Evaluation of the INNOVANCE PFA P2Y assay and its association with CYP2C19 genotypes.

The purpose of this study was to evaluate associations between INNOVANCE PFA P2Y (PFA P2Y) test results and CYP2C19 genotypes and provide baseline data for PFA P2Y testing to establish a therapeutic monitoring strategy for clopidogrel. A total of 75 new patients with acute coronary syndrome with planned percutaneous coronary intervention were enrolled between June 2012 and September 2012. All patients received clopidogrel at an initial loading dose of 600 mg followed by a 75-mg daily maintenance dose. Blood samples were obtained on the third morning after clopidogrel loading. PFA P2Y, VerifyNow P2Y12 and VASP assays were used to determine platelet inhibition due to clopidogrel, and the Verigene CYP2C19 test was used for CYP2C19 genotyping. The genotype frequency of 75 patients was as follows: CYP2C19 *1/*1 (wild type), 28 (37.3%); *1/*2, 31 (41.3%); *1/*3, 4 (5.3%); *2/*2, 5 (6.7%); *2/*3, 5 (6.7%); *1/*17, 1 (1.3%); and *2/*17, 1 (1.3%). Classified according to CYP2C19 genotypes, there were 29 (38.7%) extensive metabolizers (EM) or ultra rapid metabolizers (UM), 35 (46.7%) intermediate metabolizers (IM), and 10 (13.3%) poor metabolizers (PM). Median (interquartile range) PFA P2Y closure times (seconds) were 119 (101-260), 300 (130-300) and 300 (300-300) in the PM, IM and EM or UM groups, respectively (p < 0.05). Median (interquartile range) VerifyNow PRUs were 294 (213-297), 215 (165-320) and 189 (118-279); and the VASP platelet reactivity index (%) was 52.7 (33.3-91.9), 59.9 (41.4-72.8) and 38.9 (26.8-62.2) in the PM, IM and EM or UM groups, respectively (p > 0.05). Compared with non-carriers, carriers of reduced function CYP2C19 alleles tended to have higher platelet reactivity after clopidogrel treatment. The cut-off for PM versus other groups (IM and EM or UM) was ≤ 141 seconds (AUC 0.704, sensitivity 70%, specificity 76.6%) on the ROC curve. A statistically significant correlation between PFA P2Y (seconds) and VerifyNow (PRU) was found (ρ = -0.47, p < 0.0001). In conclusion, the PFA P2Y test showed a statistically significant association with CYP2C19 metabolizer phenotypes based on CYP2C19 genotyping and effectively determined the risk groups resistant to clopidogrel therapy, including PM.

Impact of left anterior line on left atrial appendage contractility in patients who underwent catheter ablation for chronic atrial fibrillation.

BACKGROUND: Left anterior line (LAL) has been used as a substitute for mitral isthmus line for catheter ablation of chronic atrial fibrillation (AF). However, it results in left anterolateral conduction delay and might affect left atrial (LA) contractility. We aimed to investigate whether LAL decreases LA appendage function. METHODS: This study included 46 patients (30 men, mean age 58 ± 9 years, group 1) with persistent AF who underwent catheter ablation including LAL. Thirty patients with paroxysmal AF who received no additional LA ablation were compared as control group (21 males, mean age 56 ± 8 years, group 2). Transthoracic and transesophageal echocardiography with Doppler tissue imaging was performed in sinus rhythm before and after the ablation. We compared the following variables: (1) E/A ratio of the mitral flow velocity, (2) ratio of early mitral inflow and mitral septal annulus velocity (E/Em), (3) peak velocity of appendage outflow (ApVmax), and (4) time delay from QRS onset to appendage outflow (TDqa). RESULTS: LA diameter was significantly reduced after ablation in both groups. In group 1, parameters for diastolic function (E/A ratio, 1.7 ± 0.5 vs 2.0 ± 0.6, P = 0.197; E/Em, 11.7 ± 4.8 vs 11.6 ± 5.1, P = 0.883) and appendage flow (ApVmax, 55.2 ± 19.9 cm/s vs 50.3 ± 19.3 cm/s, P = 0.203; TDqa, -77.3 ± 30.1 ms vs -66.1 ± 60.8 ms, P = 0.265) did not change significantly after ablation. Changes of ApVmax and TDqa after ablation were not significantly different between two groups (P = 0.409 and P = 0.195, respectively). CONCLUSIONS: LAL ablation did not aggravate mitral flow pattern or change appendage outflow. LAL could be used without concern over worsening LA diastolic and appendage function.

Iliocaval fistula presenting with paradoxical pulmonary embolism combined with high-output heart failure successfully treated by endovascular stent-graft repair: case report.

A 51-yr-old man presented exertional dyspnea as a consequence of iliocaval fistula combined with paradoxical pulmonary embolism and high-output heart failure. Endovascular stent-graft repair was performed to cover iliocaval fistula and restore the heart function. After the procedure, dyspnea was improved and procedure related complication was not seen. A 6-month follow-up computed tomography showed regression of pulmonary thromboembolism and well-positioned stent-graft without graft migration, aortacaval communication or endoleak. Stent graft implantation should be considered an alternative of open repair surgery for treament of abdominal arteriovenous fisula, especially in patient with high risk for surgery.

Soluble receptor of advanced glycated endproducts is associated with plaque vulnerability in patients with acute myocardial infarction.

BACKGROUND: The roles of soluble and endogenous secretory receptors for advanced glycation endproducts (sRAGE and esRAGE, respectively) in plaque vulnerability are unknown in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: We enrolled 54 patients with AMI (27 patients had type 2 diabetes mellitus [DM]) who had undergone primary percutaneous coronary intervention, and 54 controls who were matched for age, gender and the presence of DM. Plasma levels of s/esRAGE and matrix metalloproteinase (MMP)-9 were measured at the time of coronary angiography. There were no significant differences in the baseline characteristics of the AMI and control groups, except for the C-reactive protein levels (CRP: 14.1 ± 14.2 mg/L vs. 3.7 ± 5.2 mg/L, P < 0.001). The plasma levels of MMP-9 (28.6 ± 21.4 vs. 14.3 ± 8.5 ng/ml P < 0.001) and sRAGE (0.61 ± 0.28 vs. 0.41 ± 0.17 ng/ml, P < 0.001) were higher in the AMI group than in the controls. In multivariate logistic regression analysis, the plasma levels of MMP-9 and sRAGE above the median (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.02-5.58; P = 0.044; OR, 2.47; 95%CI, 1.05-5.80; P = 0.039, respectively) were independent predictors of AMI, as well as being a current smoker (OR, 2.98; 95%CI, 1.18-7.55; P = 0.021) and CRP ≥ 3.0 mg/L (OR, 3.08; 95%CI, 1.25-7.59; P = 0.015). CONCLUSIONS: An elevated plasma level of sRAGE might be independently associated with plaque vulnerability, as well as MMP-9, in patients with AMI.

Prevalence of electrocardiographic findings suggestive of sudden cardiac death risk in 10,867 apparently healthy young Korean men.

BACKGROUND: The objective of this study was to determine the prevalence of electrocardiographic (ECG) findings suggestive of sudden cardiac death risk in apparently healthy young Korean men. METHODS: We administered questionnaires that elicited personal and family histories and performed ECGs on 10,867 male subjects (mean age, 20.9 years). The subjects with abnormal ECG findings underwent echocardiography, a treadmill test, Holter monitoring, a flecainide provocation test, or an electrophysiologic study (EPS) according to the ECG findings and histories. RESULTS: Of the subjects, 5.95% had left ventricular hypertrophy on ECG, but no subjects had hypertrophic cardiomyopathy by echocardiography. The percentage of subjects with a Brugada ECG pattern was 0.90%. We identified one subject with a positive result on the flecainide provocation test. The percentage of subjects with a preexcitation ECG was 0.17%. In two of the subjects, supraventricular tachycardia was induced in the EPS. Of the subjects, 0.05% had epsilon waves, but there were no subjects with arrhythmogenic right ventricular dysplasia/cardiomyopathy by echocardiography. The percentage of subjects with long QT intervals was 0.02%, but there were no arrhythmias on the treadmill test or Holter monitoring. CONCLUSIONS: The prevalence of a Brugada ECG pattern in apparently healthy young men is higher in Korea than other countries.

Change in ischemia-modified albumin and its clinical significance during exercise stress testing.

BACKGROUND: There is little data about the additive effects of ischemia-modified albumin (IMA) on the exercise stress test (EST) used for the screening of ischemic heart disease. The relationship between myocardial ischemic burden and the change in IMA (DeltaIMA) during EST was investigated. METHODS AND RESULTS: EST was performed using the Bruce protocol to evaluate chest pain or exertional dyspnea in 155 patients (men 89, 53+/-13 years). Blood samples for IMA were obtained before and immediately after EST. According to the EST results and the pattern of DeltaIMA, patients were categorized into 3 groups (none was classified as EST(-)/DeltaIMA(+)): (1) (EST(-); (2) EST(+)/DeltaIMA(-); and (3) EST(+)/DeltaIMA(+). After EST, 60 of 155 (38.7%) patients were EST(+) and 14/60 (23.3%) were EST(+)/DeltaIMA(+). Duke treadmill score was significantly lower in the EST(+)/DeltaIMA(+) group compared with the other groups (-9.0+/-7.9, -1.7+/-4.2, 6.7+/-4.4, respectively, P<0.001); 43/60 (72%) patients with EST(+) underwent coronary angiography and the proportion of patients with a large ischemic burden was higher in the EST(+)/DeltaIMA(+)group compared with the EST(+)/DeltaIMA(-) group (72.7% vs 15.6%, P=0.001). CONCLUSIONS: Increased IMA after EST suggests a large ischemic burden in coronary artery disease, so the DeltaIMA during EST may be useful for predicting the severity of myocardial ischemia.

The significance of repetitive ventricular responses induced by radiofrequency energy application for idiopathic left ventricular tachycardia.

In radiofrequency (RF) ablation for idiopathic left ventricular tachycardia (ILVT), the termination of tachycardia during RF ablation is considered a hallmark of success. However, in cases of patients with difficulty of induction of ventricular tachycardia (VT), the evaluation of procedural success can be problematic. We have observed thermal responses reflected as ventricular rhythm change to RF energy delivered on sinus rhythm for ILVT. We therefore describe the significance of repetitive ventricular responses. The study subjects were 11 ILVT patients for whom RF energy was delivered during sinus rhythm because of difficulty in re-induction of tachycardia. During each energy delivery, we focused on the occurrence of repetitive ventricular responses especially exhibiting a similar morphology to clinical VT. The repetitive ventricular responses were noted in 10 of 11 patients. Two patients received a second procedure due to the recurrence of ILVT. The mean follow-up period was 36.2+/-12.8 months. The clinical course of the remaining patients was favorable and without recurrence of ILVT. Based on the favorable clinical outcomes, ablation-induced repetitive ventricular responses with similar QRS morphology to clinical ILVT are useful markers for selecting an ablation site and could be used as an additional mapping method, termed as "thermal mapping".

Acute changes in cardiac synchrony and output according to RV pacing sites in Koreans with normal cardiac function.

INTRODUCTION: The synchrony of the pacing heart can be affected by the right ventricular (RV) pacing site and is crucial to cardiac function in pacemaker recipients. We evaluated the acute changes in cardiac synchrony according to the RV pacing sites in normal systolic functioning subjects with normal QRS. METHODS: We conducted this study with 30 patients with the pacing in the RV apex (RVA), RV septum (RVS), and RV outflow tract (RVOT) in a sequential manner. Transthoracic echocardiography was conducted at rest and during pacing in order to measure interventricular and intraventricular dyssynchrony in all patients. RESULTS: QRS duration (148.1 +/- 12.8 ms) of RVA pacing was significantly shorter than that of RVS pacing (154.4 +/- 14.1 ms, P < 0.01) and RVOT pacing (160.6 +/- 15.7 ms, P < 0.001). We noted no statistically significant difference in cardiac output according to the pacing sites. The interventricular dyssynchrony with M-mode and Doppler echocardiography in RVOT pacing was increased to an insignificant degree as compared with those with RVS pacing or RVA pacing. The intraventricular dyssynchrony with tissue Doppler echocardiography in RVA pacing was reduced significantly as compared with that of RVS pacing or RVOT (RVA = 60.3 +/- 32.7 ms, RVS = 82.1 +/- 33.8 ms, RVOT = 79.1 +/- 33.3 ms; RVA vs RVS = P < 0.05, RVA vs RVOT = P < 0.01, RVS vs RVOT = P = NS). CONCLUSION: RVA pacing is superior to RVS and RVOT pacing with regard to intraventricular synchrony in normal systolic functioning subjects with normal QRS. Cardiac output at RVA pacing is not inferior to other sites.

Visualization of the Critical Isthmus by Tracking Delayed Potential in Edited Windows for Scar-Related Ventricular Tachycardia.

BACKGROUND AND OBJECTIVES: Identifying the critical isthmus of slow conduction is crucial for successful treatment of scar-related ventricular tachycardia. Current 3D mapping is not designed for tracking the critical isthmus and may lead to a risk of extensive ablation. We edited the algorithm to track the delayed potential in order to visualize the isthmus and compared the edited map with a conventional map. SUBJECTS AND METHODS: We marked every point that showed delayed potential with blue color. After substrate mapping, we edited to reset the annotation from true ventricular potential to delayed potential and then changed the window of interest from the conventional zone (early, 50-60%; late, 40-50% from peak of QRS) to the edited zone (early, 80-90%; late, 10-20%) for every blue point. Finally, we compared the propagation maps before and after editing. RESULTS: We analyzed five scar-related ventricular tachycardia cases. In the propagation maps, the resetting map showed the critical isthmus and entrance and exit sites of tachycardia that showed figure 8 reentry. However, conventional maps only showed the earliest ventricular activation sites and searched for focal tachycardia. All of the tachycardia cases were terminated by ablating the area around the isthmus. CONCLUSION: Identifying the channel and direction of the critical isthmus by a new editing method to track delayed potential is essential in scar-related tachycardia.

Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation.

BACKGROUND AND OBJECTIVES: The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. MATERIALS AND METHODS: Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. RESULTS: Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. CONCLUSION: Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.

Long-term outcomes of remote magnetic navigation for ablation of supraventricular tachycardias.

BACKGROUND: Little is known about the long-term outcomes of catheter ablation of supraventricular tachycardia (SVT) using remote magnetic navigation system (RMN). METHODS: One hundred twenty patients underwent catheter ablation of SVTs with RMN (Niobe, Stereotaxis, USA): atrioventricular nodal re-entrant tachycardia (AVNRT; n = 59), atrioventricular re-entrant tachycardia (AVRT; n = 45), and focal atrial tachycardia (AT, n = 16). The outcome of AVRT with right free wall accessory pathway was compared with those of a group of 26 consecutive patients undergoing manual ablation. RESULTS: Mean follow-up period was 2.2 ± 1.4 years. Overall arrhythmia-free survival was 86%; AVRT (77%), AVNRT (96%), and focal AT (71%). After the learning period (initial 50 cases), procedural outcomes had improved for AVRT and AVNRT (91% in overall group, 90% in AVRT group, 100% in AVNRT group, and 68% in focal AT group). The recurrence-free rate was higher for the free wall accessory pathways than those of the other sites (92 vs. 73%, log-rank P = 0.06). Furthermore, when it is confined for the right free wall accessory pathway, RMN showed excellent long-term outcome (7/7, 100 %) compared to the results of manual approach (18/26, 69.2%, log-rank P = 0.07). CONCLUSIONS: RMN showed favorable long-term outcomes for the ablation of SVT. In our experience, RMN-guided ablation may be associated with a higher success rate as compared to manual ablation when treating right-sided free wall pathways.

Infective endocarditis of the aortic valve complicated by massive pericardial effusion and rupture of a sinus of valsalva into the right atrium.

Infective endocarditis (IE) of the aortic valve is most commonly associated with perivalvular invasion and intracardiac fistula formation, which sometimes give rise to unpredictable clinical events. Massive pericardial effusion and aorticocardiac fistula are very rare complications of IE. We present a case in which IE of the aortic valve was initially associated with massive pericardial effusion requiring drainage and later complicated by rupture of a sinus of Valsalva with a fistula into the right atrium without formation of aneurysm. To our knowledge, the concurrent occurrence of these two events in a patient with IE has not been previously reported.

Paced QRS axis as a predictor of pacing-induced left ventricular dysfunction.

PURPOSE: The selection of the optimal right ventricular (RV) pacing site remains unclear. We hypothesized that a normal paced QRS axis would provide a physiological ventricular activation and lead to a better long-term outcome. METHODS: We evaluated 187 patients who underwent a permanent pacemaker implantation and were dependent on RV pacing. The pacing sites were classified as the apex and non-apex according to the chest radiography. A paced QRS axis was defined as that between -30° and 90°. Preservation of the left ventricular (LV) systolic function was defined as that with a <10 % decrease in the ejection fraction after the pacemaker implantation. RESULTS: The median follow-up period was 5.8 years (interquartile 3.9-9.0). Radiographically, the RV leads were located in the apex (n = 148, 79 %) or non-apex (n = 39, 21 %). In the electrocardiogram, normal paced and abnormal paced QRS axes were observed in 28 patients (15 %) and 159 patients (85 %), respectively. The LV ejection fraction was decreased in the patients with an abnormal paced QRS axis (-10 ± 10 %, P < 0.001), but not in those with a normal axis (0 ± 6 %, P = 0.80). The electrocardiographic determinant differentiated a preserved LV function (95 % vs. 35 %, log-rank P = 0.04). Among the patients with radiographically non-apical pacing, a normal paced QRS axis was an additional meaningful predictor of a preserved LV function after the pacemaker implantation (95 % vs. 24 %, log-rank P = 0.002). CONCLUSION: Compared with the radiographic method, a normal paced QRS axis was associated with a preserved LV function.

Exercise-induced intranodal atrioventricular block.

Exercise-induced atrioventricular (AV) block in patients with normal AV conduction at rest is rare. Herein, we describe the case of a 67-year-old woman with normal 1 : 1 AV conduction at rest, who developed complete AV block during a treadmill test. Our patient complained of effort-related dizziness and dyspnea, which had been ongoing for 3 months. The patient's physical examination was normal. The resting electrocardiogram showed left anterior fascicular block with a PR interval of 0.19 seconds. The echocardiogram was normal except for mild aortic valve regurgitation. During the treadmill test, the patient developed complete AV block at a sinus rate of 90 beats/min, which was followed by 2 : 1 AV block associated with dyspnea and dizziness. The patient's coronary angiogram was normal, and the ergonovine provocation test was negative. Electrophysiological studies demonstrated rate-dependent intranodal AV block. The patient received implantation of a permanent dual chamber (DDD) pacemaker and had no further symptoms during the follow-up period.

Comparison of magnetic navigation system and conventional method in catheter ablation of atrial fibrillation: is magnetic navigation system is more effective and safer than conventional method?

BACKGROUND AND OBJECTIVES: Although there have been so many reports of catheter ablation of atrial fibrillation (AF) with magnetic navigation system (MNS), it is not necessarily obvious that MNS is more effective than conventional ablation. We performed AF ablation with MNS and compared the clinical outcomes and radiofrequency ablation parameters with those of conventional ablation. SUBJECTS AND METHODS: One hundred eleven consecutive patients (conventional group, n=70 vs. MNS group, n=41) undergoing catheter ablation of AF were enrolled. We compared and analyzed the procedural parameters, namely fluoroscopic time, procedural time, acute procedural success and 3 months success rate of both groups. RESULTS: The MNS group was associated with slightly larger left atrial size (43.7±6.3 mm vs. 41.2±6.3 mm, p=0.04), significantly longer total procedure time (352±50 minutes vs. 283±75 minutes, p<0.0001), and shorter total fluoroscopic time (99±28 minutes vs. 238±45 minutes, p<0.0001) than the conventional group. The MNS and conventional group did not differ with respect to acute procedural success, AF recurrence, atrial flutter/atrial tachycardia recurrence, or total arrhythmia recurrence. While no complications were observed in the MNS group, eight cases of significant pericardial effusion occurred in the conventional group. CONCLUSION: The MNS system seems to be effective and safe in the catheter ablation of AF, particularly in the population of patients with persistent AF and slightly dilated left atria.

The feasibility and efficacy of a large-sized lasso catheter combined with 3 dimensional mapping system for catheter ablation of atrial fibrillation.

BACKGROUND AND OBJECTIVES: We aimed to investigate whether a large-sized Lasso catheter could increase the success rate of immediate complete pulmonary vein (PV) antral isolation and improve the outcome of catheter ablation in atrial fibrillation (AF) patients. SUBJECTS AND METHODS: This study included 107 consecutive patients (67 males, mean age: 57.8±9.7 years) who underwent PV mapping and ablation due to symptomatic drug-refractory AF. The first 43 patients underwent isolation of both ipsilateral PVs using the Carto-Merge 3 dimensional mapping system (group 1). The other 64 patients underwent isolation of both ipsilateral PVs using the same technique with a large-sized (a diameter of 30 to 35 mm) Lasso cathe-ter (group 2). When ipsilateral PVs did not show any potential after the initial circumferential ablation, we defined this as 'immediate complete antral isolation (ICAI)'. We compared the AF recurrence rate of both groups. RESULTS: There was no significant difference of the clinical characteristics between group 1 and group 2. All the patients were followed-up for 1 year. The ICAI rate of group 1 and group 2 was significantly different (21% vs. 78%, p<0.001), and the AF recurrence rates of group 1 and group 2 were also different (34.9% vs. 18.8%, p=0.042). Using multiple logistic regression analysis, the use of a large-sized Lasso catheter was a significant predictive factor for preventing recurrence (odds ratio: 0.489, 95% confidence interval: 0.136-0.927). CONCLUSION: It is likely that a large-sized Lasso catheter plays an important role in achieving ICAI and in lowering the rate of AF recurrence.

Left atrial volume index over late diastolic mitral annulus velocity (LAVi/A') is a useful echo index to identify advanced diastolic dysfunction and predict clinical outcomes.

BACKGROUND: Combined interpretation of late diastolic mitral annulus velocity (A') with left atrial volume index (LAVi) may have additional benefits in the assessment of diastolic dysfunction. HYPOTHESIS: The LAVi/A' ratio may be useful in the identifying advanced diastolic dysfunction (ADD) and predicting clinical outcomes in patients with dyspnea. METHODS: We enrolled 395 consecutive patients hospitalized with dyspnea (New York Heart Association class II-IV) and performed transthoracic Doppler echocardiography and B-type natriuretic peptide (BNP) measurement. LAVi/A' values were evaluated in terms of diagnosing ADD and predicting clinical outcome. RESULTS: On the receiver operation characteristic curve analysis for the determination of ADD, the area under the curves of LAVi/A' in the entire population was comparable to those of BNP (0.94 vs 0.93, P = 0.845) and mitral E/E' (0.94 vs 0.93, P = 0.614) and higher than that of LAVi (0.94 vs 0.87; P = 0.014). A LAVi/A' of 4.0 was the best cut-off value to identify ADD. During a median follow-up of 31.9 months (range, 0.3 to 45.7 months), the group with LAVi/A' ≥4.0 had a higher incidence of primary composite outcomes (cardiac death and/or rehospitalization for heart failure) than the group with LAVi/A'<4.0 (25.0% vs 3.3%, P < 0.001). LAVi/A' ≥4.0 was an independent predictor of clinical outcomes (odds ratio, 3.245; 95% confidence interval, 1.386-7.598; P = 0.007). CONCLUSIONS: As a new echo index, LAVi/A' is a useful parameter to identify ADD and predict clinical outcomes in patients with dyspnea.

Relationship between plasma adiponectin, retinol-binding protein 4 and uric Acid in hypertensive patients with metabolic syndrome.

BACKGROUND AND OBJECTIVES: Adipokines have been suggested for their potential use in tracking the clinical progress in the subjects with metabolic syndrome (MS). To investigate the relationship between the serum levels of adipokines {adiponectin and retinol-binding protein 4 (RBP4)} and the serum level of uric acid in hypertensive (HTN) patients with MS. SUBJECTS AND METHODS: In this study, 38 totally untreated HTN patients were enrolled. Anthropometric measurements, blood pressure (BP) were taken in the 12 HTN patients without MS and the 26 HTN patients with MS. Fasting blood samples were collected for measurement of adiponectin, RBP4, nitric oxide (NO), glucose, creatinine, uric acid, lipid profile and insulin. RESULTS: The HTN with MS group had significant higher values of body mass index, waist length, serum uric acid and triglyceride levels than the HTN without MS group. Compared to the HTN without MS group, the HTN with MS group showed significantly lower adiponectin (p=0.030), NO (p=0.003) and high density lipoprotein levels (p<0.001). Serum adiponectin levels negatively correlated with insulin level (R=-0.453, p=0.026) and uric acid level (R=-0.413, p=0.036), and serum RBP4 levels positively correlated with uric acid level (R=0.527, p=0.006) in the HTN with MS group. Multiple linear regression analysis using RBP4 and adiponectin levels as the dependent variables showed that uric acid level correlated with serum RBP4 level (p=0.046) and adiponectin level (p=0.044). CONCLUSION: The HTN with MS group showed a correlation with two types of adipokines (adiponectin, RBP4) and uric acid. Adiponectin, RBP4 and uric acid may be important components associated with MS, especially when associated with hypertension.

Plasma B-type natriuretic peptide level can predict myocardial tissue perfusion in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

BACKGROUND: Inadequate myocardial tissue perfusion after successful revascularization in ST-segment elevation myocardial infarction (STEMI) is associated with worse clinical outcomes. We investigated whether the plasma B-type natriuretic peptide (BNP) level on admission could predict the status of myocardial tissue perfusion in patients who underwent primary percutaneous coronary intervention (PCI). METHODS: The study prospectively enrolled 102 patients with STEMI who underwent primary PCI within 12 h of symptom onset. The grade of myocardial tissue perfusion was measured by ST-segment resolution, corrected thrombolysis in myocardial infarction frame count, and myocardial blush grade after primary PCI. All-cause mortality at 1 month after PCI was assessed. RESULTS: All patients were divided into two groups according to the BNP level; high-BNP group (≥80 pg/ml, n=43) and low-BNP group (<80 pg/ml, n=59). High-BNP group had significantly lower ST-segment resolution (42.69 ± 24.85 vs. 71.15 ± 19.37%, P<0.001), higher corrected thrombolysis in myocardial infarction frame count (53.7 ± 19.7 vs. 44.5 ± 15.5, P=0.04), lower myocardial blush grade (2.4 ± 0.9 vs. 2.9 ± 0.3, P=0.001), and higher short-term mortality (16.2 vs. 3.3%, P=0.023). In multivariate logistic regression analysis for prediction of good myocardial tissue perfusion after PCI, the odds ratio of low-BNP group was 4.12 (95% confidence interval 1.49-13.08, P<0.01). CONCLUSION: The patients with STEMI who had higher BNP level on admission showed inadequate myocardial tissue perfusion status after primary PCI. The plasma BNP level on admission may serve as a predictor of tissue perfusion after primary PCI in patients with STEMI.