Platelets play a central role in the pathogenesis of atherothrombosis. Dual antiplatelet therapy with clopidogrel plus aspirin has been shown to reduce ischemic events in patients undergoing percutaneous coronary intervention (PCI) and stenting. Although dual antiplatelet therapy reduces the risk of cardiovascular episodes after PCIs, a substantial number of incidents continue to occur. Many cardiologists have focused their attention to the relationships between the interindividual variability of platelet inhibition after aspirin or clopidogrel administration and major cardiac adverse events such as stent thrombosis. Recent evidence has suggested that "aspirin or clopidogrel resistance" is associated with poor health outcomes (recurrent atherothrombotic events and stent thrombosis) after drug eluting stent (DES) implantation. However, the current clinical guidelines do not support routine screenings for antiplatelet resistance because standardized objective screening has not yet been established. Thus, this review describes the antiplatelet therapy used in PCI and it outlines the mechanism, laboratory tests, clinical impact and treatment options for aspirin and clopidogrel resistance in the DES era.
Angioplasty ; Aspirin* ; Blood Platelets ; Drug Resistance ; Humans ; Mass Screening ; Percutaneous Coronary Intervention ; Stents* ; Thrombosis

BACKGROUND: Red blood cell (RBC) sorbitol has been implicated in the pathogenesis of organic complications of diabetes mellitus. W8 investigated RBC sorbitol level as an indicator of glucose control or diabetic complications, and also evaluated whether RBC sorbitol/plasma glucose ratio is an indicator of diabetic complications. METHODS: RBC sorbitol levels were measured in 43 healthy persons and 133 diabetes mellitus (DM) patients by enzymatic method. We also tested linearity, inter- and intra- assay precisions. Plasma glucose and Hb Alc were measured by hexokinase method and HPLC, respectively. Hospital records were reviewed. RESULTS: The intra- and inter-assay coefficients of variation of RBC sorbitol test are 8.7% and 28.5%, respectively. Linearity is good. The RBC sorbitol level(3.60+/-1.00 ug/mL) and RBC sorbitol/plasma glucose ratio (2.37+/-0.98%) in diabetic patients are significantly higher than those in normal control (1.69+/-0.43 ug/mL, 1.85+/-0.49 per mill), respectively(p<0.0001). We can't observe correlation between RBC sorbitol and Hb Alc in BM patients, but observe that in non-treatment DM patients. We also observed correlation between Hb Alc and glucose and reverse correlation between RBC sorbitol ratio and Hb Alc. We can't find significant relation between diabetic complications and RBC sorbitol or RBC sorbitol/plasma glucose. CONCLUSIONS: We suggest that the reference range of normal RBC sorbitol level and RBC sorbitol/plasma glucose ratio by enzymatic method are 1.69+/-0.86 ug/mL and 1.85+/- 0.98%,. These Ire significantly different from DM patients and may be useful in diagnosis of DM.
Blood Glucose ; Chromatography, High Pressure Liquid ; Diabetes Complications ; Diabetes Mellitus* ; Diagnosis ; Erythrocytes ; Glucose ; Hexokinase ; Hospital Records ; Humans ; Reference Values ; Sorbitol*

BACKGROUND: Red blood cell (RBC) sorbitol has been implicated in the pathogenesis of organic complications of diabetes mellitus. W8 investigated RBC sorbitol level as an indicator of glucose control or diabetic complications, and also evaluated whether RBC sorbitol/plasma glucose ratio is an indicator of diabetic complications. METHODS: RBC sorbitol levels were measured in 43 healthy persons and 133 diabetes mellitus (DM) patients by enzymatic method. We also tested linearity, inter- and intra- assay precisions. Plasma glucose and Hb Alc were measured by hexokinase method and HPLC, respectively. Hospital records were reviewed. RESULTS: The intra- and inter-assay coefficients of variation of RBC sorbitol test are 8.7% and 28.5%, respectively. Linearity is good. The RBC sorbitol level(3.60+/-1.00 ug/mL) and RBC sorbitol/plasma glucose ratio (2.37+/-0.98%) in diabetic patients are significantly higher than those in normal control (1.69+/-0.43 ug/mL, 1.85+/-0.49 per mill), respectively(p<0.0001). We can't observe correlation between RBC sorbitol and Hb Alc in BM patients, but observe that in non-treatment DM patients. We also observed correlation between Hb Alc and glucose and reverse correlation between RBC sorbitol ratio and Hb Alc. We can't find significant relation between diabetic complications and RBC sorbitol or RBC sorbitol/plasma glucose. CONCLUSIONS: We suggest that the reference range of normal RBC sorbitol level and RBC sorbitol/plasma glucose ratio by enzymatic method are 1.69+/-0.86 ug/mL and 1.85+/- 0.98%,. These Ire significantly different from DM patients and may be useful in diagnosis of DM.
Blood Glucose ; Chromatography, High Pressure Liquid ; Diabetes Complications ; Diabetes Mellitus* ; Diagnosis ; Erythrocytes ; Glucose ; Hexokinase ; Hospital Records ; Humans ; Reference Values ; Sorbitol*

We evaluated the hypolipidemic effect and adverse reaction of Lovastatin, HMG-CoA reductase inhibitor 20 to 40mg once-daily in the evening, in 20 patients with primary hypercholesterolemia for 12 weeks and the following results were obtained. 1) Lovastatin significantly reduced the total cholesterol(from 264.8+/-12.9mg/dl to 195.3+/-31.3mg/dl) by 26.3%, TG(from 191.1+/-41.5mg/dl to 156.2+/-52.9mg/dl) by 18.3%, LDL-C(from 177.0+/-12.4mg/dl to 121.3+/-19.6mg/dl) by 31.5% and increased th HDL-C (from 39.8+/-4.2mg/dl to 41.6+/-5.0mg/dl) by 4.5% at the end of 12th week. 2) The adverse reaction during the period of study were limited to diarrhea and nausea in one patient, dryness of skin and itching in one patient, and no patients was withdrawn form therapy. In this study, Lovastatin was well toterated and effective agent for the treatment of hypercholesterolemia without serious side effects.
Diarrhea ; Humans ; Hypercholesterolemia* ; Lovastatin ; Nausea ; Oxidoreductases ; Pruritus ; Skin

The high level of low density lipoprotein (LDL) is a risk factor for cardiovascular disease. Apolipoprotein (apo) B is a major protein component of LDL and plays an important role in the maintenance of cholesterol homeostasis. In this study, six polymorphic sites of the apoB gene were anlaysed in 235 patients with coronary artery disease (CAD) and 216 normal control subjects. There were no significant differences in the allele frequencies of apoB polymorphisms between the control and patient groups. However, haplotype frequencies were significantly different between the CAD patients and control (p<0.05). In addition, the allelic distributions of both EcoRI and MspI polymorphisms in Koreans were similar to those in Chinese but significantly different from those in Caucasians. ApoB polymorphisms showed no association with plasma lipid levels. In conclusion, haplotype analysis of the apoB gene using multiple diallelic markers might be a useful marker for Korean CAD patients.
Adult ; Apolipoproteins B/*genetics ; Coronary Arteriosclerosis/*genetics ; Female ; Gene Frequency ; Genetic Markers ; Haplotypes ; Human ; Korea ; Male ; Middle Age ; Polymorphism (Genetics) ; Variation (Genetics)

BACKGROUND: Left atrial thrombus(LAT) has long been recognized as a complication of mitral stenosis(MS).The transesophageal echocardiographic approach readily visualize LAT. We evaluated the risk factors for left atrial thrombus in patients with MS using transthoracic(TTE) and transesophageal echocardiography(TEE). METHODS AND RESULTS: One hundred and forty-three(patients) who had moderate to severe MS were consecutively studied with TTE and TEE. They were 43 males(30%) and 100 females(70%).The mean age was 44+/-11 years(range 21-70). Twenty-five patients had at least one episode of embolic events. Ninety-six patients were in atrial fibrillation(AF). LAT was detected in 30 pts(21%) : 16 had thrombus confined to the LA appenge(LAA), 14 to true LA cavity and/or LAA. TTE variables were compared between LAT group and non-LAT group. Univariate predictors of LAT were mitral valve area(MVA)(0.78+/-0.22cm2 vs 1.05+/-0.32cm2, p=0.001), pressure half time(353+/-88ms vs 258+/-118ms, p=0.002). LV ejection fraction(EF)(55+/-11% vs 62+/-8%,p=0.008), LA size (58+/-11mm vs 52+/-7mm, p=0.033) and AF(p=0.001). Stepwise logistic regression analysis revealed significant independent predictors of LAT to be AF(p=0.02), MVA(p=0.02) and EF(p=0.03). CONCLUSION: Left atrial thrombus was not uncommon in patients with rheumatic mitral stenosis. Small mitral valve area and reduced ejection fraction of left ventricle appear to be significant predictors of LAT in mitral stenosis with atrial fibrillation.
Atrial Fibrillation ; Echocardiography* ; Heart Ventricles ; Humans ; Logistic Models ; Mitral Valve ; Mitral Valve Stenosis* ; Risk Factors ; Thrombosis*

Pulmonary vein stenosis is a rare condition which is usually congenital in origin and is almost invariably fatal in its bilateral and severe forms. It is often overlooked, however, during clinical examination, routine echocardiography, and even at cardiac catheterization. This report describes pulsed Doppler, color flow echocardiography, and hemodynamic findings of bilateral pulmonary vein stenosis accompanying ventricular septal and atrial septal defects successfully corrected by surgery.
Cardiac Catheterization* ; Cardiac Catheters* ; Catheterization ; Constriction, Pathologic* ; Echocardiography ; Echocardiography, Doppler, Color* ; Heart Septal Defects, Atrial ; Hemodynamics ; Pulmonary Veins*

PURPOSE: This study was designed to evaluate diagnostic accuracy of serial electrocardiograms(ECG), myocardial band of creatinine phosphokinase(CK)(CK-MB/CK ratio) and two dimensional echocardiography(ECHO) for myocardial injury in patients with blunt chest trauma. METHODS: We prospectively investigated 54 patients(male : 38, female : 16, mean age : 41) with severe blunt chest trauma. Presence of myocardial injury was determined by increase(>0.1ug/L) of peak serum troponin T(TnT) concentration from serial mesurements. RESULTS: Among 54 patients with blunt chest trauma, 23 patients(43%) had increased peak TnT level which suggested of myocardial injury. Among 23 patients with increased TnT, abnormal ECG findings were found in 18(78%) and echocardiographic abnormalities were observed in 17(74%). Cardiovascular events in 9(39%) of 23 patients with increase Tnt. There was no cardiovascular events in patients with normal TnT. CONCLUSION: Significant proprotion of patients with blunt chest trauma had elevated TnT value which suggested of myocardial injury. We recommend echocardiagraphy and serial tracing of ECG to verify the clinical significance of elevated TnT in patients with blunt chest trauma.
Creatinine ; Diagnosis* ; Echocardiography ; Electrocardiography ; Female ; Humans ; Prospective Studies ; Thorax* ; Trinitrotoluene ; Troponin ; Troponin T

Advances in percutaneous coronary intervention (PCI) and peri-procedural potent antithrombotic treatments during the past decade have dramatically improved the outcomes of ischemic heart disease. The femoral artery is the vascular route used in PCI in most catheterization labs. However, when the femoral artery is used as the approaching vessel, local hemorrhagic complication is not rare in the era of potent antithrombotics. Recent studies have suggested that peri-procedural bleeding complications after PCI are associated with increased short- and long-term morbidity and mortality. On the other hand, there has been growing interest in transradial PCI due to rare complications at the puncture site, patient conveniences, early discharge and shortened hospitalization periods. Furthermore, the indications of transradial PCI are expanding to the complex lesion subsets due to the miniaturization of devices used, improvement of devices and techniques, and accumulated experience with the use of transradial PCI. In this review, we discuss the data of transradial PCI as a potential default route in coronary artery interventions, as well as other issues that may raise concerns with transradial PCI.
Angioplasty ; Catheterization ; Catheters ; Coronary Vessels ; Femoral Artery ; Glycosaminoglycans ; Hand ; Hemorrhage ; Hospitalization ; Humans ; Miniaturization ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Punctures ; Radial Artery

PURPOSE: The purpose of this study was to evaluate the occurrence of displacement while tightening the screw of scan bodies, which were compared according to the material type. MATERIALS AND METHODS: Three types of scan bodies whose base regions were made up of polyether ether ketone (PEEK) material [Straumann Group, Dentium Group, and Myfit (PEEK) Group] and another scan body whose base region was made up of titanium material [Myfit (Metal) Group] were used (15 per group). The reference model was fabricated by aligning the scan body library on the central axis of the implant, and moving this position by the resin model. The screws of the scan bodies were tightened to the implant fixture with torques of 5 Ncm, 10 Ncm, and a hand tightening torque. After the application of the torque, the scan bodies were scanned using a laboratory scanner. To evaluate the vertical, horizontal, and 3-dimensional (3D) displacements, a 3D inspection software program was used. To examine the difference among groups, one-way analysis of variance and Tukey’s HSD post hoc test were used (α=.05). RESULTS: There were significant differences in 3D, vertical, and horizontal displacements among the different types of scan bodies (P<.001). There was a significantly lower displacement in the Straumann group than in the Myfit (PEEK) and Dentium groups (P<.05). CONCLUSION The horizontal displacement in all groups was less than 10 µm. With the hand tightening torque, a high vertical displacement of over 100 µm occurred in PEEK scan bodies (Myfit and Dentium). Therefore, it is recommended to apply a tightening torque of 5 Ncm instead of a hand tightening torque.