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ABSTRACT: BACKGROUND: Pulse wave velocity (PWV) is a well-established marker for aortic stiffness and may be a prognostic factor in heart failure (HF). This study investigates whether PWV changes as patients transition from acute decompensated heart failure (ADHF) to chronic compensated heart failure (CCHF). HYPOTHESIS: Arterial stiffness is related with the development of HF. METHODS: Regional PWV was prospectively measured using noninvasive applanation tonometry in consecutive ADHF patients (n = 55). PWV measurements of 45 patients were taken at admission and 3-month follow-up (F/U). RESULTS: Central and upper-extremity PWV, but not lower-extremity PWVs, were found to have improved after 3 months compared with the admission PWV (central: 8.73 ± 1.17 vs 8.39 ± 0.99 m/s, P = 0.018; upper extremity: 8.59 ± 0.84 vs 8.33 ± 0.82 m/s, P = 0.028). Multivariate logistic regression analyses revealed that low-density lipoprotein cholesterol was significantly associated with the change of PWV in HF (odds ratio: 1.037, 95% confidence interval: 1.003-1.071, P = 0.030). In preserved left ventricular ejection fraction patients (n = 26) and ischemic patients (n = 31), central and upper-extremity PWVs improved over the admission PWV at 3-month F/U. CONCLUSIONS: The present results indicate that central and upper-extremity PWVs, but not lower-extremity PWV, are increased in ADHF and improve as patients transition from ADHF to CCHF.
Clinical Cardiology 04/2013; · 2.15 Impact Factor
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Doo-Soo Jeon,
Ki-Dong Yoo,
Chan-Suk Park,
Dong-Il Shin,
Sung-Ho Her, Hoon-Joon Park,
Yoon-Seok Choi,
Dong-Bin Kim,
Chong-Min Lee,
Chul-Soo Park,
Pum-Joon Kim,
Keon-Woong Moon,
Ki-Yuk Jang,
Hee-Yeol Kim,
Wook-Sung Chung,
Ki-Bae Seung,
Jae-Hyung Kim,
Kyu-Bo Choi
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ABSTRACT: Placement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy.
A total of 1,315 patients (846 males, 469 females) were prospectively enrolled and analyzed for the frequency of stent thrombosis. Patients with known risk factors for stent thrombosis, except diabetes and acute coronary syndrome, were excluded from the study. All patients maintained antiplatelet therapy for at least six months. To evaluate the effects of cilostazol as another option for antiplatelet therapy, triple antiplatelet therapy (aspirin+clopidogrel+cilostazol, n=502) was compared to dual antiplatelet therapy (aspirin+clopidogrel, n=813). Six months after stent placement, all patients received only two antiplatelet drugs: treatment either with cilostazol+aspirin (cilostazol group) or clopidogrel+aspirin (clopidogrel group). There were 1,033 patients (396 in cilostazol group and 637 in clopidogrel group) that maintained antiplatelet therapy for at least 12 months and were included in this study. Stent thrombosis was defined and classified according to the definition reported by the Academic Research Consortium (ARC).
defined and classified according to the definition reported by the Academic Research Consortium (ARC).
During follow-up (561.7+/-251.4 days), 15 patients (1.14%) developed stent thrombosis between day 1 to day 657. Stent thrombosis occurred in seven patients (1.39%) on triple antiplatelet therapy and four patients (0.49%) on dual antiplatelet therapy (p=NS) within the first six months after stenting. Six months and later, after stent implantation, one patient (0.25%) developed stent thrombosis in the cilostazol group, and three (0.47%) in the clopidogrel group (p=NS).
During the first six months after DES triple antiplatelet therapy may be more effective than dual antiplatelet therapy for the prevention of stent thrombosis. However, after the first six months, dual antiplatelet treatment, with aspirin and cilostazol, may have a better cost benefit ratio for the prevention of stent thrombosis.
Korean Circulation Journal 01/2010; 40(1):10-5.
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Dong-Bin Kim,
Hae-Ok Jung,
Doo-Soo Jeon,
Chan-Seok Park,
Sung-Won Jang, Hoon-Joon Park,
Pum Joon Kim,
Sang Hong Baek,
Ki-Bae Seung,
Tai-Ho Rho,
Jae-Hyung Kim,
Kyu-Bo Choi
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ABSTRACT: The treadmill exercise test (TMT) is used as a first-line test for diagnosing coronary artery disease (CAD). However, the findings of a TMT can be inconclusive, such as incomplete or equivocal results. Aortic valve sclerosis (AVS) is known to be a good predictor of CAD. We determined the usefulness of assessing AVS on 2-dimensional (2D) echocardiography for making the diagnosis of CAD in patients with inconclusive results on a TMT.
This prospective study involved 165 consecutive patients who underwent a TMT that resulted in inconclusive findings, 2D echocardiography to detect AVS, and coronary angiography to detect CAD. Following echocardiography, AVS was classified as none, mild, or severe. CAD was defined as >/=70% narrowing of the luminal diameter on coronary angiography.
CAD was more common in patients with AVS than in patients without AVS (75% vs. 47%, respectively, p<0.01). Multiple logistic regression analysis showed that AVS was the only independent predictor of CAD {odds ratio=8.576; 95% confidence interval (CI), 3.739-19.672}. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the presence of AVS for predicting CAD in a patient with an inconclusive TMT were 62%, 67%, 64%, 75%, and 53%, respectively. During a 1-year clinical follow-up, patients with and without AVS were similar in terms of event-free survival rates.
If the results of TMT for patients with chest pain on exertion are inconclusive, the presence of AVS on echocardiography is a good predictor of CAD.
Korean Circulation Journal 07/2009; 39(7):275-9.
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Sung-Won Jang,
Dong-Bin Kim,
Bum-Jun Kwon,
Dongil Shin,
Sung-Ho Her,
Chan-Seok Park, Hoon-Joon Park,
Man-Won Park,
Eun-Ju Cho,
Tae-Ho Rho,
Jae-Hyung Kim
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ABSTRACT: Simultaneous drug-eluting stent thrombosis in multivessel disease is a low incidence, but could cause lethal clinical event. We report a case with death caused by simultaneous subacute stent thrombosis of sirolimus-eluting stents in the proximal left anterior descending artery and in the proximal left circumflex artery.
International journal of cardiology 01/2009; 140(1):e8-11. · 7.08 Impact Factor
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Pum Joon Kim,
Ki-Bae Seung,
Dong-Bin Kim,
Sung-Ho Her,
Dong-Il Shin,
Seong-Wong Jang,
Chan-Seok Park, Hoon-Joon Park,
Hae-Ok Jung,
Sang Hong Baek,
Jae-Hyung Kim,
Kyu-Bo Choi
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ABSTRACT: Vasospastic angina (VA) can occasionally cause acute myocardial infarction (AMI).
From January 2003 to June 2005, coronary spastic angina was diagnosed in 292 patients by performing spasm provocation tests. Among the 292 patients, 21 (7.2% of all the VA patients) had an AMI. There were 20 patients who initially visited the emergency room for AMI without suffering prior VA. One patient with a history of VA had an AMI when he discontinued his medication. Among the 21 VA patients with AMI, 14 had experienced severe emotional stress before they visited the emergency room. The spasm provocation test showed that the VA patients with AMI had more multivessel and diffuse spasm than the VA patients without AMI (p<0.001).
Clinically, the VA patients with AMI usually had their first symptom of VA as the severe chest pain of AMI. Two-thirds of the VA patients with AMI had experienced emotional stress before their AMI. Angiographically, the spasm provocation test for VA patients with AMI showed more multivessel and diffuse spasm than in VA patients without AMI.
Circulation Journal 09/2007; 71(9):1383-6. · 3.77 Impact Factor
