Recent studies suggest that apolipoproteins may be better predictor of ischemic heart disease than are plasma lipids, such as total cholesterol and high density lipoprotein cholesterol(HDL-C). To examine this hypothesis, plasma levels of major lipids and major apolipo-proteins were measured and their derivatives were calculated in 30 male patients with ischemic heart disease(16 angina pectoris and 14 old myocardial infarction) and 30 age-matched male healthy controls. Plasma levels of lipids were obtained by conventional methods and apolipoproteins by Rocket immunoelectrophoresis. Levels of HDL-C, HDL2-cholesterol(HDL2-C), and apolipoprotein-AII, and ratios of HDL-C/total cholesterol, HDL2-C/total cholesterol, and apolipoprotein-AI/apolipoprotein-B were lower in the group of patients than in controls. Levels of low density lipoprotein cholesterol(LDL-C) and apolipoprotein-B, and ratios of lDL-C/HDL-C and apolipoprotein-AI/apolipoprotein-AII were higher in the group of patients. There were no statistically significant differences in the levels of total cholesterol and apolipoprotein-AI between the two groups. Stepwise discriminators analysis showed that apolipoprotein-B and apolipoprotein-AII were better discriminators than plasma lipids for identifying those with ischemic heart disease. One could correctly classify 78% of the cases by using the levels of the two apolipoproteins. By using the level of apolipoprotein-B, one could correctly classify 73% of the cases. There were no correlations between the levels of total cholesterol and HDL-C in the controls whereas there were positive correlations between the levels in the group of patients. In conclusion, this study showed that apolipoprotein-B was the best single discriminator for identifying the patients with ischemic heart disease, followed by apolipoprotein-AII.
Angina Pectoris ; Apolipoproteins A* ; Apolipoproteins* ; Cholesterol ; Heart ; Humans ; Immunoelectrophoresis ; Lipoproteins ; Male ; Myocardial Ischemia* ; Plasma* ; Risk Factors*

BACKGROUND AND OBJECTIVES: Most reports about coronary angiographic findings in acute myocardial infarction were done after thrombolytic therapy or several days after onset of symptom. The aim of this study is to evaluate coronary angiographic findings in patients with AMI within 24 hours after onset of symptoms and without thrombolytic therapy. Also we evaluated the correlation between the risk factors and severity of coronary artery disease. MATERIALS AND METHODS: We studied 70 patients with acute myocardial infarction admitted to Kyungpook National University Hospital (KNUH) from November 1997 to January 1999, and evaluated the clincial and coronary angiographic findings. We analyzed risk factors of coronary artery disease: age, total cholesterol, tiglyceride, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, hypertension, smoking, diabetes and family history of CAD. Coronary angiography was done immediately after the arrival at emergency room (door-to- angiography time). Exclusion criteria were delayed arrival (more than 24 hours after symptom onset), previous history of anticoagulation or medication of antiplatelet agents. RESULTS: 1) Among 70 patients (M/F: 53/17), 59 patients had Q wave myocardial infarction (QMI) (84%), 11 patients had non-Q wave-MI (NQMI) (16%). 2) The mean age was 61+/-12.2 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to angiography was 6.2+/-4.7 hours. 4) Twenty eight patients (40%) had one-vessel disease, 25 (36%) had two-vessel disease and 17 (24%) had three-vessel disease. 5) The location of infarct related arteries were as follows: LAD in 33 (47%), LCX in 13 (19%) and RCA in 24 (34%). 6) The mean diameter stenosis of infarct related artery (IRA) was 95+/-10.9%. According to the American College of Cardiology/American Heart Association (ACC/AHA) classification of IRA, type B lesion occurred most commonly in 56 patients (80%). 7) Thrombus was observed in 44 patients (63%) with QMI versus 3 patients (27%) with NQMI (p=0.006). 8) Calcifications of the wall of coronary arteries were observed in 28 patients (40%) and correlated with ages of patients. 9) History of cigarette smoking was present in 73%, hypertension in 31% and hypercholesterolemia in 15% of patients. The mean number of risk factor for each patient was 1.3. 10) Multivessel disease was significantly more frequent in patients who had two more risk factors. 11) The frequency of cigarette smoking was greater and the level of plasma triglyceride were higher in patients under 50 years of age. 12) One patient died during coronary angiography and another 2 patients died at 5 and 8 days after coronary angiography due to cardigenic shock. CONCLUSION: In immediate coronary angiographic findings in patients with AMI, multivessel disease and thrombus, and severe stenosis of IRA were observed more frequently than other studies after thrombolytic therapy or after several days of delay. Multivessel disease was significantly more frequent in the patients who had two or more risk factors of atherosclerosis.
Angiography ; Arteries ; Atherosclerosis ; Chest Pain ; Cholesterol ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Emergency Service, Hospital ; Gyeongsangbuk-do ; Heart ; Humans ; Hypercholesterolemia ; Hypertension ; Lipoproteins ; Myocardial Infarction* ; Plasma ; Platelet Aggregation Inhibitors ; Risk Factors ; Shock ; Smoke ; Smoking ; Thrombolytic Therapy ; Thrombosis ; Triglycerides

BACKGROUND AND OBJECTIVES: The intracoronary stent may be useful in the preventing of abrupt closure and coronary restenosis after coronary angioplasty, and recently primary stenting has been one of therapeutic modalities. We assessed the clinical and angiographic results of primary NIR stenting in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: Between November 1997 to January 1999, 55 stentings with NIR stents were done in 51 patients with acute myocardial infarction. Angiographic follow-up was available at 7+/-2.3 days in 35 patients. RESULTS: 1) Among 51 patients (M/F: 37/14), 44 patients had Q-wave MI (86%), 7 patients had non-Q-wave MI (14%). 2) The mean age was 61+/-12.4 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to the arrival at emergency room was 4.6 +/- 4.2 hours. The mean door-to-balloon time was 93+/-46 minutes 4) Treated vessels were as follows: 28 in LAD, 17 in RCA, 10 in LCX. 5) The indications for stent implantation were suboptimal angiographic results after PTCA in 38 lesions (69%), dissection in 9 lesions (16%), abrupt vessel closure in 1 lesion and elective in 7 lesions (13%). 6) Single stent implantation was done in 47 patients. Overlapping stents were done in 4 patients. 7) A procedure related complication occurred in one patient, peri-stent dissection without flow limitation. 8) Full expansion of the stent failed in three lesions with coronary calcifications and the residual stenosis was 35, 40, 50% in each case. In these cases, in-stent thrombus was not demonstrated in follow up angiography. 9) The minimal lumen diameter increased from 0.11+/-0.39 to 2.96+/-0.40 mm. 10) Angiographic follow-up on 38 stents in 35 patients demonstrated in-stent thrombus in 3 stents, in-stent restenosis in 1 stent. But in-stent flow limitations were not found in these 4 cases and TIMI III flow were maintained. Patients with Q-wave MI and coronary thrombus on initial angiography were more prone to subacute thrombosis. CONCLUSION: The NIR stent could be used successfully in primary coronary stenting in acute myocardial infarction. The present study shows relatively low risk of subacute stent thrombosis. The rate of restenosis needs to be confirmed by long term study.
Angiography ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Restenosis ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Stents* ; Thrombosis

BACKGROUND AND PURPOSE OF THE RESEARCH: It is believed that a long-term drinking will be one of the causes of congestive cardiomyopathy (CM). It is also possible for diagnosis of alcoholic cardiomyopathy in the majority of the patients diagnosed as idiopathic dilated cardiomyopathy if the history of mass alcoholic drinking is taken into consideration or proper blood test is conducted. This study is to confirm whether there is an improvement in the clinical result and cardiac function as has so far been known the case in the patients suspected of alcoholic. METHODS: Among 39 patients with dilated CM who were diagnosed by echocardiographic criteria and clinical evaluation, 11 patients who drank more than 77 g of alcoholic everyday for more than 10 years were defined as alcoholic CM. The changes of their clinical manifestations and m-mode echocardiographic findings in the patients with alcoholic CM were compared before and after treatment. RESULTS: All studied patients were male with the mean age of 52.6+8.0 and the mean follow up period was 38.6 months. Of the 11 patients, 3 patients could not completely free themselves from drinking. Their symptoms on first visit ranged in such order as dyspnea (63.6%), tachycardia (54.5%), and generalized edema (27.3%). Following the treatment, dyspnea and tachycardia showed a statistically significant improvement. Echocardio-graphic parameters, ie, LV diastolic dimension (6.7+/-0.6 cm before treatment and 6.3+/-1.2 cm after treatment), LV systolic dimension (5.6+/-0.7 cm before treatment and 5.2+/-1.4 cm after treatment) and E point septal separation (13.6+/-9.6 mm before treatment and 10.9+/-6.6 mm after treatment) decreased after treatment without a significant meanings in a statistical view point. Their ejection fraction (29.6+/-6% before treatment and 34.5+/-11.1% after treatment) increased after treatment. CONCLUSION: Cardiac symptoms of congestive heart failure and echo-cardiographic parameters in patients with alcoholic CM were improved after abstinence from alcoholic ingestion and medical treatment.
Alcoholics* ; Cardiomyopathy, Alcoholic* ; Cardiomyopathy, Dilated ; Diagnosis ; Drinking ; Dyspnea ; Eating ; Echocardiography* ; Edema ; Follow-Up Studies ; Heart Failure ; Hematologic Tests ; Humans ; Male ; Tachycardia

BACKGROUND: The oxidative modification of lipids and the endothelial expression of adhesion molecules are key events in the pathogenesis of atherosclerosis. The appropriate antioxidants that protected and slowed the progression of the disease were reported. We measured the antioxidant enzyme activities and the levels of soluble cellular adhesion molecules in order to evaluate whether antioxidant vitamin supplementation affected the oxidative changes and the expression of cellular adhesion molecules. METHODS: Seventy-seven patients participated in a randomized, double blind, placebo-controlled trial. The test group (38 patients) was given antioxidant vitamin doses including a daily dose of vitamin C 500 mg, beta-carotene 15 mg, vitamin E 400 IUs, and selenium 50 microgram, The control group (44 patients) received placeboes for three months. We measured the vitamin serum levels, intercellular adhesion molecules-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and activities of erythrocyte enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPX) before and at 3 months after supplementation. RESULTS: After supplementation, the serum vitamin levels increased significantly (P<0.05) and the activity of the erythrocyte SOD significantly increased by 0.85 unit/mg hemoglobin (P<0.05) in the test group. Soluble ICAM-1, VCAM-1 and E-selectin levels did not change significantly in the test group after supplementation. CONCLUSIONS: These results suggest that the antioxidant vitamin supplementation may affect erythrocyte SOD activity, but not soluble cellular adhesion molecule levels.
Antioxidants ; Ascorbic Acid ; Atherosclerosis ; beta Carotene ; Catalase ; E-Selectin ; Erythrocytes ; Glutathione Peroxidase ; Humans ; Intercellular Adhesion Molecule-1 ; Selenium ; Superoxide Dismutase ; Vascular Cell Adhesion Molecule-1 ; Vitamin E ; Vitamins*

BACKGROUND AND METHOD: Pharmacological coronary vasodilation induced by dipyridamole is often used in association with thallium-201 scintigraphy to evaluate the presence and prognostic significance of coronary artery disease(CAD). Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life(<10 seconds). The safety and diagnostic accuracy of intravenous adenosine Tc-99m MIBI imaging were evaluated in 248 patients who were referred for evaluation of CAD; 51 of the patients underwent coronary angiography and 25 of those exercise Tc-99 MIBI imaging. Adenosine was infused intravenously at a dose of 0.14 mg/kg/body weight per minute for 6 min and MIBI was injected at 3 min. RESULTS: Adenosine induced a significant decrease in systolic(p<0.05) and diastolic(p<0.001) blood pressures as well as a significant increase in heart rate(p<0.001) and rate-pressure product(p<0.01). The PR interval was slightly prolonged(p-NS). The overall sensitivity, specificity and predictive accuracy for CAD detection was 85%, 82%, and 83%, respectively. The diagnostic accuracy for individual CAD was low in left circumflex CAD. The agreement of segmental perfusion on adenosine and exercise Tc-99 MIBI imaging was 92% (Kappa index-0.83, p<0.001). Side effects occurred in 84% of 248 patients. Flushing (47%), dyspnea(45%), chest pain(28%) and headache(28%) were common. ST depression> or =1.0mm occurred in 8% and lst-, 2nd- and 3rd-degree atrioventricular block in 7%, 4%, and 1%, respectively. Side effects were mostly mild and transient except in 3 patients in whom premature termination of adenosine infusion and treatment were necessary. Aminophylline was used in only two patients. CONCLUSION: Thus, these facts suggest that pharmacological coronary vasodilation with adenosine in conjuction with Tc-99m MIBI myocardial scintigraphy appears to be a feasible, safe and valuable test for the diagnosis of coronary artery disease, particulary in patients unable to exercise.
Adenosine* ; Aminophylline ; Atrioventricular Block ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Dipyridamole ; Flushing ; Heart ; Humans ; Myocardial Perfusion Imaging ; Perfusion Imaging* ; Perfusion* ; Radionuclide Imaging ; Sensitivity and Specificity ; Thorax ; Vasodilation

BACKGROUND: Gated myocardial perfusion SPECT improved diagnostic accuracy of coronary artery disease and enabled us to observe motion and thickening of myocardial walls, ejection fraction as well as myocardial perfusion. Many studies suggested that there was a decrease of left ventricular ejection fraction (LVEF) at post-stress compared with that at rest gated myocardial perfusion SPECT (stunning). The objective of this retrospective study is to evaluate the clinical significance of the decrease of LVEF at post-stress gated myocardial perfusion SPECT by correlating with coronary angiographic finding. METHODS: Authors selected 41 patients who underwent exercise electrocardiography and gated myocardial perfusion SPECT between May, 2001 and May, 2002. The patients underwent coronary angiography within 6 months. The patients were divided into two groups, 16 patients in whom post-stress LVEF was >or=5% lower than rest (stunning group) and 25 patients in whom LVEF was not >or=5% lower than rest (non-stunning group). RESULTS: The number of patients with hyperlipidemia was higher in stunning group than in non-stunning group (50% vs 4%, p=0.001). The number of patients with angiographic stenoses >90% was significantly higher in stunning group than in non-stunning group (75% vs 28%, p=0.04). The number of patients with multi-vessel disease was also significantly higher in stunning group than in non-stunning group (75% vs 36%, p=0.015). CONCLUSION: The patients who had a decreased LVEF after stress (stunning) showed more severe coronary artery stenosis. This finding suggests that stunning may be an important additional indicator of underlying myocardial ischemia.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Electrocardiography ; Humans ; Hyperlipidemias ; Myocardial Ischemia ; Myocardial Stunning ; Perfusion* ; Retrospective Studies ; Stroke Volume* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Aneurysms of sinus Valsalva are rare anomalies thought to be primarily congenital in origin. To evaluate the clinical features and surgical results associated with ruptured aneurysm of sinus of Valsalva, we reviewed the clinical characteristics and follow up results of the patients. METHODS: From January, 1991, through June 2001, 33 patients with ruptured aneurysm of sinus of Valsalva underwent surgical correction from the above five university hospitals. The patients included 24 men and 9 women, with a mean age of 32+/-13 years. We reviewed symptoms, physical examination findings, ECG findings, the coexistent cardiac anomalies, echocardiographic findings, surgical results in 33 patients. RESULTS: Patterns of fistula tract were right coronary sinus-right ventricle in 24 patients (73%), noncoronary sinus- right atrium in 3 patients (9%), noncoronary sinus - right ventricle in 3 patients (9%), right coronary sinus - right atrium in 2 patients (6%) and right coronary sinus - right ventricle and right atrium in 1 patient (3%). Combined cardiac anomalies were VSD (20 cases; 61%), ASD (1 case; 3%) and PDA (1 case; 3%). But, only 12 cases of VSD (60%) were diagnosed with preoperative transthoracic echocardiography. The aneurysmal sacs were excised in all patients and the defects were closed with a patch in 21 patients (64%) and without patch in 12 patients (36%). No recurrence was observed during follow-up periods (68+/-38 months) for all survivors and there was no late complications or symptoms. CONCLUSION: In sinus of Valsalva aneurysm patients, combined cardiac anomalies, especially VSD, are common. Careful preoperative echocardiography should be performed to detect combined anomalies. And, surgical results are excellent without recurrence.
Aneurysm* ; Aneurysm, Ruptured ; Coronary Sinus ; Echocardiography ; Electrocardiography ; Female ; Fistula ; Follow-Up Studies ; Heart Atria ; Heart Ventricles ; Hospitals, University ; Humans ; Male ; Physical Examination ; Recurrence ; Sinus of Valsalva* ; Survivors

We report here on a case of ascending aortic dissection combined with anterior myocardial infarction that was caused by a retrograde dissection into the left main coronary trunk and proximal left anterior descending artery. We successfully treated this with stenting of the left main coronary artery and proximal left anterior descending artery, and this allowed for the definitive surgical correction. Stenting a collapsed left main coronary artery can be lifesaving procedure and serve as a bridge to surgery.
Aortic Diseases ; Arteries ; Coronary Disease ; Coronary Vessels ; Myocardial Infarction* ; Stents*

BACKGROUND AND OBJECTIVES: Epidemiologic studies and clinical trials require a more precise definition of acute myocardial infarction (AMI). The advent of sensitive and specific serologic biomarkers can identify those patients with small areas of myocardial necrosis. Acute myocardial infarction was redefined and approved by the ESC/ACC on September, 2000. To investigate the clinical implications of the revised criteria, the clinical features, the in-hospital outcomes and the 18 months outcomes were compared between the AMI patients who were diagnosed using the definition of the WHO criteria and those AMI patients added by the revised criteria. SUBJECTS AND METHODS: One hundred and seventy four consecutive patients diagnosed as AMI by the new criteria were included in the study. These patients with positive cardiac enzymes and ischemic symptoms or signs (n=174) were divided into two groups. The patients of group 1 (n=105) were the patients who were diagnosed with AMI by the WHO criteria, and the patients of group 2 (n=69), were the additional patients who were diagnosed with AMI only by the new criteria. RESULTS: The new criteria of AMI by ESC/ACC increased the numbers of AMI by 66%. As compared with group 1, women and patients with hypertension and a past history of ischemic heart disease were more common in group 2 (p<0.05). Percutaneous coronary intervention (PCI) was used less frequently and Angiotensin converting enzyme inhibitors (ACEIs), beta blockers and aspirin were prescribed less frequently in group 2. The total cardiac events and cumulative survival rate in group 1 were higher than in Group 2 (12.3% vs 7.2%, 89% vs 94%, respectively) but these differences were not statistically significant. CONCLUSION: The new criteria results in a substantial increase in the diagnosis of AMI, and the new criteria helps identify patients who were missed by the old criteria. The patients with AMI who were added by the new criteria had a similar risk of adverse outcome.
Angiotensin-Converting Enzyme Inhibitors ; Aspirin ; Biomarkers ; Diagnosis ; Epidemiologic Studies ; Female ; Humans ; Hypertension ; Myocardial Infarction* ; Myocardial Ischemia ; Necrosis ; Percutaneous Coronary Intervention ; Prognosis ; Survival Rate