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1.
J Cardiovasc Ultrasound ; 24(2): 163-7, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27358710

ABSTRACT

We report a case of successfully treated acute fulminant myocarditis induced by ulcerative colitis with extracorporeal life support and infliximab. Myocarditis is a rare but crucial complication during an exacerbation of inflammatory bowel disease. In our case, we applied extracorporeal membrane oxygenation (ECMO) for cardiac rest under impression of acute myocarditis associated with ulcerative colitis, and added infliximab for uncontrolled inflammation by corticosteroid. As a result, our patient was completely recovered with successful weaning of ECMO.

3.
Yonsei Med J ; 56(6): 1552-8, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26446636

ABSTRACT

PURPOSE: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, largescale study about the acute cardiovascular events following electrical cardioversion of AF is lacking. This study was performed to evaluate the incidence, risk factors, and clinical consequences of acute cardiovascular events following electrical cardioversion of AF. MATERIALS AND METHODS: The study enrolled 1100 AF patients (mean age 60±11 years) who received cardioversion at four tertiary hospitals. Hospitalizations for stroke/transient ischemic attack, major bleedings, and arrhythmic events during 30 days post electric cardioversion were assessed. RESULTS: The mean duration of anticoagulation before cardioversion was 95.8±51.6 days. The mean International Normalized Ratio at the time of cardioversion was 2.4±0.9. The antiarrhythmic drugs at the time of cardioversion were class I (45%), amiodarone (40%), beta-blocker (53%), calcium-channel blocker (21%), and other medication (11%). The success rate of terminating AF via cardioversion was 87% (n=947). Following cardioversion, 5 strokes and 5 major bleedings occurred. The history of stroke/transient ischemic attack (OR 6.23, 95% CI 1.69-22.90) and heart failure (OR 6.40, 95% CI 1.77-23.14) were among predictors of thromboembolic or bleeding events. Eight patients were hospitalized for bradyarrhythmia. These patients were more likely to have had a lower heart rate prior to the procedure (p=0.045). Consequently, 3 of these patients were implanted with a permanent pacemaker. CONCLUSION: Cardioversion appears as a safe procedure with a reasonably acceptable cardiovascular event rate. However, to prevent the cardiovascular events, several risk factors should be considered before cardioversion.


Subject(s)
Atrial Fibrillation/complications , Atrial Fibrillation/therapy , Cardiovascular Diseases/etiology , Electric Countershock/methods , Stroke/etiology , Aged , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/epidemiology , Bradycardia/epidemiology , Bradycardia/etiology , Cardiovascular Diseases/epidemiology , Female , Heart Failure/epidemiology , Heart Failure/etiology , Humans , Incidence , Male , Middle Aged , Risk Factors , Stroke/diagnosis , Stroke/epidemiology , Treatment Outcome
4.
J Echocardiogr ; 13(1): 35-42, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25750578

ABSTRACT

BACKGROUND: The pathophysiology of diastolic dysfunction is complex, but can be simply described as impaired LV myocardial relaxation and/or increased LV stiffness. The objective of this study is to clarify true normal left ventricular (LV) diastolic function and early stage of diastolic dysfunction before relaxation abnormality develops in patients with normal LV diastolic function using simple diastolic wall strain (DWS) in South Korea. METHODS: DWS which is a non-invasive, load-independent, and reproducible estimator of LV stiffness using two-dimensional echocardiography using the difference between posterior wall thickness in systole and diastole to approximate LV stiffness. A total of 349 consecutive patients with normal LV diastolic function by echocardiography were enrolled. According to DWS, patients were divided into two groups: high DWS (≥median 175) vs. low DWS (

Subject(s)
Diastole/physiology , Echocardiography, Doppler , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/physiology , Ventricular Remodeling , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Republic of Korea/epidemiology , Systole/physiology , Ventricular Dysfunction, Left/diagnostic imaging
5.
Korean J Intern Med ; 30(1): 49-55, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25589835

ABSTRACT

BACKGROUND/AIMS: In the bare-metal stent era, routine follow-up coronary angiography (RFU CAG) was used to ensure stent patency. With the advent of drug-eluting stents (DESs) with better safety and efficacy profiles, RFU CAG has been performed less often. There are few data on the clinical impact of RFU CAG after second- or third-generation DES implantation in clinically stable patients with coronary artery disease; the aim of this study was to examine this issue. METHODS: We analyzed clinical outcomes retrospectively of 259 patients who were event-free at 12-month after stent implantation and did not undergo RFU CAG (clinical follow-up group) and 364 patients who were event-free prior to RFU CAG (angiographic follow-up group). Baseline characteristics were compared between the groups. RESULTS: The Kaplan-Meier estimated total survival and major adverse cardiac event (MACE)-free survival did not differ between the groups (p = 0.100 and p = 0.461, respectively). The cumulative MACE rate was also not different between the groups (hazard ratio, 0.85; 95% confidence interval, 0.35 to 2.02). In the angiographic follow-up group, 8.8% revascularization was seen at RFU CAG. CONCLUSIONS: RFU CAG did not affect long-term clinical outcome after second- or third-generation DES implantation in clinically stable patients.


Subject(s)
Coronary Angiography , Coronary Artery Disease/therapy , Coronary Vessels/diagnostic imaging , Drug-Eluting Stents , Percutaneous Coronary Intervention/instrumentation , Aged , Coronary Artery Bypass , Coronary Artery Disease/diagnostic imaging , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/etiology , Coronary Restenosis/surgery , Disease Progression , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Myocardial Infarction/surgery , Patient Selection , Percutaneous Coronary Intervention/adverse effects , Predictive Value of Tests , Proportional Hazards Models , Prosthesis Design , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome
6.
Europace ; 17(7): 1051-8, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25600764

ABSTRACT

AIMS: Successful rhythm control after atrial fibrillation catheter ablation is known to induce left atrial reverse remodelling and improve left ventricular (LV) function. We explored the clinical factors affecting LV systolic and diastolic function 1-year after catheter ablation for atrial fibrillation. METHODS AND RESULTS: We compared pre-procedural and 1-year follow-up echocardiograms in 521 patients with atrial fibrillation who underwent catheter ablation. Left ventricular systolic function was estimated by the ejection fraction (EF); diastolic function was estimated by the ratio of early transmitral flow velocity (E) to early mitral annular velocity (Em). (i) Catheter ablation of atrial fibrillation significantly reduced left atrium volume index (P < 0.001) and improved LV EF both in patients with recurrent atrial fibrillation (n = 133, P = 0.008) and those without recurrence (n = 388, P < 0.001). (ii) Follow-up EF was significantly improved in patients with baseline E/Em < 15 (n = 454, P < 0.001), whereas E/Em was significantly reduced in patients with pre-procedural E/Em ≥ 15 (n = 67, P = 0.008). (iii) Baseline E/Em < 15 (ß = -3.854, 95% CI -5.99 to -1.72, P < 0.001), baseline EF <50% (ß = 10.586, 95% CI 7.55 to 13.63, P < 0.001), and female (ß = -1.726, 95% CI -3.36 to -0.10, P = 0.038) were independently associated with improved EF. Baseline E/Em ≥ 15 (ß = 4.896, 95% CI 3.45 to 6.34, P < 0.001) and younger age (ß = -0.066, 95% CI -0.11 to -0.02, P = 0.003) were independent factors associated with improved E/Em. CONCLUSION: Pre-procedural E/Em predicted improvement in LV systolic and diastolic functions 1 year after catheter ablation for atrial fibrillation. Low baseline E/Em was independently associated with improved EF, while high E/Em predicted improvement in LV diastolic function.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Image Interpretation, Computer-Assisted/methods , Mitral Valve/diagnostic imaging , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/surgery , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Blood Flow Velocity , Female , Humans , Male , Middle Aged , Mitral Valve/physiopathology , Prognosis , Reproducibility of Results , Sensitivity and Specificity , Stroke Volume , Treatment Outcome , Ultrasonography , Ventricular Dysfunction, Left/etiology
7.
J Clin Med Res ; 7(1): 62-4, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25368706

ABSTRACT

The clinical presentation of Kawasaki disease (KD) is variable and clinical implication among adults is rarely important but coronary involvement. Here we report a young patient showing recurrent acute coronary syndrome (ACS) who had a history of high-grade fever and conjunctivitis when he was little. Coronary angiography revealed aneurysmal coronary artery change in this patient. There is no particular consensus on guidelines for treatment for KD in case of coronary aneurysm causing ACS. In this case, we treated him medically without stent implantation successfully.

8.
Yonsei Med J ; 55(4): 928-36, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24954320

ABSTRACT

PURPOSE: Recent studies show positive association of early repolarization (ER) with the risk of life-threatening arrhythmias in patients with coronary artery disease (CAD). This study was to investigate the relationships of ER with myocardial scarring and prognosis in patients with CAD. MATERIALS AND METHODS: Of 570 consecutive CAD patients, patients with and without ER were assigned to ER group (n=139) and no ER group (n=431), respectively. Myocardial scar was evaluated using cardiac single-photon emission computed tomography. RESULTS: ER group had previous history of myocardial infarction (33% vs. 15%, p<0.001) and lower left ventricular ejection fraction (57±13% vs. 62±13%, p<0.001) more frequently than no-ER group. While 74 (53%) patients in ER group had myocardial scar, only 121 (28%) patients had in no-ER group (p<0.001). During follow up, 9 (7%) and 4 (0.9%) patients had cardiac events in ER and no-ER group, respectively (p=0.001). All patients with cardiac events had ER in inferior leads and horizontal/descending ST-segment. Patients with both ER in inferior leads and horizontal/descending ST variant and scar had an increased adjusted hazard ratio of cardiac events (hazard ratio 16.0; 95% confidence interval: 4.1 to 55.8; p<0.001). CONCLUSION: ER in inferior leads with a horizontal/descending ST variant was associated with increased risk of cardiac events. These findings suggest that ER in patients with CAD may be related to myocardial scar rather than pure ion channel problem.


Subject(s)
Cicatrix/physiopathology , Coronary Artery Disease/pathology , Coronary Artery Disease/physiopathology , Myocardium/pathology , Aged , Arrhythmias, Cardiac/physiopathology , Brugada Syndrome , Cardiac Conduction System Disease , Death, Sudden, Cardiac/pathology , Female , Heart Conduction System/abnormalities , Heart Conduction System/physiopathology , Humans , Male , Middle Aged , Prognosis
9.
J Hypertens ; 32(5): 1115-20; discussion 1120, 2014 May.
Article in English | MEDLINE | ID: mdl-24695396

ABSTRACT

OBJECTIVES: Clinical significance of first-degree atrioventricular block (AVB) have not been known in patients with hypertension. This study was performed to elucidate long-term prognosis of first-degree AVB in patients with hypertension. METHODS: We included 3816 patients (mean age, 61.0 ±â€Š10.6 years; men, 47.2%) with hypertension. We reviewed their ECGs and measured the PR interval. The patients were divided into two groups: normal PR interval (120 ms ≤ PR ≤200 ms) and first-degree AVB (PR >200 ms). We compared the incidence, cumulative incidence and hazard ratios of advanced AVB, sick sinus syndrome, atrial fibrillation and left ventricular dysfunction between the two groups during the follow-up period. RESULTS: The prevalence of first-degree AVB in patients with hypertension was 14.3%. The patients were followed up for 9.4 ±â€Š2.4 years. Incidence and cumulative incidence of advanced AVB, atrial fibrillation and left ventricular dysfunction in patients with first-degree AVB were significantly higher than in patients with normal PR interval. By multivariate Cox's regression, patients with first-degree AVB had an increased risk of advanced AVB [hazard ratio 2.77; 95% confidence interval (95% CI) 1.38-5.59; P = 0.004], atrial fibrillation (hazard ratio 2.33; 95% CI 1.84-2.94; P < 0.001) and left ventricular dysfunction (hazard ratio 1.49; 95% CI 1.11-2.00; P = 0.009). However, sick sinus syndrome was not associated with first-degree AVB. CONCLUSION: First-degree AVB is an independent risk factor for future development of advanced AVB, atrial fibrillation and left ventricular dysfunction in patients with hypertension.


Subject(s)
Atrial Fibrillation/complications , Atrioventricular Block , Hypertension/complications , Ventricular Dysfunction, Left/complications , Adult , Female , Humans , Male , Middle Aged
10.
J Investig Med ; 62(5): 808-12, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24569484

ABSTRACT

BACKGROUND: The current standard of care is to delay noncardiac procedure (NCP) 5 to 7 days after discontinuation of antiplatelet agents (APAs) in patients with coronary stents. However, it is often difficult to follow because of concerns over stent thrombosis. The point-of-care aspirin/P2Y(12) assay (VerifyNow; Accumetrics Inc, San Diego, CA) is useful to evaluate platelet reactivity in conjunction with APAs. In this study, we evaluated the feasible timing after discontinuation of APAs. METHODS AND RESULTS: Sixty-two patients taking APAs, who were scheduled to undergo elective NCP, were enrolled. All patients took either aspirin 100 mg or aspirin 100 mg plus clopidogrel 75 mg daily. The aspirin-reactivity unit (ARU) and P2Y(12)-reactivity unit (PRU) were measured from 0 days (day 0, no discontinuation) to as long as 5 days (day 5, 5 days after discontinuation) depending on each procedure schedule. For 15 patients, baseline ARU and PRU (592 and 288) before aspirin/clopidogrel loading at index percutaneous coronary intervention were collected as control. For ARU after discontinuation of APA, days 0 to 5 values progressively increased over time (489.4 T 85.3, 512.6 T 77.0, 589.9 T 58.8, 613.6 T 47.3, 632.6 T 49.2, 662.0 T 4.2). Likewise, for PRUs, days 0 to 5 values also increased over time (245.0 T 96.9, 253.9 T 80.9, 270.9 T 45.8, 289.0 T 68.6, 306.5 T 29.2, 351.0 T 8.5). The ARU and PRU well correlated with days after APA discontinuation by linear regression analysis ( y = 490.897 + 39.238 * x, R(2) = 0.43, P G 0.001; y = 241.739 + 16.701 * x, R(2) = 0.092, P = 0.018, respectively). Assuming baseline ARU and PRU as 592 and 288, the mean days after complete reversal of platelet reactivity by APAs are 2.6 and 2.8, respectively. CONCLUSIONS: The feasible timing of NCP after discontinuation of APAs showed less than 5 days. VerifyNow is useful in the evaluation of antiplatelet reversal after discontinuation of APAs. .


Subject(s)
Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Elective Surgical Procedures/standards , Platelet Aggregation Inhibitors/administration & dosage , Aged , Elective Surgical Procedures/trends , Feasibility Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
11.
Europace ; 16(7): 1061-8, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24381331

ABSTRACT

AIMS: It is difficult to differentiate the origins of focal atrial tachycardias (ATs) in adjacent structures by electrocardiography (ECG) alone. The aim of this study was to evaluate whether the clinical features of these ATs may help differentiate their origins. METHODS AND RESULTS: One hundred and ninety-four patients (mean age, 43.5 ± 17.9 years; male, 53.6%) who underwent electrophysiological study for focal AT were included. We evaluated accuracy in differentiating the origin of AT by using ECG alone as well as with the addition of the clinical features. Electrocardiographs of ATs originating from the left superior pulmonary vein (LSPV, n = 24) vs. the left atrial appendage (LAA, n = 6), and from the right superior pulmonary vein (RSPV, n = 14) vs. the superior vena cava (SVC, n = 8) showed similar patterns. However, while no ATs from the LAA were found to be related to paroxysmal atrial fibrillation, 22 out of 24 ATs from the LSPV were associated with this condition. After localizing AT by using ECG, this clinical feature helped differentiate the ATs from the LSPV vs. the LAA with 93% accuracy. Moreover, while an on-and-off tachycardia (initiated and terminated more than 10 times per day) was observed in 4 of 8 ATs from the SVC, this pattern was observed in 13 of 14 ATs from the RSPV. After localizing the ATs by using ECG, on-and-off tachycardia helped differentiate the ATs from the RSPV vs. the SVC with 82% accuracy. CONCLUSION: The clinical features and Holter monitoring can give additional information for differentiating the focal ATs originating from the adjacent structures.


Subject(s)
Algorithms , Atrial Appendage/physiopathology , Electrocardiography , Heart Conduction System/physiopathology , Pulmonary Veins/physiopathology , Signal Processing, Computer-Assisted , Tachycardia, Supraventricular/diagnosis , Vena Cava, Superior/physiopathology , Adult , Atrial Appendage/surgery , Catheter Ablation , Electrocardiography, Ambulatory , Electrophysiologic Techniques, Cardiac , Female , Heart Conduction System/surgery , Humans , Male , Middle Aged , Predictive Value of Tests , Pulmonary Veins/surgery , Tachycardia, Supraventricular/physiopathology , Tachycardia, Supraventricular/surgery , Time Factors , Vena Cava, Superior/surgery
12.
Cardiovasc Diabetol ; 12: 140, 2013 Oct 02.
Article in English | MEDLINE | ID: mdl-24088407

ABSTRACT

BACKGROUND: It is a matter of debate whether metabolic syndrome (MS) improves cardiovascular risk prediction beyond the risk associated with its individual components. The present study examined the association of MS score with high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), resistin, adiponectin, and angiographic coronary artery disease (CAD) severity according to the presence of DM. In addition, the predictive value of various clinical and biochemical parameters were analyzed, including the MS score for angiographic CAD. METHODS: The study enrolled 363 consecutive patients (196 men, 62 ± 11 years of age) who underwent coronary angiography for evaluation of chest pain. Blood samples were taken prior to elective coronary angiography. MS was defined by the National Cholesterol Education Program criteria, with MS score defined as the numbers of MS components. CAD was defined as > 50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD severity was assessed using the Gensini score. RESULTS: Of the 363 patients studied, 174 (48%) had CAD and 178 (49%) were diagnosed with MS. When the patients were divided into 4 subgroups according to MS score (0-1, 2, 3, 4-5), IL-6 levels and the CAD severity as assessed by the Gensini score increased as MS scores increased. In contrast, adiponectin levels decreased significantly as MS scores increased. When subjects were divided into two groups according to the presence of DM, the relationships between MS score and IL-6, adiponectin, and Gensini score were maintained only in patients without DM. Age, smoking, DM, MS score, and adiponectin independently predicted angiographic CAD in the whole population. However, age is the only predictor for angiographic CAD in patients with DM. CONCLUSIONS: In the presence of DM, neither adipokines nor MS score predicted angiographic CAD. However, in non-diabetic patients, IL-6 and adiponectin showed progressive changes according to MS score, and MS score was an independent predictor of CAD in patients without DM.


Subject(s)
Adipokines/blood , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Diabetes Mellitus/diagnosis , Inflammation Mediators/blood , Metabolic Syndrome/diagnosis , Adiponectin/blood , Aged , Biomarkers/blood , C-Reactive Protein/analysis , Coronary Stenosis/epidemiology , Cross-Sectional Studies , Diabetes Mellitus/blood , Diabetes Mellitus/epidemiology , Female , Humans , Interleukin-6/blood , Male , Metabolic Syndrome/blood , Metabolic Syndrome/epidemiology , Middle Aged , Predictive Value of Tests , Prevalence , Prospective Studies , Republic of Korea/epidemiology , Resistin/blood , Risk Factors , Severity of Illness Index
13.
Circ J ; 77(9): 2255-63, 2013.
Article in English | MEDLINE | ID: mdl-23739532

ABSTRACT

BACKGROUND: The mechanisms underlying amiodarone-induced sinoatrial node (SAN) dysfunction remain unclear, so we used 3-dimensional endocardial mapping of the right atrium (RA) to investigate. METHODS AND RESULTS: In a matched-cohort design, 18 patients taking amiodarone before atrial fibrillation (AF) ablation (amiodarone group) were matched for age, sex and type of AF with 18 patients who had undergone AF ablation without taking amiodarone (no-amiodarone group). The amiodarone group had a slower heart rate than the no-amiodarone group at baseline and during isoproterenol infusion. Only the amiodarone group had sick sinus syndrome (n=4, 22%, P=0.03) and abnormal (>550ms) corrected SAN recovery time (n=5, 29%; P=0.02). The median distance from the junction of the superior vena cava (SVC) and RA to the most cranial earliest activation site (EAS) was longer in the amiodarone group than in the no-amiodarone group at baseline (20.5 vs. 10.6mm, P=0.04) and during isoproterenol infusion (12.8 vs. 6.3mm, P=0.03). The distance from the SVC-RA junction to the EAS negatively correlated with the P-wave amplitudes of leads II (r=-0.47), III (r=-0.60) and aVF (r=-0.56) (P<0.001 for all). CONCLUSIONS: In a quarter of the AF patients, amiodarone causes superior SAN dysfunction, which results in a downward shift of the EAS and reduced P-wave amplitude in leads II, III and aVF at baseline and during isoproterenol infusion.


Subject(s)
Amiodarone/adverse effects , Atrial Fibrillation/pathology , Atrial Fibrillation/physiopathology , Heart Rate/drug effects , Sinoatrial Node , Aged , Amiodarone/pharmacology , Atrial Fibrillation/drug therapy , Female , Heart Atria/pathology , Heart Atria/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Sinoatrial Node/pathology , Sinoatrial Node/physiopathology
14.
Int J Cardiol ; 167(5): 1990-4, 2013 Sep 01.
Article in English | MEDLINE | ID: mdl-22633779

ABSTRACT

BACKGROUND: Although lipoprotein(a) [Lp(a)] has been considered a cardiovascular risk factor for many years, there is a paucity of data in regard to the potential risk of elevated Lp(a) in symptomatic patients with CAD. Therefore, we sought to evaluate whether elevated Lp(a) is associated with worse outcome in symptomatic patients with coronary artery disease (CAD), and to clarify the prognostic value of Lp(a) in the era of coronary artery revascularization. METHODS: 6252 consecutive subjects (59.2% male, mean age 61.2 ± 11.2 years) suspected of having CAD underwent coronary angiography. Laboratory values for lipid parameters including Lp(a) were obtained on the day of coronary angiography. Baseline risk factors, coronary angiographic findings, length of follow-up, and major adverse cardiovascular events (MACE), including cardiac death and non-fatal myocardial infarction were recorded. RESULTS: Over a mean follow-up period of 3.1 ± 2.2 years, there were 100 MACE (56 cardiac deaths and 44 non-fatal myocardial infarctions), with an event rate of 1.6%. In multivariate Cox regression analysis, elevated Lp(a) was a significant predictor of MACE [hazard ratio 1.773 (95% confidence interval 1.194-2.634, p=0.005)], and the addition of this factor to the model significantly increased the global х(2) value over traditional risk factors and CAD (from 79.1 to 88.7, p=0.003). CONCLUSIONS: Elevated Lp(a) is an independent prognostic risk factor for cardiovascular events, and moreover, has incremental prognostic value in symptomatic patients with coronary artery revascularization.


Subject(s)
Coronary Artery Disease/blood , Coronary Artery Disease/diagnosis , Lipoprotein(a)/blood , Myocardial Revascularization , Adult , Aged , Aged, 80 and over , Biomarkers/blood , Coronary Artery Disease/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Revascularization/trends , Prognosis , Risk Factors
15.
Pacing Clin Electrophysiol ; 36(2): 163-71, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23121003

ABSTRACT

BACKGROUNDS: Atrial fibrillation (AF) is commonly associated with structural heart disease (SHD) or sinus node dysfunction (SND). We hypothesized that regional atrial effective refractory period (ERP) is different in patients with SHD/SND from lone AF. METHODS: We included 648 patients with AF (age, 56.0 ± 11.0 years; male, 77.3%; paroxysmal AF [PAF], 67.9%; persistent AF [PeAF], 32.1%) who underwent radiofrequency catheter ablation (RFCA), and compared the clinical characteristics in patients with SHD (n = 132) versus without SHD (n = 516) and those with SND (n = 74) versus without SND (n = 574). ERPs were measured at the high and low right atrium, proximal, and distal coronary sinus. RESULTS: (1) Patients with SHD had older age (P < 0.001), greater left atrial (LA) volume (P < 0.001), LA pressure (P = 0.002), and plasma proatrial natriuretic peptide (P = 0.005) than patients without SHD. (2) Patients with SND were older (P = 0.004), more likely female (P = 0.004), and had lower body weight (P < 0.001) and higher E/E' (P < 0.001) than those without SND. (3) The mean atrial ERP was significantly shorter in patients with PeAF than those with PAF (P < 0.001). The mean ERP was significantly longer in patients with AF with SHD/SND than those with lone AF (P = 0.006). (4) The clinical outcomes of RFCA were not significantly different between SHD/SND and lone AF for 14.8 ± 8.5 months of follow-up period. CONCLUSION: The mean atrial ERP was shorter in patients with PeAF than those with PAF due to electrical remodeling. In contrast, AF patients with SHD/SND showed a more prolonged mean atrial ERP than those with lone AF, associated with LA enlargement or left ventricular diastolic dysfunction.


Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/epidemiology , Electrocardiography/statistics & numerical data , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/epidemiology , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , Prevalence , Republic of Korea/epidemiology , Risk Assessment
16.
Pacing Clin Electrophysiol ; 35(11): 1338-47, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22897504

ABSTRACT

BACKGROUND: Radiofrequency catheter ablation (RFCA) for intraatrial reentrant tachycardia (IART) in congenital heart disease (CHD) remains difficult. METHODS: Thirty-four consecutive adult patients (age, 37.6 ± 12.8 years; male, 21) with previously repaired CHD and IART underwent an electrophysiological study and RFCA. CHD included atrial septal defect (ASD, n = 14), tetralogy of Fallot (n = 11), ventricular septal defect (n = 4), pulmonary atresia (n = 2), atrioventricular septal defect (n = 1), transposition of the great arteries (n = 1), and double-outlet right ventricle (n = 1). RESULTS: Duration of CHD repair to IART onset was 19.1 ± 8.5 years. Thirty and four patients had single- and double-loop reentrant tachycardia, respectively. Among the total of 38 IARTs, which were mapped, 22 (57.9%) and 13 (34.2%) IARTs were cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) and scar-related AFL, respectively. Typical AFL electrocardiography findings including definite sawtooth appearance in inferior leads and positive F wave in lead V1 were observed in only 12 of 21 patients (57.1%) with CTI-dependent AFL. CTI-dependent AFL had a significantly longer tachycardia cycle length (TCL) than scar-related AFL (267.6 ± 34.4 ms and 235.9 ± 37.0 ms, respectively; P = 0.031). TCL > 250 ms had 79% sensitivity as the cutoff value for differentiating CTI-dependent from scar-related AFL. The acute success rates of RFCA in CTI-dependent and scar-related AFLs were 85.7% and 90.0%, respectively. The recurrence rates in CTI-dependent and scar-related AFLs were 11.1% and 11.1%, respectively, during a follow-up of 21.2 ± 28.3 months. CONCLUSIONS: CTI-dependent AFL was the most common IART in adult patients with repaired CHD and was easily manageable by RFCA. TCL might help to differentiate CTI-dependent AFL from other IARTs.


Subject(s)
Atrial Flutter/diagnosis , Cicatrix/complications , Cicatrix/diagnosis , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/etiology , Adult , Atrial Flutter/complications , Diagnosis, Differential , Electrocardiography/methods , Humans , Male , Reproducibility of Results , Sensitivity and Specificity
17.
Heart ; 98(6): 480-4, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22285969

ABSTRACT

OBJECTIVE: Circumferential pulmonary vein isolation (CPVI) has been considered the cornerstone of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, it is unclear whether linear ablation in addition to CPVI improves clinical outcome. DESIGN: Prospective randomised study to compare the efficacy of CPVI and CPVI with additional linear ablation in patients with paroxysmal AF (PAF). SETTING: University hospital. PATIENTS: This study enrolled 156 patients (male 76.3%, 55.8±11.5 years old (mean±SD)) who underwent RFCA for PAF. INTERVENTIONS: CPVI (n=52), CPVI+roof line (CPVI+RL; n=52) and CPVI+RL+posterior inferior line (CPVI+PostBox; n=52). MAIN OUTCOME MEASURES: Procedure time, ablation time and clinical outcome. RESULTS: (1) The CPVI group showed shorter total procedure time (180.4±39.5 min vs 189.6±29.0 min and 201.7±51.7 min, respectively (mean±SD); p=0.035) and ablation time (4085.5±1384.1 s vs 5253.5±1010.9 s and 5495.0±1316.0 s, respectively; p<0.001) than the CPVI+RL and CPVI+PostBox groups. (2) During 15.6±5.0 months of follow-up, the recurrence rates 3 months after RFCA were 11.5% in CPVI, 21.2% in CPVI+RL and 19.2% in CPVI+PostBox (p=0.440). (3) The achievement rate of CPVI was 100.0%, and bidirectional block rate was 80.8% in CPVI+RL and 59.6% in CPVI+PostBox. The clinical recurrence rates with or without achieving bidirectional block were not significantly different from each other (p=0.386). CONCLUSION: In patients with PAF, linear ablation in addition to CPVI did not improve clinical outcome, regardless of bidirectional block achievement, while it prolonged the total procedure and ablation time.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Pulmonary Veins/surgery , Cardiac Surgical Procedures/methods , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment Outcome
18.
Coron Artery Dis ; 22(1): 40-4, 2011 Jan.
Article in English | MEDLINE | ID: mdl-21102311

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the predictors of coronary stent fracture in patients treated with closed-cell design stents including the sirolimus-eluting stent (SES) and its bare-metal platform, Bx velocity stent (BVS). BACKGROUND: Various mechanical factors have been considered to be the predictors of stent fracture, especially in patients treated with SES. However, it is unknown whether SES is more prone to fracture compared with BVS. METHODS: We retrospectively analyzed 391 lesions treated with SES or BVS in 339 patients who underwent follow-up coronary angiography. RESULTS: A total of 30 stent fractures (7.7%) in 28 patients treated with 29 SES (96.7%) and one BVS (3.3%) was found. On univariate analyses, stent fracture was related to angulated lesions (>45°) during diastole, longer stent, larger number of stents per lesion (P<0.001), right coronary artery (RCA) placement (P=0.008), and SES (P=0.016). On multivariate analyses, however, angulated lesion (odds ratio: 6.73; 95% confidence interval: 2.71-16.71; P<0.001) and RCA placement (odds ratio: 2.82; 95% confidence interval: 1.03-7.72; P=0.044) served as independent predictors of stent fracture while SES (P=0.080) and total stent length (P=0.069) showed only trends that did not reach statistical significance. CONCLUSIONS: This study showed that fracture of SES or BVS with the same closed-cell design platform was related to angulated lesion and RCA placement, but SES itself was not an independent predictor of stent fracture.


Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Coronary Stenosis/therapy , Coronary Vessels/pathology , Drug-Eluting Stents/adverse effects , Plaque, Atherosclerotic/physiopathology , Aged , Comparative Effectiveness Research , Coronary Angiography , Coronary Stenosis/diagnosis , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/physiopathology , Drug-Eluting Stents/standards , Equipment Failure Analysis , Female , Humans , Immunosuppressive Agents/pharmacology , Male , Middle Aged , Plaque, Atherosclerotic/diagnosis , Risk Factors , Sirolimus/pharmacology , Treatment Outcome
19.
Yonsei Med J ; 51(5): 676-82, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20635441

ABSTRACT

PURPOSE: Metabolic syndrome (MS) has been reported as a potential risk factor of coronary artery disease (CAD). The aims of this study were to assess whether there was a relationship between MS score and CAD angiographic severity, and to assess the predictive value of individual components of MS for CAD. MATERIALS AND METHODS: We retrospectively enrolled 632 patients who underwent coronary angiography for suspected CAD (394 men, 61.0 +/- 10.6 years of age). MS was defined by the National Cholesterol Education Program criteria with the waist criterion modified into a body mass index (BMI) of more than 25 kg/m(2). The MS score defined as the number of MS components. CAD was defined as > 50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD angiographic severity was evaluated with a Gensini scoring system. RESULTS: Of the patients, 497 (78.6%) had CAD and 283 (44.8%) were diagnosed with MS. The MS score was significantly related to the Gensini score. High fasting blood glucose (FBG) was the only predictive factor for CAD. A cluster including high FBG, high blood pressure (BP), and low high-density lipoprotein cholesterol (HDL-C) showed the highest CAD risk. CONCLUSION: The MS score correlates with the angiographic severity of CAD. The predictive ability of MS for CAD was carried almost completely by high FBG, and individual traits with high BP and low HDLC may act synergistically as risk factors for CAD.


Subject(s)
Coronary Angiography , Coronary Artery Disease/complications , Metabolic Syndrome/complications , Aged , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/etiology , Female , Humans , Male , Metabolic Syndrome/diagnostic imaging , Middle Aged , Retrospective Studies , Risk Factors , Severity of Illness Index
20.
Echocardiography ; 27(3): E34-5, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20486955

ABSTRACT

A 29-year-old Ethiopian woman that was referred to the Wisconsin Heart Hospital for treatment of subaortic stenosis, diagnosed 4 years earlier, in Ethiopia, using transthoracic echocardiography. Preoperative evaluation included transesophageal echocardiography, which showed severe membranous subaortic stenosis with a mean outflow gradient of 70 mmHg. Cardiac computed tomographic angiography also demonstrated a subaortic membrane, and additionally showed normal epicardial coronary arteries. The patient underwent uneventful surgical resection of the subaortic membrane without undergoing cardiac catheterization.


Subject(s)
Angiography , Discrete Subaortic Stenosis/diagnosis , Echocardiography , Tomography, X-Ray Computed , Adult , Discrete Subaortic Stenosis/diagnostic imaging , Female , Humans
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