BACKGROUND: There is increasing evidence that inflammation is an important determinant of the development of atherosclerosis and that oxidation of low-density lipoprotein (LDL) obviously plays an important role in the pathogenesis of atherosclerosis. We assessed the levels of oxidized LDL and inflammatory markers in patients with ischemic heart disease and normal group who has normal coronary angiograms. METHODS: Coronary angiography was performed in 142 patients. 107 patients of ischemic heart disease (stable angina pectoris 58, unstable angina pectoris 30, acute myocardial infarction 19) and 38 normal control subjects. We assessed the level of oxidized LDL and inflammatory markers, such as CRP, ESR, fibrinogen and leukocyte. RESULTS: CRP was 3.88+/-2.05 mg/dL in acute myocardial infarction group, and 0.29+/-0.15 mg/dL in normal control subject group (p<0.05). Fibrinogen was 541.6+/-45.1 mg/dL in acute myocardial infarction group, 321.4+/-25.6 mg/dL in normal control subject group (p<0.05). Leukocyte was 10942.1+/-737.6/mm3 in acute myocardial infarction group, 6394.3+/-235.1/mm3 in normal control subject group (p<0.05). Oxidized LDL was 23.0+/-4.0 EU/mL in acute myocardial infarction group, and 16.2+/-1.5 EU/mL in normal control subject group (p<0.05). CRP, ESR and fibrinogen values of the patients with stable angina pectoris and unstable angina pectoris were higher than that of normal control group, but there were no statistical significance. Oxidized LDL (ox-LDL) and Leukocyte value of the patients with unstable angina pectoris, acute myocardial infarction was significantly higher than that of the patients with stable angina pectoris and normal control subjects (p<0.05). CRP, ESR and fibrinogen values of the patients with acute myocardial infarction were also higher than that of normal control subjects. CONCLUSION: This study demonstrate that CRP, fibrinogen and oxidized LDL, leukocyte values of acute myocardial infarction group were significantly higher than that of control group and stable, unstable angina pectoris group. Oxidized LDL and Leucokyte values were also significantly elevated in unstable angina group, but CRP values were not in unstable angina group.
Angina Pectoris ; Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Coronary Angiography ; Fibrinogen ; Humans ; Inflammation ; Leukocytes ; Lipoproteins ; Myocardial Infarction ; Myocardial Ischemia*

OBJECTIVE: This study consists of a single open clinical trial to evaluate the treatment effects of paroxetine on symptoms of hwa-byung, a Korean culture-related anger syndrome. METHODS: Eighty-nine patients with depressive disorders, anxiety disorders, somatoform disorders, or self-labeled hwa-byung were treated with paroxetine (Paxil CR) 12.5-37.5 mg/day for 8 weeks. Treatment effects were evaluated using the Hamilton Depression Scale (HAMD), the State and Trait Anger Inventory (STAXI), and the Hwa-byung Scale. RESULTS: Scores on all items ; total score on the Hwa-byung Scale ; scores on state anger, trait anger, and anger-in ; total score on the STAXI ; and total score on the HAM-D decreased significantly after eight weeks of paroxetine treatment compared to baseline. CONCLUSION: Paroxetine was shown to be effective for treating symptoms of hwa-byung, a chronic anger syndrome.
Anger ; Anxiety Disorders ; Depression ; Depressive Disorder ; Humans ; Paroxetine ; Somatoform Disorders

OBJECTIVE: Metabolic syndrome (MS) is associated with increased left ventricular (LV) mass and diastolic dysfunction. This study uses relatively load-independent Doppler tissue echocardiography to examine whether MS is associated with decreased longitudinal contractile reserve during dynamic exercise. METHODS: A total of 112 patients with relatively well-controlled, treated hypertension who complained of exertional dyspnea were enrolled (average age, 56.7+/-10.5 years). Fifty-six were non-diabetic patients with MS (group 1), and 56 were age-sex matched hypertensive patients without MS (group 2). Exercise stress echo was performed using a symptom-limited, multistage, supine bicycle exercise test. Multiple Doppler parameters were obtained at baseline, at each stage of exercise. RESULTS: There was no significant difference between the two groups in terms of age, gender, and hemodynamic variables. E/E', an index of LV filling pressure, was significantly higher in the MS group at rest and during exercise. The longitudinal contractile reserve, the change in S' (longitudinal tissue velocity) from baseline to peak exercise, was significantly lower in the MS group (2.00+/-1.65 vs. 2.90+/-1.66, P=0.015). Multiple regression analysis showed independent association of MS with longitudinal contractile reserve when controlled for confounding factors, such as LV mass index, gender, blood pressure, and age (beta=-0.235, P=0.035). CONCLUSION: Longitudinal contractile reserve was reduced in MS patients compared to others, although both groups demonstrated similar longitudinal contractile function at rest. We present the first demonstration that metabolic syndrome is independently associated with LV systolic dysfunction during exercise in hypertensive patients.
Blood Pressure ; Dyspnea ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension

Purpose: In this study, we aimed to determine the value of hypoxic liver injury (HLI) in the emergency room (ER) for predicting hypoxic hepatitis (HH) and in-hospital mortality in ST elevation myocardial infarction (STEMI) patients. Materials and Methods: 1537 consecutive STEMI patients were enrolled. HLI in the ER was defined as a ≥2-fold increase in serum aspartate transaminase (AST). HH was defined as a ≥20-fold increase in peak serum transaminase. Patients were divided into four groups according to HLI and HH status (group 1, no HLI or HH; group 2, HLI, but no HH; group 3, no HLI, but HH; group 4, both HLI and HH). Results: The incidences of HLI and HH in the ER were 22% and 2%, respectively. In-hospital mortality rates were 3.1%, 11.8%, 28.6%, and 47.1% for groups 1, 2, 3, and 4, respectively. Patients with HLI and/or HH had worse Killip class, higher cardiac biomarker elevations, and lower left ventricular ejection fraction. Multivariate logistic regression analysis showed that HLI in the ER was an independent predictor of HH [odds ratio 2.572, 95% confidence interval (CI) 1.166–5.675, p=0.019]. The predictive value of HLI in the ER for the development of HH during hospitalization was favorable [area under the curve (AUC) 0.737, 95% CI 0.643–0.830, sensitivity 0.548, specificity 0.805, for cut-off value AST >80]. Furthermore, in terms of in-hospital mortality, predictive values of HLI in the ER and HH during hospitalization were comparable (AUC 0.701 for HLI at ER and AUC 0.674 for HH). Conclusion Among STEMI patients, HLI in the ER is a significant predictor for the development of HH and mortality during hospitalization (INTERSTELLAR ClinicalTrials.gov number, NCT02800421).

Purpose: In this study, we aimed to determine the value of hypoxic liver injury (HLI) in the emergency room (ER) for predicting hypoxic hepatitis (HH) and in-hospital mortality in ST elevation myocardial infarction (STEMI) patients. Materials and Methods: 1537 consecutive STEMI patients were enrolled. HLI in the ER was defined as a ≥2-fold increase in serum aspartate transaminase (AST). HH was defined as a ≥20-fold increase in peak serum transaminase. Patients were divided into four groups according to HLI and HH status (group 1, no HLI or HH; group 2, HLI, but no HH; group 3, no HLI, but HH; group 4, both HLI and HH). Results: The incidences of HLI and HH in the ER were 22% and 2%, respectively. In-hospital mortality rates were 3.1%, 11.8%, 28.6%, and 47.1% for groups 1, 2, 3, and 4, respectively. Patients with HLI and/or HH had worse Killip class, higher cardiac biomarker elevations, and lower left ventricular ejection fraction. Multivariate logistic regression analysis showed that HLI in the ER was an independent predictor of HH [odds ratio 2.572, 95% confidence interval (CI) 1.166–5.675, p=0.019]. The predictive value of HLI in the ER for the development of HH during hospitalization was favorable [area under the curve (AUC) 0.737, 95% CI 0.643–0.830, sensitivity 0.548, specificity 0.805, for cut-off value AST >80]. Furthermore, in terms of in-hospital mortality, predictive values of HLI in the ER and HH during hospitalization were comparable (AUC 0.701 for HLI at ER and AUC 0.674 for HH). Conclusion Among STEMI patients, HLI in the ER is a significant predictor for the development of HH and mortality during hospitalization (INTERSTELLAR ClinicalTrials.gov number, NCT02800421).

No abstract available.
Endocarditis ; Sinus of Valsalva

The retrograde approach through a collateral artery is now thought to improve the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), and different kinds of strategies for this technique have been developed. However, the basic principles of PCI for CTO, such as firm back-up support with a guiding catheter and fine control of the guide wire, should be adhered to more strictly to succeed with this complex procedure. We present a case in which a CTO of the proximal left anterior descending artery was successfully opened by the retrograde approach through a collateral from the left circumflex artery, during which two guiding catheters were simultaneously used in the same coronary artery for the purpose of strong back up support for the retrograde device and fine control for the antegrade device.
Angioplasty, Balloon, Coronary ; Arteries ; Catheters ; Coronary Occlusion ; Coronary Vessels ; Percutaneous Coronary Intervention

A congenital coronary arteriovenous fistula is a rare condition, which is an abnormal communication of the coronary artery with the right or left ventricle, the right or left atrium or the pulmonary artery. A coronary arteriovenous fistula, complicated with a pulmonary aneurysm, is quite uncommon. A case of 68-year-old woman, complaining of resting chest pain for 1 week, is reported. The coronary arteriovenous fistula associated, with a pulmonary aneurysm, was confirmed by coronary angiography and multidetector-row helical CT (MDCT), and was surgically ligated.
Aged ; Aneurysm* ; Arteriovenous Fistula* ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Female ; Heart Atria ; Heart Ventricles ; Humans ; Pulmonary Artery* ; Tomography, Spiral Computed*

OBJECTIVE: To determine the optimal CT image reconstruction parameters for the measurement of early transmitral peak velocity (E), early peak mitral septal tissue velocity (E′), and E / E′. MATERIALS AND METHODS: Forty-six patients underwent simultaneous cardiac CT and echocardiography on the same day. Four CT datasets were reconstructed with a slice thickness/interval of 0.9/0.9 mm or 3/3 mm at 10 (10% RR-interval) or 20 (5% RR-interval) RR-intervals. The E was calculated by dividing the peak transmitral flow (mL/s) by the corresponding mitral valve area (cm²). E′ was calculated from the changes in the left ventricular length per cardiac phase. E / E′ was then estimated and compared with that from echocardiography. RESULTS: For assessment of E / E′, CT and echocardiography were more strongly correlated (p < 0.05) with a slice thickness of 0.9 mm and 5% RR-interval (r = 0.77) than with 3 mm or 10% RR-interval. The diagnostic accuracy of predicting elevated filling pressure (E / E′≥ 13, n = 14) was better with a slice thickness of 0.9 mm and 5% RR-interval (87.0%) than with 0.9 mm and 10% RR-interval (71.7%) (p = 0.123) and significantly higher than that with a slice thickness of 3 mm with 5% (67.4%) and 10% RR-interval (63.0%), (p < 0.05), respectively. CONCLUSION: Data reconstruction with a slice thickness of 0.9 mm at 5% RR-interval is superior to that with a slice thickness of 3 mm or 10% RR-interval in terms of the correlation of E / E′ between CT and echocardiography. Thin slices and frequent sampling also allow for more accurate prediction of elevated filling pressure.
Dataset ; Echocardiography* ; Heart Ventricles ; Humans ; Image Processing, Computer-Assisted ; Mitral Valve ; Ventricular Function

OBJECTIVES: The cloud computing-based virtual desktop infrastructure (VDI) allows access to computing environments with no limitations in terms of time or place such that it can permit the rapid establishment of a mobile hospital environment. The objective of this study was to investigate the empirical issues to be considered when establishing a virtual mobile environment using VDI technology in a hospital setting and to examine the utility of the technology with an Apple iPad during a physician's rounds as a case study. METHODS: Empirical implementation issues were derived from a 910-bed tertiary national university hospital that recently launched a VDI system. During the physicians' rounds, we surveyed patient satisfaction levels with the VDI-based mobile consultation service with the iPad and the relationship between these levels of satisfaction and hospital revisits, hospital recommendations, and the hospital brand image. Thirty-five inpatients (including their next-of-kin) and seven physicians participated in the survey. RESULTS: Implementation issues pertaining to the VDI system arose with regard to the highly availability system architecture, wireless network infrastructure, and screen resolution of the system. Other issues were related to privacy and security, mobile device management, and user education. When the system was used in rounds, patients and their next-of-kin expressed high satisfaction levels, and a positive relationship was noted as regards patients' decisions to revisit the hospital and whether the use of the VDI system improved the brand image of the hospital. CONCLUSIONS: Mobile hospital environments have the potential to benefit both physicians and patients. The issues related to the implementation of VDI system discussed here should be examined in advance for its successful adoption and implementation.
Adoption ; Androsterone ; Electronic Health Records ; Empirical Research ; Field Hospitals ; Hospital Information Systems ; Humans ; Hypogonadism ; Inpatients ; Mitochondrial Diseases ; Ophthalmoplegia ; Patient Satisfaction ; Privacy