[show abstract][hide abstract] ABSTRACT: The effects of statins on insulin resistance and new-onset diabetes are unclear. The purpose of this study was to evaluate the effects of rosuvastatin on insulin resistance and adiponectin in patients with mild to moderate hypertension. In a randomized, prospective, single-blind study, 53 hypertensive patients were randomly assigned to the control group (n=26) or the rosuvastatin (20 mg once daily) group (n=27) during an 8-week treatment period. Both groups showed significant improvements in systolic blood pressure and flow-mediated dilation (FMD) after 8 weeks of treatment. Rosuvastatin treatment improved total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglyceride levels. The control and rosuvastatin treatment groups did not differ significantly in the change in HbA1c (3.0±10.1% vs. -1.3±12.7%; p=0.33), fasting glucose (-1.3±18.0% vs. 2.5±24.1%; p=0.69), or fasting insulin levels (5.2±70.5% vs. 22.6±133.2%; p=0.27) from baseline. Furthermore, the control and rosuvastatin treatment groups did not differ significantly in the change in the QUICKI insulin sensitivity index (mean change, 2.2±11.6% vs. 3.6±11.9%; p=0.64) or the HOMA index (11.6±94.9% vs. 32.4±176.7%; p=0.44). The plasma adiponectin level increased significantly in the rosuvastatin treatment group (p=0.046), but did not differ significantly from that in the control group (mean change, 23.2±28.4% vs. 23.1±27.6%; p=0.36). Eight weeks of rosuvastatin (20 mg) therapy resulted in no significant improvement or deterioration in fasting glucose levels, insulin resistance, or adiponectin levels in patients with mild to moderate hypertension.
[show abstract][hide abstract] ABSTRACT: Passage failure of guidewire is still remained most common reason for percutaneous coronary intervention (PCI) failure in chronic total occlusion (CTO). Intravascular ultrasound study (IVUS) and cardiac CT angiography can help identify features that most influence current success rates of PCI. We report our experience using the reverse controlled antegrade and retrograde subintimal tracking technique under the aid of IVUS, cardiac CT angiography for an ambiguous CTO of proximal right coronary artery.
[show abstract][hide abstract] ABSTRACT: 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), one of the components of Agent Orange, has been reported to be a deadly poison despite its presence at extremely small doses. TCDD is reported to cause various kinds of cancers and other harmful effects on humans. However, a correlation between exposure to TCDD and acute coronary syndrome (ACS) is not yet proven. Thus, we examined the correlation between exposure to TCDD and ACS through an analysis of coronary angiograms from veterans of the Vietnam War. Two hundred fifty-one consecutive men undergoing coronary angiograms owing to ACS between April 2004 and May 2009 at Gwangju Veterans Hospital were analyzed. Included subjects were between 50 and 70 years of age. The patients were divided into two groups: 121 patients who had been exposed to TCDD (Group I) and 130 patients who had not been exposed to TCDD (Group II). Clinical and coronary angiographic findings were evaluated. Baseline clinical characteristics, inflammatory markers, and echocardiographic parameters were not significantly different between the two groups. The incidence of hypertension (71.1% vs. 60.0%, p=0.039) and hyperlipidemia (27.3% vs. 16.9%, p=0.038) was higher in Group I than in Group II. Total occlusion, stent length, stent use, and coronary lesion characteristics were not significantly different between the two groups. The rate of major adverse cardiovascular events (MACE) had no relationship with exposure to TCDD. Exposure to TCDD might not affect severity or the rate of MACE in persons with ACS.
[show abstract][hide abstract] ABSTRACT: Obesity is a well-established risk factor for many chronic disorders. However, the effect of weight change after acute myocardial infarction (AMI) is not well known. Among consecutive patients who underwent percutaneous coronary intervention between November 2005 and November 2007 due to AMI, patients who were overweight (23.0≤body mass index [BMI]<27.5 kg/m(2), n=341) and obese (BMI≥27.5 kg/m(2), n=80) were selected for analysis. According to weight change, the patients were divided into 4 groups: Group I (weight loss>5%, n=61), Group II (0%<weight loss≤5%, n=133), Group III (0%≤weight gain<5%, n=181), and Group IV (weight gain≥5%, n=46). We assessed the association between weight change and major adverse cardiac events (MACE). Greater weight loss was more frequent among older individuals (Group I: 64.1±12.4 years, II: 60.6±12.1 years, III: 59.0±11.9 years, IV: 61.4±10.6 years; p=0.028) and patients with diabetes (Group I: 34.4%, II: 27.1%, III: 21.2%, IV: 15.2%; p=0.009). However, there were no significant differences in baseline characteristics or in angiographic or procedural factors except for the proportions of patients with three-vessel disease, which were higher in patients with weight loss (Group I: 20.8%, II: 23.0%, III: 12.5%, IV: 11.6%; p=0.005). The group with greater weight loss had the highest MACE rate at the 12-month clinical follow-up (Group I: 36.9%, II: 25.0%, III: 25.9%, IV: 17.3%; p=0.020). Although weight loss after AMI appears to be associated with worse outcomes, it remains unclear whether the effect is of cardiac origin.
[show abstract][hide abstract] ABSTRACT: Below the knee (BTK) interventions are increasing in patients with rest pain or critical limb ischemia, and these interventions are frequently successful in facilitating limb salvage. New intervention techniques and devices allow successful recanalization of occluded BTK arteries. Here, we report a case of successful recanalization of BTK arteries using multidisciplinary methods, including an antegrade approach and retrograde approach without the use of a sheath, but with simple balloon angioplasty, and plaque excision using Silverhawk atherectomy device.
[show abstract][hide abstract] ABSTRACT: A 42-year-old male patient presented with refractory hypertension and congestive heart failure. He had taken hydrochlorthiazide 50 mg, carvedilol 25 mg, diltiazem 180 mg, and losartan 100 mg per day. Aortogram revealed a severe luminal narrowing in the distal thoracic aorta with a peak systolic pressure gradient of 60 mmHg across the lesion. Endovascular management was performed with 22 × 80 mm self-expandable Nitinol-S stent after predilation with 10 × 40 mm balloon. After endovascular management, the patient's blood pressure, left ventricular ejection fraction (LVEF) and dilated LV dimension were remarkably improved.
Journal of cardiovascular ultrasound 09/2011; 19(3):144-7.
[show abstract][hide abstract] ABSTRACT: Several studies have demonstrated that adenosine and nicorandil protect the myocardium against angioplasty-related myocardial injury. We conducted a prospective study to investigate the myocardial protective effects of combination therapy with intracoronary adenosine and nicorandil.
We enrolled 213 consecutive patients with stable or unstable angina who were scheduled for non-urgent PCI for de-novo coronary lesions. Patients were randomized into group I (control saline, n=55), group II (adenosine 50 μg, n=54), group III (nicorandil 4 mg, n=54), or group IV (adenosine-nicorandil combination, n=50). Serial assessments of CK-MB were used to assess myocardial necrosis before and after PCI. The primary endpoint was the incidence of myocardial necrosis (elevation of CK-MB), and the secondary endpoints were the changes in serum CK-MB and cTnI levels and the incidence of post-procedural myocardial infarction (MI).
No significant differences were observed among the four groups with regard to baseline or angiographic characteristics. No major adverse events related to adenosine and nicorandil were observed. There were no significant differences in the incidence of post-procedural myocardial necrosis among the four groups (10.9, 14.8, 14.8, and 14.0%, respectively, p=0.9). There were no significant differences in the incidence of post-procedural MI among groups (p=0.6). In multivariate regression analysis, multivessel stenting, median stent length, and the presence of a compromised side branch were independent predictors of myonecrosis.
Pretreatment with intracoronary adenosine, nicorandil, or the combination of the two drugs did not reduce the incidences of myocardial necrosis or MI after non-urgent PCI in patients with low-risk angina pectoris.
International journal of cardiology 01/2011; 158(1):88-92. · 7.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Subintimal percutaneous transluminal angioplasty (SIA) is a treatment option for long segment occlusions in the lower limb arteries. In the present study the factors influencing success and patency following SIA in patients with TransAtlantic Inter-Society Consensus (TASC) C and D peripheral arterial disease (PAD) were investigated.
The 63 consecutive SIAs were performed in 54 consecutive patients suffering from limb ischemia with TASC C and D lesions. Follow-up consisted of routine office visits with pulse examination, ankle-brachial index (ABI), and serial surveillance by color duplex ultrasound and scanning at 3- to 6-month intervals for 1 year. The morphology of lesions in all patients were type C (n=13, 20.6%) or type D (n=50, 79.4%). SIA was technically successful in 59 of 63 arterial occlusive lesions (93.6%). Post-procedural ABI was 0.89+/-0.16. The mean increase in ABI after SIA was 0.45 (range, 015-0.87). The primary patency rate at 12 months was 51.7%. Occlusion length, lesions involving the distal superficial femoral artery (SFA), and post-procedural distal run-off vessels (P=0.04, 0.006, 0.018, respectively) were independent patency determinants by multivariate analysis.
The length of the occlusion, lesions involving the distal SFA, and post-procedural distal run-off vessels were strong independent predictors for 1-year patency in TASC C/D severe occlusive femoropopliteal artery disease treated by SIA.
[show abstract][hide abstract] ABSTRACT: This study was designed to determine the effect of green tea consumption in patients with chronic kidney disease (CKD) on flow-mediated endothelium-dependent vasodilation (FMD) and the number of circulating endothelial progenitor cells (EPCs). Forty patients with CKD requiring chronic dialysis were enrolled. The patients were divided into two groups: the catechin group that consumed green tea (5 g/day for 1 month) and the control group that consumed water. The number of EPCs, inflammatory markers, oxidative stress, and FMD were determined at baseline and 4 weeks after green tea consumption. Clinical characteristics, oxidative stress, inflammatory markers, and circulating EPCs number were not significantly different. FMD was significantly improved after 4 weeks in the catechin group (from 5.68±2.67% to 8.66±3.46%, p=0.002). Short-term green tea consumption induced a rapid improvement in FMD, but did not improve circulating EPC levels in patients with CKD.
International journal of cardiology 12/2009; 145(2):261-2. · 7.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: We sought to compare the platelet responsiveness to clopidogrel between patients with chronic renal failure and those with normal renal function. We conducted a prospective, randomized, open-label, single-center trial. A total of 23 patients with normal renal function received a usual daily dose of 75 mg of clopidogrel (group I, 61 +/- 7 years). Also, 36 patients with chronic renal failure (60 +/- 5 years) were divided into 2 groups according to their daily dose of clopidogrel: a daily dose of 75 mg of clopidogrel for 30 days (group II, n = 18) or a daily dose of 150 mg (group III, n = 18). The primary efficacy variables among the study groups using the VerifyNow P2Y12 assay were the P2Y12 reaction unit value and the percentage of inhibition. A significant difference was found in the P2Y12 reaction unit value among the 3 groups (239 +/- 87 in group I, 308 +/- 70 in group II, 302 +/- 81 in group III (p = 0.013) and in the percentage of inhibition (35 +/- 20 in group I, 21 +/- 16 in group II, 23 +/- 14 in group III, p = 0.026). No significant difference was found in the P2Y12 reaction units or percentage of inhibition between groups II and III. In conclusion, platelet responsiveness to clopidogrel decreased more in patients with chronic renal failure than in those with normal renal function, and this decreased platelet responsiveness to clopidogrel was not improved by an increase in the clopidogrel dosage.
The American journal of cardiology 11/2009; 104(9):1292-5. · 3.58 Impact Factor
[show abstract][hide abstract] ABSTRACT: Several studies have shown that angiotensin II receptor blockers (ARBs) improve endothelial function and arterial stiffness. Telmisartan is a highly selective ARB that activates peroxisome proliferator-activated receptor gamma (PPARgamma). The purpose of this study was to evaluate the effects of telmisartan, such as endothelial function, arterial stiffness, and insulin sensitivity, in patients with essential hypertension.
Thirty-nine patients with essential hypertension were administered telmisartan (80 mg once daily) using an open-labeled and prospective protocol. The patients were examined before and 8 weeks after treatment to assess changes in flow mediated-vasodilation (FMD), pulse wave velocity (PWV), quantitative insulin-sensitivity check index (QUICKI), homeostasis model assessment (HOMA), and adiponection.
The systolic and diastolic blood pressure (BP) decreased from 153+/-15 mmHg and 90+/-13 mmHg to 137+/-16 mmHg and 84+/-10 mmHg after telmisartan treatment, respectively (p<0.01). Telmisartan therapy increased the FMD from 7.6+/-3.5 to 9.0+/-2.8% (p<0.01). The following parameters of arterial stiffness were significantly improved after telmisartan therapy: brachial-ankle pulse wave velocity (baPWV), from 17.2+/-3.1 to 15.9+/-2.6 m/sec; heart-carotid PWV (hcPWV), from 9.7+/-1.8 to 9.0+/-1.9 m/sec; and heart-femoral PWV (hfPWV), from 11.3+/-1.9 to 10.7+/-1.9 m/sec (p<0.01). There were no changes in QUICKI, the HOMA level, and plasma adiponectin (p=NS).
These results suggest that telmisartan is effective in improving endothelial function and arterial stiffness in patients with essential hypertension.