Hyung-Gon Je

Meta-Analysis of Cytochrome P450 2C19 Polymorphism and Risk of Adverse Clinical Outcomes Among Coronary Artery Disease Patients of Different Ethnic Groups Treated With Clopidogrel

Loss-of-function (LOF) variants of cytochrome P450 2C19 (CYP2C19) have been hypothesized to be associated with lesser degrees of platelet inhibition and increased risk for recurrent ischemic events in patients with coronary artery disease on clopidogrel therapy; however, studies from Western countries have yielded mixed results. We aimed to assess the impact of CYP2C19 LOF variants on clinical outcomes from different ethnic groups. Sixteen prospective cohort studies including 7,035 patients carrying ≥ 1 CYP2C19 LOF allele and 13,750 patients with the wild-type genotype were included in this meta-analysis. Carriers of ≥ 1 CYP2C19 LOF allele were at significantly higher risk for adverse clinical events compared to noncarriers during clopidogrel therapy (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.13 to 1.78). The summary OR showed a significant association between CYP2C19 LOF variants and an increased risk of cardiac death (OR 2.18, 95% CI 1.37 to 3.47), myocardial infarction (OR 1.42, 95% CI 1.12 to 1.81), and stent thrombosis (OR 2.41, 95% CI 1.76 to 3.30). Stratified analysis by ethnicity of study population suggested higher odds of adverse clinical events in the Asian population with LOF variants of CYP2C19 (OR 1.89, 95% CI 1.32 to 2.72) compared to Western populations (OR 1.28, 95% CI 1.00 to 1.64). In conclusion, carrier status for LOF CYP2C19 is associated with an increased risk of adverse clinical events in patients with coronary artery disease on clopidogrel therapy despite differences in clinical significance according to ethnicity.

Prognostic value of creatine kinase-myocardial band isoenzyme elevation following percutaneous coronary intervention: A meta-analysis

To assess whether different degrees of creatine kinase‐myocardial band isoenzyme (CK‐MB) elevation after percutaneous coronary intervention (PCI) affect the subsequent risk of death.

Mitral loop cerclage as a variant form of mitral cerclage annuloplasty that adds a device (CSTV) for preventing potential complications: a preclinical proof of concept and feasibility study.

AIMS Although mitral cerclage annuloplasty can reduce mitral regurgitation, the potential risks for erosion of the surrounding tissue or conduction blockage are barriers to human translation. This preclinical study aimed to provide a proof of concept for a novel approach, mitral loop cerclage (MLC), designed to address these shortcomings. METHODS AND RESULTS MLC consists of: (1) a novel appliance termed a coronary sinus and tricuspid valve protective device (CSTV) that includes a tension locker, and (2) a nylon-coated, braided stainless steel rope (0.6 mm thick) with a coronary artery protective device in a single unit (cerclage rope). Nine healthy farm swine underwent MLC in short-term (two weeks, n=4) and midterm (six weeks, n=5) survival experiments under X-ray fluoroscopic guidance imaging. The procedural success rate was 100%. MLC resulted in a significant reduction of the septal lateral dimension of the mitral annulus (24.58±2.16 vs. 21.26±1.43 mm, p=0.04) and left ventricular (LV) volume in diastole (75.9±3.9 vs. 70.6±5.0 ml, p=0.04) in the midterm group. No conduction abnormalities or serious complications were noted beyond trivial tricuspid regurgitation in all cases (n=9). Necropsy showed no evidence of tissue erosion and an excellent biocompatibility of the implanted devices. CONCLUSIONS MLC, as a novel approach for catheter-based mitral valve repair, appeared feasible in this short-term preclinical model. Further studies with longer follow-up in a cardiomyopathic animal model are needed to verify the clinical feasibility and safety of MLC.

Primary right atrial angiosarcoma misdiagnosed as aortic intramural hematoma.

The overall incidence of cardiac tumor is very low, and malignant cardiac tumors account for only 25% of all cardiac tumors. Angiosarcomas are the most common type of malignant cardiac tumors, characterized by rapidly proliferating, extensively infiltrating anaplastic cells derived from blood vessels and lining irregular blood-filled spaces. We present a 26-year-old man with angiosarcoma involving the right atrium, which was misdiagnosed as aortic intramural hematoma by computed tomography, finally confirmed by transesophageal echocardiography during the operation.

Peripheral artery questionnaire improves ankle brachial index screening in symptomatic patients with peripheral artery disease

The peripheral artery questionnaire (PAQ) is a disease‐specific health status measure of patients with peripheral artery disease (PAD). Whether the PAQ scores are associated with a PAD diagnosis among patients with symptoms suspicious for PAD is unknown and could help increase the pretest probability of ankle brachial index (ABI) screening among patients with suspicious symptoms.