Ki Hun Kim

Neutrophil to Lymphocyte Ratio Predicts Long-Term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Background and Objectives A higher neutrophil to lymphocyte ratio (NLR) has been associated with poor clinical outcomes in various cardiac diseases. However, the clinical availability of NLR in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not been known. We evaluated the availability of NLR to predict clinical outcomes in patients with STEMI undergoing primary PCI. Subjects and Methods We analyzed 326 consecutive STEMI patients treated with primary PCI. The patients were divided into tertiles according to NLR: NLR≤3.30 (n=108), 3.316.53 (n=110). We evaluated the incidence of major adverse cardiac events (MACE), a composite of all causes of death, non-fatal MI, and ischemic stroke at the 12-month follow-up. Results The high NLR group was associated with a significantly higher rate of 12-month MACE (19.1% vs. 3.7%, p<0.001), 12-month death (18.2% vs. 2.8%, p<0.001), in-hospital MACE (12.7% vs. 2.8%, p=0.010) and in-hospital death (12.7% vs. 1.9%, p=0.003) compared to the low NLR group. In the multivariable model, high NLR was an independent predictor of 12-month MACE {hazard ratio (HR) 3.33 (1.09-10.16), p=0.035} and death {HR 4.10 (1.17-14.46), p=0.028} after adjustment for gender, left ventricular ejection fraction, creatinine clearance, angiographic parameters and factors included in the Thrombolysis in Myocardial Infarction risk score for STEMI. There was a significant gradient of 12-month MACE across the NLR tertiles with a markedly increased MACE hazard in the high NLR group (log rank test p=0.002). Conclusion The NLR is a useful marker to predict 12-month MACE and death in patients with STEMI who have undergone primary PCI.

Sarcopenic obesity as an independent risk factor of hypertension

Low muscle mass has been associated with arterial stiffness. The aim of the study was to determine whether sarcopenic obesity is associated with hypertension. Subjects consisted of 6832 adults who participated in the 2009 Korea National Health and Nutrition Examination Survey. Participants were classified as normal, sarcopenic, obese, or sarcopenic-obese based on the following measures: waist circumference and appendicular skeletal muscle mass divided by weight (ASM/Wt). The sarcopenic-obese group had systolic and diastolic blood pressure levels that were ≈12 mm Hg and 5xa0mm Hg higher, respectively, than those in the normal group. Compared with the normal group, the odds ratio (OR) of having hypertension for the sarcopenic, obese, and sarcopenic-obese groups were 2.48 (95% confidence interval [CI], 1.89-6.16), 3.15 (95% CI, 2.76-3.59), and 6.42 (95% CI, 4.85-8.48) times higher, respectively. When waist circumference and ASM/Wt were used as continuous variables in the same regression model, ASM/Wt was a significant predictor of hypertension (OR, 0.94; 95% CI, 0.89-0.98). Sarcopenic obesity is associated with hypertension, while low muscle mass is also correlated with hypertension, independent of abdominal obesity. Abdominal obesity and sarcopenia may potentiate each other to induce hypertension.

Comparison of Triple Anti-Platelet Therapy (Aspirin, Clopidogrel, and Cilostazol) and Double Anti-Platelet Therapy (Aspirin and Clopidogrel) on Platelet Aggregation in Type 2 Diabetic Patients Undergoing Drug-Eluting Stent Implantation

Background and Objectives Triple anti-platelet therapy may produce more potent inhibition of platelet aggregation in patients undergoing coronary stent implantation. We tested whether this effect could be maintained in diabetic patients, where platelet reactivity is increased and the risk of stent thrombosis is higher. Subjects and Methods Fifty five type 2 diabetic patients who had undergone drug-eluting stent (DES) implantation and chronic anti-platelet therapy (>1 month) were stratified according to the status of anti-platelet therapy. Platelet aggregation after adenosine diphosphate (ADP; 10 µmol/L and 20 µmol/L) stimulation was compared using light transmittance aggregometry between dual (aspirin plus clopidogrel, n=34) and triple therapy (aspirin, clopidogrel plus cilostazol, n=21) groups. Results The 2 groups had similar clinical and procedural characteristics. Maximal ADP-induced platelet aggregation was significantly lower in the triple therapy group than the dual therapy group (ADP 10 µmol/L, 37.1±15.4 vs. 28.3±11.8, p=0.03; ADP 20 µmol/L, 63.1±15.0 vs. 49.1±15.1, p=0.01), but there were no differences in diabetic treatment (oral hypoglycemic agent vs. insulin) or diabetic control {hemoglobin Alc (HbA1c) ≤7 vs. HbA1c >7}. Conclusion Triple anti-platelet therapy showed more potent inhibition of maximal ADP induced platelet aggregation in type 2 diabetic patients receiving chronic anti-platelet therapy. This finding suggests that triple antiplatelet therapy may be more effective in preventing thrombotic complications after DES implantation in type 2 diabetic patients.

Incidental Diagnosis of the Unicuspid Aortic Valve with Ascending Aortic Aneurysm in an Asymptomatic Adult

The unicuspid aortic valve is an extremely rare congenital anomaly. It usually presents with aortic stenosis and/or aortic regurgitation. Other cardiovascular complications, such as aortic dilatation and left ventricular hypertrophy can accompany it. Herein, we present a case report of a 50-year-old asymptomatic male patient with unicuspid aortic valve, complicated by ascending aortic aneurysm.

Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy

BackgroundThyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known.MethodsThis study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation. A total of 146 patients on THR and 146 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model (age, sex, body mass index, and left atrium size). The presence of non-pulmonary vein (PV) triggers was disclosed by a high-dose isoproterenol challenge (up to 30xa0μg/min) after PV isolation.ResultsClinical characteristics were not different between the groups. When compared to the control, non-PV triggers were significantly greater in the THR patients [112 (77%) vs. 47 (32%), Pu2009<u20090.001], and most frequently originated from the right atrium (95 vs. 56%, Pu2009<u20090.001). Other sources of non-PV triggers were the interatrial septum (25 vs. 11%, Pu2009=u20090.002), coronary sinus (70 vs. 52%, Pu2009=u20090.01), left atrial appendage (47 vs. 34%, Pu2009=u20090.03), crista terminalis/superior vena cava (11 vs. 8%, Pu2009=u20090.43), and mitral valve annulus (7 vs. 5%, Pu2009=u20090.45) (THR vs. control), respectively. After mean follow-up of 14.7u2009±u20095.2xa0months, success rate was lower in patients on THR therapy [94 (64.4%)] compared to patients not receiving THR therapy [110 (75.3%), log-rank test valueu2009=u20090.04].ConclusionsRight atrial non-PV triggers were more prevalent in AF patients treated with THR. Elimination of non-PV triggers provided better arrhythmia-free survival in the non-THR group.