Cardiac Manifestations of Coronavirus Disease 2019 (COVID-19): a Multicenter Cohort Study

Background@#This study aimed to investigate the cardiac manifestations of coronavirus disease 2019 (COVID-19). @*Methods@#From February to March 2020, we prospectively and retrospectively enrolled consecutive patients diagnosed with COVID-19. Patient's data such as the demographic characteristics, symptoms, vital signs, laboratory and radiologic findings, electrocardiographic, and echocardiographic data, including the global longitudinal strain (GLS) of both ventricles, were obtained. @*Results@#Forty patients (median age, 58 years; 50% men) were enrolled in the initial analysis. Patients were classified into severe and nonsevere groups based on the current guidelines. The 13 patients in the severe group were significantly older, had a greater prevalence of bilateral pneumonia and leukocytosis, and higher aspartate transaminase levels than patients in the nonsevere group. Patients in the severe group had a slightly lower left ventricular ejection fraction (LVEF) than those in the nonsevere group (median [interquartile range], 61.0% [58.5%, 62.3%] vs. 66.7% [60.6%, 69.8%], P = 0.015). In a subgroup of 34 patients in whom GLS could be analyzed, patients in the severe group had a significantly impaired left ventricular GLS (LVGLS) than those in the nonsevere group (−18.1% [−18.8%, −17.1%] vs. −21.7% [−22.9%, −19.9%], P = 0.001). There were no significant differences in total wall (RVGLS total , −19.3% [−23.9%, −18.4%] vs. −24.3% [−26.0%, −22.6%], P = 0.060) and free wall (RVGLS fw , −22.7% [−27.2%, −18.6%] vs. −28.8% [−30.4%, −24.1%], P = 0.066) right ventricle GLS (RVGLS). @*Conclusion@#Patients with severe COVID-19 had lower LVEF and LVGLS. RVGLS was not different between patients with severe and nonsevere COVID-19.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea / 대한흉부외과학회지

BACKGROUND: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea

BACKGROUND@#Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.@*METHODS@#This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified.@*RESULTS@#CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR.@*CONCLUSION@#Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea Online only

OBJECTIVE: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Effect of Cardiac Rehabilitation on Outcomes in Patients with ST-Elevation Myocardial Infarction

PURPOSE: Whether cardiac rehabilitation (CR) improves clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) has not been thoroughly evaluated. Moreover, few studies have sought to identify patients who would benefit most from CR among STEMI patients. MATERIALS AND METHODS: Consecutively, 265 STEMI patients who underwent primary PCI with implantation of DESs and follow-up angiography were examined. Seventy-six patients (30%) who received CR were assigned to the CR+ group. Another 178 patients (70%) who did not participate in CR were assigned to the CR− group. Second generation DESs were implanted in 238 (94%) patients. RESULTS: Major adverse cardiovascular events (MACEs), including death, myocardial infarction, and revascularization, were compared. The CR+ group tended to have lower MACE than the CR− group at 3 years, although the difference was not statistically significant (9.9% vs. 18.3%, hazard ratio=0.54, p=0.138). Subgroup analysis revealed a significant interaction according to CR and preprocedural thrombolysis in myocardial infarction (TIMI) flow (p value for interaction=0.011). In patients with low preprocedural TIMI flow (TIMI flow ≤1, n=161), those in the CR+ group had significantly lower MACE than those in the CR− group (p=0.005), whereas MACE was not different among patients with higher TIMI flow (TIMI flow ≥2, n=93). CONCLUSION: CR including exercise training was associated with lower MACE, particularly in patients with lower preprocedural TIMI flow during primary PCI for STEMI in the current DES era.

Prevalence and Clinical Outcomes of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Concurrent Coronary and Carotid Angiography

PURPOSE: The prevalence and clinical outcomes of asymptomatic carotid artery stenosis (CAS) in patients with coronary artery disease (CAD) have not been thoroughly studied. We examined the prevalence and predictors of asymptomatic CAS detected by carotid angiography and determined the impact of concomitant CAS on prognosis in patients undergoing coronary angiography (CAG) due to CAD. MATERIALS AND METHODS: Between January 2013 and July 2015, 395 patients who underwent carotid digital subtraction angiography to screen for CAS during CAG were analyzed. The presence of CAS was defined as angiographically significant stenosis (≥50%). Major adverse cardiac and cerebrovascular event (MACCE) rates were compared between patients with and without CAS. MACCEs included a composite of cardiac death, cerebrovascular death, acute myocardial infarction, and stroke. RESULTS: Of the 395 patients, 101 (25.5%) patients had significant CAS. The independent predictors of CAS were age, male sex, hypertension, diabetes, and multi-vessel disease. In patients with CAD, the presence of CAS was as an independent predictor for MACCEs after adjusting for confounding factors (hazard ratio 2.47, 95% confidence interval 1.16–5.24, p=0.018). CONCLUSION: Asymptomatic CAS was documented in up to 25% of patients with CAD. The presence of CAS in patients with CAD was associated with a higher rate of MACCEs. Therefore, detection of CAS by carotid angiography during CAG may be important for risk stratification for CAD patients, particularly those with multi-vessel disease.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome

Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors—primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

How Long Should We Wait for Recovery from Acute Fulminant Myocarditis? / 대한내과학회지

A 54-year-old diabetic man presented to the hospital with shock and bradycardia. His initial estimated left ventricular ejection fraction (LVEF) was 15% and the electrocardiogram showed a junctional escape rhythm with a wide QRS complex and no P wave. Intensive supportive therapy was initiated after inserting a pacemaker and starting extracorporeal membrane oxygenation. A myocardial biopsy confirmed acute lymphocytic myocarditis with extensive myocyte necrosis, and cardiac transplantation was planned. However, the patient survived without transplantation after vigorous hemodynamic support for 2 weeks. After discharge, he had limited activity for 4 months due to dyspnea caused by a reduced systolic heart function (LVEF, 21%) with a junctional escaped beat. His systolic function recovered markedly 6 months after stopping the hemodynamic support, with the presence of a P wave and narrowed QRS complex.

The Brachial Ankle Pulse Wave Velocity is Associated with the Presence of Significant Coronary Artery Disease but Not the Extent

BACKGROUND AND OBJECTIVES: Arterial stiffness is well known as an important risk factor for cardiovascular disease. At our institution, we assessed the association between arterial stiffness, as determined by brachial ankle pulse wave velocity (baPWV), and the extent of coronary artery disease (CAD), as detected by conventional coronary angiography (CAG) in patients who visited the outpatient clinic for angina without any previous history of heart disease. In addition, we evaluated if the level of baPWV could predict the revascularization as a clinical outcome. SUBJECTS AND METHODS: On a retrospective basis, we analyzed the data of 651 consecutive patients who had undergone baPWV and elective CAG for suspected CAD between June 2010 and July 2011, at a single cardiovascular center. RESULTS: The baPWV was one of the statistically meaningful predictors of significant CAD (diameter of stenosis >50%) in addition to male gender, age, the level of high density lipoprotein-cholesterol, and hemoglobin A1c in multivariate analysis. However, baPWV was not the significant predictor of revascularization. When the extent of CAD was classified into following 4 groups; no significant CAD, 1-, 2- and 3-vessel disease, there was significant difference of baPWV between the significant and non-significant CAD group, but there was no difference of baPWV among the 3 significant CAD groups, although there was a trend toward the positive correlation. CONCLUSION: Although baPWV was an independent predictor of significant CAD, it was neither associated significantly with the extent of CAD nor with the risk of revascularization. Therefore, baPWV has a limited value for portending the severity of CAD in patients with chest pain.

Device Closure of a Large Atrial Septal Defect in a Patient with Severe Pulmonary Arterial Hypertension after 1 Year Use of an Oral Endothelin Receptor Antagonist

The presence of severe pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) is still thought to preclude shunt closure, although there are several reports of good clinical outcomes after vasodilator therapy. We report the case of a young woman with ASD and severe PAH who was able to successfully undergo percutaneous shunt closure following 1 year use of the oral endothelin receptor antagonist, bosentan.

A case of papillary fibroelastoma in the left ventricle

Cardiac papillary fibroelastoma (CPF) is a rare and benign primary cardiac neoplasm of unknown prevalence. The incidence of CPF in the left ventricle is lower than that in other parts of the heart. A 65-year-old female was referred to our cardiology department for evaluation of a cardiac mass of the left ventricle. Transthoracic echocardiography revealed a 1.8 x 1.7 cm highly mobile round mass attached by a stalk to the apical inferior wall of the left ventricle with an echolucent area. The mass was successfully removed without any postoperative complications and was identified as a CPF.

The Correlation of Carotid Artery Stiffness with Heart Function in Hypertensive Patients

BACKGROUND: The strength of each heart beat and the stiffness of large arteries contribute to blood pressure (BP). When the large arteries are stiff and their resistance greater, the afterload increases and this may change the function of the heart. However, the relation between common carotid artery stiffness and heart function in hypertensive patients has not been clarified. METHODS: Two hundred and twenty hypertensive patients underwent transthoracic and carotid echocardiography. Measurements of local arterial stiffness were taken at the right common carotid artery level and stiffness parameter (beta), pressure-strain elasticity modulus and intima-media thickness were calculated. Brachial cuff BP was measured just before starting the carotid study. The patients with any cardiovascular disease, diabetes mellitus, stroke, transient ischemic attack, or carotid stenosis were excluded. RESULTS: Carotid artery stiffness parameter (beta) was correlated with age and left ventricular mass index (p < 0.005). Even though beta was not correlated with LV systolic function, it was inversely correlated with diastolic function as measured by early mitral annular velocity. When the artery was stiffer, early mitral annular velocity (e') decreased (p < 0.001) and the index of left atrial (LA) pressure (early diastolic mitral inflow E velocity/e') increased (p = 0.001). In logistic regression, diastolic dysfunction was affected by age (beta -0.385, p = 0.001), LA volume index (beta 0.175, p = 0.013) and beta (beta -0.273, p = 0.019). CONCLUSION: In hypertensive patients, changes in carotid artery stiffness can affect the diastolic function, independent of age and LA volume index. Therefore, measurements and control of carotid stiffness can play an important role in the prevention of diastolic heart failure.

Clinical outcomes according to coronary calcium scores in asymptomatic individuals undergoing coronary CT angiography / 대한내과학회지

BACKGROUND/AIMS: In general, multidetector computed tomography (MDCT) is not recommended as a screening tool for asymptomatic individuals. However, the programs for general health evaluation at several hospitals in Korea include MDCT to detect cardiac disease. The objectives of this study were to evaluate the clinical outcomes of asymptomatic individuals according to the coronary artery calcium score (CACS) obtained from screening MDCT and to assess the eligibility of risk stratification in the NCEP-ATP III guidelines for predicting a significant stenosis on MDCT. METHODS: We reviewed the medical records of 845 asymptomatic subjects (age 53+/-9 years, 67% men) who underwent MDCT as part of a general health evaluation at Asan Medical Center, Seoul, Korea, from January to December 2008. RESULTS: Atherosclerotic plaques were identified in 332 (39.3%) subjects. Sixty (7.1%) individuals had significant stenosis (> or = 50% diameter stenosis). The prevalence of significant stenosis was higher in the group that had more than a 10% risk of coronary heart disease (CHD) at 10 years (p or = 110 was associated with a significantly higher rate of coronary revascularization in asymptomatic patients with significant stenosis on MDCT.

Prognostic Value of Initial Echocardiographic Features in Patients With Tuberculous Pericarditis

BACKGROUND AND OBJECTIVES: Tuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis. SUBJECTS AND METHODS: We evaluated initial presentation and clinical outcomes (mean follow-up 32+/-27 months) in 60 consecutive patients newly diagnosed with TB pericarditis. RESULTS: Initial presentations were pericardial effusion (PE), effusive-constrictive pericarditis, and constrictive pericarditis in 45 (75%), 9 (15%), and 6 (10%) patients, respectively. Of the 54 patients without initial constrictive pericarditis, 32 (59%) showed echogenic materials in PE, including frond-like exudative coating and fibrinous strands. These patients had a longer disease duration before diagnosis, were initially more symptomatic, in a more advanced state, showed more persistent pericardial constrictions (38% vs. 0%, p<0.001) despite anti-TB medications, and tended to require pericardiectomy more often (19% vs. 0%, p=0.07, p<0.05 by Kaplan-Meier). All patients with effusive-constrictive pericarditis showed echogenic PE. Of the 60 total patients, 10 (17%) underwent pericardiectomies during follow-up. All of these patients showed initial pericardial constrictions, whereas no patient without initial pericardial constriction underwent pericardiectomy (p<0.001). Seven patients showed transient pericardial constrictions that resolved without pericardiectomy. CONCLUSION: Initial pericardial constriction and echogenic PE are poor prognostic signs for persistent pericardial constriction and pericardiectomy in patients with newly diagnosed TB pericarditis. These results suggest that early diagnosis and prompt anti-TB medication may be critical.

Successful Transcatheter Closure of a Web-Shaped Patent Ductus Arteriosus Using Amplatzer Duct Occluder via Retrograde Wire-Assisted Approach

Patent ductus arteriosus (PDA) is a congenital heart disease occasionally encountered in adult cardiology, which can potentially be complicated by endocarditis or progressive left ventricular (LV) volume overload. Although transcatheter device closure has become a standard treatment in most cases, it can sometimes be challenged by anatomical variation of PDA. We report a case of 53-year-old man with PDA which was successfully treated by percutaneous closure, which had failed 12 years ago because of guidewire passage failure. Transesophageal echocardiography played an important role to give precise anatomical information and enable us to apply an alternative retrograde approach. Closure of PDA resulted in the resolution of symptom and decrease in LV size and volume.

Mitral Valve Replacement to Control Recurrent Systolic Anterior Motion of Mitral Valve and Left Ventricular Outflow Tract Obstruction after Alcohol Septal Ablation

Dynamic left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion (SAM) of the mitral valve is observed in variable clinical conditions with anatomical or functional abnormalities of LVOT and mitral valve. Several treatment options to relieve obstruction have been suggested including medications to change the contractility of left ventricle, volume reduction of interventricular septum by surgical or non-surgical catheter-based intervention, and surgical correction of the abnormal mitral valve. Here we reported a case of 48-year-old man who presented with shortness of breath. After repeated alcohol septal ablation, mitral valve replacement was finally performed to achieve complete symptom relief.

Comparative study of secondary hyperparthyroidism according to the mode of dialysis in patients with end-stage renal disease / 대한내과학회지

BACKGROUND: It has been well known that parathyroid hormone (PTH) plays an important role as a uremic toxin in patients with end-stage renal disease, and develops many abnormalities in musculo-skeletal, nervous, cardiovascular and immune systems, which contributes mortalities and morbidities of the patients. Recently, many researches have reported various clinical significances of PTH. Especially, there is some suggestion that parathyroid hormone level could be used as a new marker of survival in uremic patients. The purpose of this study was to assess the prevalence of secondary hyperparathyroidism according to the modality and duration of dialysis in patients with ESRD and to determine the factors that attribute to increasing iPTH levels. METHODS: From January 1996 to June 2001, 328 dialysis patients who have received maintenance hemodialysis or peritoneal dialysis more than 6 months in Severance Hospital were included in this study. We studied retrospectively by reviewing their medical records and defined hyperparathyroidism, if iPTH level was increased more than three times of upper normal limit. RESULTS: The number of patients with iPTH level greater than 195 pg/mL was 170(49.8%): HD 76 (53.9%), CAPD 94 (50.2%). The average level of iPTH was increased with dialysis duration in both groups, and also, significantly more increased in hemodialysis group than CAPD more than 40months after the beginning of dialysis. The iPTH level was negatively correlated with age and creatinine clearance by simple and multiple regression analysis in both dialysis groups. Alkaline phosphatase and serum phosphorus levels had positive correlation with the level of iPTH in both CAPD and HD patients. Cox regression analysis showed an increment of development of secondary hyperparathyroidism with duration of dialysis. In patients on HD, the prevalence of secondary hyperparathyroidism was much higher than those on CAPD with statistical significance in patients on dialysis more than 40 months. CONCLUSION: In this study, iPTH level was correlated with age, serum phosphorus level and residual renal function at the initiation of dialysis in both groups. And also, in patients on HD, the average level of iPTH and the prevalence of secondary hyperparathyroidism were much higher than those on CAPD with statistical significance. So, we suggest that early dialysis and intensive attention to serum phosphorus level would be required in patients with ESRD for preventing the secondary hyperparathyroidism and more careful monitoring for serum calcium, phosphorus and parathyroid hormone with adequate treatments would be needed especially in hemodialysis patients.

A case of amyloidosis associated with early gastric cancer / 대한내과학회지

The amyloidosis combined with malignant neoplasm, especially stomach cancer, is rare. We experienced a case of a 60 year-old male patient who had complained of facial and lower leg edema. The laboratory findings were consistent with nephrotic syndrome, and CEA was slightly elevated. Gastroduodenoscopy revealed early gastric cancer, which suggested that the nephrotic syndrome should be associated with neoplasm, an example of membranous glomerulonephritis. Wedge resection of stomach was done with incidental splenectomy and liver biopsy. Following microscopic examination, amyloidosis was found to be involved in the liver and spleen. Bone marrow biopsy did not show any evidence of plasma cell dyscrasia. According to the literature, neoplasm can stimulate the production or precipitation of serum amyloid A like chronic infection and inflammation. But we cannot conclude that stomach neoplasm caused secondary amyloidosis, such as renal cell carcinoma or Hodgkin disease, regarding as the possibility of coincidental amyloidosis. We report a case of amyloidosis associated with early gastric cancer, represented by nephrotic syndrome.

Primary Aldosteronism Complicated with Chronic Renal Failure / 대한신장학회잡지

Primary aldosteronism is a disease entity characterized by hypertension, hypokalemia, metabolic alkalosis and muscle weakness. Aldosteronoma is the most common cause of primary aldosteronism. The prevalence of primary aldosteronism in patients with hypertension appears to be low, less than 1%. However, primary aldosteronism is the one of common cause of secondary hypertension that is one of a few potentially curable forms of hypertension by surgical treament. The malignant hypertension in primary aldosteronism is very rare and the renal vascular damage due to hypertension seldom occurs. There has been no known reports about primary aldosteronism complicated with chronic renal failure in Korea. We report the rare case of primary aldosteronism in patient with hypokalemia, metabolic alkalosis complicated with chronic renal failure due to malignant hypertension with evident nephrosclerosis.