Jong-Ho Nam

Hemorheologic Alterations in Patients with Type 2 Diabetes Mellitus Presented with an Acute Myocardial Infarction

Background Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. Methods A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n=77) and control group (AMI−, n=118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. Results The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI−, P<0.001) but the level of CSS was higher (316.13±108.20 mPa in AMI+ and 286.80±85.34 mPa in AMI−, P=0.040) in the AMI+. The CSS was significantly related to the erythrocyte sedimentation rate (R2=0.497, P<0.001) and use of dipeptidyl peptidase-4 inhibitors (R2=0.574, P=0.048). Conclusion Diabetics with AMI resulted in adverse hemorheologic changes with lower EI and higher CSS compared to diabetic subjects without AMI. Evaluation of the hemorheologic parameters may provide valuable supplementary information for managing patients with AMI and T2DM.

Discordant Relationships between Systemic Inflammatory Markers and Burden of Oxidative Stress in Patients with Atrial Fibrillation

Background and Objectives Oxidative stress (OS) plays an important role in the pathophysiology of atrial fibrillation (AF) by amplifying the inflammatory cascade, wherein augmented inflammation facilitates the atrial electrical remodeling process. Few studies have investigated the possible link between systemic inflammation and OS in AF. Subjects and Methods A total of 220 consecutive patients with AF (117 patients) or healthy controls (103 patients) were enrolled. Among the 117 AF patients, 65 paroxysmal AF (PaAF) and 52 persistent AF (PeAF) patients were included. The level of 8-iso-prostaglandin F2α (8-iso-PGF2α) was measured as a marker of OS burden. We evaluated the correlations between 3 systemic inflammatory markers, high-sensitivity C-reactive protein (hsCRP), neutrophil to lymphocyte ratio (NLR), and red cell distribution width (RDW), and 8-iso-PGF2α. Results The 8-iso-PGF2α concentration in both PaAF and PeAF patients was higher than that of controls (p<0.001 and p=0.024, respectively). The NLR and RDW of PeAF patients were higher than those of both control and PaAF patients (p=0.041 and p=0.031 for NLR, p=0.057 and p=0.031 for RDW, respectively). There were no correlations between specific inflammatory markers and the 8-iso-PGF2α in AF. The 8-iso-PGF2α level decreased gradually with an increase in AF duration (p=0.008), contrary to the graded increase in hsCRP. Multiple regression analysis indicated that AF duration persisted as a significant determinant of 8-iso-PGF2α (β=−0.249, p=0.044). Conclusion Systemic inflammatory marker levels were not proportional to the levels of 8-iso-PGF2α, an OS marker, in AF.

Giant Right Atrial Aneurysm ― Multimodality Imaging ―

mal. Routine laboratory tests including cardiac troponin and N-terminal pro-B-type natriuretic peptide were also normal. Chest radiography showed a triangular shaped cardiomegaly with a bulging right cardiac border (Figure 1A). Transthoracic echocardiography indicated a large aneurysmal structure in 51-year-old man was referred to cardiology for evaluation of a dilatation of the right atrium (RA), which was found incidentally on chest computed tomography (CT) during postoperative follow-up for colon cancer. He had no cardiac symptoms and physical examination was norA

CLINICAL USEFULNESS OF MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY FOR DETECTING STRESS INDUCED CARDIOMYOPATHY IN THE EMERGENCY DEPARTMENT

BACKGROUND The purpose of this study was to investigate the clinical usefulness of myocardial contrast echocardiography (MCE) to distinguish stress-induced cardiomyopathy (SCMP) from acute myocardial infarction (AMI) in the emergency department (ED). METHODS AND RESULTS We investigated 51 patients (62±13 years, 29 women) who had suspected SCMP in the ED with acute chest pain and showed apical wall motion abnormality on 2-dimensional echocardiography. All patients were assessed by real-time MCE and the perfusion status and quantitative myocardial perfusion parameters were analyzed. After MCE, coronary angiography was performed within 24h. Of 51 patients, 27 had significant perfusion defects (group A) and 24 had preserved perfusion at the apex (group B) by MCE. In group A, 25 patients showed significant luminal stenosis in the left anterior descending artery (LAD) and 2 patients showed no critical luminal stenosis. In group B, 20 patients showed no luminal stenosis and 4 patients showed moderate LAD stenosis. Sensitivity, specificity, positive and negative predictive values of MCE for detection of SCMP were 91%, 86.2%, 83%, and 93%, respectively. Quantitative MCE parameters were significantly decreased in group A compared with group B. CONCLUSIONS Myocardial perfusion measured by MCE is relatively preserved in patients with SCMP compared with those with AMI. Therefore, real-time MCE may be a useful noninvasive diagnostic tool to distinguish SCMP from AMI in the ED.