Hyperinsulinemia is an independent predictor for complex atherosclerotic lesion of thoracic aorta in non-diabetic patients.

OBJECTIVE: Hyperinsulinemia is a well known risk factor for cardiovascular event. However, it is not known whether hyperinsulinemia facilitates atherosclerotic complex lesions of aorta in non-diabetic patients. We investigated whether hyperinsulinemia is an independent marker of severity of atherosclerosis in thoracic aorta of non-diabetic patients using multiplane transesophageal echocardiography (TEE). RESEARCH DESIGN AND METHODS: Non-diabetic 90 patients with cardiovascular disease underwent TEE, and were analyzed for plasma insulin levels of oral glucose tolerance test, conventional atherosclerotic risk factors and coronary angiographic features. RESULTS: Thoracic aortic plaques were detected in 84 patients (93%). The complex atherosclerotic lesions were observed in 35 (39%) patients, most frequently at the part of aortic arch (p<0.005), showing the greatest atheroma score in thoracic aorta (p<0.05). Univariate analysis showed age, male gender, smoking, coronary artery disease, HDL-cholesterol, insulin levels in glucose tolerance test and homeostasis model assessment insulin resistance index (HOMA index) were found to be significant predictors of complex atherosclerotic lesions. Multivariate regression analysis revealed that HOMA index was an independent predictor of complex atherosclerotic lesions (odds ratio 1.93, p=0.006). There was a significant positive correlation between HOMA index and the atheroma score of thoracic aorta (p<0.001). CONCLUSIONS: Hyperinsulinemia is an independent predictor of complex atherosclerotic lesions detected by TEE in the thoracic aorta of non-diabetic patients.

[Takotsubo-like left ventricular dysfunction with delayed recovery of left ventricular shape: a case report].

A 70-year-old woman was admitted to our hospital because of left ventricular dysfunction, which was observed after permanent pacemaker implantation in another hospital. The left ventricular dysfunction was apical ballooning. Left ventriculography demonstrated takotsubo-like shape. However, the dysfunction did not improve immediately with medical treatment. In this case, 75% stenosis was observed in the left anterior descending artery. We suppose that this lesion corresponded to the delayed recovery of the dysfunction and performed coronary intervention. The takotsubo-like shape improved gradually for about 1 year. Whether the coronary intervention was effective for the recovery of the dysfunction is unclear, this clinical course was interesting in evaluating the delayed recovery of takotsubo-like left ventricular dysfunction.