BACKGROUND: In an effort to improve the diagnostic accuracy of the exercise electrocardiography (ECG) to detect coronary artery disease, exercise-induced changes in Q, R and S wave amplitudes has been evaluated in conjunction with or without ST segment changes. We measured the exercise-induced changes in Q, R and S wave amplitudes, and calculated the Athens QRS score to assess its diagnostic value. MATERIALS AND METHOD: Fifty patients who underwent the exercise test and MIBI myocardial scan and were proved to have coronary artery diameter stenosis > or =50% in coronary angiography were included in the patient group. Data of forty-nine persons showing negative findings in the exercise test and MIBI scan were used as control. The exercise test was performed according to the modified Bruce protocol using Marquette case 16. Exercise ECG was positive in 58% (29/50) of the patient group. The Q, R and S wave amplitudes at peak exercise were subtracted from the values of standing position at rest to obtain Athens QRS score. RESULTS: The mean age of patients and control were 54.5+/-9.4 years and 49.8+/-11.4 years respectively (p=NS), and their exercise capacity was 8.5+/-3.1 mets and 9.8+/-1.9 mets respectively (p=NS). The values of delta(R-Q-S)V5 + delta(R-Q-S)aVF and delta(R-Q-S)aVF were significantly lower in patients than the control (0.85+/-6.60 mm vs 3.72+/-5.09 mm, p=0.017, -0.60+/-4.76 mm vs 1.00+/-2.72 mm, p=0.030), and the values of deltaQV5 and deltaSaVF were significantly higher in patients than the control (-0.045+/-0.65 mm vs -0.41+/-0.78 mm, p=0.012, -0.84+/-1.90 mm vs -1.62+/-1.60 mm, p=0.009). However, the values were too widely overlaped between the patients and the control to give diagnostic cutoff points. CONCLUSION: It seems that exercise QRS scores do not have additive diagnostic value for coronary artery disease.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Humans

No abstract available.
Atrial Fibrillation* ; Stroke*

BACKGROUND: Decreased heart rate variability(HRV) has been shown to be an independent predictor of poor outcome after acute myocardial infarction, Spectral analysis of HRV has recently been shown to be a reliable noninvasive test for quantiative assessment of cardiovascular autonomic regulatory response. We estimated the reproducibility and circadian rhythm of HRV parameters in patients with acute myocardial infarction. METHODS: Three consecutive 24-hour ambulatory electrocardiographic recordings were made in 24 patients with acute myocardial infarction, with 10~14 days after the acute attack, and analyzed for HRV parameters of both frequency and time domains. Parameters of frequency domain include low frequency(LF) and high frequency(HF) components. Parameters of time domain include sdRR, SDANN, SD, pNN50, rMSSD, HRV index. RESULTS: Mean total, low frequency and high frequency amplitude spectral densities were 33msec, 19msec and 11msec, respectively. Mean values of sdRR, SDANN, SD, rMSSD, pNN50 and HRV index were 103msec, 90msec, 47msec, 28msec, 7% and 32, respectively. Coefficients of variation(CV) of total amplitude spectral density, and low and high frequency components were 7%, 9% and 12%, respectively. CV of most HRV parameters of time domain were also around 10% except rMSSD and pNN50. Heart rate increased in the morning to be sustained during the day time and decreased in the night. Heart rate variability of high frequency component decreased in the early morning to be sustained during day time with increase in the night. CONCLUSIONS: We conclude that in the predischarge period of acute myocardial infarction, HRV parameters of frequency and time domains are reproducible and there are some morning fall of cardiac vagal activity.
Circadian Rhythm ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Myocardial Infarction*

BACKGROUND: Much of the recent understanding of hypertensive has focused on the importance of concomitant atherosclerotic risk factors in addition to the blood pressure itself and has created new therapeutic challenges. METHODS AND RESULTS: We conducted a prospective study to determine the prevalence rates of hyperlipidemia, smoking, diabetes, obesity and left ventricular hypertrophy(LVH) in 185 hypertensive subjects. Serum levels of total cholesterol, triglyceride and HDL-cholesterol were measured by enzymatic method. 1) Mean values of serum total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol and atherogenic index were not significantly different between sex and resident area. 2) The most frequent risk factor in hypertensive subjects was overweight, followed by M-mode echocardiographic LVH, hypertriglyceridemia, high LDL-cholesterol levels, low HDL-cholesterol levels, hypertriglyceridemia, electrocardiographic LVH, and diabetes. 3) The prevalence rates of both total cholesterol levels over 240mg/dl and LDL-cholesterol over 160mg/dl were about 20%, regardless of sex and resident area. CONCLUSION: These results indicate that hypertensive subjects have many concomitant risk factors of atherosclerosis. Hypercholesterolemia(> or =200 mg/dl), M-mode echocardiographic LVH and overweight among the selected risk factors were observed in more than a half of the hypertensive subjects, regardless of sex and resident area. These findings suggest that for the effective management of hypertensive subjects, physician should not only treat hypertension itself, but also control the concomitant risk factors.
Atherosclerosis* ; Blood Pressure ; Cholesterol ; Echocardiography ; Electrocardiography ; Hyperlipidemias ; Hypertension ; Hypertriglyceridemia ; Obesity ; Overweight ; Prevalence ; Prospective Studies ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

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*

The role of platelets is well known in the atherogenesis, acute coronary syndrome and development of complications of percutaneous coronary intervention. Until recently, aspirin was the only antiplatelet agent available for the primary and secondary prevention of coronary heart disease. Over the past several years, there has been a substantial expansion in our antiplatelet armamentarium, as well as in our understanding of the clinical importance of antiplatelet therapy in patients with coronary artery disease. The benefits and limitations of the currently available antiplatelet agents, including aspirin, thienopyridines (ticlopidine and clopidogrel) and the platelet glycoprotein IIb/IIIa blockers, in the secondary prevention of coronary heart disease, and high-risk clinical situations, such as unstable angina, acute myocardial infarction and percutaneous coronary intervention, have been reported. Antiplatelet agents should be used, in proper combination, in all relevant cases, as they have been shown to improve the prognosis of various forms of high-risk patients with coronary artery disease.
Acute Coronary Syndrome ; Angina, Unstable ; Angioplasty, Balloon, Coronary ; Aspirin ; Atherosclerosis ; Blood Platelets ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Glycoproteins ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors* ; Prognosis ; Secondary Prevention ; Thienopyridines

The role of platelets in atherogenesis, acute coronary syndrome and the development of complications from percutaneous coronary intervention is relatively well known. Until recently, aspirin was the only antiplatelet agent available for the primary and secondary prevention of coronary heart disease. Recently, there has been a substantial expansion in the antiplatelet armamentarium as well as in the understanding of the clinical importance of antiplatelet therapy in patients with coronary heart disease. The benefits and limitations of the currently available antiplatelet agents including aspirin, thienopyridines (ticlopidine and clopidogrel), and the platelet glycoprotein IIb/IIIa inhibitors in the primary and secondary prevention of coronary heart disease and special clinical situations, such as unstable angina, acute myocardial infarction and percutaneous coronary intervention are discussed.
Acute Coronary Syndrome ; Angina, Unstable ; Aspirin ; Atherosclerosis ; Blood Platelets ; Coronary Disease ; Glycoproteins ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Secondary Prevention ; Thienopyridines

Atherosclerosis is a major cause of coronary heart disease. Many clinical characteristics and laboratory parameters are known to be related with atherosclerosis and/or coronary heart disease, either epidemiologically or causally. Although the risk to develop cardiovascular disease (CVD) is on a continuum, the risk factor modification was traditionally categorized into primary or secondary prevention based on the presence of clinical CVD. Mega-trials of the primary and secondary prevention have been reported rendering the previous recommendations obsolete. Several guidelines, including the Adult Treatment Panel III, JNC-VII, and the European and British guidelines, were recently released for dyslipidemia and hypertension. Global assessment of CVD risk with multiple risk factors, rather than risk assessment by an individual risk factor is adopted in all of the current guidelines. Absolute risk levels are used for setting of a target level of a given risk factor and for selection of intervention modalities. Complete cessation of smoking, control of dyslipidemia, hypertension, diabetes, and body weight, moderation of alcohol consumption, and guided use of certain medications have been recommended. The hormone replacement therapy was believed to be cardioprotective and recommended for the primary and secondary prevention of coronary heart disease. However, it is no longer recommended for the purpose of the prevention of coronary heart disease. The concept of "the more, the better" is recommended for exercise. Guidelines are ever so changing!
Adult ; Alcohol Drinking ; Atherosclerosis ; Body Weight ; Cardiovascular Diseases ; Coronary Disease* ; Dyslipidemias ; Hormone Replacement Therapy ; Humans ; Hypertension ; Primary Prevention ; Risk Assessment ; Risk Factors* ; Secondary Prevention* ; Smoke ; Smoking

Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCI. In the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.
Cause of Death ; Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Drug Therapy ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Reperfusion ; Stents ; Thrombolytic Therapy

No abstract available.
*Asian Continental Ancestry Group ; Female ; Heart Failure/*diagnosis ; *Hospitalization ; Humans ; Hyponatremia/*diagnosis ; Male ; Sodium/*blood