BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; C-Reactive Protein ; Enalapril ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Peptidyl-Dipeptidase A ; Plasma ; Prospective Studies ; Renin-Angiotensin System ; Stroke Volume ; Tetrazoles ; Valine ; Valsartan

BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; C-Reactive Protein ; Enalapril ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Peptidyl-Dipeptidase A ; Plasma ; Prospective Studies ; Renin-Angiotensin System ; Stroke Volume ; Tetrazoles ; Valine ; Valsartan

Right sided aortic arch is an uncommon congenital anomaly. It can be classified into three types, depending on the left aortic arch's degenerating pattern and the branching pattern of the great vessels. It can be associated with major congenital heart disease, depending on the type of right sided aortic arch. We report a case of an 18-years-old female who has right sided aortic arch with atrial septal defect (ASD). In our case, the patient had a right sided aortic arch and aberrant left subclavian artery, also she had ASD (ostium secundum) and moderate tricuspid regurgitation with pulmonary hypertension. The patient was successfully performed patch closure of ASD and tricuspid valve annuloplasty via midline sternotomy. The patient had uneventful postoperative course.
Aneurysm ; Aorta, Thoracic ; Cardiovascular Abnormalities ; Deglutition Disorders ; Female ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Sternotomy ; Subclavian Artery ; Tricuspid Valve ; Tricuspid Valve Insufficiency

BACKGROUND AND OBJECTIVES: Arterial stiffness is a precursor to premature cardiovascular disease. The augmentation index (AI) and pulse pressure (PP) are cardiovascular risk factors. The aim of this study was to define the diagnostic values of the AI and PP from the peripheral arterial and central aortic waveforms in healthy subjects. SUBJECTS AND METHODS: We recruited 522 consecutive subjects (mean age 46.3+/-9.6 years, 290 males) who came to our facility for a comprehensive medical testing. We measured the body mass index (BMI), blood pressure, peripheral and central PP, and a pulse wave analysis that included the central and peripheral AI. RESULTS: The peripheral and central AIs in the female subjects were significantly higher than that in the male subjects (p<0.001). The peripheral and central PPs in the subjects with hyperlipidemia were significantly higher than subjects with normal lipid profiles (p<0.001). The peripheral and central PPs and peripheral and central AIs significantly increased with age. CONCLUSION: Pending validation in prospective outcome-based studies, a peripheral PP of 70 mmHg, central PP of 50 mmHg, peripheral AI of 100%, and central AI of 40% may be preliminary values in adult subjects.
Adult ; Arteries ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Female ; Humans ; Hyperlipidemias ; Male ; Porphyrins ; Prospective Studies ; Pulse Wave Analysis ; Reference Values ; Risk Factors ; Vascular Stiffness

BACKGROUND AND OBJECTIVES: Non-invasive detection and characterization of plaque composition may constitute an important step in risk stratification and monitoring of the progression of coronary atherosclerosis. Multislice computed tomography (MSCT) allows for accurate, non-invasive detection and characterization of atherosclerotic plaques, as well as determination of coronary artery stenosis. The aim of this study was to determine the usefulness of MSCT for characterizing non-calcified coronary plaques previously classified by intravascular ultrasound (IVUS). SUBJECTS AND METHODS: Seventy-one plaques were evaluated in 42 patients undergoing MSCT and IVUS. Coronary plaques were classified as hypoechoic or hyperechoic based on IVUS echogenicity. On MSCT, CT attenuation was measured using circular regions of interest (ROI) and represented as Hounsfield units (HU). RESULTS: MSCT attenuation in hypoechoic plaques was significantly lower than it was in hyperechoic plaques (52.9+/-24.6 HU vs. 98.6+/-34.9 HU, respectively, p<0.001). When comparing CT attenuation between hypoechoic and hyperechoic plaques, 60.2 HU was the cut-off value for differentiating between the two, with a 90.7% sensitivity and a 78.6% specificity. CONCLUSION: MSCT might be a useful tool for non-invasively evaluating the characteristics of coronary artery plaques.
Atherosclerosis ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Humans ; Multidetector Computed Tomography ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Hyperuricemia is known to be a risk factor for atherosclerosis, as is gender. The variables related to metabolic syndrome (MS), as well as other cardiovascular risk factors such as serum uric acid (SUA), differ according to gender. The aim of this study was to evaluate the relationship between SUA and the variables of MS according to gender. SUBJECTS AND METHODS: We randomly recruited 675 subjects (373 men and 302 women), who underwent health screening. The subjects were divided into four groups according to SUA quartiles. We compared each quartile of the SUA with the incidence of MS. The variables included body mass index (BMI), hypertension, fasting blood glucose (FBS), high-density lipoprotein (HDL) cholesterol, triglyceride (TG), and the MS score. RESULTS: The incidence of MS in men was significantly increased compared to women, and the incidence of MS was increased according to the SUA values in women. The MS scores tended to increase according to the SUA values in both genders. The incidence of high BMI, high blood pressure, and high TG were correlated with the SUA values in both genders. However, HDL-cholesterol was correlated with MS scores in women, and fasting glucose was not correlated with MS in either gender. CONCLUSION: The variables of the MS might be independently associated with SUA values in both genders. In addition, the incidence of MS in women might be significantly increased according to the SUA values. However, large scale follow-up studies will be required to confirm these possibilities.
Atherosclerosis ; Blood Glucose ; Body Mass Index ; Cholesterol ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Hyperuricemia ; Incidence ; Lipoproteins ; Male ; Mass Screening ; Risk Factors ; Uric Acid

BACKGROUND AND OBJECTIVES: The aims of this study were to assess the long term overall survival of patients after an acute myocardial infarction (AMI), and to determine the association of survival with the occurrence of ventricular arrhythmia, as recorded by Holter electrocardiography (ECG) and signal-averaged electrocardiography (SAECG). SUBJECTS AND METHODS: One hundred fifty two patients with an AMI were enrolled between January 2000 and August 2006. SAECG and Holter ECG were performed before hospital discharge (at range of 2-10 day). The grading system of Lown was used to evaluate the ventricular premature beats on Holter ECG. Three groups of patients were identified based on the seriousness of the ventricular arrhythmia, as identified by the Holter ECG: Lown grade 0, Lown grades 1, 2 and Lown grades 3, 4, 5. SAECG was performed with a high pass frequency of 25 Hz and 40 Hz. The presence of late potentials (LPs) recorded on SAECG was evaluated. The predictors for survival were assessed using Cox's proportional hazard model and Kaplan-Meier analysis. RESULTS: The mean duration of follow-up was 45.8+/-25.5 months. Twenty four patients (15.8%) died during follow-up. The multivariate predictors of all cause death included age [hazard ratio (HR)=1.25, 95% confidence interval (CI)=1.08-1.47, p=0.003] and Lown grades 3, 4 and 5 (HR=19.17, 95% CI=1.25-290.80, p=0.034). Survival analysis did not show a significant relationship between LPs and overall patient survival. The only predictors for overall mortality were age and the Lown grade. CONCLUSION: SAECG did not predict mortality for the patient with AMI. The ventricular arrhythmias recorded by conventional Holter before hospital discharge may be a useful noninvasive prognostic test after an AMI.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature ; Electrocardiography ; Electrocardiography, Ambulatory ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Myocardial Infarction ; Prognosis ; Proportional Hazards Models

Although 25 to 36% of systemic lymphoma patients develop cardiac involvement, a primary lymphoma involving only the heart or pericardium is much less common. We detected an intracavitary mass in the right atrium and right ventricle in a 73-year-old man with dyspnea on exertion and generalized edema using transthoracic and transesophageal echocardiography. A thoracotomy was performed due to a possible cardiac tamponade, and a myocardial biopsy showed a malignant non-Hodgkin's lymphoma of the diffuse large B cell type. We report a rare case of a primary cardiac lymphoma detected using a transthoracic and transesophageal echocardiography in patient presenting with a massive pericardial effusion.
Aged ; Biopsy ; Cardiac Tamponade ; Dyspnea ; Echocardiography, Transesophageal ; Edema ; Heart ; Heart Atria ; Heart Neoplasms ; Heart Ventricles ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Pericardial Effusion ; Pericardium ; Thoracotomy

OBJECTIVE: To determine the correlation between total anti-oxidant capacity (TAOC)and lipid peroxidase (LPO)levels in serum and disease activity in systemic lupus erythematosus (SLE). METHODS: The study population consisted of 99 patients with SLE according to the 1982 revised ACR criteria and 83 healthy controls.The serum TAOC levels in 99 patients with SLE and 83 healthy controls by the ABTS(R) inhibition method (Randox Ltd,Antrim,UK)and serum malondialdehyde (MDA)levels in 37 out of 99 patients with SLE were measured.Anti-dsDNA antibody (anti-dsDNA),albumin,AST,ALT,cholesterol,uric acid and creatinine were mea-sured to determine the association with the serum TAOC levels.The correlation between the serum TAOC levels and nephritis in 27 cases with nephritis out of 99 SLE patients was also investigated.The SLE disease activity was determined by the SLE disease activity index (SLEDAI)at the time of sample collection. RESULTS: Compared to the controls (1.37 +/- 0.127mmol/L),serum TAOC levels were significantly decreased (1.29 +/- 0.124mmol/L)in SLE patients (p=0.001). And there was a negative correlation between serum TAOC levels and SLEDAI total scores in the SLE patients (r=-0.388,p=0.0001),but no significant correlation between TAOC levels and C3 and anti-dsDNA.Further,a significant difference (p<0.04)in TAOC levels was found in SLE patients with and without nephritis.In comparison with other parameters such as AST,ALT,and cholesterol which might change anti-oxidant level,there was no correlation between the serum TAOC levels and them,except for serum uric acid (r=0.387, p=0.0001),creatinine,and albumin (r=0.507,p=0.0001).Additionally,we couldn't find significant correlation between the serum TAOC levels and MDA. CONCLUSIONS: The serum TAOC levels correlate significantly with SLE disease activity and are associated with nephritis.Also,this study showed a significant correlation with serum albumin levels in these patients.Conclusively,the measurement of the serum TAOC levels in patients with SLE will provide useful information on SLE disease activity.
Cholesterol ; Creatinine ; Humans ; Lupus Erythematosus, Systemic* ; Malondialdehyde ; Nephritis ; Peroxidase ; Serum Albumin ; Uric Acid

Phenylpropanolamine is a sympathomimetic amine used widely as a decongestant or appetite suppressant. Reports of the myocardial injury from the use of phenylpropanolamine are rare and the mechanism of the myocardial injury is not known clearly. We experienced a case of myocardial injury after ingestion of phenyl-propanolamine. A 46-year-old woman was admitted because of chest pain and dyspnea after ingestion of 5 tablets of anorectic pill containing phenylpropanolamine 75 mg per tablet. The serum creatine kinase MB isoenzyme levels were elevated and electrocardiographic abnormalities suggesting myocardial infarction were seen in the precordial lead. In echocardiograpy, left ventricular anteroseptal wall motion was nearly akinetic but coronary angiography showed normal coronary arteries except sluggish blood flow in left anterior descending artery.
Appetite ; Arteries ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Creatine Kinase ; Dyspnea ; Eating* ; Electrocardiography ; Female ; Humans ; Middle Aged ; Myocardial Infarction ; Phenylpropanolamine* ; Tablets