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LEOPARD syndrome (LS) is a rare hereditary disorder in Asian countries. This syndrome consists of multiple systemic abnormalities. In particular, characteristic cardiovascular effects in LS may include variable clinical manifestations from benign to life-threatening courses. The cardiac effects of this syndrome consist of left ventricular hypertrophy (LVH), pulmonary stenosis (PS), coronary artery dilatation and electrocardiogram(ECG) abnormalities. Since there are few LS patients who have undergone a complete cardiovascular evaluation, the nature and clinical prognosis of cardiovascular abnormalities in this syndrome remain uncertain. Also, there have been few reports on therapeutic strategies for cardiovascular abnormalities in LS. Here we describe a case of LS who presented with multiple cardiovascular problems and underwent successful surgical and medical treatment.

Background and Objectives: The aim of this study was to evaluate the efficacy of lacidipine in reducing blood pressure (BP) and to determine its effect on endothelial function in mild-to-moderate hypertensive patients with type 2 diabetes mellitus (DM). Subjects and Methods: This was a prospective, multicenter, open-label, single-arm study, enrolling 290 patients with mild-to-moderate hypertension and type 2 DM. Patients were initially treated with 2 mg lacidipine orally once daily for 4 weeks, which was then increased as necessary every 4 weeks to a maximal dose of 6 mg daily. The primary endpoint was the mean change in systolic blood pressure (SBP) from baseline after 12 weeks of treatment. Secondary endpoints included mean changes in diastolic blood pressure (DBP), flow-mediated vasodilatation (FMD), and serum concentrations of biochemical markers such as high-sensitivity C-reactive protein (hs-CRP), monocyte chemo-attractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), and plasminogen activator inhibitor-1 (PAI-1). Results: Lacidipine treatment significantly reduced SBP by -13.4±13.0 mmHg (p

The most common symptoms of pheochromocytoma are paroxysmal or sustained hypertension, or symptoms of paroxysmal adren-ergic stimulation such as palpitation, headache, and diaphoresis. These patients can on rare occasion reveal or be complicated with cardiovascular symptoms such as arrhythmia, cardiomyopathy, acute coronary syndrome and cardiogenic shock. These cardiac manifestations of pheochromocytoma may delay the diagnosis, which can cause a catastrophic outcome. A pheochromocytoma cri-sis is provoked by surgery, anesthesia, exercise and, several drugs and it is known to be an endocrine emergency with mortality as high as 85%. Many classes of drugs are well known to precipitate adverse reactions, but the presentation of pheochromocytoma af-ter the administration of steroid has rarely been reported. We report here on a case of pheochromocytoma crisis with acute myocar-dial infarction after the patient took prednisolone. Furthermore, we discuss the mechanism of glucocorticoid induced crisis and myocardial infarction in pheochromocytoma patients. (

BACKGROUND: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). METHODS: Participants in this study consisted of 65 type 2 diabetes patients (M : F = 45 : 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 +/- 2.5 kg/m(2)) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. RESULTS: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 +/- 2.5 vs. 50.5 +/- 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 +/- 0.7 vs. 24.6 +/- 0.3 kg/m(2); P < 0.01) and diabetes duration was longer (9.65 +/- 1.48 vs. 4.71 +/- 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A(1)C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex, and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). CONCLUSION: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.

c-axis oriented La0.7Sr0.3MnO3 (LSMO) films on MgO-buffered SiO2/Si substrates were prepared, and their texture, microstructure, and magnetotransport properties were studied and compared to epitaxial LSMO/MgO (001) and polycrystalline LSMO/SiO2/Si films. c-axis oriented MgO buffer layers were obtained on amorphous SiO2 layer through rf sputter deposition at low substrate temperature and consequent postannealing processes. In situ pulsed laser deposition-grown LSMO films, deposited on the MgO layer, show strong c-axis texture, but no in-plane texture. The c-axis oriented LSMO films which are magnetically softer than LSMO/SiO2/Si films exhibit relatively large low field magnetoresistance (LFMR) and sharper MR drop at lower field. The large LFMR is attributed to a spin-dependent scattering of transport current at the grain boundaries.

Background/Aims: Many prognostic models have been developed to help physicians make medical decisions on treating patients with pulmonary embolism. Among these models, the Pulmonary Embolism Severity Index (PESI) has been shown to be a successful risk stratification tool for patients with acute pulmonary embolism. The PESI, however, had not been applied to patients with pulmonary embolism in Korea. Methods: The patients included in this study were diagnosed by computed tomography at Inje University's Ilsan Paik Hospital between December 1999 and March 2007. Risk stratification for the patients was performed using the PESI. The mortality rate was calculated according to each PESI risk class. Results: Of the 90 patients enrolled in this study, ten were assigned to PESI class I, 29 to PESI class II, 22 to PESI class III, eight to PESI class IV, and ten to PESI class V. The mortality rate after 30 days in each class was 0, 10.3, 9.1, 0, and 50% (p=0.0016), respectively, whereas the respective hospital mortality rate was 4.8, 13.8, 13.6, 12.5, and 50% (p=0.0065). The overall mortality was 9.5, 27.6, 31.8, 50.0, and 60%, respectively (p=0.0019). The mortality rate was significantly associated with the PESI class. Conclusions: The PESI class was found to be significantly correlated with the 30-day mortality rate, hospital mortality, and overall mortality. Our data indicate that the PESI can be used to predict the prognosis of patients with pulmonary embolism and in making medical decisions regarding the treatment of patients with pulmonary embolism. (Korean J Intern Med 2009;24:123-127)

Femoral arterial closure devices are now commonly used after both diagnostic and therapeutic coronary procedures. They have been shown to reduce the time to ambulation and to decrease the length of the hospital stay. Angioseal is a commercially available femoral artery closure device that has been approved by the Food and Drug Administration (FDA). The device sandwiches an intra-arterial absorbable anchor on the luminal side of the vessel and a thrombin plug on the surface of the vessel with using a self-cinching stitch. We report here on three patients who presented with acute and delayed arterial occlusive complications that were found to be due to an Angioseal anchor that was not appropriately reabsorbed. (Korean Circ J 2008;38:339-342)

An anomalous origin of the right coronary artery (RCA) from the left coronary cusp is a rare congenital anomaly. Because of the unusual location and the noncircular luminal orifice of this anomaly, cannulation of this artery during coronary angiography and percutaneous coronary intervention (PCI) poses significant technical difficulties when using the currently available guiding catheters. Primary PCI should be performed as quickly as possible when a patient displays this condition. When we face the situation of an anomalous artery during primary PCI, it takes a much longer time to open the occluded artery. We report here on two cases of successful primary PCI with using manually manipulated catheters and Ikari type guiding catheters in 2 patients who both had an anomalous RCA arising from the left coronary cusp. (Korean Circ J 2008;38:179-183)

Pre-term infants born before the end of the 37th week of pregnancy have not been exposed to their mother's womb full-term. Because they are born too soon, many of their biological systems, such as those involving the lungs and liver, are not developed enough to work property on their own. The lungs are not functional in the fetus, and the blood passes directly from the right atrium to the left atrium or from the right ventricle to the aorta. In this study, we analyzed protein profiles in the umbilical cord of term and pre-term infants by 2DE and MALDI-TOF analysis. Protein patterns of the umbilical cord were established using the pH range 4–7, isoelectric focusing (IEF) cell system, and 7.5–17.5&percnt; gradient 2-dimensional polyacrylamide gel electrophoresis (2DE). Image analysis was performed following Coomassie brilliant blue G staining to reveal spots, and spot intensities were compared using a PDQuest analysis system. Peptide mass fingerprinting with matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and a SWISS-PROT database search were utilized to identify proteins. Around 1000 protein spots were recognized by image analysis for umbilical cords from each treatment. Analysis of umbilical cords from pre-term infants revealed 35 different spots compared with those from full-term infants. Levels of 12 proteins increased, such as serum albumin precursor and tropomyosin, whereas levels of 11 proteins decreased, including 78 kDa glucose-regulated protein and protein disulfide isomerase A3. Another 12 proteins had levels that were different between 35 and 36 weeks of pregnancy. In general, proteins that increased represented precursor and cell mobility or structure-related proteins, whereas proteins that decreased included chaperon-related proteins. Expression levels of this protein were confirmed by Western blot analysis and real-time PCR. The results of this experiment suggest differential protein profiles between umbilical cords of pre-term and full-term infants that may be related to fetal circulation and early birth of infant.

Carbon nanotubes (CNTs) with different diameters as a counter electrode to fabricate dye-sensitised solar cells with high conversion efficiency are investigated. The CNT electrodes with large diameter demonstrated better redox reaction and higher energy conversion efficiency.

Abciximab is one of the glycoprotein IIb/IIIa receptor inhibitors, and it is known to be effective for preventing and treating the thrombotic complications of percutaneous coronary intervention (PCI). On the other hand, there is an increasing risk of hemorrhagic complications when using abciximab, especially in the case of abciximab-induced thrombocytopenia. Acute profound thrombocytopenia is a rare, but life threatening adverse reaction to abciximab, and it can even occur within a few hours of the first exposure. We report here on a case of 56 yearold woman who experienced massive bleeding of her brachial artery access site. This was caused by abciximab-induced acute profound thrombocytopenia after performing PCI concomitant with using abciximab. (Korean Circ J 2007;37:594-598)

Background and Objectives:Arterial stiffness and wave reflections increase with advancing age, and the systolic and pulse pressures are elevated. These changes in aortic stiffness and pulse wave velocity with aging may change the cardiac function. The diastolic function of the left ventricle declines with aging even in normal healthy subjects too. This investigation was designed to assess the correlations between the left ventricular diastolic function and arterial stiffness with using echocardiography including doppler tissue imaging (DTI) and an applanation tonometer. Subjects and Methods:The subjects were 100 healthy volunteers who had normal left ventricular systolic function and no major cardiovascular risk factors such as hypertension, hypercholesterolemia, diabetes, obesity and smoking. The left ventricular diastolic function was assessed with the mitral inflow indexes and DTI, and the pulmonary venous return was measured by echocardiography. The central aorta blood pressure, the augmentation index (AIx) and the pulse wave velocity (PWV) were evaluated by using an applanation tonometer (SphygmoCoR system). Results:With advancing age, the left mitral E/A ratio decreased (r=-.738, p

Background and Objectives:Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality in coronary angiography. Although the mechanism is unclear, N-acetylcysteine (NAC) is known to protect against CIN. Preliminary studies with NAC have found conflicting results for the prevention of CIN in patients undergoing coronary angiography. This study was designed to evaluate the efficacy and safety of NAC for the prevention of CIN in patients undergoing coronary angiography. Subjects and Methods:48 patients with chronic renal insufficiency (mean (±SD) serum creatinine concentration, 2.06±0.56 mg/dL), who were undergoing coronary angiography with a nonionic, low-osmolar contrast agent, were prospectively studied. Pa- tients were randomly assigned to receive either the antioxidant, NAC (600 mg orally twice daily), and 0.45% saline intravenously (n=25), before and after administration of contrast agents, or saline only (n=23). The renal function parameters were assessed 48 hour before and after radiocontrast media administration. Results:14 of the 48 patients (29%) showed an increase in the 0.5 mg/dL serum creatinine concentration after 48 hours of contrast media administration: 4 of the 25 patients in the NAC group (16%) and 10 of the 23 in the control group (43%; p=0.036; relative risk, 0.37; 95% confidence interval, 1.04 to 7.79). In the NAC group, the mean serum creatinine concentration insignificantly increased (p=0.54), from 2.2±0.8 to 2.3±0.9 mg/dL, after 48 hours of contrast media administration; whereas, in the control group, the mean serum creatinine concentration significantly increased (p=0.011), from 1.9±0.4 to 2.2±0.8 mg/dL. The absolute change in serum creatinine concentration was significantly greater in the control than the NAC group (p=0.044). Conclusion:Prophylac- tic oral administration of the antioxidant NAC, along with hydration, prevents the decrease in the renal func- tion induced by a nonionic, low-osmolality contrast agent in patients with chronic renal insufficiency. (Korean Circulation J 2005;35:696-701)

The present study was conducted to investigate the developmental competence of male and female somatic cell derived nuclear transfer (NT) porcine embryos and also the production and survival efficiency of cloned male and female piglets. Maturation of porcine COCs was accomplished by incubation in NCSU-23 medium supplemented with 0.6 mM cysteine, 10% porcine follicular fluid, 1 mM dibutyryl cyclic adenosine monophosphate, and 0.1 IU/mL human menopausal gonadotrophin for 20 h and then culture without dbcAMP and hMG for another 18 to 24 h. Fetal cells were isolated from a male fetus and two female fetuses, and cultured in ES-DMEM medium containing 10% FCS. Enucleated oocytes were fused with fetal fibroblasts (passage 4 to 15). Reconstructed embryos were cultured in NCSU-23 with 4 mg/mL BSA under mineral oil at 39°C in 5% CO2 in air for up to 6 days. NT eggs that had been activated with electric pulses and cultured for 1 or 2 days were transported to the experimental station in modified NCSU-23 with antibiotics. NT embryos were surgically transferred into the oviducts of recipients between Day 27 and Day 30; pregnancy was determined by ultrasound. The potential of NT embryos to develop into blastocysts was not different among donor cells of different origins. However, the mean cell number of in vivo female and male blastocysts (83.8 ± 46.2 to 99.2 ± 55.7) was higher than in in vitro culture of NT groups (31.4 ± 8.29 to 33.2 ± 10.15). A total of 11,535 NT embryos (1- to 8-cell stage) were surgically transferred into 66 surrogate gilts. Among fourteen pregnant gilts, four recipients aborted during the period of conception. Five pregnant gilts delivered fifteen female piglets, 1.28 ± 0.33 kg (0.48∼1.83 kg) in female piglets and 0.84±0.25 kg (0.45∼1.25 kg) in male piglets. Nine live cloned female (60.0%) and four male piglets (18.2%) were produced. According to these results, survival rates and birth weights of female cloned piglets were higher than those of cloned male piglets (P < 0.05). This study suggests that use of female, compared with male, fetal fibroblast cells as nuclear donors may increase cloning outcomes. This work was supported in part by a grant program from RDA(Biogreen21) and Cho-A, Republic of Korea.

The proper post-transcriptional modification of recombinant human erythropoietin (rhEPO) is critical to retain its biological functions, either in vivo or in vitro. The major glycosyltransferases for the determinant of glycosylation patterns of rhEPO are N-acetylglycosaminyltransferase (GnT) and α-1-3/4 fucosyltransferase (Fut). GnT-III expression (388 ± 19.09) in the mouse mammary gland has been shown to be dramatically different from that in CHO cells, although FuT-VIII expression in CHO cells (1970 ± 255.9) is comparable to mouse mammary gland (272 ± 14.8), suggesting that the mammary gland may proceed with the proper glycosylation of rhEPO as shown in CHO cells. To identify this hypothesis and establish the rhEPO bioreactor system for mass production of protein in transgenic animals, we have generated two transgenic mouse lines that express rhEPO in milk. Both lines of transgenic mouse express only rhEPO in the lactating mammary gland, and the protein yield of rhEPO in lactating milk is comparable to that in CHO cells. After determining the protein expression in lactating milk, using three different methods – enzymatic release of oligosaccharide analysis, two-dimensional electrophoresis, and 2-aminobenzamide-labeled analysis – we report that the rhEPO produced by the animal bioreactor system has the proper glycosylation patterns as shown in CHO cell-derived Epoietin α, and has more tetra-acidic oligosaccharide structures than Epoietin α, which is the widely used rhEPO for therapeutic purposes. The in vitro biological property of transgenic mouse milk-derived rhEPO has been tested by measuring luciferase activity in MCF-7 cells, indicating that rhEPO from mammary gland up-regulates the EPO-receptor-mediated STAT5 gene expression in a dose-dependent manner the same as Epoietin α does. In addition, in vivo biological activity demonstrated that direct injection of rhEPO into a mouse vein increases blood components such as RBC and HCT. In light of these findings, we suggest that high levels of tetra-acidic structures observed in transgenic mouse milk-derived rhEPO may be related to the high level of expression of glycosiltransferases (GnT-III and FuT-VIII) in mammary gland; thus the bioreactor system using the mammary gland of a transgenic animal could be a good candidate for production of rhEPO for pharmaceutical purposes. This work was supported in part by a grant program from RDA(Biogreen21) and Cho-A, Republic of Korea. D.N. Kwon is the recipient of a scholarship from the BK21 program, granted by the Ministry of Education, Korea.

Rationale Since nitrogen dioxide has been inconsistently associated with decrement of lung function, we examined the association between the changes of lung function in asthmatics and the concentration of nitrogen dioxide which was personally measured. Methods Peak expiratory flow rate and daily personal exposure to nitrogen dioxide were recorded on 13 patients with asthma (confirmed by methacholine provocation test) over 30 days. Multilevel modeling, measurement day as the first level and individual as the second level, was done to estimate the effect of daily average of nitrogen dioxide on the peak expiratory flow rate (MLwiN, v1.1). Results An increase of 10 ppb of nitrogen dioxide corresponded to 1.7(L/min) decrement of peak expiratory flow rate (95% CI, −4.2 ~ 0.8). Conclusions This finding gives weak support to the hypothesis that exposure to nitrogen dioxide decreases lung function in the asthma patients. Further studies with more subjects would be useful.

Background and Objectives:The optimal treatment for in-stent restenosis (ISR) is controversial, although intracoronary radiation therapy (ICRT) has provided the most consistent results to date. This study was designed to assess the early and late angiographic results, and to find independent predictors of recurrent restenosis, following cutting balloon angioplasty (CBA) for ISR. Subjects and Methods:Eighty patients (87 lesions) with first time ISR underwent CBA and systematic follow-up (FU) angiography. A conventional balloon was used before, or after, the CBA, if required. ICRT was used in 18 lesions (21%). A multivariate logistic regression analysis was performed. (Why?) Results:The ISR was focal (n=32, 37%), diffuse or proliferative (n=51, 58%) and occlusive (n=4, 5%). Procedural success was achieved in all 87 lesions (100%). No significant edge dissection occurred. The preand post-procedural diameter stenoses (DS) were 81.5±10.8% and 6.7±6.0%, respectively, and the preand post-procedural MLD (Define MLD?) 0.71±0.44 mm and 2.85±0.32 mm, respectively, with 2.14±0.44 mm of acute gain. A FU angiography was performed in 54 (78%) of the 69 lesions treated with CBA alone. The overall angiographic restenosis rate was 24% (13/54), with 9% (2/22) in the focal ISR and 34% (11/32) in the diffuse or occlusive ISR. The FU DS and MLD were 32.0±23.4% and 2.1±0.7 mm, respectively, with 0.79±0.69 mm of late loss. The length of a restenotic lesion (OR 12.2, 95% CI:1.3115.2, p=0.0286) was an independent predictor of recurrent restenosis. Conclusion:CBA is a simple and efficient first line treatment for ISR, with an acceptable restenosis rate, and the length of a restenotic lesion is an independent predictor of recurrent restenosis. In diffuse or occlusive ISR, more definite treatment modalities, such as ICRT combined with CBA or debulking techniques, might be required to reduce recurrent restenosis. (Korean Circulation J 2003;33 (3):196-204)

We report a case with an isolated single coronary artery originating from the ascending aorta, which to our knowledge has never been described before. A 51-year-old man presented for evaluation of atypical chest pain, suffering from a short resting chest pain for 3 days. However, serial electrocardiogram showed no change during chest pain. Cardiac enzymes such as CK-MB, Troponin-I, and myoglobin were within normal limit. Aortography and coronary angiography revealed a single coronary artery originating from the postero-lateral wall of the ascending aorta above the left coronary siuns. However, this anomaly was not of clinical significance based on the atypical nature of the chest pain, negative exercise echocardiography and an absence of obstruction of the coronary artery. (Korean Circulation J 2002;32(4):363-366)

Background and Objectives:Climacteric women often suffer from vasomotor symptoms. These symptoms are thought to be related to an imbalance of autonomic control of the cardiovascular system and are effectively controlled with hormonal replacement therapy. Heart rate variability (HRV reflects the autonomic integration of the cardiovascular system. In this study, we attempted to compare the HRV indices of postmenopausal wo- men before and after hormonal replacement therapy. Subjects and Methods:Eighteen patients with postme- nopausal syndrome (mean age:53±4 years received estrogen and/or progesterone replacement therapy. They underwent 24-hour ambulatory electrocardiographic monitoring at baseline and after the early period of therapy (mean:112±19 days and eleven patients underwent the examination after the later period of the- rapy (mean 213±23 days. HRV was analyzed over a full 24-hour period, using time and frequency domain para-meters. Results:No statistically significant HRV change was observed during the early period of ther- apy. However, during the later therpy period , HRV indices such as rMSSD(from 27.6 to 31.3 (msec) , HF(from 4.8 to 5.05 ln (ms 2 ) , LF/HF ratio (from 1.17 to 1.12 were significantly changed (p value

Background and Objectives:Head-up tilt test is increasingly being used to diagnose neurocardiogenic syncope. But the protocol of head-up tilt test has not been settled. The purpose of this study was to evaluate the effect of isoproterenol provocation during head-up tilt test in normal volunteers with no prior history of syncope or presyncope. Method:Head-up tilt test was performed with 53 volunteers (mean age 30±9 years, male 27, female 26) in the fasting state. After supine heart rate and blood pressure were obtained, each volunteer was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol infusion was started at 1 μ g/min and then increased by 1 μg/min every three minutes to a maximum of 5 μg/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance to isoproterenol, heart rate >150 beat/min, and completion of the protocol. When an end point was reached, the volunteer was rapidly returned to the supine position. Results:Positive response to head-up tilt test was noted in 14 cases (26%). The pattern of positive response was vasodepressive in all cases. There was no significant side effect of isoproterenol. There was no significant difference between positive and negative response group in terms of age, sex, peak infusion rate of isoproterenol and hemodynamic response. The positive response rate at 2 μ g/min , 3 μg/min, 4 μg/min, and 5 μg/min of isoproterenol infusion was 1.9%, 9.7%, 23.7% and 32.5%, respectively. Conclusion:Head-up tilt test at 70 degree angle with isoproterenol infusion provided an adequate specificity. (Korean Circulation J 2000;30(7):841-846)

Background and Objectives:This study was designed to evaluate the appropriate dose and dose-dependent effect of benidipine hydrochloride, a Ca-channel blocker, in patients with mild–moderate essential hypertension. Material and Methods:Benidipine was administered in 2 mg, 4 mg and 8 mg once daily with 1 month interval in 41 hypertensive patients with diastolic blood pressure over 90 mmHg and systolic blood pressure from 140 to 210 mmHg. Blood pressure, heart rate, subjective symptoms and adverse effects were checked every 4 weeks after benidipine administration. Laboratory examinations were performed before and after benidipine administration. Results:The dose-dependent, antihypertensive effect of benidipine was evaluated in 41 patients. The blood pressure significantly reduced from 166±15 mmHg/103±7 mmHg to 13815 mmHg/88±11 mmHg at 12 weeks administration of benidipine and overall effective rate was 95%. The systolic and diastolic blood pressure was reduced significantly in proportion to dose of benidipine (p

Background and Objectives:Previous studies have shown a high restenosis rate after balloon angioplasty for diffuse in-stent restenosis. Debulking strategy has been expected to be helpful to reduce the restenosis rate. This study evaluated the safety and long-term clinical event rate after excimer laser coronary angioplasty (ELCA) and adjunctive balloon angioplasty for in-stent restenosis. Materials and Method:We included 29 in-stent restenotic lesions treated in 28 patients (18 men, 10 women, mean age 60±2 years) admitted to Samsung Medical Center between June 1997 and August 1998. Quantitative coronary angiography was performed and clinical characteristics, acute complications, 30-day and 8-month major cardiac adverse event rate was analyzed. Results: Initial success rate was 97%. We stopped the ELCA procedure in one lesion located in the proximal left anterior descending artery due to bradycardia and hypotension. In the 28 lesions successfully treated with ELCA and adjunctive balloon angioplasty, the minimal luminal diameter increased from 0.7±0.1 mm before ELCA to 1.9± 0.1 mm after ELCA and to 2.7±0.1 mm after adjunctive balloon angioplasty (p

Background:The prophylactic use of temporary pacemaker during coronary intervention has been markedly decreased since 1980’s. There is, however, few systematic report focusing on right coronary intervention in which temporary pacemaker would be most beneficial. Moreover, there has been marked development in coronary intervention recent years that risk and benefit of prophylactic pacemaker should be reconsidered. Method:We performed right coronary artery intervention without prophylactic use of temporary pacemaker in 100 successive patients in Samsung Medical Center. Patients with previous AV block and rotational atherectomy cases were excluded. The incidence of all complications and changes of blood pressure as well as heart rate during coronary intervention were examined prospectively. Results:The lesion type was B2 or C in 52% and intracoronary thrombus was found in 18% of patients. Nevertheless, there was neither life threatening bradycardia nor new onset arrhythmia in any patient during right coronary intervention. Conclusion:These data suggest that omission of prophylactic use of temporary pacemaker may be safe in right coronary intervention only if excluding previous patients with high degree atrioventricular block and rotational atherectomy cases. This approach may reduce procedure time and cost as well as pacemaker-associated complications. (Korean Circulation J 1999;29(11): 1182-1187)

Antiplatelet treatment is an important component in optimizing the clinical outcomes after percutaneous coronary intervention (PCI) especially in patients with acute coronary syndrome (ACS). Prasugrel, which is a new P2Y12 inhibitor, has been confirmed as efficacious in a large trial in Western countries, and a similar trial is also to be launched in Asian countries. Although a 60-mg loading dose of prasugrel followed by 10 mg per day should be acceptable, there have been no data regarding the optimal dose in Asian patients. Furthermore, serum levels of prasugrel and the rates of platelet inhibition are known to be higher in Asians than Caucasians with the same dose of the drug. Polymer, a key component of drug-eluting stents (DES), has been suggested as the cause of inflammation leading to late complications, and has driven many companies to develop biodegradable-polymer DES. Currently, there are limited data regarding the head-to-head comparison between BP-BES and the biostable polymer CoCr-EES or the newest platinum-chromium everolimus-eluting stent (PtCr-EES). Furthermore, the polymer issue may be more important in ACS where there is ruptured thrombotic plaque where polymer-induced inflammation may affect the local milieu of the stented artery. Therefore, the present study dedicated only to ACS patients, will offer important information on the optimal prasugrel dose in the Asian population by comparing a 10-mg versus a 5-mg maintenance dose beyond 1 month after PCI, as well as giving important insight into the polymer issue by comparing BP-BES versus biostable-polymer PtCr-EES. Harmonizing Optimal Strategy for Treatment of coronary artery diseases – comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS) trial is a multicenter, randomized and open-label clinical study with a 2 × 2 factorial design, according to the type of stent (PtCr-EES versus BP-BES) and prasugrel maintenance dose (5 mg versus 10 mg), to demonstrate non-inferiority of PtCr-EES relative to BP-BES or the reduced prasugrel dose relative to conventional dose in an Asian all-comers PCI population presenting with ACS. Approximately 3400 patients will undergo prospective, random assignment separately to either stent or prasugrel arm (1:1 ratio, respectively). When the patients have contraindications to prasugrel, they are categorized into an antiplatelet observation group after stent-randomization. The primary endpoint is the patient-oriented composite outcome, which is a composite of all-cause mortality, any myocardial infarction (MI), any repeat revascularization in the stent arm at 12 months after index PCI. In the prasugrel arm, primary endpoint is any major adverse cardiovascular event, which is a composite of all-cause mortality, any MI, any stent thrombosis (Academic Research Consortium (ARC)-defined), any repeat revascularization, stroke, or bleeding (BARC class ≥ 2). The HOST-REDUCE-POLYTECH-ACS RCT is the first study exploring the optimal maintenance dose of prasugrel beyond 1 month after PCI for ACS in Asian all-comers. In addition, this is the largest study dedicated only to ACS patients to evaluate the polymer issue in the situation of ACS by directly comparing biostable-polymer PtCr-EES versus BP-BES. ClinicalTrials.gov (ID: NCT02193971 , 13 July 2014).

We used optical coherent tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS) to assess culprit lesions in 133 patients with acute coronary syndrome (ACS). Culprit lesion plaque rupture (PR, n=90) or plaque erosion (PE, n=43) was diagnosed with OCT; and IVUS was used to

Paclitaxel eluting balloon (PEB) angioplasty has been shown to superior to plain old balloon angioplasty (POBA) for treatment of in–stent restenosis (ISR), but 10% of target lesion revascularization rate at 12 or 24 months. There is no report which IVUS characteristics are associated with PEB

Recent randomized trials showed that FFR-guided revascularization is safe and effective. However, long-term clinical outcomes of real world use of FFR, including the decisions against FFR, have not been fully evaluated. 1294 patients who underwent FFR measurement for de novo coronary lesions were