BACKGROUND: To compare the effects of low dose and high dose of statin treatment on endothelial function and carotid intima-media thickness (IMT) in patients with variant angina (VAP). METHODS: A total of 70 patients with VAP were divided into two groups; atorvastatin 10 mg treatment group (group I: n = 35, 54.2 +/- 12.5 years) versus atorvastatin 40 mg treatment group (group II: n = 35, 52.6 +/- 9.8 years). Flow mediated vasodilation (FMD) of the brachial artery and IMT of the carotid artery were compared between the groups after 6 months of statin treatment. RESULTS: The baseline FMD and carotid IMT were not different between the groups. After 6 months of statin therapy, FMD was significantly improved in both groups (7.7 +/- 2.5% to 8.9 +/- 2.2% in group I, p = 0.001, 7.9 +/- 2.7% to 9.5 +/- 2.8% in group II, p < 0.001), but the degree of FMD change and FMD at 6 month were not different between the groups. Carotid IMT were not changed in both groups after 6 months of statin therapy. CONCLUSION: The use of statin for 6 months significantly improved endothelial function in patients with VAP, but carotid IMT was not changed. The use of high dose statin did not show significant additional benefit as compared with the use of low dose statin. The present study suggested that statin therapy would be beneficial in the treatment of VAP.
Atorvastatin Calcium ; Brachial Artery ; Carotid Arteries ; Carotid Intima-Media Thickness ; Heptanoic Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Pyrroles ; Vasodilation

BACKGROUND: Chronic total occlusion (CTO) has been considered as an unsuitable lesion for percutaneous coronary intervention (PCI) because of technical difficulty and low success rate. Owing to technical advances and increased operator's experience, PCI has been attempted in a large number of patients with CTO in recent years, but there are few long-term follow-up reports for PCI to CTO. METHODS: We analyzed 83 patients (59.7+/-9.2 years, 28 female) with CTO on diagnostic coronary angiogram at the Heart Center and Coronary Care Unit of Chonnam National Hospital from January 1996 to July 1997. The patients were divided into two groups according to revascularization by PCI or CABG (coronary artery bypass graft): the revascularized group (received PCI or CABG, Group I) and non-revascularized group (Group II). RESULTS: PCI was tried in 46 patients and successful in 33 patients (71.7% of the success rate). Eleven patients (13.3%) were treated with the coronary artery bypass graft (CABG) and 31 (37.3%) patients were medically treated. During 5-year clinical follow-up 11 patients died [13.1%; cardiac death 6 (7.1%), non-cardiac death 5 (6.0%)] and the major adverse cardiac events occurred to 24 (28.6%) patients. Cardiac death occurred to one patient of the Group I and 5 patients of Group II (p=0.06). The mean survival time was significantly different (57.8+/-9.2 months in Group I and 50.9+/-19.5 months in Group II, p=0.038). CONCLUSIONS: Revascularization for CTO prolonged the mean survival time of the patients on long- term clinical follow-up.
Angioplasty ; Arteries ; Coronary Artery Bypass ; Coronary Care Units ; Coronary Disease ; Coronary Vessels* ; Death ; Follow-Up Studies* ; Heart ; Humans ; Jeollanam-do ; Percutaneous Coronary Intervention ; Survival Rate ; Transplants

BACKGROUND: Sinus node dysfunction (SND) is caused not only by intrinsic sinus node disease, but also by the extrinsic factors. Among the extrinsic factors, autonomic imbalance is most common. Symptomatic SND usually requires permanent pacemaker therapy. However, the clinical characteristics and patient response to medical therapy for hypervagotonic SND have not been properly clarified. MATERIALS AND METHODS: Thirty two patients (14 men, 18 women, 51 +/- 14 years) with hypervagotonic SND were included in this study, but those patients who had taken calcium antagonists, beta-blockers or other antiarrhythmic drugs were excluded. Hypervagotonic SND was diagnosed if the abnormal electrophysiologic properties of the sinus node were normalized after the administration of atropine (0.04 mg/kg). RESULTS: The presenting arrhythmias were 16 cases of sinus bradycardia (50.0%), 12 of sinus pause (37.5%), 3 of sinoatrial block (9.4%) and 1 of tachy-bradycardia (3.1%). Nine (28.1%) patients had hypertension, 7 (21.9%) smoked, 2 (6.3%) had diabetes mellitus, and 1 (3.1%) had hypercholesterolemia. Among the patients, 3 had no remarkable symptoms, 13 had dizziness, 7 had syncope, 3 had weakness and 6 had shortness of breath. Twenty five (78.1%) patients were treated with theophylline, 1 patient with tachy-bradycardia syndrome was treated with digoxin and propafenone, and 6 (18.8%) were treated with no medication. During the 43 +/- 28 month follow-up, 25 patients remained asymptomatic, but 6 who took no medication developed mild dizziness. One patient needed permanent pacemaker implantation owing to recurrent syncope despite of theophylline treatment. CONCLUSION: These results show that hypervagotonic SND has a benign course and most of the patients can be managed safely without implanting a pacemaker. (Ed note: I like the abstract. It is short and direct, as it should be.)
Dizziness/etiology ; Dyspnea/etiology ; Female ; Humans ; Male ; Middle Aged ; Muscle Weakness/etiology ; Sick Sinus Syndrome/*complications/drug therapy ; Syncope/etiology ; Theophylline/therapeutic use ; Vasodilator Agents/therapeutic use

BACKGROUND: Diabetes is a major risk factor for restenosis after percuataneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) has been considered desirable in diabetics with multivessel disease. However, recent developments in devices and techniques of PCI have led to speculation about advantages of CABG in diabetic patients. We sought to compare long-term clinical outcomes of coronary stenting and those of CABG in diabetics with coronary artery disease. METHODS: Among diabetics who underwent revascularization therapy in Chonnam National University Hospital between Mar 1998 and Feb 1999, 122 patients (Group I, 84 males, 60+/-8 years) who had stent implanted, and 38 patients (Group II, 24 males, 60+/-8 years) who had bypass surgery were selected and their short- and long-term clinical were compared. RESULTS: As for clinical diagnosis and risk factors there were no differences between the two groups. In ACC/AHA types Group II had more multiple and complex vessel disease than Group I (p<0.05). Incidences of in-hospital adverse cardiac events were not different between the two groups, but during the period of 30.5+/-6.7 months the incidence of target lesion revascularization was significantly higher in Group I (18.9% versus 5.7%, p<0.005). CONCLUSION: Short-term clinical outcomes of coronary stenting were comparable to those of CABG in patients with diabetes, but the incidence of repeat revascularization was higher in the coronary stenting group. With the advent of adjunctive therapies in the prevention of restenosis after PCI, these results require fu rther clinical assessment.
Angioplasty ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Diagnosis ; Humans ; Incidence ; Jeollanam-do ; Male ; Risk Factors ; Stents

BACKGROUND: The current techniques for percutaneous coronary interventions (PCI) remain limited by restenosis. Recent studies have provided evidence of inflammation playing a role in the pathogenesis of cardiovascular disease. METHODS: Whether inflammatory markers are predictors of subsequent restenosis were prospectively tested in 272 consecutive patients with angiographically proven coronary artery disease. Patients having undergone PCI at Chonnam National University Hospital, between Sept. 1999 and Mar. 2001, were divided into two groups according to the occurrence of restenosis on a follow-up coronary angiogram: Group I were patients with restenosis (n=99, 59.5 +/- 10.8 years, M: F=77: 22) and Group II were those without restenosis (n=173, 58.8 +/- 10.2 years, M: F=131: 42). The IgG seropositivity, cytomegalovirus (CMV) titers, C. pneumoniae, H. pylori and levels of C-reactive protein (CRP) were compared between the two groups. RESULTS: There were no statistical differences in the seropositivity of the CMV IgG C. pneumoniae IgG and H. pylori IgG between the two groups (Groups I vs. II: 100 vs. 100%, 24.7 vs. 25.7% and 62.2 vs. 63.7%, respectively). Of the angiographic parameters, a low Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI 0 or I) was more common in Group I than Group II (p=0.038). The patients with an elevated CRP (> 0.5 mg/dL) were more common in Group I than Group II (57.6 vs. 36.4%, p=0.001), with the CRP values being higher in Group I than Group II (3.3 +/- 5.8 vs. 1.3 +/- 2.6 mg/dL, p=0.001). According to a multiple logistic regression analysis, the CRP was the only predictor of restenosis, with an odds ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). CONCLUSION: The CRP value is the most important predictor of restenosis after PCI.
*Angioplasty, Transluminal, Percutaneous Coronary ; Antibodies, Bacterial/blood ; Antibodies, Viral/blood ; Biological Markers/analysis ; C-Reactive Protein/*analysis ; Chlamydophila pneumoniae/immunology ; Comparative Study ; Coronary Angiography ; Coronary Restenosis/*blood/diagnosis/*therapy ; Cytomegalovirus/immunology ; Female ; Helicobacter pylori/immunology ; Human ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Recurrence

BACKGROUND: High-risk percutaneous coronary interventions (PCIs) are associated with a high complication rate, a low procedural success rate and a high restenosis rate, especially in diabetics. We sought to determine whether abciximab (ReoPro (R) ) therapy affects long-term clinical outcomes of Korean patients with diabetes undergoing high-risk PCI. METHODS: One hundred and nineteen patients with 152 lesion sites were administered ReoPro (R) among 2, 231 patients who underwent PCI at Chonnam National University Hospital from March 1999 to Feb 2001. These 119 patients were divided into two groups, 30 were allocated to a diabetic group (Group I, 57.7 +/- 8.2 years, 22 male), and 89 to a non-diabetic group (Group II, 59.6 +/- 10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. RESULTS: In terms of clinical diagnosis, the number of acute myocardial infarctions in Group I was 25 (83.3%) and 76 in Group II (85.4%). As for risk factors, target artery lesions, and ACC/AHA types, no differences were found between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%), and the number with a thrombus-containing lesion was 28 (93.3%) and 88 (98.9%) in Groups I and II, respectively. The procedure was successful in 27 (90.0%) in Group I, and in 80 (89.9%) in Group II, and no differences were evident between the two groups in terms of bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death, were observed in Group I, but 8 cases of MACE occurred in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) over 18.5 +/- 6.7 (5-28) months. The number of overall MACEs was 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). CONCLUSION: ReoPro (R) used in high-risk PCI in diabetics was effective in terms of early clinical outcomes, but its long-term clinical benefits were not proven.
*Angioplasty, Transluminal, Percutaneous Coronary ; Antibodies, Monoclonal/*therapeutic use ; Comparative Study ; Coronary Angiography ; Coronary Stenosis/*therapy ; Diabetes Mellitus/*complications/drug therapy/radiography ; Female ; Human ; Immunoglobulins, Fab/*therapeutic use ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/*therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors ; Risk Factors ; Safety ; Stents ; Treatment Outcome

BACKGROUND: It is known that prolonged QRS duration (QRSd) in a 12-lead ECG is associated with decreased left ventricular (LV) systolic function in patients with dilated cardiomyopathy. Development of LV systolic dysfunction and prolongation of paced QRSd are often observed in patients with permanent pacemakers (PPM). However, the significance of prolonged paced QRSd in patients with PPM is not determined. METHODS: We studied sixty-four patients (male:female=27:37, mean age=57.6+/-15.4 years) who had been on PPM (DDD: 15, VDD: 18, VVI: 31) for more than one year (mean: 68.2+/-44.0 months). LV function was normal before implantation of PPM. The 12-lead ECG and echocardiography were recorded prior to implantation, immediately after implantation and at the last follow-up. RESULTS: Paced QRSd did not significantly increase during the follow-up period. LVEF at the last follow-up (LVEF-FU) was significantly lower than that prior to implantation (59.3+/-11.5% vs. 64.9+/-10.1%, p<0.001). Eleven (17.2%) patients developed LV systolic dysfunction (LVEF<50%) during the follow-up period. Paced QRSd at the last follow-up and diabetes mellitus were correlated with LV systolic dysfunction (R2=0.302, p<0.001). There was a significant negative correlation between the paced QRSd and LVEF-FU (r=-0.451, p<0.01) and between change of paced QRSd and that of LVEF during follow-up (r=-0.419, p<0.01). LVEF-FU was reduced more in patients with paced QRSd >or=180 ms than in patients without (44.4+/-12.0% vs. 61.7+/-9.5%, p<0.001). In predicting LV systolic dysfunction with the paced QRSd (cut-off value: 180 ms), sensitivity, specificity, positive and negative predictive values were 60.0%, 88.7%, 50.0% and 99.2%, respectively. The paced QRSd at the last follow-up was significantly correlated with paced QRSd immediately after implantation (r=0.542, p<0.01). CONCLUSION: LV systolic dysfunction after long-term right ventricular apical pacing may develop. Prolongation of paced QRSd 180 ms during follow-up may suggest development of LV systolic dysfunction. New technologies to minimize prolongation of paced QRSd should be investigated to prevent LV systolic dysfunction after permanent ventricular pacing.
Cardiomyopathy, Dilated ; Diabetes Mellitus ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ventricular Dysfunction, Left* ; Ventricular Function

BACKGROUND AND OBJECTIVES: Despite marked advances in the design of percutaneous coronary intervention hardware, total occlusion remains associated with a low primary success rate. The most common cause of failure is the inability to cross the lesion with a guidewire. We report the results of a non-randomized single-center investigation using a hydrophilic coated guidewire (Crosswire NT). SUBJECTS AND METHODS: We analyzed the angiographic results of 92 patients (68 males, 24 females, age 58.8+/-9.7 years-old) who underwent angioplasty utilizing Crosswire NT for either total (TIMI flow 1) or subtotal occlusion at Chonnam National University Hospital between December 2000 and July 2001. RESULTS: Clinical diagnoses of the studied subjects revealed 40 cases of acute myocardial infarction, 15 of myocardial infarction, 29 of unstable angina and 8 of stable angina. The primary success rate was 79.3% (73/92), the success rate in total occlusion was 69.0% (40/58), and that of the chronic total occlusion cases among the total occlusion group was 64.3% (18/28). The success rates in the use of Crosswire NT as the first and second choice were 85.7% and 78.8%, respectively. The abrupt occlusive lesions, complex lesions more than type B 2, and presence of collateral circulation were all associated with a lower success rate. Coronary artery perforation occurred in one case. CONCLUSION: The new nitinol hydrophilic wire, Crosswire NT, is a safe and effective tool for the recanalization of total occlusive coronary lesion.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary ; Collateral Circulation ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention*

BACKGROUND AND OBJECTIVES: It has been reported that intracoronary radiation therapy (ICRT) using a Ho-166 coated balloon inhibits restenosis of porcine coronary arteries. However, the consequences of ICRT on coronary artery endothelial function are unknown. The aim of this study is to investigate the effects of ICRT using a Ho-166 balloon on coronary artery endothelial function and vasomotor reactivity. MATERIALS AND METHODS: Female pigs (25-35 kg) were orally premedicated daily with aspirin (100 mg) and ticlopidine (250 mg) for the duration of the study. Under sterile conditions with local anesthesia of the skin provided by 2% lidocaine, an arteriotomy of the left carotid artery was performed, an 8 Fr sheath was inserted, and intraarterial heparin sodium (10,000 IU) was injected. Under fluoroscopic guidance, the coronary artery main branch was selected through an 8 Fr guiding catheter for coronary artery overdilation injury (balloon to artery ratio, 1.3:1) and ICRT. A Ho-166 coated balloon prepared to deliver 20 Gy at a depth of 2 mm from the balloon surface was used for ICRT. The coronary artery main branch in each pig was randomly assigned to either balloon injury (Group I) or balloon injury plus ICRT (Group II). Coronary artery segments were taken from the animals at 0 week (n=8), 4 weeks (n=6) and 8 weeks (n=8) after the intervention. Data in each group denote the relative ratio compared to non-injured coronary artery and are expressed as mean +/- standard error of mean. RESULTS: The degree of KCl-induced contractile response (g) was not different between the two groups at 0 and 4 weeks, but was significantly decreased in group II compared to group I at 8 weeks (I:1.04+/-0.06, II:0.79+/-0.07, p=0.014). In rings precontracted with prostaglandin F 2alpha (PGF 2alpha), the degree of NO-dependent relaxation (%) induced with substance P was significantly decreased in group II compared to group I at 0 week (I:0.93+/-0.33, II:0.47+/-0.31, p=0.03), but the difference between the two groups was not significant at 4 and 8 weeks. In rings precontracted with PGF 2alpha and LAME in the presence of indomethacin, the degree of EDHF-induced relaxation (%) using substance P was not different between the two groups at 0, 4 and 8 weeks; nor was the degree of sodium nitroprusside-induced endothelium independent relaxation (%) in depolarized conditions with PGF 2alpha. CONCLUSION: Endothelial function of the porcine coronary artery is only transiently impaired after ICRT using a Ho-166 coated balloon. Therefore this therapy can be used as an effective method to prevent restenosis after percutaneous coronary intervention.
Anesthesia, Local ; Angioplasty ; Animals ; Arteries ; Aspirin ; Carotid Arteries ; Catheters ; Coronary Restenosis ; Coronary Vessels ; Endothelium ; Female ; Heparin ; Humans ; Indomethacin ; Lidocaine ; Percutaneous Coronary Intervention ; Prostaglandins F ; Relaxation ; Skin ; Sodium ; Substance P ; Swine ; Ticlopidine

BACKGROUND AND OBJECTIVES: Angiotensin converting enzyme inhibitor is known to be effective in the prevention of left ventricular remodeling following myocardial infarction. However, little data is available concerning the clinical effects of angiotensin (AT) receptor blocker in ischemic cardiomyopathy. This study evaluated the clinical effects of the concomitant use of losartan with low doses of hydrochlorthiazide in cases of ischemic cardiomyopathy. SUBJECTS AND METHODS: A combined agent of 50 mg of losartan potassium with 12.5 mg of hydrochlorthiazide (HCTZ) was administrated once daily over a 12-week period to 29 patients (M:F=26:3, 61.4+/-8.7 years) who were diagnosed with ischemic heart failure (ejection fraction lower than 50% by echocardiography) at Chonnam National University Hospital. RESULTS: Clinical symptoms of dyspnea in the 29 patients improved from 2.08+/-0.49 to 1.15+/-0.38 as measured by New York Heart Association class. The systolic and diastolic blood pressure did not change significantly following treatment (116.5+/-18.0/77.0+/-11.9 mmHg vs. 118.7+/-15.1/78.1+/-11.1 mmHg). The ejection fraction following administration of Losartan/HCTZ increased from 40.3+/-8.1% to 46.7+/-10.8% (p=0.001). Losartan/HCTZ was well tolerated in all patients without significant adverse effects or laboratory changes. CONCLUSION: A fixed combination of losartan and low dose hydrochlorthiazide is effective in patients with ischemic heart failure.
Angiotensins ; Blood Pressure ; Cardiomyopathies ; Diuretics ; Dyspnea ; Heart Failure* ; Heart* ; Humans ; Jeollanam-do ; Losartan* ; Myocardial Infarction ; Peptidyl-Dipeptidase A ; Ventricular Remodeling