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Introduction: In patients with early repolarization patterns on ECG, many researchers have studied to find predictors of fatal arrhythmia. However, there are no satisfying clinical predictors. We evaluated the value of the Tpeak–Tend interval on pseudo‐ECG in canine myocardial wedge preparation models of early repolarization syndrome. Methods and Results: Transmural pseudo‐ECG and endocardial/epicardial action potentials were recorded from coronary‐perfused canine left ventricular wedge preparations (n = 34). The Ito agonist NS5806 (8‐10 µM), the calcium channel blocker verapamil (3 µM) and acetylcholine (2‐3 µM) were used to mimic the disease model. A ventricular arrhythmia induction test was performed. QTpeak, QTend, Tpeak–Tend, and Tpeak–Tend/QTend were measured at 15 to 20 minutes after the provocative agent infusion. Polymorphic ventricular tachycardias (pVT) developed in 23 of the 34 preparations (67%). The maximal values of Tpeak–Tend and Tpeak–Tend/QTend were recorded just before pVT induction. At baseline, without the provocative agents, Tpeak–Tend and Tpeak–Tend/QTend were not different between pVT‐induced and pVT‐noninduced preparations. The Tpeak–Tend of the pVT‐induced preparations was longer than that of non‐induced preparations (58 ± 26.8 msec vs 33 ± 6.8 msec, P < .001). The Tpeak–Tend/QTend of pVT‐ induced preparations was larger than that of noninduced preparations (0.220 ± 0.1017 vs 0.128 ± 0.0312, P < .001). The transmural and epicardial dispersion of repolarization of pVT‐induced preparations were larger than those of pVT‐noninduced preparations. The transmural dispersion of repolarization showed a positive correlation with Tpeak–Tend. Conclusion: Tpeak–Tend predicted malignant ventricular arrhythmias in early repolarization syndrome models. Tpeak–Tend reflects the repolarization heterogeneity of ventricular myocardium. [ABSTRACT FROM AUTHOR]

Pacemaker-Induced SVC Syndrome. The superior vena cava (SVC) syndrome is an uncommon but sometimes serious complication associated with permanently implanted pacemakers. The mechanical stress associated with pacemaker wires may lead to vessel wall inflammation, fibrosis, thrombus formation, and, ultimately, venous stenosis and occlusion. The surgical treatment of pacemaker-related SVC syndrome requires thoracotomy and may result in significant morbidity. The long-term effects on the pacemaker electrodes, due to compression between the stent and the wall of the vein, remain unknown. We describe a case in which balloon venoplasty successfully resolved the SVC syndrome. The patient has remained symptom-free and with normal pacemaker function for 6 months.(J Cardiovasc Electrophysiol, Vol. 16, pp. 1-3, February 2005) [ABSTRACT FROM AUTHOR]

In the pathological aspect of J wave syndrome, delayed depolarization is defined as the difference in local conduction velocity of the ventricular myocardium. If polymorphic ventricular tachycardia is induced without local conduction velocity heterogeneity, this contradicts the delayed depolarization theory. In the present study, the transmural conduction time at was evaluated at several transmural locations in a canine early repolarization model. The transmural pseudo-electrocardiogram and endocardial/epicardial action potentials were recorded from coronary-perfused canine left ventricular wedge preparations (n=18). The Ito agonist NS5806 (9-10 µM), Ca2+ channel blocker verapamil (2 µM) and acetylcholine (ACh) (2 µM) were used to pharmacologically mimic early repolarization syndrome genotypes. The transmural conduction times were measured at five fixed epicardial unipolar electrodes before and after the perfusion of provocative agents. The transmural conduction time was defined as the time from endocardial stimulation to the maximal negative deflection (dV/dt) of the endocardial electrogram at the unipolar electrode. Polymorphic ventricular tachycardia developed in 14/18 preparations. In the transmembrane action potentials, there was no definite delayed phase 0 upstroke in any induced polymorphic ventricular tachycardia preparations. In all preparations, the transmural conduction time increased significantly after perfusing the Ito agonist NS5806, verapamil and Ach; however, the increase was only 2.6±0.4 msec, and dispersion of the transmural conduction time did not exhibit significant heterogeneity (7.16±0.93 vs. 7.76±1.21 msec; P=0.240). In the early repolarization model, polymorphic ventricular tachycardia was induced without any regional conduction velocity heterogeneity. This finding suggests that local depolarization heterogeneity would not be a major contributor to the generation of ventricular arrhythmia in the early repolarization syndrome wedge preparation model. [ABSTRACT FROM AUTHOR]

Background: We investigated the usefulness of the left atrial (LA) strain measurement on the prediction of upcoming cancer therapeutics-related cardiac dysfunction (CTRCD) after trastuzumab therapy in patients with breast cancer who did not develop CTRCD after chemotherapy.Methods: A total of 72 females with breast cancer who did not develop CTRCD after chemotherapy and underwent additional trastuzumab therapy were divided into CTRCD (n = 13) and no CTRCD group (n = 59). Echocardiographic measurements including left ventricular global longitudinal strain (LVGLS) and peak atrial longitudinal strain (PALS) decline were compared.Results: CTRCD was identified in 13 patients (18.1%) after additional trastuzumab therapy. Baseline echocardiographic findings were not different. After the completion of chemotherapy, conventional echocardiographic parameters were not different, but PALS decline (15.0 ± 4.7 vs. 8.9 ± 3.2%, p < 0.001) and LVGLS decline (10.5 ± 1.3 vs. 9.1 ± 1.1%, p = 0.002) were significantly greater in CTRCD than in no CTRCD group. PALS decline at the time of chemotherapy completion could predict future CTRCD after trastuzumab therapy with better sensitivity and specificity (cutoff value 11.79%, sensitivity 76.9% and specificity 81.4%) than LVGLS decline (cutoff value 9.9%, sensitivity 69.2% and specificity 78.0%).Conclusions: PALS or LVGLS decline developed before developing overt CTRCD after chemotherapy for breast cancer, and PALS decline showed better sensitivity and specificity in predicting future CTRCD than LVGLS decline. Serial measurement of PALS can be used as a useful parameter in the prediction of future CTRCD. [ABSTRACT FROM AUTHOR]

Background: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature.Case Presentation: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved.Conclusion: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored. [ABSTRACT FROM AUTHOR]

Background: To identify the predictors of left ventricular functional recovery (LVFR) and its impacts on clinical outcomes in acute heart failure (AHF) patients with newly diagnosed dilated cardiomyopathy (DCM).Methods: A total of 175 consecutive patients with newly diagnosed DCM and AHF were divided into two groups according to LVFR on FU echocardiography; the recovered group (n=54, 54.3±18.5years, 31 males) vs. the non-recovered group (n=121, 60.5±15.1years, 79 males). Clinical, laboratory, and echocardiographic findings were compared, and major adverse cardiac and cerebrovascular events (MACCE) including death, rehospitalisation, and stroke were analysed.Results: Left ventricular function (LV) was normalised in 54 patients (30.8%) on follow-up echocardiography. The change in the level of N-terminal pro-B-type natriuretic peptide (ΔNT-proBNP) between initial presentation and discharge >1633.5pg/mL was an independent predictor of LVFR, whereas diabetes and LV end-systolic diameter >50mm were negative predictors of LVFR on multivariate analysis. During five years of clinical follow-up, MACCE developed in 91 patients: 58 deaths, 29 rehospitalisations, and 4 strokes. On multivariate analysis, baseline LVEF <30% and no LVFR were independent predictors of MACCE.Conclusion: Left ventricular functional recovery was not uncommon in newly diagnosed DCM with AHF. The changes in NT-proBNP level during hospitalisation, diabetes, and larger initial LV size were independent predictors of LVFR, and LVFR was an independent predictor of future MACCE. Serial monitoring of NT-proBNP and LV function would be useful in the risk stratification of newly diagnosed DCM with AHF. [ABSTRACT FROM AUTHOR]

Background: To investigate the impacts of carotid plaque and intima-media thickness (IMT) on future vascular events (VEs) in the patients with acute ischemic stroke.Methods: A total of 479 consecutive Korean patients with acute ischemic stroke were divided into 2 groups according to development of VEs; VE group (65.4 ± 10.9 years) vs no VE group (62.8 ± 13.2 years). VEs were defined as the development of recurrent stroke, coronary events, peripheral arterial disease, and death. Clinical, laboratory, and imaging findings were compared between the groups.Results: During 105.5 ± 29.0 months of follow up, VEs were developed in 142 patients (29.6%). In univariate analysis, VEs were significantly associated with age, gender, diabetes, renal function, lipid levels, left ventricular function, carotid plaque or IMT. In multivariate analysis, the presence of carotid plaque, diabetes, renal function and male gender were independent predictors of future VEs in the patients with ischemic stroke, but carotid IMT was not a predictor of future VEs. Event free survival was significantly lower in patients with carotid plaque than without carotid plaque on Kaplan-Meier analysis (log rank p < 0.001).Conclusion: The present study demonstrated that diabetes, impaired renal function, male gender, and the presence of carotid plaque rather than IMT were independent predictors of future VEs in Korean patients with acute ischemic stroke. Active medical management and careful monitoring for the development of recurrent VEs are strongly recommended in patients with acute ischemic stroke and carotid plaque. [ABSTRACT FROM AUTHOR]

Background: The long-term prognosis of patients with variant angina presenting with aborted sudden cardiac death (ASCD) is unknown.Objectives: The purpose of this study was to evaluate the long-term mortality and ventricular tachyarrhythmic events of variant angina with and without ASCD.Methods: Between March 1996 and September 2014, 188 patients with variant angina with ASCD and 1,844 patients with variant angina without ASCD were retrospectively enrolled from 13 heart centers in South Korea. The primary endpoint was cardiac death.Results: Predictors of ASCD manifestation included age (odd ratio [OR]: 0.980 by 1 year increase; 95% confidence interval [CI]: 0.96 to 1.00; p = 0.013), hypertension (OR: 0.51; 95% CI: 0.37 to 0.70; p < 0.001), hyperlipidemia (OR: 0.38; 95% CI: 0.25 to 0.58; p < 0.001), family history of sudden cardiac death (OR: 3.67; 95% CI: 1.27 to 10.6; p = 0.016), multivessel spasm (OR: 2.06; 95% CI: 1.33 to 3.19; p = 0.001), and left anterior descending artery spasm (OR: 1.40; 95% CI: 1.02 to 1.92; p = 0.04). Over a median follow-up of 7.5 years, the incidence of cardiac death was significantly higher in ASCD patients (24.1 per 1,000 patient-years vs. 2.7 per 1,000 patient-years; adjusted hazard ratio [HR]: 7.26; 95% CI: 4.21 to 12.5; p < 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 per 1,000 patient-years vs. 9.6 per 1,000 patient-years; adjusted HR: 3.00; 95% CI: 1.92 to 4.67; p < 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received implantable cardioverter-defibrillators (ICDs). There was a nonsignificant trend of a lower rate of cardiac death in patients with ICDs than those without ICDs (p = 0.15).Conclusions: The prognosis of patients with variant angina with ASCD was worse than other patients with variant angina. In addition, our findings supported ICDs in these high-risk patients as a secondary prevention because current multiple vasodilator therapy appeared to be less optimal. [ABSTRACT FROM AUTHOR]

Background Acute myocardial infarction (AMI) is a risk factor for contrast-induced nephropathy (CIN). We investigated whether pretreatment with statin, N-acetylcysteine (NAC) and sodium bicarbonate (NaHCO 3 ) reduces the risk of CIN. Methods We conducted a prospective trial and enrolled a total of 334 ST-segment elevation myocardial infarction (STEMI) patients. Patients were divided into four groups: Group I (statin 40 mg), Group II (statin 80 mg), Group III (statin 80 mg plus NAC 1200 mg) and Group IV (regimen of group III plus NaHCO 3 154 mEq/L). CIN was defined as ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine from the baseline within the 72 h after PCI. Results CIN occurred in 72 (21.6%) patients. The incidence of CIN was the lowest in the group III (14.3%), and multivariate analysis showed the lower incidence of CIN in group III compared to Group I [odds ratio (OR) 0.29, 95% confidence interval (CI) 0.13–0.64, p = 0.002]. Admission hyperglycemia [(AHG) > 198 mg/dL] (OR 2.20, 95% Cl 1.20–3.68, p = 0.011) and the use of intra-aortic balloon pump (IABP) (OR 4.20, 95% CI 1.38–12.78, p = 0.016) were independent predictors for CIN. The CIN (OR 9.00, 95% CI 1.30–62.06, p = 0.026) was an independent predictor for in-hospital mortality. Conclusions Combination of high-dose statin plus NAC was associated with lower incidence of CIN in patients with STEMI who underwent primary PCI compared to statin only. [ABSTRACT FROM AUTHOR]

Vascular calcification is associated with increased risk of morbidity and mortality in patients with cardiovascular diseases, chronic kidney diseases, and diabetes. Gallic acid, a natural compound found in gallnut and green tea, is known to be antifungal, antioxidant, and anticancer. Here we investigated the effect of gallic acid on vascular smooth muscle cell (VSMC) calcification and the underlying mechanism. Gallic acid inhibited inorganic phosphate-induced osteoblast differentiation markers as well as calcification phenotypes (as determined by calcium deposition, Alizarin Red, and Von Kossa staining). Knockdown of BMP2 or Noggin blocked phosphate-induced calcification. Gallic acid suppressed phosphorylation of Smad1/5/8 protein induced by inorganic phosphate. Taken together, we suggest that gallic acid acts as a novel therapeutic agent of vascular calcification by mediating BMP2–Smad1/5/8 signaling pathway. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cardiac arrest complicating acute ST elevation myocardial infarction (STEMI) is known to be associated with increased in-hospital mortality. However, little is known about the long-term outcomes after cardiac arrest complicating first onset STEMI in contemporary percutaneous coronary intervention (PCI) era. Methods: We analyzed 7942 consecutive patients who were diagnosed with STEMI and had no previous history of MI. They were divided into two groups according to the presence of cardiac arrest (group I, patients with cardiac arrest; n=481, group II, patients without cardiac arrest; n=7641). Results: In a stepwise multivariate model, previous history of chronic kidney disease, high serum level of glucose and low high density lipoprotein-cholesterol was an independent predictor of cardiac arrest complicating STEMI. Group I had significantly higher in-hospital mortality (adjusted hazard ratio [HR] 3.06, 95% confidence interval [CI] 2.08–4.51, p<0.001) and 30-day mortality after hospital discharge (adjusted HR 2.92, 95% CI 1.86–4.58, log-rank p<0.001). However, there was no significant increase in mortality beyond 30days (6-month, adjusted HR 1.46, 95% CI 0.45–4.77, log rank p=0.382; 1-year, adjusted HR 1.84, 95% CI 0.83–4.05, log-rank p=0.107). Also, there were no significant differences in 6-month and 1-year major adverse cardiac events in 30-day survivors. Performing PCI was associated with decreased 12-month mortality in 30-day survivors. Conclusions: Although patients with cardiac arrest complicating first onset STEMI had higher in-hospital and 30-day mortality after hospital discharge, cardiac arrest itself did not have any residual impact on mortality as well as clinical outcomes. [Copyright &y& Elsevier]

Abstract: Background: The mechanisms of antagonism vary between the angiotensin II type 1 receptor blockers (ARBs): insurmountable antagonism and surmountable antagonism. Recent retrospective observational studies suggest that ARBs may not have equivalent benefits in various clinical situations. The aim of this study was to compare the effect of two categories of ARBs on the long-term clinical outcomes of patients with acute myocardial infarction (AMI). Methods: We analyzed the large-scale, prospective, observational Korea Acute Myocardial Infarction Registry study, which enrolled 2740 AMI patients. They divided by the prescription of surmountable ARBs or insurmountable ARBs at discharge. Primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, nonfatal MI, and re-percutaneous coronary intervention, coronary artery bypass graft surgery. Results: In the overall population, the MACEs rate in 1year was significantly higher in the surmountable ARB group (14.3% vs. 11.2%, p=0.025), which was mainly due to increased cardiac death (3.3% vs. 1.9%, p=0.031). Matching by propensity-score showed consistent results (MACEs rate: 14.9% vs. 11.4%, p=0.037). In subgroup analysis, the insurmountable ARB treatment significantly reduced the incidence of MACEs in patients with left ventricular ejection fraction greater than 40%, with a low killip class, with ST segment elevation MI, and with normal renal function. Conclusions: In our study, insurmountable ARBs were more effective on long-term clinical outcomes than surmountable ARBs in patients with AMI. [Copyright &y& Elsevier]

Background: This study was conducted to evaluate the endothelialization and the inflammatory responses depending on the administration duration of triple anti-platelet therapy at overlapping bioabsorbable polymer coated biolimus-eluting stents (BESs) in a porcine coronary model. Methods: We successfully deployed 36 overlapping BESs for the left anterior descending coronary and left circumflex artery or right coronary artery in 18 non-injured pigs. Total pigs were divided into 3 groups (12 overlapping stents of 6 pigs in each group) as follows: group I received aspirin 100mg and clopidogrel 75mg daily for 8weeks, group II received aspirin 100mg and clopidogrel 75mg daily for 8weeks and cilostazol 200mg daily for initial 4weeks, and group III received aspirin 100mg, clopidogrel 75mg, and cilostazol 200mg daily for 8weeks. Follow-up coronary angiograms and histomorphometric and histopahtologic analyses at overlapping and non-overlapping segments were performed respectively. Results: Inflammation score was similar between overlapping and non-overlapping segments in all pigs (1.2±0.33 vs. 1.1±0.17, p=0.117). The neointima area (NA) and percent area stenosis (%AS) at overlapping segments were not significantly different among the 3 groups. However, at non-overlapping segments, NA and %AS in group III were significantly smaller than those in group I (2.3±0.50mm2 vs. 1.8±0.43mm2, p=0.037; 48.9±12.85% vs. 37.7±9.08%, p=0.031). Conclusions: Our study shows that BES appears to be reliable on the inflammatory response at overlapping segments as well as non-overlapping segments. Long-term administration of cilostazol is more effective in reducing neointimal formation at non-overlapping segments of BESs in a porcine coronary model. [ABSTRACT FROM AUTHOR]

Background: Impact of plaque composition on late stent malapposition (LSM) after drug-eluting stent (DES) implantation has not been evaluated. Methods: We evaluated the relation between plaque components at poststenting peristent area (between external elastic membrane and stent areas) and LSM after DES implantation in 266 patients (314 native lesions; paclitaxel-eluting stent in 205 lesions, sirolimus-eluting stent in 66 lesions, zotarolimus-eluting stent in 32 lesions and everolimus-eluting stent in 11 lesions) in whom virtual-histology intravascular ultrasound was performed at index (poststenting) and follow-up (mean: 11.7±4.8months). Results: LSM occurred in 24 patients with 30 lesions (9.6%) and there were no significant differences in the incidences of LSM among 4 DES groups [21/205 (10.2%) in paclitaxel-eluting stent, 6/66 (9.1%) in sirolimus-eluting stent, 2/32 (6.3%) in zotarolimus-eluting stent and 1/11 (9.1%) in everolimus-eluting stent, p =0.5)]. Patients with LSM were presented with more acute myocardial infarction (50% vs. 28%, p =0.026) and were more diabetics (50% vs. 30%, p =0.030) compared with those without LSM. Lesions with LSM had more poststenting peristent %necrotic core (NC) volume compared with those without LSM (25.8±11.1% vs. 21.0±5.7%, p <0.001). Independent predictors of LSM were poststenting peristent %NC volume [odds ratio (OR); 1.216, 95% CI; 1.053–1.405, p =0.008], acute myocardial infarction (OR; 2.897, 95% CI; 1.675–4.118, p =0.029), and diabetes mellitus (OR; 2.413, 95% CI; 1.543–3.996, p =0.038). Conclusions: Poststenting peristent NC component especially in patients with acute myocardial infarction and in those with diabetes mellitus is associated with the development of LSM after DES implantation. [ABSTRACT FROM AUTHOR]

Objective: We used virtual histology-intravascular ultrasound (VH-IVUS) to evaluate the relation between coronary artery remodeling pattern and plaque components in 1133 patients. Methods: We divided the patients into two groups according to the remodeling pattern as positive remodeling (PR, remodeling index>1.05) (n=192) and intermediate remodeling (IR, remodeling index≤1.05 and ≥0.95)/negative remodeling (NR, remodeling index<0.95) (n=941). VH-IVUS analysis classified the color-coded tissue into four major components: green (fibrotic, FT); yellow–green (fibro-fatty); white (dense calcium); and red (necrotic core, NC). Thin-cap fibroatheroma (TCFA) was defined as focal, NC-rich (≥10% of the cross-sectional area) plaques being in contact with the lumen in a plaque burden≥40%. Results: At the minimum lumen site, PR group had greater plaque plus media area (12.8±4.9 vs. 9.9±3.8mm2, p <0.001) and greater %NC area (21.7±12.3 vs. 18.2±11.6%, p <0.001) and smaller %FT area (57.0±14.5 vs. 59.4±14.6%, p =0.037) compared with IR/NR group. PR group had greater plaque volume (188±150 vs. 135±130mm3, p <0.001) and greater %NC volume (19.1±9.6 vs. 16.6±9.2%, p =0.001) and smaller %FT volume (58.3±11.7 vs. 60.6±11.0%, p =0.009) compared with IR/NR group. PR group had more TCFA compared with IR/NR group (21% vs. 13%, p =0.006). Similar findings about plaque components were observed in terms of greater %NC volume and smaller %FT volume in PR group compared with IR/NR group in patients with both acute coronary syndrome and stable angina. Conclusions: VH-IVUS analysis demonstrates that PR was associated with more vulnerable plaque components compared with IR/NR regardless of their clinical presentation. [ABSTRACT FROM AUTHOR]

Abstract: Background: We used intravascular ultrasound (IVUS) to evaluate the association of tissue prolapse (TP) with short- and long-term outcomes after stent implantation in 418 acute myocardial infarction (AMI) patients. Methods: We evaluated the incidences of stent thrombosis, no-reflow, and long-term outcomes between patients with TP (n=142) and those without TP (n=276). Results: twb.42w?>Acute and subacute stent thromboses occurred more frequently in patients with TP compared with those without TP (3.5% vs. 0.7%, p =0.035, and 4.2% vs. 0.7%, p =0.013, respectively). TP volumes in 14 patients with stent thrombosis were significantly greater than those in 128 patients without stent thrombosis (3.3±1.6mm3 vs. 2.6±1.9mm3, p =0.012). No-reflow was developed more frequently in patients with TP compared with those without TP (25.4% vs. 9.8%, p <0.001). Creatine kinase-MB and cardiac-specific troponin I were elevated more significantly after stenting in patients with TP compared with those without TP (Δ=+9.0±25.2U/l vs. −4.2±41.6U/l, p =0.001 and Δ=+10.0±43.5ng/ml vs. −1.2±35.6ng/ml, p =0.005, respectively). There were no significant differences in the incidences of cardiac death, MI, and target vessel revascularization at 1-year. Multivariate analysis showed that TP was the independent predictor of composite of acute and subacute stent thromboses [odds ratio (OR)=4.211; 95% CI 1.198–14.805, p =0.025] and composite of acute stent thrombosis and no-reflow (OR=2.551; 95% CI 1.315–4.952, p =0.006). Conclusions: TP was associated with poor short-term outcomes (more acute and subacute thromboses and no-reflow phenomenon), however it was not associated with worse long-term outcomes after stent implantation for infarct-related arteries in patients with AMI. [Copyright &y& Elsevier]

We assessed the plaque characteristics and postpercutaneous coronary intervention (PCI) outcome according to the remodeling pattern (positive remodeling [PR], n = 113; and intermediate/negative remodeling [IR/NR], n = 198) in 311 saphenous vein graft lesions using intravascular ultrasound. The remodeling index was the ratio of the lesion site saphenous vein graft area to the mean of the proximal and distal references (PR/remodeling index >1.05, IR 0.95 to 1.05, and NR <0.95). Tissue prolapse was defined as tissue extrusion through the stent strut after PCI, and the tissue prolapse volume was calculated by subtracting the lumen volume from the stent volume. The presence of hypoechoic plaque (59% vs 36%, p = 0.001), plaque rupture (26% vs 16%, p = 0.042), multiple plaque rupture (12% vs 5%, p = 0.020), and an intraluminal mass (59% vs 41%, p = 0.002) were more common in the PR lesions than in the IR/NR lesions. The plaque cavity area was significantly greater in the PR lesions than in the IR/NR lesions (0.83 ± 1.43 mm2 vs 0.42 ± 1.07 mm2, p = 0.009). Post-PCI no-reflow (19% vs 9%, p = 0.019) and post-PCI tissue prolapse (53% vs 27%, p <0.001) were observed more frequently, and the tissue prolapse volume was significantly greater after PCI for PR lesions than for IR/NR lesions (0.86 ± 1.30 mm3 vs 0.34 ± 0.74 mm3, p <0.001). PR was the independent predictor of post-PCI no-reflow (odds ratio 2.58, 95% confidence interval 1.25 to 5.64, p = 0.040) and post-PCI tissue prolapse (odds ratio 2.45, 95% confidence interval 1.46 to 5.41, p = 0.045). In conclusion, saphenous vein graft lesions with PR have vulnerable plaque and are associated with no-reflow and tissue prolapse after PCI. [ABSTRACT FROM AUTHOR]

Abstract: Curcumin, a polyphenolic compound derived from turmeric, has protective effects on myocardial injury through attenuation of oxidative stress and inflammation. Toll-like receptor 2 (TLR2), a key mediator of the innate immune system, is involved in myocardial infarction and examined if controlled by curcumin. Rat cardiomyocytes (CMs) were stimulated with tumor necrosis factor (TNF)-α, peptidoglycan (PGN) or hypoxia/reoxygenation (H/R) with or without curcumin pretreatment. Sprague–Dawley rats were fed curcumin (300 mg/kg/day) 1 week before cardiac ischemia/reperfusion (I/R) injury. The expression level of TLR2 and cardiac function were assessed. Both mRNA and protein of TLR2 were up-regulated in infarcted myocardium, while TLR4 remained unchanged. In CMs, TLR2 and monocyte chemoattractant protein (MCP)-1 mRNAs were increased by TNF-α, PGN or H/R, whereas they were blunted by curcumin. Immunofluorescence staining of CMs also showed that TLR2 and MCP-1 were increased after H/R, whereas curcumin-pretreated CMs were not. In animal study, 2 weeks after I/R, TLR2 was increased in the infarct zone, whereas it stayed unchanged in the Cur+I/R group. Macrophage infiltration (CD68), high-mobility group box 1 and fibrosis were increased in the I/R group, whereas they were decreased in the Cur+I/R group. Connexin 43 was reduced in the I/R group, while it recovered significantly in the Cur+I/R group. Cardiac contractility in the Cur+I/R group was also improved compared with that in the I/R group (max dp/dt in Cur+I/R group: 9660±612 vs. I/R group: 8119±366, P<.05). These results suggest that selective inhibition of TLR2 by curcumin could be preventive and therapeutic for myocardial infarction. [Copyright &y& Elsevier]

Oxytocin stimulates the cardiomyogenesis of embryonic stem cells and adult cardiac stem cells. We previously reported that oxytocin has a promigratory effect on umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs). In this study, UCB-MSCs were cultured with oxytocin and examined for their therapeutic effect in an infarcted heart. UCB-MSCs were pretreated with 100 nM oxytocin and cardiac markers were assessed by immunofluorescence staining. Next, oxytocin-supplemented USC-MSCs (OT-USCs) were cocultured with hypoxia/reoxygenated neonatal rat cardiomyocytes and cardiac markers and dye transfer were then examined. For the in vivo study, ischemia/reperfusion was induced in rats, and phosphate-buffered saline (group 1), 1-day OT-USCs (group 2), or 7-day OT-USCs (group 3) were injected into the infarcted myocardium. Two weeks after injection, histological changes and cardiac function were examined. UCB-MSCs expressed connexin 43 (Cnx43), cardiac troponin I (cTnI), and α-sarcomeric actin (α-SA) after oxytocin supplementation and coculture with cardiomyocytes. Functional gap junction formation was greater in group 3 than in groups 1 and 2. Cardiac fibrosis and macrophage infiltration were lower in group 3 than in group 2. Restoration of Cnx43 expression was greater in group 3 than in group 2. Cnx43- and cTnI-positive OT-USCs in the peri-infarct zone were observed in group 2 and more frequently in group 3. The ejection fraction (EF) was increased in groups 2 and 3 in 2 weeks. The improved EF was sustained for 4 weeks only in group 3. Our findings suggest that the supplementation of UCB-MSCs with oxytocin can contribute to the cardiogenic potential for cardiac repair. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The burden of atrial fibrillation (AF) and the lack of data on AF and its management in the Asia Pacific highlight the need for a comprehensive prospective study of AF management in this region. To address this need, the REgistry on Cardiac rhythm disORDers (RecordAF-Asia Pacific [AP]) has been initiated to assess the management of AF in 8 countries across the Asia Pacific. RecordAF-AP is a prospective, observational survey of the management of recently diagnosed AF with 1 year of follow-up. Eligible patients with AF, treated or not, were included in the registry; with data recorded prospectively during the follow-up visits at 6 and 12 months. A total of 2,721 patients with AF were recruited, of whom 2,629 were eligible for evaluation (intent-to-treat population). At study inclusion, rhythm- and rate-control strategies were applied to 37% (n = 959) and 62% (n = 1,610) of the patients, respectively. At baseline, the rhythm-control patients were mainly prescribed class III agents (49%), class Ic agents (39%), or β blockers (except for sotalol; 35%). The rate-control patients were mainly prescribed β blockers (except for sotalol; 57%) or cardiac glycosides (32%). Patients receiving rate-control strategies were more likely to have a history of heart failure or valvular heart disease and persistent AF. In contrast, those receiving rhythm-control strategies were more likely to have recently diagnosed or paroxysmal AF. In conclusion, RecordAF-AP will provide much needed insight into the real-life management of patients with AF in the Asia Pacific region. [Copyright &y& Elsevier]

There are few data available on the prognosis of painless ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine the incidence, clinical characteristics, and outcomes of painless STEMI. We analyzed the Korea Acute Myocardial Infarction Registry (KAMIR) study, which enrolled 7,288 patients with STEMI (61.8 ± 12.8 years old, 74% men; painless STEMI group, n = 763; painful STEMI group, n = 6,525). End points were in-hospital mortality and 1-year major adverse cardiac events (MACEs). Patients with painless STEMI were older and more likely to be women, nonsmokers, diabetic, and normolipidemic and to have a higher Killip class. The painless group had more in-hospital deaths (5.9% vs 3.6%, p = 0.026) and 1-year MACEs (26% vs 19%, p = 0.002). In Cox proportional hazards analysis, hypotension (hazard ratio [HR] 4.40, 95% confidence interval [CI] 1.41 to 13.78, p = 0.011), low left ventricular ejection fraction (HR 3.12, 95% CI 1.21 to 8.07, p = 0.019), and a high Killip class (HR 3.48, 95% CI 1.19 to 10.22, p = 0.023) were independent predictors of 1-year MACEs in patients with painless STEMI. In conclusion, painless STEMI was associated with more adverse outcomes than painful STEMI and late detection may have contributed significantly to total ischemic burden. These results warrant more investigations for methodologic development in the diagnosis of silent ischemia and painless STEMI. [Copyright &y& Elsevier]

Abstract: Background: In patients with non-ST-elevation myocardial infarction (NSTEMI), current guidelines did not recommend optimal revascularization management in multivessel coronary artery disease. We compared clinical outcomes between multivessel revascularization and culprit-only revascularization in this setting. Methods: A total of 1919 patients with multivessel disease (1011 patients; multivessel revascularization group, 908 patients; culprit-only revascularization group) diagnosed as NSTEMI was enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008. The primary end-points were major adverse cardiac events (MACE), all-causes of deaths, myocardial infarction (MI), and repeated percutaneous coronary intervention (PCI) during 1-year clinical follow-up. Also, subgroup analysis was performed in patients with high TIMI (Thrombolysis In Myocardial Infarction) risk score (≥4) to find efficacy of multivessel PCI in high-risk patients. Results: Baseline clinical characteristics and the risk factors of coronary artery disease were similar between both groups. In angiography, three-vessel lesion was more presented in the multivessel group (46.1% vs. 40.9%, p =0.024) and rates of left anterior descending and left main stem coronary artery as culprit vessel were higher in the multivessel group (p =0.003 and p =0.001 respectively). In-hospital mortality was higher in the culprit-only group (1.4% vs. 2.9%, p =0.025). Primary end-points occurred in 241 patients (15.5%) during 1-year follow-up. Multivessel revascularization reduced MACEs [hazard ratio (HR) 0.658, 95% confidence interval (CI) 0.45 to 0.96, p =0.031], death or myocardial infarction (HR 0.58, 95% CI 0.35 to 0.97, p =0.037) and non-target vessel revascularization (HR 0.44, 95% CI 0.24 to 0.81, p =0.008). There were no significant differences in target lesion revascularization (TLR; HR 1.38, 95% CI 0.51 to 3.71, p =0.529) and target vessel revascularization (TVR; HR 0.28, 95% CI 0.05 to 1.47, p =0.131). In subgroup analysis in patients with a higher TIMI risk score, similar results were presented. Conclusion: Multivessel revascularization in multivessel coronary artery disease presenting with NSTEMI showed better clinical outcomes without significant in-stent restenosis and progression of diseased-vessel compared to culprit-only revascularization. [Copyright &y& Elsevier]

Objectives: We investigated whether statin therapy could be beneficial in patients with acute myocardial infarction (AMI) who have baseline low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dl. Background: Intensive lipid-lowering therapy with a target LDL-C value <70 mg/dl is recommended in patients with very high cardiovascular risk. However, whether to use statin therapy in patients with baseline LDL-C levels below 70 mg/dl is controversial. Methods: We analyzed 1,054 patients with AMI who had baseline LDL-C levels below 70 mg/dl and survived at discharge from the Korean Acute MI Registry between November 2005 and December 2007. They were divided into 2 groups according to the prescribing of statins at discharge (statin group n = 607; nonstatin group n = 447). The primary endpoint was the composite of 1-year major adverse cardiac events, including death, recurrent MI, target vessel revascularization, and coronary artery bypass grafting. Results: Statin therapy significantly reduced the risk of the composite primary endpoint (adjusted hazard ratio [HR]: 0.56; 95% confidence interval [CI]: 0.34 to 0.89; p = 0.015). Statin therapy reduced the risk of cardiac death (HR: 0.47; 95% CI: 0.23 to 0.93; p = 0.031) and coronary revascularization (HR: 0.45, 95% CI: 0.24 to 0.85; p = 0.013). However, there were no differences in the risk of the composite of all-cause death, recurrent MI, and repeated percutaneous coronary intervention rate. Conclusions: Statin therapy in patients with AMI with LDL-C levels below 70 mg/dl was associated with improved clinical outcome. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the prevalence of electrocardiographic (ECG) findings suggestive of sudden cardiac death risk in apparently healthy young Korean men. We administered questionnaires that elicited personal and family histories and performed ECGs on 10,867 male subjects (mean age, 20.9 years). The subjects with abnormal ECG findings underwent echocardiography, a treadmill test, Holter monitoring, a flecainide provocation test, or an electrophysiologic study (EPS) according to the ECG findings and histories. Of the subjects, 5.95% had left ventricular hypertrophy on ECG, but no subjects had hypertrophic cardiomyopathy by echocardiography. The percentage of subjects with a Brugada ECG pattern was 0.90%. We identified one subject with a positive result on the flecainide provocation test. The percentage of subjects with a preexcitation ECG was 0.17%. In two of the subjects, supraventricular tachycardia was induced in the EPS. Of the subjects, 0.05% had epsilon waves, but there were no subjects with arrhythmogenic right ventricular dysplasia/cardiomyopathy by echocardiography. The percentage of subjects with long QT intervals was 0.02%, but there were no arrhythmias on the treadmill test or Holter monitoring. The prevalence of a Brugada ECG pattern in apparently healthy young men is higher in Korea than other countries. (PACE 2011; 1-7) [ABSTRACT FROM AUTHOR]

Abstract: Mast cells are multifunctional cells containing various mediators, such as cytokines, tryptase, and histamine, and they have been identified in infarct myocardium. Here, we elucidated the roles of mast cells in a myocardial infarction (MI) rat model. We studied the physiological and functional roles of mast cell granules (MCGs), isolated from rat peritoneal fluid, on endothelial cells, neonatal cardiomyocytes, and infarct heart (1-hour occlusion of left coronary artery followed by reperfusion). The number of mast cells had two peak time points of appearance in the infarct region at 1day and 21days after MI induction in rats (p <0.05 in each compared with sham-operated heart). Simultaneous injection of an optimal dose of MCGs modulated the microenvironment and resulted in the increased infiltration of macrophages and decreased apoptosis of cardiomyocytes without change in the mast cell number in infarct myocardium. Moreover, MCG injection attenuated the progression of MI through angiogenesis and preserved left ventricular function after MI. MCG-treated cardiomyocytes were more resistant to hypoxic injury through phosphorylation of Akt, and MCG-treated endothelial cells showed enhanced migration and tube formation. We have shown that MCGs have novel cardioprotective roles in MI via the prolonged survival of cardiomyocytes and the induction of angiogenesis. [Copyright &y& Elsevier]

Complete blood count is the most widely available laboratory datum in the early in-hospital period after ST-elevation myocardial infarction (STEMI). We assessed the clinical utility of the combined use of hemoglobin (Hb) level and neutrophil-to-lymphocyte ratio (N/L) for early risk stratification in patients with STEMI. We analyzed 801 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) within 12 hours of onset of symptoms. Patients with cardiogenic shock or underlying malignancy were excluded, and 739 patients (63 ± 13 years, 74% men) were included in the final analysis. Patients were categorized into 3 groups using the median value of N/L (3.86) and the presence of anemia (Hb <13 mg/dl in men and <12 mg/dl in women); group I had low N/L and no anemia (n = 272), group II had low N/L and anemia, or high N/L and no anemia (n = 331), and group III had high N/L and anemia (n = 136). There were significant differences on clinical outcomes during 6-month follow-up among the 3 groups. Prognostic discriminatory capacity of combined use of Hb level and N/L was also significant in high-risk subgroups such as patients with advanced age, diabetes mellitus, multivessel coronary disease, low ejection fraction, and even in those having higher mortality risk based on Thrombolysis In Myocardial Infarction risk score. In a Cox proportional hazards model, after adjusting for multiple covariates, group III had higher mortality at 6 months (hazard ratio 5.6, 95% confidence interval 1.1 to 27.9, p = 0.036) compared to group I. In conclusion, combined use of Hb level and N/L provides valuable timely information for early risk stratification in patients with STEMI undergoing primary PCI. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is a paucity of data concerning the clinical outcome of patients presenting with acute myocardial infarction (AMI) and near-normal coronary angiograms. The purpose of this study was to evaluate the clinical outcome and the prognosis of the patients with near-normal coronary angiograms who were registered in the Korean Acute Myocardial Infarction Registry (KAMIR). Methods: The subjects were divided into three groups according to findings from coronary angiograms performed between September 2005 and November 2006. Among 8510 consecutive AMI patients, 372 patients (Group I) had near-normal coronary arteries, 6136 patients (Group II) had one- or two-vessel disease, and 2002 patients (Group III) had three-vessel or left main disease. Results: Clinical characteristics, in-hospital mortality, and major cardiac adverse events (MACE) were analyzed. Group I was younger, had the lower prevalence of DM, and showed the higher percentage of previous angina history compared to the other two groups. Group III showed a higher incidence of in-hospital mortality, but there was no significant difference between Group I and Group II (2.6% in Group II and 2.2% in Group I, p =0.952). Furthermore, MACE at 1month, 6months and 12months revealed no significant difference between Groups I and II (12month MACE: 7.8% in Group I and 12.2% in Group II, p =0.359). Conclusions: Patients with near-normal coronary angiograms had similar clinical outcomes and prognosis compared with one- or two-vessel diseased patients presenting with an acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: The literature suggests that the prevalence of atrial fibrillation (AF) may be lower in Asian countries than in Western countries. Nevertheless, AF remains a significant public health problem in the region. The burden of AF, the experiences of previous trials and the lack of data on AF and its management in Asia Pacific highlight the need for a comprehensive prospective study of AF management. Methods: The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation Asia Pacific (RecordAF-AP) is a prospective, observational survey of the management of recently diagnosed AF patients with 1-year follow-up in 8 countries across Asia Pacific. Eligible patients presenting with AF, treated or not, will be included in the registry and data will be recorded prospectively during follow-up visits at 6 and 12 months. Results: RecordAF-AP will recruit more than 3000 patients. Study recruitment commenced in April 2009 and the final results anticipated at the end of 2011. Conclusions: RecordAF-AP will assess the real-life management of AF patients in Asia Pacific, including a comparison of clinical outcomes in rhythm versus rate control strategies, providing much needed insight into the costs, treatment choices and clinical outcomes of AF patients in this region. [ABSTRACT FROM AUTHOR]

Abstract: Background and objectives: Prediction for long-term clinical outcomes in patients with non-ST elevation acute coronary syndrome is important as well as early risk stratification. The aim of this study is to develop a simple assessment tool for better early bedside risk stratification for both short- and long-term clinical outcomes. Subjects and methods: 2148 patients with non-ST-segment elevation myocardial infarction (NSTEMI) (64.9±12.2 years, 35.0% females) were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR). A new risk score was constructed using the variables related to one year mortality: TIMI risk index (17.5–30: 1 point, >30: 2 points), Killip class (II: 1 point, >II: 2 points) and serum creatinine (≥1.5 mg/dL: 1 point), based on the multivariate-adjusted risk relationship. The new risk score system was compared with the Global Registry of Acute Coronary Events (GRACE) and TIMI risk scores during a 12-month clinical follow-up. Results: During a one year follow-up, all causes of death occurred in 362 patients (14.3%), and 184 (8.6%) patients died in the hospital. The new risk score showed good predictive value for one year mortality. The accuracy for in-hospital and one year post-discharge mortality rates, the new risk score demonstrated significant differences in predictive accuracy when compared with TIMI and GRACE risk scores. Conclusion: A new risk score in the present study provides simplicity with accuracy simultaneously for early risk stratification, and also could be a powerful predictive tool for long-term prognosis in NSTEMI. [ABSTRACT FROM AUTHOR]

It is not well known which lesions are progressed or regressed in patients with angina pectoris who use statins. We assessed the impact of plaque components on plaque progression in patients with angina pectoris who used rosuvastatin 10 mg/day using virtual histology plus intravascular ultrasound. Sixty-six patients who underwent baseline and 9-month follow-up virtual histology plus intravascular ultrasound for nonintervened intermediate coronary stenosis were grouped according to plaque progression (increase of plaque plus media area, n = 22) or plaque regression (decrease of plaque plus media area, n = 44) at baseline minimum lumen area (MLA) site at follow-up and compared the various parameters including baseline plaque components between the 2 groups. Follow-up low-density lipoprotein cholesterol was not significantly different between the progression and regression groups (85 ± 30 vs 82 ± 24 mg/dl, p = 0.6). Baseline percent necrotic core (NC) area was significantly larger (26.1 ± 10.9% vs 17.6 ± 10.8%, p = 0.004) and baseline percent fibrofatty area was significantly smaller (8.1 ± 6.2% vs 14.2 ± 12.1%, p = 0.008) at the MLA site in the progression group compared to the regression group. Thin-cap fibroatheroma was observed more frequently in the progression group compared to the regression group (32% vs 9%, p = 0.020). Change of plaque plus media area from baseline to follow-up at the MLA site correlated with baseline percent NC area (r = 0.375, p = 0.002), baseline percent fibrofatty area (r = −0.388, p = 0.001), and baseline percent fibrotic area (r = −0.242, p = 0.050). Baseline percent NC area at the MLA site was an independent predictor of plaque progression at follow-up (odds ratio 1.265, 95% confidence interval 1.069 to 1.497, p = 0.006). In conclusion, NC is associated with plaque progression in patients when low-density lipoprotein cholesterol level is around 80 mg/dl at 9-month follow-up in patients with angina pectoris on rosuvastatin 10 mg/day. [Copyright &y& Elsevier]

We used virtual histology and intravascular ultrasound (VH-IVUS) to evaluate the relation between aortic knob calcium (AKC) and plaque components in diabetic patients. The presence of AKC was assessed by posteroanterior view of chest x-ray or fluoroscopy at the time of coronary angiography. A total of 137 de novo coronary culprit lesions in 137 consecutive diabetic patients were studied and coronary plaque components were analyzed using VH-IVUS according to the presence (n = 45) or absence (n = 92) of AKC. Patients with AKC were significantly older (68 ± 8 vs 62 ± 9 years, p <0.001) and had significantly higher high-sensitivity C-reactive protein levels (1.97 ± 1.33 vs 0.48 ± 1.35 mg/dl, p = 0.005) compared to patients without AKC. Absolute and percent necrotic core (NC) volumes (30 ± 26 vs 20 ± 19 mm3, p = 0.003; 23.4 ± 10.3% vs 17.4 ± 8.9%, p = 0.005, respectively) and absolute and percent dense calcium (DC) volumes (17 ± 12 vs 11 ± 12 mm3, p = 0.010; 13.3 ± 7.3% vs 9.6 ± 7.9%, p = 0.011, respectively) were significantly greater in lesions with AKC compared to those without AKC. Multivariable analysis showed that age (odds ratio [OR] 1.233, 95% confidence interval [CI] 1.121 to 1.355, p <0.001), high-sensitivity C-reactive protein (OR 1.871, 95% CI 1.090 to 2.943, p = 0.007), absolute DC volume (OR 1.020, 95% CI 1.050 to 1.178, p = 0.003), and absolute NC volume (OR 1.026, 95% CI 1.057 to 1.199, p <0.001) were independent predictors of AKC. In conclusion, diabetic patients with AKC were older, had greater NC- and DC-containing plaques, and higher inflammatory status compared to diabetic patients without AKC. [Copyright &y& Elsevier]

We used intravascular ultrasonography to assess plaque morphology and morphometry in 310 patients with acute myocardial infarction (125 with ST-segment elevation and 185 with non–ST-segment elevation myocardial infarction) with varying degrees of renal dysfunction according to the creatinine clearance (CrCl): CrCl >70 ml/min in 153, CrCl of 30 to 69 ml/min in 103, and CrCl of <30 ml/min in 54 patients, including 20 patients requiring dialysis). The lesion site plaque burden was greatest (77.4 ± 11.0% vs 79.8 ± 12.5% vs 82.0 ± 10.3%, p = 0.031) and the lesion was longest (20.9 ± 9.1 vs 23.1 ± 9.5 vs 26.3 ± 9.6 mm, p = 0.038) in the lowest CrCl group. Infarct-related artery plaque rupture (31.4% vs 34.0% vs 53.7%, p = 0.011) and multiple plaque ruptures (11.1% vs 12.6% vs 33.3%, p <0.001) were the most common, the ruptured plaque cavities were the largest (1.98 ± 0.89 vs 2.20 ± 1.45 vs 3.06 ± 1.70 mm2, p = 0.002), and the ruptured plaque was longest (2.33 ± 0.93 vs 2.59 ± 1.50 vs 3.33 ± 1.76 mm, p = 0.008) in the lowest CrCl group (<30 ml/min). Intravascular ultrasound-detected thrombus was observed most frequently in the lowest CrCl group (22.9% vs 23.3% vs 40.7%, p = 0.027). CrCl was the one of the independent predictors of culprit lesion plaque rupture (odds ratio 0.979, 95% confidence interval 0.963 to 0.994, p = 0.008). During 1 year of follow-up, the incidence of nonfatal myocardial infarction (2.6% vs 4.9% vs 11.1%, p = 0.044) and cardiac death (3.9% vs 6.8% vs 14.8%, p = 0.024) was greatest in the lowest CrCl group. Also, a strong trend was found toward the greatest incidence of stent thrombosis (2.0% vs 3.9% vs 9.3%, p = 0.057) in the lowest CrCl group. In conclusion, patients with acute myocardial infarction and significant renal dysfunction had more plaque vulnerability compared to those with normal renal function. This might be associated with poor clinical outcomes in patients with acute myocardial infarction and renal dysfunction. [Copyright &y& Elsevier]

Zotarolimus-eluting stents (ZESs) demonstrated greater in-segment late luminal loss and in-segment binary restenosis rates compared to sirolimus-eluting stents (SESs) in several studies. However, no data are available in direct comparison between the clinical outcomes of the 2 stents in unselected patients with ST-segment elevation acute myocardial infarction (STEMI). The aim of the present study was to compare the clinical outcomes of ZESs and SESs in real-world patients with STEMI. A total of 873 patients with STEMI (306 patients in the ZES group and 567 patients in the SES group) were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) from January 2007 to January 2008. The primary end points were major adverse cardiac events, a composite of all causes of death, myocardial infarction, and target lesion revascularization during a 12-month clinical follow-up. During 1 year of follow-up, the primary end points occurred in 140 patients (16.0%). The use of glycoprotein IIb/IIIa inhibitors and the occurrence of multivessel disease were more common in the SES group. The SES group had a significantly lower incidence of major adverse cardiac events (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.07 to 2.16, p = 0.02), target lesion revascularization (HR 2.16, 95% CI 1.01 to 4.59, p = 0.046), and target vessel revascularization (HR 2.24, 95% CI 1.18 to 4.24, p = 0.013). However, no significant differences were found in death or myocardial infarction (HR 1.37, 95% CI 0.91 to 2.05, p = 0.129). In conclusion, SESs provided superior angiographic outcomes, translating into better clinical outcomes and negating any change in STEMI patient safety profiles compared to ZESs. [Copyright &y& Elsevier]

Abstract: Thermo-responsive hydrogel-mediated gene transfer may be preferred for the muscle, because the release of DNA into the surrounding tissue can be controlled by the 3-dimensional structure of the hydrogel. Such a system for the controlled release of a therapeutic gene may extend the duration of gene expression. Here, a thermo-responsive, biodegradable polymeric hydrogel was synthesized for local gene transfer in the heart. Initially, the luciferase gene was delivered into mouse heart. The intensity of gene expression assessed by optical imaging was closely correlated with the expressed protein concentration measured by luciferase assay in homogenized heart. Polymeric hydrogel-based gene transfer enhanced gene expression up to 4 fold, compared with naked plasmid, and displayed 2 bi-modal expression profiles with peaks at 2 days and around 25 days after local injection. Histological analyses showed that gene expression was initially highest in the myocardium, whereas lower and longer expression was seen mainly in fibrotic or inflammatory cells that infiltrated the injury site during injection. Next, a rat myocardial infarction model was made for 1 week, and human vascular endothelial growth factor (hVEGF) plasmid was injected into the infarct area with an amphiphilic thermo-responsive polymer. Enhanced and sustained hVEGF expression in the infarct region mediated by amphiphilic thermo-responsive polymer increased capillary density and larger vessel formation, thus enabling effective angiogenesis. [Copyright &y& Elsevier]

Abstract: Background and objectives: The first on-line prospective, open and observational registration, Korea Acute Myocardial Infarction Registry (KAMIR), has been carried out throughout 41 primary percutaneous coronary intervention (PCI) centers by the support of the Korean Circulation Society (KCS) in the memorandum of the 50th Anniversary of the KCS. Subjects and methods: Between Nov 2005 and Aug 2006, 5624 enrolled patients (3925 male, 1699 female; age=64.0±13.0 years) were analyzed. The treatment strategy of acute myocardial infarction (AMI) was analyzed according to the sex differences in the field of acute ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Results: In the initial selection of treatment strategy, invasive treatment was more commonly performed in males than females with both STEMI and NSTEMI (82.0% vs. 78.7%, p =0.001; 50.4% vs. 43.7%, p =0.004). Severe heart failure was the most important predictor of invasive treatment after multivariate adjustment. During hospital stay, PCI regardless of its subtype was more frequently performed in males than in females with both STEMI and NSTEMI (STEMI: 89.5% vs. 84.7%, p <0.001; NSTEMI: 77.0% vs. 66.7%, p <0.001). Success rate of PCI in STEMI was not different between the sexes (95.8% vs. 93.8%, p =0.075), but that of NSTEMI was higher in males than females (96.8% vs. 95.6%, p =0.005). Major adverse cardiac events (MACE) developed more frequently in women than men with both STEMI (9.2% vs. 17.0%, p <0.001) and NSTEMI (7.3% vs. 12.0%, p <0.001) during 1 month clinical follow-up. Conclusions: In the initial treatment of AMI in Korea, there is no gender difference for invasive treatment. However, success rate of PCI in NSTEMI was lower and 1 month MACE was higher in females than males in Korea. [Copyright &y& Elsevier]

Abstract: Background: Smaller postprocedural minimum stent areas (MSA) measured by intravascular ultrasound (IVUS) have been associated with higher restenosis rates. Methods: This was a single-center, prospective, randomized trial and we assessed the predictive value of MSA for long-term patency and the incidence and extent of incomplete stent apposition (ISA) following abciximab-coated stent (n =69) compared to bare metal stent (BMS) implantation (n =69). All patients underwent IVUS follow-up at 6 months. Results: At follow-up coronary angiogram, the restenosis rate and late loss were 12%, 0.30±0.24 mm in abciximab-coated stent group and 29%, 0.68±0.36 mm in BMS group (p =0.011, 0.010, respectively). At follow-up IVUS, intrastent lumen area was significantly larger and intrastent neointimal hyperplasia area was significantly smaller in abciximab-coated stent group than those in BMS group (5.9±1.6 mm2 vs. 4.5±1.7 mm2, p =0.001, and 1.9±1.5 mm2 vs. 3.3±1.9 mm2, p <0.001, respectively). Target lesion revascularization occurred in 9%, 0%, and 0% in abciximab-coated stent group and 19%, 4%, and 1% in BMS group in lesions with a MSA <6.0 mm2, from 6 to 7.5 mm2, and >7.5 mm2, respectively. Late-acquired ISA at follow-up was observed in 7 patients and there was no difference in the incidence of ISA between both groups [abciximab-coated stent: n =3 (4%) vs. BMS: n =4 (6%), p =0.698]. Conclusion: Abciximab-coated stent reduced restenosis and had a considerably lower optimal MSA threshold compared to BMS and showed lower incidence of late-acquired ISA. [Copyright &y& Elsevier]

The no-reflow phenomenon after primary percutaneous coronary intervention (PCI) is associated with larger infarct size, worse functional recovery, and higher incidence of complication after acute ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the relation between preprocedural N-terminal pro–brain-type natriuretic peptide (NT–pro-BNP) and angiographic no-reflow phenomenon. We measured preprocedural serum NT–pro-BNP level in 159 consecutive patients with acute STEMI (aged 63 ± 12 years; 72% men) before PCI. Angiographic no-reflow after PCI was defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade <3. Baseline characteristics, including time from chest pain onset, between the no-reflow (n = 67) and normal-reflow groups (n = 92) were similar. NT–pro-BNP was significantly higher in the no-reflow group than the normal reflow group (1,982 ± 3,314 vs 415 ± 632 pg/ml; p = 0.005). Also, high-sensitivity C-reactive protein, monocytes, and troponin-T were significantly higher in the no-reflow group than the normal-reflow group. In the no-reflow group, NT–pro-BNP was much higher in patients with TIMI flow grade 0 (n = 41; 2,290 ± 3,495 pg/ml) than those with TIMI grade 1 or 2 (n = 26; 1,575 ± 2,340 pg/ml), but without significant difference. The area under the receiver-operating characteristic curve for NT–pro-BNP was 0.78, and the optimal cut-off value identified using receiver-operating characteristic curve analysis was 500 pg/ml. At the standard cut-off value of >500 pg/ml, increased NT–pro-BNP showed a high probability of no-reflow phenomenon (odds ratio 4.42, 95% confidence interval 1.15 to 17.00, p = 0.028). In conclusion, preprocedural NT–pro-BNP may be a strong predictor of the development of no-reflow phenomenon after PCI in patients with acute STEMI. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study was to compare the effects of granulocyte-colony stimulating factor (G-CSF) on in-stent restenosis (ISR) in bare and sirolimus-eluting stents (SES) in a porcine myocardial infarction model. Background: Using G-CSF to mobilize stem cells has shown promise in infarcted heart. However, G-CSF may aggravate ISR and an aggressive strategy to prevent ISR is needed. Methods: Bare stents and SES were implanted in coronary arteries (Group I, bare stents; Group II, bare stents with G-CSF; Group III, SES; Group IV, SES with G-CSF, n =10 in each group) 72 h after experimental myocardial infarction (MI). G-CSF (10 μg/kg/day) was injected for 7 days from 24 h after stent implantation. Results: In coronary angiographic and histomorphometric analysis, percent area stenosis was significantly increased in Group II compared with that in Group I at 28 days (P <0.05). The ratio of inflammatory cells in the neointima was higher in Group II (P <0.05). No significant differences were observed between Group III and IV. In Group II, phosphorylated signal transducers and activators of transcription (STAT)-3, STAT-3, and vascular endothelial growth factor (VEGF) showed increased neointimal expression. In porcine aortic smooth muscle cells (PASMC), G-CSF increased the growth rate, migration, STAT-3 phosphorylation, and VEGF, which were suppressed by rapamycin and AG490, a STAT-3 inhibitor. Conclusions: STAT-3 and VEGF are important in the development of enhanced ISR by G-CSF in bare stents. SES could be a good strategy to prevent the G-CSF-stimulated proliferation and migration of smooth muscle cells, which could be responsible for neointimal hyperplasia. [Copyright &y& Elsevier]

The level of N-terminal pro–B-type natriuretic peptide (NT–pro-BNP) is a strong predictor of mortality in patients with acute coronary syndrome and may be a strong prognostic marker in patients with chronic coronary artery disease. We investigated whether NT–pro-BNP could predict in-stent restenosis (ISR) in asymptomatic patients with preserved left ventricular (LV) systolic function who underwent percutaneous coronary intervention. We measured serum NT–pro-BNP levels in 249 patients (61 ± 9 years of age; 73% men) with preserved LV systolic function (ejection fraction >50%) who underwent follow-up coronary angiography. Initial diagnoses were stable angina in 50 (20%), unstable angina in 133 (53%), and myocardial infarction in 66 (27%). Baseline characteristics between groups with ISR (n = 92) and without ISR (n = 157) were similar. The level of NT–pro-BNP was higher in patients with ISR than in those without ISR (222 ± 327 vs 94 ± 136 pg/ml, p = 0.001). In the ISR group, NT–pro-BNP level was higher in patients with left anterior descending coronary artery ISR (n = 53, 312 ± 479 pg/ml) than in those with left circumflex coronary artery ISR (n = 19, 115 ± 98 pg/ml, p = 0.018). At the standard cutoff of >200 pg/ml, a high NT–pro-BNP level indicated a high probability of ISR (odds ratio 2.18, 95% confidence interval 1.0 to 4.5, p = 0.038). In multivariate analysis, NT–pro-BNP level was an independent predictor for ISR. In conclusion, NT–pro-BNP could be a predictor of ISR in asymptomatic patients with preserved LV systolic function. [Copyright &y& Elsevier]

Although various predictors relating to in-stent restenosis (ISR) have been demonstrated, the relation between the parameters of intravascular ultrasound and inflammatory markers and ISR has not been reported. This study included 120 patients who underwent stent implantation for angiographically significant stenosis. Patients were divided into a soft plaque group (n = 50) and a nonsoft plaque group (n = 70). All patients underwent angiographic and intravascular ultrasound follow-up at 6 months. The baseline high-sensitivity C-reactive protein (hs-CRP) level was significantly higher in the soft plaque group. The follow-up minimal lumen diameter was significantly smaller in the soft plaque group. Soft plaque was detected in 73% of the ISR group but only 27% of the non-ISR group. Also, ISR was observed in 44% of the soft plaque group in contrast to only 11% of the nonsoft plaque group. The neointimal area at the minimal lumen cross-sectional area at follow-up was significantly larger in the soft plaque group (3.7 ± 1.5 vs 1.9 ± 1.5 mm2, p <0.001). In conclusion, in patients with soft plaque, an elevated hs-CRP level was significantly associated with ISR (63% vs 15%, p <0.001). By multivariate analysis, the combination of soft plaque and elevated hs-CRP was the most significant independent predictor of ISR. [Copyright &y& Elsevier]

Abstract: Objective: This study was designed to examine whether mesenchymal stem cells (MSCs) transduced with Akt enhance cardiac repair after transplantation into the ischemic porcine heart. Methods: MSCs isolated from porcine bone marrow and transduced with myr-Akt were transplanted into porcine hearts after experimental myocardial infarction (MI) using intracoronary injection [Group I, vehicle; Group II, MSCs; Group III, Akt-MSCs]. Myocardial single photon emission tomography (M-SPECT) was performed to assess myocardial function and the infarcted area. Pigs were also sacrificed for immunohistochemical characterization and histologic analysis. In addition, in vitro assays were performed to examine the resistance of Akt-MSCs to H2O2 stimulation. Results: Transplantation of MSCs into the ischemic porcine myocardium (Group II) increased the left ventricular ejection fraction (ΔLV EF; −6.3±15.1% versus 0.5±6.4%, P <0.001) and decreased the Δarea of MI (6.8±5.6% versus −5.0±5.3%, P <0.001) compared with the vehicle control (Group I). Transplantation of MSCs transduced with myr-Akt (Group III) resulted in further improvement in ΔLV EF (−6.3±15.1% versus 5.8±11.3%, P <0.001) and in Δarea of MI (6.8±5.6% versus −17.0±7.6%, P <0.001). Akt-MSCs were more resistant to apoptosis, and the levels of extracellular signal-regulated protein kinase (ERK) activation and vascular endothelial growth factor (VEGF) were higher in H2O2-stimulated Akt-MSCs. Conclusion: Cellular transplantation of Akt-MSCs further enhances the repair of injured myocardium compared to MSC transplantation alone by increasing the number of viable MSCs after cellular transplantation. [Copyright &y& Elsevier]

Objectives: This study is a prospective randomized trial investigating clinical outcomes of patients with acute myocardial infarction (AMI) treated with abciximab (ReoPro)-coated stents. Background: Recently we have demonstrated that abciximab-coated stents have inhibitory effects in the prevention of coronary restenosis. Methods: Ninety-six patients with AMI were randomly allocated into two groups; group I received abciximab-coated stents (n = 48, 57.1 ± 12.0 years), and group II received bare metal control stents (n = 48, 58.4 ± 11.6 years). Results: At baseline, clinical characteristics, percent diameter stenosis, and minimal luminal diameter were no different between the two groups. One patient in group II had reinfarction and target lesion reintervention during hospital stay. Follow-up coronary angiography was obtained in 77.1% (37 of 48) in group I and 75.0% (36 of 48) in group II. Percent diameter stenosis and late loss were significantly lower in group I than group II (18.9 ± 5.54% vs. 37.9 ± 6.25%, p = 0.008; and 0.39 ± 0.29 mm vs. 0.88 ± 0.45 mm; p = 0.008, respectively). At follow-up intravascular ultrasound, intrastent lumen area and intrastent neointimal hyperplasia (NIH) area were 5.4 ± 1.8 mm2 and 2.2 ± 1.5 mm2, respectively, in group I and 4.3 ± 1.6 mm2 and 3.4 ± 1.8 mm2, respectively, in group II (p = 0.045). And, in-stent restenosis rate was lower in group I than group II (p = 0.011 and p = 0.008, respectively). During 1-year follow-up, two patients in group II (4.1%) had AMI, whereas no patient in group I suffered AMI. Target lesion revascularization and total major adverse cardiac events rates were relatively lower in group I compared with those in group II (10.4% [5 of 48] vs. 20.8% [10 of 48], p = 0.261, and 10.4% vs. 25.0%, p = 0.107, respectively). Conclusions: Abciximab-coated stent implantation was safe and effective without stent thrombosis in AMI patients. [Copyright &y& Elsevier]

Abstract: We describe the case of a 17-year-old boy with Becker''s muscular dystrophy (BMD) presenting with rapid progression from hypertrophic cardiomyopathy to heart failure within 2 years. Initial echocardiogram showed severe hypertrophy of left ventricle (LV) and right ventricle (RV) with normal chamber size, and preserved LV systolic function. Microscopic study of cardiac muscle obtained by endomyocardial biopsy of the interventricular septum showed severe hypertrophy of the muscle fibers and interstitial fibrosis. Follow-up echocardiogram 2 years after the first examination exhibited marked dilated LV and RV with severe LV global hypokinesia. Follow-up endomyocardial biopsy demonstrated increased interstitial cellular matrix. Immunohistochemical staining for dystrophin revealed significant loss of dystrophin along the sarcoplasmic membrane of the right biceps brachii muscle, compatible with BMD. [Copyright &y& Elsevier]

We prospectively followed 202 patients with ischemic heart failure who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (left ventricular [LV] ejection fraction &#60;40%). Patients were divided into 2 groups: groups I (simvastatin group, n = 106, aged 60.8 ± 10.3 years, men 71.7%) and II (non-simvastatin group, n = 96, aged 60.9 ± 10.4 years, men 78.1%). During 1-year clinical follow-up, simvastatin therapy was associated with a significant reduction in mortality (1.9% vs 7.5%, p = 0.048), restenosis rate (25.7% vs 43.1%, p = 0.033), and repeat PCI rate (25.7% vs 43.1%, p = 0.033), and with significant improvement in LV ejection fraction (31% to 42% vs 32% to 39%, p = 0.042). The event-free survival rate was higher in group I than in group II (79.8% vs 57.0%, p = 0.001). In conclusion, simvastatin therapy improves LV systolic function and decreases mortality, restenosis, and repeat PCI rate in patients with ischemic heart failure who underwent PCI for acute myocardial infarction. [Copyright &y& Elsevier]

The investigators tested whether abciximab-coated stents prevent neointimal hyperplasia (NIH) formation in coronary de novo lesions. Abciximab-coated stents were compared with control stents. All patients underwent follow-up coronary angiography and intravascular ultrasound (IVUS). All stents were successfully deployed, and patients were discharged home without clinical events. At follow-up coronary angiography, the restenosis rate and late loss were 14% and 0.33 ± 0.28 mm in the abciximab-coated stent group and 28.6% and 0.64 ± 0.32 mm in the control stent group (p = 0.099 and p = 0.014, respectively). At follow-up IVUS, the intrastent luminal area and intrastent NIH area were 5.7 ± 1.6 and 2.0 ± 1.6 mm2, respectively, in the abciximab-coated stent group and 4.2 ± 0.8 and 3.4 ± 1.7 mm2, respectively, in the control stent group (p = 0.001 and p = 0.001, respectively). Abciximab-coated stents are feasible and significantly inhibit NIH, with potential therapeutic benefit in preventing stent restenosis. [Copyright &y& Elsevier]

Rescue percutaneous coronary intervention (PCI) has been used to treat patients after failed thrombolysis in acute myocardial infarction. However, the short- and long-term benefits of rescue PCI have not been known exactly. The goal of this study was to examine the clinical and angiographic outcomes, the success rate of the procedure, and the long-term survival rate after rescue PCI. The clinical and angiographic outcomes of 31 patients (Group I; 59.7 ± 11.4 years, 80.6% male), who underwent rescue PCI were compared with those of 177 patients (Group II; 59.7 ± 9.7 years, 79.7% male), who underwent primary PCI at Chonnam National University Hospital between January 1997 and December 1999. There were no significant differences in the risk factors for coronary artery diseases except for smoking (Group I; 24/31, 77.4% vs. Group II; 76/177, 42.9%, P = 0.011 ). The incidence of cardiogenic shock was higher in Group I than in Group II (Group I; 7/31, 22.6% vs. Group II; 11/177, 6.2%, P = 0.021 ). The coronary angiographic findings were not different between two groups, except for Thrombolysis in Myocardial Infarction (TIMI) flow of Group I was lower than in Group II (Group I; 1.14 ± 0.93 vs. Group II; 1.61 ± 1.14, P = 0.001 ). The primary success rate was 93.6% (29/31) in Group I and 94.9% (168/177) in Group II (P = 0.578) . The baseline ejection fraction was lower in Group I than in Group II (Group I; 44.2 ± 8.9% vs. Group II; 50.8 ± 11.7, P = 0.023 ), which improved in both groups (Group I; 51.7 ± 7.9% vs. Group II; 60.7 ± 13.4%, P = 0.001 respectively) at 6 months after the procedures. The survival rates of Group I were 93.5%, 93.5%, and 90.3% and those of Group II were 94.5%, 93.7%, and 91% at 1, 6, and 12 months, respectively. Rescue PCI is associated with the risk factor of smoking. The indication for rescue PCI was more common in patents with cardiogenic shock. The success rate of rescue PCI was comparable to that of primary PCI, and left ventricular function is improved after rescue PCI on long-term clinical follow-up with relatively high survival rate. (J Interven Cardiol 2003;16:209–216). [ABSTRACT FROM AUTHOR]