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Background and Objectives:NT-proBNP, a sensitive and specific marker of congestive heart failure (CHF), is also useful in monitoring the effectiveness of treatment and in predicting prognosis. However, the usefulness of NT-proBNP for measuring the functional capacity as a component of the quality of life (QoL) in patients with CHF remains to be discovered. The Korean Activity Scale/Index (KASI) is a Koreanized tool for measuring the functional capacity in patients with cardiac diseases during daily activities, thus representing the physical domain of the QoL. The purpose of this study was to evaluate the relationship between NT-proBNP and the KASI. Subjects and Methods:Between July, 2003 and September, 2003, the NT-proBNP levels were measured in 76 patients with CHF that visited the OPD or who were hospitalized. They were asked to fill out a selfadministered questionnaire, from which their KASI scores were obtained. NYHA Fc and Heart Failure scores were also obtained from a history taking and physical examination conducted by the investigator. Results: The level of NT-proBNP increased with increasing NYHA Fc (p

Background:Recent advances of percutaneous coronary intervention (PCI) and transradial coronary intervention (TRI) have made it possible to reduce the local complication rate and the time until a return to ambulation. The aim of this study is to assess the safety and the patient satisfaction of the TRI-based one-day admission program for PCI. Methods:Total 230 consecutive patients underwent TRI on the day of admission, according to pre-determined inclusion criteria, from May 2001 to October 2003. The subjects were examined for clinical and angiographic characteristics. The patients having a same-day discharge were telephone-interviewed one day and seven days after discharge to assess late complications and the patients’ satisfaction. Results:The mean age of the subjects was 59±9 years and 77.4% were male patients. 169 (73.4%) had stable angina and 37 (16.1%) had unstable angina. Stents were implanted in 178 cases (69.3%). Of the 230 patients who underwent TRI, 206 patients (89.6%) could discharge on the same day after the procedure. The procedure was successful in 98.5%. The average hospital stay for them was 9.4±1.4 hours. Two subjects reported hematoma near the puncture site within 24 hours after discharge, and one reported this problem 7 days after discharge. During the follow-up, there were no cases reporting chest pain needing rehospitalization or such complications as subacute vessel closure. No deaths, myocardial infarctions or revascularization were noted during the follow-up period. The majority of the patients (n=197, 95.6%) were satisfied with the same-day admission and discharge. Conclusions:Sameday admission and discharge after TRI seems to be safe as well as satisfactory for not low-risk patients. (Korean Circulation J 2004; 34 (7):647-654)

Objective—Increased risk of cardiovascular disease in patients with chronic renal failure (CRF) has been explained by accelerated atherosclerosis and impaired angiogenesis, in which endothelial progenitor cells (EPCs) may play key roles. We hypothesized that altered EPC biology may contribute to the pathophysiology of CRF. Methods and Results—EPCs were isolated from CRF patients on maintenance hemodialysis (n44) and from a normal control group (n30). CRF patients showed markedly decreased numbers of EPC (44.6%) and colonies (75.3%) when compared with the controls (P0.001). These findings were corroborated by 30.5% decrease in EPC migratory function in response to vascular endothelial growth factor (VEGF) (P0.040) and 48.8% decrease in EPC incorporation into human umbilical vein endothelial cells (HUVEC) (P0.001). In addition, Framingham’s risk factor score of both CRF (r0.461, P0.010) and normal group (r0.367, P0.016) significantly correlated with the numbers of EPC. Indeed, the number of circulating EPC was significantly lower in CRF patients than in normal group under the same burden of risk factors (P0.001). A significant correlation was also observed between dialysis dose (Kt/V) and EPC incorporation into HUVEC (r0.427, P0.004). Conclusions—EPC biology, which is critical for neovascularization and the maintenance of vascular function, is altered in CRF. Our data strongly suggest that dysfunction of circulating EPC has a role in the progression of cardiovascular disease in patients with CRF. (Arterioscler Thromb Vasc Biol. 2004;24:1246-1252.)

Background and Objectives:Coronary artery perforation is a rare, but potentially deadly, complication of percutaneous coronary intervention (PCI). The purpose of this study was to analyze the clinical characteristics, and outcome, of coronary artery perforation. Subjects and Methods:We retrospectively reviewed 3,782 consecutive PCIs, performed between January, 1994 and May, 2002 at the Samsung Medical Center, from the database records. The medical records and angiograms of the patients were also reviewed. The coronary artery perforations were classified according to Ellis’ classification. Results:A coronary artery perforation was noted in 24 patients (0.6%). It was most commonly observed during PCI of the right coronary artery (46%) and a chronic total occlusion intervention (42%). The number of the patients with Ellis’ classes I, II and III were 11, 8 and 5, respectively. The most frequent causes of the perforation were guidewire, followed by balloon (11 and 8 cases, respectively). The interventional modality with the highest risk of perforation in this study was rotational atherectomy, (4 out of 157, 2.6%). Five patients had cardiac tamponade, of which four occurred during a rotablator procedure. Pericardiocentesis was performed in 5 patients, while 3 patients with class III perforations received emergent coronary artery bypass surgery. There were no in-hospital mortalities, although the duration of the hospital stay for the class III patients was longer than those with classes I or II perforations. Conclusion:A coronary artery perforation during percutaneous coronary intervention is a potentially serious complication. However, the immediate and adequate management results in a fairly good prognosis. (Korean Circulation J 2003;33(4):277-283)

Background and Objectives:For the development of an arteriogenic gene therapy in peripheral artery occlusive disease, we developed a novel angiogenesis assay, with electroporation-mediated naked DNA delivery to the skeletal muscle. Materials and Methods:The levels of the expression CAT were compared between pJDK and pcDNA3.1, in HeLa and C2C12 cell lines, and skeletal muscle. The well known angiogenic gene, pJDK-hVEGF165, was injected, intramuscularly, into the tibialis anterior muscle of Balb/C mice, which was followed by electroporation. Two days later, the anterior tibialis muscles were divided into halves, embedded, and cultured in growth factor-reduced Matrigel. The capillary network area formed by the newly sprouting tube-like structures was calculated. For validation of this ex vivo assay, the connective tissue growth factor gene (pJDK-CTGF) was tested both by this new assay, and by the mice-hind limb ischemia model, with Laser Doppler imaging. Results:The pJDK showed a significantly higher level of CAT expression than the pcDNA3.1. From the pJDK-hVEGF165 injected explants, endothelial cell migration and tube-like formation occurred on day 2, and the capillary network formation peaked on day 7. The capillary network formation in the pJDK-hVEGF165 group was markedly increased to that in the pJDK group. From the skeletal muscle assay, the pJDK-CTGF showed no angiogenic activity or attenuated VEGF-induced capillary network formation. The LDI flux ratio, on day 10 in the mice-hind limb ischemia model, for the mice treated with the pJDK-CTGF and pJDK-hVEGF165 was significantly lower than that of the mice treated with the pJDK-hVEGF165 alone. Conclusion:The skeletal muscle ex vivo assay, using an electroporationmediated naked DNA delivery, is a simple, quantitative and reproducible method for assessing angiogenic genes. CTGF could be an anti-angiogenic factor due to its inhibition of VEGF. (Korean Circulation J 2003;33 (4):321-332)

Lupus myocarditis is usually treated using immunosuppressive agents, such as high-dose corticosteroids, azathioprine and cyclophosphamide. Viral myocarditis and enteroviruses have been identified as the most common causative agents of myocarditis in lupus patients. Although immunosuppressive therapy has an important role in the treatment of lupus myocarditis, it is not recommended in patients with infectious or post-infectious viral myocarditis, and supportive care is very important in these patients. A 25-year old female patient, with systemic lupus erythematosus, was admitted due to severe dyspnea, and diagnosed as having heart failure. She recovered 7 days after supportive care for heart failure, without Immuno-suppression. Her sera neutralized coxsackievirus B3 (CVB3) in neutralization test, with the horse anti-CVB3 antibody (Ab, ATCC V030-501-560) used as a positive control. The titers for the neutralizing Ab in her sera were 4 times higher than that of the standard control ATCC Ab. (Korean Circulation J 2003;33 (12):1147-1150)

Background and Objectives:Idiopathic dilated cardiomyopathy (IDC) is a disease entity with no known specific curative measures. However, significant improvement in the left ventricular (LV) systolic function, during the management course for IDC, is frequently observed. In this study we tried to ascertain associated factors for the improvement of the LV function in patients with IDC. Subjects and Methods:Thirty-three patients, newly diagnosed as IDC between Jan. 1999 and Jan. 2001, on whom a 6-month follow-up echocar-diography was performed, were included in the study. Improvement in the LV systolic function was defined as an increase in the LV ejection fraction greater than 10% from the baseline. The subjects were divided into two groups; the improved group (IG) and the unimproved group (UG). The clinical characteristics and management methods were evaluated, and compared between the two groups. Results:Seventeen patients (M/F:15/2) were included in the IG, and 16 (M/F:7/9) were included in the UG. There were no significant differences in the baseline LV systolic function (IG:23.4±1.5% vs. UG:28.9±2.3%), age, NYHA functional class or resting heart rate on admission between the two groups. b-blocker therapy (p=0.002), the absence of diabetes mellitus (p=0.046) and male sex (p=0.007), were all significantly associated with an improvement in the LV systolic function from the univariate analyses. With the multivariate analyses, only b-blocker therapy was significantly associated with an improvement in the LV systolic function. The 6-month event-free survival rate was significantly better in the IG compared with UG (94±5% vs. 63±13%, p=0.031). Conclusion:b-blocker therapy exerts a considerable effecs on the improvement in the LV systolic function of patients with IDC. (Korean Circulation J 2002;32(12):1064-1071)

Pharmacotherapy for the treatment of heart failure has advanced considerably in recent years, and clinical trials have demonstrated the favorable long-term effects of angiotensin-converting enzyme inhibitors (ACEI and beta- blockers on the morbidity and mortality. Although the current guidelines recommend ACEI and beta-blockers as standard therapy for heart failure, as they have demonstrated benefits in terms of mortality, only one third of patients with heart failure are receiving both classes of drug due to concern over their adverse effects. The benefit of ACEI has been attributed largely to blockade of angiotensin II production, but also to the accumulation of bradykinin. The accumulation of bradykinin however, has been implicated as contributing to adverse effects, such as a dry cough, associated with ACEI treatment, and has also been suggested to result in prejunctional norepinephine release. Recently, many clinical trials have shown that angiotensin receptor blockers (ARBs had similar effect on the mortality and morbidity of patients with heart failure. The side effects, notably the cough, are significantly less than with ACE inhibitors. ARBs could also be recommended for patients who can not tolerate ACE inhibitors for symptomatic treatment. In combination with ACEI, ARBs may improve the sym- ptoms of heart failure, and reduce hospitalizations due to heart failure deterioration. Whether concomitant beta- blockade negatively affects the effect of ARB will require further evaluation. In this paper, recent large clinical trials of ARBs therapy in heart failure, and the ongoing clinical trials, were reviewed for the recommendation of the optimal conditions for ARBs treatment in heart failures. (Korean Circulation J 2002;32(12 :1039-1045

Background and Objectives：Cardiac troponin T (cTnT has been used as a very sensitive marker of cardiac injury caused by ischaemia, myocarditis, and cardiomyopathy. After cardiac injury, the fetal cTnT isoform expression in the heart and serum cTnT increases. To investigate the increased levels of serum cTnT, and the expression of fetal cTnT isoform in the heart, that can predict myocardial injury, we measured serum cTnT levels and the fetal cTnT isoform expression at various time points during the early phase of myocardial toxicity induced by adriamycin (ADR in rat. Materials and Methods：Male Sprague-Dawley rats were injected, intraperitoneally, with ADR (5 mg/kg twice a week for 2 weeks. Control rats were injected with saline. Serum cTnT levels were measured by ELISA. The ratio of fetal/adult (F/A cTnT isoform expression (% was semi-quantified by RT-PCR using total RNA from frozen hearts. Results：Serum cTnT levels did not increase by 1 week after ADR injection, but increased significantly after 2 weeks. The ratio of F/A cTnT in the heart significantly increased from day 1, peaked at 1 week and persisted until the end of 2 week. Conclusion：The expression of the fetal cTnT isoform occurred from 1 day after ADR injection when the serum cTnT levels were still normal. Although the serum cTnT level is a very sensitive, and an early marker, of cardiac damages, the fetal cTnT isoform expression in the endomyocardial biopsy specimen may be a more sensitive and an earlier marker in the ADR-induced myocardial damage. (Korean Circulation J 2002;32( ( ( (6 :485-491

To the Editor: Enteroviruses are the most common agents of myocarditis and have been implicated in the pathogenesis of dilated cardiomyopathy. There are still discrepancies in our knowledge of the association of enteroviruses and myocardial disease, partially due to a lack of data on detection of viral antigen on viral culture of tissue.1 For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of the excellent long-term prognosis of patients.2 A 16-year-old girl was admitted with anterior chest pain of one day's duration. Two weeks earlier, she had had influenza-like symptoms. The patient had a positive troponin T . . .

Background and Objectives:Calcineurin-dependent transcriptional pathway has recently been implicated in cardiac hypertrophy. Whether calcineurin inhibition can prevent the development of pressure-overload left ventricular hypertrophy (LVH is still controversial. To elucidate this issue, the effects of calcineurin inhi- bitors on the prevention of pressure-overload LVH were examined in mice. Materials and Methods:Pressure overload was induced by transverse aortic contriction (TAC in 57 ICR mice. Three different doses of CsA (TAC/CsA group, n=21 and FK506 (TAC/FK group, n=20 were administered subcutaneously from -2 to 14 days after surgery and 16 mice were treated with vehicle (TAC group. Another 60 mice were sham-operated and treated with CsA (CsA group, n=19, FK506 (FK group, n=18 or vehicle (Control group, n=23. Results:Two weeks after TAC, the LV weight-to-body weight (LVW/BW ratio was not significantly diff- erent among the Control, CsA and FK groups although it was greater in the TAC group (4.55±0.69 mg/g than in the Control (2.78±0.70 mg/g and other sham-operated groups (p

Background:Lipoprotein lipase (LPL) is a key enzyme in the metabolism of serum triglyceride (TG) which is utilized in the peripheral tissue as free fatty acid and stored in adipose tissue. LPL gene consists of 10 exons which encode 475 amino acids and more than 9 LPL gene polymorphisms have been reported. LPL gene polymorphism is related to lipids level and the severity of atherosclerosis in coronary artery disease. In Korea, LPL polymorphism has not been reported yet. The purpose of this study is to know the incidences of LPL gene polymorphism and it's relationship with blood lipids level and the severity of atherosclerosis. Methods:Subjects were divided into three groups;normal controls (n=50), coronary artery disease (CAD, n=51) and cerebrovascular disease (CVD, n=52). The PCR-amplified genomic DNA from peripheral white blood cell was analyzed with restriction fragment length polymorphism (RFLP) by two different restriction enzymes (Pvu II, Hind III). Results:Total cholesterol (TC) was higher in CVD than in controls and CAD (203±60 mg/dl vs 188±37, 167±42, p

Background:The relationship between infection of microorganism and atherosclerosis has been studied because the pathophysiology after infection is similar to those of cell injury and/or lipid theory. Although there are many reports which described the relationships between the infection of chalamydia pneumoniae and the atherosclerosis. In Korea, even the prevalence of chlamydia infection has not been studied yet. This study was purposed on the prevalence of chlamydia infection and it's correlation to atherosclerosis. Methods:235 subjects were enrolled and age and sex adjusted subjects were divided into two groups, normal controls (n=43), atherosclerosis (AS, n=90) group;coronary artery disease (CAD, n=61) and cerebrovascular disease (CVD, n=29). Serum total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C) were measured, LDL-cholesterol (LDL-C) was calculated. Serum IgG chlamydia antibody were measured by ELISA method. Results:TG was significantly higher in AS (162.51±100.04 mg/dL vs 122.91±63.31 mg/dL, mean±SD, p=0.019), and HDL-C was significantly higher in controls (47.30± 9.88 mg/dL vs 39.38±8.29 mg/dL, p

For the treatment of coarctation of aorta, surgical intervention has been known as a standard therapy. During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient between ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation(2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angio-plasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angio-plasty for coarctation of aorta is the first case reported in Korea.

Objectives The aim of this study was to investigate intracardiac hemodynamic idiosyncrasies responsible for various presentations of severe aortic stenosis (AS). Background Syncope, dyspnea, and chest pain are well-established indications for aortic valve replacement in patients with severe AS. Patients' survival is limited once they develop symptoms from AS, and survival depends on what type of symptoms a patient develops. We hypothesized that there would be a relationship between the type of AS symptoms and intracardiac hemodynamics as well as AS severity. Methods We analyzed 498 patients (men: 58.4%, 66 ± 12 years of age) with severe AS and normal left ventricular ejection fraction from 2003 to 2009 who had comprehensive echocardiography examination for AS. The study population was divided into 4 groups based on presenting symptom(s) (341 in group I, asymptomatic; 15 in group II, syncope; 110 in group III, dyspnea; 32 in group IV, chest pain). Echocardiographic measurements for cardiac structure, function, and intracardiac hemodynamic parameters were compared among these 4 groups. Results Mean aortic valve pressure gradient and aortic valve area were 57.1 ± 15.2 mm Hg and 0.74 ± 0.19 cm 2 , respectively. AS severity based on mean gradient and aortic valve area was similar among 4 groups. Compared with the asymptomatic group, symptomatic patients were older and had lower cardiac output, and higher E/e' ratio while having a similar aortic valve area and gradient. Group II (syncope) displayed smaller LV dimension, stroke volume, cardiac output, left atrial volume index, and E/e' ratio. Conversely, group III (dyspnea) was found to have the worst diastolic function with largest left atrial volume index and highest E/e' ratio. Conclusions Among patients with severe AS, their symptoms are often linked to specific hemodynamic patterns associated with AS: smaller left ventricular cavity and reduced output for syncope versus more advanced diastolic dysfunction for dyspnea. Hence, comprehensive intracardiac hemodynamics including diastolic function and stroke volume need to be evaluated in addition to aortic valve area and pressure gradient for assessment of AS.