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1.
J Interv Cardiol ; 29(2): 216-24, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26927366

RESUMEN

OBJECTIVES: To compare outcomes and rates of optimal stent placement between optical coherence tomography (OCT) and intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI). BACKGROUND: Unlike IVUS-guided PCI, rates of clinical outcomes and optimal stent placement have not been well characterized for OCT-guided PCI. METHODS: The study enrolled 290 patients who underwent implantation of a second generation drug eluting stent under OCT (122 patients) or IVUS (168 patients) guidance. The two groups were compared after adjusting for baseline differences using 1:1 propensity score matching (PSM) (114 patients in each group). Optimal stent placement was defined as achieving an adequate lumen (optimal minimum stent area [MSA > 4.85 mm(2) for OCT, >5 mm(2) for IVUS] or a final MSA ≥ 90% of the distal reference lumen area, without edge dissection, incomplete stent apposition, or tissue prolapse), or otherwise performing additional interventions to address suboptimal post-stenting OCT or IVUS findings. The primary endpoint was one-year cumulative incidence of major adverse cardiac events (MACE; cardiac death, myocardial infarction and target lesion revascularization). Definite or probable stent thrombosis (ST) rates were evaluated. RESULTS: In adjusted comparisons between OCT and IVUS groups, there was no significant difference in rates of MACE (3.5% vs. 3.5%, P = 1.000) and ST (0% vs. 0.9%, P = 1.000) at 1 year, optimal stent placement (89.5% vs. 92.1%, P = 0.492), and further intervention (7.9% vs.13.2%, P = 0.234), despite OCT significantly more frequently detecting tissue prolapse (97.4% vs. 47.4%, P < 0.001), and numerically more edge dissection (10.5% vs. 4.4%, P = 0.078) or incomplete stent apposition (48.2% vs. 36.8%, P = 0.082). CONCLUSIONS: OCT guidance showed comparable results to IVUS in mid-term clinical outcomes, suggesting that OCT can be an alternative tool for stent placement optimization.


Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Stents Liberadores de Fármacos/efectos adversos , Intervención Coronaria Percutánea/métodos , Tomografía de Coherencia Óptica/métodos , Ultrasonografía Intervencional/métodos , Anciano , Angiografía Coronaria/métodos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Puntaje de Propensión , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía Intervencional/efectos adversos
2.
Int J Infect Dis ; 98: 462-466, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32702415

RESUMEN

OBJECTIVES: Two Coronavirus Disease 2019 (COVID-19) outbreaks simultaneously occurred at a church and a long-term care facility in Daegu, South Korea. This study aimed to investigate the epidemiological characteristics of COVID-19 and factors related to severe outcomes. METHODS: We enrolled all inpatients diagnosed with COVID-19 between February 21 and April 2, 2020, in Daegu Dongsan Hospital. We analyzed their clinical and demographic data, laboratory parameters, radiological findings, symptoms, and treatment outcomes. RESULTS: Of 694 patients, severe cases accounted for 19.7% (137 patients). No severe case was observed among patients aged ≤19 years. Hypertension was the most common comorbidity (27%), and cough was the most common symptom (59%). Asymptomatic patients accounted for 14.4% of cases. Lymphopenia, lactate dehydrogenase, C-reactive protein, and albumin were associated with severe outcomes. The first outbreak was mostly associated with younger age groups, and asymptomatic patients mostly showed mild progression. In the second outbreak involving a long-term care facility, both the number of severe patients and the mortality rate were higher. CONCLUSIONS: The overall mortality in Daegu was low, which might have resulted from large scale mass screening to detect patients and starting appropriate treatment, including hospitalization for severe cases, and quarantine for asymptomatic patients.


Asunto(s)
Betacoronavirus/fisiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus/genética , Proteína C-Reactiva/metabolismo , COVID-19 , Niño , Preescolar , Infecciones por Coronavirus/metabolismo , Infecciones por Coronavirus/virología , Tos , Brotes de Enfermedades , Femenino , Hospitales , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Pandemias , Neumonía Viral/metabolismo , Neumonía Viral/virología , República de Corea/epidemiología , SARS-CoV-2 , Resultado del Tratamiento , Adulto Joven
3.
JACC Cardiovasc Interv ; 13(16): 1907-1916, 2020 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-32819479

RESUMEN

OBJECTIVES: The aim of this study was to evaluate the clinical and anatomical features to predict the long-term outcomes in patients with fractional flow reserve (FFR)-guided deferred lesions, verified by intravascular ultrasound (IVUS). BACKGROUND: Deferral of nonsignificant lesion by FFR is associated with a low risk of clinical events. However, the impact of combined information on clinical and anatomical factors is not well known. METHODS: The study included 459 patients with 552 intermediate lesions who had deferred revascularization on the basis of a nonischemic FFR (>0.80). Grayscale IVUS was examined simultaneously. The primary endpoint was patient-oriented composite outcome (POCO) (a composite of all-cause death, myocardial infarction, and any revascularization) during 5-year follow-up. RESULTS: The rate of 5-year POCO was 9.8%. Diabetes mellitus (hazard ratio: 3.50; 95% confidence interval [CI]: 1.86 to 6.57; p < 0.001), left ventricular ejection fraction ≤40% (hazard ratio: 4.80; 95% CI: 1.57 to 14.63; p = 0.006), and positive remodeling (hazard ratio: 2.04; 95% CI: 1.03 to 4.03; p = 0.041) were independent predictors for POCO. When the lesions were classified according to the presence of the adverse clinical characteristics (diabetes, left ventricular ejection fraction ≤40%) or adverse plaque characteristics (positive remodeling, plaque burden ≥70%), the risk of POCO was incrementally increased (4.3%, 13.6%, and 21.3%, respectively; p < 0.001). CONCLUSIONS: In patients with FFR-guided deferred lesions, 5-year clinical outcomes were excellent. Lesion-related anatomical factors from intravascular imaging as well as patient-related clinical factors could provide incremental information about future clinical risks.


Asunto(s)
Cateterismo Cardíaco , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Reserva del Flujo Fraccional Miocárdico , Revascularización Miocárdica , Tiempo de Tratamiento , Ultrasonografía Intervencional , Anciano , Toma de Decisiones Clínicas , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios/fisiopatología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica/efectos adversos , Revascularización Miocárdica/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Seúl , Factores de Tiempo , Resultado del Tratamiento
4.
Heart Rhythm ; 5(1): 131-9, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18055272

RESUMEN

BACKGROUND: Little information is available on the temporal relationship between instantaneous sympathetic nerve activity and ventricular arrhythmia in ambulatory animals. OBJECTIVE: The purpose of this study was to determine if increased sympathetic nerve activity precedes the onset of ventricular arrhythmia. METHODS: Simultaneous continuous long-term recording of left stellate ganglion (LSG) nerve activity and electrocardiography was performed in eight dogs with nerve growth factor infusion to the LSG, atrioventricular block, and myocardial infarction (experimental group) and in six normal dogs (control group). RESULTS: LSG nerve activity included low-amplitude burst discharge activity (LABDA) and high-amplitude spike discharge activity (HASDA). Both LABDA and HASDA accelerated heart rate. In the experimental group, most ventricular tachycardia (86.3%) and sudden cardiac death were preceded within 15 seconds by either LABDA or HASDA. The closer to onset of ventricular tachycardia, the higher the nerve activity. The majority of HASDA was followed immediately by either ventricular arrhythmia (21%) or QRS morphology changes (65%). HASDA occurred in a circadian pattern. HASDA occurred twice as often in the experimental group than in the control group. Electrical stimulation of LSG increased transmural heterogeneity of repolarization (Tpeak-end intervals) and induced either ventricular tachycardia or fibrillation in the experimental group but not in the control group. Immunohistochemical studies revealed increased synaptogenesis and nerve sprouting in the LSG in the experimental group. CONCLUSION: Two distinct types of LSG nerve activity (HASDA and LABDA) are present in the LSG of ambulatory dogs. The majority of malignant ventricular arrhythmias are preceded by either HASDA or LABDA, with HASDA particularly arrhythmogenic.


Asunto(s)
Muerte Súbita Cardíaca/prevención & control , Ganglio Estrellado/fisiología , Sistema Nervioso Simpático/fisiopatología , Taquicardia Ventricular/fisiopatología , Fibrilación Ventricular/fisiopatología , Animales , Perros , Estimulación Eléctrica , Electrocardiografía , Electrofisiología , Frecuencia Cardíaca , Modelos Animales , Taquicardia Ventricular/etiología , Factores de Tiempo , Fibrilación Ventricular/etiología
5.
Eur J Echocardiogr ; 9(1): 58-9, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17030022

RESUMEN

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.


Asunto(s)
Cuerdas Tendinosas , Fallo Renal Crónico/complicaciones , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Adulto , Ecocardiografía Transesofágica , Humanos , Fallo Renal Crónico/terapia , Masculino , Diálisis Renal , Rotura Espontánea , Insuficiencia de la Válvula Tricúspide/etiología
6.
Echocardiography ; 25(9): 961-7, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18771554

RESUMEN

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.


Asunto(s)
Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/diagnóstico por imagen , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Volumen Sistólico , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Tamaño de los Órganos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estadística como Asunto , Ultrasonografía
7.
Echocardiography ; 25(7): 781-3, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18476978

RESUMEN

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.


Asunto(s)
Defectos del Tabique Interventricular/diagnóstico por imagen , Infarto del Miocardio/terapia , Anciano , Angioplastia Coronaria con Balón/métodos , Ecocardiografía Doppler , Estudios de Seguimiento , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/fisiopatología , Humanos , Masculino , Monitoreo Fisiológico/métodos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Remisión Espontánea , Medición de Riesgo , Índice de Severidad de la Enfermedad , Stents , Factores de Tiempo
8.
Clin Ther ; 29(11): 2365-73, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18158077

RESUMEN

BACKGROUND: Although previous studies have examined the efficacy of pitavastatin, its tolerability and effects on lipid concentrations have not been compared with those of atorvastatin in a multicenter, randomized study. OBJECTIVE: This trial compared the efficacy and tolerability of pitavastatin and atorvastatin in hypercholesterolemic Korean adults. METHODS: This 8-week, multicenter, randomized, open-label, dose-titration study was conducted at 18 clinical centers in Korea between May 2005 and February 2006. After a 4-week dietary lead-in period, patients with hypercholesterolemia were randomized to receive either pitavastatin 2 mg/d or atorvastatin 10 mg/d. Patients who had not reached the low-density lipoprotein cholesterol (LDL-C) goal by week 4 received a double dose of the assigned medication for an additional 4 weeks. Efficacy was evaluated in terms of achievement of the National Cholesterol Education Program Adult Treatment Panel III LDL-C goals and changes from baseline in other lipids and high-sensitivity C-reactive protein (hs-CRP). The tolerability profile was assessed by physical and electro-cardiographic examinations, laboratory tests, and recording adverse reactions at all visits. RESULTS: A total of 268 patients were randomized to treatment, and 222 (82.8%) completed the study (149 women, 73 men; mean age, 59 years; mean weight, 63.5 kg). At the end of the study, there was no significant difference between the pitavastatin and atorvastatin groups in the proportion of patients achieving the LDL-C goal (92.7% [102/110] vs 92.0% [103/112], respectively). In addition, there were no significant differences between groups in terms of the percent changes from baseline in LDL-C, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), or hs-CRP. Twenty-six of 136 patients (19.1%) taking pitavastatin reported 35 treatment-emergent adverse reactions; 33 of 132 patients (25.0%) taking atorvastatin reported 39 treatment-emergent adverse reactions. Elevations in creatine kinase were observed in 6 patients (4.4%) in the pitavastatin group and 7 patients (5.3%) in the atorvastatin group. There were no serious adverse drug reactions in either group. CONCLUSIONS: In these adult Korean patients with hypercholesterolemia, pitavastatin and atorvastatin did not differ significantly in terms of the proportions of patients achieving the LDL-C goal; reductions in LDL-C, total cholesterol, and triglycerides; or increases in HDL-C. Both drugs were well tolerated.


Asunto(s)
Ácidos Heptanoicos/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Pirroles/uso terapéutico , Quinolinas/uso terapéutico , Atorvastatina , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Femenino , Ácidos Heptanoicos/administración & dosificación , Ácidos Heptanoicos/efectos adversos , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Hipercolesterolemia/sangre , Corea (Geográfico) , Masculino , Persona de Mediana Edad , Pirroles/administración & dosificación , Pirroles/efectos adversos , Quinolinas/administración & dosificación , Quinolinas/efectos adversos , Triglicéridos/sangre
9.
Korean J Radiol ; 8(2): 94-102, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17420626

RESUMEN

OBJECTIVE: The purpose of this study was to describe the myocardial enhancement patterns in patients with myocardial infarction using two-phase contrast-enhanced multidetector-row computed tomography (MDCT). MATERIALS AND METHODS: Twenty-three patients with clinically proven myocardial infarction (17 acute myocardial infarction [AMI] and 6 chronic myocardial infarction [CMI]) were examined with two-phase contrast-enhanced ECG-gated MDCT. The presence, location, and patterns of myocardial enhancement on two-phase MDCT images were compared with infarcted myocardial territories determined by using electrocardiogram, echocardiography, thallium-201 single photon emission computed tomography, catheter and MDCT coronary angiography. RESULTS: After clinical assessment, the presence of myocardial infarctions were found in 27 territories (19 AMI and 8 CMI) of 23 patients. Early perfusion defects were observed in 30 territories of all 23 patients. Three territories not corresponding to a myocardial infarction were detected in three patients with AMI and were associated with artifacts. Fourteen of perfusion defects were in the left anterior descending artery territory, four in the left circumflex artery territory, and nine in the right coronary artery territory. Delayed enhancement was observed in 25 territories (17 AMI and 8 CMI) of 21 patients. Delayed enhancement patterns were variable. Transmural early perfusion defects (n =12) were closely associated with transmural late enhancement (n = 5) and subendocardial residual defect with subepicardial late enhancement (n = 5). CONCLUSION: Myocardial infarction showed early perfusion defects and variable delayed enhancement patterns on two-phase contrast-enhanced MDCT. Delayed enhancement technique of MDCT could provide additional information of the location and extent of infarcted myocardium, and could be useful to plan appropriate therapeutic strategies in patients with AMI.


Asunto(s)
Infarto del Miocardio/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Angiografía Coronaria , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Yohexol/análogos & derivados , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión de Fotón Único
10.
Atherosclerosis ; 189(1): 106-14, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-16413026

RESUMEN

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.


Asunto(s)
Antioxidantes/farmacología , Enfermedades de las Arterias Carótidas/prevención & control , Quimiocinas CX3C , ADN/genética , Expresión Génica , Proteínas de la Membrana , Músculo Liso Vascular/patología , Ácido Tióctico/farmacología , Angioplastia de Balón/efectos adversos , Animales , Northern Blotting , Western Blotting , Enfermedades de las Arterias Carótidas/metabolismo , Enfermedades de las Arterias Carótidas/patología , Células Cultivadas , Quimiocina CX3CL1 , Quimiocinas CX3C/antagonistas & inhibidores , Quimiocinas CX3C/biosíntesis , Quimiocinas CX3C/genética , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Hiperplasia/prevención & control , Masculino , Proteínas de la Membrana/antagonistas & inhibidores , Proteínas de la Membrana/biosíntesis , Proteínas de la Membrana/genética , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/metabolismo , Ratas , Ratas Sprague-Dawley , Túnica Íntima/efectos de los fármacos , Túnica Íntima/patología
11.
Int J Cardiol ; 108(3): 422-3, 2006 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-16513193

RESUMEN

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.


Asunto(s)
Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/etiología , Ultrasonografía Intervencional/efectos adversos , Enfermedad Aguda , Anciano , Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Humanos , Masculino , Fibrilación Ventricular/etiología
12.
J Invasive Cardiol ; 15(12): 729-31, 2003 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-14660830

RESUMEN

A coronary artery fistula is a rare complication following percutaneous transluminal coronary angioplasty (PTCA). It may result in communication with either the left or right ventricle. Previous reported cases were diagnosed by coronary angiography using contrast medium. We present a case with a septal coronary artery fistula to the left ventricle following PTCA that was diagnosed by contrast echocardiography.


Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/terapia , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Fístula Vascular/diagnóstico , Fístula Vascular/etiología , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/etiología , Ecocardiografía , Femenino , Tabiques Cardíacos/diagnóstico por imagen , Tabiques Cardíacos/patología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/patología , Humanos
13.
Int J Cardiol ; 148(2): 179-82, 2011 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-19942304

RESUMEN

BACKGROUND: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: The incidence of SECI after diagnostic CAG was not infrequent. Diagnostic CAG with IMA angiography may increase the risk of SECI.


Asunto(s)
Enfermedades Asintomáticas/epidemiología , Infarto Cerebral/epidemiología , Angiografía Coronaria/efectos adversos , Angiografía Coronaria/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Embolia Intracraneal/epidemiología , Anciano , Infarto Cerebral/patología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Incidencia , Embolia Intracraneal/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Retrospectivos
16.
J Cardiol ; 56(3): 348-53, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20889311

RESUMEN

PURPOSE: Radiofrequency catheter ablation of the cavotricuspid isthmus (CTI) is effective in the treatment of typical atrial flutter (AFL) and atrial fibrillation (AF). AF and AFL often coexist. However, AF often occurs following successful ablation of CTI. The aim of this study was to investigate the predictors of concomitant AF following successful ablation of AFL. METHODS: We enrolled 122 patients [59.1 ± 11.3 years, male 100 (82.0%)] with typical AFL, who received successful ablation of the CTI. They were followed up at outpatient clinic (24.6 ± 25.7 months). Twelve-lead electrocardiogram and Holter monitoring were used to confirm the diagnosis of recurrent AFL or AF. We assessed prior history of AF, structural heart disease, left ventricular ejection fraction, left atrial diameter (LAD), left atrial volume index (LAVI), and AFL cycle length. RESULTS: Among the 122 ablated patients, 15 (12.3%) had recurrent AFL and 33 (27.0%) had recurrent AF. In univariate logistic analysis, LAD and LAVI could significantly predict the recurrence of AF after AFL ablation. However, multivariate logistic regression analysis found that the independent predictor of recurrent AF was LAVI. An LAVI of 42.6 mL may allow for the differentiation between only AFL and AFL with concomitant AF with 69.0% sensitivity and 69.8% specificity. CONCLUSIONS: LAVI might be a useful predictor for occurrence of AF after ablation of typical AFL.


Asunto(s)
Fibrilación Atrial , Aleteo Atrial/cirugía , Volumen Cardíaco , Complicaciones Posoperatorias , Anciano , Fibrilación Atrial/diagnóstico , Aleteo Atrial/diagnóstico , Ablación por Catéter , Electrocardiografía , Femenino , Predicción , Atrios Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Válvula Tricúspide/cirugía , Vena Cava Inferior/cirugía
17.
Korean J Intern Med ; 24(4): 323-9, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19949730

RESUMEN

BACKGROUND/AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Although SES showed significantly greater suppression of NIH at follow-up, both stents were highly effective at inhibiting NIH in complex coronary lesions.


Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Paclitaxel/administración & dosificación , Sirolimus/administración & dosificación , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Stents Liberadores de Fármacos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Hiperplasia , Masculino , Persona de Mediana Edad , Túnica Íntima/patología
18.
Int J Cardiol ; 133(1): e3-5, 2009 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-18068831

RESUMEN

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.


Asunto(s)
Endocarditis Bacteriana/microbiología , Defectos del Tabique Interatrial/complicaciones , Válvula Mitral/microbiología , Embolia Pulmonar/etiología , Infecciones Estafilocócicas/complicaciones , Adolescente , Ecocardiografía , Endocarditis Bacteriana/diagnóstico por imagen , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X
19.
Clin Cardiol ; 32(11): 633-8, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19938048

RESUMEN

BACKGROUND: 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. METHODS: 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). RESULTS: 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). CONCLUSION: In patients with long CCL, both SES and PES were comparably effective in either angiographic or clinical long-term outcomes.


Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Calcinosis/terapia , Fármacos Cardiovasculares/administración & dosificación , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Paclitaxel/administración & dosificación , Sirolimus/administración & dosificación , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/mortalidad , Calcinosis/diagnóstico por imagen , Calcinosis/mortalidad , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Reestenosis Coronaria/etiología , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , República de Corea/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
20.
Circ J ; 72(10): 1658-65, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18728335

RESUMEN

BACKGROUND: 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). METHODS AND RESULTS: 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). CONCLUSIONS: Both NT-ProBNP and LADI might have the most predictable power, particularly in non-ischemic advanced DCM.


Asunto(s)
Cardiomiopatía Dilatada/sangre , Cardiomiopatía Dilatada/patología , Atrios Cardíacos/patología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Anciano , Proteína C-Reactiva/metabolismo , Cardiomiopatía Dilatada/diagnóstico por imagen , Diástole/fisiología , Electrocardiografía , Femenino , Tasa de Filtración Glomerular , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Pronóstico , Sístole/fisiología , Ultrasonografía
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