Despite the improvements in medical, surgical and endovascular therapies, vascular disease is still a significant, critical clinical problem. The advances in understanding the mechanisms of neovascularization and the accumulated experiences of successful therapeutic application in animal models have raised expectations for therapeutic angiogenesis as a promising treatment option. However, the large, double-blinded, controlled clinical trials using therapeutic agent in the form of protein, naked DNA or viral gene therapy have failed to show clinical benefit. Nevertheless, by this time, cell based therapeutic angiogenesis has raised a promising option for the treatment of ischemic diseases. This article summarizes the essential preclinical research and major clinical trials on therapeutic angiogenesis, and it deals with several issues related to the failure of the clinical trials. Future directions in the realm of therapeutic angiogenesis are also described with focusing on cell based therapy.
DNA ; Genes, Viral ; Models, Animal ; Tissue Therapy ; Vascular Diseases

No abstract available.
Humans ; Percutaneous Coronary Intervention* ; Renal Insufficiency, Chronic*

No abstract available.
Smoke ; Smoking

No abstract available.
Atrial Fibrillation

OBJECTIVES: Evaluation of left ventricular function and wall motion analysis is essential in patients with heart disease, especially ischemic heart disease. However, it is frequently limited by many factors ', obesity, chronic obstructive lung disease, etc. We conducted our study to know the feasibility of PMI technique, recently developed method to overcome these lirnitation. METHODS: We recorded echocardiography of consecutively admitted patients by ATL HDI 3000 and conducted LV wall motion analysis according to standardization of ASE and then recorded echocardiography again by PMI technique in 44 patients in which more than on left ventricular segments were poorly visualized. We compared the resolution of echocardiography of PMI technique with traditional echocardiography. We categorized the segments semiquantitatively ; grade A in which endocardium is clearly visualized, grade C in which endocardium is not discernible, grade B in which endocardium is suboptimally visualized. RESULTS: 1) 44 patients(30 males and 14 females) were studied and their rnean age was 63.4+/-10.5 years old. 2) 20 patients had myocardial infarction and 12 patients angina, 6 patients heart failure, 4 patients arrhythmia, and 2 patients other diseases. 3) Among total 704 segments, 462 segments(65.6%) were categorized as grade A, 203 segments(28.8%) as grade B, 39 segments(5.6%) as grade C. In 19 patients, more than one segments were categorized as grade C. In 6 patients, rnore than 3 segments were categorized as grade C. 4) With PMI technique, 557 segrnents(79.1%) were categorized as grade A, 126 segments (17.9%) as grade B, 21 segments(2.9%) as grade C with upgrade from grade C to A in 124 segments(17.6%) and grade C to B or B to A in 17 segments(2.4%). CONCLUSION: Echocardiography by PMI technique is feasible in left ventricular wall motion analysis in patients with poor echocardiographic windows.
Arrhythmias, Cardiac ; Echocardiography ; Endocardium ; Heart Diseases ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Obesity ; Pulmonary Disease, Chronic Obstructive ; Ventricular Function, Left

No abstract available.
Atrial Fibrillation* ; Mitral Valve Stenosis*

Phenylpropanolamine is a sympathomimetic amine used widely as a decongestant or appetite suppressant. Reports of the myocardial injury from the use of phenylpropanolamine are rare and the mechanism of the myocardial injury is not known clearly. We experienced a case of myocardial injury after ingestion of phenyl-propanolamine. A 46-year-old woman was admitted because of chest pain and dyspnea after ingestion of 5 tablets of anorectic pill containing phenylpropanolamine 75 mg per tablet. The serum creatine kinase MB isoenzyme levels were elevated and electrocardiographic abnormalities suggesting myocardial infarction were seen in the precordial lead. In echocardiograpy, left ventricular anteroseptal wall motion was nearly akinetic but coronary angiography showed normal coronary arteries except sluggish blood flow in left anterior descending artery.
Appetite ; Arteries ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Creatine Kinase ; Dyspnea ; Eating* ; Electrocardiography ; Female ; Humans ; Middle Aged ; Myocardial Infarction ; Phenylpropanolamine* ; Tablets

Mycotic aneurysm, uncommon complication of infective endocarditis (IE), develope more often in patients with subacute IE than acute IE. We report an unusual case of acute endocarditis complicated with multiple mycotic aneurysm and mitral valve perforation. 42 year old man who are referred for management of uncontrolled fever and dyspnea was diagnosed as acute mitral valve infective endocarditis caused by Staphylococcus aureus. He got complication of mycotic aneurysm on right femoral artery and mitral valve perforation with severe mitral regurgitation during favorable course of antibiotic treatment. Mycotic aneurysm was successfully treated with endovascular coil insertion and thrombin injection and mitral valve replacement was performed. On second day after operation, he died due to catastrophic intracranial hemorrhage which suggests another mycotic aneurysm rupture.
Adult ; Aneurysm* ; Aneurysm, Infected ; Dyspnea ; Endocarditis* ; Femoral Artery ; Fever ; Humans ; Intracranial Hemorrhages ; Mitral Valve Insufficiency ; Mitral Valve* ; Rupture ; Staphylococcus aureus ; Thrombin

BACKGROUND AND OBJECTIVES: Reverse redistribution pattern (RRP), that is defined as the worsening of the perfusion defect at rest image, can be observed in 99mTC-sestamibi (methoxy isobutyl isonitrile) myocardial scan with standard stress-rest protocol. This study was prepared to evaluate the prevalence and clinical characteristics of RRP in stress 99mTc-sestamibi myocardial scan. MATERIALS AND METHODS: We retrospectively reviewed 1304 images of 99mTC-sestamibi myocardial perfusion scan performed between January 1995 and June 1997, and scintigraphic findings were compared with clinical and angiographic data. RESULTS: The prevalence of RRP was 5.2%(68 of 1,304). RRP was noted in 6.0% (41 of 679) of the adenosine study and 4.3% (27 of 625) of the exercise study. The mean coronary artery stenosis at RRP territory was 51.5+/-38.9%. However, normal coronary artery at RRP territory was noted in 45.8% (11 of 24). There was no significant differences in luminal narrowing of coronary arteries, TIMI flow grade and LV wall motion between the patient with RRP positive and RRP negative at the infarct related artery territory. CONCLUSION: Reverse redistribution pattern on 99mTC-sestamibi myocardial SPECT does not seem to indicate the presence of significant coronary artery disease or patency of the infarct related arteries in the patients with acute MI.
Adenosine ; Arteries ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Perfusion* ; Phenobarbital ; Prevalence ; Retrospective Studies ; Technetium Tc 99m Sestamibi* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: The purpose of the study was to determine the value of exercise electrocardiography in predicting the area of myocardial ischemia. METHOD: Seventy-six anginal patients with a perfusion defect in one vessel territory on exercise 99mTc-MIBI myocardial perfusion scan were studied. Each patient underwent exercise electrocardiograhy using modified Bruce protocol. Exercise electrocardiography was interpreted as abnormal when the horizontal or downsloping depression in ST segment was 0.1 mV or greater at 80 msec after the J point during exercise. Forty-eight patients had exercise induced ST-segment depression. RESULT: Twenty-five patients had exercise induced ST-segment depression in single lead-group and 23 patients had in multiple lead-groups. In 18 patients (18/23) with exercise induced ST-segment depression in multiple lead-groups, the perfusion defect involved the apical area on myocardial perfusion scanning and in 21 patients (21/25) with ST-segment depression in single lead-group, the perfusion defect did not involve the apical area. In patients without perfusion defect in the apical area, ST-segment depression in anterior lead-group (V1 to V4) was associated with myocadial perfusion defects in left anterior descending artery territories in five of five cases (100%), ST-segment depression in lateral lead-group (I, aVL, V5, V6) was associated with defects in left circumflex artery territories in six of six cases (100%), and ST-segment depression in inferior lead group (II, III, aVF) was associated with defects in right coronary artery territories in nine of ten (90%) (p<0.01). In patients with perfusion defect in the apical area, exercise induced ST-segment depressions were observed in multiple lead-groups (18/22). CONCLUSION: ST-segment depression on 12 lead exercise electrocardiography was a good predictor of the site of myocadial ischemia in anginal patients with single vessel territory ischemia when ST-segment depression developed in single lead group. However, ST-segment depressions in mutiple lead-groups suggested that the perfusion defect involved the apical area and did not predict the site of myocardial ischemia.
Angina Pectoris* ; Arteries ; Coronary Vessels ; Depression ; Electrocardiography* ; Humans ; Ischemia ; Myocardial Ischemia ; Perfusion*