annulus tissue Doppler were significantly different between patients with normal and abnormal diastolic filling patterns. In patients with normal filling, impaired relaxation and pseudonormalized filling patterns, the VpTD were 63.1+/-14.9, 85.2+/-25.5 and 107.8+/-36.8 ms (p<0.001), the E/Vp were 1.3+/-0.4, 1.6+/-0.6 and 3.1+/-0.7 (p<0.001), and the E/VpTD were 1.2+/-0.5, 0.7+/-0.2 and 0.9+/-0.4 (p<0.001), respectively. The Ap and ApTD showed significant differences between patients with normal and pseudonormalized filling patterns (Ap 58.3+/-23.5 vs. 36.2+/-15.1, p=0.000; ApTD 47.1+/-19.5 vs. 66.7+/-22.2, p=0.001). The PVa duration, an index that depends on the left ventricular end-diastolic pressure, was the most important independent predictor for ApTD from a multiple regression analysis (R2=71.4%). CONCLUSION: The color M-mode Doppler indices, Ap, VpTD and ApTD, are new diagnostic parameters for diastolic dysfunction.

Short-Term Effect of High Dose of Vitamin C on Coronary Flow Velocity and Coronary Flow Reserve in Healthy Young Non-Smoker Men

BACKGROUND AND OBJECTIVES: Vitamin C, water-soluble antioxidant, has been reported to restore coronary microcirculatory responsiveness and impaired coronary flow reserve in smokers. However, the effect of high dose of vitamin C on coronary circulation is unclear in nonsmokers. METHODS: We used transthoracic echocardiography to measure the coronary flow reserve, an integrated measure of coronary flow in 20 male healthy nonsmokers (26+/-3 years) before and after administration of the high dose of vitamin C. RESULTS: The coronary peak diastolic velocity was increased by 14.8% after administration of antioxidant vitamin C, whereas the coronary flow reserve did not changed. CONCLUSION: High dose of vitamin C acutely increases the coronary flow velocity without restoration of coronary flow reserve in male healthy nonsmokers.

Micturition syncope / 대한내과학회지

No abstract available.

Alterations of Autonomic Nervous Activity Associated with Spontaneous Coronary Spasm in Patients with Variant Angina

BACKGROUND AND OBJECTIVES: It is now well known that coronary artery spasm plays an important role in the pathogenesis of variant angina. Previous studies have shown that stimulation of the sympathetic or parasympathetic nervous system can provoke coronary artery spasms, although the precise causes of such spasms remain unclear. Power spectral analysis of heart rate variability has been proposed as a noninvasive parameter of autonomic nervous activity. To determine the possible role of the autonomic nervous system in the development of variant angina, we used spectral analysis of heart rate variability obtained from ambulatory Holter monitoring in patients with ST-elevation and chest pain to clarify the alterations of autonomic activity before angina. SUBJCETS AND METHODS: Cardiac autonomic nervous activities were evaluated from the power of the low-frequency and the high-frequency spectral components of heart rate variability obtained from Holter monitoring in a total of 18 episodes of 12 patients with variant angina. Samples during each 10-minute period from 60 minutes before to immediately before an anginal attack were analyzed by fast Fourier transformation. RESULTS: Significant organic coronary stenosis and multiple coronary spasms were detected by coronary angiography in two (20%) and four (40%) of the patients, respectively. The values of the power of the low-frequency component and the low-to-high frequency ratio were significantly greater during the 10-to 0-minute period than during the other 10-minute periods. CONCLUSION: Sympathovagal imbalance - or sympathetic activation without parasympathetic augmentation - enhanced in the 10-minute period before an anginal attack may play an important role in the genesis of coronary artery spasms in patients with variant angina.