BACKGROUND AND OBJECTIVES: The earliest atrial (A)/ventricular (V) activation potential, or accessory pathway (AP) potential are commonly used as ablation targets for atrioventricular (AV) APs. However, these targets are sometimes ambiguous. SUBJECTS AND METHODS: We reviewed 119 catheter ablation cases in 112 patients diagnosed with orthodromic atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Local A/V amplitude potentials with the earliest activation or AP potential were measured shortly before achieving antegrade AP conduction block, ventriculoatrial block during right ventricle (RV) pacing, or AVRT termination with no AP conduction. RESULTS: APs were located in the left lateral (55.5%), left posterior (17.6%), left posteroseptal (10.1%), midseptal (1.7%), right posteroseptal (7.6%), right posterior (1.7%), and right lateral (5.9%) regions. The mean earliest activation time was 16.7±15.5 ms, mean A/V potential was 1.1±0.9/1.0±0.9 mV, and mean A/V ratio was 1.7±2.0. There was no statistically significant difference between the activation methods (antegrade vs. RV pacing vs. orthodromic AVRT) or AP locations (left vs. right atrium). However, when the local A/V ratio was divided into 3 groups (≤0.6, 1.0±0.3, and ≥1.4), the antegrade approach resulted in an A/V ratio greater than 1.0±0.3 (86.7%, p=0.007), and the orthodromic AVRT state resulted in a ratio of less than 1.0±0.3 (87.5%, p<0.001). CONCLUSION: The mean local A/V potential and ratio did not differ by activation method or AP location. However, a different A/V ratio based on activation method (≥1.0±0.3, antegrade approach; and ≤1.0±0.3, orthodromic AVRT state) could be a good adjuvant marker for targeting AV APs.
Catheter Ablation* ; Catheters* ; Electrophysiologic Techniques, Cardiac ; Heart Ventricles ; Humans ; Methods ; Tachycardia ; Tachycardia, Supraventricular

BACKGROUND AND OBJECTIVES: A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI. SUBJECTS AND METHODS: We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR< or =3.30 (n=108), 3.316.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up. RESULTS: The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002). CONCLUSION: The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.
Cause of Death ; Creatinine ; Heart Diseases ; Humans ; Incidence ; Lymphocytes ; Myocardial Infarction ; Neutrophils ; Percutaneous Coronary Intervention ; Stroke ; Stroke Volume

BACKGROUND/AIMS: The aims of this study were to identify real world treatment patterns of hypertension according to cardiovascular risk stratification and to evaluate blood pressure changes with anti-hypertensive treatment in each risk group. METHODS: This study included patients who were newly-diagnosed with hypertension or known hypertensive patients with uncontrolled blood pressure (BP) at seven tertiary hospitals in Busan and Ulsan. World Health Organization/International Society of Hypertension (WHO/ISH) cardiovascular risk stratification was performed through retrospective chart review. RESULTS: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers were the most frequently prescribed drugs. The higher WHO/ISH risk group received a greater number of drugs at the initial treatment, and one year after treatment. Target BP was achieved less frequently in the higher risk group (68.2% vs. 85.2% vs. 89.0%, p < 0.001). The rate of attaining target BP was lower (50.7% vs. 81.6%, p < 0.001), and the time to attaining target BP was longer (106.5 +/- 79.2 days vs. 82.1 +/- 75.3, p = 0.001), in patients with renal disease or diabetes. Initial systolic BP above 160 mmHg (OR: 4.91, 95% CI: 2.27~10.65), renal disease (3.42, 1.60~7.32), medium or high risk group status (2.27, 1.23~4.20), initial diastolic BP above 100 mmHg (2.11, 1.11~4.04), and diabetes (2.06, 1.29~3.25) were independent factors that predicted failure of attaining the target BP. CONCLUSIONS: BP control was relatively unsatisfactory in patients with higher initial BP, renal disease, higher WHO/ISH risk group status, and diabetes. Individualized approaches for such patients are needed to improve BP control in routine clinical practice.
Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Blood Pressure ; Humans ; Hypertension ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; World Health ; World Health Organization

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role.
Automobiles ; Early Diagnosis ; Echocardiography ; Emergencies ; Papillary Muscles ; Rupture ; Thoracic Injuries ; Thoracic Surgery ; Thorax ; Tricuspid Valve Insufficiency ; Ventricular Dysfunction, Right

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.
Acute Coronary Syndrome ; Angioplasty ; Coronary Artery Disease ; Hemophilia A ; Humans ; Life Expectancy ; Percutaneous Coronary Intervention ; Prevalence

Cardiac papillary fibroelastoma (CPF) is a benign cardiac tumor that usually affects cardiac valves. It is usually discovered incidentally on routine echocardiography. However, left ventricular CPF is rare. This report describes the case of a 73-year-old female, referred to a cardiology department for evaluation of a mass of the left ventricle. The mass was found routine echocardiography. The transthoracic echocardiography revealed a 2.2x1.3 cm highly oscillating mass, attached by stalk on the inferior wall of the left ventricle. Cardiac magnetic resonance imaging demonstrated a non-enhanced, 1.8x1.0 cm mass on the inferior wall of the left ventricle. The patient underwent surgical resection of the mass, histopathologic examination of the mass confirmed the diagnosis of a CPF.
Aged ; Cardiology ; Echocardiography ; Female ; Heart Neoplasms ; Heart Valves ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging

BACKGROUND AND OBJECTIVES: Plaque composition rather than degree of luminal narrowing may be predictive of future coronary events in high risk patients. The purpose of this study was to compare degree of plaque burden and composition with multislice computed tomography (MSCT) angiography between diabetic and non-diabetic patients. SUBJECTS AND METHODS: A total of 452 consecutive MSCT angiography examinations were performed between July 2007 and June 2009. Of these, the patients who underwent invasive coronary angiography were evaluated for the presence and type of atherosclerotic plaque and severity of luminal narrowing. RESULTS: Ninety two (46 in the diabetic group and 46 in the non-diabetic group) patients underwent both MSCT angiography and invasive coronary angiography. Among them, 30 patients (65.2%) in the diabetic group and 26 patients (56.5%) in the non-diabetic group had significant coronary narrowing on MSCT angiography. Sixteen patients (34.8%) in the diabetic group and 15 patients (32.6%) in non-diabetic group underwent coronary angioplasty and stenting. Forty-two patients (93.3%) in the diabetic group and 39 patients (88.6%) in the non-diabetic group had multiple types of coronary plaque (p=0.485). MSCT angiography was similar to conventional coronary angiography in its ability to predict significant coronary artery disease in that the area under the curve was 0.88 (95% confidence interval, 0.81 to 0.95). Diabetic patients had more mixed plaque compared with non-diabetic patients. CONCLUSION: Differences in coronary plaque composition between diabetic and non-diabetic patients can be determined noninvasively by MSCT angiography. In patients with diabetes, mixed plaque types contribute to the total plaque burden to a higher degree than in non-diabetic patients.
Angiography ; Angioplasty ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Multidetector Computed Tomography ; Phenobarbital ; Plaque, Atherosclerotic ; Stents

A 55-year-old male patient presented with an acute myocardial infarction. A sirolimus-eluting stent (SES) was implanted in the proximal left anterior descending artery (LAD). Eight months later, there was a newly developed distal LAD lesion. An additional SES was implanted. Twenty-eight months after the index procedure of primary coronary intervention, the electrocardiogram showed ST elevation in the precordial leads and an emergency coronary angiogram showed diffuse stent thrombosis (ST) in the proximal LAD. Thirty-four months after the index procedure, coronary angiography showed a large peri-stent coronary aneurysm in the proximal LAD and focal in-stent restenosis (ISR) at the proximal edge of the distal LAD stent. On fluoroscopy, a fracture was noted in the middle part of the distal SES. A zotarolimus- eluting stent (ZES) was deployed and overlapped the restenosis and fracture sites. Forty months after the index procedure, there were no changes in the size of the aneurysm or in the other stent complications including the fracture and restenosis. At present, the patient has remained asymptomatic for eight months.
Aneurysm ; Arteries ; Coronary Aneurysm ; Coronary Angiography ; Drug-Eluting Stents ; Electrocardiography ; Emergencies ; Fluoroscopy ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; Stents ; Thrombosis

In systemic lupus erythematosus patients, prevalence of renal involvement is high, even in the absence of overt clinical manifestation. Lupus nephritis can usually be categorized according to the widely used WHO classification. however, clinically significant renal disease unrelated to lupus nephritis have rarely been described in patients with SLE. Especially, there has been few reported cases of IgA nephropathy with SLE since first reported in 1995, but their relationship is not apparent yet. We experienced a 72-year-old female who was admitted to our hospital due to generalized edema, arthralgia, proteinuria, microscopic hematuria. Her diagnosis of IgA nephropathy was estabilished on biopsy. At the same time, she was diagnosed as SLE. in that the serology for ANA was positive at 1:640, lupus anticoagulant and anti-cardiolipin antibody were positive, hemolytic anemia, arthritis and oral ulcer. and eventually she was diagnosed end-stage renal disease 2 months later. In conclusion, atypical glomerular lesion in SLE should raise the possibility of a non-lupus glomerulopathy, including IgA nephropathy.
Aged ; Anemia, Hemolytic ; Arthralgia ; Arthritis ; Biopsy ; Classification ; Diagnosis ; Edema ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Lupus Nephritis ; Oral Ulcer ; Prevalence ; Proteinuria

BACKGROUND: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by the peripheral cytopenias and hypercellular or normocellular dysplastic bone marrow. The event responsible for the development of MDS is generally not known. Several recent reports have described an increased frequency of apoptosis in bone marrow cells from patients with aplastic anemia or MDS. Gersuk et al observed that Fas ligand expression was significantly increased on bone marrow cells from MDS patients as compared to normal individuals. METHODS: We examined apoptosis and Fas antigen expression using ISNEL method and immunohistochemistry on marrow cells from 36 patients with MDS. RESULTS: Among the 36 patients, 15 patients (42%) demonstrated apoptosis positive cells (>15%) and 9 patients (25%) demonstrated positive Fas antigen expression (>20%). The presence of apoptosis significantly correlated with hemoglobin level at diagnosis (P<0.05) and the expression of Fas antigen significantly correlated with bone marrow cellularity and CD34 positive cell aggregate group at diagnosis (P<0.05). There was no statistically significant relationship between apoptosis and Fas antigen expression. The median survival of all patients with MDS was 44 months (2-117+). Multivariate analysis showed that FAB classification and hemoglobin level at diagnosis were significant prognostic factor but presence of apoptosis and expression of Fas antigen had no significance. CONCLUSION: The data indicate that the apoptosis and expression of Fas antigen are present in patients with MDS and correlate with some clinical parameters but not significantly associated with survival period of the patients with MDS.
Anemia, Aplastic ; Antigens, CD95* ; Apoptosis* ; Bone Marrow ; Bone Marrow Cells ; Classification ; Diagnosis ; Fas Ligand Protein ; Humans ; Immunohistochemistry ; Multivariate Analysis ; Myelodysplastic Syndromes*