[Show abstract][Hide abstract] ABSTRACT: Background:
Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis.
To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population.
708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups.
Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose.
Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients.
Full-text · Article · Jan 2016 · Arquivos Brasileiros de Cardiologia
[Show abstract][Hide abstract] ABSTRACT: Nitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT.
We evaluated 40 patients with suspected vasovagal syncope. Beat-to-beat changes in blood pressure, heart rate (HR), cardiac index (CI), and systemic vascular resistance (SVR) during HUTT were measured with thoracic impedance cardiography and a plethysmographic finger arterial pressure monitoring device.
None of the 40 patients complained of presyncopal symptoms during passive HUTT. However, after the administration of NTG 28 patients showed presyncopal symptoms (NTG+ group) and the remaining 12 patients did not (NTG- group). HR, CI, and the stroke index did not significantly differ between the two groups, whereas mean arterial pressure and SVR were significantly lower in the NTG+ group.
Presyncopal symptoms during NTG-stimulated HUTT are SVR mediated, not cardiac output mediated. This study challenges the conventional idea of a decrease in cardiac output mediated by NTG as the overriding cause of presyncopal symptoms during HUTT.
Full-text · Article · Apr 2015 · Journal of Arrhythmia
[Show abstract][Hide abstract] ABSTRACT: Failure to achieve optimal stent expansion poses a risk of treatment failure in percutaneous coronary intervention (PCI). Although intravascular ultrasound provides useful information for suboptimal stent expansion, substantial portion of PCI are currently being performed under angiographic guidance only. : AIM: To evaluate the adequacy of stent expansion of 4 widely-used drug-eluting stents in angiography-guided PCI, we performed a retrospective analysis of lesions undergoing PCI using quantitative coronary angiography (QCA).
Total 112 de novo lesions were analyzed. Minimal lumen diameter (MLD) was measured at peak pressure during stent deployment (MLD1), after stent deployment (MLD2) and after postdilatation (MLD3). Stent underexpansion, stent elastic recoil, and stent deficit were calculated. Optimal stent deployment was defined as final MLD ≥ 90% of predicted diameter.
For deploying stent balloon, higher than nominal pressure was used in 83% (93/112). However, optimal deployment was observed in only 32% (36/112). Adjuvant postdilatation was performed in 59% (45/76) of lesions with suboptimal expansion, which increased the optimal deployment rate by 60% (27/45). Final optimal stent deployment rate was achieved in 56% (63/112). We newly found that the MLD1 (p=0.04), MLD3 (p=0.02), final MLD (p=0.04), and optimal stent deployment rate (p=0.036) were significantly reduced in longer stent deployment lesion (≥ : 20 mm) compared to shorter lesion (< 20 mm).
Stent length may be a contributing factor of suboptimal stent expansion in angiography-guided PCI.
Full-text · Article · Mar 2015 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: Coronary artery disease (CAD) is a major determinant of long-term prognosis in patients with peripheral artery disease (PAD). We investigated the predictors of CAD in patients with lower extremity PAD.A total of 107 patients with PAD who underwent peripheral and simultaneous coronary angiography were reviewed. PAD was defined as (≥ 50%) stenosis associated with claudication or critical limb ischemia. PAD was divided into proximal and distal lesions. CAD was defined as angiographically significant (≥ 50%) stenosis of coronary arteries.The prevalence of CAD in patients with PAD was 62% (67/107), and of this 62%, only 13% (9/67) had angina and 72% (48/67) had multi-vessel disease. Diabetes significantly increased the risk of CAD in patients with PAD and the odds ratio of having multi-vessel CAD was 2.5 (1.1-5.9, P = 0.037) in multivariate regression analysis. The patients with multi-vessel CAD had more cardiovascular risk factors than those with normal, minimal and single CAD (P = 0.032). Interestingly, the prevalence of proximal PAD was higher in the normal or single CAD group than the multi-vessel CAD group, whereas both proximal and distal involvement of PAD was higher in the multi-vessel CAD group.Diabetes, multi-cardiovascular risk factors, and involvement of both proximal and distal lesions significantly increased the risk of multi-vessel CAD. Therefore, simultaneous CAD evaluation should be considered in patients with lower extremity PAD having diabetes, multi-cardiovascular risk factors, or multi-level disease.
Full-text · Article · Feb 2015 · International Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Besides poor clinical outcomes, female gender has been known as a high-risk factor for bleeding complications. This study aimed to investigate the impact of gender on clinical outcomes and bleeding complications after transradial coronary intervention (TRI). The Korean TRI registry is a retrospective multicenter registry with 4,890 patients who underwent percutaneous coronary intervention in 2009 at 12 centers. To compare clinical outcomes and bleeding complications between the male and female groups, we performed a propensity score matching in patients who received TRI. A total of 1,194 patients (597 in each group) were studied. The primary outcome was 1-year major adverse cardiac events, including all-cause mortality, myocardial infarction, target vessel revascularization, and stroke. The secondary outcome was major bleeding (composite of bleeding requiring transfusion of ≥2 units of packed cells or bleeding that was fatal). The proportion of major adverse cardiac events was similar between the 2 groups (6.2% vs 4.7%, p = 0.308). The female group had a greater incidence of major bleeding (0.3% vs 3.2%, p <0.001). On multivariate analysis, female gender (odds ratio [OR] 7.748, 95% confidence interval [CI] 1.767 to 13.399), age ≥75 years (OR 5.824, 95% CI 2.085 to 16.274), and chronic kidney disease (OR 7.264, 95% CI 2.369 to 12.276) were independent predictors of major bleeding. In conclusion, the female gender had a tendency for more bleeding complications than male gender after TRI without difference in the clinical outcome.
No preview · Article · Apr 2014 · The American journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: The benefit of thrombus aspiration during percutaneous coronary intervention in patients with acute myocardial infarction (AMI) is well established; however, the optimal management strategy for patients with a large thrombus burden after repeated thrombectomy (i.e., "failed" thrombectomy) is unknown. Here, we report the case of a 67-year-old male with polycythemia vera who was treated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomy did little to reduce the coronary thrombus burden; thus, intracoronary urokinase infusions were applied to the thrombus-containing lesion. Repeat coronary angiography 4 days later revealed markedly improved antegrade flow in the infarct-related artery, and successful revascularization was performed. This case demonstrates the potential utility of intracoronary thrombolytic therapy for select AMI patients with a large thrombus burden who are in a hypercoagulable state.
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
Full-text · Article · Sep 2013 · Journal of Korean medical science
[Show abstract][Hide abstract] ABSTRACT: In this study, for the purpose of improving the rotordynamic characteristics of a large power recovery train, PRT, motor-generator rotor fundamentally by design, firstly, a bearing improvement analysis is carried-out by retrofitting from plain partial journal bearings, originally applied for an operation at a rated speed of 1,800 rpm, to final tilting pad journal bearings. Results show that satisfying evenly key basic lubrication performances such as the minimum lift-off speed and maximum oil-film temperature, a careful design solution of 5-pad tilting pad journal bearings may effectively result in enhancing the direct stiffness of bearings by about two times at such a relatively low rated speed. Next, a detailed rotordynamic analysis is performed, applying both of the original plain partial and retrofitted tilting pad journal bearings, in order to confirm the effect of rotordynamic improvement after the suggested bearing retrofit. Results show that the rotor unbalance response vibrations with the tilting pad journal bearings are greatly reduced to as much as about 11% of those with the plain partial journal bearings. In addition, for the tilting pad journal bearings there is no critical speed up to the rated speed while for the plain partial journal bearings there is one critical speed close to the rated speed with some damping but not sufficiently enough.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Augmentation index (AIx) and pulse pressure amplification (PPA, here the aortic/brachial pulse pressure ratio) are an age-related emerging risk factor for cardiovascular disease. However, it has not been clearly shown that AIx and PPA predict a high risk of coronary artery disease (CAD). OBJECTIVES: The aim of the study was to investigate the association between non-invasively measured aortic wave reflection (AWR) and PPA and CAD. METHODS: The study group consisted of 80 patients who were admitted to our institute for elective coronary angiography. We non-invasively measured augmentation pressure (AP), AIx, and PPA using radial applanation tonometry. RESULTS: When the extent of CAD was divided by no or minimal CAD, 1- or 2- and 3-vessel disease (VD), there was a significant association between the extent of CAD and AIx and PPA in patients aged <65 years, but not in patients aged ≥65 years. In multivariate regression analysis after controlling the traditional risk factors, the odds ratio of having 3VD was significant in patients aged <65 years: 2.15 (1.04-4.44; p=0.039) per 5% increase of AIx and 2.02 (1.15-3.55; p=0.015) per 0.05 increase of PPA, but not in patients aged ≥65 years. The severity of CAD expressed as a Gensini score showed a significant correlation with AP, AIx, and PPA in patients aged <65 years, but not in patients aged ≥65 years. CONCLUSION: Increasing of non-invasively measured AWR and PPA is related to the severity of CAD, particularly in younger patients up to 65 years of age.
Full-text · Article · May 2013 · Journal of Cardiology
[Show abstract][Hide abstract] ABSTRACT: This paper deals with the study on repair case of journal shaft and bearing damage in 25MW industrial gas turbine caused by sudden blackout, operation mistake, and logic abnormal, etc. When a serious accident such as journal and bearing damage in a gas turbine occurs, the domestic local companies having the gas turbine are dependent on manufacturer for all maintenance and repair schedule until now. This case study shows that the damaged gas turbine is normally re-operated itself in domestic by establishing repair schedule in a short period of time, repairing damage journal shaft and tilting pad bearings, and performing rotating test for a reliability check. This paper can be regarded as the important case study of emergency test run experience of the refurbished 25MW gas turbine rotor.
[Show abstract][Hide abstract] ABSTRACT: Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.
Full-text · Article · Nov 2012 · Korean Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: Background:
There is paucity of data with regard to the clinical spectrum according to left ventricle (LV) morphological variation in stress-induced cardiomyopathy (SCMP) patients, and still there is controversy in terms of prognosis since some people believe that the published in-hospital mortality data of patients with SCMP are underestimated. Therefore, we sought to investigate the morphological features of LV and in-hospital outcome of patients with SCMP and explored predictors of short-term prognosis.
This was a multicenter, observational study of 208 SCMP patients. Morphological features of LV were determined by echocardiography and were divided into typical (apical) and atypical ballooning types, which were subcategorized into mid-LV ballooning and basal 'inverted' ballooning type. All-cause mortality of patients with SCMP during hospitalization was recorded.
The apical ballooning type was most common (67.3%) in SCMP followed by the mid-LV ballooning type (28.3%), and the basal 'inverted' ballooning type (4.3%). There were no differences in stressor types and in-hospital mortality between patients with typical and atypical SCMP. Notably, all the in-hospital mortality of SCMP patients occurred in patients with physical stressors, where age, shock, and LV ejection fraction were the independent risk factors for predicting in-hospital mortality.
SCMP patients showed diverse patterns of LV morphology, but there were no definite differences on clinical spectrum among SCMP patients presenting various LV morphological patterns. In terms of short-term prognosis, underlying physical conditions combined with old age, hemodynamic compromise, and low LV systolic function might be the most important factors in SCMP patients.
Full-text · Article · Oct 2012 · International journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Background:
It is well known that cardiac rehabilitation (CR) including regular exercise training (ET) is cardioprotective with respect to clinical events in patients with acute myocardial infarction (AMI). However, it is not known whether the regular ET may affect coronary restenosis after percutaneous coronary intervention (PCI) with stenting in AMI. The aim of this study was to evaluate the effect of regular ET on a stented coronary segment and its association with inflammatory markers in AMI.
Consecutively 74 AMI patients who underwent PCI with implantation of a drug-eluting stent and 9 month follow-up angiography were included. Thirty seven patients who received CR with ET were assigned to the ET group. Another 37 patients who did not participate in ET, of similar age to those of participants, were assigned to the control group. At 9 months, angiographic restenosis measured as in-segment late luminal loss of the stented coronary artery was analyzed via quantitative coronary angiography using CAAS 5.9.
There were no significant differences in baseline characteristics including age, sex, body mass index, smoking, DM, hypertension, lipid profile, use of statin, and complete blood cell between two groups. On 9 month follow-up angiography, late luminal loss per stent was significantly smaller in the ET group compared to the control group (0.14 ± 0.57 vs. 0.54 ± 0.88 mm, p=0.02). Maximal oxygen consumption (VO2max) significantly improved in the ET group after 9months (27.9 ± 6.4 vs. 30.8 ± 5.2 mL/kg/min, p<0.001). Increment in high density lipoprotein-cholesterol (HDL-C) was significantly larger in the ET group at 9 months (0.15 ± 0.12 vs. 0.04 ± 0.24 mg/dL, p=0.03).
Regular ET contributes to a significant reduction in late luminal loss in the stented coronary segment in AMI patients. This effect was associated with increased exercise capacity and increased HDL-C.
Full-text · Article · Jul 2012 · International journal of cardiology