BACKGROUND AND OBJECTIVES: Diabetes is associated with a unique form of cardiomyopathy in the absence of atherosclerosis. The mechanisms of diabetic cardiomyopathy have not been defined, but is associated with early left ventricular (LV) diastolic dysfunction following an altered LV contractile performance. However, less attention has been paid to the right ventricular (RV) diastolic function in diabetes. Therefore, the changes in the RV ans LV filling dynamics, in patients with early type 2 diabetes, were investigated. SUBJECTS AND METHODS: The transtricuspid and trans-mitral flows were assessed by transthoracic Doppler echocardiography, at maximal inspiration and expiration, in 48 subjects (mean age: 62+/-9 years, M:F=16:32) with type 2 diabetes (Type 2 DM group) and 34 normal subjects (control group ; mean age:59+/-9 years, M:F=15:19, ranging from 45-75 years of age) with normal LV systolic function and ECG at rest. Subjects with diabetic complication, nephropathy (Cr >1.5 mg/dL), LVH and COPD were excluded. RESULTS: The mitral E/A ratio and DT (deceleration time) showed no significant difference between the type 2 DM and control groups. The LV and RV systolic functions also showed no significant difference between the two groups. However, the type 2 DM group had a lower tricuspid E/A ratio (0.98+/-0.25 vs. 1.17+/-0.21, p<0.001) and a longer tricuspid DT (241+/-65 msec vs. 208+/-51 msec, p=0.016) than the control group. CONCLUSION: The right ventricular diastolic function is frequently abnormal in early type 2 diabetes. This suggests that right ventricular diastolic dysfunction may be an important predictor for the early detection of diabetic cardiomyopathy.
Atherosclerosis ; Cardiomyopathies ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Heart Ventricles ; Humans ; Pulmonary Disease, Chronic Obstructive

OBJECTIVES: This study aimed to investigate the medication adherence rate and related factors in chronic schizophrenia. METHODS: A total of 65 (34 male and 31 female) outpatients with schizophrenia and with less than 5 years schizophrenia treatment were randomly selected to participate in the study survey. Medication adherence rate was evaluated by counting remaining tablets. The Korean version of Drug Attitude Inventory-10 (KDAI-10) was used to determine the subjective adherence rate. Adherence was defined as a patient taking more than 80% of their total prescribed medication. Positive KDAI-10 scores indicate good adherence. RESULTS: The rate of good adherence was 87.7%. Our analysis showed that an older age (r=0.323, p=0.009), longer duration of illness (r=0.296, p=0.017), employment (F=4.41, p=0.016), remaining married (F=5.26, p=0.008), and being supported by family members, especially spouse or siblings (F=3.02, p=0.025) were significantly associated with good adherence. Presence of symptoms such as delusion (p=0.033) and hallucination (p=0.032) were related to poor adherence. CONCLUSION: The results indicate that future study should investigate patient characteristics associated with medication adherence and analyze the clinician/patient alliance and its affect on adherence. The results also show that further studies might be useful in developing and validating measures of adherence, as well as in designing and evaluating interventions to improve adherent behaviors.
Delusions ; Employment ; Hallucinations ; Humans ; Male ; Medication Adherence* ; Outpatients* ; Schizophrenia* ; Siblings ; Spouses ; Tablets

We recently experienced 2 cases of a novel cardiomyopathy following various stressful conditions. Here, we report on this novel cardiomyopathy showing transient left ventricular apical wall motion abnormalities following stress. Our cases exhibited an acute onset, transient left ventricular apical wall motion abnormalities with chest symptoms, electrocardiographic changes and minimal enzyme release, which mimicked acute myocardial infarction without stenosis on the coronary angiograms. The novel cardiomyopathy developed in our patients following aggravation of a systemic disorder (acute pyelonephritis with septicemia) and noncardiac surgery (total hysterectomy). Both our cases exhibited the typical echocardiographic findings of asynergy of the apical region with hypercontraction of the basal segment of the left ventricle, and wall motion abnormalities, which improved rapidly within a few weeks.
Cardiomyopathies* ; Constriction, Pathologic ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Myocardial Infarction* ; Pyelonephritis ; Thorax

BACKGROUND: DHEA-S is the most abundant steroid hormone in circulation, and primarily secreted from the adrenal cortex, but its physiological role is little known. One of the characteristic features of DHEA-S is progressive decrement of plasma DHEA-S level with advancing age, in contrast, plasma levels of other adrenal hormones are not chaging or littie decreasing. To grasp the trends of plasma DHEA-S level and DHEA-S/cortisol ratio by age in healthy Korean, we measured the plasma DHEA-S levels and DHEA-S/cortisol ratios in healthy Korean. METHODS: Healthy Korean (men: 99, women: 102, age range: 15-97 year old)were studied. Subjects were not taking drugs (such as glucocorticoid or androgenic medication) or cigarettes known to modify the plasma level of DHEA-S and cortisol, and had no evidence of hepatic, renal disease or hyperlipidemia as determined by serum lipid, bilirubin, SGOT, SGPT, BUN, creatinine. Data were analyzed by 10-year age group for men and women: i.e, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89 and 90 year or more. Plasma DHEA-S levels were measured by using a commercially available RIA kit with 125I labeled-DHEA-SO4 (Coat-A Count DHEA-SO4), and for the measurement of plasma cortisol levels, commercial Gamma Coat TM[125I] Cortisol Radioimmunassay Kit was used. RESULTS:. 1) In both men and women, plasma DHEA-S level showed high interindividual variation within the same age group. 2) There were individual sex differences in plasma levels of DHEA-S, in all age groups, plasma DHEA-S levels were significantly higher values for men than for women. 3) Maximum plasma DHEA-S levels (men; 237+-3.35 ug/dL, women; 108+-17.5 ug/dL) were at third decade in both men and women. 4) Both men and women showed the continuous decline in plasma DHEA-S level with age. These age-related decline was more prominent in men than in women (men; y=-3.152 * +292.6, r2= 0.8459, P<0.05, women; y= -1.417 * +143.3, r2 = 0.7278, P< 0.05). 5) As an index of aging, there was no stastical difference between DHEA-S and DHEA-S/cortisol ratio. CONCLUSION: In healthy Korean, there were high interindividual variation of plasrna DHEA-S levels. In both men and women plasma DHEA-S level was peak at third decade, and from when it declined progressively with age. These results suggest that although the reliability of single plasma DHEA-S measurement are limited, the decline of DHEA-S with advancing age might be a specific marker of endocrinologic hormonal milieu (aging index). Also, concerning to individual adrenal secreting capacity, we measured DHEA-S/cortisol ratio. But we did not found that plasma DHEA-S/cortisol ratio is superior to the plasma DHEA-S level as an aging index.
Adrenal Cortex ; Aging ; Alanine Transaminase ; Aspartate Aminotransferases ; Bilirubin ; Creatinine ; Female ; Hand Strength ; Humans ; Hydrocortisone* ; Hyperlipidemias ; Male ; Plasma* ; Sex Characteristics ; Tobacco Products

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is the capability of coronary arteriolar bed to dilate in response to increased cardiac metabolic demand. Nocorandil, a hybrid of ATP-sensitive K+ channel opener and nitrates, causes coronary vasodilation of both epicardial and resistance vessels. We investigated the feasibility and safety of nicorandil as compared to adenosine in the measurement of CFR using a Doppler guide wire. SUBJECTS AND METHODS: We measured CFR in 26 consecutive patients (mean age 52+/-19 years, M:F=16:10) during coronary intervention with a 0.014-inch Doppler guide wire. We recorded the baseline average peak velocity (APV) and the hyperemic APV induced by intracoronary adenosine or nicorandil. The heart rate, mean aortic pressure and the time interval from maximal APV to baseline APV were also recorded. RESULTS: There were no significant differences between APV, diastole/systole velocity ratio and CFR induced by adenosine and those induced by nicorandil (44.4 +/- 17.3 vs 45.5 +/- 17.6, p=0.78, 1.59 +/- 0.51 vs 1.57 +/- 0.52 p=0.78, 2.22 +/- 0.89 vs 2.27 +/- 0.94, p=0.36). The CFR and diastole/systole velocity ratio induced by nicorandil showed a strong positive linear correlation with those by adenosine (r2=0.77, p=0.0001, r2=0.83, p=0.0001). Adenosine significantly decreased the heart rate as compared to nicorandil =-25.5 +/- 9.7 vs -8.7 +/- 4.9 bpm, p=0.001). There were no differences in the changes of mean aortic pressure between adenosine and nicorandil (-7 +/- 9 vs -2 +/- 3 mmHg, p=0.17). Nicorandil prolonged the time interval from maximal APV to baseline APV compared to adenosine (194 +/- 62 vs 37 +/- 12 sec, p=0.001). CONCLUSION: Nicorandil is feasible and safe for use in measuring CFR using a Doppler guide wire and may replace adenosine.
Adenosine* ; Arterial Pressure ; Blood Flow Velocity ; Heart Rate ; Humans ; Nicorandil* ; Nitrates ; Ultrasonography ; Vasodilation

BACKGROUND AND OBJECTIVES: Chlamydia pneumoniae (CP) has been linked with atherosclerosis. While several studies have shown that CP contributes to the acceleration of atherosclerotic lesions, any studies on the initiation of atherosclerosis are sparse. The present study investigated whether CP infection could initiate atherosclerotic lesions in rats that are known to be resistant to atherosclerosis; further, we investigated if these lesions do form, then how does the CP participate in this and develop of atherosclerosis in these rats. MATERIALS AND METHODS: Thirty 11-week-old Otsuka Long-Evans Tokushima Fatty (OLETF) rats, thirty type 2 diabetic rats and thirty age-matched Long-Evans Tokushima Fatty (LETO) rats that were maintained on a high-cholesterol diet were either mock-inoculated or inoculated intranasally 3 times at 11, 13 and 15 weeks of age. The serum levels of the lipid profiles, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1) and C-reactive protein (CRP) were measured by performing ELISA at 24 weeks and 40 weeks of age. The atherosclerotic lesion areas were analyzed, and immunohistochemical staining using chlamydia genus-specific monoclonal antibody and PDGF-B was performed in the ascending aorta at 40 weeks of age. RESULTS: Immunohistochemical staining with using specific monoclonal antibody demonstrated CP infection in the vessel walls. The serum PAI-1 level of the OLETF rats was higher than that of the LETO rats (p<0.05) regardless of the state of the CP infection, but there were no differences in the serum MCP-1 and CRP levels between the OLETF rats and the LETO rats. While no atherosclerotic lesion was observed in the mock-infected LETO rats, early-to-advanced atherosclerotic lesions were found in the other rat groups. CP-infected OLETF rats showed more advanced atherosclerotic lesions and greater mean lesion areas than the other rat groups (LT-N, 0 mm2; LETO-CP, 3.29+/-1.23 mm2; OT-N, 4.91+/-2.11 mm2; OT-CP, 9.20+/-4.62 mm2)(p<0.05). The characteristics of the atherosclerotic lesions in the rats were intimal thickening that was mainly composed of smooth muscle cells. The atherosclerotic lesion area positively correlated with the presence and the extent of PDGF-B staining in the aortic wall (p<0.01). CONCLUSION: Chronic infection of CP in the vessel walls initiated the development of atherosclerosis in the LETO rats and it accelerated the atherosclerosis in the OLETF rats. CP-induced smooth muscle proliferation and the resultant intimal thickening may be mediated by PDGF-B in these atherosclerotic lesions.
Acceleration ; Animals ; Aorta ; Atherosclerosis* ; C-Reactive Protein ; Chemokine CCL2 ; Chlamydia* ; Chlamydophila pneumoniae* ; Diet ; Enzyme-Linked Immunosorbent Assay ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Rats* ; Rats, Inbred OLETF

BACKGROUND AND OBJECTIVES: The coronary vasospasm has been shown to play an important role in the pathogenesis of not only variant angina but also ischemic heart disease in general, including other forms of angina pectoris, acute myocardial infarct, and sudden death. The angiographic features of coronary vasospasm are focal and diffuse patterns in clinical setting. We attempted to clarify the differences in vessel wall morphologic appearance between the sites of focal and diffuse vasospasm by intravascular ultrasound(IVUS). MATERIAL AND METHODS: We studied 23 patients(32 segments) with variant angina in whom coronary angiograms were normal and coronary spasm was documented by intracoronary injection of acetylcholine. Coronary spasm was defined as luminal diameter reduction > or = 90% compared with baseline coronary artery diameter. Focal spasm was defined if the length of spastic narrowing was less than 10mm. By IVUS, we observed atheromatous plaques in 32 spasm segments with either focal or diffuse vasospasm. We measured maximal intimal thickness, luminal cross-sectional area(CSA), and external elastic membrane-CSA in spasm sites. RESULT: When comparing maximal intimal thickness between focal (n=15) and diffuse vasospasm segments(n=17), there was significantly greater thickness at focal spasm segments(1.21+/-0.36mm vs. 0.70+/-0.23mm, P<0.001). The maximal plaque area was similar between two groups but tended to be greater in focal spasm segments(6.03+/-2.06mm2 vs. 4.92+/-2.59mm2, P=NS). When circular shaped factor(CSF : standardized index of eccentricity) was compared, focal spasm segments were greater than diffuse spasm segments(0.89+/-0.06 vs. 0.97+/-0.02, P<0.001). At the segments of focal spasm, remodeling index was greater compared to the segments of diffuse spasm(1.02+/-0.16 vs. 0.86+/-0.13, P<0.001). CONCLUSION: Focal spasm segments were more eccentric and had greater atheromatous plaque than diffuse spasm segments. Positive remodeling pattern was observed at the segments of focal spasm and negative remodeling pattern at the segments of diffuse spasm. There were morphologic differences of vessel wall appearance between focal and diffuse spasm sites.
Acetylcholine ; Angina Pectoris ; Coronary Vasospasm* ; Coronary Vessels ; Death, Sudden ; Muscle Spasticity ; Myocardial Infarction ; Myocardial Ischemia ; Phenobarbital ; Plaque, Atherosclerotic ; Spasm

BACKGROUND AND OBJECTIVES: Radiation therapy is one of the promising new treatment for restenosis, which is a major problem for the long-term success after angioplasty. We compared radiation therapy only and combined therapy of paclitaxel and radiation on neointimal hyperplasia after injury of rat carotid artery to see whether we can reduce the effective dosage of radiation and thus diminish untoward consequence of radiation if paclitaxel could function as a cell-cycle selective radiosensitizer. MATERIAL AND METHODS: A standardized carotid balloon catheter arterial injury was produced in 65 rats. First group was composed of a single dose of paclitaxel 1 mg/kg body weight, 2 mg/kg or 4 mg/kg, which was administrated intraperitoneally at 2 hours after injury. Second group received external radiation at doses of 2.5 or 5 Gy at 24 hours after injury. Third group was treated with combined paclitaxel-radiation: paclitaxel was injected at 2 hours after injury and then external radiation was delivered 24 hours later. At 21 days after injury, the cross-sectional area of neointima and the ratio of intima/medial area were determined from axial sections using image analysis. RESULTS: Single dose of paclitaxel had no effect in reducing smooth muscle cell proliferation. Minimum effective single dose to inhibit neointimal hyperplasia was 5 Gy. Combined paclitaxel-radiation group except subgroup with paclitaxel 1 mg/kg and 2.5 Gy radiation showed significant reduction of neointimal area compared to group with 2.5 Gy radiation. CONCLUSION: Low-dose external radiation combined with paclitaxel can more effectively inhibit smooth muscle cell pro-liferation and neointimal hyperplasia than radiation only in the rat carotid injury model.
Angioplasty ; Animals ; Body Weight ; Carotid Arteries ; Catheters ; Hyperplasia* ; Myocytes, Smooth Muscle ; Neointima ; Paclitaxel* ; Radiation Dosage ; Rats*

BACKGROUND AND OBJECTIVES: This study was designed to investigate whether the serum concentration of the carboxy-terminal propeptide of procollagen type I PIP, a marker of myocardial fibrosis, was related to the change of the ventricular filling dynamics in patients with early type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: Echocardiography was performed in 28 patients with type 2 DM and 32 age-matched healthy controls, ranging from 31-69 years of age, with normal left ventricular (LV) systolic function and ECG at rest. Subjects with diabetic complications, including microalbuminuria, nephropathy (Cr>1.3 mg/dL), severe obesity (BMI> or =30 kg/m2), LV hypertrophy (LV septal thickness and/or posterior wall thickness 12 mm on M-mode) and hypertension, were excluded. The serum concentrations of PIP and Transforming growth factor TGF-beta1 were measured by enzyme immunoassay methods. RESULTS: The type 2 DM group had lower mitral (Type 2 DM vs. Control: 0.88+/-0.28 vs. 1.17+/-0.34, p<0.01) and tricuspid E/A ratios (1.15+/-0.25 vs. 1.30+/-0.25, p=0.01) than the control group. The level of serum PIP was higher (p<0.05) in patients with type 2 DM than in the control group (131.1+/-45.6 vs. 109.3+/-32.5). The difference in the duration between transmitral forward (A) and pulmonary venous retrograde (Ar) waves (A-Ar) was considered an estimate of a passive diastolic function. A-Ar was inversely related with the serum PIP level in type 2 diabetes (r=-0.43, p=0.03). CONCLUSION: These results show a relationship between the LV diastolic function and the serum concentration of PIP in early type 2 DM. These findings suggest that the determination of the serum level of PIP is a useful method for the screening and early diagnosis of myocardial fibrosis associated with DM.
Collagen Type I ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Diastole ; Early Diagnosis ; Echocardiography ; Electrocardiography ; Fibrosis* ; Humans ; Hypertension ; Hypertrophy ; Immunoenzyme Techniques ; Mass Screening ; Obesity, Morbid ; Procollagen ; Transforming Growth Factor beta1 ; Transforming Growth Factors

BACKGROUND AND OBJECTIVES: The ventricular pacing electrodes are customarily placed into the right ventricular muscle because there is easily accessible. However detailed physiologic studies have shown that the single stimulation of right ventricular sites causes dysynchronous ventricular contraction due to early depolarization of the right ventricle and delayed depolarization of the left ventricle. In contrast, normal human ventricular activation, which is conducted by the Purkinje system, spreads transmurally from the endocardium to multiple paraseptal epicardial regions and results in more synchronous contraction of the ventricle. Therefore, the hypothesis that producing biventricular activation by simultaneously pacing ventricles across the septum might confer hemodynamic benefits over those of conventional right ventricular pacing. The purpose of this study was to evaluate the acute hemodynamic changes of different pacing modes (right ventricular : RV, biventricular : BV, atrio-right ventricular : A-RV, and atrio-biventricular : A-BV pacing). MATERIALS AND METHOD: In 9 open chest dogs anesthetized with alpha-chloralose, sinus node crushing was done, and then hemodynamic data (QRS width, femoral arterial pressure : FAP, pulmonary arterial pressure : PAP, and Cardiac output : CO) were acquired after 5 minutes of pacing at a fixed rate during each pacing mode. RESULTS: Results were as follow : 1. BV pacing significantly increased cardiac output compared with RV pacing (P<0.01). BV pacing significantly shortened QRS width compared with RV pacing (P<0.01). 2. A-BV pacing significantly increased cardiac output compared with A-RV pacing (P<0.01). A-BV pacing significantly shortened QRS width compared with A-RV pacing (P<0.01). 3. A-RV pacing significantly increased systolic pulmonary arterial pressure and cardiac output compared with BV pacing (P<0.01). CONCULSION: These results support the use of atrio-biventricular pacing to improve acute hemodynamic performance.
Animals ; Arterial Pressure ; Cardiac Output ; Cardiac Resynchronization Therapy* ; Chloralose ; Dogs* ; Electrodes ; Endocardium ; Heart Ventricles ; Hemodynamics* ; Humans ; Sinoatrial Node ; Thorax*