BACKGROUND AND OBJECTIVES: Acute coronary syndrome occurs most commonly in the setting of atherosclerotic coronary artery disease, but there is little information concerning the mechanism responsible for the transition from stable to unstable coronary atherosclerotic plaque. Hypothetically, several microorganism(Chlamydia pneumonia, Cytomegalovirus and Helicobacter pylori) and their inflammatory reaction have been suggested as a causative motive in progression of acute coronary syndrome. Although it is unclear whether the serum level of CRP as a inflammatory parameter is concerned with previous inflammatory change or myocardial necrosis, CRP apper to be predictive of higher risk for cardiac event in the patients with acute coronary syndrome. Our objective was to evaluate whether the inflammatory parameters(CRP, ESR and WBC count) is useful in predicting the short-term cardiac risk within 30 days. MATERIALS AND METHOD: One hundred and ten patients with acute coronary syndrome were enrolled from April 1998 through August 1998. Blood samples were collected at 1st hour, 24th hour, 48th hour and 7th day and tested for CRP, ESR, WBC count and CK-MB level. Values of 323 normal were used as control. All patients were followed up for 30 days and assessed for the presence of cardiac complications. RESULTS: Peak CRP value of the patients with acute myocardial infarction(3.4+/-3.85 mg/dL, n=2) was higher than that of the patients with unstable angina(0.7+/-0.93 mg/dL, n=8, p<0.05) and controls(0.3+/-0.48 mg/dL, n=23, p<0.05). Peak CRP value of patients with cardiac complication was higher than that of patients without complication(7.7+/-4.77 mg/dL, n=5 vs 1.3+/-1.74 mg/dL, n=5 ; p<0.05). In multivariate analysis, peak CRP value was the only predictive parameter for development of cardiac complications in the patients with acute coronary syndrome(Odds ratio 4.893, 95% confidence interval 1.212-19.756, p value=.026). In the high-CRP group(>2 mg/dL, n=0), the cardiac complication rate was higher than the low-CRP group(< or =2 mg/dL, n=0) (43.3% vs 2.5%, p<0.05). Peak CRP value was correlated with age(r=.191, p=.045), pulse rate(r=.186, p=.008), left ventricular ejection fraction(r=0.384, p<0.001), peak ESR(r=.383, p<0.001) and peak WBC count(r=.307, p=.001), but not with peak CK-MB level. CONCLUSION: Elevated CRP level in patients with acute coronary syndrome seems to be a valuable prognostic factor for the development of cardiac complications within 1 month after admission.
Acute Coronary Syndrome* ; Coronary Artery Disease ; Cytomegalovirus ; Helicobacter ; Humans ; Multivariate Analysis ; Necrosis ; Plaque, Atherosclerotic ; Pneumonia

BACKGROUND: Assessment of segmental wall motion is one of the most challenging tasks in echocardiography. The diagnosis of ischemic heart disease by echocardiography depends on the accurate detection of segmental wall motion abnormalities. However, echocardiographic regional wall motion analysis is impaired by incomplete endocardial definition due to obesity, chronic obstructive lung disease, etc. The purpose of this study was to examine the value of tissue harmonic imaging for endocardial border definition. METHODS: We recorded echocardiograms in 30 consecutive patients, in which more than one segment of left ventricule were poorly visualized, by ATL HDI 3000 and analyzed left ventricular segmental wall motion and then recorded echocardiograms again by tissue harmonic imaging (THI) technique. Endocardial border definition for each segment was graded from grade A to C (grade A in which endocardium is clearly visualized, grade B in which endocardium is poorly visualized and grade C in which endocardium is not seen). Densitometric analysis was perfromed in 10 randomly selected patients. Mean density and dynamic range in histogram were obtained at septum, posterior wall and left ventricle cavity on parasternal long axis view with both techniques. RESULTS: Among total 480 segments, 237 segments (49.4%) were categorized as grade A, 152 segments (31.7%) were categorized as grade B and 91 segments (18.9%) were categorized as grade C in fundamental modes. However, 380 segments (79.2%) were categorized as grade A, 75 segments (15.6%) were categorized as grade B and 25 segments (5.2%) were categorized as grade C in tissue harmonic modes. Visualization of 37.7% (181 segments/480 segments) of all segments was improved in tissue harmonic imaging, with 5.2% (25 segments/480 segments) improved from "not seen" to "clearly visualized". Of these improved 181 segments in THI, 105 segments (58%) were the lateral and anterior walls on apical views. In densitometric analysis of septum, wall density and delta density (wall densityLV cavity density) were significantly higher in THI than fundamental modes (p<0.05). But, W/C ratio (wall density/LV cavity density) was not different between two imaging modalities. In densitometric analysis of posterior wall, all parameters were not significantly different between two imaging modalities. Also, W/C ratio of dynamic range (posterior wall dynamic range/LV cavity dynamic range) was not significantly different between two imaging modalities. CONCLUSION: Tissue harmonic imaging has significant value in endocardial border definition in the patients with poor echocardiographic windows and appears promising with the added advantage of no requirement for intravenous access.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography ; Endocardium ; Heart Ventricles ; Humans ; Myocardial Ischemia ; Obesity ; Pulmonary Disease, Chronic Obstructive

Exercise-induced ischemic ST responses were analyzed in 36 patients who presented with chest pain and had exercise test and the results were compared with their coronary angiographic findings. Among 36 exercise test positives, the incidences of one-, two- and three vessel disease, and left main disease were 25%(9 cases), 30%(11 cases), 25%(9 cases) and 9%(3 cases), respectively. The incidence of multivessel disease(i.e., two-to three vessel disease or left main disease) in patients with ST depression > or =2.0mm was 72% and that in those with ST depression of 1.0-1.9mm was 45%. In patients with downsloping ST depression, the incidence of multivessel disease was significantly higher than that of one vessel disease(86% vs 14%, p<0.001). But both incidences of one vessel disease and multivessel disease were similar in patients with flat and slowly upsloping ST depression. More than two thirds of patients with ischemic ST depression appearing in the first 6 minutes of exercise or those lasting past 7 minutes in recovery were associated with multivessel disease. It is concluded that attention to depth, type, appearance time and duration of ST depression during exercise test is particularly helpful in detecting patients with advanced coronary disease.
Chest Pain ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Depression ; Electrocardiography* ; Exercise Test ; Humans ; Incidence

10 Patients with primary hypercholesterolemia were treated for 12 weeks with lovastation(20mg t.i.d). Lovastatin reduced mean total and low density lipoprotein cholesterol by 43% and 57% respectively(p<0.001). High density lipoprotein cholesterol and triglyceride levels were unchanged by the drug. Adverse effects attributable to lovastatin were not observed. Thus lovastatin is considered as an effective lipid lowering agent for the treatment of primary moderate hypercholesterolemia.
Cholesterol, HDL ; Cholesterol, LDL ; Humans ; Hypercholesterolemia* ; Lovastatin* ; Triglycerides

We report on a 28 years old female with recurred cardiac myxomas who presented with dizziness, headache, and blurred vision. She had an excision of biatrial atrial myxomas 10 years age. Varying sized multiple cerebral aneuysms and myxomas in left atrium and left ventricle were found on a cerebral angiogram and echocardiogram, respectively. After wide excision including interatrial septum and part of left ventricular septum, her symptoms were much improved.
Adult ; Dizziness ; Female ; Headache ; Heart Atria ; Heart Ventricles ; Humans ; Intracranial Aneurysm ; Myxoma* ; Ventricular Septum

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.
Animals ; Apoptosis ; Arthroplasty, Replacement, Hip ; Cell Line ; Cell Proliferation ; Cytokines* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Histones ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Mice ; Nitric Oxide ; Osteolysis* ; Tumor Necrosis Factor-alpha

PURPOSE: Osteolysis has become a major cause of aseptic loosening in total hip arthroplasty. Macrophages phagocytose wear debris from implants and release the pro-inflammatory mediators such as IL-1beta, IL-6, TNF-alpha and nitric oxide. We evaluated the effects of metal patricles on the release of bone-associated cytokines and nitric oxide from J774 mouse macrophage cell line. MATERIALS AND METHODS: Titanium-Aluminum-Vanadium (Ti6Al4V) and Cobalt-Chrome-Aluminium (CoCr) particles were loaded and nitric oxide production was measured indirectly by the nitrite assay. The effect on cell proliferation, and apoptosis were also investigated with non-isotopic proliferation assay, and ELISA to DNA and histone. The levels of two proinflammatory cytokines, IL-6 and TNF-alpha, were measured with ELISA. The modulatory effect of anti-inflammatory cytokine on the nitrite, IL-6 and TNF-alpha production was additionally investigated. RESULTS: Nitrite levels increased after administration of Ti6Al4V and CoCr particle. IL-10 and IL-4 inhibited the production of nitrite with TiAl4V particle, but not in significant amount with CoCr particles. Cellular proliferative activity decreased and apoptosis increased after administration of Ti6Al4V and CoCr particle. Levels of IL-6 and TNF-a increased with both particles. IL-10 and IL-4 inhibited the production of IL-6 and TNF-alpha in varying degrees. CONCLUSION: Our data confirmed the increased production of pro-inflammatory cytokines and nitric oxide with metal particles and the inhibitory effect of IL-10 and IL-4 on the production of these substances, and suggest differences in the specific action between different metal particles.
Animals ; Apoptosis ; Arthroplasty, Replacement, Hip ; Cell Line ; Cell Proliferation ; Cytokines* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Histones ; Interleukin-10 ; Interleukin-4 ; Interleukin-6 ; Macrophages ; Mice ; Nitric Oxide ; Osteolysis* ; Tumor Necrosis Factor-alpha

OBJECTIVES: Prehypertension is associated with a higher risk of developing hypertension compared with normotension. Yet, factors predicting the development of hypertension among prehypertensive people are ill-understood. This prospective cohort study was performed to examine if serum gamma-glutamyltrasferase (GGT) within a normal range can predict the future risk of hypertension among prehypertensive adults. METHODS: Study subjects were 293 prehypertensive persons >30-years-of-age who participated in a community-based health survey in 2003 and who were followed up in 2008. Sex-specific quartiles of baseline serum GGT were used to examine association with 5-year hypertension incidence. RESULTS: Baseline serum GGT within normal range predicted the risk of developing hypertension for 5 years only in prehypertensive women. Adjusted relative risks were 1.0, 3.7, 3.6, and 6.0 according to quartiles of baseline serum GGT (P for trend <0.01). This pattern was similarly observed in non-drinkers. However, serum GGT was not associated with incident hypertension in men. Different from serum GGT, baseline serum alanine aminotransferase, another well-known liver enzyme, did not predict the risk of incident hypertension in both genders. CONCLUSIONS: Even though baseline serum GGT within normal range strongly predicted the future risk of hypertension, it was observed only in women, Although underlying mechanisms of this association are currently unclear, serum GGT can be used to select a high risk group of hypertension in prehypertensive women.

BACKGROUND: Tc-99m tetrofosmin is a recently developed myocardial perfusion agent that has shown promising characteristics, displaying rapid accumulation in and slow clearance from the myocardium with rapid clearance from background organs. Adenosine is relatively safe, direct and potent coronary vasodilator and has been used as a stress agent in myocardial perfusion scintigraphy. We have performed tetrofosmin single photon emisson computed tomography(SPECT) in patients suspected of coronary artery disease. This study was aimed to assess the safety profile and diagnostic accuracy of adenosine Tc-99m tetrofosmin SPECT. METHOD: One hundred forth six patients underwent Tc-99m tetrofosmin SPECT with intravenous adenosine. Four hours after resting Tc-99m tetrofosmin SPECT imaging, adenosine was infused intravenously at a dose of 0.14 mg/kg of body weight per minute for 6 min and Tc-99m tetrofosmin was injected at 3 min after start of infusion. Blood pressure, heart rate and side effects was recorded during and after four minites of adenosine infusion. Forty seven of patients underwent coronary angiography within 2 weeks. RESULTS: Adenosine induced a significant and mild decrease in systolic and diastolic blood pressure at 2 min after start of adenosine infusion and a significant and mild increase in heart were observed in 70% of 146 patients. Chest discomfort(30%), mild dyspea(25%), chest pain(19%), and headach(12%) were common. No serious side effects were observed despite of continuation chest pain and restlessness, respectively. The diagnostic sensitivity for detection of CAD(>/=50% and >/=70% coronary stenosis by coronary angiography) by adenosine Tc-99m tetrofosmin SPECT were sensitivity 92%, 97%, and specificity) were 76%, 79% for LAD, 67%, 67% for LCX, and 73%, 82% for RCA, respectively. Specificities were 92%, 89% for LAD, 100%, 100% for LCX, 92%, and 87% for RCA. CONCLUSION: Adenosine Tc-99m tetrofosmin SPECT appears to be a feasible, safe, highly sensitive and specific test for the diagnosis of coronary artery disease.
Adenosine* ; Blood Pressure ; Body Weight ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis ; Heart ; Heart Rate ; Humans ; Myocardium ; Perfusion ; Perfusion Imaging ; Psychomotor Agitation ; Thorax ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: Tetrofosmin is a new Tc-99m labeled myocardial perfusion imaging agent that shows slow clearance from the myocardium and rapid clearance from background organs. The purpose of this study was to assess the ability of exercise Tc-99m tetrofosmin single photon emission computed tomography(SPECT) to identify and localize coronary artery disease. METHODS: The study population consists of 49 patients with suspected coronary artery disease who underwent both exercise Tc-99m tetrofosmin SPECT and coronary angiography within 2 weeks. Using the one day imaging protocol, 7-10mCi of Tc-99m tetrofosmin was injected at rest and 4 hours later, 25 mCi of Tc-99m tetrofosmin was injected at peak exercise. RESULTS: The sensitivity and specificity of exercise Tc-99m tetrofosmin SPECT was 94.9% and 60% for detection of coronary artery disease with luminal narrowing more than 50%, and 96.4% and 33.3% for detection of coronary artery disease with luminal narrowing more than 70%. The sensitivity of exercise Tc-99m tetrofosmin SPECT for detection of individual stenosed vessels(>or=50% and >or=70% coronary stenosis) was 79.2%, 100% for LAD, 55.6%, 55.6% for LCx and 85.0%, 92.9% for RCA and the specificity was 88.0%, 75.0% for LAD, 100%, 87.5% for LCx, 86.2%, 77.1% for RCA respectively. CONCLUSION: Exercise Tc-99m tetrofosmin SPECT appears to be an feasible and useful noninvasive test for the diagnosis of coronary artery disease
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Phenobarbital ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*