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ABSTRACT: Inflammation plays a significant role in acute coronary syndrome (ACS) and type 2 diabetes mellitus (DM). There may be similar inflammatory changes in non-DM patients with ST elevation myocardial infarction (STEMI) and DM patients with stable angina (SA), and DM patients with STEMI may have more severe changes than the former two groups. The objectives of this study were to investigate whether the level of inflammation was similar in patients with non-DM STEMI and DM SA, and to evaluate whether the changes in the level of inflammation were more severe in patients with DM STEMI compared to the other two groups.
A variety of inflammatory markers including: highly sensitive C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), IL-18, vascular cell adhesion molecule-1 (VCAM-1), and matrix metallopeptidase-9 (MMP-9) as well as insulin resistance were compared among the three groups: DM STEMI (90 patients), DM SA (91 patients), and non-DM STEMI (76 patients). Inflammatory marker levels were not significantly different between the DM SA and non-DM STEMI groups. However, hsCRP and IL-6 were increased in the DM STEMI compared to the DM SA patients (p=0.005 and p=0.004, respectively). In addition, hsCRP, ESR, and IL-18 were increased in the DM STEMI compared to the non-DM STEMI patients (p=0.017, p=0.020, and p=0.033, respectively). Furthermore, the fasting insulin and the homeostasis model assessment were significantly increased in the DM STEMI compared to the DM SA patients (p=0.04 and p=0.004, respectively).
DM SA and non-DM STEMI may have similar inflammatory changes. DM STEMI may be a more severe inflammatory condition compared to patients with DM SA or non-DM STEMI.
Journal of Cardiology 05/2012; 60(3):204-9. · 1.28 Impact Factor
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ABSTRACT: The correlations between circulating angiogenic cell mobilizations and improvement of microvascular integrity were investigated in patients (n=110) with acute myocardial infarction (AMI) during an 8-month follow up.
Coronary flow reserve (CFR) was measured at baseline and at 8 months by using an intracoronary Doppler wire. Serial changes in the absolute numbers of circulating angiogenic cells such as CD34+, CXCR4+, CD117+, CD133+ and C-met+ were measured at baseline, day 1, day 5 and at 8 months. The absolute numbers of circulating angiogenic cells at day 1 were significantly higher than those at baseline. A positive correlation was found between the numbers of circulating angiogenic cells of CD34+, CXCR4+, CD117+ and CD133+ cells at day 1 and the CFR changes from baseline. The cut-off value of CFR changes at 8 months by a receiver operating characteristic curve between a circulating CD34+ cell at day 1 and changes of CFR at 8 months was 0. Late-loss showed the positive correlation with the absolute number of C-met+ cells and the negative correlation with the absolute number of CXCR4+ cells after AMI. The negative correlation was found between changes in high-sensitive C-reactive protein and soluble intercellular adhesion molecule-1 and changes in CFR at 8 months.
The recovery of microvascular integrity after acute ischemic injury was expedited by the increases in circulating angiogenic cell mobilization together with the greater decreases in inflammatory cytokines. The improvement in CFR could be predicted by the measurement of circulating angiogenic cells after AMI.
Circulation Journal 02/2012; 76(5):1213-21. · 3.77 Impact Factor
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ABSTRACT: The impacts of acute myocardial infarction (AMI) with different regional wall motion abnormalities on left ventricular (LV) rotation have not been well investigated. We assessed the impacts of AMI on LV rotational mechanics and to compare the alterations in basal and apical rotation between patients with anterior and inferior AMI.
Thirty-five patients with anterior AMI and 31 patients with inferior AMI who had a single culprit lesion were analysed. Thirty age-matched subjects were included for controls. The apical and basal rotations were obtained and LV twist and torsion were measured by two-dimensional speckle tracking imaging. Compared with normal, LV twist was reduced in all AMI patients. The basal rotation was larger in anterior AMI than in inferior AMI and normal (-9.0 ± 2.6 vs. -3.4 ± 2.1° and -6.0 ± 1.9°, P < 0.001), although the apical rotation was lower in anterior AMI. As a result, LV twist and torsion were not different between anterior AMI and inferior AMI (17.0 ± 4.6 vs. 16.7 ± 3.3° and 2.08 ± 0.59 vs. 2.07 ± 0.44°/cm, P = NS, respectively), although LV ejection fraction was lower in anterior AMI. By multivariate analysis, LV torsion [odds ratio (OR) =0.13, 95% confidential interval (CI) = 0.02-0.75, P = 0.02] and basal rotation (OR = 0.67, 95% CI = 0.45-1.00, P = 0.05) were independently related to LV recovery in patients with anterior AMI and in patients with inferior AMI, respectively.
Although LV twist and torsion were decreased either by reduced apical and basal rotation in AMI patients; the basal rotation was rather increased in anterior AMI. LV functional recovery can be predicted by LV torsion in anterior AMI and by basal rotation in inferior AMI. The basal rotation has often been ignored; however, our findings suggest that the basal rotation has an important role in LV function.
European heart journal cardiovascular Imaging. 12/2011; 13(6):483-9.
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ABSTRACT: To investigate the mechanistic basis underlying antirestenosis and the antiatherogenic effect of pioglitazone in patients with type 2 diabetes mellitus who were undergoing zotarolimus-eluting stent implantation.
Recent studies highlight the beneficial effect of pioglitazone in attenuating neointimal growth after stent implantation. Patients with coronary artery diseases were randomly assigned to pioglitazone (n=47) or placebo (n=47) after stent implantation. Pioglitazone significantly reduced neointimal hyperplasia within the stented lesion and attenuated total plaque burden in the in-segment regions of the stent, as assessed by intravascular ultrasonography at the 8-month follow-up. These changes were preceded by reduced circulating natural killer (NK) cells, diminished interleukin 6 and monocyte chemoattractant protein-1 levels, and downregulation of chemokine receptor 2 at 2 days after stent implantation; and an elevated interleukin 10 level at 10 days after implantation. Furthermore, the proliferation and migration of vascular smooth muscle cells were inhibited in the presence of pioglitazone-treated patient serum, demonstrating that the antiproliferative effects of pioglitazone occurred concurrently with its antiinflammatory action.
Our data present early cellular and immunologic changes by pioglitazone that might have been associated with antirestenotic and antiatherogenic effects in diabetic patients. Inhibiting proinflammatory responses while promoting antiinflammatory circuits, together with an antiproliferative action, may, in part, account for the antirestenotic effect of pioglitazone by altering vascular remodeling processes in the early phase.
Arteriosclerosis Thrombosis and Vascular Biology 10/2010; 30(12):2655-65. · 6.37 Impact Factor
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ABSTRACT: Although warfarin is an effective oral anticoagulation (OAC) drug to reduce the risk of thromboembolism in patients with non-valvular atrial fibrillation (NVAF), long term follow-up data are scarce to be certain whether the target INR level is maintained in warfarin-treated patients in Korea. The aim of this study was to evaluate how well INRs are maintained within the target range using a new index, INR stability (= 100 x number of INRs within target range/total number of INR measurements) which we made, and to find out any correlation between thromboembolic events and INR stability.
This study was an observational analysis of retrospectively collected data of 129 patients with NVAF from April 2000 to December 2005 at a single tertiary hospital. All patients were registered at the anticoagulation service.
The median duration of follow up was 2.03 years (interquartile range 1.35 - 2.96). During the follow-up period, 60.9 +/- 14.9% of the INR were within the target INR range. INR stability was not significantly different between patients without and with stroke (61.2 +/- 15.0% vs 53.3 +/- 4.9%). Among the known factors affecting fluctuations of the INR value, the most frequent factor was noncompliance (41.8%).
The present study showed that it was not enough to maintain INR values within the target range in warfarin-treated patients with NVAF even at a tertiary hospital. Noncompliance is an important problem which interferes with maintaining target INR range.
Yonsei medical journal 03/2009; 50(1):83-8. · 0.77 Impact Factor
