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The prognostic value of arterial stiffness in patients with diabetes mellitus (DM) remains unclear. The aim of this study was to investigate the association between brachial-ankle pulse wave velocity (baPWV) and the occurrence of cardiovascular events in people with DM. A total of 2714 subjects (mean age, 63.6 years; males, 59.3%) with type 2 DM and without documented cardiovascular disease and stroke were analyzed. The primary end-point of this study was composite cardiovascular events of cardiac death, non-fatal myocardial infarction, coronary revascularization and stroke. There were 118 composite events (4.3%) during a median follow-up period of 3.84 years (interquartile range, 1.60-5.52 years). In multivariable Cox regression analysis, higher baPWV (≥1672 cm/s) was associated with composite events even after controlling for potential confounders (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.31-3.07; P = .001). Compared to the lowest baPWV tertile, both middle (HR, 1.84; 95% CI, 1.03-3.27; P = .037) and the highest (HR, 2.97; 95% CI, 1.69-5.22; P .001) tertile of baPWV were associated with increased risk of cardiovascular events in the same multivariable model. In conclusion, the baPWV was associated with cardiovascular events in people with type 2 DM. Considering the simplicity and convenience of baPWV measurement, baPWV may be useful for risk stratification of people with type 2 DM.

BACKGROUND Aortic knob width (AKW), which can be measured easily in simple radiography, is associated with the degree of dilatation and tortuosity of the aortic arch. Pulsatile stress influences aortic geometry. This study was carried out to investigate whether AKW can represent invasively measured aortic pulse pressure (APP). METHODS A total of 252 patients who underwent invasive coronary angiography (ICA) for the evaluation of coronary artery disease were enrolled. AKW was defined as the perpendicular length from the lateral margin of the main bronchus to the most prominent edge of the aortic knob on chest radiography. APP was measured at the ascending aorta using a pigtail catheter immediately before ICA. RESULTS When patients were divided into two groups according to the median value of APP (69 mmHg), AKW was significantly greater in patients with higher APP (≥69 mmHg) than in those with lower APP (

Background: Soluble forms of tumor necrosis factor receptors (sTNFRs) are emerging target molecules of inflammatory disease. However, their role in vascular biology is not well known. This study was performed to investigate the association between serum concentrations of sTNFRs and arterial stiffness. Methods and Results: A total of 117 consecutive patients with suspected coronary artery disease (CAD) (63.6 ± 11.0 years; men, 65%) who were referred for invasive coronary angiography (ICA) were prospectively enrolled. Arterial blood sTNFR1 and sTNFR2 were measured using commercially available ELISA kits. Brachial-ankle pulse wave velocity (baPWV) measurements were made within 24 hours of blood sampling for sTNFRs measurement. Most of the patients (86.3%) had significant CAD (stenosis ≥ 50%) in ICA. In simple linear regression analyses, there were significant positive correlations of baPWV with sTNFR1 ( β = 0.483, P < 0.001) and sTNFR2 ( β = 0.366, P < 0.001). The baPWV values increased proportionally with increasing sTNFR1 ( P = 0.002) and sTNFR2 ( P = 0.076) tertiles. In multiple linear regression analyses, sTNFR1 ( β = 0.300, P < 0.001) and sTNFR2 ( β = 0.206, P = 0.013) had independent association with baPWV even after controlling for potential confounders including age, gender, systolic blood pressure, diabetes mellitus and hypertension. Conclusions: Taken together, sTNFR1 and sTNFR2 were independently associated with baPWV in patients undergoing ICA. This study suggests that sTNFR1 and sTNFR2 can be considered therapeutic targets as well as new makers of arterial stiffness.

Despite the well-documented value of ST2 in heart failure and myocardial infarction, the role of ST2 in vascular biology has not yet been well defined. This study was performed to investigate the association between serum soluble ST2 (sST2) and invasively measured aortic pulse pressure (APP). A total of 167 consecutive patients with suspected coronary artery disease (CAD) (65.1 ± 9.8 years; men, 65.9%) referred for invasive coronary angiography was prospectively enrolled. APP was measured at the ascending aorta with a pig-tail catheter, and arterial blood samples for the measurement of sST2 were collected before coronary angiography. Serum sST2 levels were quantified by radioimmunoassay. Most of the patients (73.9%) had significant CAD (stenosis ≥ 50%) on coronary angiography. Patients with higher APP (≥76 mmHg) showed a significantly higher sST2 level compared to those with lower APP (

Supplemental Digital Content is available in the text, The inferior border of the femoral head (IBFH) is widely used as a landmark in femoral artery puncture during invasive coronary angiography (ICA). However, application of this technique can be challenging especially in obese patients. This study was performed to investigate the association between body mass index (BMI) and the risk of low puncture in femoral artery puncture. A total of 464 patients (64.8 ± 11.1 years, 55.8% male) who underwent ICA via trans-femoral access were retrospectively reviewed. IBFH was used as a landmark for a skin nick and the femoral artery cannulation site was confirmed by femoral angiography. Cannulation at the bifurcation of the common femoral artery (CFA) or below were considered low puncture. Twenty-nine patients (5.8%) were identified as having an angiographically high CFA bifurcation and low femoral artery puncture occurred in 27 (93.1%) patients of them. Among patients with normal bifurcation (n = 464), low puncture occurred in 74 (15.9%) patients. Underweight (BMI < 18.5 kg/m2) or obese (BMI ≥ 30 kg/m2) patients were more common in the low puncture group than in the proper puncture group (36.5% vs. 5.9%, P < .001). Multivariable analysis showed underweight or obesity (odd ratio, 9.10; 95% confidential interval, 4.77–17.35; P

Aim: Statin decreases low density lipoprotein cholesterol level and prevents atherosclerosis. Although statin may be beneficial for patients with acute myocardial infarction (AMI) due to its direct anti-atherosclerotic effect, statin is not usually prescribed to all patients with AMI. This study was performed to identify different determinants of statin treatment and its prognostic impacts in patients with AMI according to their baseline LV systolic function. Methods: 12,988 patients with AMI were enrolled into nationwide registry database study. Patients were stratified into 2 groups according to their LV ejection fraction (LVEF): LVEF < 40% vs ≥ 40%, and determinant factors for statin treatment and MACE were identified in each group. Major adverse cardiovascular events (MACE) within 12 months of AMI including death, nonfatal MI and revascularization were assessed. Results: 1,962 patients (15.1%) with LVEF < 40% were older and had more un¬favorable cardiovascular risk factors than those with LVEF ≥ 40%. Statin treatment rate was significantly lower in group with LVEF < 40% than those with LVEF ≥ 40 % (70.5% vs 76.2%, p=0.001). Mean LDL-C level of patients with LVEF < 40% was lower than those with LVEF ≥ 40 %. MACE rate in patients with LVEF < 40% was higher than those with LVEF ≥ 40% (26.8% vs 11.4%, P < 0.001). Independent predictors for 12-month MACE in patients with LVEF ≥ 40% were history of previous myocardial infarction, high Killip stage, three vessel disease, and lower renal function, which are already known risk factors. Conclusions: The patients with LVEF < 40% were less treated with statin and showed lower LDL-C level and higher MACE rate than those with LVEF ≥ 40 %. Statin treatment may be considered in patients with AMI and LVEF < 40%.

Introduction: This study was conducted to investigate the prognostic value of high-degree atrioventricular block (HDAVB) among patients with acute myocardial infarction (AMI) treated with DES. Methods: A total of 13,862 patients with AMI, registered in the nation-wide AMI database between January 2005 and June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block (AVB) were considered as HDAVB in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Results: Percutaneous coronary intervention with implantation of DES was performed in 89.8% of the patients. HDAVB occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with HDAVB showed worse clinical parameters at initial admission, and the presence of HDAVB was associated with 30-day MACE in univariate analyses. However, the prognostic impact of HDAVB was not significant after adjustment of potential confounders (p = 0.489). Among patients with HDAVB, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio, 5.28; 95% confidence interval, 1.22-22.81; p = 0.026). Conclusions: Despite differences in clinical parameters at the initial admission, HDAVB was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with HDAVB.

Left ventricular (LV) diastolic dysfunction and subsequent overt heart failure are more prevalent in elderly women. Close interaction between arterial stiffness and LV morphology/function has been reported. The aim of this study was to investigate whether there is an age- and gender-dependent relationship between arterial stiffness and LV diastolic function. A total of 819 subjects (58.6 ± 13.3 years, 50.2% men) without structural heart disease (LV ejection fraction ≥50%) were retrospectively analyzed. All participants underwent transthoracic echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement on the same day. The association of baPWV with septal e′ velocity and average E/e′ was assessed. In the total study subjects, baPWV was negatively correlated with septal e′ velocity (r = 0.383, P 0.05 for each). In conclusion, baPWV was independently associated with septal e′ velocity and E/e′ in elderly women but not in younger women or men. The results of this study provide additional evidence that increased arterial stiffness plays an important role in the development of heart failure with preserved ejection fraction as well as LV diastolic dysfunction in elderly women.

This study aimed to determine the incidence and the risk factors of hospitalization for variant angina (VA) in Korean patients. Using the National Inpatient Sample (NIS) database, manufactured and released by the Health Insurance Review and Assessment Service (HIRA) in Korea, the incidence of hospitalization and rehospitalization for VA were calculated. The numbers of patients hospitalized for VA were estimated to be 14,362 in 2009, 17,492 in 2010, and 20,592 in 2011. The standardized incidence rates of hospitalization for VA were 31.4% in 2009, 36.5% in 2010, and 41.7% in 2011 (relative increase rate from 2009 to 2011, 33.0%, P for trend