The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m2 in the early-start group compared with 6.1 mL/min/1.73 m2 in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged > or = 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels > or = 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.
Adult ; Age Factors ; Aged ; Female ; Glomerular Filtration Rate ; Humans ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/diagnosis/*mortality ; Male ; Middle Aged ; Propensity Score ; Proportional Hazards Models ; *Renal Dialysis ; Risk Factors ; Serum Albumin/analysis ; Time Factors

Hyperkalemia is a common adverse effect of treatment for heart failure and is associated with high mortality and morbidity. The cardiac manifestations of hyperkalemia include various electrocardiogram changes. We describe a case of a 74-year-old woman with heart failure and permanent atrial fibrillation who reverted to normal sinus rhythm during recovery from hyperkalemia.
Aged ; Atrial Fibrillation ; Electrocardiography ; Female ; Heart Failure ; Humans ; Hyperkalemia

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) decreases in the presence of significant coronary stenosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. SUBJECTS AND METHODS: We studied 99 patients (71 males/28 females, mean age 58+/-11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0+/-1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 microgram.kg(-1).min(-1)). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. RESULTS: CFRs in 69 patients without restenosis were 2.55+/-0.99 at 48 hours after PCI and 2.93+/-1.00 at follow-up (p<0.005). CFRs in 30 patients with restenosis (>50% in diameter stenosis) decreased significantly from 2.70+/-1.01 at 48 hours after PCI to 1.98+/-0.91 at follow-up (p<0.001). There was a significant difference in CFR change (ratio of CFR(followup)/CFR(initial)) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR=0.76, AUC for CFR change=0.82]. CONCLUSION: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.
Adenosine ; Angina, Stable ; Angina, Unstable ; Angiography ; Area Under Curve ; Arteries ; Coronary Restenosis ; Coronary Stenosis ; Echocardiography ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; Infusions, Intravenous ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Polyenes ; ROC Curve ; Transducers

PURPOSE: Hypertension (HT) has been known to play an important role in progression of chronic kidney disease (CKD). However, limited data are available in Korean HT patients. We evaluated the prevalence of CKD and the predictors of decrease in kidney function (DKF) in HT patients. METHODS: We retrospectively analyzed the medical records of outpatients with HT in Bundang Seoul National University hospital. DKF was defined as annual loss of estimated glomerular filtration rate (eGFR) more than 7% of baseline eGFR. RESULTS: The prevalence of CKD was 51% in 981 total participants. In HT patients without CKD (NCKD-HT), the incidence of DKF was 46.2%. The incidence of DKF in HT patients with CKD (CKD- HT) was 40.8%. Age was only baseline risk factor of DKF in NCKD-HT group. In multifactorial analysis, history of diabetes mellitus (odds ratio [OR], 2.99; 95% Confidence Interval [CI], 1.88+/-4.78), hemoglobin levels (OR, 0.86; 95% CI, 0.76+/-0.98), proteinuria (OR, 1.86; 95% CI, 1.16+/-2.98), and hematuria (OR, 1.62; 95% CI, 1.02+/-2.58) were related to DKF in CKD-HT group. CONCLUSION: We suggest that the prevalence of CKD in HT patients is high and DKF is frequent in both NCKD-HT and CKD-HT groups. The pattern of the predictors of DKF shows the difference between the two groups. Especially diabetes, abnormal urinalysis, and anemia are strongly associated with DKF in CKD-HT group.
Anemia ; Diabetes Mellitus ; Glomerular Filtration Rate ; Hematuria ; Hemoglobins ; Humans ; Hypertension ; Incidence ; Kidney ; Medical Records ; Outpatients ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors ; Urinalysis

There are short-term and long-term variations seen in blood pressure. An abnormal pattern in cyclic variations of blood pressure (diurnal or seasonal) correlates well with an increased cardiovascular risk for hypertension, regardless of the resting blood pressure level. Increased blood pressure reactivity to external stimuli is also associated with a higher cardiovascular risk, and may be a significant determinant of cyclic blood pressure variations. A further understanding of the pathophysiological basis of abnormal blood pressure variations is recommended, and the physiological factors should be considered as new therapeutic targets.
Blood Pressure ; Circadian Rhythm ; Hypertension ; Prognosis ; Seasons

A 33-year-old man was admitted to our hospital with chest pain and exertional dyspnea. Two-dimensional echocardiography showed prominent trabeculations and deep intertrabecular recesses, findings consistent with noncompaction of the ventricular myocardium. Thoracoabdominal CT and cardiac magnetic resonance imaging (CMR) revealed situs ambiguous with polysplenia and noncompaction of the left ventricular myocardium. CMR also demonstrated delayed enhancement of the trabeculations located at the apical portion of the left ventricle. The coronary angiogram was normal. This is the first case of noncompaction of the ventricular myocardium associated with situs ambiguous with polysplenia.
Abnormalities, Multiple/*pathology ; Adult ; Echocardiography ; Heart Ventricles/abnormalities ; Humans ; Magnetic Resonance Imaging ; Male ; Myocardium/*pathology ; Spleen/*abnormalities ; Syndrome ; Tomography, X-Ray Computed

Peripartum cardiomyopathy has rarely been reported in the presence of pheochromocytoma. We report a case of 18-year-old female, who presented with cardiogenic shock at postpartum period. After extracorporeal membrane oxygenation, her cardiopulmonary function improved. She was diagnosed with peripartum cardiomyopathy, thereafter 24hr urine study and abdomen CT was compatible with pheochromocytoma. The adrenal mass was surgically removed without complications.
Abdomen ; Adolescent ; Cardiomyopathies ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Peripartum Period ; Pheochromocytoma* ; Postpartum Period ; Shock, Cardiogenic* ; Ventricular Dysfunction, Left*

Peripartum cardiomyopathy has rarely been reported in the presence of pheochromocytoma. We report a case of 18-year-old female, who presented with cardiogenic shock at postpartum period. After extracorporeal membrane oxygenation, her cardiopulmonary function improved. She was diagnosed with peripartum cardiomyopathy, thereafter 24hr urine study and abdomen CT was compatible with pheochromocytoma. The adrenal mass was surgically removed without complications.
Abdomen ; Adolescent ; Cardiomyopathies ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Peripartum Period ; Pheochromocytoma* ; Postpartum Period ; Shock, Cardiogenic* ; Ventricular Dysfunction, Left*

BACKGROUND AND OBJECTIVES: Nicorandil is a potassium channel opener, and it has been known to have a cardioprotective effect against ischemia/reperfusion injury. However, the exact mechanisms of the effect are not known. In the previous studies on cardioprotection, administration of nicorandil was started early during the coronary occlusion. Therefore, it is not clear whether nicorandil can also be beneficial when it is administered from the time of coronary recannalization. MATERIALS AND METHODS: We studied 15 cats that had their chests surgically opened (8 nicorandil cats and 7 control cats). The proximal portion of the left anterior descending artery (LAD) was occluded with ligation for 90 minutes, then it was recannalized for 60 minutes. Intravenous injection of nicorandil was started at the time of recannalization of the artery (a bolus of 100 microgram.kg(-1) plus an infusion at a rate of 10 microgram.kg(-1).min(-1) ). At each stage of the experiments, the risk area and myocardial perfusion were assessed using color microspheres and myocardial contrast echocardiography. The size of the infarction was evaluated by postmortem triphenyltetrazolium chloride staining. Myocardial contrast echocardiography was performed with Pulse Inversion Harmonic Imaging (Sonoace9900, Medison). RESULTS: The risk area during coronary occlusion was 18.8+/-12.6% in the nicorandil group and 19.3+/-9.6% in the control group (p=NS). The perfusion defect immediately after and 1 hour after reperfusion was 13.0+/-8.7% and 8.4 +/-7.6%, respectively, in nicorandil group, and 16.7 +/-11.1 % and 13.4+/-8.8%, respectively, in the control group, (p=NS between groups). Myocardial blood flow in the LAD territory during occlusion immediately after and 1 hour after reperfusion was 56+/-31 %, 73+/-31 % and 69+/-28%, respectively, of the normal myocardium in the nicorandil group, and 65+/-20%, 101+/-75% and 77+/-42%, respectively, in the control group (p=NS between groups). The postmortem infarction size was 8.1+/-9.6% in the nicorandil group and 7.7+/-7.5% in the control group (p=NS). CONCLUSION: With administration of nicorandil from the time of recannalization in the ischemia/reperfusion injury model, we could not find any significant cardioprotective effect. The cardioprotective effect of nicorandil may be associated with preconditioning before reperfusion.
Animals ; Arteries ; Cats ; Coronary Artery Disease ; Coronary Occlusion ; Drug Therapy ; Echocardiography ; Infarction ; Injections, Intravenous ; Ischemia ; Ligation ; Microspheres ; Myocardium ; Nicorandil* ; Perfusion ; Potassium Channels ; Reperfusion ; Thorax

BACKGROUND: Cardiac involvement in Duchenne muscular dystrophy (DMD) is common, but usually latent without symptoms or signs in the initial period of disease. This study investigated the incidence and predictor of cardiac involvement in DMD patients. METHOD: From January 2000 to June 2005, we enrolled 45 patients with DMD (aged 20.2+/-3.0 years) who admitted to the Yongdong Severance Hospital. Electrocardiography and transthoracic echocardiography was done to evaluate the cardiac function. RESULT: Electrocardiographic abnormalities were present in 80.1% of patients. Sinus tachycardia was most common (50%). LVEF was decreased (46.7+/-13.8%), and 56% of the patients had diastolic dysfunction. Patients with pulmonary involvement were older (20.7+/-3.8 vs 17.6+/-2.8 years, p=0.028), and patients with reduced LVEF (<50%) had longer duration of disease (11.4+/-4.4 vs 14.3+/-2.4 years, p=0.04). However, on multivariate analysis, age, duration of disease, pulmonary involvement, dyspnea symptom, electrocardiographic abnormality was not an independent predictor for LV systolic dysfunction in adolescent and adult patients with DMD. CONCLUSION: Cardiac involvement in adolescent and adult patients with DMD was frequently observed independent of age, duration of disease, pulmonary involvement, and dyspnea symptom. Therefore, more active cardiac investigation is required in patients with DMD, even without clinical suspicion.
Adolescent ; Adult ; Dyspnea ; Echocardiography ; Electrocardiography ; Humans ; Incidence ; Lung Diseases ; Multivariate Analysis ; Muscular Dystrophy, Duchenne* ; Tachycardia, Sinus