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Author's summary The Korean Society of Cardiology has recently published the Korea Heart Disease Fact Sheet 2020 to provide overview of the cardiovascular disease (CVD) burden and its temporal changes. CVD mortality, hospitalization, and risk factor distributions were analyzed from nationwide databases. Over the last decade, CVD mortality and hospitalization have increased, while their age-standardized rates have declined. In addition, a considerable proportion of adults had multiple risk factors, which markedly increased with older age. Thus, concerted efforts should be continued to address the rising burden of CVD in Korea., Background and Objectives Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. To provide an overview of the temporal trends in the burden of CVD, the Korean Society of Cardiology has published the Korea Heart Disease Fact Sheet in 2020. Methods We analyzed anonymized data of the Causes of Death Statistics, National Health Insurance Claims Database, and Korea National Health and Nutrition Examination Survey to assess mortality, hospitalizations, and risk factors for CVD. Results The CVD mortality decreased until 2010, then steadily increased up to 123 per 100,000 persons in 2018. Since 2002, the number and rate of CVD hospitalization have continued to grow. In 2018, approximately 12.1 million Korean adults had hypertension, 4.3 million had diabetes, 8.7 million had hypercholesterolemia, 14.9 million had obesity, and 8.8 million were currently smoking. The number of risk factors increased markedly with older age; 58.4% of adults age ≥70 years had ≥2 risk factors. Conclusions CVD mortality and hospitalization have gradually increased in the last decade, and a substantially high proportion of adults were carrying more than 1 cardiovascular risk factor in 2018. With the rapid population aging, a continued increase in CVD appears inevitable in Korea. Concerted and sustained approaches are essential to achieve early prevention and reduce the burden of CVD.

BACKGROUND AND OBJECTIVES The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI. METHODS Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10-30 cases/year), and below the 25th percentile (

Background and Objectives Both carotid intima-media thickness (CIMT) and carotid plaque are important factors in the primary prevention of cardiac disease. However, it is unclear which one is more important for prognosis, especially in patients with coronary artery disease (CAD). Subjects and Methods In total, 1426 consecutive CAD patients, proven by angiography, were followed-up for a mean of 85 months. The study population was divided into four groups depending on the CIMT (≥0.83 mm, >95 percentile in Korea) and the presence or absence of carotid plaque. Results Patients with carotid plaque and thick CIMT (n=237, 16.6%) had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia than those had plaque and thin CIMT (n=213, 14.9%), those without plaque and thick CIMT (n=265, 18.6%) and those without plaque and thin CIMT (n=711, 49.9%). The patients with carotid plaque and thick CIMT group had a higher cardiac mortality rate (20.7% vs. 13.1%, 9.4% and 3.9%, respectively, p

Background and Objectives It is unclear which plaque component is related with long-term clinical outcomes in patients with coronary artery occlusive disease (CAOD). We assessed the relationship between plaque compositions and long-term clinical outcomes in those patients. Subjects and Methods The study subjects consisted of 339 consecutive patients (mean 61.7±12.2 years old, 239 males) who underwent coronary angiogram and a virtual histology-intravascular ultrasound examination. Major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, non-fatal myocardial infarction, cerebrovascular events, and target vessel revascularization were evaluated during a mean 28-month follow-up period. Results Patients with high fibrofatty volume (FFV, >8.90 mm3, n=169) had a higher incidence of MACCE (25.4% vs. 14.7%, p=0.015), male sex (75.7% vs. 65.3%, p=0.043), acute coronary syndrome (53.3% vs. 35.9%, p=0.002), multivessel disease (62.7% vs. 41.8%, p

Background and Objectives: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. Subjects and Methods: From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vesselonly revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year. Results: There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myo cardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascu larized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascular ization (8.6% vs. 1.8%, p=0.002). Conclusion: Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI. (Korean Circ J 2011;41:718-725)

Background and Objectives: Left ventricular (LV) remodeling is a heterogeneous process, involving both infarcted and non-infarcted zones, which affects wall thickness and chamber size, shape and function. Subjects and Methods: A total of 758 consecutive patients (62.8±12.0 years, 539 males) with acute myocardial infarction (AMI), who were examined by echocardiography at admission and after 6 months. An increase in LV end-diastolic volume index >10% was defined as a progres sive LV dilation. They were divided into two groups according to the extent of progressive LV dilatation during 6 months. Group I with progressive LV dilatation (n=154, 61.4±11.0 years, 110 males) vs. group II without LV dilatation (n=604, 64.1±12.0 years, 429 males). Results: The age and gender were no significant differences between two groups. The levels of glucose, creatinine, maximal creatine kinase (CK), CK-MB, troponin T and I were significantly increased in group I than in group II (p

Background and Objectives: Undiagnosed diabetes mellitus (DM) or impaired glucose tolerance (IGT) is not uncommon in patients with coronary atherosclerosis and is known to be associated with abnormal scores for atherosclerosis surrogates. We sought to determine the prevalence of undiagnosed DM or IGT, and the association between insulin resistance (IR) and atherosclerosis surrogates in patients with coronary atherosclerosis. Subjects and Methods: The study population consisted of 187 consecutive patients with angiographically proven coronary atherosclerosis (mean: 61 years old, 94 males). We measured carotid intima-media thickness (IMT) and flow mediated brachial artery dilatation (FMD). We also did oral glucose tolerance tests (OGTT), quantitative insulinsensitivity check indexes (QUICKI) and homeostasis model assessment-IR (HOMA-IR). Results: Abnormal OGTT was found in 164 patients (87.7%), even though there were only 63 known cases of DM (33.7%). There were 58 patients (31%) with newly diagnosed IGT and 43 patients (23%) with newly diagnosed DM. There were 71 patients (38%) who had IR (defined as measured HOMA-R ≥3.0). HOMA-IR showed a positive correlation with body mass index (BMI) (r=0.275, p

Background and Objectives Although increasing evidence has indicated that radial access is a beneficial technique, few studies have focused on Korean subjects. The aim of this study was to evaluate current practice of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using radial access in South Korea. Subjects and Methods A total of 6338 subjects were analyzed from Korean Transradial Intervention prospective registry that was conducted at 20 centers in Korea. After evaluating the initial access, subjects intended for radial access were assessed for their baseline, procedure-related, and complication data. Subjects were categorized into three groups: group of overall subjects (n=5554); group of subjects who underwent PCI (n=1780); and group of subjects who underwent primary percutaneous coronary intervention (PPCI) (n=167). Results The rate of radial artery as an initial access and the rate of access site crossover was 87.6% and 4.4%, respectively, in overall subjects. Those rates were 82.4% and 8.1%, respectively, in subjects who underwent PCI, and 60.1% and 4.8%, respectively, in subjects who underwent PPCI. For subjects who underwent CAG, a 6-F introducer sheath and a 5-F angiographic catheter was the most commonly used. During PCI, a 6-F introducer sheath (90.6%) and a 6-F guiding catheter were standardly used. Conclusion The large prospective registry allowed us to present the current practice of CAG and PCI using radial access. These data provides evidence to achieve consensus on radial access in CAG and PCI in the Korean population.

Background and objectives Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease. However, the clinical outcome of acute myocardial infarction (AMI) with MetS has not been well examined. The purpose of this study was to evaluate the clinical outcomes of AMI patients with MetS. Subjects and methods We evaluated a total of 6352 AMI patients who had successful percutaneous coronary interventions and could be identified for MetS between 2005 and 2008 at 51 hospitals participating in the Korea Acute Myocardial Infarction Registry. They were divided into 2 groups according to the presence of MetS: the MetS group (n=2493, 39.2%) versus the Non-MetS group (n=3859, 60.8%). In addition, 4049 AMI patients with high levels of low density lipoprotein-cholesterol (LDL-C) (≥100 mg/dL) among them, were divided into the MetS group (n=1561, 38.6%) versus the Non-MetS group (n=2488, 61.4%). Results In the overall population, there was no significant difference in 12-month the major adverse cardiac events (MACE) rate between the 2 groups. However, the MetS group showed a significantly higher 12-month MACE rate in the high LDL-C population. Multivariate analysis showed that MetS was an independent prognostic factor for 12-month MACE {hazard ratio (HR) 1.607, 95% confidence interval (CI) 1.027 to 2.513, adjusted p=0.038} and for 12-month target vessel revascularization (HR 1.564, 95% CI 1.092 to 2.240, adjusted p=0.015) in the high LDL-C population. Conclusion MetS patients with AMI in the overall population showed no significant difference in 12-month clinical outcomes. However, in patients with higher LDL-C ≥100 mg/dL, they showed significantly worse clinical outcome than Non-MetS patients. Therefore, it is important to ascertain the presence of MetS in AMI patients, and more aggressive therapy should be strongly considered for AMI patient with MetS.

BACKGROUND AND OBJECTIVES Success rates of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have recently been reported to range from 80% to 90%. A better understanding of the pathologic characteristics of the CTO lesion may helpful to improving CTO PCI success rates. We evaluated the CTO lesion in patients with stable angina (SA) by virtual histology-intravascular ultrasound (VH-IVUS). SUBJECTS AND METHODS The study population consisted of 149 consecutive patients with SA underwent VH-IVUS examination. We analyzed demographic and VH-IVUS findings in 22 CTO patients (17 males; mean, 62.3 years old) compared with 127 non-CTO patients (82 males; mean, 61.3 years old). RESULTS A significantly lower ejection fraction (57.6±13.0% vs. 65.4±8.8%, p=0.007) was detected in the CTO group compared with the non-CTO group. Reference vessel lumen area of the proximal and distal segment was significantly less in CTO group than in non-CTO group. The lesion length of the CTO group was significantly longer than those of the non-CTO group (24.4±9.6 mm vs. 17.2±7.4 mm, p

Background and objectives The benefit of early statin treatment following acute myocardial infarction (MI) complicated with cardiogenic shock (CS) has not been well studied. We sought to assess the effect of early statin therapy in patients with CS complicating acute MI. Subjects and methods We studied 553 statin-naive patients with acute MI and CS (Killip class IV) who underwent revascularization therapy between November 2005 and January 2008 at 51 hospitals in the Korea Acute Myocardial Infarction Registry. Patients were divided into 2 groups: those who received statins during hospitalization (n=280) and those who did not (n=273). The influence of statin treatment on a 12-month clinical outcome was examined using a matched-pairs analysis (n=200 in each group) based on the propensity for receiving statin therapy during hospitalization. Results Before adjustment, patients receiving statin, compared to those not receiving statin, had a more favorable clinical profile, were less likely to suffer procedural complications, and more likely to receive adequate medical therapy. Patients receiving statin had lower unadjusted in-hospital mortality and composite rate of mortality, MI, and repeat revascularization at 12 months, which remained significantly lower after adjustment for patient risk, procedural characteristics, and treatment propensity. Conclusion In CS patients with acute MI undergoing revascularization therapy, early statin treatment initiated during hospitalization was associated with lower rates of in-hospital death and 12-month adverse cardiac events.

Background and Objectives: Carotid intima-media thickness (IMT) has been associated with an increased risk of ischemic stroke. To better understand this association, we evaluated the relationships of vascular risk factors, including carotid IMT and carotid plaque, and large territory cerebral infarction and small vessel stroke. Subjects and Methods: A total of 502 patients with acute ischemic stroke were divided into two groups according to neurologic examinations and imaging studies; 1) a large territory infarction group (group I: n=126, 64.4±11 years, 78 males) and 2) a small vessel stroke group (group II: n=376, 62.5±11 years, 242 males). We evaluated associations between (a) territory and non-territory strokes and (b) age, sex, potential vascular risk factors, carotid image and cardiac function (by echocardiography). Results: We did not find significant between group differences of age, sex, diabetes, previous history of ischemic stroke, plaque (presence, site and size of carotid plaque), and velocity of carotid blood flow and left ventricle ejection fraction. However, group I had a higher incidence of hypertension (p=0.006), smoking (p=0.003), and dyslipidemia (p=0.001). Group I had thicker carotid IMT than group II (right carotid: 0.81±0.21 mm vs. 0.76±0.19 mm, p=0.035; left carotid: 0.88±0.23 mm vs. 0.80±0.20 mm, p=0.014) and a higher e/e’ level (12.08 vs. 9.66, p

Background—Biological mechanisms underlying statin and angiotensin II type 1 receptor blocker therapies differ. Therefore, we compared vascular and metabolic responses to these therapies either alone or in combination in hypercholesterolemic, hypertensive patients. Methods and Results—This was a randomized, double-blind, placebo-controlled crossover trial with 3 treatment arms (each 2 months) and 2 washout periods (each 2 months). Forty-seven hypertensive, hypercholesterolemic patients were given simvastatin 20 mg and placebo, simvastatin 20 mg and losartan 100 mg, or losartan 100 mg and placebo daily during each 2-month treatment period. Losartan alone or combined therapy significantly reduced blood pressure compared with simvastatin alone. Compared with losartan alone, simvastatin alone or combined therapy significantly changed lipoproteins. All 3 treatment arms significantly improved flow-mediated dilator response to hyperemia and decreased plasma malondialdehyde and monocyte chemoattractant protein-1 levels relative to baseline measurements. However, these parameters were changed to a greater extent with combined therapy compared with simvastatin or losartan alone (both P0.001 and P0.030 for monocyte chemoattractant protein-1 by ANOVA). Combined therapy or losartan alone significantly increased plasma adiponectin levels and insulin sensitivity (determined by QUICKI) relative to baseline measurements. These changes were significantly greater than in the group treated with simvastatin alone (P0.001 for adiponectin, P0.029 for QUICKI by ANOVA). Conclusions—Simvastatin combined with losartan improves endothelial function and reduces inflammatory markers to a greater extent than monotherapy with either drug in hypercholesterolemic, hypertensive patients. (Circulation. 2004; 110:3687-3692.)

Background and Objectives: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. Subjects and Methods: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (≥200 mg/dL, n=114) and normocholesterolemic group (

Background and Objectives The relationship between the positive remodeling (PR) of a coronary artery and plaque composition has been studied only in a relatively small number of study population or non-culprit lesion. We evaluated the association between coronary plaque composition and coronary artery remodeling in a relatively large number of culprit lesions. Subjects and Methods The study population consisted of 325 consecutive patients with coronary artery disease that underwent intravascular ultrasound-virtual histology examination in a culprit lesion. The remodeling index (RI) was calculated as the lesion external elastic membrane (EEM) area divided by the average reference EEM area. Results The lesions with PR (RI>1.05, n=97, mean RI=1.19±0.12) had a higher fibrous volume/lesion length (3.85±2.12 mm3/mm vs. 3.04±1.79 mm3/mm, p=0.003) and necrotic core volume/lesion length (1.26±0.89 mm3/mm vs. 0.90±0.66 mm3/mm, p=0.001) than those with negative remodeling (NR) (RI

Background and Objectives: Morning hypertension is closely related to target organ damage and cardiovascular events. Little data is available concerning the baseline characteristics and comprehensive blood pressure analysis of hypertensive patients on treatment with morning hypertension. Subjects and Methods: We evaluated 1,087 hypertensive patients who had taken stable anti-hypertensive medication at least 6 months. The enrolled patients measured their home blood pressure for 7 days. Baseline characteristics and the laboratory data were analyzed. Morning hypertension was defined as a morning blood pressure ≥135/85 mm Hg and systolic or diastolic blood pressure difference between morning and evening exceeding 10 mm Hg. Results: One hundred seventy three patients with morning hypertension showed a preponderance of males, older patients, alcohol consumers, and greater waist circumference and waist-to-hip ratio despite the same body mass index. Impaired fasting glucose and metabolic syndrome were more prevalent in the patients with morning hypertension. The morn ing hypertensives took more anti-hypertensive drugs and displayed higher blood pressure in the clinic and at home. Conclusion: The worse clinical variables and relatively poorly controlled blood pressure of those with morning hypertension supports a potential relationship of morning hypertension with poor cardiovascular outcome. Morning blood pressure should be monitored at home for the optimal treatment of hypertension. (Korean Circ J 2011;41:733-743)

Background and Objectives Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients. Subjects and Methods Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated. Results NT-proBNP was significantly higher in lower BMI (p

Background and Objectives Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis. Subjects and Methods The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7±10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm. Results Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p

Chronic total occlusion (CTO) remains one of the most challenging lesion subsets for interventional cardiologists due to a low success rate and higher incidence of restenosis, especially with current use of bare metal stents (BMSs). However, successful CTO revascularization has a beneficial effect on long-term survival and relief of angina. With recent advances in technology (with the use of special techniques and devices), the initial success rate of recanalization of occlusions is quite high (approximately 90%). However, the long-term clinical outcome of the use of bare metal stents is not satisfactory due to a high restenosis rate. Recently, the introduction of the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) has shown favorable clinical outcomes, such as a reduction in the restenosis rate in patients with CTOs. Consequently, the use of the new types of stents can reduce the incidence of major adverse cardiac events detected at follow-up. (Korean Circ J 2008;38:295-300)

Toad toxin has digitalis-like cardioactive effects that include bradycardia, varying degrees of atrioventricular block, ventricular tachycardia, ventricular fibrillation and sudden cardiac death. We report here on a 54-year-old man who had varying degrees of atrioventricular block and nonsustained ventricular tachycardia two hours after he ate a bowl of toad soup. (Korean Circulation J 2007;37:283-286)

Background and Objectives：Serum uric acid has been reported to be an independent risk factor for coronary artery disease (CAD) and a predictor of mortality in patients with CAD. Yet there is gender difference for the serum uric acid levels. We evaluated the influence of the uric acid levels on major adverse cardiovascular events (MACEs) in patients with CAD according to their gender. Subjects and Methods：Of the 777 patients with angiographically proven CAD, 660 patients (378 males, 57.3%) were followed up a median of 18 month (maximum: 61 month). The MACEs included acute myocardial infarction, cerebral infarction, coronary artery bypass graft, percutaneous coronary intervention due to de novo lesion during follow up, new onset congestive heart failure and sudden cardiac death. Results：MACEs in men were associated with acute coronary syndrome (ACS)(odds ratio (OR): 2.03, 95% confidence intervals (CI): 1.01 to 3.96, p=0.038), multi-vessel disease (OR: 3.68, 95% CI: 1.82 to 7.47, p=0.000) and the serum uric acid levels (OR: 1.23, 95% CI: 1.01 to 1.50, p=0.044), according to multivariate Cox regression analysis. For women, MACEs were associated with multi-vessel disease (OR: 2.43, 95% CI: 1.15 to 5.13, p=0.020) and the highest uric acid quartile (OR: 2.64, 95% CI: 1.31 to 5.30, p=0.006) according to multivariate Cox regression analysis. For all patients, the highest uric acid quartile was associated with an increased risk of MACE (p=0.000), and CHF was the major contributor to the observed MACEs (p=0.004). Conclusion：In male patients with CAD, the serum uric acid level is a predictor of cardiovascular events, and the highest uric acid quartile is a predictor of cardiovascular events in women. (Korean Circulation J 2007;37:196-201)

Background and Objectives: Nitroglycerin-mediated arterial dilation (NMD) was shown to be preserved in most previous studies, and this is possibly due to using a single high dose of nitroglycerin (NTG), which causes maximal arterial dilation. We sought to evaluate the clinical factors of flow-mediated dilation (FMD) and NMD at different doses of NTG in the patients with coronary artery disease (CAD). Subjects and Methods: Thirty-two consecutive patients (mean age: 61 years old, 18 males) with angiographically proven CAD underwent FMD and NMD at total cumulative doses of 25μg, 175μg and 325μg with using high-resolution ultrasound for the imaging. Results: The FMD, NMD (25μg), NMD (175μg) and NMD (325μg) were 4.72±1.82%, 7.08±3.02%, 13.33±6.14% and 15.89±7.24%, respectively (p

Background and Objectives：Rupture-prone plaque, characterized by a large necrotic core, thin fibrous cap and large number of inflammatory cells, is known to be associated with acute coronary syndrome (ACS) from several autopsy and animal studies. We sought to assess in-vivo lesion characteristics of culprit lesions in patients with ACS. Subjects and Methods：One hundred consecutive patients (mean age 60.4 years, 70 males), who underwent percutaneous coronary intervention, were analyzed for intravascular ultrasound (IVUS) radiofrequency information using IVUS-virtual histology (VH) software. Results：Patients with ACS (n=44, mean 59.7 years, 34 males) had a lower prevalence of hypertension (45.5% vs. 67.9%, p=0.024), higher level of high-sensitivity C-reactive protein (0.36±0.36 mg/dL vs. 0.22±0.27, p=0.043), longer lesion length (22.6±8.6 mm vs. 19.3±6.9 mm, p=0.036), and more plaque rupture (63.6% vs. 10.7%, p

Background and Objectives:Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD). Subjects and Methods:The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death. Results:In the CAD patients with a uric acid level ≤3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p

Background and Objectives：While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease. Subjects and Methods：A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50±21 months. Results：Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, ≤2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p= 0.009) than those having lower IMT values (n=55, ≤0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046). Conclusion：This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT. (Korean Circulation J 2007; 37:365-372)

Background and Objectives: A prolonged heart rate-corrected QT interval (QTc) is known to be related to an increased risk of coronary artery disease (CAD) and sudden cardiac death, while the carotid intima-media thickness (IMT) is related to CAD. We sought to evaluate the relationship among the QTc, the carotid IMT and the severity of CAD. Subjects and Methods: The QTc and the carotid IMT were measured in 165 consecutive patients who underwent coronary angiography. The measurement of the QTc was done automatically by a digital QT Guard TM system (GE Marquette Medical System, Milwaukee, USA) and the carotid IMT was measured by M’ATH software (METRIS Co., Argenteuil, France). The severity of CAD was divided into minimal disease (90, 54.5%), one-vessel disease (32, 19.4%), and multi-vessel disease (43, 26.1%), according to the number of vessels that were narrowed by more than 50%. Results: The mean values of the QTc were 415.1±20.5 msec in the minimal disease group, 411.7±17.0 msec in the one-vessel disease group and 434.2±46.1 msec in the multi-vessel disease group. The QTc was correlated with age (r=0.236, p=0.002), HDL cholesterol (r=-0.160, p=.043), the right carotid IMT (r=0.17, p=0.026), the left carotid IMT (r=0.178, p=0.022) and the severity of CAD (r=0.243, p=0.002). On the multiple linear regression analysis after adjustment for age and HDL cholesterol, the QTc was an independent factor for the severity of CAD. Conclusion: These results suggest that repolarization abnormalities are associated with the severity of CAD and they may reflect the severity of the morphologic atherosclerotic surrogates. (Korean Circ J 2007;37:538-542)

Background and Objectives:It’s not clear whether the serum lipid level is associated with the individual carotid arterial wall thickness for patients suffering with coronary atherosclerosis, although hypercholesterolemia is associated with an increased carotid IMT. We sought to evaluate the association between the serum lipid level and the individual carotid arterial wall thickness (intimal thickness (IT) and medial thickness (MT)) as well as the carotid intima-media thickness (IMT) for patients with coronary atherosclerosis. Subjects and Methods:The carotid arterial wall thickness was measured using high-resolution B-mode ultrasound in 139 consecutive patients (58±11 years old, 75 males) with coronary atherosclerosis by performing coronary angiography. Results: Measurement of the individual arterial wall thickness was possible in 126 patients (90.6%) out of all the study subjects. The carotid IMT was correlated with the total cholesterol (r=0.207, p=0.015) and low-density lipoprotein (LDL) cholesterol (r=0.237, p=0.006). The carotid IT was correlated with the total cholesterol (r=0.210, p= 0.020), triglyceride (r=0.212, p=0.018), and LDL-cholesterol (r=0.246, p=0.006), whereas the MT did not show any significant correlation with the serum lipid level. Multivariate analysis disclosed that the serum LDL cholesterol level was associated with the carotid IMT and IT for the patients with coronary atherosclerosis, but it was not correlated with the MT. Conclusion:This study suggests that the serum LDL cholesterol level is more closely associated with the carotid IT than the IMT for patients with coronary atherosclerosis, and each carotid arterial wall has a different response to the serum lipid level. (Korean Circulation J 2007;37:380-384)

Background and Objectives：Increased carotid intima-media thickness (IMT) is known to be associated with adverse cardiovascular events in the patients with risk factors or established atherosclerosis. However, the prognostic importance of carotid IMT is uncertain in the patients who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of carotid IMT with major adverse cardiovascular events (MACE) and restenosis in the patients who underwent PCI. Subjects and Methods：The study population consisted of 308 consecutive patients who underwent PCI, and they were followed up for mean of 30.6±13.3 months. Base on the median values of carotid IMT, which was measured in the right common carotid artery at the time of PCI with using high-resolution ultrasound and a semiautomatic method, the subjects were divided into the thick (n=156, 1.003±0.14 mm) and thin IMT (n=152, 0.748±0.07 mm) groups, and they were followed up for at least 1 year. Results：Patients with thick carotid IMT were older (61±9 years vs. 57±10 years, respectively, p=0.001), had a higher body mass index (25.0±3.0 vs. 23.9±4.0, respectively, p=0.017), a history of previous myocardial infarction (20% vs. 9%, respectively, p=0.008), more multivessel disease and more restenosis (34.6% vs. 23.0%, respectively, p=0.025) than those patients with a thin carotid IMT. However other MACEs such as death, myocardial infarction, stroke, heart failure and target lesion revascularization did not show any significant differences between the two groups. Multivariate Cox regression analysis showed that carotid IMT was an independent predictor of restenosis (odds ratio: 1.754, 95% confidence interval: 1.1296 to 2.726, p=0.012). Conclusion：An increased carotid IMT is associated with restenosis, but it does not have clinical prognostic importance for the patients who underwent PCI during a mean follow up period of 31 months. (Korean Circulation J 2007;37:103-107)

Electrical injury may lead to a conduction disorder of the heart. We report here on a 36-year-old man, who was treated with a permanent pacemaker, after an electrical injury induced high-degree atrioventricular block and clinical manifestations (dizziness and dyspnea). (Korean Circulation J 2006;36:767-770)

Most studies related with plaque histopathology and/or morphology are based on the gray scale intravascular ultrasound (IVUS) and autopsy findings, although IVUS is limited for differentiating echolucent areas, and tissue shrinkage almost always occur during tissue fixation. In addition, autopsy studies can not establish the causal relationship between the autopsy findings and the clinical findings. Spectral analysis of the IVUS radiofrequency data may be a new and useful tool because it allows detailed assessment of plaque composition in vivo, with a high predictive accuracy of 87.1% to 96.5% in fibrous, fibrofatty, calcified and necrotic core regions with performing tissue mapping and geometric assessment like that for classic gray scale IVUS. This new imaging technique offers clear benefits compared with the results of classic IVUS and autopsy studies. This review will briefly discuss the methodology of spectral analysis of the IVUS radiofrequency data, the recent clinical studies that have used this technique and the future perspectives. (Korean Circulation J 2006;36:553-558)

Background and Objectives:There is little clinical data on the results of using Sirolimus-Eluting Stent (SES) for treating In-Stent Restenosis (ISR). We performed this study to evaluate the clinical outcomes for implanting SES for treating ISR in a real world hospital environment. Subjects and Methods:A total of 30 patients with 32 ISRs (males: 73.3%, mean age: 60.2) (focal lesions: 21.9%, diffuse intra-stent lesions: 34.4%, proliferative lesions: 21.9%, total occlusions: 21.9%) were treated with SES after balloon predilation was performed. We evaluated the clinical results and the performed coronary angiography after 6 months. Results:All the procedures were successful. The mean SES diameter and length were 3.0±0.3 mm and 27.1±5.5 mm, respectively, and the mean acute gain was 2.42±0.38 mm. No in-hospital major adverse cardiac events (MACE) were observed. Twenty five patients with 27 lesions (84.4%) underwent coronary angiography at their 6 month follow-up. The late loss and loss index were 0.41±0.56 mm and 0.18±0.22, respectively. The binary restenosis rate was 7.4% (2/27 lesions). The rate of target lesion revascularization was 3.7% (1/27 lesion). The incidence of MACE at 6 months was 3.3% (1/30 patient). Conclusion:Treating ISR with SES is a safe and effective procedure for reducing ISR without the occurrence of acute or sub-acute thrombosis. (Korean Circulation J 2006;36:121-125)

Background and Objectives:The endothelial function and carotid arteries intima-media thickness (IMT) are abnormal in patients with coronary artery disease (CAD). We performed this study to evaluate the impact of the ejection fraction on the endothelial function and carotid IMT in patients with CAD. Subjects and Methods: The study population consisted of 283 patients who had undergone coronary angiography (mean age; 59 years, 176 males). The endothelial function and the carotid IMT were assessed by measuring the flow-mediated vasodilation (FMD) of the brachial artery and semi-automatically using high-resolution ultrasound, respectively. Results: Patients (n=236) with an ejection fraction (EF) (55% on routine echocardiogram were younger (mean age; 58 vs. 62 years), showed a lower prevalence of diabetes (15 vs. 38%) and myocardial infarction (13 vs. 66%), a higher FMD (4.8±2.4 vs. 4.0±2.0%, p

Background and Objectives:The reduction in the mean platelet component (MPC) concentration may be used to detect platelet activation. We performed this study to find the clinical usefulness of the MPC concentration in the differentiation of patients with stable angina from those with acute coronary syndrome (ACS). Subjects and Method:We evaluated 175 consecutive patients (57.9±10.4 years, 107 male) undergoing coronary angiography. The study patients were divided into two groups; patients with ACS (n=55, 57.5±11.8 years, 37 male) and those with stable angina (n=120, 58.1±9.7 years, 70 male). Venous blood samples were take into EDTA tube and immediately sent to laboratory room for measurement of the MPC concentration using the ADVIA® 120 hematology system. Results:The MPC concentration was significantly decreased in those with ACS (27.3±1.2 g/dL vs. 28.6±0.9 g/dL, p=0.013) compared to those with stable angina, and also decreased in patients with unstable compared to stable angina (27.4±1.2 g/dL vs. 28.6±0.9 g/dL, p

We report a case of in-stent restenosis due to the fracture of a sirolimus-eluting stent, which was confirmed by intravascular ultrasound. It can be suggested that a stent fracture is an important cause of restenosis in this era of drug-eluting stents. (Korean Circulation J 2005;35:787-789)

Background and Objectives:The carotid intima-media thickness, endothelial function and arterial stiffness have been shown to be parameters of atherosclerosis. We have performed this study to evaluate the impact of atherosclerotic coronary risk factors on several atherosclerotic parameters in patients with coronary artery disease. Subjects and Methods:The study subjects consisted of one hundred and forty (140) consecutive patients (mean age: 61 years, and 85 males), who demonstrated via coronary angiogram more than 50% stenosis in at least 1 major coronary artery. In an overnight fasting state, the carotid intima-media thickness (IMT), and endothelial function (flow-mediated brachial artery dilatation, FMD) were measured by high-resolution ultrasound, and arterial stiffness (pulse wave velocity, PWV) was measured by using a non-invasive pulse wave analyser. Results:The hypertensive group showed more evidence of greater arterial stiffness (aorta; 8.5±1.0 m/s vs. 7.9±1.2 m/s, p=0.004, and greater stiffness of the artery of the lower extremity; 9.2±1.2 m/s vs. 8.7±1.3 m/s, p=0.010), which was measured by the pulse wave velocity, than that of the normotensive group. The carotid IMT and the endothelial function showed no significant differences between the two groups. Furthermore, these parameters did not show significant differences with other parameters such as diabetes mellitus, smoking, and hyperlipidemia. Multivariate analysis revealed that hypertension and systolic blood pressure were still the independent factors of arterial stiffness, but carotid IMT and endothelial function were not independent factors. Conclusion:Hypertension and systolic blood pressure are the independent factors of arterial stiffness in patients with coronary artery disease (CAD), but this study did not show that carotid IMT and endothelial function made a significant difference in arterial stiffness. However, in this study, other risk factors were not associated with the differences of these parameters. (Korean Circulation J 2005;35:131-139)

Background and Objectives：This study was performed to evaluate the clinical usefulness of the carotid intimamedia thickness (IMT) as a screening test for coronary artery disease (CAD), and evaluate the differences in the carotid IMT in CAD patients with age- and sex-matched healthy subjects and hyperlipidemic hypertensive patients. Subjects and Methods：The study was conducted on a total of 609 subjects; 229 patients with CAD (mean age; 53 yrs, 148 males), 207 age- and sex-matched hyperlipidemic hypertensive patients (mean age; 52 yrs, 115 males) and 173 age and sex matched healthy subjects (mean age; 52 yrs, 100 males). The carotid IMT was semi-automatically measured using high-resolution ultrasound. The clinical variables and carotid IMT in the study subjects were compared, and the data analyzed. Results：The mean carotid IMT in patients with CAD (0.87±0.19 mm) was significantly higher than that in hyperlipidemic hypertensive patients (0.72±0.14 mm, p

Background and Objectives:We performed this study to evaluate the feasibility and accuracy of the newly developed Korean software (KS) for measurement of the carotid intima-media thickness (IMT), which was compared with the commercial software. Subjects and Methods:The study population consisted of 60 consecutive patients (mean of 59 years old, 27 males) undergoing transthoracic echocardiography. We measured the carotid IMT using both software packages, and also measured the intima thickness (IT) and media thickness (MT), separately, using the KS package. Results:Measurement of the IMT was possible in all the study subjects with both software packages, but the separate measurements of the IT and MT was possible in only 24 patients using the KS package. The mean IMT using the commercial and KS packages were 0.727±0.157 and 0.733±0.156 mm, respectively, which were found to correlate (r=0.985, p=0.000). The mean IMT, IT and MT of the 24 patients were 0.841±0.138, 0.340±0.033 and 0.505±0.124 mm, respectively. The carotid IMT was correlated with the IT and MT and also with the IT/IMT, MT/IMT and IT/MT ratios (r=0.562, p=0.004; r=0.934, p=0.000; r= -0.809, p=0.000; r=0.591, p=0.002; r=-0.754, p=0.000, respectively). The IT was found not to correlate with the MT (r=0.369, p=0.076). Age was found to correlate with the IMT using both the commercial and KS packages (r=0.616, p=0.000; r=0.583, p=0.000, respectively), and with the MT and IT/IMT and IT/MT ratios (r=0.504, p=0.012; r=-0.538, p=0.007; r=-0.428, p=0.037), but not with the IT (r=0.300, p=0.154). Conclusion:The newly developed KS was feasible and accurate in measuring the carotid IMT, which can also be used to separately measure the IT and MT. (Korean Circulation J 2005;35:625-632)

Background and Objectives:The endothelial function is impaired in patients with atherosclerosis risk factors as well as in those with atherosclerotic disease, such as coronary artery disease. This study was performed to evaluate the impact of individual risk factors and their number in patients with coronary atherosclerosis, who already had an impaired endothelial function. Subjects and Methods:The endothelial function was measured in 884 consecutive patients (mean age; 59 years old, 486 male) undergoing coronary angiography, using highresolution ultrasound. The flow-mediated brachial artery dilation (FMD, %) was used to measure the endothelial function. The risk factors were classified according to the hypertension, diabetes mellitus, smoking and dyslipidemia, and their number classified from 0 to 4. Results:The FMD was lower (3.85±2.1% vs. 4.27±2.1%, p

Background and Objectives:The endothelial function, carotid intima-media thickness (CIMT) and arterial stiffness are known as surrogates of atherosclerosis, but it is not clear whether these surrogates can discriminate patients with coronary artery disease (CAD) from those with risk factor. The intention was to compare these 3 surrogates in patients with CAD and those with risk factor only. Subjects and Methods: Forty-three patients with CAD (mean age:58, 32 men), 18 age and sex matched healthy people (mean age: 52, 9 men) and 16 patients (mean age:53, 12 men) with atherosclerosis risk factor only were enrolled. The endothelial function (flow-mediated brachial artery dilation, FMD) and CIMT were measured by high-resolution ultrasound and the arterial stiffness by an oscillometric method. Results:There was a significant difference between the CAD and risk factor groups (3.46±1.3% vs. 5.77±2.54%, p 0.05) in the measured FMD. The CIMT showed a significant difference between the CAD and healthy groups (0.89±0.14 mm vs. 0.78±0.07 mm, p 0.05). There were significant differences among all groups in relation to the arterial stiffness (CAD group:1524±289 cm/sec, risk group:1342±202 cm/sec, healthy group:1195±119 cm/sec, p

Background and Objectives:The purposes of this study were to provide evidence of any correlation between the endothelial dysfunction and the extent of coronary atherosclerosis, and the relationship between the endothelial function and individual atherosclerosis risk factors in patients with significant coronary artery stenosis. Subjects and Methods:The endothelial function was measured by hyperemia induced brachial artery dilation, using high resolution ultrasound, in 284 consecutive patients (mean age 59 years, men:176) having undergone coronary angiography. The subjects were divided into four groups according to the number of coronary arteries narrowed by more than 50%;0 (n=88), 1 (n=98), 2 (n=54) and 3 (n=44). The endothelial functions were compared to see if significant coronary artery disease was present, according to the groups and the presence of individual atherosclerosis risk factors. Results:There were no significant differences in the endothelial dysfunction between the narrowed and normal coronary artery groups (4.66±2.45% vs. 4.43±1.53% p>0.05) or between the four groups. The endothelial function in patients with significant coronary artery stenosis (n=196) was significantly lower when coupled with hypertension (n=84, 2.99±2.4% vs. 4.20±2.4%, p

A massive intracoronary thrombus, during percutaneous coronary intervention (PCI), implies a high risk of major adverse cardiac events. We experienced a case of successful PCI, using Percusurge®, in an acute myocardial infarc-tion patient, with massive intracoronary thrombi. The TIMI 3 coronary flow could not be restored during a primary PCI of the right coronary artery, despite repeated ballooning, intracoronary urokinase injection, parenteral abciximab and heparin. However, successful PCI, with stenting, was performed by aspiration of the large intracoronary thrombi, with the Percusurge® system, 5 days after the primacy PCI. (Korean Circulation

Background and Objectives:We performed this study to elucidate whether there were significant correlations 1) between intima-media thickness (IMT) of carotid artery and the extent of coronary atherosclerosis and 2) between carotid IMT and risk factors of atherosclerosis in patients with coronary atherosclerosis. Subjects and Methods:All study subjects (n=326, 200 males, 59±10 years) had chest pain and underwent coronary angiography. IMT was measured in the far wall of the internal and common carotid arteries and the carotid bulb using high-resolution ultrasound with a 3-11 MHz linear probe. We also evaluated the presence of plaque in the carotid artery. The extent of coronary atherosclerosis was divided into 4 groups (0, 1, 2, and 3) according to the number of coronary arteries narrowed more than 50% of the diameter. Results:In patients with one or more diseased coronary vessels, IMT of the common carotid artery was thicker (0.81±0.15 mm vs. 0.91±0.28 mm, p

We report two cases of radiofrequency catheter ablation (RFCA) with atrioventricular nodal reentrant tachycardia (AVNRT) in patients associated with persistent left superior vena cava (PLSVC). AVNRT with PLSVC differs in terms of catheter positioning and location of slow AV nodal pathway as compared with AVNRT alone. In our two patients, a coronary sinus electrode catheter was easily introduced through the PLSVC and directly into the coronary sinus. Successful RFCA was performed with the energy delivery at the bed of the proximal portion of the markedly enlarged coronary sinus without any complications in the two patients. (Korean Circulation J 2002;32(4):355-358)

Background and Objectives：Angiotensin-converting enzyme (ACE inhibitors have been shown to improve the endothelial dysfunction and prevent the development of atherosclerosis in animal models. We performed this study to investigate the effects of the ACE inhibitor, ramipril, on carotid atherosclerosis and endothelial dysfunction of the brachial artery in patients with coronary artery disease (CAD. Subjects and Methods：We studied 69 subjects with a mean age of 59yrs, and divided them into two groups according to ramipril use (39 patients with ramipril and 30 without. Using a double-blind, randomized, prospective design, we measured the flow-mediated vasodilatation (FMD of the brachial artery and intima-media thickness (IMT of the carotid artery, prior to, and 1, 3 and 6 months following coronary angiograms in CAD patients. Results：The FMD was significantly increased in the ramipril group from 4.6±2.2% baseline to 5.3±2.5% at the 1 month followup (p

Background:The purpose of this study was to evaluate the lower limit of the normal endothelial function, which may differentiate normal from abnormal values, and to evaluate changes of endothelial function according to ages. Materials and Methods:The study population were consisted of four groups:patients with coronary artery disease (CAD (group A, n=42, mean age:55 yrs, patients with one or more risk factors of atherosc- lerosis (group B, n=43, mean age:54 yrs, age- and sex-matched healthy subjects (group C, n=25, mean age:54 yrs), and healthy young subjects (group D, n=13, mean age:26 yrs. We measured the flow-mediated endothelium-dependent dilation (FMD of the brachial artery in all subjects using a high-resolution ultrasound and we analyzed the receiver operating characteristic (ROC curve. Results:The FMD of the A and B groups were significantly lowered (8.6±3.7% vs 9.9±4/5% (4.5% ? than the C (14.3±3.3%, p

Background:This study was undertaken to evaluate the long-term clinical prognosis, the effects of anti-anginal medicines and the factors of recurrence in patients with angina and insignificant coronary artery stenosis (CAS. Methods:The study population was consisted of 372 patients with angina and normal or minimal (less than 50% stenosed CAS out of 2475 consecutive patients who underwent coronary angiogram over a 3.5 year period. We retrospectively reviewed the medical records of the study population. Results:Myocar- dial infarction was developed in 2 cases (0.5%, recurrence of angina in 59 cases (16%, and there was no death during mean 19-month follow-up period of the 372 patients. Patients with normal coronary artery (n= 266 were younger (mean 54 yrs vs 59 yrs, p

Background and Objectives:We undertook this study to determine whether there is any difference in end- othelial function according to the presence of restenosis in patients who had undergone percutaneous translu- minal coronary angioplasty (PTCA, although it is well known that endothelial dysfunction is present in patients with coronary artery disease. Subjects and Methods:The study population comprised 39 patients (mean age: 61 years old, male:30 patients who underwent PTCA a mean 12 months before follow-up coronary angiogram (CAG. We measured the flow-mediated brachial artery dilation (FMD using high-resolution ultrasound 1 day before taking the follow-up CAG in an overnight fasting state. We also analyzed the risk factors of athero- sclerosis, lipid and glucose levels, the presence of chest pain, and the types of drug taken by patients according to the presence of restenosis. Results:FMD was significantly lower in patients with restenosis (n=19 than without restenosis (7.5±3.7% vs 10.2±2.5%, p=0.013. However, there were no significant differences in other variables according to the presence of restenosis. Conclusion:Endothelial dysfunction was more pro- nounced in patients with restenosis than without restenosis following PTCA. However, we do not yet know whether the severity of endothelial dysfunction is a predictor for restenosis as the FMD was taken just prior to the follow-up coronary angiogram. (Korean Circulation J 2001;31(11 :1117-1122

Background and Objectives:We performed this study to compare the endothelial function of the patients with newly diagnosed essential hypertension (EH to age and sex-matched normal subjects or patients with known coronary artery disease (CAD and to evaluate the effect of calcium channel blockers (amlodipine on the endothelial dysfunction in patients with EH. Materials and Methods: The endothelial function, expressed as percent brachial artery diameter changes at hyperemic phase compared to resting state, using high-resolution ultrasound was measured before taking amlodipine and 3 to 4 months after taking amlodipine (5 to 10 mg daily, when the high blood pressure (BP was well controlled (129/83 mmHg, in patients with EH (mean age:53 yrs, n=12. We also measured the endothelial function in normal subjects (mean age:54 yrs, n=25 and patients with proven CAD (mean age:56 yrs, n=30. Results:The mean BP of the patients with EH, CAD, and normal subjects were 172/108 mmHg, 110/69 mmHg, and 113/72 mmHg, respectively. There were no significant differences among the study groups in regard to the serum glucose and various lipid levels. The endothelial function of the patients with EH (6.6±2.3% was significantly (p=0.000 lowered when compared to the normal subjects (14.3±3.3%, but did not show any significant differences when compared to the patients with CAD (8.6±3.4%. The endothelial function in patients with EH was significantly (p=0.007 improved from 6.6±2.3% to 11.0±2.7% 3 to 4 months after taking the amlodipine. Conclusion:Calcium channel blockers, especially amlodipine, can improve endothelial dysfunction in patients with EH as well as controlling high BP. ( ( ( (Korean Circulation J 2000;30( ( ( (8 :1010-1016

Background and Objectives:The identification of a specific etiology of effusive pericardial disease is difficult because of the limited yield of cytologic and microbiologic pericardial fluid analysis. We performed retrospective study to find out whether pericardial biopsy was superior to pericardial fluid analysis in search of the etiology of pericardial effusion. Materials and Method:We reviewed 76 cases of moderate to severe pericardial effusion on which we performed surgical pericardial biopsy from Sep. 1986 to Sep. 1996. The results of pericardial fluid analysis, clinical manifestation, pericardial biopsy were compared retrospectively. Results:1) Clinical diagnosis of pericardial effusion were as follow;neoplastic disease (7.9%), tuberculosis (72.4%), constrictive pericarditis (17.1%), and others (2.6%). 2) By the percutaneous pericardial biopsy, we confirmed 19 cases (25%). Etiology of 4 cases (5.3%) were malignancy and 15 cases (19.7%) tuberculosis. Fifteen out of 76 patients who were diagnosed by biopsy as tuberculous pericarditis and 28 patients who were suspected as tuberculous pericarditis clinically were treated with antituberculous medications. Ten patients (66.7%) of pathologically diagnosed patients and 18 patients (69.2%) of clinically diagnosed patients showed complete resolution of pericarditis. Conclusion:By pericardial biopsy, we only confirmed 19 cases (25.0%). It means that pericardial biopsy is not superior to pericardial fluid analysis in searching of etiology of pericardial effusion. Moreover, it is not sufficient for final diagnosis of pericardial effusion. (Korean Circulation J 1999;29(5):517-522)