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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 There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI). Methods From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months. Results After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31-3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924). Conclusions Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.

Background and Objectives Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis. Methods From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR. Results After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78±7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p

A 63-year-old female was admitted to our hospital for catheter ablation during atrial fibrillation. After catheter ablation, the patient was transferred to the cardiac care unit and mechanically ventilated due to dyspnea and hypotension. Imaging showed active bleeding from the right common carotid artery (CCA) with extensive hematoma into the mediastinum. She was successfully treated with a stent graft at the CCA. Further bleeding or neurologic sequel did not occur after treatment.

Background and Objectives Oxidative stress (OS) plays an important role in the pathophysiology of atrial fibrillation (AF) by amplifying the inflammatory cascade, wherein augmented inflammation facilitates the atrial electrical remodeling process. Few studies have investigated the possible link between systemic inflammation and OS in AF. Subjects and Methods A total of 220 consecutive patients with AF (117 patients) or healthy controls (103 patients) were enrolled. Among the 117 AF patients, 65 paroxysmal AF (PaAF) and 52 persistent AF (PeAF) patients were included. The level of 8-iso-prostaglandin F2α (8-iso-PGF2α) was measured as a marker of OS burden. We evaluated the correlations between 3 systemic inflammatory markers, high-sensitivity C-reactive protein (hsCRP), neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW), and 8-iso-PGF2α. Results The 8-iso-PGF2α concentration in both PaAF and PeAF patients was higher than that of controls (p

Aneurysm of the sinus of Valsalva that causes dissection of the interventricular septum is an extremely rare entity. In this report we describe a case of aneurysm of the sinus of Valsalva dissecting into the interventricular septum, from the base to mid septum, after aortic valve replacement. After the diagnosis was made by transthoracic echocardiography and magnetic resonance imaging, the patient was successfully treated with surgical sealant-mediated occlusion of the aneurysmal sac and cardiac resynchronization therapy used for the first time.

Background and Objectives The aim of this study was to evaluate the outcomes of repeated percutaneous coronary intervention (PCI) based on the restenosis pattern in drug-eluting stent (DES) failure. Subjects and Methods From April 2003 to March 2006, all 67 patients (67 lesions) at our 3 centers who had DES in-stent restenosis (ISR) were enrolled. The patients were divided into 3 groups: group I had focal edge restenosis, group II had focal body restenosis, and group III had non-focal restenosis. All patients were treated with conventional PCI including plain old balloon angioplasty (POBA), cutting balloon angioplasty (CBA), and repeated DES implantation (Re-DES). Angiographic and clinical one year follow-up results for the 3 groups were evaluated. Results Sixteen patients were enrolled in group I, 36 in group II, and 15 in group III. Baseline clinical and angiographic characteristics and the proportion of patients in each group receiving each type of treatment strategy were not significantly different among the groups. Within each group, a comparison of angiographic and clinical outcomes for each therapeutic modality revealed that restenosis rates were not statistically different. Although rates of major adverse cardiac events (MACE) were not statistically different between groups I and II, in group III, MACE were 3-fold higher for the POBA (4/4, 100.0%) and CBA (4/4, 100.0%) subgroups than for Re-DES (1/3, 33.3%) (p=0.06), but the differences did not reach statistical significance. Conclusion The present study suggests that treatment of DES ISR should be individualized according to restenosis pattern: any PCI strategy appears appropriate for focal ISR patterns, while Re-DES might be a better choice for non-focal ISR patterns.

Background and Objectives: The Mayo clinic quadratic (MCQ) glomerular filtration rate (GFR) equation accurately estimates the GFR when the presence of kidney disease is unknown. The aim of this study is to evaluate the usefulness of the MCQ GFR equation for predicting contrast-induced nephropathy (CIN) in patients with angina pectoris and who are undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Subjects and Methods: One hundred seven patients diagnosed with stable or unstable angina and who had normal serum creatinine levels (SCr

Cilostazol inhibits phosphodiesterase III (PDE III), which is predominantly distributed to and regulates physiologic responses in platelets, cardiac muscle cells, vascular smooth muscle cells, and adipose cells. Clinically, it is well known as an antiplatelet agent that inhibits the platelet aggregation normally induced by collagen, 5’-adenosine diphosphase (ADP), epinephrine, and arachidonic acid. It also has pleotropic effects, including the prevention of restenosis after angioplasty and the promotion of peripheral vascular flow in patients with peripheral vascular diseases. In the drug-eluting stent era, it has emerged as an effective post-intervention anti-atherothrombotic agent and a useful agent for therapy in diabetic patients. The aim of this study was to review the mechanisms of action and clinical trial results associated with cilostazol in cardiovascular disease patients. (Korean Circ J 2008;38:441-445)

Thrombolytic therapy during cardiopulmonary resuscitation is not routinely recommended, but 50-70% of cardiac arrests are caused by either acute myocardial infarction or massive pulmonary embolism. Thrombolytic therapy can be a reasonable treatment modality for a patient suffering with cardiac arrest in an emergency situation and whose diagnosis is not known. We report here on a case with cardiac arrest and the diagnosis was not known. The patient was refractory to conventrional cardiopulmonary resuscitation, and he was treated with a bolus injection of a thrombolytic agent. He recovered completely without complications. (Korean Circ J 2007;37:663-665)

Background and Objectives:Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) stenosis is a promising technique in the drug-eluting stent era. However, there is a lack of data as to the impact of the lesion location in the LMCA on the procedural and postprocedural outcomes. The aim of this study is to evaluate the effect of lesion location on the procedural and postprocedural outcomes. Subjects and Methods: From July 2003 to January 2006, we enrolled 82 patients (Males: n=49), who underwent PCI for unprotected LMCA stenosis at Yeungnam University Medical Center, Keimyung University Dong-san Hospital and In-je University Baik Hospital in Busan. The patients were divided into two groups according to the lesion location. Group 1 (n= 38) was defined as those patients who had a significant stenosis in the ostium and/or body. Group 2 (n=44) was defined as those patients had a left main coronary lesion involving a bifurcation. All the patients had a sirolimus eluting stent (Cypher, Cordis) deployed into the LMCA stenosis. Stenting techniques such as the T, crush and kissing stent techniques for treating the LMCA were used at the discretion of the operator and according to the characteristics of the lesion location. The in-hospital outcomes were compared between the two groups and followup coronary angiography was performed after 6 months; the major adverse cardiac events (MACE) and restenosis were analyzed between the two groups. Results:The baseline characteristics between the two groups were not statistically different. The procedural outcomes showed that for the stenting methods, the conventional stent technique was the only one used in all cases of Group 1, but the kissing, T stenting and Crush techniques were also used in Group 2 (p=0.001). The clinical outcomes showed that that there was no statistical difference for the in-hospital MACEs between the two groups, but for the out-of hospital MACEs at 6 month, the target lesion revascularizatin rates, including PCI or bypass graft operation, in Group 1 were higher than those in Group 2 (0% vs 13.6%, respectively p=0.043). Both groups had one cardiac death each (2.3% vs 2.6% respectively) and there was 1 MACE in Group 1 and 7 MACEs in Group 2 (2.6% vs 16%, respectively, p=0.045). The angiographic outcomes at 6 month showed that all 8 significant restenosis cases were included in Group 2 (18%, 9.7% in the total population); the restenosis site was the left circumflex artery in all cases. Conclusion:PCI with using drug eluting stents in the left main lesion showed favorable short term outcomes in selected patients. The lesion location is also an important factor for the clinical and angiographical outcomes. (Korean Circulation J 2007;37:419-424)

Background and Objectives:Atrial dilatation contributes to the inducibility of atrial fibrillation (AF) by changing the atrial electrophysiological properties. There has been no report regarding the electrophysiologic data of the left atrium (LA), where the most significant electrophysiological impact might be expected to occur in case of mitral stenosis (MS). We investigated the electrophysiological changes after reduction of the LA pressure in patients who were undergoing percutaneous balloon mitral commissurotomy (PBMC). Subjects and Methods:We studied 26 patients (21 women, age range: 50±12 years) with MS, including 7 sinus rhythm (SR) patients. The effective refractory period (ERP), the monophasic action potential duration (MAPD90), and the conduction time (CT) were measured simultaneously in both atriums at 600, 500, 400 and 300 ms of drive cycle length (DCL). The restitution slope (RS) was also calculated by the S1S2 method. The atrial fibrillation cycle length (AFCL) and dominant frequency (DF) for the cases of AF were also calculated. All the measurements were repeated after PBMC. Results: The mean LA pressure was significantly reduced after PBMC in both the AF and SR patients (17.0±5.5 mmHg vs 10.4±4.0 mmHg, respectively, p

A 52-year-old woman, who was suffering from aplastic anemia, presented with the clinical features of severe heart failure. The transthoracic echocardiogram showed a heterogeneous, huge mass on the base of the posterior mitral valve. We guessed that the mass would be a benign neoplasm and probably myxoma, and we decided upon surgical resection. After tumor resection, an unexpected result of the histopathology was a high grade osteosarcoma. The other studies that were done after we had the diagnosis could not reveal any evidence of metastatic malignancy. (Korean Circulation J 2006;36:764-766)

Background and Objectives:Compared to bare metal stent, drug-eluting stent has improved the clinical and angiographic outcomes for de novo, simple lesions. In real world clinical practice, we often encounter more complex, long lesions, which increase the rate of restenosis and cardiovascular events. The aim of this study was to evaluate the clinical and angiographic outcome of sirolimus-eluting stent (SES) for the treatment of very long lesions in real world clinical practice. Subjects and Methods:We implanted multiple SESs (>40 mm in total length) in 113 de novo lesions in 113 patients. The average length of the implanted stents was 58±14 mm (range: 41-112 mm) and a mean of 2.2 stents were implanted in each lesion and the average stent diameter was 3.0 ±0.3 mm. Results:Procedural and angiographic success were achieved in all the patients without death or coronary artery bypass surgery. Non-Q wave MI (CK-MB≥ 3 times the normal value) developed in 13 patients (11.5%). Two patients experienced late stent thrombosis after discharge (1.8%). The major adverse cardiac events (MACE)-free survival was 94% at 12 months. There were two sudden cardiac deaths. Six months follow up angiography was performed on 76 patients (67%) and angiographic binary restenosis developed in 7 patients (9.2%). All of them were the focal type in-stent restenosis and these were found to be located at the distal stents. Conclusions:In conclusion, long lesion coverage with SESs is feasible with a favorable mid-term outcome in real world clinical practice. (Korean Circulation J 2006;36:490-494)

Background and Objectives:Vascular brachytherapy for stent restenosis has been demonstrated to reduce restenosis and major adverse cardiac events (MACE). However, the angiographic and clinical outcomes after β-radiation, using a Holmium (Ho)-DTPA filled balloon, has not been sufficiently evaluated. Subjects and Methods: Between March 2002 and August 2003, 78 consecutive patients (mean age 50 yrs, 53 male) with in-stent restenosis were randomly enrolled for either cutting balloon angioplasty only (control group, n=38) or in combination with vascular brachytherapy using a Ho-DTPA filled balloon (brachytherapy group, n=40). The radiation dose applied was 18 Gy, at a depth of 1.0 mm from the vascular lumen. Results:The treated vessels comprised of 50 left anterior descending arteries (64.1%), 23 right coronary arteries (29.5%) and 5 circumflex arteries. The mean radiation dose and time were 375±67.8 mCi/ml and 191±76 seconds, respectively. Six cases were fractionated. The mean lesion length was 18.2±7.9 mm, with no difference between the 2 groups. Eight month follow-up coronary angiography revealed a restenosis rate of 17.1% (6/35) in the brachytherapy group vs. 39.3% (11/27) in the control group (p=0.042). However, there was no difference in the 1 year MACE. Conclusion:In patients with in-stent restenosis, vascular brachytherapy, using a Ho-DTPA filled balloon, showed favorable angiographic outcomes at the 8 month follow-up compared to the control group. (Korean Circulation J 2005;35:591-596)

Background and Objectives：It is known that ventricular fibrillation (VF) can be enhanced by sympathetic activity and antagonized by vagal activity, and that the kinetics of electrical restitution is a key determinant of VF induction or maintenance. However, little is known about the effects of autonomic stimulation on electrical restitution. Therefore, we studied the effect of sympathetic (SS) and vagus nerve stimulation (VS) on the electrical restitution and VF induction. Materials and Methods：A monophasic action potential (MAP) was simultaneously recorded from the endocardium and epicardium of the left ventricle in 12 open chest canine hearts. The restitution kinetics were studied using a single ventricular extra-stimuli (S2), following a 15 beat drive train (300 ms), down to the effective refractory period (ERP). S2-MAPD was plotted against the preceding diastolic intervals, fitted to exponential curves and the maximum restitution slope (Smax) measured. The VF threshold (VFT) was determined as the minimum current that would induce VF with rapid pacing (50×50 ms). Parameters were studied at the baseline (control) and separately during VS and SS. Results：SS increased the Smax of the endocardium (1.14±0.37 vs. 0.80±0.25, p

Background and Objectives:The Angio-Seal (a St. Jude Medical Co., USA) hemostatic puncture closure device produces direct femoral arterial hemostasis, by anchoring a collagen plug to the anterior vascular wall, through a sheath delivery system. The rapid and effective hemostasis leads to earlier ambulation, minimized hospital stay, patient discomfort and vascular complications. This study was performed to evaluate the efficacy and complications of an Angio-Seal in patients undergoing coronary angiography and angioplasty. Subjects and Methods:A total 228 consecutive patients, admitted to our hospital for percutaneous coronary intervention, between October 2001 and May 2002, were enrolled and randomized into 2 groups. 116 patients were treated with an Angio-Seal and the other 112 with manual compression only (control group). The clinical characteristics, procedure related factors, time to ambulation, times to outpatient discharge and complications were analyzed in each patient. All the clinical and procedure-related factors, leading to oozing and delayed bleeding, were also analyzed in the 113 patients who had a successfully completed Angio-Seal deployment. Results:The times to ambulation (7.96±5.81 hours vs. 23.32±3.35 hours) and times to outpatient discharge (2.00±0.94 days vs. 3.47 ±3.61 days) were significantly shorter in the Angio-Seal compared to the control group (p=0.001 & p=0.001, respectively). There was oozing in 20 patients (17.7%) and delayed bleeding in 6 (5.3%) of the successful AngioSeal deployment group. The occurrence of oozing was significantly higher in the heparin infusion cases (40% vs. 18.3%, p=0.034), and was correlated with a later hematoma formation rate and the size of the hematoma (30% vs. 9.7%, 0.68±1.26 cm vs. 0.17±0.70 cm, p=0.015 & p=0.001, respectively). Delayed bleeding was correlated to the hematoma occurrence rate (50% vs. 11.2%, p=0.006). Conclusion:The Angio-Seal resulted in earlier ambulation and shorten the patients’ hospital stay. Oozing, delayed bleeding, hematomas were noted as complications. Oozing and delayed bleeding were correlated with a high hematoma occurrence rate. Careful inspection of the puncture sites, following an Angio-Seal deployment, should be performed. (Korean Circulation J 2003;33 (7):574-582)

Background and Objectives:Primary (idiopathic) pulmonary hypertension is a rare, progressive and fatal dise- ase. It has been defined, by the World Health Organization, as a mean pulmonary arterial pressure greater than 25 mmHg at rest, or greater than 30 mmHg during exercise, without the apparent cause of secondary pulmonary hypertension. This study was performed to better understanding the clinical presentation, natural history and prognosis of primary pulmonary hypertension. Subjects and Methods:A total of 18 patients, who were diagno- sed as primary pulmonary hypertension, at three University Hospitals, were retrospectively reviewed. All patients had undergone echocardiography and cardiac catheterization. Results:With the patients there was a male: female ratio of 1:8, ranging in age between 10 and 50 years. The most common presenting symptom was dysp- nea on exertion, with other symptoms comprising of fatigue in 11, chest pain in 5, syncope in 3 and hemoptysis in 2. The ECG & echocardiography reflected the presence of right-sided heart enlargement. The average right ventricular systolic pressure, from Doppler echocardiography, was 73.6±18.8 mmHg. The mean pulmonary ar- tery pressure and pulmonary capillary wedge pressure were 52.9±18.4 and 9.2±3.1 mmHg, respectively. The survival times were within 30 and 21 to 60 months in 9 and the remaining patients, respectively. Conclusion: We conclude that primary pulmonary hypertension is common in female patients in their third to fifth decades. This study also showed a poor prognosis, as in other reports. (Korean Circulation J 2003;33 (6):507-512)

Background and Objectives:The pulmonary veins and surrounding ostial areas frequently house focal triggers or reentrant circuits critical to the genesis of atrial fibrillation (AF). The purpose of this study was to assess the efficacy of pulmonary vein isolation, aided by intraoperative radiofrequency catheter ablation, for the treatment of AF associated with mitral valvular heart disease. Subjects and Methods:32 consecutive patients with AF associated with mitral valvular disease, requiring mitral valvular replacement or valvuloplasty were included. We divided these patients into two groups. The first group, PVI, consisted of 16 patients that had mitral valvular operations with intraoperative radiofrequency pulmonary vein isolation, and the other 16 patients, the controls, had mitral valvular operation only. The conversion rate to sinus rhythm and other clinical data were compared between the two groups. Results:Circumferential pulmonary vein isolation, with radiofrequency catheter ablation, was achieved in an average of 15±3 min. There were no mortalities or morbidities associated with this procedure. In the immediate postoperative period, the conversion rate to normal sinus rhythm in the PVI group was significantly higher than in the controls (81% vs. 37.5% p=0.016). After 21±4 weeks of follow up, the sinus rhythm maintenance rates in PVI group was also significantly higher than those of the control group (75% vs. 31.2% p=0.01). Conclusion:Circumferential pulmonary vein isolation, aided by intraoperative radiofrequency catheter ablation, is simple and effective for the treatment of chronic atrial fibrillation associated with mitral valvular disease. (Korean Circulation J 2002;32(7):596-603)

Background and Objectives:Prolonged atrial conduction time and inhomogeneous electrical atrial activity have been known to be important electrophysiologic characteristics in patients with paroxysmal atrial fibrillation (PAF). Filtered P wave duration dispersion (Pdisp) is defined as the difference between the maximal and minimal filtered P wave duration of the three X, Y, Z leads of P wave signal averaged ECG (PSAECG). The purpose of this study was to determine and compare conventional PSAECG parameters with this newly developed parameter, Pdisp, for the prediction of PAF risk. Subjects and Methods:The study population, consisting of 65 patients with PAF (Group 1) and 56 age and sex matched controls (Group 2), was further subgrouped by the presence (Group A) and absence (Group B) of organic heart disease. The PSAECG was recorded using P wave triggered SAECG and the following parameters were measured:total filtered P wave duration (TFPD), vector magnitude, RMS10, RMS20, RMS30 and Pdisp. These parameter values were compared between groups. Results:TFPD and Pdisp were significantly longer in the PAF group than in the control group (121.2±9.7 msec versus 108.5±12.7 msec, p=0.005;25.2±11.5 msec versus 14.7±7.9 msec, p

Background:It is well known that ischemic preconditioning protects the heart against infarction or arrhythmias from a subsequent ischemic injury. Two phases of the effect of preconditioning has been explored, early protection and second window of protection at 24 hours. The late protection was seen in some animal model, but the precise mechanism is controversal. This study was designed to evaluate the late cardioprotective effect and role of HSP70 in ischemic preconditioning of cat heart. Methods:Two groups of cats were studied. Control animals were subjected to an episode of 40-min coronary artery occlusion followed by 30-min reperfusion. Experimental animals were subjected to ischemic preconditioning before the 40-min ishcemia/reperfusion. The preconditioning protocol was comprised of three 5-min episodes of ischemia interspersed by 10-min episodes of reperfusion. After sustained ischemia and reperfusion, left ventricular risk area and infart area were measured by injection of Evans blue bye and triphenyltetrazolium staining, and myocardial HSP70 mRNA was examined in risk (left ventricular anterior wall) and nonrisk (left ventricular posterior wall) area using northern blot hybridization. HSP70 mRNA expression was quantified as a percent of GAPDH. The late cardioprotective effects of ischemic preconditioning were determined by infarct size (% area at risk). Results: Infarct size was markedly limited by ischemic preconditioning when compared with the control group (18.5± 6.9% vs 38.5±11.1%;p

Background and Objectives：Coronary stents have been used increasingly in the field of coronary intervention. However, in-stent restenosis (ISR remains a therapeutic challenge. The subsequent response to repeat intervention in the restenotic lesion may be predicted by the angiographic pattern of ISR. In particular, the restenosis rate following re-intervention in this lesion is higher. This study evaluated the incidence of restenosis types and the predictors for diffuse type ISR. Subjects and Methods：The study population included 66 patients with in-stent restenotic lesions after stent implantation. Angiographic restenosis was defined as a diameter stenosis of ≥50% at follow-up coronary angiography. Patterns of ISR were defined as focal type (

Background and Objectives:Percutaneuous transvenous mitral commissurotomy (PTMC) has been performed as an effective non-surgical treatment modality of rheumatic mitral stenosis. Mitral regurgitation (MR) as a complication of the procedure occur in 20~53% of the patients. The moderate to severe mitral reguargitation, created by the PTMC, sometimes leads to the requirement for mitral valve replacement, but most of the MR limits the optimal dilation of mitral commissure due to the worry about the progression of the MR. This study was designed to evaluate the occurrence of mitral regurgitation and predictive factors for the moderate to severe mitral regurgitation (grade≥2) induced by PTMC. Methods:This study enrolled 46 patients (female 42, mean age 45 years) who have performed PTMC in Yeungnam University Hospital from May 1996 to May 1999. We analyzed the occurrence rate of mitral regurgitation (MR) and predictive factors for MR grade≥2 after procedure. Results:MR was detected in 35% of the patients prior PTMC, and in 56% after the procedure (grade 1, 30%;grade 2, 15%;grade 3, 11%). 21 cases of the MR was commissure MR as a grade≤2. MR grade 3, occured in 5 patients, was non-commissure MR caused by the unilateral rupture of the lateral commissure in 4 patients and tearing of the annulus in one patient. On the univariate analysis, patients with MR grade≥2 showed more frequent atrial fibrillation, mitral regurgitation and fluoroscopic calcification, and had more severe symptoms than patients with MR grade

Background:Percutaneous mitral balloon valvuloplasty (PMV) has been proposed as an alternative to surgery for selected patients with symptomatic mitral stenosis. The presence of mild mitral regurgitation (MR) in mitral stenosis is usually not considered as a contraindication for the procedure. But, the results of PMV in the subgroup of patients with concomitant mild MR are unknown. Accordingly, this study evaluates the clinical outcome of a consecutive series of patients with mitral stenosis and mild MR undergoing PMV. Methods:Between August 1992 and December 1996 we attempted to dilate the mitral valves of 43 consecutive patients with symptomatic mitral stenosis. Mean age of the group was 45.9±10.6 years and 37 patients were women. They were divided into two groups according to the presence or absence of mild MR before the procedure. Clinical feature, inital result, complication were compared. Results:1) Age, gender, symptomatic status, and atrial fibrillation were similar in both groups. 2) Patients with MR had more thickened valve (2.50±0.33 vs 1.84±0.55, p=0.048) and subvalvular tissue (2.55±0.73 vs 1.88±0.73, p=0.015), higher echocardiographic score (8.44±1.01 vs 7.08±1.65, p=0.004). 3) Mitral valve area gain on the first day after PMV was smaller in patients with MR (p=0.008). 4) The success rate of PMV, the incidence of severe MR after PMV, and the restenosis rate on 6 month were similar in both groups. Conclusion:Although the PMV in patients with mild MR obtained smaller increments in mitral valve area compared to those without MR, they showed similar immediate and short-term results after PMV. (Korean Circulation J 1999;29(6):596-601)

Background and Objectives:QT dispersion (QTd is defined as the difference between the maximum and minimum QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. Ischemic dilated cardiomyopathy (DCM may lead to more spatial and temporal dispersion in ventricular repolarization than idiopathic DCM. The purpose of this study was to determine the difference of QTd between patients who had ischemic and idiopathic DCM. Materials and Methods:The study population included 30 patients with ischemic DCM and 30 with idiopathic DCM. All standard 12-lead ECGs were examined prospectively by two observers who were unware of the patient's details. Results:QTd in ischemic DCM was significantly higher than that in idiopathic DCM (63±32 vs. 44 ±26 msec, p=0.012 and JTd in ischemic DCM was significantly higher than that in idiopathic DCM (48± 21 vs. 36±22 msec, p=0.036. Results did not change when Bazett's QTc and JTc was substituted for QT (QTcd:69±33 vs. 52±28 p=0.039 and JT (JTcd:56±21 vs. 41±25 p=0.043. Conclusion:Ischemic DCM has increased spatial inhomogeneity of repolarization probably due to more regional myocardial damages compared with idiopathic DCM. The value of QT dispersion as an easily accessible, non-invasive method in predicting the risk of life threatening arrhythmia and overall mortality in patients with dilated cardiomyopathy must be confirmed in prospective trials. (Korean Circulation J 1999;29(5 :492-497

Background and Objectives:To evaluate the clinical and prognostic significance of precordial ST segment depression in precordial leads on admission electrocardiogram (ECG) in acute inferior myocardial infarction treated with intravenous thrombolytic therapy. We analysed about clinical and angiographic characters. Materials and Method:ECG findings in 50 patients with acute inferior myocardial infarction were retrospectively studied with results of coronary angiography and clinical informations. We classified all patients in two group according to the admissional ECG. Twenty nine patients (Group A) had no or

Background and Objectives:The myocardial protective effect of ischemic preconditioning is well known. However, the mechanism is remains unclear. The purpose of this study is to determine the role of adenosine, protein kinase C, KATP channel and the change of monophasic action potential duration on cardioprotective effect of ischemic preconditioning in cat. Materials and Methods:In this experiment, 66 cats were allocated into 7 groups:control (n=10, ischemic preconditioning (n=10, adenosine pre-treated (n=10, SPT (8-p- sulfophenyl theophylline pre-treated (n=9, polymyxin B pre-treated (n=9, glibenclamide pre-treated (n= 9 and nicorandil pre-treated (n=9 groups. Ischemic preconditioning was performed in ischemic precondi- tioning, SPT pre-treated, polymyxin B pre-treated and glibenclamide pre-treated groups by 3 episodes of 5 minutes ischemia and 10 minutes reperfusion. All animals were subjected to 40 minutes of ischemia and 40 minutes of reperfusion. Monophasic action potential duration at 50% repolarization (MAP50 was measured in the ischemic and non-ischemic area respectively by epicardial probe throughout the experiment. The effect of ischemic preconditioning was determined by infarct size (% area at risk. Results:Ischemic preconditioning, adenosine pre-treatment and nicorandil pre-treatment groups demonstrated a significant reduction in infarct size (26±4%, 25±4% and 34±8% infarction of the risk zone, respectively, p