The Impact of Pulmonary Hypertension on the Clinical Outcomes of Acute Myocardial Infarction after Percutaneous Coronary Intervention / 대한내과학회지

Background/Aims@#Pulmonary hypertension (PH) in patients with heart failure contributes to a poor prognosis. However, the role of PH in the long-term clinical outcome is unclear in those with acute myocardial infarction (AMI). The clinical significance of elevated right ventricular systolic pressure (RVSP) on routine echocardiography is underestimated. @*Methods@#This study enrolled 2,526 AMI patients (65.1 ± 12.7 years; 1,757 males [69.6%]) from the Korean AMI registry who underwent successful percutaneous coronary intervention and pre-discharge transthoracic echocardiography (TTE). The patients were divided into four groups according to the RVSP on TTE: normal RVSP (RVSP < 35 mmHg, n = 1,695), mild PH (35 ≤ RVSP < 45 mmHg, n = 601), moderate PH (45 ≤ RVSP < 70 mmHg, n = 211), and severe PH (RVSP ≥ 70 mmHg, n = 19). Major adverse cardiac events (MACE) were compared among the four groups. @*Results@#During the 3-year clinical follow-up period, MACE occurred in 562 patients (22.2%), including 321 (18.9%), 145 (24.1%), 83 (39.3%), and 13 patients (68.4%) in the normal RVSP and mild, moderate, and severe PH groups, respectively. On multivariate analysis, independent factors for MACE were moderate or severe PH, age ≥ 65 years, Killip class ≥ III, left ventricular ejection fraction < 40%, hypertension, and diabetes. @*Conclusions@#Measuring RVSP is useful for stratifying the risk of patients with AMI; MACE occurred in patients with moderate or severe PH.

Extremely Severe Hypernatremia Caused by Wrong Belief in a Patient with Cervical Cancer

A 56-year old female patient who was undergoing follow-up for cervical cancer in our oncology center was presented to the emergency center with anxiety and excessive thirst. The initial serum sodium level of the patient exceeded 200mEq/L, rising up to 238mEq/L during hospitalization. The extremely severe hypernatremia was caused by patient’s wrong belief that bay salt would cure the cancer. The patient was treated with hypotonic solution and finally with appropriate hydration, she was fully recovered without any neurological complications.

Extremely Severe Hypernatremia Caused by Wrong Belief in a Patient with Cervical Cancer

A 56-year old female patient who was undergoing follow-up for cervical cancer in our oncology center was presented to the emergency center with anxiety and excessive thirst. The initial serum sodium level of the patient exceeded 200mEq/L, rising up to 238mEq/L during hospitalization. The extremely severe hypernatremia was caused by patient’s wrong belief that bay salt would cure the cancer. The patient was treated with hypotonic solution and finally with appropriate hydration, she was fully recovered without any neurological complications.

Effects of Fimasartan/Amlodipine Fixed-Dose Combination on Left Ventricular Systolic Function and Infarct Size in Rat Myocardial Infarction Model / 전남의대학술지

The aim of this study was to evaluate the effects of fimasartan/amlodipine fixed-dosed combination (F/A) on left ventricle (LV) systolic function and infarct size in the rat myocardial infarction (MI) model. We induced MI in 20 rats by ligation of the left anterior descending coronary artery and they were divided into two groups [MI group (n=10) vs. MI+F/A 10 mg/kg group (n=10)]. F/A was administered for 28 days between day-7 and day-35 in the MI+F/A group and echocardiography was performed at day-7 and at day-35 after the induction of MI. Picrosirius red staining was performed to confirm the fibrotic tissue and infarct size was measured using image analysis program for Image J. At the 35-day follow-up, the LV ejection fraction (EF) was significantly higher (38.10±3.92% vs. 29.86±4.56%, p<0.001) and delta (day-35 minus day-7) EF was significantly higher (0.14±2.66% vs. −8.53±2.66%. p<0.001) in the MI+F/A group than the MI group. Systolic blood pressure was significantly lower in the MI+F/A group than the MI group (103.23±13.35 mmHg vs. 123.43±14.82 mmHg, p<0.01). The MI+F/A group had a smaller infarct size (26.84±5.31% vs. 36.79±3.10%, p<0.01) than the MI group at the 35-day follow-up. Oral administration of F/A 10 mg/kg could improve LV systolic function and reduce infarct size in a rat MI model.

Effects of Ivabradine on Left Ventricular Systolic Function and Cardiac Fibrosis in Rat Myocardial Ischemia-Reperfusion Model / 전남의대학술지

We evaluated the effects of Ivabradine on left ventricle (LV) ejection fraction (EF) and LV infarcted tissue in the rat myocardial ischemia-reperfusion model. Twenty rats were randomly assigned to group 1 (ischemia-reperfusion, no treatment, n=10) and group 2 (ischemia-reperfusion + Ivabradine 10 mg/kg, n=10). Ivabradine was administered for 28 days. Echocardiography was performed at 7 days and at 28 days after the induction of ischemia-reperfusion injury. Cardiac fibrosis induced by ischemia-reperfusion injury was evaluated by Masson's trichrome staining. The infarct size was quantified using the Image J program. At the 28-day follow-up, LVEF was significantly higher (36.02±6.16% vs. 45.72±2.62%, p<0.001) and fractional shortening was significantly higher (15.23±2.84% vs. 20.13±1.38%, p<0.001) in group 2 than group 1. Delta (28 day minus 7 day) EF was significantly higher in group 2 than group 1 (−4.36±3.49% vs. 4.31±5.63%, p<0.001). Also, heart rate (beats/min) was significantly lower in group 2 than group 1 (251.67±25.19 vs. 199.29±31.33, p=0.025). Group 2 had a smaller infarct size (40.70±8.94% vs. 30.19±5.89%, p<0.01) than group 1 at 28-day follow-up. Oral administration of Ivabradine could improve LV systolic function and reduce infarcted tissue area in rat myocardial ischemia-reperfusion model.

Comparative Effects of Statin Therapy versus Renin-Angiotensin System Blocking Therapy in Patients with Ischemic Heart Failure Who Underwent Percutaneous Coronary Intervention / 전남의대학술지

Statins and renin-angiotensin system (RAS) blockers are key drugs for treating patients with an acute myocardial infarction (AMI). This study was designed to show the association between treatment with statins or RAS blockers and clinical outcomes and the efficacy of two drug combination therapies in patients with ischemic heart failure (IHF) who underwent revascularization for an AMI. A total of 804 AMI patients with a left ventricular ejection fraction <40% who undertook percutaneous coronary interventions (PCI) were analyzed using the Korea Acute Myocardial Infarction Registry (KAMIR). They were divided into four groups according to the use of medications [Group I: combination of statin and RAS blocker (n=611), Group II: statin alone (n=112), Group III: RAS blocker alone (n=53), Group IV: neither treatment (n=28)]. The cumulative incidence of major adverse cardiac and cerebrovascular events (MACCEs) and independent predictors of MACCEs were investigated. Over a median follow-up study of nearly 1 year, MACCEs had occurred in 48 patients (7.9%) in Group I, 16 patients (14.3%) in Group II, 3 patients (5.7%) in Group III, 7 patients (21.4%) in Group IV (p=0.013). Groups using RAS blocker (Group I and III) showed better clinical outcomes compared with the other groups. By multivariate analysis, use of RAS blockers was the most powerful independent predictor of MACCEs in patients with IHF who underwent PCI (odds ratio 0.469, 95% confidence interval 0.285-0.772; p=0.003), but statin therapy was not found to be an independent predictor. The use of RAS blockers, but not statins, was associated with better clinical outcomes in patients with IHF who underwent PCI.

Chemotherapy-Induced Left Ventricular Dysfunction in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: As the numbers of cancer cases and survivors increase, the incidence and natural history of chemotherapy-induced cardiotoxicities in patients with breast cancer may also be expected to change. The present study aimed to investigate the incidence and predictors of chemotherapy-induced left ventricular dysfunction (LVD) in patients with breast cancer. METHODS: From 2003 to 2010, 712 female patients with breast cancer (55.7±10.7 years) were enrolled and divided into the LVD group (n=82, 56.7±10.1 years) and the non-LVD group (n=630, 55.6±10.8 years). Baseline clinical and treatment-related variables were compared. RESULTS: Chemotherapy-induced LVD developed in 82 cases (11.4%). Low body mass index (BMI), low triglyceride level, advanced cancer stage, and the use of doxorubicin, paclitaxel, trastuzumab, or radiotherapy were significant predictors of LVD in a univariate analysis. In a multivariate analysis, low BMI, advanced cancer stage, and the use of target therapy with trastuzumab were independent predictors of chemotherapy-induced LVD. Chemotherapy-induced LVD was recovered in 53 patients (64.6%), but left ventricular function was not recovered in 29 patients (35.4%). CONCLUSION: Chemotherapy-induced LVD was not uncommon and did not reduce in many of our patients with breast cancer. Low BMI, advanced cancer stage, and the use of trastuzumab were independent predictors of chemotherapy-induced LVD in patients with breast cancer. The development of chemotherapy-induced LVD should be carefully monitored in patients with breast cancer who are receiving trastuzumab therapy, have poor nutritional status, and advanced cancer stage.

Comparative Effects of Statin Therapy versus Renin-Angiotensin System Blocking Therapy in Patients with Ischemic Heart Failure Who Underwent Percutaneous Coronary Intervention / 전남의대학술지

Statins and renin-angiotensin system (RAS) blockers are key drugs for treating patients with an acute myocardial infarction (AMI). This study was designed to show the association between treatment with statins or RAS blockers and clinical outcomes and the efficacy of two drug combination therapies in patients with ischemic heart failure (IHF) who underwent revascularization for an AMI. A total of 804 AMI patients with a left ventricular ejection fraction <40% who undertook percutaneous coronary interventions (PCI) were analyzed using the Korea Acute Myocardial Infarction Registry (KAMIR). They were divided into four groups according to the use of medications [Group I: combination of statin and RAS blocker (n=611), Group II: statin alone (n=112), Group III: RAS blocker alone (n=53), Group IV: neither treatment (n=28)]. The cumulative incidence of major adverse cardiac and cerebrovascular events (MACCEs) and independent predictors of MACCEs were investigated. Over a median follow-up study of nearly 1 year, MACCEs had occurred in 48 patients (7.9%) in Group I, 16 patients (14.3%) in Group II, 3 patients (5.7%) in Group III, 7 patients (21.4%) in Group IV (p=0.013). Groups using RAS blocker (Group I and III) showed better clinical outcomes compared with the other groups. By multivariate analysis, use of RAS blockers was the most powerful independent predictor of MACCEs in patients with IHF who underwent PCI (odds ratio 0.469, 95% confidence interval 0.285-0.772; p=0.003), but statin therapy was not found to be an independent predictor. The use of RAS blockers, but not statins, was associated with better clinical outcomes in patients with IHF who underwent PCI.

Predictors of the Development of Significant Tricuspid Regurgitation after Permanent Pacemaker Implantation / 대한내과학회지

BACKGROUND/AIMS: We sought to identify predictors of significant tricuspid regurgitation (TR) after successful permanent pacemaker (PPM) implantation in Korean patients. METHODS: Of 404 patients who underwent PPM implantation, 187 patients who had both baseline and follow-up echocardiographic examinations were assigned to one of two groups: no development or change in TR (Group I, n = 172, 65.5 +/- 13.7 years) versus the development of significant TR (Group II, n = 15, 72.1 +/- 8.3 years). Clinical, laboratory, and echocardiographic variables were compared between the two groups. RESULTS: Overall, the grade of TR was significantly aggravated from 0.46 +/- 0.73 to 0.81 +/- 0.84 (p < 0.001) during 3.1 +/- 1.8 years of follow-up (0.49 +/- 0.75 to 0.69 +/- 0.74 in Group I, p < 0.001; 0.13 +/- 0.35 to 2.27 +/- 0.46 in Group II, p < 0.001). The de novo development or aggravation of TR was observed in 66 patients (35.3%), and significant TR developed in 15 patients (8.0%). The presence of atrial fibrillation (AF) was significantly higher (53.3 vs. 18.6%, p = 0.002), and the implantation of a ventricle pacing, ventricle sensing, inhibited by ventricular event (VVI) type pacemaker was more frequent in Group II than in Group I (46.7 vs. 15.1%, p = 0.002). Other variables were not different between the groups. CONCLUSIONS: The development or aggravation of TR was not rare after successful PPM implantation, even though the development of significant TR was uncommon. The presence of AF and the implantation of a VVI type pacemaker were predictors of the development of significant TR. Together, the results of this study suggest that the development or aggravation of TR should be monitored carefully after PPM implantation.

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent / 전남의대학술지

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13x5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent / 전남의대학술지

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13x5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.