Goo-Young Cho

Effects of the novel angiotensin II receptor type I antagonist, fimasartan on myocardial ischemia/reperfusion injury.

BACKGROUND The aim of this study was to investigate the cardioprotective effect of fimasartan, a newly developed angiotensin II receptor type I blocker (ARB), against myocardial ischemia/reperfusion (I/R) injury and to identify the mechanism by which it reduces mitochondrial damage. METHODS Fimasartan was administered intravenously to Sprague-Dawley rats (3mg/kg), cardiomyocytes (50 μM), and H9c2 cells (50 μM) before ischemia or hypoxia. Myocardial infarction (MI), echocardiograms, DNA fragmentation, terminal deoxynucleotidyl transferase-mediated dUTP in situ nick-end labeling, immunoblotting, oxygen consumption, confocal microscopic appearance, and L-type Ca(2+) current (ICa,L) were then assessed. RESULTS Fimasartan pretreatment remarkably reduced the rate of MI and improved cardiac performance well after I/R (n = 9/group). Fimasartan also reduced apoptotic cell death both in vivo and in hypoxia/reoxygenation (H/R)-treated H9c2 cells (n = 5~8/group). H/R-induced mitochondrial O2(-) production and collapse of membrane potential were markedly attenuated in fimasartan-treated cardiomyocytes (n = 4 ~ 6/group). Additionally, mitochondrial Ca(2+) overload during reoxygenation was suppressed by fimasartan (n = 4~6/group), and this was found to be possibly related to the inhibition of ICa,L and mitochondrial Ca(2+) uniporter. Furthermore, fimasartan pretreatment increased phosphorylations of Akt and glycogen synthase kinase-3β (n = 5 ~ 7/group), decreased pro-apoptotic p53 levels, and increased anti-apoptotic Bcl-2 levels (n = 4) during reperfusion. CONCLUSIONS Fimasartan preconditioning has the potential to modulate Bcl-2 and suppress I/R-induced Ca(2+) overload by inhibiting ICa,L and MCU. These beneficial effects could prevent the mitochondrial dysfunction and apoptosis accompanied by I/R.

Low Serum Total Cholesterol Level is a Surrogate Marker, But Not a Risk Factor, for Poor Outcome in Patients Hospitalized With Acute Heart Failure: A Report From the Korean Heart Failure Registry

BACKGROUND Hypercholesterolemia is a major risk factor for incident coronary artery disease and the prevalence of heart failure (HF). The causal relationship between low total cholesterol (TC) levels and poor clinical outcome in patients with acute HF has not been investigated. This study evaluated the effect of cholesterol levels on the long-term outcome in patients hospitalized due to acute HF. METHODS AND RESULTS We analyzed a cohort of 2,797 HF patients who were eligible for analysis in 3,200 patients of the Korean Heart Failure Registry. Patients were stratified into quartiles of TC (Q1 <133, Q2 133-158, Q3 159-190, and Q4 >190 mg/dL). Propensity score matching was performed with the patients in Q1 and Q4. Patients with lower serum TC had lower blood pressure, lower hemoglobin, lower serum sodium, and higher natriuretic peptide levels than patients with higher TC levels. Low TC was associated with increased risks for death and readmission due to HF; the adjusted hazard ratio (HR) of Q1 compared with Q4 was 1.57 (95% confidence interval [CI] 1.30-1.90). However, propensity score matching analysis revealed that low cholesterol itself did not affect outcome (HR 1.12, 95% CI 0.85-1.48). CONCLUSIONS Low TC is strongly associated with mortality and morbidity in patients with HF. However, low TC seemed to be a secondary result of the patients state rather than an independent risk factor for poor outcome.

Different pattern of carotid and myocardial changes according to left ventricular geometry in hypertensive patients.

The relation between left ventricular (LV) hypertrophy and LV function is well known. However, less is known about the vascular changes influenced by LV geometry. We sought to investigate the relationship of LV geometry to carotid arterial and LV function. A total of 476 hypertensive patients were prospectively recruited. All subjects underwent echocardiography and carotid ultrasound. LV geometry is categorized into four groups according to relative wall thickness (RWT) and LV mass index (LVMI). Concentric LV geometry was associated with increased carotid intima-media thickness (IMT), β-stiffness, and lower strain. All of the carotid parameters showed a stepwise change according to RWT of LV, whereas LV function was worse in hypertrophic geometry, as reflected by significantly lower systolic mitral annular velocity, higher left atrial volume index and E/E′ ratio (P<0.001). By multivariate analysis after adjustment for clinical and laboratory parameters, IMT was independently associated with RWT, whereas myocardial function was independently associated with LVMI. Carotid arterial function and IMT showed worse values in concentric geometry, whereas LV systolic and diastolic function were worse in hypertrophic geometry, suggesting a discrepancy between carotid arterial and LV function in hypertensive patients.

PREVALENCE, AWARENESS, TREATMENT, AND CONTROL OF HYPERTENSION IN KOREA; KOREAN NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY 2007: PP.28.103

Objective: We analyzed the Korean National Health and Nutrition Examination Survey (KNHNES) database to determine the prevalence, awareness, treatment, and control of hypertension in a Korean population. Design and Methods: The KNHNES, which was conducted by the Korean Ministry of Health and Welfare, was a cross-sectional, nationally representative survey in which a stratified multistage sampling design was used. The most recent KNHANES survey, conducted in 2007, was analyzed. Hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, or current treatment with antihypertensive drugs. Results: A total of 2,888 adults (≥20 years) were included in the analysis. Mean age was 49.9±16.3 years and male subjects were 41.8%. The prevalence of hypertension increased with aging (5.1%, 15.0%, 31.9%, 44.0% and 55.0% in the < 40, 40–49, 50–59, 60–69 and ≥70 age groups, respectively) and overall prevalence was 25.3%. However, the prevalence of prehypertension was not different according to the age group (overall prevalence was 26.4%). Overall, 67.2% of those with hypertension were aware of their diagnosis, 59.5% were receiving pharmacologic treatment and only 42.3% had their blood pressure under control. The awareness, treatment, and control rate of hypertension were significantly lower in the younger age group and male subjects. (Fig 1) However, no significant difference in the control rate of hypertension among the treated subjects was identified according to the age and gender. Conclusions: For the improvement of blood pressure control in Korea, we should enhance the awareness and treatment of hypertension in the younger age group and male subject through education and target screening. Figure 1. No caption available.

Additive Role of Coronary Magnetic Resonance Angiography for the Evaluation of Coronary Artery Disease

Coronary magnetic resonance angiography (CMRA) allows a noninvasive assessment of the coronary anatomy without exposing the patients to radiation. It is also superior to coronary computed tomography angiography (CCTA) for the evaluation of luminal narrowing in heavily calcified coronary segments. We report a case with triple-vessel disease, but it could not be accurately assessed by CCTA because of calcification and lack of a significant perfusion defect or myocardial scarring on cardiac magnetic resonance imaging (MRI). However, whole-heart CMRA performed as part of the cardiac MRI protocol demonstrated significant triple-vessel disease with left main involvement, confirmed by subsequent invasive angiography with a fractional flow reserve measurement.

PS 15-13 THE EFFECT OF SECONDHAND SMOKE EXPOSURE (SHSE) AS A CARDIOVASCULAR RISK FACTOR

Objective: Secondhand smoke exposure (SHSE) in non-smokers has been associated with premature cardiovascular mortality and ischemic heart disease.We conducted a cross-sectional population-based study evaluating the effects of SHSE measured by subjective and objective methods on cardiovascular risk such as blood pressure and lipid profiles. Design and Method: We extracted 7,376 never smokers with available urine cotinine levels from the Korea National Health and Nutrition Examination Survey 2008–2011. SHSE was defined using self-report with structure questionnaires and objectively using urine cotinine levels. Main outcomes included systolic and diastolic blood pressure, and serum lipid profiles. Results: Mean age of the study population was 45.4 years, and 22.2% were male. Self-reported SHSE had no significant association with study outcomes except diastolic blood pressure and serum triglyceride levels, which had marginally positive relationships (p = 0.078 and 0.070, respectively). Unadjusted models found no significant relationship of urine cotinine levels and any study outcomes. Triglyceride was inversely associated with urine cotinine after multivariable adjustment (p = 0.015), while there were no significant relationships for other outcomes. Conclusions: In this cross-sectional study, we found no significant increase in blood pressure or deterioration in serum lipid levels attributable to SHSE. Objective measurements using urine cotinine levels did not augment the relationship. These study findings suggest cardiovascular effects of SHSE take a long time period and may not be apparent in the short term.

Left atrial remodeling and mechanical dysfunction in hypertrophic cardiomyopathy

Background Patients with hypertrophic cardiomyopathy (HCM) and LA enlargement have more serious cardiovascular events. This study sought to determine the contribution of left atrial (LA) remodeling and mechanical function to hypertrophic cardiomyopathy (HCM) by comparing HCM patients to ageand gender-matched control subjects and young healthy control subjects, and also to assess whether LA remodeling and mechanical function including global strain are related to the characteristics of HCM. Methods A total of 79 patients with HCM who underwent both 2Dspeckle tracking echocardiography and cardiac MRI were included (54 ± 12 years; 60 men) and compared to 79 ageand gender-matched control subjects and 20 young healthy control subjects. LA diameter and volume, expansion index for reservoir function, active emptying fraction for pump function, global longitudinal LA strain were measured. The type of HCM, the presence and extent of late gadolinium enhancement (LGE) in left ventricular

Prognostic value of late gadolinium enhanced MRI in patients underwent coronary artery bypass graft surgery; long term follow up data

Background It has not been well evaluated whether late gadolinium enhanced (LGE)-MRI can provide prognostic information in patients who underwent coronary artery bypass graft (CABG) surgery, especially in patients with preserved left ventricular ejection fraction (LVEF). Further, long-term follow-up data after MRI and CABG surgery are not available. The purpose of this study was to evaluate the impact of myocardial viability assessment by LGE-MRI on prognosis in patients who underwent CABG surgery.