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Hyponatremia in the early phase of acute myocardial infarction (AMI) is a well-known predictor of poor prognosis. However, little is known about the clinical implication of sodium levels at discharge in hospital survivors after AMI. The study included 1290 consecutive patients (64 ± 12 years; 877 men) who survived the index hospitalization after AMI. We determined the 12-month mortality rates of these patients. Patients who died during the 12-month follow-up had lower sodium levels at discharge than those who had survived (137 ± 6 vs. 139 ± 4 mmol/L; P < 0.014). Hyponatremia at discharge, defined as a serum sodium level ≤135 mmol/L, was present in 210 patients (16.3 %). In the Cox-proportional hazard model, hyponatremia at discharge (hazard ratio, 2.264; 95 % confidence interval, 1.119-4.579; P = 0.023) was an independent predictor of 12-month mortality. Moreover, hyponatremia at discharge had an incremental prognostic value over conventional risk factors ( χ = 7, P = 0.007), and conventional risk factors and log N-terminal Pro-B-type natriuretic peptide combined ( χ = 5, P = 0.021). In the subgroup analysis, the 12-month mortality of patients with hyponatremia at discharge was significantly higher than in those without, irrespective of age, Killip class, left ventricular ejection fraction, percutaneous coronary intervention at index hospitalization, and prescription of diuretics at discharge. Hyponatremia at discharge is an independent predictor of 12-month mortality in hospital survivors after AMI. [ABSTRACT FROM AUTHOR]

Background: Hypermethylation of DLX4 (distal-less homeobox 4) has been disclosed in a variety of cancers. Our work was aimed to examine the pattern of DLX4 methylation and further investigate its clinical relevance in patients with myelodysplastic syndrome (MDS). Methods: Real-time quantitative methylation-specific PCR and bisulfite sequencing PCR were carried out to detect the level of DLX4 methylation. Clinical significance of DLX4 methylation was analyzed between the DLX4 hypermethylated and non-hypermethylated patients. Results: DLX4 was significantly hypermethylated in MDS patients than controls (p<0.001). No significant differences were observed between the hypermethylated and non-hypermethylated MDS patients in white blood cells, platelets, age, WHO classifications, FAB classifications, IPSS risks, and common gene mutations (p>0.05). However, DLX4 hypermethylated patients tended to have higher hemoglobin (HB) than DLX4 non-hypermethylated patients (p=0.079). Moreover, there was a trend that male patients, poor karyotype patients, and IPSS Int-2/High patients had a higher frequency of DLX4 hypermethylation (p=0.067, 0.065, and 0.068). DLX4 hypermethylated patients had significantly shorter overall survival than DLX4 non-hypermethylated patients (p=0.004). Multivariate analysis confirmed the prognostic value of DLX4 methylation in MDS patients (p<0.001). Conclusions: Our study indicated that DLX4 hypermethylation was a frequent event and acted as an independent prognostic biomarker in de novo MDS patients. [ABSTRACT FROM AUTHOR]

There have been no studies that have assessed the possible correlation between conduction abnormality (CA) and systemic embolism, or the long-term outcomes of patients with infective endocarditis (IE). In this study, 82 consecutive patients with IE and interpretable electrocardiography (ECG) were admitted to Kyungpook National University Hospital from July 2002 to June 2008. ECGs obtained at the time of admission or during hospitalization were analyzed. Patients with CA, which was defined as atrioventricular or intraventricular block, of 'new' or 'of unknown duration' were considered as those with CA. Composite events were defined as the composite of death and embolic events. Twenty-three (28%) patients had CA classified as new ( n = 11) or of unknown duration ( n = 12). No significant differences were found between patients with and without CA in terms of age and gender. Mean follow-up duration was 21 ± 23 months. Patients with CA had more frequent embolic events ( p = 0.001) and composite events ( p = 0.002) during hospitalization, and had more frequent composite events ( p < 0.001) during follow-up than those without CA. Kaplan-Meier survival curves showed that patients with CA had a higher composite event rate during follow-up ( p = 0.003). However, there was no significant difference between the two groups regarding mortality rates during hospitalization and follow-up. In multivariate analysis, CA was an independent predictor of embolic event rates during hospitalization [odds ratio (OR) 5.198, 95% confidence interval (CI) 1.086-24.867, p = 0.039] and of composite event rates during follow-up (OR 27.168, 95% CI 4.590-160.802, p < 0.001). CA is associated with increased frequency of embolic events during hospitalization and follow-up. Moreover, CA might be a useful predictor of embolic event occurrences during both hospitalization and follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Background: It is still controversial whether carotid plaque is associated with cardiovascular events in patients with coronary artery disease (CAD). The aim of the present study is to evaluate the impact of carotid plaque on long term clinical outcomes especially in patients with CAD. Methods: The study population consisted of 1390 consecutive patients with angiographically proven CAD. All subjects underwent carotid scanning 1day before or after coronary angiogram and were followed up for major adverse cardiovascular events (MACE; death, myocardial infarction, stroke, revascularization, restenosis and hospitalization for heart failure) during a mean of 54.2±23.9months. Results: Patients with carotid plaque (n=433) were older, had higher prevalence of cardiovascular risk factors and acute coronary syndrome (34.2% vs. 24.6%, p<0.001) than those without carotid plaque (n=957). On univariate analysis, the presence of carotid plaque was a predictor of cardiac death, hard MACE (death, myocardial infarction and stroke) and total MACE, whereas carotid intima-media thickness (CIMT) was a predictor of total MACE. Multivariate analysis revealed that carotid plaque was associated with cardiac death (HR 6.99, 95% CI 1.88–25.95, p=0.004), hard MACE (HR 1.89, 95% CI 1.18–3.04, p=0.008) and total MACE (HR 1.47, 95% CI 1.13–1.90, p=0.004), whereas CIMT was associated only with total MACE (HR 1.39, 95% CI 1.06–1.81, p=0.017). Conclusions: Carotid plaque is a strong predictor of future cardiac death and MACE in patients with CAD. This study suggests that carotid plaque has additional value for secondary prevention and more important prognostic factor than CIMT in patients with CAD. [Copyright &y& Elsevier]