Chong-Yun Rhim

Left atrial dyssynchrony assessed by strain imaging in predicting future development of atrial fibrillation in patients with heart failure

BACKGROUND The clinical and echocardiographic parameters associated with the risk of developing new onset atrial fibrillation (AF) in congestive heart failure (CHF) have not been studied comprehensively. We determined if dyssynchronous left atrial (LA) lengthening and contraction predicted future development of new onset AF in patients with CHF. METHODS One hundred fifty-eight patients who were admitted for CHF without past or current AF were evaluated. We measured the time to peak velocity and time to peak strain with reference to the QRS complex during ventricular systole (reservoir) and late diastole (atrial contraction) in mid-portion of 4 LA walls. Dyssynchronous atrial lengthening and contraction (atrial dyssynchrony) was defined as the standard deviation of each parameter. RESULTS New onset AF developed in 21 patients (13.3%) after a mean follow-up of 43+/-15 months. Based on univariate Cox analysis, older age, larger LA dimension and volume index, lower LA fractional shortening, and the presence of atrial dyssynchrony were associated with new onset AF. In multivariate Cox analysis, atrial dyssynchrony based on strain (>39 ms, HR 10.0, p=0.003) and LA size (> or =45 mm, HR 4.3, p=0.016) were independent predictors of new onset AF in CHF. CONCLUSIONS We demonstrated that atrial dyssynchrony based on strain is the strongest univariate and multivariate predictor for new onset AF in hospitalized patients with CHF.

Left transradial coronary angiography in a patient with dextrocardia.

Although dextrocardia occurs rarely, the incidence of coronary artery disease is similar to the general population. Because of unfamiliarity with performing catheterization, transradial coronary angiography has seldom been performed in a patient with dextrocardia. We successfully performed left transradial coronary angiography in a patient with a right side heart using counter-directional torquing of the catheters and mirror-image angiographic angles.

Prognostic factors in patients with minor troponin-I elevation but without acute myocardial infarction

Objectives Although cardiac troponin I is widely used as a marker for myocardial infarction, its minor elevations are also observed in other clinical situations, and the prognostic factors in such clinical settings have not been well established. The aim of this study was to identify predictors of mortality in patients with minor troponin elevations without an acute myocardial infarction. Methods We consecutively enrolled 134 patients from the emergency department with a peak troponin I level greater than the lower limit of detectability (0.04 ng/ml) but less than the 10% coefficient of variation cutoff value for diagnosis of myocardial infarction (0.26 ng/ml). These patients had chest pain or nonspecific symptoms of a circulatory abnormality but lacked the traditional features of an acute myocardial infarction. End point was defined as death from all causes. Cox regression analysis was used to test relations between clinical and biochemical variables and the outcome. Results During the follow-up of 7.6±7.4 months, 12 patients died. Age, log creatine kinase myocardial isoform, and log C-reactive protein were found to be significantly correlated with death. After adjusting for possible confounders in the multivariate model, age (hazard ratio 1.09, confidence interval 1.02–1.16, P=0.012), log creatine kinase myocardial isoform (hazard ratio 13.11, confidence interval 2.01–85.52, P=0.007), and log C-reactive protein (hazard ratio 1.64, confidence interval 1.02–2.56, P=0.041) were identified as independent predictors of mortality. Conclusions Creatine kinase myocardial isoform and C-reactive protein levels and age can be integrated to risk-stratify patients with minor troponin I elevation for reasons other than acute myocardial infarction.

Coronary Artery Fistula With a Huge Aneurysm Treated by Transcatheter Coil Embolization

A 75-year-old man presented with chest pain that suggested angina. His only risk factor for coronary artery disease was smoking. He had not experienced chest trauma or thoracic surgery. Cardiac echocardiography revealed severe hypokinesia at the myocardial territory of left anterior descending coronary artery (LAD), and myocardial perfusion scan showed reversible ischemia at the same region. Coronary angiography revealed a fistula at the LAD and a huge aneurysm connected to …

Rationale and design of STOP DVT study: Rosuvastatin for the prevention of deep vein thrombosis in patients undergoing total knee replacement arthroplasty — A prospective randomized open-label controlled trial☆ , ☆☆ ,★

BACKGROUND Deep vein thrombosis (DVT) frequently occurs in high-risk cardiovascular patients receiving orthopedic surgery, despite prophylactic measures for its prevention. Statins, a class of drugs used to lower cholesterol levels, have been reported to help prevent the development of DVT. METHODS We will conduct a prospective randomized clinical trial to compare the effects of high-dose rosuvastatin plus a low-molecular-weight heparin (LMWH), enoxaparin, with conventional LMWH therapy in the prevention of DVT. Patients will be naive to both statins and anti-coagulants and then underwent total knee replacement arthroplasty (TKRA). In total, 180 patients will be randomized into two groups of 90, consisting of a LMWH group (40 mg enoxaparin subcutaneously beginning at 12h prior to surgery and continuing for 7 days every 24h after surgery) and a statin plus LMWH group (20mg rosuvastatin orally for 14 days, 7 days before and after surgery in combination with LMWH). All patients will undergo computed tomography angiography of both extremities 7 days after index surgery to assess the development of DVT. DISCUSSION DVT remains prevalent despite the use of conventional prophylactic measures, in part because certain patients (particularly the elderly) are unable to receive preventive treatment because of a high risk of bleeding complications and co-morbidity. Statins have been shown to have beneficial effects in arterial atherothrombosis and are frequently administered to elderly patients to treat coronary artery. We hypothesize that peri-operative statin treatment may be beneficial in those patients restricted from the conventional prophylaxis for DVT.

SIROLIMUS ELUTING- VS. PACLITAXEL ELUTING STENT IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND RENAL INSUFFICIENCY UNDERGOING PRIMARY ANGIOPLASTY

Methods: A total of 4770 patients with STEMI were registered in nationwide acute myocardial infarction registry conducted at 50 hospitals in Korea from October 2005 to June 2007. Among them, 796 with baseline creatinine clearance (CrCl) ≤ 60mL/min were enrolled who received either SES or PES stent and were followed up at 6and 12-month. The primary endpoint was the composite of major adverse cardiovascular events (MACE), defined as death, myocardial infarction, and any repeated revascularization.

844-1 Doppler tissue imaging assessment of dyssynchronicity is a powerful predictor of mortality in severe congestive heart failure with normal QRS duration

Novasive Im aing to peak double product (heart rate peak x systolic blood pressure), maximal dobutamine infusion rate, and atropine administration. The difference between peak and rest wall motion score index (∆ WMSI) was –0.05± 0.13 versus 0.20± 0.23 (p<0.001) in patients with and without ischemia respectively. A correlation was found between the extent of stress induced ischemia and the reduction of ejection fraction during recovery (Y= -3.9 + 0.8 x number of ischemic segments (p=0.003). Conclusion: The transient reduction of ejection fraction during recovery correlates with the presence and extent of stress induced ischemia during DSE. Thus this objective parameter may provide additional informations combined with wall motion analysis in the assessment of myocardial ischemia during DSE.