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Current Status of Prophylaxis for Endocarditis.

Hyun Kyun KI ; Sun Hee KIM ; Kyung Mok SOHN ; Yu Mi WI ; Ji Young RHEE ; Chi Sook MOON ; Won Sup OH ; Kyong Ran PECK ; Eun Suk JEON ; Nam Yong LEE ; Jun Seop YEOM ; Choon Kwan KIM ; Jun Sung SON ; Yeon Suk KIM ; Suk In JUNG ; Hyun Ha JANG ; Shin Woo KIM ; Hyuck LEE ; Jae Hoon SONG

Korean Circulation Journal.2005;35(4):328-334. doi:10.4070/kcj.2005.35.4.328

BACKGROUND AND OBJECTIVES: Antibiotic prophylaxis of infective endocarditis is required before high-risk procedures in patient with high-risk heart diseases. Although guidelines for the prevention of infective endocarditis were proposed by the American Heart Association in 1997, compliance to these recommendations has not been evaluated in Korea. SUBJECTS AND METHODS: This was a retrospective, multicentered study in 8 Korean university hospitals. Patients with high-risk heart diseases, having undergone invasive dental procedures between Jan. 1, 2000 and Dec. 31, 2003, were enrolled. The medical and dental records of the patients were reviewed to evaluate whether the prophylaxis had been appropriate. RESULTS: Of the initial 4,912 patients, 184 that had been treated with invasive dental procedures (255 total episodes, mean 1.4/patient) were evaluated. The most common high-risk heart disease was a prosthetic heart valve (233 procedures), followed by a previous history of infective endocarditis (22 procedures), cyanotic heart diseases (5 procedures) and systemic pulmonic venous shunts (2 procedures). Antibiotic prophylaxis was performed in 231 procedures (90.8%). Amoxicillin was the most common antibiotic used for prophylaxis (88.6%); however, the adequate dosage (2 gm) was administered in only 56% of these cases. Therefore, the appropriate prophylaxis, according to the AHA recommendations, was performed in only 14.1% (36 procedures). The mean duration of prophylaxis and number of antibiotic doses were 2.40 days (2.40+/-2.44) and 7.97 doses (7.97+/-7.18), respectively. A previous history of infective endocarditis (p=0.03) and dental extraction (p<0.01) resulted in a longer duration of prophylaxis. CONCLUSION: Only 14.1% of the high risk group procedures were given appropriate antibiotic prophylaxis according to the AHA recommendations. These data suggest that protocol-based education of both doctors and patients is required for appropriate antimicrobial therapy during high-risk procedures for the prevention of infective endocarditis in patients with high-risk heart disease.
American Heart Association ; Amoxicillin ; Antibiotic Prophylaxis ; Compliance ; Dental Records ; Education ; Endocarditis* ; Heart Diseases ; Heart Valves ; Hospitals, University ; Humans ; Korea ; Retrospective Studies

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The Clinical Effects of Nicorandil during Percutaneous Coronary Intervention in Patients with Unstable Angina.

Ju Han KIM ; Myung Ho JEONG ; Sang Yup LIM ; Sang Hyun LEE ; Yun Sang LEE ; Kyung Ho YOON ; Dong Goo KANG ; Kye Hun KIM ; Young Joon HONG ; Hyung Wook PARK ; Ok Young PARK ; Weon KIM ; Young Keun AHN ; Jeong Gwan CHO ; Jong Chun PARK ; Jung Chaee KANG

Korean Circulation Journal.2005;35(4):322-327. doi:10.4070/kcj.2005.35.4.322

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the clinical effect of Nicorandil during percutaneous coronary intervention (PCI) in patients with unstable angina (UA). SUBJECTS AND METHODS: Two hundred patients (61+/-10 years, male 143) with UA were randomly assigned to two groups: intravenous Isosorbide dinitrate (Group I, n=100) and intravenous Nicorandil (Group II, n=100). PCI was performed 12-48 hours after infusion of the agents. The post-procedural cardiac enzymes, 6-month MACE (major adverse cardiac event) and left ventricular ejection fraction (LVEF) were compared between the two groups. RESULTS: Successful PCI was performed in 96 patients (Group I=54, Group II=42). Patients requiring either emergent coronary angiography, temporary pacemaker or platelet glycoprotein IIb/IIIa receptor blocker were excluded. No significant differences were observed between the two groups in terms of the clinical and coronary angiographic characteristics. The level of creatine kinase-MB was elevated in 9 (17%) and 6 patients (14%), troponin T in 16 (30%) and 6 (14%) and troponin I in 25 (46%) and 9 (21%) patients of Groups I and II, respectively, after the PCI. The elevation of all troponins was lower in Group II (28 vs. 10 patients, p=0.01). MACE developed in 9 (17%) and 5 (12%) patients of Groups I and II (p=NS), respectively, during the 6-month clinical follow-up. The LVEF was higher in Group II than in Group I on follow-up echocardiography (65.4+/-7.2% vs. 71.0+/-6.7%, p=0.003). CONCLUSION: Nicorandil may have a myocardial protective effect during PCI in patients with UA.
Angina, Unstable* ; Angioplasty ; Blood Platelets ; Coronary Angiography ; Creatine ; Echocardiography ; Follow-Up Studies ; Glycoproteins ; Humans ; Isosorbide Dinitrate ; Male ; Nicorandil* ; Nitroglycerin ; Percutaneous Coronary Intervention* ; Stroke Volume ; Troponin ; Troponin I ; Troponin T

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Tissue Doppler Image-Derived Myocardial Performance(Tei Index) as a Simple Assessment of Global Cardiac Function in Adults.

Il Suk SOHN ; Heung Sun KANG ; Soo Joong KIM ; Chung Whee CHOUE ; Kwon Sam KIM ; Jung Sang SONG ; Jong Hoa BAE

Korean Circulation Journal.2005;35(4):315-321. doi:10.4070/kcj.2005.35.4.315

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.
Adult* ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Ventricular Function

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Serum C-Reactive Protein Level and its Association with Atrial Fibrillation in Korean Adults.

Sang Jun HWANG ; Ki Chul SUNG ; Yong Su LEE ; Jang Hyuk YOON ; Byung Jin KIM ; Bum Soo KIM ; Jin Ho KANG ; Man Ho LEE ; Jung Ro PARK ; Dong Keuk KEUM

Korean Circulation Journal.2005;35(4):309-314. doi:10.4070/kcj.2005.35.4.309

BACKGROUND AND OBJECTIVES: Recent studies have implicated inflammation as playing an important role in the occurrence, persistence and recurrence of atrial fibrillation and that C-reactive protein is a useful marker of the inflammation. The purpose of this study is to evaluate the association between serum CRP levels and the risk of atrial fibrillation. SUBJECTS AND METHODS: This study was performed on 9,487 subjects (5,263 men and 4,224 women; mean age: 58.8+/-6.6 years) who underwent medical check-ups at the Health Promotion Center in Kanbuk Samsung Hospital. 9,438 normal control subjects and 49 atrial fibrillation patients were included in the study. The CRP was measured using a highly sensitive Behring Nephelometer II. RESULTS: When comparing the two groups, there were significant differences in age, gender and the presence of hypertension and cerebrovascular accident, and these are the previously known risk factors for atrial fibrillation. After adjustment was made for the clinical significant variables of atrial fibrillation, multiple regression analysis revealed that the hsCRP levels were not associated with the risk for atrial fibrillation (p=0.52). CONCLUSION: The inflammatory markers (CRP, WBC count) were not predictive of a higher risk for atrial fibrillation in the Korean population.
Adult* ; Atrial Fibrillation* ; C-Reactive Protein* ; Female ; Health Promotion ; Humans ; Hypertension ; Inflammation ; Male ; Recurrence ; Risk Factors ; Stroke

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Age, Gender, and Number of Atherosclerotic Risk Factors are the Independent Factor of Endothelial Dysfunction in Patients with Coronary Atherosclerosis.

Hyun Ju YOON ; Jang Ho BAE ; Ki Young KIM ; Jung Kyu KIM

Korean Circulation Journal.2005;35(4):302-308. doi:10.4070/kcj.2005.35.4.302

BACKGROUND AND OBJECTIVES: The endothelial function is impaired in patients with atherosclerosis risk factors as well as in those with atherosclerotic disease, such as coronary artery disease. This study was performed to evaluate the impact of individual risk factors and their number in patients with coronary atherosclerosis, who already had an impaired endothelial function. SUBJECTS AND METHODS: The endothelial function was measured in 884 consecutive patients (mean age; 59 years old, 486 male) undergoing coronary angiography, using high-resolution ultrasound. The flow-mediated brachial artery dilation (FMD, %) was used to measure the endothelial function. The risk factors were classified according to the hypertension, diabetes mellitus, smoking and dyslipidemia, and their number classified from 0 to 4. RESULTS: The FMD was lower (3.85+/-2.1% vs. 4.27+/-2.1%, p<0.005) in patients with hypertension (n=431) than in those without (n=453); however, no significant difference was shown according to the presence of other risk factors. A multivariate analysis showed age (beta=-0.204, p<0.001), gender (beta=0.118, p<0.01) and the number of risk factors (beta=-0.150, p<0.01) were independent risk factors of the FMD in patients with coronary atherosclerosis. Furthermore, the FMD was significantly associated with the number of risk factors in our study subjects (r=-0.083, p<0.05, n=884). CONCLUSION: This study suggests that the increased number of risk factors, old age and male are independent factors for endothelial dysfunction, even in patients with coronary atherosclerosis, who already had an impaired endothelial function.
Atherosclerosis ; Brachial Artery ; Coronary Angiography ; Coronary Artery Disease* ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Male ; Middle Aged ; Multivariate Analysis ; Risk Factors* ; Smoke ; Smoking ; Ultrasonography

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The Effects of Abciximab(ReoPro(r))-Coated Stents on Extracellular Matrix Synthesis and Apoptosis.

Young Joon HONG ; Myung Ho JEONG ; Weon KIM ; Sang Yup LIM ; Seo Na HONG ; Sang Hyun LEE ; Kye Hun KIM ; Kyung Ho YUN ; Dong Goo KANG ; Yun Sang LEE ; Hyung Wook PARK ; Ju Han KIM ; Youngkeun AHN ; Jeong Gwan CHO ; Jong Tae PARK ; Chang Soo PARK ; Jong Chun PARK ; Jung Chaee KANG

Korean Circulation Journal.2005;35(4):290-301. doi:10.4070/kcj.2005.35.4.290

BACKGROUND AND OBJECTIVES: The most important mechanism of coronary stent restenosis is neointimal hyperplasia (NIH). In addition to neointimal cell proliferation, synthesis of the extracellular matrix (ECM) may be important for the induction of NIH. The effects of the abciximab (ReoPro(r))-coated stent on the ECM synthesis and cellular apoptosis in coronary stent restenosis were observed. MATERIALS AND METHODS: Twenty one abciximab-coated stents and 21 control stents were placed in porcine coronary arteries and histopathologic analyses were performed at 14 days, 28 days and 56 days after the stenting procedures, respectively. Each specimen was analyzed by hematoxylin and eosin staining, modified Movat, immunohistochemical staining and TUNEL analysis. RESULTS: The area of neointima in the abciximab-coated stents was reduced by 45.7% and 45.5% of the control stents at 28 days and 56 days after stenting, respectively (1.9+/-0.5 vs. 3.5+/-0.7 mm2, 2.4+/-0.5 vs. 4.4+/-0.6 mm2, p=0.012, 0.001, respectively). The content ratio of the proteoglycan of the abciximab-coated stents was reduced by 23% at 14 days (12.4+/-4.4 vs. 16.1+/-4.3%, respectively, p=0.041) and the content ratio of collagen in the abciximab-coated stents was reduced by 19.7% and 25% at 28 days and 56 days, respectively (27.7+/-5.0 vs. 34.5+/-8.7%, 36.6+/-10.5 vs. 48.8+/-12.7%, p=0.021, 0.001, respectively). The proliferating cell nuclear antigen index of neointima for the abciximab-coated stents was reduced by 22.2% at 14 days (10.5+/-5.4 vs. 13.5+/-8.4%, respectively, p=0.022). There was no significant difference in the apoptosis, as was determined by TUNEL analysis between the two groups on the 56-day follow-up after stenting. CONCLUSION: The Abciximabcoated stent inhibits ECM synthesis, but it does not inhibit apoptosis in a porcine stent restenosis model.
Apoptosis* ; Cell Proliferation ; Collagen ; Coronary Restenosis ; Coronary Vessels ; Eosine Yellowish-(YS) ; Extracellular Matrix* ; Follow-Up Studies ; Hematoxylin ; Hyperplasia ; In Situ Nick-End Labeling ; Neointima ; Proliferating Cell Nuclear Antigen ; Proteoglycans ; Stents*

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Antifibrillatory and Proarrhythmic Effects of d,l-Sotalol Mediated by the Action Potential Duration Restitution Kinetics.

Hui Nam PAK ; Young Hoon KIM ; Gyo Seung HWANG ; Soo Jin LEE ; Hyun Soo LEE ; Hong Euy LIM ; Young Moo RO

Korean Circulation Journal.2005;35(4):282-289. doi:10.4070/kcj.2005.35.4.282

BACKGROUND AND OBJECTIVES: The action potential duration (APD) restitution kinetics has been known to play a crucial role in the initiation and maintenance of ventricular tachycardia (VT)/fibrillation (VF). We hypothesized that "the anti-arrhythmic and proarrhythmic effects of d,l-sotalol are mediated by changing the APD restitution (APDR) kinetics". MATERIALS AND METHODS: The purposes of this study were: 1) to assess the effects of d,l-sotalol on the APDR kinetics, and 2) to correlate the anti-arrhythmic and proarrhythmic action using the APDR kinetics. We recorded the transmembrane potentials (TMPs), using the microelectrode technique, in seven isolated perfused swine right ventricles, at the baseline, and with 1, 5, 10 and 20 mg/L of d,l-sotalol, with a washout period of 1 hour. The ventricular effective refractory periods (VERP), APD at 90% repolarization (APD90), spontaneous defibrillation rate and VF inducibility were measured at each concentration. We plotted APDR curves of S1-S2 pacing against VF, and calculated the maximal slopes (Smax) of the APDR. RESULTS: Sotalol (10 mg/L) prolonged the APD90 (p<0.001) by reducing the Smax of the APDR (by S1-S2 pacing, p<0.01; during VF, p<0.05). Accordingly, 41.7% of the VT/VF was terminated spontaneously, and VT/VF inducibility reduced from 91.1% at the baseline to 25% with 10 mg/L sotalol. A higher dose of sotalol (20 mg/L) increased the Smax, despite continuous prolongation of the VERP and APD90, resulting in the increase in the VT/VF inducibility (36.4%). CONCLUSION: Sotalol produces its anti-fibrillatory effect by APD prolongation in parallel with a flattening of the Smax at therapeutic doses. However, a higher concentration of sotalol increased the Smax and VF inducibility in isolated swine ventricular tissue.
Action Potentials* ; Heart Ventricles ; Kinetics* ; Membrane Potentials ; Microelectrodes ; Sotalol ; Swine ; Tachycardia, Ventricular ; Ventricular Fibrillation

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Demonstration of Pathologic Coronary Flow Dynamics using Transthoracic Doppler Echocardiography: Its Potential Role in Clinical Decision-Making.

Ho Joong YOUN

Korean Circulation Journal.2005;35(4):269-281. doi:10.4070/kcj.2005.35.4.269

With advancements in high frequency transducers, transesophageal (TEE) and transthoracic Doppler echocardiography (TTE) are emerging as promising methods for the evaluation of coronary arteries. In addition to visualizing images for the detection of stenosis of the proximal and distal coronary arteries, as well as various kinds of coronary artery anomalies, the functional assessment through measurement of the coronary flow reserve using TEE and TTE have become valuable and additive tools for coronary angiography that define only the epicardial coronary arteries. Further efforts to develop new techniques, including real time 3D echocardiography, in the anatomic and functional assessments of coronary artery disease should be undertaken.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Circulation ; Coronary Vessels ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Three-Dimensional ; Transducers

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A Case of Isolated Left Main Coronary Ostial Stenosis due to Acute Angle Takeoff.

Won Jea JEONG ; Hweung Kon HWANG ; Chang Kyun LEE ; In Koo KANG ; Il Suk SOHN ; Joung Eun SOH ; Dal Soo LIM

Korean Circulation Journal.2001;31(4):442-442. doi:10.4070/kcj.2001.31.4.442

Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.
Angioplasty ; Aortic Valve ; Aortitis ; Chest Pain ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Dilatation ; Female ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Hypertension ; Pericardium ; Smoke ; Smoking ; Syphilis ; Syphilis, Cardiovascular

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Multicenter Clinical Trial of Atorvastatin in Patients with Hypercholesterolemia.

Jong Hwa BAE

Korean Circulation Journal.2001;31(4):434-441. doi:10.4070/kcj.2001.31.4.434

BACKGROUND & OBJECTIVES: The aim of this study was to investigate the efficacy & safety of a new HMG-CoA reductase inhibitor, atorvastatin, to improve serum lipid profiles in patients with primary hypercholesterolemia. MATERIALS AND METHODS: Three hundred and six patients from 21 hospitals, all with total cholesterol level over 240 mg/dl and triglyceride level below 400 mg/dl were enrolled in the study. Following diet therapy for 2 weeks, atorvastatin 10 mg was taken for 6 weeks if the total cholesterol level remained higher than 240 mg/dl. The percent change of total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol from baseline to 6 weeks of treatment were evaluated. Patients were monitored for safety through careful history talking, physical examination, serum sampling for liver and muscle enzyme. RESULTS: 1) The study was completed in a total of 166 patients. The mean age of patients the was 58 1/2 years and the percent of male and female patients was 37%, 37% and 63%, respectively. 2) The baseline mean values of total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol following diet therapy for 2 weeks were 280+/-34 mg/dl, 172+/-77 mg/dl, 190+/-35 mg/dl, 56+/-13 mg/dl, respectively. 3) After 6 weeks treatment, the level of total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol were 195+/-34 mg/d, 150+/-67 mg/dl, 110+/-33 mg/dl, 55+/-12 mg/dl, respectively, and the rates of change were -30%, -7%, -42%, -0.2%, respectively. 4) The level of LDL-cholesterol at the end of treatment was below 100 mg/dl in 44%, 100-130 mg/dl in 33%, 130-160 mg/dl in 14%, over 160 mg/dl in 9% of patients. 5) 77% of total patients achieved the target goal of LDL cholesterol (below 130 mg/dl) according to the NCEP guideline. 6) The reduction rate of LDL-cholesterol was different among the patients. At the end of treatment, the patients with initial LDL-cholesterol below 100 mg/dl achieved a higher reduction rate (52%) as compared with those patient's inithal LDL-cholesterol level were higher. 7) There are was only 1 patient (0.6%) who showed 3 times a three-fold increase of liver enzyme and no patient showed an increase of creatine kinase. CONCLUSION: Atorvastatin is effective and safe in improving the lipid profiles in of patients with hypercholesterolemia without serious side effects. (Korean Circulation J 2001;31 (4):434-441)
Cholesterol ; Cholesterol, LDL ; Creatine Kinase ; Diet Therapy ; Female ; Humans ; Hypercholesterolemia* ; Liver ; Male ; Oxidoreductases ; Physical Examination ; Triglycerides ; Atorvastatin Calcium

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