Kyung-Pyo Hong

Moderate Hyperhomocyst(e)inemia Is Associated with the Presence of Coronary Artery Disease and the Severity of Coronary Atherosclerosis in Koreans

To examine whether moderate hyperhomocyst(e)inemia is associated with coronary artery disease and the number of diseased coronary vessels in Koreans, we investigated 201 patients with angiographically documented coronary artery disease and 187 healthy subjects without evidence of stroke and coronary artery disease. The mean plasma total homocysteine in patients was higher than in controls (10.3 micromol/L; 95% confidence interval, 7.0-13.6 vs. 8.9 micromol/L; 6.0-11.8) (p=0.005). The prevalence of moderate hyperhomocyst(e)inemia, defined as the top 90th percentile in controls (13.2 micromol/L), was higher in patients than in controls (23.9% vs. 10.2%, p=0.001). Plasma homocyst(e)ine levels were not correlated to age, body mass index, levels of serum cholesterol, creatinine, and uric acid. Based on multiple logistic regression analyses with adjustment for total cholesterol, hypertension, smoking status, diabetes, age, and body mass index, the adjusted odds ratio of moderate hyperhomocyst(e)inemia for coronary artery disease was 1.53 (95% confidence interval: 1.39-1.65, p=0.0001). Moderate hyperhomocyst(e)inemia, diabetes mellitus, and old age were more prevalent in patients with triple-vessel disease than in single- or double-vessel disease (p=0.02). Multiple logistic regression analysis revealed that moderate hyperhomocyst(e)inemia was a significant predictor of triple-vessel disease with odds ratio of 2.78 (95% confidence interval: 1.08-7.10, p=0.02). We conclude that moderate hyperhomocyst(e)inemia is an independent risk factor for coronary artery disease, and also related significantly to the presence of triple-vessel disease.

Comparison of vessel geometry in bifurcation between normal and diseased segments: intravascular ultrasound analysis.

OBJECTIVE To investigate the geometry in bifurcation using intravascular ultrasound (IVUS) analysis. METHODS We performed quantitative three-dimensional IVUS analysis of 31 true bifurcation lesions and 30 angiographically normal bifurcation segments including the main and side branches as well as parent vessel. RESULTS The external elastic membrane (EEM) area changed significantly according to distance from bifurcation in the parent vessel and main branches of the lesion group while there was no significant change in the EEM area in the normal group. Vessel size of bifurcation segments obeyed the principle of minimum work (Murrays law). The cube of the mean EEM diameter of parent vessel nearly equaled the sum of the cubes of the mean EEM diameters of main and side branches (95.5 +/- 38.9 mm(3) versus 90.7 +/- 36.1 mm(3) for the lesion group and 93.4 +/- 49.6 mm(3) versus 85.3 +/- 47.3 mm(3) for the normal group). However, the deviation from the optimal relationship of lumen size was noted more frequently in bifurcation lesion than normal bifurcation segments (71% versus 43%, P=0.03). CONCLUSIONS The EEM pattern may differ between bifurcation lesions and normal bifurcating segments. Although human coronary artery system obeys the principle of minimum work, the geometry may deviate from the optimal relationship in bifurcation lesions.