BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin

BACKGROUND: Evaluating the segmental wall motion of left ventricle is important in patients with myocardial infarction for choosing therapeutic modality and predicting prognosis. Radionuclide Multigated Angiography(MUGA) is a reliable noninvasive method for the evaluation of left ventricular performance. Methods : MUGA scan(LV ejection fraction, phase image histogram, regional wall motion) was performed and analyzed in 45 patients with myocardial infarction(31 : acute MI, 14: old MI) and 13 normal controls. RESULTS: 1) The LVEF of acute and old MI group was significantly reduced and the SDph of acute and old MI group was significantly increased as compared with that of control group(p<0.05). 2) In acute MI group, the LVEF of group without, IV Urokinase was more reduced than that of group with IV Urokinase and the SDph of group without IV Urokinase was more increased than that of group with IV Urokinase(p<0.05). As a result of wall motion scoring, the linear correlation exists between SDPh and sum of wall motion scoring(r=0.62, p<0.01). 3) In MI group, the LVEF of anterior wall MI was more reduced than that of inferior wall MI and the SDPh of anterior wall MI was more increased than that of inferior wall MI(p<0.05). 4) In acute anterior wall MI, the reverse correlation exists between LVEF and SDPh and the linear correlation exists between sum of wall motion scoring and SDPh(r=-0.73, 0.72, p<0.01). But there are no statistical significances of correlation between them in acute inferior MI(r=-0.44, 0.42, p>0.05), in old anterior MI(r=-0.65, 0.47, p>0.05) and in old inferior MI(r=-0.47, 0.46, P>0.05). CONCLUSION: These results suggest that Phase angle(SDPh) is thought to be valuable index to evaluate left ventricular function with application of other indeces in Myocardial infarction. Left ventricular function measured by SDph in acute or anterior MI is lower than old or inferior MI.
Heart Ventricles ; Humans ; Myocardial Infarction* ; Prognosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

BACKGROUND: Efficacy of percutaneous transluminal angioplasty(PTA) in the treatment of Peripheral arterial disease has been established. Complications such ans PTA-induced dissections or residual stenosis with occasional mural thrombi have been reported, which compromise the results. New procedures can be used in combination with PTA to improve the immediate and long term results, such ans prolonged balloon inflation, atherectomy, or implantation of endovascular prosthesis. In addition, the occurrence of other lesions, such as spontaneous or post-catheterization dissection or post-PTA restenosis, has prompted the insertion of a vascular stent. But there was few reports on stenting for peripheral arterial disease in Korea. METHODS: To evaluate the safety, efficacy and stability of stent in peripheral arterial disease, twenty-six consecutive symptomatic patients with 37 peripheral lesions were treated with 39 balloon expandable(33 Strecker and 6 Palmaz)stents with or without prior balloon angioplasty in the period of March 1991 and February 1994. RESULTS: The major cause of disease was arteriosclerosis(22 out of 26). The implantation sites for our study include 22 in common iliac artery, 11 in external iliac artery 2 in aorta, subclavian artery, superficial femoral artery each other. Indication for stent deployment were primarily suboptimal results(19 lesions), insufficient PTA such as dissections(4), restenosis after previous PTA(2), and primary stenting was performed without preceding therapeutic PTA(10). Stent deployment was technically successful in 24 of the 26 patients(92%) and clinical success rate was in 25 of the 26 patients treated(96%). Hemodynamic change revealed markedly improvement before and after stenting(peak pressure difference from 66.329.0mmHg to 9.1+/-7.1mmHg; Mean pressure difference from 33.0+/-22.5mmHg to 4.7+/-4.3mmHg). There were two procedural complications which included one stent migration and one artery perforation. During the 7 months of follow-up(1-18 momths), two restenosis occurred. One patient died due to cerebral hemorrhage during thrombolysis with urokinase. CONCLUSION: The stent deployment is relatively safe and very effective primary therapeutic modality and may abolish the limitation of PTA such as suboptimal result, dissection with sudden occlusion and restenosis in peripheral vascular disease and highly recommended in selected cases.
Angioplasty, Balloon ; Aorta ; Arteries ; Atherectomy ; Cerebral Hemorrhage ; Constriction, Pathologic ; Femoral Artery ; Hemodynamics ; Humans ; Iliac Artery ; Inflation, Economic ; Korea ; Peripheral Arterial Disease* ; Peripheral Vascular Diseases ; Prostheses and Implants ; Stents* ; Subclavian Artery ; Urokinase-Type Plasminogen Activator

In order to investigate the efficacy and safety of oral fosinopril, a new phosphorus containing angiotensin converting enzyme inhibitor, a single dose of 10 to 20mg was administered in 23 hypertensive patients with diastotic blood pressure above 95mmHg and all other anti-hypertensive agents were not administered during 4 weeks of study. Blood pressure and heart rate were measured on the 2nd and 4th week of therapy. The complete blood count with platelet count, blood chemistry by SMA-12 and serum electrolytes were performed at the begining and 4th week of therapy. The urinalysis and electrocardiography were performed at the beginning and 4th week of therapy. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) At the beginning and 4th weeks of therapy, the average systolic and diastolic pressure were 170.0+/-17.6/101.6+/-6.1mmHg, 142.7+/-15.1/87.3+/-6.7mmHg respectively. The systolic and diastolic blood pressure were declined statistically significantly(p<0.05) throughout the period of treatment and diastolic blood pressure of all subjects except 3 patients(86%) was maintained below 90mmHg after 4th week of treatment. 2) There was no significant change in the pulse rate before and after therapy. 3) There were no significant changes in blood chemistry, serum electrolytes, hematologic findings, urinalysis and electrocardiographic findigns. 4) side effect were developed in 5 patients(23%) with dry cough, 3 patients(13%) with headache and 2 patients with facial edema but side effects were mostly mild in nature without potenitally serious episodes. These results suggested that antihypertensive therapy with onec-daily fosinopril was effective and well tolerated in essential hypertensive patients.
Antihypertensive Agents ; Blood Cell Count ; Blood Pressure ; Chemistry ; Cough ; Edema ; Electrocardiography ; Electrolytes ; Fosinopril* ; Headache ; Heart Rate ; Humans ; Hypertension ; Peptidyl-Dipeptidase A ; Phosphorus ; Platelet Count ; Urinalysis

BACKGROUND: The visceral fat obesity is known to be associated with coronary artery disease. We investigated the relation between visceral fat obesity and the severity of coronary artery disease by angiography. METHODS: The coronary artery disease (CAD) group included 54 angina patients (43 men and 11 women) with angiographically demonstrated coronary artery disease. The control group included angiographically normal 28 controls (15 men and 13 women). The subjects with hypertension, non-insulin dependent diabetes mellitus (NIDDM) and taking any medication known to affect the insulin sensitivity were excluded. We measured the visceral fat area, abdominal subcutaneous fat area, thigh muscle area and the thigh fat area with computed tomography (CT) in both groups. We measured the plasma lipid profile, fasting plasma insulin and glucose level in both groups. RESULTS: There were no differences in the age, sex ratio and body mass index (BMI) between both groups. Total cholesterol and triglyceride increased in CAD group significantly (p<0.05, p<0.001). The HDL cholesterol decreased in CAD group. But there was no statistical significance (p=0.056). The fasting insulin increased in CAD group significantly (p<0.001). There were significant differences between CAD group and the control group in the visceral fat area (117.8+/-34.4 cm2vs. 85.5+/-17.6 cm2, p<0.001), thigh fat area (50.0+/-22.3 cm2vs. 65.8+/-12.9 cm2, p<0.001), visceral fat to abdominal subcutaneous fat area ratio (VS ratio:0.81+/-0.31 vs. 0.51+/-0.15, p<0.001) and the visceral fat to thigh fat area ratio (VSFTF ratio:2.72+/-1.24 vs. 1.34+/-0.35, p<0.001). In the male subgroup (CAD:43, control:15), triglyceride and fasting insulin increased in CAD group significantly (p<0.001). The visceral fat area, VS ratio, and VSFTF ratio increased in CAD group significantly (P<0.001) The thigh fat area decreased in CAD group significantly (P<0.001). In the female subgroup (CAD:11, control:13), fasting insulin and visceral fat area increased in CAD group significantly (p<0.001, p<0.05). Multiple logistic regression analysis revealed that VSFTF ratio, fasting insulin and the HDL cholesterol were independent associated factors of coronary artery disease. In comparison with normal control, one-vessel disease and multi-vessel disease (two vessel and three vessel), there were significant differences between groups in fasting insulin, triglyceride, visceral fat area, thigh fat area, VS ratio, VSFTF ratio. In Turkey's HSD Post Hoc test, however, there were no significant differences between one-vessel disease and multi-vessel disease. CONCLUSION: We observed significant increases in the visceral fat area, VS ratio and VSFTF ratio and decrease in thigh fat area in angiographically demonstrated CAD group compared with age, BMI matched angiographically normal control. But we did not observed any relation between the visceral fat area and the severity of coronary disease by angiography.
Angiography ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Diabetes Mellitus ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Intra-Abdominal Fat* ; Logistic Models ; Male ; Obesity* ; Plasma ; Sex Ratio ; Subcutaneous Fat, Abdominal ; Thigh ; Triglycerides

Lipoprotein(a)[Lp(a)] is a LDL-like particle with a glycoprotein called apo(a) attached to its apoB through disulfide bond. Many case-control studies support the opinion that plasma Lp(a) levels were associated with coronary artery disease. This study was conducted to assess the relationship between plasma Lp(a) level and coronary artery disease in Korean population. Serum levels of Lp(a), in addition to other lipids and known clinical risk factors for coronary artery disease were determined in 92 subjects undergoing coronary angiography. Among them 30 patients had no obstruction in the coronary artery(cath-control group), while the others revealed the presence of coronary artery stenosis more than 50%(CAD group). The Lp(a) levels of the CAD group were significantly higher the those of cath-control group(31.8+/-25.0mg/dl vs 14.6+/-11.9mg/dl, p<0.005). Other lipids except triglycerides(166.9+/-70.5mg/dl vs 116.2+/-56.1mg/dl, p<0.005) were not significantly different between two groups. The patients with significant coronary artery disease of two or more vessels were found to have higher Lp(a) levels than those of one vessel disease. Lp(a) levels had no relations with other lipids, diabetes, smoking, hypertension and age. Stepwise discriminant analysis revealed that Lp(a) was the best discriminator among risk factors for coronary artery disease. These results suggested that Lp(a) level was a significant independent risk factor for coronary artery disease.
Apolipoproteins B ; Case-Control Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Glycoproteins ; Humans ; Hypertension ; Lipoprotein(a)* ; Plasma ; Risk Factors* ; Smoke ; Smoking

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Fibrinogen* ; Plasma*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Fibrinogen* ; Plasma*

Neovascularization of the adventitial vasa vasorum with extension into the intima of atherosclerotic lesions is frequently observed, but its pathophysiological significance is still subject to debate. Recently, leptin, the product of the Ob gene, was identified. Leptin, via activation of the endothelial receptor (Ob-R), generates a growth signal involving a tyrosine kinase-dependent intracellular pathway and promotes angiogenic processes. We hypothesized that a high concentration of leptin within vasa vasorum and plaque itself, may influence inflammatory and vascular neovascularization coupling with functional upregulation of the vascular endothelial growth factor (VEGF). Microscopic computerized tomography was utilized for the spatial distribution of vasa vasorum and intimal neovascularization from atherosclerotic human coronary arteries. Atherosclerotic coronary arteries showed a dense plexus of microvessels in the adventitia and plaque itself. Microscopic analysis from human atherosclerotic aortas revealed an increase in the intimal thickness with neovascularization. The immunoreactivity for Ob-R, VEGF and matrix metalloproteinase (MMP) increased in atherosclerotic plaque, predominantly in the endothelial lining of the intimal neovessel and macrophages/foam cells. Our observation of a prominent colocalization between Ob-R, VEGF and MMP supports this hypothesis and these factors participate in the neovascularization of atherosclerotic lesions. The present study is the first report on vascular tissue and it opens a promising perspective concerning future investigations of leptin-dependent modulation of atherogenesis and vascular neovascularization under pathophysiolgical conditions.
Adult ; Arteriosclerosis/physiopathology ; Arteriosclerosis/pathology ; Arteriosclerosis/metabolism* ; Blood Vessels/pathology ; Blood Vessels/metabolism ; Carrier Proteins/physiology ; Carrier Proteins/metabolism* ; Human ; Middle Age ; Neovascularization, Pathologic/physiopathology