Search

We compared heart rate variability (HRV) values according to the following body size phenotypes: metabolically healthy normal weight (MHNW), metabolically unhealthy but normal weight (MUNW), metabolically healthy but obese (MHO), and metabolically unhealthy obese (MUO). We retrospectively analyzed a dataset from 1200 participants who had visited the Cardiovascular Center at Korea University Guro Hospital between March 2009 and February 2014 and underwent Holter monitoring for 24h. HRV was calculated from standard deviation of normal-to-normal R-R intervals (SDNN), standard deviation of the average normal-to-normal intervals (SDANN), and root mean square of successive differences (rMSSD) measurements, and study subjects were classified according to body mass index (BMI) and presence or absence of metabolic syndrome. Various HRV indices, including SDNN, SDANN, and rMSSD, were significantly lower in MUNW subjects than in MHNW or MHO subjects, while there were no significant differences between MUNW and MUO subjects. Although BMI had no significant correlation with any HRV indices, SDNN, SDANN, and rMSSD values had significant negative correlations with waist circumference and levels of C-reactive proteins, AST, ALT, fasting glucose, and HOMA-IR. A significant positive correlation was observed between HRV index and HDL level. Furthermore, the SDNN value significantly decreased with an increase in the number of metabolic syndrome components after adjusting for other covariates. Compared to MHNW or MHO subjects, Korean men and women with the MUNW phenotype exhibited decreased HRV, suggesting that low HRV is related to adverse cardiovascular outcomes in MUNW individuals.

Myocardial bridge (MB) is characterised by focal compression of a coronary artery in systole by an overlying band of myocardium. Chronic compression and relaxation of the MB may produce endothelial dysfunction by direct stress.To determine whether MB alters endothelial function, thus influencing the plaque formation.128 patients (mean (SD) age 54.7 (10.9) years, 56 men) with typical angiographic systolic milking effects and30% reduction in diameter of the coronary artery during systole after intracoronary nitrate (glyceryl trinitrate, 200 mug) infusion were studied. 231 control patients (mean (SD) age 52.9 (12.1) years, 111 men) without overt coronary artery disease including MB were also studied. Endothelial function was estimated by incremental acetylcholine (Ach) infusion into the left coronary ostium. Intracoronary ultrasound assessments were obtained in 74/128 patients with MB and 81/231 controls.The mean (SD) vasoconstrictive response to maximal Ach was more pronounced at the bridging segments than at matched segments in controls (-71.9 (14.9) vs -30.3 (22.6), p = 0.009). Coronary vasoconstriction (50%) to Ach was seen more often in the MB group than in controls (114/128 (89.1%) vs 81/231 (35.1%), p = 0.007). No significant correlation was found between the severity of MB and vasoconstriction in response to Ach. A typical half-moon phenomenon was seen in 71/74 (95.9%) cases of the MB group, but not in controls (p0.001). Plaques at the bridging segments were absent in 67/74 (90.5%) and mild in 7/74 (9.5%) cases, as compared with those of matched segments of the left anterior descending coronary artery in controls (plaque burden 5.91 (1.37)% vs 24.71 (24.21)%, p = 0.002).Despite the prominent relationship between MB and endothelial dysfunction, bridging segments are spared from atherosclerotic plaque formation.

The longstanding compression-relaxation effects of myocardial bridging may produce endothelial dysfunction by direct stress on the endothelium. We tested the hypothesis that myocardial bridging induces endothelial dysfunction and subsequently increases the risk of coronary spasm and investigated the symptomatic response to medication in patients with documented myocardial bridging and coronary spasm. In 81 patients with myocardial bridging (44 men; mean age 57.2 years) and 195 control patients without bridging and atherosclerotic lesions confirmed by angiography (97 men; mean age 58.4 years), spasm provocation testing was done by incremental acetylcholine infusion into the left coronary artery. Spasm was documented in 62 of 81 patients with bridging and in 31 of 195 controls (p0.001). A focal spasm was limited to the bridging segments compared with controls (p0.001). In conclusion, the results of this study showed that myocardial bridging increased the risk of coronary spasm by endothelial dysfunction in the bridging segment.

Background and Objectives:Studies on the stability of atheromatous plaques, as a determinant of the cause of complications, have been reported. Among the functional features of plaques related with vulnerability, inflammation has emerged as a leading cause of clinical presentation. The purpose of this study was to find the source of the inflammatory response in the patients with acute myocardial infarction (AMI). Subjects and Methods:Patients with AMI, whose lesion of in either the left anterior descending artery (LAD group, n=13) or the right coronary artery (RCA group, n=11), were selected. The levels of interleukin-6 (IL-6) and P-selectin were measured in blood from the aortic root (A), great cardiac vein (G) and peripheral vein (V). The control group (n=15) included patients with either stable or variant angina. Results:The levels of IL-6 were 4.77±6.0 (A), 11.32±7.8 (G) and 4.39±5.0 pg/mL (V) in the LAD group, and 3.64±2.1 (A), 6.05±4.9 (G) and 3.84±3.2 pg/mL (V) in the RCA group. Unrelated to the infarction related artery, the level of IL-6 in the great cardiac vein was significantly increased in patients with AMI. The percentages of platelet expressed P-selectin were 6.03±7.0 (A), 8.14±8.1 (G) and 8.83±7.9 (V) in the LAD group and 6.46±8.4 (A), 5.80±6.0 (G) and 5.91±6.9 (V) in the RCA group. Conclusion:These findings suggest that the generalized inflammatory response is activated across the coronary vascular bed in patients with AMI, regardless of the infarction related artery site. Therefore, systemic therapy, as well as local management for vulnerable plaque, would be required. (Korean Circulation J 2005;35:155-162)

Anomalous origin of the right coronary artery (RCA) is uncommon in patients undergoing cardiac catheterization. Most RCA anomalies are usually found incidentally. However, some anomalies may be associated with malignant courses such as myocardial ischemia, syncope or sudden cardiac death. We present a previously unreported case of a 55-year-old female who had anomalous RCA arising from the diagonal branch of LAD, a variant of L-II Lipton classification, which caused chest pain. (Korean Circulation J 2004;34(6):615-617) KEY WORD:Coronary vessel anomalies.

Background and Objectives：We undertook this study to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). Subjects and Methods：Thirty-seven patients (33 men, mean age 50, range 25-68 years) with paroxysmal AF (n=29) and persistent AF (n=8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were enrolled. The multielectrode array and ablation catheter were positioned in the LA via the double transseptal approach. Atrial premature beats (APBs) which triggered initiation of AF that lasted longer than 1 min were mapped and the activation sequence was analyzed on isopotential color maps. Wave front dynamics and the relationship with the underlying structures were assessed. Results：More than half, 56.4%, of APBs from PV were related to the initiation of AF, but not related to the maintenance of AF. A quarter, 25.6%, of APBs from PV not only initiated AF, but also maintained AF without continuous triggering. Mixed type and indeterminate type of AF was 5.0% and 12.8%, respectively. During AF, the mean number of wavelets was 1.45 (maximum 3 in 76.5%). Anatomical structures showing slow conduction and wavebreaks were mostly located at the septopulmonary bundle (86.5%) and the posterior roof of the LA between the left superior PV and right superior PV (54.1%). Conclusion：Focal repetitive activity from PV played an important role in both the initiation and maintenance of AF. Specific anatomical structures such as septopulmonary bundle or posterior roof of the LA were related to the heterogeneous conduction delay and spontaneous wavebreak

Background and Objectives:There is still uncertainty regarding the relative importance of systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) in predicting the risk of cardiovascular disease. The relative importance of the BP components, as markers of left ventricular hypertrophy (LVH) and coronary artery disease (CAD), were examined in relation to age. Subjects and Methods:In 257 subjects receiving no antihypertensive medication, LVH was determined using the M-mode echocardiography when left ventricular mass index (LVMI) was ≥129 g/m in men or ≥118 g/m in women. In a further 265 subjects, CAD was determined using the coronary angiography when stenosis of the coronary arterial diameter was ≥70%. The most important BP component was determined using a logistic regression analysis. Results:With respect to LVH, in the group 0.10) for DBP, SBP and PP respectively. In the group 50 to 59 years of age, ORs were 1.65, 1.35, 1.36 (all p 0.10), 1.07 (p>0.10), 1.21 (p

Background and Objectives:Adiponectin is known for its anti-inflammatory and anti-atherogenic effects. The purpose of this study is to characterize the relationships among serum adiponectin, essential hypertension (EH), left ventricular mass index (LVMI), and LV diastolic function. Subjects and Methods:Serum adiponectin by RIA and body mass index were measured in 275 patients (M:F=137:138). We calculated LVMI, E/A ratio, deceleration time (DT), and isovolumetric relaxation time (IVRT) by using echocardiograms. Results:The serum adiponectin level of the hypertensive group was significantly lower than that of the non-hypertensive group (9.9±9.8 ug/mL vs. 12.9±9.5 ug/mL, p

Amiodarone hydrochloride is a benzofuran derivative used for the treatment of cardiac arrhythmias. It is associated with a number of side effects, including thyroidopathy, neuropathy, cutaneous pigmentation, photosensitivity, pulmonary toxicity, hepatotoxicity and keratopathy. Amiodarone keratopathy has been classified into four stages. Corneal pigmentation varies from stage 0, which is a clear cornea without pigment deposition, to stage 3, that is, corneal pigmentation encroaching upon the pupil. We present a case of amiodarone induced keratopathy of stage 3 who received low dose oral amiodarone maintain therapy. (Korean Circulation J 1998;28(8):1382-1386)

Background：Coronary angiography have become important and integral components in the investigation of patients with cardiovascular disease. Technical improvement combined with an increased need of coronary angiography, and efforts to decrease the length of inpatient hospital stay have prompted the development of outpatient coronary angiography. In this study, we compared the procedure-related complications and costs of inpatient and outpatient coronary angiography when performed at the same institution. In addition, we attempted the coronary angiography as outpatient setting in patients with unstable angina, old age, and anticoagulation therapy, who have been regarded as contraindication for outpatient procedure. Methods：Diagnostic coronary angiography was performed in 199 cases as inpatient setting, and 225 cases as outpatient setting at Korea University Guro Hospital From January through July 1996. There was no significant difference in sex, age, risk factor, blood pressure, cholesterol level, and ejection fraction. We did not give the heparin during the procedure and, use the Judkins’ method in all patients. After the procedure, pressure dressing was done with compressor device for 15 minutes, then sandbag was applied on the puncture site. In outpatient, they took bed rest for 6 hours in oneday care room. Results： 1 In the inpatient group, there were 6 cases(3.0% of catheterization-related complication, and there were 7 cases(3.1% of complication in the outpatient group. There was no major complication in both groups, such as death, myocardial infarction, stroke, and perforation of heart and great vessels. In the inpatient group, 2 cases of arrhythmia, 3 cases of hematoma at puncture site, and 1 case of femoral artery pseudoaneurysm occurred. In the outpatient group, 2 cases of arrhythmia, 1 case of hematoma at puncture site, 2 cases of skin rash, 1 case of acute febrile reaction, and 1 case of femoral artery dissecting aneurysm developed. There was no significant difference in the rate of complications