Celecoxib Does Not Attenuate the Antiplatelet Effects of Aspirin and Clopidogrel in Healthy Volunteers

BACKGROUND AND OBJECTIVES: The prevalence of arthritis, which is often treated with celecoxib, is high in patients with coronary artery disease. Furthermore, celecoxib has been reported to reduce restenosis after coronary stenting by inhibiting expression of the proto-oncogene Akt. A concern is that celecoxib increases thrombogenicity by inhibiting the synthesis of prostacyclin in endothelial cells. However, it is not known whether the administration of celecoxib will attenuate the antiplatelet effects of aspirin and clopidogrel, which are used after stenting. We addressed this gap in our knowledge. SUBJECTS AND METHODS: We recruited healthy volunteers (n=40) and randomized them into five subgroups (n=8 for each group: aspirin, celecoxib, aspirin+celecoxib, aspirin+clopidogrel, and aspirin+clopidogrel+celecoxib). Each subject received their medications for 6 days and blood samples were taken on day 0 and day 7. Celecoxib (200 mg twice a day), and/or aspirin (100 mg daily), and/or clopidogrel (75 mg daily) were administered. We compared platelet function among subgroups using light transmittance aggregometry and arachidonic acid metabolite assays. RESULTS: Celecoxib treatment alone did not significantly affect platelet aggregation. The reduction in adenosine diphosphase (ADP)-induced platelet aggregation by aspirin+clopidogrel was not affected by addition of celecoxib (31.3+/-6.9% vs. 32.4+/-12.2%, p=0.83). Inhibition of collagen-induced platelet aggregation by aspirin+clopidogrel was not affected by addition of celecoxib (47.6+/-13.4% vs. 51.6+/-3.7%, p=0.69). Drug-induced changes in prostacyclin and thromboxane levels did not differ among treatment groups. CONCLUSION: Celecoxib treatment does not interfere with the antiplatelet effects of aspirin or clopidogrel, suggesting that celecoxib can be safely administered in combination with dual antiplatelet therapy in patients with coronary stenting without increased thrombogenicity.

Systolic Mitral Annular Velocity as a Simple Marker of Left Ventricular Peak Systolic dP/dt in Patients with Significant Mitral Regurgitation

BACKGROUND: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S') can be a good marker of LV dP/dt. METHODS: We studied 62 patients (25 men, age: 47+/-15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S' velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated. RESULTS: Mean LV ejection fraction was 60+/-6% and regurgitant fraction was 59+/-15%. S' velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S' velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction. CONCLUSION: Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR.

Late Late Stent Thrombosis after Intracoronary Brachytherapy: Learning from Brachytherapy Experiences in the Drug-Eluting Stent Era

Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Combined antiplatelet therapy is recommended to prevent stent thrombosis in those patients who have undergone stenting. However, there are conflicting opinions on the appropriate duration of instituting antiplatelet treatment, especially after intracoronary radiation therapy or drug-eluting stent implantation, which are two situations closely associated with an increased risk of stent thrombosis. We report here on 2 cases of late stent thrombosis that occurred despite giving combined antiplatelet therapy, and these maladies developed more than 4 years after intracoronary brachytherapy.

A Case of Congenital Left Atrial Appendage Aneurysm

Atrial aneurysms involving the free wall or atrial appendage are very rare intracardiac anomalies, less than 100 case reported worldwide. It is usually detected by chance and also could be associated with atrial arrhythmias or systemic embolism. Transthoracic echocardiography and cardiac MRI is the standard diagnostic modality. Aneurysmectomy is usually recommended especially in symptomatic cases. We review the literature and report a case of atrial appendiceal aneurysm, a 23 year-old young man whose diagnosis was established with transthoracic echocardiography and cardiac CT angiography.

A Case of Isolated Congenital Right Ventricular Diverticulum in Adult

Congenital right ventricular diverticulum is extremely rare and is associated with other congenital cardiac anomalies. It functionally behaves like an accessory ventricular chamber which contracts synchronously with the normal ventricles. Only dozens of patients with right ventricular diverticulum have been reported in literature worldwide and one case in Korea. An apical right ventricular diverticulum occurs in patients with thoracoabdominal midline defects or abnormalities of the cardiac position. However, an antero-superior diverticulum is usually associated with other congenital cardiac defects, such as a ventricular septal defect, tetralogy of Fallot, double outlet right ventricle, and pulmonary stenosis. We report a 69-year-old woman with a congenital right ventricular diverticulum without associated cardiac anomalies. The right ventricular diverticulum was diagnosed by echocardiography, right ventriculography, and cardiac MRI.

A Case of Extranodal NK/T Cell Lymphoma, Nasal Type Involving Anus

Involvement of the anus by a malignant lymphoma is rare, but occurs with a high incidence in acquired immunodeficiency syndrome patients, with most cases having a B-cell phenotype. Although NK/T cell lymphomas; the nasal type, often present with skin or gastrointestinal tract involvement, there has been no reported cases of anal involvement in Korea. Herein, we describe the case of a 23-year-old man who presented with fever, weight loss and a perianal abscess. A biopsy specimen of the anus revealed an extranodal NK/T cell lymphoma of the nasal type. In-situ hybridization for the Epstein-Barr Virus proved positive. Despite the use of combination chemotherapy, the patient died due to the disease 2 months after diagnosis. In patients presenting with a perianal lesion, other involved sites, as well as B symptoms, lymphoma involvement of the anus should be considered, with a biopsy of the anus performed.

Echocardiographic Parameters for Predicting the Outcome of Patients Undergoing Surgery for Severe Tricuspid Regurgitation

BACKGROUND AND OBJECTIVES: This study was performed to identify echocardiographic parameters related to postoperative clinical outcome (PCO) in patients undergoing surgery for severe tricuspid regurgitation (TR) following mitral valve surgery. The indications for surgery due to severe TR following mitral valve surgery are not well defined largely because of a lack of knowledge of the prognostic factors of PCO in these patients. SUBJECTS AND METHODS: Eighteen patients (male/female; 2/16, mean age 58 years) with severe TR associated with prior mitral valve surgery were prospectively enrolled. Comprehensive echocardiographic examinations were performed before and 15+/-7 months after surgery. Favorable PCO was defined as an improvement of > or =1 in New York Heart Association (NYHA) functional class or a >25% increase in respiratory variation of IVC diameter. Non-survivors and survivors without a favorable PCO were defined as having an unfavorable PCO. RESULTS: The operative mortality was 11% (2/18). Of the 16 survivors, nine (9/16, 56%) achieved a favorable PCO. NYHA functional class, age, left ventricular ejection fraction, right ventricular fractional area change, severity of TR and pulmonary artery pressure were not related to PCO. Only systolic tricuspid annulus velocity (ST') was found to be associated with PCO (favorable vs unfavorable PCO; 12.9+/-2.1cm/s vs 9.7+/-1.7cm/s, p<0.05). For ST' value (9.5 cm/s, the sensitivity, specificity, positive and negative predictive values for predicting an unfavorable PCO were 67%, 100%, 100% and 75%, respectively. CONCLUSION: This study shows that ST' can predict PCO in patients undergoing surgery for severe TR following mitral valve surgery.