[Show abstract][Hide abstract] ABSTRACT: Background
The three-dimensional (3D) dynamic change of mitral geometry during preload manipulation has not been fully investigated. We investigated how preload manipulation affected the mitral apparatus geometry in hypertrophic cardiomyopathy (HCM) patients using 3D echocardiography.Methods and ResultsTwenty five HCM patients, thirteen with obstructive HCM (HOCM) and twelve with nonobstructive HCM (HNCM), and six healthy controls were studied. Subjects underwent 3D echocardiography during rest, leg raising, the Valsalva maneuver, and the Valsalva maneuver after nitroglycerin intake (NTG-Valsalva). Left ventricular outflow tract (LVOT) pressure gradients, mitral annular area, annular circumference, and the tenting volume of the mitral leaflets were measured. Standardized annular area significantly decreased during the NTG-Valsalva maneuver in all 3 groups (▵2.23 mm2/m2 in control, P = 0.031; ▵0.46 mm2/m2 in HNCM, P = 0.012; ▵1.3 mm2/m2 in HOCM, P = 0.013). Standardized annular area decrease during the Valsalva maneuver alone was more prominent in HNCM patients (▵0.57 mm2/m2, P = 0.009) than HOCM patients (▵0.3 mm2/m2, P = 0.094). Standardized mitral tenting volume during the NTG-Valsalva maneuver significantly decreased only in HOCM patients (▵1.18 mm3/m2, P = 0.046).Conclusion
Decreased mitral annular area and changes in leaflets tenting volume during preload reduction might affect the development of LVOT obstruction. Our data suggest the importance of preserving the saddle-shaped of the mitral annulus in management of HCM with LVOT obstruction.
[Show abstract][Hide abstract] ABSTRACT: Purpose
Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) binds to low-density lipoprotein. The levels of Lp-PLA2 reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA2 levels and found that it might be a potential biomarker for ACS.
Materials and Methods
We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group).
Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA2 levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA2 to the ACS model significantly increased the global χ2 value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA2 was 0.624 (p=0.004). The addition of Lp-PLA2 level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS.
Lp-PLA2 levels are related to plaque stability and might be a diagnostic biomarker for ACS.
Full-text · Article · Nov 2014 · Yonsei Medical Journal
[Show abstract][Hide abstract] ABSTRACT: Objective:
Home blood pressure (HBP) measurements are known as an important adjunct to office blood pressure (OBP) measurements in clinical practice. But little is known about the relationship between HBP and subclinical target organ damage (TOD) other than left ventricular hypertrophy (LVH). So we investigated the relationship of HBP measurements with subclinical TOD in untreated hypertensive patients.
We measured ambulatory blood pressure (ABP), HBP and OBP of 93 untreated hypertensive patients (men: 60 and women: 33, mean age, 49±13 years). The ABP was recorded for 24 hours, HBP was measured for one week, and OBP was measured at least in two visits. All BP measurements were taken using automatic BP measuring device. The parameters indicating subclinical TOD were the left-ventricular mass index (LVMI) by transthoracic echocardiography, urinary albumin excretion rate (AER), brachial ankle pulse-wave velocity (PWV), and carotid intima-media thickness (IMT).
The LVMI was significantly correlated with systolic HBP and 24 hours systolic ABP, but not with OBP. The AER, PWV and IMT were also significantly correlated with systolic HBP and 24 hours systolic ABP. In a binary logistic regression analysis, systolic HBP, 24 hours systolic and diastolic ABP were the predictors of LVMI, AER and PWV (all p<0.05).
Our data suggest that HBP is as good as ABP monitoring and superior to OBP measurements in regard to their association with subclinical TOD. Therefore, HBP measurements give valuable information on the subclinical TOD in hypertensive patients in addition to ABP monitoring.
Preview · Article · Apr 2014 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Purpose: Biodegradable polymer drug-eluting stents (DES) offer potential for better prognosis in comparison with permanent polymer stents. However, benefits of biodegradable polymer DES has not been clarified as compared with permanent polymer stents in small vessel. The aim of this study was to compare efficacy and safety of abluminal biolimus-eluting biodegradable polymer stents and zotarolimus-eluting permanent polymer stents in small vessel coronary stenting.
Methods: A total of 187 patients (116 men, 62.5±9.8 years) who needed small vessel stenting were prospectively randomized into abluminal biolimus-eluting biodegradable polymer stent group (Group I, n=90) or zotarolimus-eluting permanent polymer stent group (Group II, n=97). Clinical outcomes of one year were investigated in both groups and all patients underwent follow up coronary angiography (CAG).
Results: There was no difference between abluminal biolimus-eluting biodegradable polymer stent group and zotarolimus –eluting permanent polymer stent group in demographic data and baseline QCA data. In follow up CAG data, late loss of group I tends to lower than that of group II, however there was no statistical significance (0.14±0.30 vs. 0.27±0.36, p=0.075). There was no in-stent restenosis and major adverse cardiac events (MACE) in both groups.
Conclusions; The safety and efficacy of abluminal biolimus-eluting biodegradable polymer stent were not inferior to those of zotarolimus-eluting permanent polymer stent. Although there was no statistical significance between the two groups, late loss of abluminal biolimus-eluting biodegradable polymer stent tends to be lower than that of zotarolimus-eluting permanent polymer stent in patients with stent diameter of less than 2.75 mm.
Preview · Article · Apr 2014 · Journal of the American College of Cardiology
[Show abstract][Hide abstract] ABSTRACT: Background: When blood pressure (BP) is measured conventionally over the brachial artery, it is assumed that these measurements accurately reflect pressures in the central circulation. Despite similar peripheral BP (PBP), central hemodynamics could be different. The objective of the present study was to investigate the factors which could influence the discrepancy between central BP (CBP) and peripheral BP.
Methods: 669 patients (376 males, 48±12 year-old) were enrolled. As antihypertensive drug could affect central and peripheral pressure differently, we excluded the patients on medication. Using applanation tonometry, SphygmoCor, central BP was noninvasively derived. The difference between PBP and CBP was calculated (median: 8mmHg). We defined the discrepancy between PBP and CBP as differences over 8mmHg between PBP and CBP. For adjustment of CBP, population was divided into 3 groups according to the CBP: group 1 <140mmHg of CBP (n=416, 247 males), group 2 140≤ CBP <160mmHg (n=196, 96 males), group 3 ≥160mmHg of CBP (n=35, 21 males). All the central hemodynamic parameters of the patients, including augmentation index (AI), heart rate (75bpm) adjusted augmentation index (AI@HR75) and subendocardial viability ratio, were measured by applanation tonometry. Using multivariate logistic regression analysis, we evaluated the factors which could influence the discrepancy between PBP and CBP.
Results: In group 1 & 2, the gender, body mass index, heart rate and AI@HR75 were significantly different according to the discrepancy between PBP and CBP. In group 3, the gender and AI@HR75 were significantly different. In all groups, the risk factors were not statistically different according to the discrepancy between PBP and CBP.
AI@HR75 was significantly correlated with the discrepancy between PBP and CBP in all 3 groups (Exp(B)=0.85, p<0.001 in group 1, Exp(B)=0.837, p<0.001 in group 2 and Exp(B)=0.564, p=0.032 in group 3). Mutivariate logistic analysis showed that gender was significantly correlated with the discrepancy between PBP and CBP, only in group 1 (Exp(B)=2.158, p=0.04).
Conclusion: In present study, central hemodynamics might affect the discrepancy between CBP and PBP. Also, gender difference was closely related with the discrepancy between CBP and PBP especially with normal CBP under 140mmHg. Not only CBP, the discrepancy between CBP and PBP should be considered for understanding the central hemodynamics.
Preview · Article · Aug 2013 · European Heart Journal
[Show abstract][Hide abstract] ABSTRACT: Background: The aim of this study, we tried to search the differences in certain well-defined blood pressure pattern according to gender between obese and non-obese patients in newly diagnosed hypertensive patients. Methods: Total 773 hypertensive patients (442 male, 48 +/- 11year) enrolled from Korean Hypertesion Network II were evaluated in this study. The patients were no history of hypertensive medication. BP was checked by nurse or doctor in office, self measurement in home and ambulatory monitoring. The study population was divided into two groups based on their BMI (obese group <= 24 kg/m2 and non obese group II > 25 kg/m2). The mean systolic and diastolic BP for both male and female categories of patients were compared between two groups. Results: In female, there was no significant difference of systolic and diastolic BP measured in office, home and ambulatory monitoring between groups. In male gender, there was no significant systolic BP difference measured in office, home and ambulatory monitoring between groups. Mean diastolic BP in office (97 +/- 12 vs. 94 +/- 11mmHg, p = 0.016), average diastolic BP in AM at home (92 +/- 14 vs. 88 +/- 11mmHg, p = 0.017), average diastolic BP in PM at home (90 +/- 14 vs. 86 +/- 11mmHg, p = 0.010) and mean diastolic BP in home (91 +/- 12 vs. 87 +/- 11mmHg, p = 0.005) were significantly higher in obese group than non-obese group. Conclusions: Diastolic but not systolic blood pressure was more significantly affected by the gender in newly diagnosed hypertensive patients with obesity
No preview · Article · Sep 2012 · Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: Although the white-coat effect (WCE) is not rare, its detection is often difficult in treated hypertensive patients. The aim of this study was to elucidate the factors that affect and predict the WCE in treated hypertensive patients in Korea. A total of 1087 outpatients (mean age: 57 ± 10 y; 52% female) checked blood pressure in office and at home. We divided the outpatients into two groups according to the presence or absence of the WCE. Waist circumference was smaller in the WCE group. In addition, in the WCE group, the incidence of diabetes mellitus (DM) was lower, but family history of premature cardiovascular disease was higher. Target organ damage, including damage to the heart, was lower in the WCE group. Pulse pressure (PP) in the clinic was higher in the WCE group and was also positively correlated with a systolic WCE, especially when measured by a doctor (r = 0.511, P < .001). By multivariate regression analysis, PP measured by a doctor independently correlated with systolic WCE (ß = 0.573, P < .001). Our findings suggest that PP measured by a doctor at a clinic may predict the WCE, which can help in the treatment of hypertensive patients.
No preview · Article · May 2012 · Clinical and Experimental Hypertension
[Show abstract][Hide abstract] ABSTRACT: Libman-Sacks endocarditis (LSE) is a valvular heart disease that is associated with autoimmune diseases such as systemic lupus erythematosus and antiphospholipid syndrome (APS). Cases of LSE and APS associated with infection have been reported during the last several years. Herein, we present a patient who was suspected to have developed LSE and catastrophic APS during the treatment of her definite infective endocarditis, which was caused by Staphylococcus aureus, and the patient's condition was complicated with cerebral abscess, sensorineural hearing loss, endophthalmitis, renal infarction, splenic abscess, and septic arthritis.
[Show abstract][Hide abstract] ABSTRACT: Patients with masked hypertension (MH) tend to have a higher risk than those with white-coat hypertension (WCH). Therefore, we evaluated the characteristics of MH and WCH in Korean patients receiving medical treatment for hypertension. We enrolled 1019 outpatients (56 ± 10 y, 488 males) with diagnosed hypertension who had not changed oral anti-hypertensive medication for 6 months. Clinic blood pressure (CBP) was checked by a nurse and doctor twice per visit. Home BP (HBP) was checked every morning and evening for 1 week. In the MH patients, mean CBP was 130/80 mmHg, whereas HBP was 137/86 mmHg. In the WCH patients, mean CBP was 149/86 mmHg by physician and 143/85 mmHg by nurse and mean HBP was 124/75 mmHg. Age and gender did not differ between the groups. Waist and hip circumferences and the level of fasting glucose were higher in patients with MH than in patients with WCH (p = 0.008, 0.016, 0.009, respectively). Metabolic risk factors were more frequent in patients with WCH, MH, and uncontrolled hypertension than in patients with controlled hypertension. The incidence of metabolic risk factors, however, did not differ between patients with WCH and MH. Heart damage was more frequent in MH than in WCH (p = 0.03). The incidence of metabolic risk factors did not differ between patients with WCH and those with MH. Target organ damage was more closely related to MH than to WCH. Home BP measurement was a useful tool for discriminating WCH and MH in patients with hypertension.
No preview · Article · Nov 2010 · Clinical and Experimental Hypertension
[Show abstract][Hide abstract] ABSTRACT: Masked hypertension (MH) is characterized by its hidden nature and poor prognosis. However, it is not practical to routinely recommend home or ambulatory blood pressure monitoring (HBP or AMBP) to all patients with apparently well-controlled BP. The purpose of this study is to present, within the group of patients with well-controlled office BP (OBP), the clinical predictors of MH and to evaluate the gap (ie, the `mask effect' (ME)) between OBP and HBP.
BP was measured at the outpatient clinic and at home in 1,019 treated hypertensive patients. Candidate predictors for MH were analyzed within 511 patients with well-controlled OBP (45.6% men, 57.1±9.0 years). Among them, the prevalence of MH was 20.9% (n=107). In the multivariate-adjusted analysis, the risk of MH increased with high serum fasting blood glucose level (odds ratio (OR) 1.009, 95% confidence interval (CI): 1.001-1.018, P=0.020), higher systolic OBP (OR 1.075, 95%CI 1.045-1.106, P<0.001), higher diastolic OBP (OR 1.045, 95%CI 1.007-1.084, P=0.019) and the number of antihypertensive medications (OR 1.320, 95%CI 1.113-1.804, P=0.021). Furthermore, systolic HBP correlated well with systolic OBP (r=0.351, P<0.001) and with the degree of systolic ME (r=-0.672, P<0.001).
To recognize MH, it is practical to investigate those patients who are taking multiple antihypertensive drugs and have a high OBP with a high FBG level. The term "ME" identifies MH more appropriately than the term "negative white-coat effect".
No preview · Article · Oct 2010 · Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: Left ventricular (LV) geometric patterns have never been evaluated as independent risk factors for renal disease progression (RDP). We investigated the risk factors for RDP in type 2 diabetic nephropathy patients, especially focusing on the effects of LV geometric patterns.
This was a single-center retrospective cohort study. Type 2 diabetic nephropathy patients who underwent echocardiography for routine checkup were recruited. Baseline laboratory data within 1 month from the time of echocardiography and clinical and follow-up laboratory data were collected by retrospective reviews.
A total of 150 patients (90 men, mean age 62.9 years) were enrolled. Distributions of the patients according to LV geometric patterns were as follows: normal 21 (14.0%), concentric remodeling 18 (12.0%), concentric hypertrophy 70 (46.7%) and eccentric hypertrophy 41 (27.3%). During the study period (30.1 ± 19.4 months), RDP developed in 53 of 150 patients (35.3%). On univariate analysis, use of erythropoiesis-stimulating agent, hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, log-transformed 24-hour urine protein, LV mass index and eccentric hypertrophy were strong predictors of renal outcomes. RDP-free survival was significantly decreased in the eccentric hypertrophy group (p=0.001, vs. other groups) according to Kaplan-Meier analysis. On multivariate analysis, eGFR, eccentric hypertrophy and hemoglobin levels were significant predictors of renal outcome.
Anemia and eccentric hypertrophy may be considered as important risk factors for RDP. Multicenter prospective trials should be needed to validate the effect of LV geometric patterns on RDP.
No preview · Article · May 2010 · Journal of nephrology
[Show abstract][Hide abstract] ABSTRACT: Clinic-based blood pressure measurements may lead to untoward results in the management of hypertension. Masked hypertension (MH) has been shown to be related to a poor prognosis due to its hidden nature. The purpose of this study is to present the clinical predictors of MH in elderly patients over 65 years with well-controlled clinic blood pressure (CBP) and to evaluate the gap, the 'mask effect' (negative white-coat effect), between CBP and home blood pressure (HBP).
[Show abstract][Hide abstract] ABSTRACT: An 18-year-old pregnant woman had cardiac failure and severe pulmonary edema developed immediately after the delivery of her baby. The patient's respiratory distress was severe and her oxygen saturation was under 50%, despite full mechanical ventilatory support. Echocardiogram revealed an ejection fraction of 18%, and she was diagnosed with peripartum cardiomyopathy. Her vital signs were unstable when she received conventional treatment for acute heart failure. Extracorporeal membrane oxygenation was applied 3 hours after the patient was transferred to the emergency department. The patient was weaned from extracorporeal membrane oxygenation 28 hours afterward, and she was extubated 2 days after extracorporeal membrane oxygenation. The patient was discharged 12 days after admission.
No preview · Article · Aug 2007 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: To determine whether there is a relationship between aortic plaques and intracranial (IC) atherosclerosis.
We reviewed 922 patients with stroke who had both transesophageal echocardiography and cerebral angiography. The plaques of these patients were classified as either complex aortic plaques (CAP), which protruded > or =4 mm or were present as mobile lesions in the proximal aorta, or simple aortic plaques (SAP), which were <4 mm or present in the descending aorta. Cerebral artery atherosclerosis was classified as either an IC or extracranial (EC) atherosclerosis.
Among the 922 patients, we found aortic plaques in 237 patients (26%). There were 111 (47%) patients of SAP, 74 (31%) patients with CAP, and 52 (22%) patients that had both SAP and CAP. Angiography showed IC or EC atherosclerosis in 511 patients (55%). The presence of aortic plaques was significantly associated with IC or EC atherosclerosis. The significance appeared to be due to the strong association between the presence of SAP and IC atherosclerosis (51% SAP vs 35% no plaques; odds ratio = 1.94, 95% CI: 1.17 to 3.21). In the multiple logistic regression analysis, SAP were independent predictors of IC atherosclerosis
The presence of simple aortic plaques may be a marker of advanced vascular disease. Detection of simple aortic plaques during transesophageal echocardiography may have clinical implications because patients with these plaques frequently had concomitant intracranial atherosclerosis, a risk factor for stroke.
[Show abstract][Hide abstract] ABSTRACT: Background and Objectives: About 25% of the patients with non-ischemic left ventricular (LV) systolic dysfunction will improve spontaneously. However, little has been known about the fate of the patients stricken with heart failure after recovery from DV dysfunction. We hypothesized that the patients who recovered from non-ischemic LV dysfunction have a substantial risk for recurrent heart failure. Subjects and Methods: Fifty patients (32 males, mean age: 54.9 ± 12.4 years) who recovered from systolic heart failure (LV ejection fraction: an EF of 28.8 ± 7.2% at the initial presentation) to near-normal (LVEF >40% and a 10% or more increase in the absolute value) were monitored for the recurrence of heart failure. Patients with significant coronary artery disease were excluded. The etiologies of heart failure were idiopathic dilated cardiomyopathy (n=39), alcoholic cardiomyopathy (n=7), adriamycin-induced cardiomyopathy (n=2), and tachycardia-induced cardiomyopathy (n=2). After recovery of LV dysfunction, the patients were followed up for a mean of 41.0 ± 26.3 months. Results: In 9 patients (18%), the LV systolic dysfunction recurred during follow-up (LVEF 32.6 ± 7.3%). There was no significant difference in the baseline clinical and echocardiographic variables between the patients with and without recurrent heart failure. However, cessation of anti-heart failure medication was more frequently observed in the patients with recurrent LV systolic dysfunction (55.6% vs 4.9%, respectively, p<0.05). Conclusion: Recurrent heart failure may ensue in the patients with reversible non-ischemic LV systolic dysfunction. The maintenance of anti-heart failure medication in these patients may be a significant influencing factor for their clinical prognosis.
Preview · Article · Jan 2006 · Korean Circulation Journal