No abstract available.
Dipyridamole* ; Heart Ventricles*

Exercise-induced ischemic ST responses were analyzed in 36 patients who presented with chest pain and had exercise test and the results were compared with their coronary angiographic findings. Among 36 exercise test positives, the incidences of one-, two- and three vessel disease, and left main disease were 25%(9 cases), 30%(11 cases), 25%(9 cases) and 9%(3 cases), respectively. The incidence of multivessel disease(i.e., two-to three vessel disease or left main disease) in patients with ST depression > or =2.0mm was 72% and that in those with ST depression of 1.0-1.9mm was 45%. In patients with downsloping ST depression, the incidence of multivessel disease was significantly higher than that of one vessel disease(86% vs 14%, p<0.001). But both incidences of one vessel disease and multivessel disease were similar in patients with flat and slowly upsloping ST depression. More than two thirds of patients with ischemic ST depression appearing in the first 6 minutes of exercise or those lasting past 7 minutes in recovery were associated with multivessel disease. It is concluded that attention to depth, type, appearance time and duration of ST depression during exercise test is particularly helpful in detecting patients with advanced coronary disease.
Chest Pain ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Depression ; Electrocardiography* ; Exercise Test ; Humans ; Incidence

No abstract available.
Adenosine* ; Diagnosis* ; Radionuclide Imaging*

Electrocardiographic findings in 18 cases of hypertrophic obstructive cardiomyopathy(HOCM) were compared with those in 20 hypertensives with disproportinate septal hypertrophy(DSH) and in 20 normal controls. In conventional 12 leads electrocardiograms, abmormal Q waves were seen only in 6 cases of HOCM and none in the remadinder. The R waves were tallest in leads V4 in 6 cases(33%) of HOCM, 3(15%) hypertensives with DSH, and 4(20%) of the controls. The correlations of the QRS voltages with echocardiographically measured left ventricular dimension, interventricular septal thickness and left ventricular mass were significant in the hypertensives with DST and normal controls, but insignificant in patients with HOCM. We conclude that these electrocardiographic differences in patients with HOCM from the others would be caused by uneven distribution of hypertrophied muscle mass in the left ventricule and/or by the altered depolarization in hypertrophied cardiac muscles.
Cardiomyopathy, Hypertrophic* ; Electrocardiography* ; Humans ; Hypertension* ; Myocardium

BACKGROUND: TAn increased occurrence of morning time acute myocardial infarction(AMI) based on subjective self-reports and objective confirmation has been reported in the USA and Europe. We tried to see if the same circadian pattern is found among Korea patients in the regard. We have also studied how various modifying factors such as age, gender, history of congestive heart failure, previous angina pectoris, hypertension and smoking may affect the circadian pattern. METHODS: The onset of chest pain was studied in 471 patients with AMI admitted to four teaching hospitals in Taegu. Korea. We categorized the patients according to the modifying factors described above. RESULTS: The patients with AMI indeed showed bimodal variation at the onset of myocardial infarction with the primary peak between 6 A.M. and 12 noon. The frequency of the onset of pain occurred during this 6 hour period was 1.8 times higher than the average of the remaining period(p<0.001). The secondary peak occurring in the evening was barely noticeable. On the other hand. the sub-group(n=96) with a history of congestive heart failure demonstrated its peak(30%) in the evening(6 pm~12 midnight) and the sub-group with a history of hypertension(n=177) demonstrated its peak(37%) in the afternoon(12noon-6P.M.). However. the rest of the sub-groups smokers, patients with previous angina and patients over the age of 70 revealed typical circadian rhythm with a pronounced primary morning peak. CONCLUSIONS: This study clearly showed that Korean patients with AMI revealed a remarkably similar circadian pattern, primary morning peak of onset of myocardial infarction and that the marked differences in diurnal patterns of myocardial infarction onset occur in sub-groups of patients with modifying factors, particularly previous congestive heart failure and hypertension.
Angina Pectoris ; Chest Pain ; Circadian Rhythm ; Daegu ; Europe ; Hand ; Heart Failure ; Hospitals, Teaching ; Humans ; Hypertension ; Korea ; Myocardial Infarction* ; Smoke ; Smoking ; Triacetoneamine-N-Oxyl

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate whether antioxidant supplementation with tocopherol, vitamin C, beta-carotene, and selenium reduces lipid peroxide levels and increases antioxidative enzyme activities in patients with coronary heart disease. SUBJECTS AND METHODS: Eighty nine patients participated in a randomized, double-blind, placebo-controlled trial. The antioxidant group (45 patients) was given daily doses of tocopherol (400 IU), vitamin C (500 mg), beta-carotene (15 mg), and selenium (50 microgram) and the placebo group (44) received placebo. Thirty eight of the antioxidant group (84.4%) and thirty nine (88.6%) of the placebo group completed the 3-month supplementation. RESULTS: Serum levels of alpha-tocopherol, vitamin C and beta-carotene were significantly increased in the antioxidant group as compared to the placebo group (p<0.05), however, retinol was not. Thiobarbituric acid-reactive substances (TBARS) decreased significantly (0.6 nmol MDA/mL) in the antioxidant group as compared with the level (0.09 nmol MDA/mL) seen in the placebo group (p<0.05). Antioxidants did not affect the oxidized-LDL level. The activities of erythrocyte superoxide dismutase (SOD) significantly increased by 0.85 unit/mg hemoglobin in the antioxidant group versus 0.27 unit/mg hemoglobin in the placebo group (p<0.01), and the activities of erythrocyte catalase significantly decreased by 0.04 unit/mg hemoglobin versus 3.37 unit/mg hemoglobin (p<0.01). However, the activities of erythrocyte glutathione peroxidase (GPX) increased insignificantly by 0.09 unit/mg hemoglobin vs 0.1 unit/mg hemoglobin. CONCLUSION: These results suggest that antioxidant supplementation with tocopherol, vitamin C, beta-carotene and selenium in patients with coronary heart disease may provide a prophylactic effect against oxidative stress.
alpha-Tocopherol ; Antioxidants ; Ascorbic Acid ; beta Carotene ; Catalase ; Coronary Disease* ; Erythrocytes ; Glutathione Peroxidase ; Humans ; Lipid Peroxidation* ; Oxidative Stress ; Selenium ; Superoxide Dismutase ; Tocopherols ; Vitamin A

The Thrombolysis in Myocardial Infarction (TIMI) risk score (TRS) has proven value in predicting prognosis in unstable angina/non ST-elevation myocardial infarction (NSTEMI) as well as in ST-elevation myocardial infarction. The TRS system has little implication, however, in the extent of myocardial damage in high-risk patients with NSTEMI. A total of 1621 patients (63.6+/-12.2 years; 1043 males) with NSTEMI were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR). We analyzed the risk for major adverse cardiac events (MACE) during a 6-month follow-up period. The TRS system showed good correlation with MACE for patients in the low and intermediate groups but had poor correlation when the high-risk group was included (p=0.128). The MACE rate was 3.8% for TRS 1, 9.4% for TRS 2, 10.7% for TRS 3, and 12.3% for TRS 4 (HR=1.29, p=0.026). Among the biomarkers and clinical risk factors, elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) (HR=2.61, p=0.001) and Killip class above III showed good correlation with MACE (HR=0.302, p<0.001). Therefore, we revised an alternative clinical scoring system by including these two variables that reflect left ventricular dysfunction: age > 65 years, history of ischemic heart disease, Killip class above III, and elevated pro-BNP levels above the 75th percentile. This modified scoring system, when tested for validity, showed good predictive value for MACE (HR=1.64, p<0.001). Compared with the traditional TRS, the novel alternative scoring system based on age, history of ischemic heart disease, Killip class, and NT-proBNP showed a better predictive value for 6-month MACE in high-risk patients with NSTEMI.
Angina, Unstable ; Biomarkers ; Follow-Up Studies ; Humans ; Korea ; Myocardial Infarction ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Risk Factors

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
Acute Disease ; Aged ; Drug Therapy, Combination ; Female ; Hemorrhage ; Heparin/*therapeutic use ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/epidemiology/mortality/*therapy ; Myocardial Revascularization ; Odds Ratio ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism ; Prognosis ; Registries

PURPOSE: There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). MATERIALS AND METHODS: 2,845 patients with acute NSTEMI (65.6 +/- 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 +/- 12.6 years, 856 males) and late invasive treatment (65.3 +/- 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (> or = 5 points). Conclusions: The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.
Age Factors ; Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Female ; Fibrinolytic Agents/*therapeutic use ; Hemodynamics/drug effects ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/*drug therapy/pathology/therapy ; Prospective Studies ; Thrombolytic Therapy/*methods

BACKGROUND AND OBJECTIVES: Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients. SUBJECTS AND METHODS: Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated. RESULTS: NT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393+/-4,022 pg/mL in the lean group (n=875), 1,506+/-3,074 pg/mL in the overweight group (n=724) and 1,100+/-1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01). CONCLUSION: NT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.
Acute Coronary Syndrome ; Body Mass Index ; Brain ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Korea ; Male ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Obesity ; Overweight ; Peptide Fragments ; Risk Factors