BACKGROUND AND OBJECTIVES: The assessment of CT-derived coronary artery calcification (CAC) has been used as a surrogate measurement for coronary atherosclerosis. However, the blooming artifact caused by CAC on MDCT is the potential limitation when evaluating the coronary artery stenosis. The aim of this study was to classify the morphologic characteristics of CAC on MDCT and to test whether this new classification predicts the stenotic severity on coronary angiography. SUBJECTS AND METHODS: A total of 73 CAC lesions were observed on 64 slice MDCT in the 56 enrolled patients (M:F=33:23, mean age: 66+/-9.3 years) who underwent coronary angiography. The morphologic types of CAC on 64-slice MDCT were classified into four groups [degree of stenosis (S), shape of the calcification (M), length of the calcification (L) and the number of calcified vessels (N)] with using a scoring system, and this morphologic classification was compared with the angiographic severity of coronary stenosis. RESULTS: Diffuse (L3), elongated (M2) and multi-vessel (N2) calcified lesions were significantly associated with angiographic coronary artery stenosis (p=0.03, p=0.019 and p=0.002, respectively) On the multivariate regression analysis, multivessel CAC was the only independent predictor for significant coronary artery stenosis [p=0.019, beta=3.77, CI: 1.23-11.5 (95%)]. The type of stenosis (luminal narrowing > or =50%) accompanying CAC on MDCT was not correlated with the angiographically determined stenosis (p=0.13). A total morphologic score less than 4 had a negative predictive value of 78% for predicting significant coronary artery stenosis. CONCLUSION: Our results suggest that the diffuse and multi-vessel CAC on MDCT can predict the coronary artery stenosis; however, the stenosis severity of the lesion accompanying CAC on MDCT might not coincide with the angiographic severity. Therefore, the morphologic classification with this scoring system should be considered for use when evaluating lesion with CAC on MDCT.
Artifacts ; Calcification, Physiologic ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Humans

BACKGROUND AND OBJECTIVES: Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD). SUBJECTS AND METHODS: The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death. RESULTS: In the CAD patients with a uric acid level < or =3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p<0.001). CONCLUSION: The serum uric acid level and multi-vessel disease are associated with subsequent cardiovascular events in the patients with CAD.
Acute Coronary Syndrome ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Death, Sudden, Cardiac ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Stroke ; Transplants ; Uric Acid*

BACKGROUND AND OBJECTIVES: Although the rate of prescribing hydroxylmethyglutaryl-CoA reductase inhibitors (statin) has recently increased, there is a large treatment gap between the guidelines and actual clinical practice. We studied the effect of high potency statin on the percentage of patients who achieve the target low density lipoprotein (LDL) cholesterol level, and we determined the changes of lipid profiles with using 10 mg of rosuvastatin and 20 mg of atorvastatin. MATERIALS AND METHODS: 222 consecutive patients with acute coronary syndrome or acute ischemic stroke were randomly assigned to either the group treated with rosuvastatin 10 mg (Group I) or atorvastatin 20 mg (Group II). We compared the percentage of patients who achieved the target LDL cholesterol level, and the percent change of the serum lipid profile from baseline to the 40th week between the two groups. RESULTS: 117 (52.7%) patients completed this study. When the target LDL cholesterol level was <100 mg/dL, there was no significant difference in the target attainment rate between the two groups (86.7% vs. 77.2%; respectively, p=0.182). When the target LDL cholesterol level was <70 mg/dL, 48.3% of Group I and 29.8% of Group II reached the goal (p=0.040). The LDL cholesterol level was reduced by 46.8% in Group I (p<0.001), and by 40.1% in Group II (p<0.001). However, the final level showed a trend to be lower in the rosuvastatin group (p=0.077). There were no serious side effects in both groups. The study drug was discontinued due to adverse events in 2 patients (2.6%) of Group I, and in 3 patients (3.8%) of Group II (p=0.523). CONCLUSION: This study showed that the reduction of LDL cholesterol was not statistically different between rosuvastatin 10 mg and atorvastatin 20 mg. However, fewer than half of the patients achieved the goal in both groups despite of high potency statin therapy. This suggests that more aggressive statin therapy is preferred for high risk patients.
Acute Coronary Syndrome ; Cholesterol ; Cholesterol, LDL ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Lipoproteins ; Oxidoreductases ; Stroke ; Atorvastatin Calcium ; Rosuvastatin Calcium

BACKGROUND AND OBJECTIVES: Measurements obtained using an intracoronary electrocardiogram (IC-ECG) reflect the electrical activity in various regions of the myocardium. This technique can be easily used in the catheterization laboratory during percutaneous coronary intervention (PCI) procedures. Furthermore, IC-ECG could be used to evaluate myocardial viability in patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the usefulness of IC-ECG in predicting the microvascular integrity and late improvement of left ventricular (LV) function after primary PCI in patients with AMI. SUBJECTS AND METHODS: A total of 78 patients (62 male, 16 female) who underwent primary PCI with stent implantation were enrolled in this study. After the implantation of the stent, IC-ECG was recorded from the tip of an insulated angioplasty guidewire before and after balloon occlusion of the infarct-related artery. The IC-ECG was obtained from the inferior and inferolateral areas in inferior wall MI, or apex and apical anterior wall regions in anterior wall MI. Significant ST segment elevation was defined as a further ST segment elevation of > or =0.2 mV at 80 msec after the J-point in comparison to the baseline value. The microvascular integrity of the myocardium was evaluated by myocardial contrast echocardiography (MCE) one day after the PCI was performed. Six months later, all of the patients were followed up by echocardiography and the wall motion score index (WMSI) and ejection fraction (EF) were measured. RESULTS: Significant ST elevation was noted in 47 patients (Group A) after coronary occlusion. There was no significant change in the other 31 patients (Group B). MCE showed microvascular perfusion in 41 patients in group A (87%) and in four patients in group B (13%) (p<0.05). The six-month follow-up echocardiography showed that group A had a lower WMSI (1.20+/-0.18 vs 1.56+/-0.34, p<0.05) and higher EF (57.6+/-7 vs 47+/-11, p<0.05) than group B. The LV end diastolic dimension (LVEDD) in group B was increased compared to group A (p=0.021). The LV end systolic dimension (LVESD) was also increased in group B; however, the LVESD in group A was decreased after six months (p=0.002). CONCLUSION: IC-ECG during PCI is a simple and useful method for assessing the microvascular integrity of the myocardium and for predicting the long-term improvement of LV function.
Angioplasty ; Arteries ; Balloon Occlusion ; Catheterization ; Catheters ; Coronary Occlusion ; Echocardiography ; Electrocardiography* ; Follow-Up Studies ; Humans ; Male ; Myocardial Infarction* ; Myocardium ; Percutaneous Coronary Intervention* ; Perfusion ; Stents ; Ventricular Function

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 AND OBJECTIVES: The dominant mode of cell death in cardiomyocytes under acute ischemic insult, either necrosis or apoptosis, remains to be clearly shown. MATERIALS AND METHODS: Cultured neonatal rat ventricular myocytes (NRVM) were incubated under hypoxic (mixture gas of 95%N2/5%CO2 in glucose containing media), ischemic (hypoxia plus glucose depletion in the media), ischemic and acidic conditions (ischemia with media pH 7.1). The level of cell death was assessed by trypan blue staining. To differentiate the mode of cell death, genomic DNA extraction and electrophoresis, Annexin V/propodium iodide staining, western blot for caspase activation and transmission electron microscopy were employed. RESULTS: The number of cell deaths in the NRVM cultured under hypoxic conditions was similar to that of the controls. The rate of cell death was significantly increased in the NRVM cultured under ischemic conditions, and was accelerated further in an acidic milieu, which simulated the accumulation of metabolic byproducts in ischemia. No signs of apoptotic cell death were observed in the NRVM cultured under ischemic conditions. The morphological examination of the cells in ischemia mostly revealed necrotic death. CONCLUSION: The presence of glucose protected the cardiomyocytes from cell death under hypoxic conditions. Incubation of the NRVM in ischemia resulted in increased cell deaths, which was accelerated in an acidic milieu. In our model of acute ischemia, without reoxygenation, the cardiomyocyte cell deaths appeared to be primarily induced via necrosis rather than apoptosis.
Animals ; Apoptosis ; Blotting, Western ; Cell Death* ; DNA ; Electrophoresis ; Glucose ; Hydrogen-Ion Concentration ; Ischemia ; Microscopy, Electron, Transmission ; Muscle Cells ; Myocytes, Cardiac* ; Necrosis ; Rats ; Trypan Blue

BACKGROUND AND OBJECTIVES: The Vascular system exhibits altered morphological and functional properties during hypertension and after anti-hypertensive therapy. To characterize such changes, the contractile, histological and molecular responses in the common carotid arteries (CCA) were compared in 35 rats. MATERIALS AND METHODS: By partial transverse aortic constriction (TAC), the right CCAs were made to lie under a high pressure environment, while the left CCAs remained under normotension, the latter being used as control vessels. The ligations were removed after two weeks, to enable the recovery process to begin. RESULTS: The vessel contractility, two weeks after the TAC, was nearly abolished. The recovery process from high pressure showed an initial hypercontractile period of around 1-2 week after recovery, prior to the subsequent decline to a normal contractility after 2 weeks. The relaxation response due to acetylcholine was minimal at the end of the hypertensive period, recovered slowly, and reached a normal magnitude after 4 weeks. A high pressure increases the medial thickness & area, and enhances the adventitial tissue formation. These changes persist during the first 4 weeks of recovery, after which normotension returns. Apoptosis at the endothelial layer was significantly increased two weeks after the TAC, but normalized two weeks after recovery. The expression of ecNOS was not detect 2 weeks after the TAC, but gradually returned to a basal level at 2 weeks after the untying. CONCLUSION: A high blood pressure causes decreases in the contractility and endothelium-dependent relaxation. It also increases endothelial apoptosis, the medial thickness & area, and enhances the adventitial tissue formation. The recovery processes from high blood pressure are not uniform, but show different normalizations among the structural, contractile and apoptotic parameters.
Acetylcholine ; Adventitia ; Animals ; Apoptosis ; Arteries ; Carotid Arteries* ; Carotid Artery, Common ; Constriction ; Hypertension ; Ligation ; Nitric Oxide ; Rats* ; Relaxation

Adenosine is well known as a safe and effective drug for the termination of paroxysmal supraventricular tachycardia (PSVT), and is also widely used for the termination of both narrow and wide QRS-complex tachycardia of unknown origin in the setting of hemodynamic stability. However, due to a shortening of atrial refractoriness, adenosine can facilitate the induction of atrial fibrillation. A life threatening tachycardia may result from a potential rapid conduction of the atrial fibrillation over an accessory pathway. A case of patient, where the intravenous administration of adenosine, during regular, narrow QRS tachycardia, was followed by atrial fibrillation with rapid conduction over a manifest accessory pathway, is reported.
Adenosine* ; Administration, Intravenous ; Atrial Fibrillation* ; Hemodynamics ; Humans ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

Left pulmonary artery agenesis, accompanied by a coronary arterial fistula, is a very rare anomaly. Although unilateral pulmonary artery agenesis is associated with other cardiovascular defects, like as ventricular septal defect, patent ductus arteriosus, and tetralogy of fallot, this anomaly, accompanied by a coronary arterial fistula, has not yet been reported. Most patients with no associated cardiac anomalies have only minor, or absent, symptoms, and survive to adulthood, but some patients may suffer from recurrent respiratory infections and hemoptysis. The vessel to the affected lung in many of the proved cases has been described as arising from either the bronchial artery or the aortic arch. The blood supply from the coronary artery to the affected lung has never been reported. Recently, a case of left pulmonary artery agenesis, accompanied with a coronary arterial fistula was experienced, which was diagnosed by coronary angiography and a chest CT, which is presented, with the review of relevant literature.
Aorta, Thoracic ; Arteries* ; Bronchial Arteries* ; Coronary Angiography ; Coronary Vessels ; Ductus Arteriosus, Patent ; Fistula* ; Heart Septal Defects, Ventricular ; Hemoptysis ; Humans ; Lung ; Pulmonary Artery* ; Respiratory Tract Infections ; Tetralogy of Fallot ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Chronic atrial fibrillation (AF) causes atrial enlargement and impairs cardiac function. It is known that restoration of sinus rhythm reduces left atrial size and improves left ventricular ejection fraction (EF). However, it's unclear whether the restoration of sinus rhythm is more beneficial than controlling the ventricular rate. This study was designed to compare the effects of two treatment strategies on structural and functional changes of the heart in patients with AF. SUBJECTS AND METHODS: Thirty-seven AF patients who initially cardioverted to sinus rhythm were studied. At 6 months after cardioversion, 17 patients (Group I) maintained normal sinus rhythm (NSR) and 20 (Group II) experienced AF recurrence. Initial and follow-up echocardiography were evaluated in each patient and compared between the two groups. RESULTS: Baseline clinical and echocardiographic findings were similar between the two groups except that the left atrial length was longer in Group II than in Group I. Compared to baseline, left atrial dimension (LAD) and left ventricular mass index (LVMI) measured by M-mode were significantly reduced in group I at follow-up (p<0.05); however, these changes were not observed in group II. The reduction of LAD and LVMI was observed only in patients with less than 50% EF and/or dilated left atrium at baseline (p<0.05). CONCLUSION: In patients with AF, maintenance of NSR after cardioversion significantly reduces LAD and LVMI, especially in cases of left ventricular dysfunction or dilated left atrium. Even after adjustment of baseline LAD, LVMI and EF, maintenance of NSR remains the independent factor that reduces LAD at follow-up (p=0.001).
Atrial Fibrillation* ; Echocardiography ; Electric Countershock* ; Follow-Up Studies ; Heart Atria ; Heart* ; Humans ; Recurrence ; Stroke Volume ; Ventricular Dysfunction, Left