Prevalence of congenital coronary artery anomalies of korean men detected by coronary computed tomography.

BACKGROUND AND OBJECTIVES: It has been demonstrated that the anomalous origin of coronary arteries (AOCA) are generally asymptomatic and rare diseases. However, some cases can cause severe life threatening events. To detect these anomalies, coronary angiographies and autopsies were used to detect coronary artery anomalies, but these procedures have limitations because of their invasiveness. The new device, Multidetector Computed Tomography (MDCT), now replaces the method of choice for detecting coronary anomalies. The prevalence of these anomalies in Korea has not been studied yet. This present analysis attempted to determine the prevalence of AOCA in Korean men by MDCT. SUBJECTS AND METHODS: 1582 Korean male police officers underwent coronary MDCT for their health screening voluntarily. After reconstruction of CT images, we could confirm coronary artery anomalies. RESULTS: The prevalence of AOCA in Korean men was 1.14% (18 out of 1582 cases). The most common abnormality (11 cases, 0.70%) was the origin of the coronary artery. Anomalies of the coronary artery end point were observed in 5 cases (0.32%). The anomalous location of coronary ostium on the aortic root was observed in 1 case (0.06%). An anomalous collateral vessel was observed in 1 case (0.06%). CONCLUSION: The prevalence of coronary artery anomalies in Korean men was 1.14%. Coronary CT is a safe and noninvasive modality for detecting coronary anomalies.

Chronic kidney disease and metabolic syndrome in a general Korean population: the Third Korea National Health and Nutrition Examination Survey (KNHANES III) Study.

BACKGROUND: The aims of this study are to examine the prevalence of chronic kidney disease (CKD) with metabolic syndrome (MS) and to investigate the association between CKD and MS after adjustment for socioeconomic position and health behavior factor. METHODS: The random sample used in this study included 5136 Korean subjects ≥20 years of age. We divided the subjects into two groups based on the presence of MS, for which the criteria described in the NCEP ATP III and International Diabetes Federation were used. Also, CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m(2). RESULTS: The prevalence of CKD in our study was 6.8%. The age-adjusted prevalence of CKD among those with MS was 9.0% whereas those without MS was 5.6%. After adjusting for age and confounders, people with MS had a 1.77 times greater risk of CKD than those without MS. The adjusted OR increased as the number of MS components increased (P < 0.05). CONCLUSION: The age-adjusted prevalence of CKD in the MS group was higher than that in the non-MS group. After adjustment for socioeconomic position and health behavior factor, MS showed significant association with CKD.

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 (0 < 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.

Frequency of arrhythmic events during head-up tilt testing in patients with suspected neurocardiogenic syncope or presyncope.

Head-up tilt testing (HUT) is a useful diagnostic tool for evaluating suspected neurocardiogenic syncope. Although arrhythmic events during HUT have been occasionally reported, their incidence in a large number of patients is unknown. We aimed to assess the incidence and clinical significance of arrhythmic events in patients with suspected neurocardiogenic syncope who underwent HUT with isoproterenol provocation. For 2,242 patients who underwent HUT, the incidence of total arrhythmic events was 31%: bradyarrhythmias 24%, premature beats 4%, and tachyarrhythmias 3%. For 547 patients who developed bradyarrhythmias during HUT, the incidence of junctional arrhythmias was 92%. For 702 arrhythmic events, the incidence of arrhythmic events during the first phase of HUT was significantly lower than the second phase (p <0.001). The incidence of arrhythmic events in patients with positive HUT responses was significantly higher than in those with negative responses (p <0.001). In patients with positive responses, bradyarrhythmias were noted in 85%, and junctional arrhythmia was the most common arrhythmic event. Of the positive responses, 353 patients (61%) had the vasodepressive type, 181 (32%) patients the mixed type, and the remaining 39 (7%) the cardioinhibitory type. Of 2,242 patients, ventricular fibrillation occurred in 1 patient (0.04%). Thus, bradyarrhythmias were the most common arrhythmic events during HUT with isoproterenol provocation. Serious ventricular tachyarrhythmia rarely occurred.

Cardiopulmonary exercise testing before and one year after mitral valve repair for severe mitral regurgitation.

For the evaluation of efficacy of cardiopulmonary exercise testing, we compared New York Heart Association functional class with peak oxygen consumption rate (VO(2)peak) in 31 patients with severe mitral regurgitation who underwent mitral valve repair surgery. One year later, the VO(2)peak values did not show significant improvement; however, the patients who had more than a mild degree of residual mitral regurgitation (n = 14) after 1 year of surgery had a VO(2)peak value that was significantly decreased (from 22.7 +/- 6.4 to 21.0 +/- 6.3 ml/kg/min, p = 0.04). Patients with a higher preoperative VO(2)peak value (>/=18.5 ml/kg/min) had a significantly better New York Heart Association functional class 1 year after surgery than patients with a lower VO(2)peak value (<18.5 ml/kg/min, p = 0.03).