High Sodium Intake in Women with Metabolic Syndrome

BACKGROUND AND OBJECTIVES: Metabolic syndrome and high sodium intake are associated with frequent cardiovascular events. Few studies have estimated sodium intake in subjects with metabolic syndrome by 24-hour urine sodium excretion. We evaluated sodium intake in individuals with metabolic syndrome. SUBJECTS AND METHODS: Participants were recruited by random selection and through advertisement. Twenty four-hour urine collection, ambulatory blood pressure measurements, and blood test were performed. Sodium intake was estimated by 24-hour urine sodium excretion. Participants receiving antihypertensive medications were excluded from analysis. RESULTS: Among the 463 participants recruited, subjects with metabolic syndrome had higher levels of 24-hour urine sodium excretion than subjects without metabolic syndrome (p=0.0001). There was a significant relationship between the number of metabolic syndrome factors and 24-hour urine sodium excretion (p=0.001). The proportion of subjects with metabolic syndrome was increased across the tertile groups of 24-hour urine sodium excretion (p<0.0001). The association of high sodium intake and metabolic syndrome was significant only among women. Among the factors related to metabolic syndrome, body mass index had an independent association with 24-hour urine sodium excretion (p<0.0001). CONCLUSION: Women with metabolic syndrome exhibited significantly higher sodium intake, suggesting that dietary education to reduce sodium consumption should be emphasized for women with metabolic syndrome.

Subclinical Renal Insufficiency Range of Estimated Glomerular Filtration Rate and Microalbuminuria Are Independently Associated with Increased Arterial Stiffness in Never Treated Hypertensives

BACKGROUND AND OBJECTIVES: Microalbuminuria (MAU) and decreased estimated glomerular filtration rate (eGFR) are risk factors for cardiovascular disease (CVD) in patients with hypertension. However, in hypertensive patients with normal or minimally reduced eGFR (> or =60 mL/min/1.73 m2) and with normo- or MAU, the value of combined estimation of eGFR and urine microalbumin for the risk assessment has not been widely reported. We evaluated the association between arterial stiffness and the combined estimation of eGFR and urine microalbumin. SUBJECTS AND METHODS: Subjects with never treated hypertension and normal or minimally reduced eGFR were evaluated (n=491, 50.1+/-10.4 years). eGFR was calculated by the simplified Modification of Diet in Renal Disease formula. Urinary albumin-to-creatinine ratio (UACR) was assessed with spot urine. Arterial stiffness was assessed with heart-femoral pulse wave velocity (hfPWV). All subjects were divided into four groups; group 1, eGFR > or =90 mL/min/1.73 m2 (normal eGFR) and normo-albuminuria (NAU); group 2, eGFR 89.9-60 mL/min/1.73 m2 (minimally reduced eGFR) and NAU; group 3, normal eGFR and MAU; group 4, minimally reduced eGFR and MAU. RESULTS: Group 1 had the lowest hfPWV (964.6+/-145.4; group 2, 1013.5+/-168.9; group 3, 1058.2+/-238.0; group 4, 1065.8+/-162.9 cm/sec). Analysis adjusting age, sex, body mass index, heart rate and mean arterial pressure showed significantly lower hfPWV of group 1 compared to group 2 (p=0.032) and 3 (p=0.007). Multiple regression analysis showed a significant association of hfPWV with logUACR {beta=0.096, 95% confidence interval (CI) 8.974-60.610, p=0.008} and eGFR (beta=-0.069, 95% CI -1.194 - -0.005, p=0.048). CONCLUSION: Minimally reduced eGFR or MAU is independently associated with increased arterial stiffness, indicating greater CVD risk.

Relationship Between Serum Uric Acid Levels, Metabolic Syndrome, and Arterial Stiffness in Korean

BACKGROUND AND OBJECTIVES: Associations have been reported between the serum uric acid (SUA) level, metabolic syndrome (MS), and atherosclerosis. We have determined the relationship between the SUA level, MS, and arterial stiffness in Korean. SUBJECTS AND METHODS: Cross-sectional data from 1,276 adults who underwent routine laboratory tests and pulse wave velocity (PWV) measurements during a health check-up were analyzed in a gender-specific manner. None of the participants had atherosclerotic cardiovascular disease, diabetes, renal disease, or systemic disease, or were under treatment which would affect SUA levels, or taking medications for hypertension or dyslipidemia. RESULTS: After adjustment for age, smoking status, total cholesterol (TC), and creatinine, the odds ratios (ORs, 95% confidence interval) of gender-specific quartiles of SUA for MS were 1.0, 1.28 (0.66-2.47), 1.46 (0.76-2.82), and 2.21 (1.15-4.26) in females, and 1.0, 1.33 (0.82-2.17), 1.60 (0.96-2.66), and 2.03 (1.21-3.40) in males. However, after adjustment for waist circumference, there were no significant differences in the ORs among the SUA quartile groups in females and males (both, p=NS). The Pearson's correlation coefficients for the relationship between SUA levels and heart-femoral (hf) PWVs or brachial-ankle (ba) PWVs were not significant in females and males (r=0.054 and r=0.015, respectively, in females; r=-0.036 and r=-0.015, respectively, in males; all, p=NS). CONCLUSION: An elevated SUA level is associated with abdominal obesity among the MS components, but the SUA level is not associated with PWV in females or males.

Effects of Physical Activity and Aerobic Exercise Capacity on Aortic Stiffness in Patients With Untreated Hypertension

BACKGROUND AND OBJECTIVES: High aerobic exercise capacity and sport-related physical activity are reported to be inversely associated with arterial stiffness in healthy young adults. However, it is unknown whether increased physical activity and/or high aerobic exercise capacity attenuate arterial stiffness in patients with untreated hypertension. SUBJECTS AND METHODS: We studied subjects with never-treated hypertension {n=84 (55 males); mean age+/-SD, 49+/-7 years; age range, 36-65 years}. We excluded subjects with a history of diabetes, angina, myocardial infarction, major arrhythmia, or cerebrovascular diseases and those who were taking any cardiovascular medications, including lipid-lowering agents. Carotid intima-media thickness (IMT) and heart-femoral pulse wave velocity (hfPWV) were measured before exercise testing was performed. Physical activity was estimated using a modified Baecke questionnaire. Aerobic exercise capacity was measured with maximal cardiopulmonary exercise testing (maximum oxygen uptake, Vo2max). RESULTS: Linear regression analysis showed a significant inverse correlation between sport-index and hfPWV (r=-0.404; p0.05). Carotid IMT was not associated with physical activity indices or Vo2max. CONCLUSION: In patients with untreated hypertension, increased sport activity was associated with lower aortic stiffness, but high aerobic exercise capacity was not. These results suggest that regular daily exercise, but not exercise capacity, is an important determinant of aortic stiffness in patients with untreated hypertension.

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.

Increased Arterial Stiffness in Behcet's Disease Patients

BACKGROUND AND OBJECTIVES : Pulse wave velocity (PWV) is an ideal indicator of arterial stiffness. This study investigated arterial stiffness of different vascular regions in patients suffering with Behcet's disease (BD), and we assessed whether arterial stiffness was affected by the clinical parameters of BD. Subjects and METHODS : This study included 53 BD patients (mean age: 38+/-8 years) and 65 healthy controls (mean age: 38+/-8 years) who were without any known cardiovascular diseases. After recording the clinical parameters of the BD patients, pulse wave velocity was measured with an automated device in the heart-femoral, heart-carotid, heart-brachial and femoral-ankle segments. RESULTS : Patients with BD had significantly higher PWV values than did the controls in all the regional arterial segments. The PWV values were not correlated with the duration of the disease, corticosteroid use or the presence of active disease at the time of examination. The clinical variables related to severe BD manifestations, which included severe disease, male gender, vascular lesions or immunosuppressant use, were partly associated with increased PWV on the univariate analysis, but any statistical significance for these clinical variables was lost in all the regional arterial segments on multivariate analysis. In addition, multivariate regression analysis revealed that age and the mean arterial pressure were independently associated with increased PWV in most regional arterial segments for BD patients. CONCLUSION : The patients with BD had significantly increased arterial stiffness in all the regional arterial segments when compared with the healthy controls. Longitudinal studies that employ a large population are required to determine the pathophysiologic and prognostic implications of increased arterial stiffness in BD.

Association of the Invasively Measured Aortic Stiffness and Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Aortic stiffness is believed to be an important risk factor of coronary artery atherosclerosis (CAA), as it directly affects coronary perfusion. The following aspects of the invasively measured aortic pulse wave velocity (PWV) were assessed in relation to CAA: The effect of cardiovascular risk factors on PWV, the effect of PWV on the severity of CAA and on the development of the restenosis after drug-eluting stent (DES) implantation. SUBJECTS AND METHODS: 371 subjects who had undergone coronary angiography were enrolled, with all undergoing an invasive aortic PWV measurement also. 112 patients, who had undergone a DES implantation, were prospectively investigated for the effect of PWV in relation to the subsequent risk of major adverse cardiac events (MACE). RESULTS: Among the conventional cardiovascular risk factors, an age >60 (10.79+/-4.92 vs. 8.35+/-4.02, p=0.0006), diabetes (10.97+/-4.66 vs. 9.26+/-4.70 m/sec, p=0.0118) and dyslipidemia (10.38+/-4.97 vs. 9.47+/-4.55m/sec, p=0.0421) were significantly associated with an increased PWV, but sex, smoking and hypertension were not associated with an increased PWV. The PWV was shown to be significantly associated with the severity of CAD. The odds ratio (OR) of 1m/sec increment in the PWV for an increased vessel score was 1.08 (95% confidence interval (CI): 1.03-1.13, p=0.0017). There were no differences in the incidence of MACE and the changes in the angiographic parameters between the high (>10 m/sec) and low PWV groups. CONCLUSION: The invasively measured aortic PWV was affected by age (>60), diabetes and dyslipidemia, and also showed a strong association with the severity of CAD. The aortic PWV was not a significant risk factor for restenosis following a DES implantation.

NF-kappa B decoy potentiates the effects of radiation on vascular smooth muscle cells by enhancing apoptosis

NF-kappa B promotes cell survival against external stress such as radiation. We examined whether NF-kappa B decoy transfection enhances the antiproliferative effects of radiation on vascular smooth muscle cells (VSMCs) in vitro. The irradiation induced activation or nuclear translocation of NF-kappa B p65 in VSMCs was confirmed by immunofluorescence. NF-kB decoy transfection resulted in inhibition of the radiation-induced NF-kB activation in VSMCs and the subsequent reduction of transcription and translocation of ICAM, iNOS, and TNF-alpha, downstream molecules under the control of NF-kappa B. By using MTT assay, NF-kappa B decoy augmented the antiproliferative effects of radiation, where the effect of low dose radiation (2 and 8-Gy) of the cells transfected with NF-kappa B decoy was equivalent to the high dose (16-Gy) irradiated non-transfected cells at 48 h after irradiation: 1.06+/-0.16, 1.11+/-0.22, 1.20+/-0.25, respectively. The decrease in proliferation and survival of the radiation treated cells by flow cytometry analysis showed that NF-kappa B inhibition did not show any additive effects on the cell cycle of the irradiated VSMCs, while apoptosis was significantly increased after NF-kappa B decoy transfection in the irradiated VSMCs (apoptosis fraction: 13.33+/-2.08% vs. 26.29+/-7.43%, for radiation only vs. radiation+NF-kappa B decoy transfection, P < 0.05). In addition, at 48 h, NF-kappa B decoy transfection dose dependently (10 mM vs. 20 mM) inhibited proliferation of 16Gy-irradiated VSMCs, and showed greater antiproliferative efficacy than 100 mM sulfasalazine, a specific NF-kappa B inhibitor. These results indicate that NF-kappa B inhibition reduces proliferation and survival of irradiated VSMCs, likely by increased apoptosis rather than additive cell cycle arrest and suggest the possibility of adjunctive gene therapy using NF-kappa B decoy to improve efficacy and to decrease the adverse effects of intracoronary radiation therapy.

Morphologic Follow-Up of the Anastomotic Sites Using One-year and Five-year Angiography after Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: We analysed the characteristics of anastomotic sites after coronary artery bypass grafting (CABG) using coronary angiographies (CAGs) performed at one and five years postoperatively in the same patient population. MATERIAL AND METHOD: Among the 219 patients who underwent isolated CABGs between January 1995 and December 1997, follow-up coronary angiograms were performed in 149 (75.3%) patients at one year and in 115 (58.1%) patients at five years postoperatively. FitzGibbon grading system was used to evaluate the anastomotic sites. RESULT: The patency rates of arterial grafts at one- and five-year were 96.5% (192/199) and 93.1% (134/144), which were higher than those of saphenous vein grafts (SVGs) (82.9% (224/270) and 77.5% (141/182), respectively) (p=0.01). Although there were significant decreases in the patency rates between one- and five-year CAGs of both arterial and venous grafts, the proportion of FitzGibbon grade B among the SVGs was increased from 5.2% (one-year) to 8.2% (five-year), suggesting the progression of vein graft disease (p<0.01). CONCLUSION: The patency rate of the arterial graft was higher than that of SVG in both one- and five-year CAGs. The attrition rate of saphenous vein graft was higher than arterial grafts.

Cellular Cardiomyoplasty Using Bone Marrow Derived Mesenchymal Stem Cells Transplantation in Post Myocardial Infarction Heart Failure

BACKGROUND AND OBJECTIVES: Cellular cardiomyoplasty (CCM) is considered to be a novel therapeutic approach for post-myocardial infarction (MI) heart failure. In this study, the functional effects of cultured mesenchymal stem cells (MSCs) transplantation and the associated histopathologic changes were evaluated in a rat model of MI. MATERIALS AND METHODS: Rats were subjected to 5 hours of coronary ligation followed by reperfusion, and 10 days after MI, animals were randomized into either the MSCs transplantation (MI-MSC, n=8) group or the control (n=8) group. Allogeneic MSCs (3x10(6) cells) or media were epicardially injected into the center and the border area of the infarct scar. RESULTS: Four weeks after the MSCs transplantation, the echocardiogram showed preserved anterior regional wall motion and increases in fractional shortening in the MI-MSC heart relative to the control heart. Left ventricular (LV) end diastolic pressure was smaller in the MI-MSC than in the control group. Implanted MSCs formed islands of cell clusters on the border of the infarct scar, and the cells were positively immunostained by sarcomeric alpha-actinin and cardiac troponin T. In addition, the number of microvessels on the border area of the infarct scar was greater in the MI-MSC than in the control group. CONCLUSION: Allogeneic MSCs transplanted into the MI scar formed clusters of cell grafts on the border of the infarct, expressed cardiac muscle proteins, increased microvessel formation, and improved regional and global LV function. Our data indicate that CCM using MSCs may have a significant role in the treatment of post-MI heart failure.

Long-term clinical outcomes of newly implanted stents during intracoronary radiation / 대한내과학회지

BACKGROUND: New stent implantation during intracoronary brachytherapy is discouraged due to the high risk of late thrombosis. However, new stent implantation is inevitable in some cases due to the inadequate ballooning or major dissections. Long-term follow-up results of newly implanted stents during brachytherapy are not well-known. We performed this study to evaluate the long-term clinical outcomes of newly implanted stents during intracoronary brachytherapy. METHODS: In the Seoul national university Post-Angioplasty RhEnium irradiation (SPARE) trial, patients were treated with conventional catheter-based technique and then randomized to either beta- radiation (RG) or control group (CG). Radiation was performed with 188 -rhenium-filled conventional balloon catheter system. From 1999 to 2001, new stent implantation was performed in 58 and 56 patients in RG and CG, respectively. Clinical and angiographic follow up data were analyzed. RESULTS: In RG, short-term angiographic restenosis rate was lower than CG (28.6% vs 53%, p=0.03). In RG, late thrombosis was found in 3 patients. However, there was no late thrombosis in CG. Two year major cardiac event rates were not different between the 2 groups (RG: 25.9% vs CG: 28.3%). Independent predictors for major cardiac event in RG were major dissections (>or=type C) after stent implantation (beta=70, p=0.01) and longer administration of dual antiplatelets (aspirin+clopidogrel/ ticlopidine, >6 months, beta=0.07, p=0.04). CONCLUSION: Stenting during intracoronary brachytherapy seems to be ineffective in reducing long-term event rates. When new stent implantation is inevitable during brachytherapy, extreme attention is required not to make a dissection and long-term dual antiplatelet treatment should be followed after stent implantation.

Long-Term Effect of Repeated Brachytherapy in Intracoronary Brachytherapy Failed Lesions

BACKGROUND AND OBJECTIVES: An intracoronary brachytherapy is the only approved treatment for in-stent restenosis. However, a considerable rate of restenosis occurs after a brachytherapy. Up to now, there was no long term outcome for repeated brachytherapy for these lesions. SUBJECTS AND METHODS: Eleven patients were admitted due to angina, with significant ischemic evidence in the stress test after the intracoronary brachytherapy. These patients were re-treated with a beta-emitting 188 rhenium-DTPA (diethylene triamine penta-acetic acid) filled balloon catheter system, using an identical method and radiation dose (17.6 Gy) to the initial radiation treatment. The long term angiographic and clinical outcomes of repeated brachytherapy in these patients were evaluated. RESULTS: The angiographic and clinical data of ten patients were evaluated, as 1 was lost. The follow-up period was 37.4+/-16.2 months (range, 8 to 53 months). There was no angiographic restenosis or target lesion revascularization (TLR) during the short term follow-up period (mean 6 months). but 2 restenosis (25%) occurred in the 2 year follow-up period and one other was added during the long term clinical follow-up period. All these restenosis lesions needed revascularization. These three TLRs occurred at 15, 24 and 43 months after the repeated brachytherapy. There was no death or nonfatal MI. No vascular perforation, aneurysm or late thrombosis was observed. CONCLUSION: A repeated brachytherapy for the treatment of a failed intracoronary brachytherapy lesion is safe and acceptably effective during the long term follow-up period. This modality might be considered as a therapeutic option for failed intracoronary brachytherapy lesions.

Risk Factors of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention with Stent Implantation

BACKGROUND AND OBJECTIVES: No-reflow is an important phenomenon for limiting the prognosis of patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Coronary stenting is the current standard procedure for primary PCI in AMI. However, stenting is suspected to cause more microembolization, and no-reflow phenomenon. This study was performed to elucidate the risk factors for the no-reflow phenomenon following primary PCI with stenting, in patients with AMI. SUBJCETS AND METHODS: The clinical, angiographic and procedure related parameters were reviewed in patients with AMI that had undergone primary PCI, with stent implantation, within 12 h of the onset of chest pain, at Seoul National University Hospital, Yonsei University Hospital Cardiovascular Center and Chungbuk National University Hospital (n=183). RESULTS: 29 patients (16%) showed no-reflow phenomenon (final TIMI flow grade less than 3). Conventional risk factors for coronary artery disease were not significant risk factors for the no-reflow phenomenon. In a univariate analysis, a high initial CK-MB level (>50 IU) (8.45% vs. 21.9%, p=0.04), low left ventricular ejection fraction (LV EF) (30 sec) (31% vs. 15%, p=0.04) were significant risk factors of the no-reflow phenomenon. A low LV EF and long pre-dilatation balloon inflation time were significant risk factors in a multivariate analysis. CONCLUSION: LV dysfunction at presentation and a long pre-dilatation balloon inflation time were independent risk factors for the no-reflow phenomenon following primary PCI with stenting for AMI. Preventive measures against the no-reflow phenomenon should be considered in patients with these risk factors.

Risk Factors of No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention with Stent Implantation

BACKGROUND AND OBJECTIVES: No-reflow is an important phenomenon for limiting the prognosis of patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Coronary stenting is the current standard procedure for primary PCI in AMI. However, stenting is suspected to cause more microembolization, and no-reflow phenomenon. This study was performed to elucidate the risk factors for the no-reflow phenomenon following primary PCI with stenting, in patients with AMI. SUBJCETS AND METHODS: The clinical, angiographic and procedure related parameters were reviewed in patients with AMI that had undergone primary PCI, with stent implantation, within 12 h of the onset of chest pain, at Seoul National University Hospital, Yonsei University Hospital Cardiovascular Center and Chungbuk National University Hospital (n=183). RESULTS: 29 patients (16%) showed no-reflow phenomenon (final TIMI flow grade less than 3). Conventional risk factors for coronary artery disease were not significant risk factors for the no-reflow phenomenon. In a univariate analysis, a high initial CK-MB level (>50 IU) (8.45% vs. 21.9%, p=0.04), low left ventricular ejection fraction (LV EF) (30 sec) (31% vs. 15%, p=0.04) were significant risk factors of the no-reflow phenomenon. A low LV EF and long pre-dilatation balloon inflation time were significant risk factors in a multivariate analysis. CONCLUSION: LV dysfunction at presentation and a long pre-dilatation balloon inflation time were independent risk factors for the no-reflow phenomenon following primary PCI with stenting for AMI. Preventive measures against the no-reflow phenomenon should be considered in patients with these risk factors.

Incidence, Risk factors, and Clinical Outcomes of Contrast Induced Nephropathy After Percutaneous Coronary Intervention in Elderly Patients

BACKGROUND: Contrast induced nephropathy(CIN) has been known to be a risk factor of significant in-hospital and long-term adverse outcomes. In old aged patients undergoing percutaneous coronary intervention(PCI) in the modern era, the incidence and prognostic implications of nephropathy are unknown. METHODS: With a retrospective analysis of the clinical and angiographic data, we determined the incidence of, risk factors for, and prognostic implications of CIN(defined as an increase in serum creatinine[Cr] >0.5 mg/dL from baseline) after PCI. RESULTS: Of 360 patients, 16(4.4%) patients experienced CIN and 5(1.4%) patients required temporary renal replacement therapy (hemodialysis or hemofiltration). Patients with baseline Cr 1.4 mg/dL and diabetic patients had a significant risk of CIN. In multivariate analysis, CIN was significantly associated with baseline renal dysfunction and diabetes showed marginal significance in developing CIN. Twenty-five percent of patients with CINdied during the index hospitalization compared with only 1.2% of patients without CIN (p<0.001). In patients with CIN, events of CIN impair renal function at six-month follow up. CONCLUSIONS: In old aged patients who are undergoing PCI, diabetic patients with baseline renal impairment are at higher risk for CIN. Furthermore, CIN was highly correlated with death during the index hospitalization.

Relationship of Polymorphisms in the Oxidative Stress Related Genes - Paraoxonase and p22phox - to Variant Angina and Coronary Artery Stenosis in Korean

BACKGROUND AND OBJECTIVES: Oxidative stress plays an important role in the pathogenesis of coronary atherosclerosis and spasm. We investigated whether the polymorphisms in two oxidative stress-related genes, paraoxonase and p22phox, are associated with risks of coronary artery spasm and stenosis. SUBJECTS AND METHODS: The study comprised of 116 patients with variant angina, 118 patients with coronary artery stenosis and 117 control subjects, who were all classified by coronary angiography. In all three groups, the genotype frequencies of the Q192R polymorphism of the paraoxonase gene and C242T polymorphism of the p22phox gene were analyzed, and the serum thiobarbituric acid-reactive substance concentrations measured. RESULTS: The frequency of the RR genotype of the paraoxonase Q192R polymorphism was significantly higher in patients with variant angina and coronary artery stenosis than in the control subjects (40.4% in variant angina and 37.8% in coronary artery stenosis vs. 24.7% in control, p=0.020 and 0.048, respectively). From the multivariate analysis, the odds ratio of the RR genotype was 2.240 for variant angina (95% confidence interval ; 1.012-4.956), and 2.333 for coronary artery stenosis (95% confidence interval ; 1.140-4.777), in relation to the control subjects. The thiobarbituric acid-reactive substance level was significantly higher in the RR type than in the QQ+QR types (RR vs. QQ+QR : 1.106+/-0.420 nmol/mL vs. 0.949+/-0.311 nmol/mL, p=0.028). There was no significant difference in the prevalence of the C242T polymorphism of the p22phox gene between the three groups. CONCLUSION: The RR genotype of the paraoxonase gene Q192R polymorphism was found to be an independent risk factor for both coronary spasm and stenosis.

Long-Term Follow-Up Results of Intracoronary Beta-Radiation Therapy with a Rhenium-188 Diethylene Triamine Penta-Acetic Acid-Filled Balloon

BACKGROUND AND OBJECTIVES: Intracoronary irradiation has emerged as a successful intervention for the treatment of restenosis. However, the radiation process is complex, difficult and hard to perform. On the contrary, intracoronary radiation therapy using a 188Re-DTPA-filled balloon system is simple and inexpensive. The short-term follow-up results of this system have been reported, but the long-term results remain to be elucidated. The object of this study is to evaluate the short and long-term follow-up results of intracoronary radiation using a 188ReDTPA-filled balloon system in restenotic lesions. SUBJECTS AND METHODS: Thirty-eight patients, with restenotic lesion after previous percutaneous coronary intervention, were selected from the SPARE trial (Seoul National University Post-Angioplasty RhEnium irradiation trial). There were 27 cases in the irradiation group, with 11 in the control group. Irradiation was performed in the restenotic lesions after successful interventions. The results of 6-month angiographic and 6-month and 3-year clinical follow-up data were compared between the two groups. RESULTS: A 6-month angiographic follow-up was performed in 33 patients (87%), 25 in the radiation group and 8 in control. Binary restenosis developed in 1 of 25 (4%) and 4 of 8 (50%) in the radiation and control groups, respectively (p=0.008). At the 6-month clinical follow-up, there were no significant differences in the event rates between the two groups. At the 3-year clinical follow-up, there was a significant difference in the target vessel revascularization: 2 of 27 (7.4%) and 5 of 11 (45.4%) in the radiation and control groups, respectively (p=0.017). There were no deaths or myocardial infarctions. CONCLUSION: Radiation therapy using a 188ReDTPA-filled balloon system is feasible, and may be effective in improving the long-term outcomes in restenotic lesions.

Multicenter Analysis of Clinical Characteristics and Prognostic Factors of Patients with Congestive Heart Failure in Korea

BACKGROUND AND OBJECTIVES: Congestive heart failure is one of the most frequent problems in cardiovascular patients. However, very little data concerning this syndrome in Korea was available. The objectives of this study were to evaluate the demographic and clinical characteristics, and the prognostic factors of patients hospitalized with congestive heart failure in Korea. SUBJECTS AND MEHTODS: Six university hospitals, fulfilling the protocol for clinical information of patients with heart failure, were prospectively engaged in this study. One thousand and forty seven patients, admitted between Jan.1. 1998 and Dec. 31. 2000 were enrolled. RESULTS: The cumulative survival rates at 3 and 6 month, and 1 and 2 years were 90.5, 87.5, 82 and 75.9%, respectively. Ischemic heart disease was the most frequent underlying disease (36.7%). Diabetes mellitus (OR : 1.626, 95% CI : 1.156-2.289, p=0.005), previous history of myocardial infarction (OR : 2.044, 95% CI : 1.488-2.808, p<0.0001), atrial fibrillation (OR : 1.516, 95% CI : 1.042-2.206, p=0.02), and cerebrovascular accident (OR : 2.187, 95% CI : 1.366-3.501, p=0.001) were the worse prognostic factors. CONCLUSION: Ischemic heart disease was the major cause of heart failure. The cumulative 1 year survival rate, of the patients of congestive heart failure was 82%. The poor prognostic factors were diabetes, old myocardial infarction, atrial fibrillation and cerebrovascular accident.

Relationship Between the Right Ventricular Pressure Waveform and the Vasodilator Response of Pulmonary Artery Pressure in Pulmonary Artery Hypertension

BACKGROUND AND OBJECTIVES: This study was performed to discern whether the vasodilatory response of pulmonary artery pressure could be predicted by the right ventricular (RV) pressure waveforms, and therefore, from continuous wave Doppler signals of tricuspid regurgitant jet (CWTR). SUBJECTS AND METHODS: Twelve patients with pulmonary hypertension who underwent cardiac catheterization were enrolled. Nitroprusside was infused at a dose of 0.5 microgram/kg/min, with the dosage being increased by 0.5 microgram/kg/min every 5 minutes to a maximum of 4 microgram/kg/min. Cardiac output (CO), pulmonary vascular resistance (PVR), peak systolic RV pressure (Pp), RV pressure at the inflection point (Pi), deltaP (Pp-Pi) and CWTR were obtained before and at the end of the nitroprusside infusion. A positive response to the vasodilator was defined when there was > or =20% change in the mean pulmonary artery pressure at the end of the nitroprusside infusion. RESULTS: Eight patients did not show a positive response (Group 1) while four patients did (Group 2). Mean decrements in Pp following the nitroprusside test were 4.1+/-7.7 mmHg in group 1 and 27.8+/-5.6 mmHg in group 2. There were no significant differences between groups 1 and 2 in baseline CO, PVR or Pp. However group 1 had a significantly higher deltaP than group 2 (29.0+/-10.5 mmHg vs. 13.3+/-3.0 mmHg, p<0.05). In the configuration analysis of CWTR, the slope between the inflection point and peak velocity was linear in group 1, while there was an indentation in group 2. CONCLUSION: Patients with a small difference between Pp and Pi tend to be reactive to a vasodilator and this tendency can be predicted from the configuration of CWTR.

A Case of Hereditary Hemorrhagic Telangiectasia Combined with Pulmonary- Systemic Fistula

We report the first case of hereditary hemorrhagic telangiectasia combined with multiple pulmonary-systemic fistulae. In this case, a 39-year-old woman presented with long standing chest pain, dyspnea and hemoptysis. Finally she was diagnosed as systemic- pulmonary fistula, a rare form of hereditary hemorrhagic telangiectasia.