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ABSTRACT: We investigate to determine whether N-acetylcysteine (NAC) can prevent anthracycline-induced cardiotoxicity.
A total of 103 patients were enrolled in this prospective randomized open label controlled trial. They are patients first diagnosed with breast cancer or lymphoma, who require chemotherapy, including anthracycline like adriamycine or epirubicine. Patients were randomized to the NAC group {n=50; 1200 mg orally every 8 hours starting before and ending after the intravenous infusion of anthracycline in all chemotherapy cycles (3-6)} or the control group (n=53). Primary outcome was the decrease in left ventricular ejection fraction (LVEF) absolutely ≥10% from the baseline and concomitantly <50% at 6-month. Composite of all-cause death, heart failure and readmission were compared.
The primary outcome was not significantly different in the NAC and control groups {3/47 (6.4%) vs. 1/52 (1.9%), p=0.343}. The mean LVEF significantly decreased in both the NAC (from 64.5 to 60.8%, p=0.001) and control groups (from 64.1 to 61.3%, p<0.001) after the completion of whole chemotherapy. The mean LVEF change did not differ between the two groups (-3.64% in NAC vs. -2.78% in control group, p=0.502). Left ventricular (LV) end systolic dimension increased with higher trend in NAC by 3.08±4.56 mm as compared with 1.47±1.83 mm in the control group (p=0.064). LV end diastolic dimension did not change in each group and change does not differ in both. Peak E, A and E/A ratio change and cardiac enzymes were comparable in two groups. Cumulative 12-month event rate was 6% and 3.8% in the NAC group and the control group, respectively, with no difference (p=0.672).
We cannot prove that NAC prevents anthracycline-induced cardiomyopathy.
Korean Circulation Journal 03/2013; 43(3):174-81.
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ABSTRACT: INTRODUCTION: There are limited long-term follow-up data on functional changes in the myocardium after high-voltage electrical injury (HVEI). METHODS: Twenty-three patients who had been exposed to HVEI (> 20,000 volts) and preserved left ventricular ejection fraction ([greater than or equal to]55%) were enrolled the study. Echocardiographic parameters including peak systolic strain (S) and strain rate (SR) were evaluated at baseline, 6 weeks, and 6 months later. These data were compared with healthy control group who were matched in terms of age, sex, and body mass index. RESULTS: The systolic and diastolic blood pressure and the heart rate were significantly higher in the HVEI group compared with the control group at baseline and at 6-week, but not at the 6-month follow-up. Conventional echocardiographic data showed no differences between the groups during the study period. In contrast to the S, the baseline and 6-week SR was significantly increased in the HVEI group compared with the control group. However, at the 6-month follow-up, there was no difference in the SR between the groups. Among the twenty-three patients with HVEI, 17 of the patients had vertical current injury, and six patients had horizontal current injury. There was no difference in terms of the conventional echocardiography, S, and SR between the patients with vertical injury and those with horizontal injury at baseline and at the 6-month follow-up. CONCLUSIONS: The long-term contractile performance of the myocardium is preserved when patient do not experience left ventricular dysfunction in the early stages after HVEI.
Critical care (London, England) 02/2013; 17(1):R26. · 4.61 Impact Factor
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ABSTRACT: AIMS: The reversal of the early diastolic mitral annular velocity (e') to the late diastolic mitral annular velocity (a') ratio (e'/a' <1) develops earlier in the septum than in the lateral mitral annulus on tissue Doppler imaging (TDI). Accordingly, patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' ratio can be divided into two groups depending on the presence of a reversal of lateral e'/a'. The aim of this study was to identify the determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction. METHODS AND RESULTS: A total of 1166 consecutive patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' were classified on the basis of their diastolic function at the lateral mitral annulus. Two hundred and fifteen patients had a preserved lateral e'/a' (e'/a' >1) and 915 patients had a reversed lateral e'/a' (e'/a' <1).Patients with lateral e'/a' >1 were younger, male, and had a lower prevalence of diabetes and hypertension and showed less evidence of left ventricular (LV) diastolic dysfunction and structural remodelling as LV hypertrophy and LA enlargement, than those with a lateral e'/a' <1. Multivariate analysis revealed that age, septal e', septal peak systolic annular velocity, and LV mass indexed to height(2.7) (LVM/h(2.7)) were independently associated with preserved diastolic function at the lateral annulus. CONCLUSION: The age, septal TDI, and LVM/h(2.7) were independent determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' ratio.
European heart journal cardiovascular Imaging. 08/2012;
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ABSTRACT: Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Journal of Korean medical science 07/2011; 26(7):945-50. · 0.84 Impact Factor
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ABSTRACT: Deep vein thrombosis (DVT) frequently occurs in high-risk cardiovascular patients receiving orthopedic surgery, despite prophylactic measures for its prevention. Statins, a class of drugs used to lower cholesterol levels, have been reported to help prevent the development of DVT.
We will conduct a prospective randomized clinical trial to compare the effects of high-dose rosuvastatin plus a low-molecular-weight heparin (LMWH), enoxaparin, with conventional LMWH therapy in the prevention of DVT. Patients will be naive to both statins and anti-coagulants and then underwent total knee replacement arthroplasty (TKRA). In total, 180 patients will be randomized into two groups of 90, consisting of a LMWH group (40 mg enoxaparin subcutaneously beginning at 12h prior to surgery and continuing for 7 days every 24h after surgery) and a statin plus LMWH group (20mg rosuvastatin orally for 14 days, 7 days before and after surgery in combination with LMWH). All patients will undergo computed tomography angiography of both extremities 7 days after index surgery to assess the development of DVT.
DVT remains prevalent despite the use of conventional prophylactic measures, in part because certain patients (particularly the elderly) are unable to receive preventive treatment because of a high risk of bleeding complications and co-morbidity. Statins have been shown to have beneficial effects in arterial atherothrombosis and are frequently administered to elderly patients to treat coronary artery. We hypothesize that peri-operative statin treatment may be beneficial in those patients restricted from the conventional prophylaxis for DVT.
Contemporary clinical trials 06/2011; 32(5):779-82. · 1.51 Impact Factor
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ABSTRACT: Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.
Korean Circulation Journal 06/2011; 41(6):334-7.
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ABSTRACT: Few data are available on sinus tachycardia among medical intensive care unit (ICU) patients. We investigated new critical illnesses related to new-onset prolonged sinus tachycardia (NOPST) and the relationship of NOPST with ICU mortality.
The heart rate (HR) of all enrolled patients was monitored hourly over a 12-month period, and NOPST was defined as sinus tachycardia (>100 beats/min) with an increase in HR of more than 20% from the baseline value lasting longer than 6 hours.
Among the 522 patients enrolled, the average mean HR was 96.1 ± 18.4 beats/min. Fifty-two (10.0%) patients met the criteria for NOPST; pneumonia, delirium, septic shock, acute respiratory distress syndrome, catheter-related infections, and mechanical ventilator-related problems were related to the occurrence of NOPST. The ICU mortality rate in patients with a NOPST duration of more than 72 hours was higher compared with other patients with NOPST (60.0% vs 18.5%; P = .002). A high daily mean HR rather than NOPST was a significant predictor of ICU mortality (odds ratio, 1.415; 95% confidence interval, 1.177-1.700).
Although NOPST was not associated with ICU mortality, it indicates the presence of new critical events in the medical ICU setting.
Journal of critical care 03/2011; 26(5):534.e1-8. · 2.13 Impact Factor
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ABSTRACT: A 59-year-old man treated with pneumococcal meningitis 4 months ago was hospitalized for acute heart failure and performed aortic valve replacement by rupture of aortic valve. The frequent association of pneumococcal meningitis and endocarditis is known as Austrian syndrome. Though Austrian syndrome is a clinically rare disease, the evolution of pneumococcal endocarditis is very aggressive and associated with high mortality, and early recognition for evidence of endocardial lesion in patients with pneumococcal meningitis is important to reduce the complications and mortality rate.
Journal of cardiovascular ultrasound 03/2011; 19(1):35-7.
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ABSTRACT: The aim of this paper is to critically assess the extent to which the concept of second modernity and reflexive modernization proposed by Beck and Grande is relevant to East Asia. Concepts such as driving forces, human agency, objective-structural versus cultural-discursive dimensions, radicalizing versus deficiencies aspects of modernity, push versus pull factors are used to clarify the basic conditions of this historical transformation. Utilizing these conceptual schemes, this paper has advanced the following central claims: 1) Second modernity and reflexive modernization, as a global trend, affects East Asia as deeply as it does in the West, especially when we see this as a structurally conditioned historical transformation; 2) Global risks, as a driving force of second modernity, are more relevant in East Asia because, as a result of the side-effects of the rush-to development, East Asian countries face complex risks of far greater intensity than in the West; 3) The action-mediated pull factor of second-modern transformation in East Asia, expressed through the cultural-discursive articulation of collective desire and aspiration, differs significantly from the West. Consequently, the East Asian pathways to individualization display distinctive characteristics despite the common structural background where push factors operate; 4) East Asia also differs from the West in terms of the normative vision anchored in second modernity; 5) Nevertheless, concrete pathways to second modernity within East Asia differ from one country to another.
British Journal of Sociology 09/2010; 61(3):465-88. · 1.62 Impact Factor
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Ja-Ryong Koo,
Jong-Woo Yoon, Sang-Jin Han,
Myung-Jin Choi,
In-Il Park,
Young-Ki Lee,
Sung-Gyun Kim,
Ji-Eun Oh,
Jang-Won Seo,
Hyung-Jik Kim,
Jung-Woo Noh
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ABSTRACT: Paraquat poisoning can be lethal, and aggressive treatments might have little or no effect on severely poisoned patients. Accordingly, a convenient prognostic test is necessary to guide therapy for acute paraquat poisoning. Sodium dithionite reduces paraquat to a blue radical form in alkaline plasma with a paraquat detection sensitivity of 2.0 mg/L, which is a 100% lethal concentration at 10 to 12 hours postingestion. The prognostic utility of this simple reaction was examined prospectively.
Of 233 paraquat-poisoned patients, who were taken to the hospital within 12 hours after ingestion, the plasma samples obtained on arrival were tested using the sodium dithionite reaction. Standard saline containing 2.0 mg/L paraquat was used as the positive control. The test result was interpreted as being positive when the plasma test yielded a blue color darker than that of the positive control. The effects of aggressive treatment, including cyclophosphamide pulse and continuous venovenous hemofiltration, were evaluated retrospectively.
The discharge survival rate was 41.6% (97 of 233). Ninety-seven of 142 patients with negative or equivocal plasma dithionite test survived. However, all 91 patients with positive plasma dithionite test died of multiorgan failure. Cyclophosphamide and/or continuous venovenous hemofiltration could not improve survival.
In this single-center study, a positive plasma dithionite test was associated with 100% mortality, despite aggressive treatment. In contrast, negative or equivocal tests were associated with a 68% survival rate. It is believed that after further verification, this test can be used to guide therapy and predict the outcomes of patients suffering acute paraquat poisoning.
The American Journal of the Medical Sciences 10/2009; 338(5):373-7. · 1.39 Impact Factor
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Young-Cheoul Doo M.D, Sang‐Jin Han,
Woo‐Jung Park,
Seong‐Man Kim,
Seung‐Hyuk Choi,
Goo‐Yeong Cho,
Kyung‐Soon Hong,
Kyoo‐Rok Han,
Nam‐Ho Lee,
Dong‐Jin Oh,
Kyu‐Hyun Gryu,
Chong‐Yun Rhim,
Kwang‐Hwahk Lee,
Yung Lee
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ABSTRACT: Background: There is growing evidence that C-reactive protein (CRP) may have a direct role in the pathogenesis of atherosclerosis.Hypothesis: The purpose of this study was to assess associations between CRP and adhesion molecules and to determine the prognostic value of adhesion molecules as a predictor of cardiac events in patients with unstable angina.Methods: Fifty-five consecutive patients (33 males, mean age 61 years) with unstable angina (Braunwald class IIb or Ib) undergoing coronary stenting were included in this study.Results: The test for a trend toward increasing intercellular adhesion molecule (ICAM)-1 concentrations by the 75th percentile of CRP levels at 72 h after coronary stenting was significant (p = 0.03). At 72 h after coronary stenting, CRP levels were the only determinants of ICAM-1 concentrations by multiple linear regression analysis. An elevated level of CRP (>5.4mg/l) (oddsratio [OR] 1.5,95%confidenceinterval [CI] 1.3–3.7, p<0.05) and ICAM-1 (>321 ng/ml) (OR 1.2, 95% CI 1.1–2.1, p < 0.05) at 72 h after coronary stenting is an independent risk factor for an adverse cardiac event.Conclusions: These results suggest that in patients with unstable angina undergoing coronary stenting, the measurements of inflammatory parameters, especially CRP and ICAM-1, may be useful for identifying those at higher risk of a cardiac event, and CRP may play a direct role in promoting the inflammatory component of atherosclerosis by inducing significant expression of ICAM-1.
Clinical Cardiology 12/2006; 28(1):47 - 51. · 2.15 Impact Factor
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Young-Cheoul Doo M.D, Sang‐Jin Han,
Sung‐Woo Han,
Woo‐Jung Park,
Seung‐Hyuk Choi,
Goo‐Yeong Cho,
Kyung‐Soon Hong,
Kyoo‐Rok Han,
Nam‐Ho Lee,
Dong‐Jin Oh,
Kyu‐Hyung Ryu,
Chong‐Yun Rim,
Kwang‐Hahk Lee,
Yung Lee
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ABSTRACT: Background: Statins are believed to reduce coronary heart disease by mechanisms in addition to their well-known cholesterol lowering effect.Hypothesis: We studied the effect of statins on expression of C-reactive protein (CRP), interleukin-6 (IL-6), adhesion molecules, and antioxidized low-density lipoprotein antibody (anti-oxLDL Ab) in patients with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting.Methods: Consecutive 50 patients with unstable angina were included in the study. We classified the study subjects as patients using statins (Group A, n = 20, men 10, mean age 62 years) and patients notusing statins (Group B, n= 30, men 15, mean age 60 years).Results: Baseline levels of inflammatory markers were similar in the two groups. However, 24 h after coronary stenting, serum levels of CRP (2.00 vs. 4.63 mg/l, p < 0.05), intercellular adhesionmolecule-1 (ICAM-1) (217 vs. 261 ng/ml, p<0.01), and anti-oxLDL Ab (8.97 vs. 12.96 U/ml, p < 0.05) were significantly higher in Group B than in Group A. Furthermore, 72 h after coronary stenting, serum levels of CRP (3.00 vs. 5.50 mg/l, p<0.01)and ICAM-1 (222 vs. 277 ng/ml, p< 0.05) were significantly higher in Group B than in Group A.Conclusions: Preexisting statin therapy plays a role in reducing the serum levels of CRP, IC AM-1, and anti-oxLDL Ab after coronary stenting in patients with unstable angina. These data support an anti-inflammatory or plaque-stabilizing effect of statin therapy.
Clinical Cardiology 12/2006; 28(2):72 - 76. · 2.15 Impact Factor
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Young-Cheoul Doo, Sang-Jin Han,
Sung-Woo Han,
Woo-Jung Park,
Seung-Hyuk Choi,
Goo-Yeong Cho,
Kyung-Soon Hong,
Kyoo-Rok Han,
Nam-Ho Lee,
Dong-Jin Oh,
Kyu-Hyung Ryu,
Chong-Yun Rim,
Kwang-Hahk Lee,
Yung Lee
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ABSTRACT: Statins are believed to reduce coronary heart disease by mechanisms in addition to their well-known cholesterol lowering effect.
We studied the effect of statins on expression of C-reactive protein (CRP), interleukin-6 (IL-6), adhesion molecules, and antioxidized low-density lipoprotein antibody (anti-oxLDL Ab) in patients with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting.
Consecutive 50 patients with unstable angina were included in the study. We classified the study subjects as patients using statins (Group A, n=20, men 10, mean age 62 years) and patients not using statins (Group B, n=30, men 15, mean age 60 years).
Baseline levels of inflammatory markers were similar in the two groups. However, 24 h after coronary stenting, serum levels of CRP (2.00 vs. 4.63 mg/l, p < 0.05), intercellular adhesion molecule-1 (ICAM-1) (217 vs. 261 ng/ml, p < 0.01), and anti-oxLDL Ab (8.97 vs. 12.96 U/ml, p < 0.05) were significantly higher in Group B than in Group A. Furthermore, 72 h after coronary stenting, serum levels of CRP (3.00 vs. 5.50 mg/l, p < 0.01) and ICAM-1 (222 vs. 277 ng/ml, p < 0.05) were significantly higher in Group B than in Group A.
Preexisting statin therapy plays a role in reducing the serum levels of CRP, ICAM-1, and anti-oxLDL Ab after coronary stenting in patients with unstable angina. These data support an anti-inflammatory or plaque-stabilizing effect of statin therapy.
Clinical Cardiology 02/2005; 28(2):72-6. · 2.15 Impact Factor
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Young-Cheoul Doo, Sang-Jin Han,
Woo-Jung Park,
Seong-Man Kim,
Seung-Hyuk Choi,
Goo-Yeong Cho,
Kyung-Soon Hong,
Kyoo-Rok Han,
Nam-Ho Lee,
Dong-Jin Oh,
Kyu-Hyung Ryu,
Chong-Yun Rhim,
Kwang-Hwahk Lee,
Yung Lee
[show abstract]
[hide abstract]
ABSTRACT: There is growing evidence that C-reactive protein (CRP) may have a direct role in the pathogenesis of atherosclerosis.
The purpose of this study was to assess associations between CRP and adhesion molecules and to determine the prognostic value of adhesion molecules as a predictor of cardiac events in patients with unstable angina.
Fifty-five consecutive patients (33 males, mean age 61 years) with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting were included in this study.
The test for a trend toward increasing intercellular adhesion molecule (ICAM)-1 concentrations by the 75th percentile of CRP levels at 72 h after coronary stenting was significant (p = 0.03). At 72 h after coronary stenting, CRP levels were the only determinants of ICAM-1 concentrations by multiple linear regression analysis. An elevated level of CRP (>5.4 mg/l) (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3-3.7, p < 0.05) and ICAM-1 (>321 ng/ml) (OR 1.2, 95% CI 1.1-2.1, p < 0.05) at 72 h after coronary stenting is an independent risk factor for an adverse cardiac event.
These results suggest that in patients with unstable angina undergoing coronary stenting, the measurements of inflammatory parameters, especially CRP and ICAM-1, may be useful for identifying those at higher risk of a cardiac event, and CRP may play a direct role in promoting the inflammatory component of atherosclerosis by inducing significant expression of ICAM-1.
Clinical Cardiology 02/2005; 28(1):47-51. · 2.15 Impact Factor
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Young-Cheoul Doo, Sang-Jin Han,
Jun-Hee Lee,
Goo-Yung Cho,
Kyung-Soon Hong,
Kyoo-Rok Han,
Nam-Ho Lee,
Dong-Jin Oh,
Kyu-Hyung Ryu,
Chong-Yun Rhim,
Kwang-Hwahk Lee,
Yung Lee
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ABSTRACT: Oxidized low-density lipoprotein (LDL) is believed to play a key role in the development of atherosclerosis. However, the significance of anti-oxidized LDL antibody in atherogenesis is unclear. The purposes of this study were to assess whether anti-oxidized LDL antibody titers are related to other inflammatory markers of possible interest in atherosclerotic development, such as soluble cell adhesion molecules, interleukin-6, and C-reactive protein (CRP), and to determine the prognostic value of anti-oxidized LDL antibody as a predictor of cardiac events in patients with unstable angina pectoris. Sixty patients (35 men and 25 women; mean age 60 years) with unstable angina were included in this study. The levels of CRP and of intercellular adhesion molecule-1 (ICAM-1) at 24 and 72 hours after admission were significantly higher than their baseline levels (p <0.05, respectively). After adjusting for age, gender, body mass index, and statin use, anti-oxidized LDL antibodies were positively correlated with CRP (r = 0.72, p <0.001) and ICAM-1 (r = 0.68, p <0.001). Elevated anti-oxidized LDL antibodies (mean >11.37 U/ml) and CRP levels (median >2.4 mg/L) on admission were correlated with a significantly lower 16-month, event-free survival rate (Kaplan-Meier event-free survival analysis, log-rank p <0.01 and p <0.05, respectively). Multivariate analysis by logistic regression revealed that elevated levels of anti-oxidized LDL antibody (mean >11.3 U/ml) on admission were an independent risk factor for an adverse cardiac event (odds ratio 2.2, 95% confidence interval 1.5 to 10.7, p = 0.001). This study demonstrates that anti-oxidized LDL antibody expression is associated with the expression of CRP and adhesion molecules, especially ICAM-1, and is a predictor of cardiac events in patients with unstable angina pectoris. The observed elevated levels of anti-oxidized LDL antibody suggest plaque instability and may be useful for identifying patients at higher risk of a cardiac event.
The American Journal of Cardiology 03/2004; 93(5):554-8. · 3.37 Impact Factor
