Efficacy and Safety of Omega-3 Fatty Acids in Patients Treated with Statins for Residual Hypertriglyceridemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia.METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment.RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups.CONCLUSION: The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

Isolated Non-Compaction of the Left Ventricle in a Patient with New-Onset Heart Failure: Morphologic and Functional Evaluation with Cardiac Multidetector Computed Tomography

We describe a case of new-onset heart failure in a patient in whom cardiac CT enabled the non-invasive diagnosis of isolated non-compaction and associated functional abnormalities of the left ventricle with the concomitant evaluation of coronary arteries. This case highlights the utility of cardiac CT for the morphological and functional evaluation of the heart as a single imaging modality.

Acute Pyogenic Sacroiliitis Caused by Staphylococcus aureus without Predisposing Conditions

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.

A Case of Pericardial Tamponade in a Korean Man with Pericardial Abscess due to Bacteroides fragilis

Purulent pericarditis is a rare, life-threatening condition and usually involves the whole pericardium. However only few cases have been reported in which a loculated pericardial abscess occurred from purulent pericarditis. The prevalence of acute pericarditis due to bacteria was 6%. Purulent pericarditis due to anaerobic bacteria has been reported less frequently than aerobic bacteria. There was no report about purulent pericarditis due to Bacteroides fragilis in Korea until now. So we report the first case of pericardial abscess due to B. fragilis in 59 year old Korean male with history of chronic renal failure and hemodialysis, that was complicated with pericardial tamponade.

Acute Pyogenic Sacroiliitis Caused by Staphylococcus aureus without Predisposing Conditions

Pyogenic sacroiliits is a rare disease and the diagnosis is difficult because of unawareness of the disease and nonspecific symptoms and signs mimicking septic hip, iliopsoas muscle abscess and herniation of intervertebral disk. There are some predisposing factors related to the disease like trauma, pregnancy, intravenous drug abuse and infection of other systems such as skin, genitourinary system and heart. Staphylococcus aureus is the most common causative bacteria. Here we describe a case of 27-year-old woman presented with acute onset of back and left buttock pain. Bone scintigraphy revealed increased uptake at left sacroiliac joint and computed tomography of the pelvis showed left sacroiliitis with left iliacus and iliopsoas abscess. There was no history of usual predisposing conditions. S. aureus was grown from blood cultures and the patient improved with 2 weeks of intravenous cefazolin followed by 4 weeks of oral clindamycin treatment.

A Case of Pericardial Tamponade in a Korean Man with Pericardial Abscess due to Bacteroides fragilis

Purulent pericarditis is a rare, life-threatening condition and usually involves the whole pericardium. However only few cases have been reported in which a loculated pericardial abscess occurred from purulent pericarditis. The prevalence of acute pericarditis due to bacteria was 6%. Purulent pericarditis due to anaerobic bacteria has been reported less frequently than aerobic bacteria. There was no report about purulent pericarditis due to Bacteroides fragilis in Korea until now. So we report the first case of pericardial abscess due to B. fragilis in 59 year old Korean male with history of chronic renal failure and hemodialysis, that was complicated with pericardial tamponade.

Alfuzosin-induced Acute Liver Injury / 대한간학회지

We describe a 56-year-old man who developed an acute liver injury after taking alfuzosin for 1 month to control his newly diagnosed benign prostatic hypertrophy (BPH). There was no history of alcohol consumption or the taking herbal or traditional remedies. Viral causes, autoimmune hepatitis, and biliary tree obstruction were excluded. Other rare causes of hepatitis such as hemochromatosis, primary biliary cirrhosis and Wilson's disease were also absent in this patient. His liver test results began to improve after discontinuing the alfuzosin. Two weeks later, alfuzosin was administered again because the patient complained of dysuria. After 10 days of alfuzosin reuse, his liver test results worsened. Five months later after the complete discontinuation of the drug, his liver test results had returned to normal. This clinical sequence suggests that alfuzosin caused his acute liver injury.

Cases of Pathology-Proven Lung Adenocarcinoma Presenting as Pneumonic Pattern

Lung adenocarcinoma is the cancer originated in terminal bronchiole or alveolar epithelium and its incidence is on the increase. The most common radiologic pattern of lung adenocarcinoma is peripheral nodule or mass, but it can be showed various findings such as hilar mass, consolidation, atelectasis or multicentric lesions. Sometimes it is difficult to differentiate lung adenocarcinoma from other diseases, especially pneumonia. We experienced three patients with lung adenocarcinoma, just only presented as pneumonic consolidation on chest X-ray and CT scan. The clinician should consider seriously lung adenocarcinoma including bronchioloalveolar carcinoma in patients who did not respond to antibiotics. And in such cases, pathologic diagnosis must be perfomed at proper time to confirm disease.

Comparison of Efficacy and Safety of Simvastatin, 10 mg and 20 mg in the Treatment of Hypercholesterolemia Patients Over 60-Year Old

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day over 60-year-old patients. METHODS: Seventy-senven patients with hyperlipidemia(triglycerides 130 mg/dL) were randomized to receive either simvastatin 10 mg/day(n=32) or 20 mg/day(n=45). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein(HDL) cholesterol. RESULTS: Of the senventy-seven patients randomized to treatment, eighteen patients were men and fiftynine patients were women. sixty-five percent of patients had hypertension, eighteen percent coronary artery disease and fourteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 254 (total cholesterol), 291(triglycerides), 50(HDL) and 166 mg/dL(LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters(p<0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater(p<0.001) reductions from baseline LDL cholesterol(32.9 mg/dL vs 24.2 mg/d). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level and TG cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline(ATP III) were 100% and 89% for patients in low risk but 25% and 38.5% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients(6.6%) in the 20 mg group and one patient(3. 1%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION: In patients with hypercholesterolemia over 60 year old in Korea, both doses(10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.

Comparison of efficacy and safety of simvastatin, 10 mg and 20 mg in the treatment of hypercholesterolemia / 대한내과학회지

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day. METHODS: One hundred six patients with hyperlipidemia (triglycerides130 mg/dL) were randomized to receive either simvastatin 10 mg/day (n=43) or 20 mg/day (n=63). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol. RESULTS: Of the one hundred six patients randomized to treatment, forty patients were men and sixty-six patients were women. Fifty-five percent of patients had hypertension, nine percent coronary artery disease and thirteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 258 (total cholesterol), 201 (triglycerides), 50 (HDL) and 167 mg/dL (LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters (p< 0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater (p< 0.001) reductions from baseline LDL cholesterol (34.9 mg/dL vs 20.8 mg/dL). But 10 mg of simvastatin was more effective than 20 mg of simvastatin at reducing triglycerides level (42.7 mg/dL vs 22.3 mg/dL). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline (ATP III) were 81% and 80% for patients in low risk but 35% and 50% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients (4.8%) in the 20 mg group and one patient (2.3%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION : In patients with hypercholesterolemia in Korea, both doses (10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients' preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.

Effect of Steroid on Impaired Vascular Function Induced by Irradiation

BACKGROUND AND OBJECTIVES: Intracoronary irradiation has been proven to reduce restenosis following percutaneous transluminal coronary angioplasty, however late thrombosis is another recurring problem. We evaluated the sequential changes of vascular dysfunction and morphological changes according to the radiation dosage in rats. The effects of dexamethasone on these changes were also evaluated. MATERICAL AND METHODS: Female Sprague-Dawley rats were randomized into 4 groups (n=20, each group), and were irradiated with 0, 5, 10, 20 Gray (Gy). The rats were sacrificed at 1 hour, 1, 3 and 7 days after irradiation. The physiographic responses and morphologic changes of the arterial rings were evaluated. After the time- and dose-response relationship was determined, an additional 40 rats were pretreated with dexamethasone for 3 days and irradiated with 10 or 20 Gy to evaluate the effects of the dexamethasone. 5 Gy irradiation did not induce endothelial dysfunction. 10 Gy irradiation induced an impairment of endothelium dependent relaxation (EDR) only 7days after irradiation. 20 Gy caused an impairment of EDR from the very time of irradiation, although endothelium independent relaxation (EIDR) was not affected irrespective of dose or time. On immuno-histochemistry of vWF, all irradiated arteries showed mild de-endothelialization in acute phase and subsequent re-endothelialization. However, after 20 Gy irradiation, re-endothelialization did not occur. With dexamethasone treatment, all of these vascular dysfunctions were prevented, and re-endothelialization was promoted. CONCLUSION: Irradiation induced the impairment of EDR as well as de-endothelialization, in a time- and dose-response relationship in rats. Pretreatment with dexamethasone may partly prevent radiation-induced vascular dysfunction and de-endothelialization.

Endothelium-Dependent Relaxation Is Impaired by Environmental Tobacco Smoke Exposure in Guinea Pig Aorta

BACKGROUND & OBJECTIVES: Smoking is a risk factor for the development of atherosclerosis. However, the exact mechanism of smoking-related damage to the arterial wall and its relation to the atherosclerotic process are not known. The endothelium plays an important role for the regulation of vascular tone and its function is impaired in the presence of risk factors early in the process of atherosclerosis. To assess the effect of smoking on endothelium-dependent relaxation, we examined vascular reactivity in vitro in an animal model of environmental tobacco smoke exposure. MATERIALS & METHODS: Guinea pigs were randomized to control group or environmental tobacco smoke exposure group. The source of environmental tobacco smoke exposure was sidestream smoke during 6 hours per day and 5 days per week over 6 weeks or 12 weeks in a smoking chamber. Fresh aortic rings were suspended in organ baths(37degrees C, 95%O2-5%CO2). Rings were precontracted with phenylephrine(10(-7)M) and exposed to acetylcholine(10(-7)-10(-4)M) and sodium nitroprusside(10(-7)-10(-5)M) in increasing doses and isometric tension was recorded to evaluate the endothelium-dependent and -independent relaxation. RESULTS: Acetylcholine-induced maximal relaxation(mean+/-SD) was 18+/-9% in the rings from the 6-week smoked guinea pigs and 4+/-3% in the rings from the 12-week smoked guinea pigs in comparison with 49+/-6% of the controls(p<0.05). The endothelium-dependent relaxation of the rings from 12 week-exposure was significantly less than that of 6 week-exposure. In contrast endothelium-independent relaxation to SNP was not different among three groups. CONCLUSION: Environmental tobacco smoke exposure impairs endothelial function in guinea pig aorta.

Long Term Survival Rate and Prognostic Factors of Acute Myocardial Infarction of Elderly Patients

BACKGROUND: Acute myocardial infarction (AMI) is a common disease in older patients, and common cause of death in this age group. In the United State, more than 670,000 persons are hospitalized annually for an acute myocardial infarction, 60% of these persons are more than 65 years of age and one third are above 75 years of age. above 65 years of age and 60% above 75 years of age. Also in Korea, AMI has been increased and being a major cause of death. Especially in elderly patients, more intensive care is required, because they have more risk factors and show high mortality. For will decrease unnecessary treatment on low risk group and will do more intensive management on high risk group. This study was performed, therefore, to provide the clinical features, prognosis and prognostic factors of AMI in Korean elderly patients. METHODS: To identify the long term survival rate and prognostic factors of acute myocardial infarction of elderly persons (above 65 year old) in Korea, total 358 patients who presented between Jan. 1980 and Dec. 1997 at Seoul National University Hospital were followed for an average of 92 months. 151 patients were died during follow up period, 63 patients lost, and 144 patients were alive till the end point of the study. RESULTS: Overall survival rates (+/-standard error) were 82.1+/-2.0, 79.6+/-2.2, 76.7+/-2.3, 72.2+/-2.5, 67.4+/-2.7, 62+/-3.0, 56.9+/-3.2% at 1, 6, 12, 24, 36, 48, 60 months. In univariate analysis, old age, female, presence of history of diabetes, higher degree of Killip class, lower ejection fraction on echocardiography or gated blood pool scan, lower total cholesterol level on the time of AMI proved as poor prognostic factors of AMI with statistical significance (p<0.05). BMI, history of hypertension, myocardial infarction and angina, peak CK level, infarct site on ECG, existence of Q-wave on ECG, larger extent of coronary artery disease, residual ischemia on treadmill test or MIBI scan, patency of infarct related artery, and HDL and LDL-cholesterol level on the time of AMI, total, HDL- and LDL-cholesterol at least 3 months after AMI did not show statistical significance. In multivariate analysis, Killip class III, IV and ejection fraction on echocar-diography are proved as independent prognostic factors of AMI with statistical significance (p<0.05). CONCLUSION: The mortality of elderly AMI is composed of two component. At acute phase, within 1 month, the mortality reaches to about 18 %, and at chronic phase, after 1 month from AMI, mortality increases each 5% a year for 5 years. The other conclusion is elderly patients who have poor left ventricular systolic functions shows higher mortality.

Long Term Survival Rate and Prognostic Factors of Acute Myocardial Infarction

BACKGROUND AND METHODS: To identify the long term survival rate and prognostic factors of acute myocardial infarction (AMI) in Korea, total 1139 patients who presented between Jan. 1980 and Dec. 1997 at Seoul National University Hospital were followed for an average of 115 months. 321 patients died during follow up periods, 238 patients were lost and 580 patients are alive till the end point of the study. RESULTS: Overall survival rates (+/-standard error) were 88.2+/-1%, 86.8+/-1%, 85.3+/-1.1%, 82.1+/-1.2%, 79.6+/-1.3%, 75.6+/-1.5%, 73.1+/-1.6%, 70.3+/-1.7%, 67.4+/-1.8%, 64.5+/-1.9%, 60.0+/-2.2%, 56.3+/-2.5% at 1,6,12,24,36,48,60,120 months. In univariate analysis, older, history of diabetes, higher degree of Killip class, higher peak creatine kinase level, residual ischemia on treadmill test or MIBI scan, lower ejection fraction on echocardiography or gated blood pool scan, more severe extent of coronary artery disease, lower HDL-cholesterol level at least 3 months after AMI proved as poor long term prognostic factors of AMI with statistical significance (p0.05). In mltivariate analysis, old age and Killip class III versusIproved as independent poor long term prognostic factors of AMI with statistical significance (p<0.05) at combinations of age, sex, Killip class, existence of Q-wave, history of diabetes, ejection fraction on gated blood pool scan. CONCLUSION: The morthality of AMI is composed of two components. At acute phase, within 1 month, the mortality reaches to about 12%, and at chronic phase, after 1 month from AMI, mortality increases by 3% a year for 10 years. The other conclusion is old patients who have poor left ventricular functions show poor prognosis.

The relationship of the Coronary Artery Disease and Paraoxonase Gene Polymorphism / 대한내과학회지

OBJECTIVES: Paraoxonase is a high density lipoprotein (HDL)-associated enzyme, which has been implicated in preventing low density lipoprotein-cholesterol (LDL-C) from oxidation. The human paraoxonase gene is codominantly expressed as allele A and B. The A allele codes for glutamine (A subtype) and the B allele for arginine (B subtype) at codon 192 of the paraoxonase enzyme. This genetic polymorphism divides the enzyme into high and low activity form. It has been believed that this difference of specific activity might change the metabolism of cholesterol and the prevalence of coronary artery disease. The present study investigated the association among the paraoxonase gene polymorphism and the level of plasma lipoprotein and coronary artery disease. METHODS: The 416 subjects who have undergone coronary angiography in SNUH were recruited. The patients (n=251) had >50% stenosis of at least one of the major coronary arteries. To identify the genotype of paraoxonase, we amplified the target region in the paraoxonase gene by PCR ( polymerase chain reaction) and electrophoresed the products. RESULTS: There was no difference between the two groups in the allele frequency (A : B = 0.41 : 0.59 in patients, A : B = 0.37 : 0.63 in controls; p=0.21) or in the genotype frequency (AA:AB:BB= 45:116:90 in patients, AA:AB:BB=22:77:66 in controls; p=0.41). There was no association of the paraoxonase genotype with serum lipoprotein level and acute coronary syndrome in this study. The B allele was not an independent risk factor for coronary artery disease in this study. CONCLUSION: The paraoxonase gene 192 polymorphism was not an independent risk factor for coronary artery disease in this study.

The Frequency Distribution of Apolipoprotein E Genetic Polymorphism and Relationship of Apolipoprotein E Genetic Polymorphism with Development of Coronary Artery Disease in Patients with Familial Hypercholesterolemia / 대한내과학회지

OBJECTIVES: Apolipoprotein E genetic polymorphism was screened in subjects with FH to determine the genetic effects of Apo E polymorphism on basal cholesterol levels, severity of coronary atherosclerosis and response to lipid lowering therapy using HMG CoA reductase inhibitor. METHODS: Total 45 unrelated patients with FH (M:F= 24:21, 48.0/11.5yr.) were included in this study. Apolipoprotein E genetic polymorphism was screened. Clinical parameters were checked. Change of lipid profile to lovastatin,; 20mg/d (n=19), 40mg/d (n=12), and of Achilles tendon thickness were analysed. RESULTS: 1) Genotype frequencies of E2/3, 3/3, 4/3 were 8.9, 60.0, 31.1% respectively, and allele frequencies of epsilon2, epsilon3, and epsilon4 were 0.044, 0.800, and 0.155 respectively.2) Presence and degree of coronary atherosclerosis, the thickness of Achilles tendon and lipid levels were not significantly different by apolipoprotein E genotype.3) On multivariate study, age, triglyceride and cholesterol /high density lipoprotein were significantly related to presence of coroanry atherosclerosis. 4) Percent reduction of LDL-cholesterol by lovastatin was significantly low in subjects having E4/3 genotype than those having E3/3 genotype (p=0.05; 40mg/d), and the percent reduction of Achilles tendon thickness was significantly low in subjects having E4/3 genotype than those having E3/3 genotype (p=0.037; 20mg/d). CONCLUSION: The distribution of apolipoprotein E genotype in patients with familial hypercholesterolemia was not significantly different with that in normal subjects. But apolipoprotein E polymorphism may affect the reduction of LDL-cholesterol and Achilles tendon xanthoma with medication of HMG CoA reductase inhibitor in patients with familial hypercholesterolemia.

Screening of the Presence of Enterovirus and Cytomegalovirus Infections in Terminally Failing Human Hearts

BACKGROUND: In order to evaluate the prevalence of enterovirus and cytomegalovirus infections to terminally failing hearts, the presence of enteroviral RNA and cytomegaloviral DNA was screened in the explanted hearts of transplantation recipients. METHODS: RNA and DNA extractions were performed from explanted failing hearts (N=22) and normal hearts (N=5). Reverse transcription-polymerase chain reaction (RT-PCR) of enterovirus and polymerase chain reaction (PCR) of cytomegalovirus were performed. In situ RT-PCR and in situ PCR were performed with positive nucleic acids of viruses. RESULTS: The positivity of enterovirus in failing hearts was 4.4% (1/22) and 0% (0/5) in normal hearts in nested RT-PCR. There was no significant difference in positivity of enteroviral RNA between failing and normal hearts. Nuclei of myocardium was stained in dark-violet color with in situ RT-PCR. The positivity of cytomegalovirus in failing hearts was 45% (10/22) and 40% (2/5) in nested PCR. There was no significant difference in positivity of cytomegaloviral DNA between failing and normal hearts. Nuclei of myocardium was stained in dark-violet color with in situ PCR. Positive chambers of cytomegalovirus were in decreasing tendency according to increasing patient's age. CONCLUSION: Enterovirus was very rarely observed in explanted terminally failing hearts and cytomegalovirus was frequently found both in explanted failing hearts and normal. These viruses have little direct causal relationship with the development of heart failure.

Troponin T and I Expression in Failing and Hypertrophic Heart, and during Normal Development in Human

BACKGROUND AND OBJECTIVES: Human Troponin T & I (TnT, TnI) has several isoforms which have different functional property. This study was designed to describe the isoform expression of TnT & TnI in failing and hypertrophic human heart and during normal development. MATERIALS AND METHOD: Myocardium was attained from hypertrophic hearts (n=10) of TOF patients who underwent myomectomy, from failing hearts (n=10) of transplant recipients, from normal hearts (n=5) of patients in brain death and from aborted fetal hearts (n=5). After the extraction of RNA, RT-PCR was performed for TnT & TnI isoforms and GAPDH to evaluate the isoform expression qualitatively and quantitatively. RESULTS: In terms of TnI, slow skeletal TnI was expressed more than cardiac TnI in fetal hearts[ratio of Troponin over GAPDH (R)=1.3:0.5] but cardiac TnI was dominant in adult hearts (r=0.3:1.1) (p 0.05). Failing hearts showed similar pattern with adult hearts (r=0.3:1.2) and hypertrophic hearts showed the intermediate pattern (r=0.9:1.3). In terms of TnT, T1 and T3 were expressed in fetal hearts (r=0.04, 0.8) but only T3 was expressed in adult hearts (r=1.1). Failing hearts and hypertrophic hearts showed similar pattern with adult hearts and no differences in the amount of expression (r=1.4, 1.3). CONCLUSION: There is isoform switch from fetal to adult form during development and it might be responsible for the differences of myocardial functional property between fetal and adult heart. Failing and hypertrophic hearts showed no differences with normal hearts, which means the isoform switch of TnT & I might have no significant role in functional disturbances in these conditions.

The Role of Angiotensin Converting Enzyme inhibitor in Ventricular Remodeling after Experimental Nontransmural Myocardial Infarction- Effects on Transforming Growth Factor-beta 1 Expression

BACKGROUND:With the application of early reperfusion by thrombolysis after acute MI, the importance of nontransmural infarction is increasing. We evaluated 1) the changes of LV dimension, LV fibrosis and transforming growth factor-beta1 (TGF-beta1) mRNA expression in a rat model of nontransmural infarction and 2) effects of angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ATRB) treatment after nontransmural infarction. METHOD AND RESULTS: Female Sprague-Dawley rats were subjected to 45 minutes of coronary occlusion followed by reperfusion, and at 5 days after the operation, animals were randomized to untreated (MI-vehicle, n=19), captopril-treated (MI-captopril, n=15) and losartan-treated (MI-losartan, n=14) groups. LV dimension, measured by transthoracic echocardiography, was significantly increased at 26 days after MI, and both captopril and losartan treatment inhibited LV cavity dilatation (LV end-diastolic dimension (mm): MI-vehicle, MI-captopril, MI-losartan; 8.6 +/- 0.2, 7.8 +/- 0.2, 8.0 +/- 0.2, p<0.05 vs. MI-vehicle each). Interstitial fibrosis was reduced with both captopril and losartan treatment (p<0.05 vs. MI-vehicle). TGF-beta1 mRNA increased 2.6 fold at 10 days (p<0.05 vs. pre-MI), and normalized at 26 days after nontransmural MI. Captopril and losartan treatment blocked the induction of TGF-beta1 expression after nontransmural MI (p=S vs. pre-MI). CONCLUSION: After large nontransmural MI, ACEI and ATRB treatments attenuate LV remodeling and decrease interstitial fibrosis, at least partly by blocking the acute induction of TGF-beta1 mRNA expression.

Clinical Study of Risk Factors in Patients with Acute Myocardial Infarction

BACKGROUND: The major risk factors such as hypercholesterolemia, hypertension, diabetes melitus and cigarrete smoking have not been studied in an attempt to provide a composition of major risk factors in Korea. Also we have met with some patients without major risk factors. METHODS: A Retrospective Study was done on 160 patients of acute myocardial infarction who had been admitted to National Medical Center within 48 hours from onset, from January 1948 to December 1992 and studied on major risk factors of acute myocardial infarction. RESULTS: 1) Among major risk factors, smoking was found in 50%, hypertension in 49%, diabetes in 25% and hypercholesterolemia in 21%. 2) The percentage of patients without major risk factors was 19%. 3) Among major risk factors, hypertension, hypercholesterolemia and diabetes were increasing tendencies, recentely. CONCLUSION: Some patients with acute myocardial infarction don't have any major risk factors. Also hypertension, hypercholesterolemia and diabetes were increasing tendencies. So further study for other risk factors is needed and preventive management should require a commitment to behavior modification and alteration in life-style.