[show abstract][hide abstract] ABSTRACT: Recent intravascular ultrasound (IVUS) studies of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have demonstrated a significant reduction in neointimal hyperplasia (NIH) based on simple coronary lesions. In this study, we evaluated the efficacy of SES and PES using IVUS in complex coronary lesions.
Eighty-seven patients in whom 95 drug-eluting stents (66 SES and 29 PES) were implanted in complex coronary lesions were enrolled in this study. Case selection was based on the availability of IVUS and quantitative coronary angiographic (QCA) examinations at the index procedure and at follow-up. The neointimal volume index (volume/length: NIVI) and percent neointimal volume (% NIV) were calculated. The longitudinal length of stented segments without IVUS-detectable NIH was also evaluated.
The baseline patient demographics were similar between the SES and PES groups. At follow-up, no significant differences were observed in the vessel, plaque, or stent volume indices between the two groups. However, the NIVI and % NIV were significantly lower in the SES group (p<0.01). The longitudinal length of stented segments without IVUS-detectable NIH was significantly higher in the SES group (p<0.01). The net gain was significantly larger in the SES group (2.3+/-0.7 vs. 2.0x0.6 mm, p=0.025), while the rate of major adverse cardiac events was similar between the two groups.
Although SES showed significantly greater suppression of NIH at follow-up, both stents were highly effective at inhibiting NIH in complex coronary lesions.
The Korean Journal of Internal Medicine 12/2009; 24(4):323-9.
[show abstract][hide abstract] ABSTRACT: Coronary angiography (CAG) is an invasive diagnostic procedure, which could lead to procedure related complications. One of the well known post-procedural complications is cerebral embolic infarction with or without symptoms. Silent embolic cerebral infarction (SECI) has clinical significance because it can progress to a decline in cognitive function and increase the risk of dementia in the long term. The aim of this study was to detect the incidence and predictors of SECI after diagnostic CAG using diffusion-weighted magnetic resonance imaging (DW-MRI).
A total of 197 patients with coronary artery disease who underwent DW-MRI for evaluation of intracranial vasculopathy before coronary artery bypass graft surgery were retrospectively enrolled in the present study. DW-MRI was performed within 48 h after diagnostic CAG. SECI was diagnosed as presence of focal bright high signal intensity in DW-MRI. Patients were divided into groups according to presence/absence of SECI (+ SECI vs. - SECI, respectively). The clinical and angiographic characteristics were analyzed and independent predictors were evaluated.
Of the 197 patients, SECI occurred in 20 patients (10.2%) after diagnostic CAG. Age, female gender, frequency of underlying atrial fibrillation, extent of coronary disease, and fluoroscopic time during diagnostic CAG were not different between the + SECI and - SECI groups. Left ventricular ejection fraction was significantly lower in the + SECI group than in the - SECI group (45.9 ± 8.5% vs. 51.4 ± 13.1%, p=0.014) and performance rate of internal mammary artery (IMA) angiography was significantly higher in the + SECI group compared with the - SECI group (85% vs. 37.2%, p<0.001). By multivariate analysis, performing IMA angiography was the only predictor of SECI (OR=14.642; 95% CI=3.201 to 66.980, p=0.001).
The incidence of SECI after diagnostic CAG was not infrequent. Diagnostic CAG with IMA angiography may increase the risk of SECI.
International journal of cardiology 11/2009; 148(2):179-82. · 7.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although previously reported studies on coronary calcification mainly focused on its presence or absence in discrete focal target lesions, calcified coronary lesions (CCL) angiographically present as diffuse long lesions in some patients. The aim of our study was to evaluate the long-term efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) on long CCL.
A total of 122 patients with 134 lesions (77 patients with 88 lesions for SES and 45 patients with 46 lesions for PES) were enrolled from 3 centers. Long CCL was defined visually as a culprit lesion with type B or C that was mainly due to coronary calcification with > 20 mm in total length by coronary angiography. Clinical follow-up was performed at 1 year and angiographic follow-up at 6 to 9 months after procedure. Major adverse coronary events (MACE) were defined as all-cause death, myocardial infarction (MI), and repeat target-lesion revascularization (TLR).
There were no statistically significant differences in baseline, procedural, or angiographic characteristics and in 1-year rates of all-cause death, MI, and TLR between the 2 groups (all P = NS [not significant]). Likewise, the cumulative incidence of MACE at 1 year was similar between the 2 groups (7.8% of patients in the SES group vs 4.4% of patients in the PES group, respectively, P = NS). In patients who underwent follow-up angiography, the angiographic binary restenosis rate was 6.2% in the SES group vs 12.1% in the PES group, respectively (P = NS).
In patients with long CCL, both SES and PES were comparably effective in either angiographic or clinical long-term outcomes.
[show abstract][hide abstract] ABSTRACT: Patients with heart failure with a preserved ejection fraction (HFPEF) have high N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) level and a high ratio of early transmitral inflow to diastolic velocity of the mitral annulus (E/E') derived from tissue Doppler imaging (TDI). Because left atrial volume indexed to body surface area (LAVI) is believed to reflect chronic diastolic dysfunction, we assessed the ability of LAVI and E/E' ratio to predict NT-pro-BNP level in patients with HFPEF.
One hundred forty-eight patients with HFPEF (ejection fraction >or= 50%, NT-pro-BNP >or= 100 pg/ml) underwent conventional echocardiography including LAVI and E/E' ratio, which were compared with NT-pro-BNP level.
In the overall patient population, modest correlations were found between NT-pro-BNP level and peak systolic TDI (S') (P = 0.009), LAVI (P = 0.009), and E/E' ratio (P = 0.017). However, in patients with E/E' ratio >or=13, LAVI was the most important predictor of NT-pro-BNP level (P < 0.001), whereas in those with E/E' ratio <13 it was S' (P < 0.001) in multivariate analysis.
In patients with HFPEF evidenced by high NT-pro-BNP level, LAVI correlates with NT-pro-BNP level in the setting of elevated E/E' ratio. However, in the setting of low E/E' ratio, LAVI does not seem to be associated with NT-pro-BNP level.
[show abstract][hide abstract] ABSTRACT: The ratio of peak early diastolic mitral inflow to annular velocity (E/E') and left atrial size could provide prognosis on congestive heart failure (CHF). N-terminal Pro B-type natriuretic peptide (NT-ProBNP) has also been useful for predicting adverse cardiac events. However, it is not clear how these parameters compare with conventional risk factors. Thus, we investigated whether E/E', left atrial dimension index (LADI) and NT-ProBNP would predict adverse events and add incremental value to conventional risk factors, even in non-ischemic advanced dilated cardiomyopathy (DCM).
Both NT-ProBNP and echocardiography were evaluated in 105 patients. The cardiac events were defined as the composite of cardiac death and re-admission for CHF. At follow up, cardiac events occurred in 24 patients who had high NT-ProBNP and showed higher LADI and E/E'. In multivariate analysis, both NT-ProBNP and LADI, but not E/E', remained as independent predictors; patients with both increased LADI and NT-ProBNP had a 27-fold higher risk of cardiac events than those without any risk factors (p = 0.003). Moreover, LADI and NT-ProBNP showed a better incremental prognostic value over conventional risk factors (global chi-square increase from 7 to 17 to 49, p = 0.003, p < 0.001, respectively).
Both NT-ProBNP and LADI might have the most predictable power, particularly in non-ischemic advanced DCM.
[show abstract][hide abstract] ABSTRACT: Hypertension is an important contributor to different left ventricular (LV) geometric patterns with resultant myocardial dysfunction. Strain rate image (SRI) has been suggested as a useful tool for the evaluation of myocardial function. The aim of this study was to assess whether SRI correlates with LV geometric patterns in hypertensive subjects. Fifty-one hypertensive subjects and 21 healthy controls were enrolled and examined with conventional echocardiography including LV mass index (LVMI). Moreover, tissue Doppler imaging (TDI) and strain or SRI were obtained in all subjects. The hypertensives were subanalyzed according to geometric patterns. The hypertensive subjects were more likely to have enlarged left atrial dimensions, prolonged decelerating time and isovolumic relaxation time, and showed a lower TDI of early diastolic mitral annulus and SRI of early diastolic component (SR-e). Among hypertensive subjects, there was a significant trend toward a lower value of SR-e in those with hypertrophy and SR-e was the lowest in the concentric hypertrophy than other geometric patterns. In addition, SR-e was associated most strongly with LVMI of LV other than echoparameters. The hypertrophic hypertensive subjects showed altered systolic and/or diastolic function. Moreover, SR-e appeared to be correlated most with geometric patterns according to LVMI.
Heart and Vessels 07/2008; 23(4):271-8. · 2.13 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 79-year-old man was followed in our hospital for 4 years following primary percutaneous coronary intervention at another hospital to deploy two stents at the left anterior descending coronary artery for acute myocardial infarction (AMI). At the first visit in our hospital, echocardiography revealed a small ventricular septal defect (VSD, 0.8 to 1.0 cm) in the apicoseptal wall with an aneurysm that was probably the result of the AMI. There was no hemodynamic decompensation, and because the patient refused surgical correction we instead placed him under close follow-up observation in the outpatient clinic. A second follow-up echocardiography 6 months later still revealed a VSD. However, after 3 years the VSD murmur was no longer audible and follow-up echocardiography showed the defect to be nearly closed.
[show abstract][hide abstract] ABSTRACT: Spontaneous chordae rupture of the tricuspid valve is relatively rare, unlike the mitral valve. We present a 27-year-old male with chronic renal failure on hemodialysis therapy for treatment of parathyroid adenoma. The echocardiography showed the severe tricuspid regurgitation with chordae rupture which was not noted 1 year ago. In addition, the papillary muscle of both mitral and tricuspid valve was shortened and calcified extensively. However, in his clinical history, the specific causes for chordae rupture, such as chest trauma or endocarditis, were not disclosed. It was presumed that dilated right ventricle with volume or pressure overloading and secondary hyperparathyroidism are probably responsible for the chordae rupture of tricuspid valve.
[show abstract][hide abstract] ABSTRACT: We report a case of infective endocarditis of the mitral valve, which was accompanied by pulmonary emboli traveling through an atrial septal defect. An 18-year-old male was admitted to our hospital due to a fever, polyarthritis and subcutaneous hemorrhage. Transthoracic echocardiography revealed a mobile mass and possible vegetation lodged in the mitral valve and a secundum-type atrial septal defect. Computed tomography revealed a hepatic, splenic and renal embolic infarction. During antibiotic therapy, he felt a sudden right flank pain. Follow-up computed tomography revealed a pulmonary embolic infarction that drifted through an atrial septal defect. This association is the first report, of pulmonary emboli which migrated through an atrial septal defect from the mitral valve.
International journal of cardiology 01/2008; 133(1):e3-5. · 7.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Several cases of stent strut fractures (SSFs) have recently been reported following drug-eluting stent (DES) im- plantation Although SSF is a rare complication, it has been suggested to be a cause of restenosis. To date, a num- ber of cases of stent fracture have been associated with sirolimus-eluting stents and they occurred from 2 days to about 2 years after the initial procedure. We report here on a case of paclitaxel-eluting stent fracture at the time of stent placement in a calcified coronary lesion. (Korean Circ J 2008;38:387-389)
[show abstract][hide abstract] ABSTRACT: The cases of two Asian brothers with idiopathic left ventricular tachycardia are reported. Their 12-electrocardial leads showed regular, wide QRS tachycardia showing left bundle branch block morphology with a superior axis deviation. Radiofrequency ablation was performed and there was no specific events during 10 year follow up.
[show abstract][hide abstract] ABSTRACT: Vascular inflammation induced by the proinflammatory cytokine/NF-kappaB pathway is one of the key mechanisms in the development of neointimal hyperplasia. Accumulating evidence suggests that a recently identified chemokine, fractalkine, is involved in arterial inflammation and atherogenesis. However, no study has examined the expression of neointimal fractalkine and the effects of pharmacological agents on this process. The purposes of this study were to measure neointimal fractalkine expression in the rat carotid artery following balloon injury and to determine if alpha-lipoic acid (ALA) inhibits fractalkine expression and neointimal hyperplasia. Balloon injury of the rat carotid artery induced fractalkine expression in the medial as well as neointimal regions. ALA inhibited this expression and consequently prevented neoinitmal hyperplasia in a balloon-injured rat carotid artery. Additionally, ALA inhibited TNF-alpha-stimulated fractalkine expression in cultured vascular smooth muscle cells (VSMCs), a process which is mediated through the NF-kappaB pathway. In addition to fractalkine, ALA successfully inhibited TNF-alpha-stimulated expression of vascular cell adhesion molecule-1 and monocyte chemotactic protein-1 in cultured VSMCs. These data suggest that the cytokine-fractalkine system is involved in the pathogenesis of restenosis. The present study supports the possibility that ALA, which inhibits the NF-kappaB/fractalkine pathway, may be used to prevent neointimal hyperplasia after angioplasty or stenting.
[show abstract][hide abstract] ABSTRACT: Although patients may present with typical chest pain and exhibit ischemic changes on the cardiac stress test, they are frequently found to have a normal coronary angiogram. Thus, we wanted to determine which procedures should be performed in order to make an adequate diagnosis of the cause of chest pain.
121 patients (males: 42, 34.7%) who had a normal coronary angiogram with typical chest pain were included in this study. All the patients underwent upper endoscopy, Bernstein's test and esophageal manometry.
Among the 121 patients, clinically stable angina was noted in 107 (88.4%). Stress testing was done in 82 (67.8%); it was positive in 52 (63.4%). Endoscopic findings were erosive gastritis in 18 (14.8%), gastric ulcer in 4 (3.3%), duodenal ulcer in 5 (4.1%), and reflux esophagitis in 16 (13.2%). Positive results were observed on Berstein's test for 68 patients (56.2%); 59 (86.8%) of them had non-erosive reflux disease. On the esophageal manometry, 35 (28.9%) of these patients had motility disorders. Nutcracker esophagus was observed in 27 patients (22.3%), nonspecific esophageal motility disorder was observed in 5 (4.1%), and hypertensive lower esophageal sphincter was observed in 3 (2.5%). Among the 52 patients with positive cardiac stress testing and a negative coronary angiogram (this clinically corresponded to microvascular angina), 46 patients (85.1%) showed abnormal findings on the gastro-esophageal studies.
In our study, 85.1% of the patients with microvascular angina revealed positive results of gastric or esophageal disease. In spite of any existing evidence of microvascular angina or cardiac syndrome X, it would be more advisable to perform gastro-esophageal studies to adequately manage chest pain.
The Korean Journal of Internal Medicine 07/2006; 21(2):94-6.
[show abstract][hide abstract] ABSTRACT: Intravascular ultrasound is considered as having few complications, most of them are just a transient coronary spasm. However, we experienced one case of acute left anterior descending coronary artery occlusion following an intravascular ultrasound study during the intervention and this was treated successfully with cardiopulmonary resuscitation and stent implantation.
International Journal of Cardiology 05/2006; 108(3):422-3. · 5.51 Impact Factor