Jae-Kyun Kim

Fatal Subacute Stent Thrombosis Induced by Guidewire Fracture with Retained Filaments in the Coronary Artery

During percutaneous coronary intervention, guidewire fractures are very exceptionally encountered in medical practice, but can cause fatal complications such as intracoronary thrombus formation, embolization and perforation. Removal of the remnant segments of guidewire is important for the prognosis. There are several methods being recommended for the treatment of fractured guidewire remnants. However, the best treatment of remnant guidewire filament is still unclear. Herein, we present a case where we did not completely remove remnant guidewire filaments that caused fatal coronary thrombosis.

Low Pressure Pulmonary Artery Aneurysm with Atrial Septal Defect

Pulmonary artery (PA) aneurysm is a rare finding in the thoracic cavity, accompanied by pulmonary hypertension. Clinical presentation of PA aneurysms is usually asymptomatic. The guideline for PA aneurysm treatment is unclear. We report an unusual case of low pressure PA aneurysm associated with atrial septal defect in a 69-year-old man.

Multiple Papillary Fibroelastomas and Thrombus in the Left Heart

Cardiac papillary fibroelastomas (CPF) are benign cardiac tumors and usually discovered incidentally during echocardiography. This report describes the case of a 68-year-old man, referred to cardiology for multiple masses of the left ventricle and left atrium. The transthoracic echocardiography revealed multiple oscillating masses in the left ventricle and aortic valve, non-mobile mass in the left atrium with severe mitral stenosis and moderate aortic regurgitation. The patient underwent surgical resection of the masses with valve replacements. Histopathologic examination confirmed the diagnosis of CPF in the left ventricle and aortic valve, thrombus in the left atrium.

Multiple feeding vessels from left circumflex artery and right coronary artery to myxoma in left atrium.

A 62-year-old woman with six months history of dizziness was admitted to our hospital. A large mass in the left atrium was detected by transthoracic echocardiography. Coronary angiography showed two feeding arteries from the right coronary artery and left circumflex artery to the left atrium. Chest computed tomography, coronary computed tomographic angiography and contrast echocardiography were performed. Those showed multiple intratumoral neovascularities from surface of the mass. After those examinations, the mass was completely resected. Histopathologic examination confirmed the diagnosis of cardiac myxoma. There was no abnormal remnant mass, based on a follow-up transthoracic echocardiography.

A Case of Chronic Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of incomplete resolution of large pulmonary embolism (PE).Transthoracic echocardiography (TTE) and chest computed tomography (CT) are useful for the diagnosis and follow-up of CTEPH. We report a case of 40-year-old male who wasadmitted with gradually aggravated dyspnea in recent 2 years and had history of acute PE 10 years ago, was detected CTEPH by TTE and confirmed with chest CT.

TCT-714 A Meta-Analysis of Randomized Controlled Trials Appraising The Efficacy and Safety of New Oral Antithrombotics in Patients with Acute Coronary Syndrome

Recently introduced oral antithrombotics, including apixaban, rivaroxaban, and vorapaxar, has been developed as alternative to conventional antiplatelet regimen for patients with acute coronary syndrome (ACS). We searched MEDLINE, EMBASE, and Cochrane databases for randomized controlled trials (

610 RELATIONS OF LEFT VENTRICULAR HYPERTROPHY AND BLOOD PRESSURE IN PATIENTS WITHOUT CORONARY ARTERY DISEASE

Background: Left ventricular hypertrophy (LVH) is caused by a chronically increased cardiac workload, most commonly from hypertension. Coronary artery disease may play a role in the pathogenesis of LVH. However, the relationship between LVH and blood pressure (BP) in patients without coronary artery disease is not clear. Method: We evaluated 248 consecutive patents(118 men and 130 women) with ejection fraction higher than 50%, who underwent coronary angiography. We divided the patients into 2 groups according to LVH. Coronary artery disease defined as a least one vessel with coronary artery stenosis >50%. LVH defined left ventricular mass index (LVMI) > 116 g/m2 in men, > 104 g/m2 in women. LVMI was measured with echocardiography. The brachial BP was measured with a mercury sphygmomanometer. The central BP parameters were measured with a SphygmoCor®device. Results: The baseline characteristics were similar between two groups. There were significantly increased peripheral systolic BP (125±22 vs. 120±15 mmHg, p=0.02), central systolic BP (118±21 vs. 113±14 mmHg, p=0.01) and central pulse pressure (40±15 vs. 36±7mmHg, p=0.018) in LVH patients (Table). The central and brachial systolic pressure were positively correlated with LVMI. (r=0.135, p=0.023, r=0.149, p=0.027). Conclusions: Systolic blood pressure and pulse pressure may be important factors for LVH. Moreover, LVMI may be related to systolic blood pressure than diastolic or pulse pressure. Table. No title available.

611 RELATIONS OF LEFT VENTRICULAR HYPERTROPHY AND IMPAIRED HEART RATE RECOVERY AFTER TREADMILL TEST

Background: Heart rate recovery (HRR) after exercise is known as a predictor of cardiac death in patients with heart disease. The mechanism is not fully understood, although a parasympathetic mechanism has been reported. An attenuated HRR may be considered to be due to sympathetic activation. Sympathetic activation has been suggested to contribute to left ventricular hypertrophy (LVH). This study aimed at assessing relation with between LVH and impaired HRR. Methods: 693 consecutive patients without a history of heart failure or valvular disease were enrolled. The patients were undergoing symptom-limited exercise testing, echocardiography. Abnormal HRR was defined as the difference in heat rate between peak exercise and 1, 2 minutes later (1 minute: a value < 18 beats/min, 2 minutes: a value < 42 beats/min were considered abnormal). LVH defined left ventricular mass index (LVMI) values of >104 g/m2 in women and >116 g/m2 in men. Results: Abnormal HRR at 2 minutes were more common in the LVH group as compared to the non-LVH group (47.8% versus 25.6%, p=0.001). However, there were no differences between the groups in the percentage of patients with abnormal HRR at 1 minute (10.1% versus 8.2 %, p=0.54). LVMI was significantly correlated with HRR at 1 minute (r = - 0.116, P = .0002), HRR at 2 minutes (r = - 0.156, P<.0001), but with a weak association. Conclusion: Abnormal HRR at 2 minutes was associated with the presence of LVH. LVMI might be related to the impaired HRR after exercise test.

612 RELATIONSHIP BETWEEN ARTERIAL STIFFNESS AND HEART RATE RECOVERY

Background: Arterial stiffness and heart rate recovery (HRR) following exercise testing have emerged as factors holding significant prognostic value. The relationship between arterial stiffness and HRR has, however, not been investigated. Methods: HRR was measured at 1- minute time points after treadmill testing in 538 patients being evaluated for chest pain. Arterial stiffness, wave reflections and central blood pressure were quantified noninvasively using applanation tonometry of the radial artery with a validated transfer function to generate the corresponding ascending aortic pressure wave form. Results: Pearson correlation analysis revealed a significant correlation between augmentation Index and HRR. Multiple linear regression analysis showed the age, heart rate, augmentation index were positive predictors of HRR (r= 0.23 r2= 0.052, p<0.024). Conclusions: This cross-sectional study indicate that HRR is significantly correlated with aortic stiffness. Further studies are now required to identified the mechanism underling this newly described association.