Search

Background/aims Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). Methods A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). Results After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. Conclusions In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.

Hypertension is a risk factor for coronary heart disease and stroke, and is one of the leading causes of death. Although over a billion people are affected worldwide, only half of them receive adequate treatment. Current guidelines on antihypertensive treatment recommend combination therapy for patients not responding to monotherapy, but as the number of pills increase, patient compliance tends to decrease. As a result, fixed-dose combination drugs with different antihypertensive agents have been developed and widely used in recent years. CCBs have been shown to be better at reducing central blood pressure and arterial stiffness than diuretics. Recent studies have reported that central blood pressure and arterial stiffness are associated with cardiovascular outcomes. This trial aims to compare the efficacy of combination of calcium channel blocker (CCB) or thiazide diuretic with an angiotensin receptor blocker (ARB). This is a multicenter, double-blinded, active-controlled, phase 4, randomized trial, comparing the antihypertensive effects of losartan/amlodipine and losartan/hydrochlorothiazide in patients unresponsive to treatment with losartan. The primary endpoint is changes in mean sitting systolic blood pressure (msSBP) after 4 weeks of treatment. Secondary endpoints are changes in msSBP, mean 24-h ambulatory mobile blood pressure, mean 24-h ambulatory mobile central SBP, mean 24-h ambulatory carotid-femoral pulse wave velocity, ambulatory augmentation index, and microalbuminuria/proteinuria after 20 weeks of treatment. The sample size will be 119 patients for each group in order to confer enough power to test for non-inferiority regarding the primary outcome. The investigators aim to prove that combination of a CCB with ARB shows non-inferiority in lowering blood pressure compared with a combination of thiazide diuretic and ARB. We also hope to distinguish the subset of patients that are more responsive to certain types of combination drugs. The results of this study should aid physicians in selecting appropriate combination regimens to treat hypertension in certain populations. ClinicalTrials.gov NCT02294539. Registered 12 November 2014.

Objective:With limitation of clinic and brachial BP, central BP and vascular parameters have known to be better to probe efficacy of antihypertensive drug. Because vascular parameters are measured at resting state, role of ambulatory central BP and vascular parameters to explain the difference in cl

Background and Objectives:B-type natriuretic peptide (BNP) is released from the cardiac ventricles in response to increased wall tension. Early diagnosis of congestive heart failure (CHF) and assessment of the left ventricular end diastolic pressure (LVEDP) are thought to be important in the diagnosis, treatment and follow up of patients with CHF. Subjects and Methods:Between March, 2002 and November, 2002, 50 patients, who were admitted for treatment and hemodynamic monitoring, were studied. For the BNP measurement, 3 to 5ml blood samples were collected into tubes containing EDTA. The BNP was measured with a fluorescence immunoassay kit (Triage, Biosite, San Diego, U.S.A.). Cardiac Catheterization was performed for the assessment of the LVEDP. Results: Of the 50 subjects, 34 with CHF had a mean BNP level of 483.1±77.8 pg/mL, whereas those without CHF had a level of 79.2±24.0 pg/mL. The difference between the groups was statistically significant (p=0.005). A significant positive correlation was seen between the BNP and the LVEDP (r=0.53, p=0.001). The correlation between the BNP and the left ventricular ejection fraction (LVEF) was not statistically significant (r=-0.226, p=0.198). Conclusion:The plasma BNP was significantly increased in CHF, and might reflect the LVEDP. Further study will be required to see whether the BNP is a useful parameter for the staging and treatment of CHF. (Korean Circulation J 2003;33 (8):695-700)

Background and Objectives：It has been suggested that the indices based on tissue doppler and color M-mode echocardiography reflect the left ventricular end-diastolic pressure. These include the early diastolic transmitral velocity (E to early myocardial velocity ratio measured by tissue doppler (E’ and the E to the wave propagation velocity (Vp ratio measured from color M-mode images. However, these indices have not been well validated in congestive heart failure patients. Subjects and Methods：Thirty one congestive heart failure patients who underwent simultaneous cardiac catheterization and echocardiography, and had normal sinus rhythm were enrolled in this study. The left ventricular end-diastolic pressure obtained from the left heart catheterization was compared with the diastolic indices using pulsed doppler, tissue doppler and color M-mode echocardiography. Results： The left ventricular end-diastolic pressure (LVEDP ranged from 3.3 to 23 mmHg. Some parameters showed a significant correlation with the LVEDP. The propagation velocity showed a significant correlation with the LVEDP (r＝-0.382, p＝0.034, and the E to propagation velocity ratio (E/Vp showed a good correlation with the LVEDP (r＝0.408, p＝0.023. In addition, the E to early diastolic velocity of the mitral annulus (E’ ratio had an insignificant correlation with the LVEDP (r＝0.322, p＝0.078. Among the patients with ischemic congestive heart failure, the E to the propagation velocity ratio (E/Vp showed a marginal correlation with the LVEDP (r＝ 0.461, p＝0.047. Conclusion：In patients with congestive heart failure, the Vp and E/Vp showed a good correlation with the LVEDP. In the subgroup of patients with ischemic congestive heart failure, only the E/Vp showed a significant correlation with the LVEDP. (Korean Circulation J 2002;32 (10 :872-877