Man-Young Lee

Uptake of F-18 FDG and ultrasound analysis of carotid plaque

ObjectivesTo elucidate the relation between the echolucent plaque on carotid ultrasound and acute inflammation on F-18 FDG carotid PET/CT.MethodsThirty nine patients (M:F ratioxa0=xa023:16, mean agexa0=xa063xa0±xa011xa0years) that underwent coronary angiography and carotid ultrasound were divided into three groups—echolucent plaque (nxa0=xa022), calcified (nxa0=xa010), and no plaque(nxa0=xa07). All the patients underwent F-18 FDG carotid PET/CT. The mean standardized uptake values (SUV), namely target to background ratio (TBR) on 180xa0minutes delayed F-18 FDG carotid PET/CT images were compared with levels of serum inflammatory markers and lipid profiles, and in terms of the presence of carotid plaque on carotid US.Results180xa0minutes TBR of carotid arterial wall at echolucent plaque, calcified plaque, and no plaque were 1.40xa0±xa00.05, 1.23xa0±xa00.03, 1.17xa0±xa00.03 in both carotid artery. TBR of carotid arterial walls for echolucent plaque were significantly larger than TBR for calcified, and no plaque respectively at the both side of carotid artery (Pxa0<xa0.05). Serum HDL levels were found to be inversely correlated with F-18 FDG uptake at both carotid arteries (rxa0=xa0−0.43, Pxa0=xa0.005) on 180xa0minutes delayed phase images. Also serum hs-CRP levels were found to be correlated with F-18 FDG TBR values of right carotid arteries (rxa0=xa00.41, Pxa0=xa0.04).ConclusionsOur results show that F-18 FDG carotid PET/CT can depict metabolically active atherosclerotic plaques, and suggest that F-18 FDG carotid PET/CT can be used as a noninvasive imaging modality for functional evaluation of atherosclerosis.

Computed tomographic analysis of the esophagus, left atrium, and pulmonary veins: implications for catheter ablation of atrial fibrillation

Purpose:The aim of this study was to investigate the anatomic relationship around the left atrium (LA) and to provide clinical information to help avoid the risk of an atrio-esophageal fistula during atrial fibrillation (AF) ablation.Methods:The multidetector spiral computed tomography images of 77 male patients (mean age, 54u2009±u20099xa0years) with drug-refractory AF and 37 male control subjects (mean age, 50u2009±u200911xa0years) were analyzed. We measured the following variables: (1) distance between the ostia of the pulmonary veins (PVs) and the ipsilateral esophageal border, (2) presence of a pericardial fat pad around each PV, and (3) contact width/length and presence of a fat pad between the LA and the esophagus.Results:The distance between the esophagus and the ostia of right superior PV, right inferior PV (RIPV), left superior PV, and left inferior PV (LIPV) was 27.2u2009±u20099.4xa0mm, 22.9u2009±u200910.3xa0mm, 2.7u2009±u20099.4xa0mm, and 7.1u2009±u20098.8xa0mm, respectively. A fat pad between the esophagus and the superior PV was present in more than 90% of the subjects in both groups. However, the fat pad around inferior PV was present less frequently in the patients than in the control group (pu2009=u20090.011, RIPV; pu2009<u20090.001, LIPV). The average length of the LA–esophagus contact in the patients and the control group subjects was 26.2u2009±u200910.4 and 18.5u2009±u20095.1xa0mm, respectively (pu2009<u20090.001).Conclusion:Caution should be exercised when ablating the LIPV because the esophagus is located in close proximity to the left-sided PV and most of the inferior PVs in patients with AF are not covered with fat pads.

Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Patients Following Ablation of Atrial Fibrillation

Background and Objectives It is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation. Subjects and Methods One hundred fifty-two patients (mean age, 57±10 years; M : F=94 : 58) who underwent catheter ablation due to drug-refractory paroxysmal (mean age, 57±10 years; M : F=58 : 43) or persistent AF (mean age, 56±10 years; M : F=36 : 15) were enrolled. We compared the recurrence rates between the groups with and without ACEIs or ARBs use in paroxysmal and persistent AF. The mean duration of follow-up was 18±14 months. Results The overall recurrence rate after ablation therapy was 26% (n=39). The recurrence rate was significantly decreased in the patients with persistent AF with the use of ACEIs or ARBs (12.1% vs. 61.1%, p<0.01), but this difference was not observed in the patients with paroxysmal AF (24.2% vs. 22.9%, p=0.87). In patients with persistent AF with and without recurrence, the size of the left atrium (44.2±8.4 mm vs. 44.3±5.8 mm, respectively, p=0.45) and the ejection fraction (62±6.5% vs. 61.5±6.2%, respectively, p=0.28) were not significantly different. In multivariate analysis, the use of ACEIs or ARBs was independently associated with recurrence after adjusting for the size of the left atrium and the ejection fraction {odds ratio (OR)=0.078, 95% confidence interval (CI)=0.02-0.35, p<0.01}. Conclusion ACEIs and ARBs were shown to be effective in preventing AF recurrence after catheter ablation in patients with persistent AF.

Optimal antithrombotic strategy in patients with atrial fibrillation after coronary stent implantation.

Background and Objectives Little evidence is available on the optimal antithrombotic therapy following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). We investigated the outcomes of antithrombotic treatment strategies in AF patients who underwent PCI. Subjects and Methods Three hundred sixty-two patients (68.0% men, mean age: 68.3±7.8 years) with AF and who had undergone PCI with stent implantation between 2005 and 2007 were enrolled. The clinical, demographic and procedural characteristics were reviewed and the stroke risk factors as well as antithrombotic regimens were analyzed. Results The accompanying comorbidities were as follows: hypertension (59.4%), diabetes (37.3%) and congestive heart failure (16.6%). The average number of stroke risk factors was 1.6. At the time of discharge after PCI, warfarin was prescribed for 84 patients (23.2%). Cilostazol was used in addition to dual antiplatelet therapy in 35% of the patients who did not receive warfarin. The mean follow-up period was 615±385 days. The incidences of major adverse cardiac events (MACE), stroke and major bleeding were 11.3%, 3.6% and 4.1%, respectively. By Kaplan-Meier survival analysis, warfarin treatment was not associated with a lower risk of MACE (p=0.886), but it was associated with an increased risk of major bleeding (p=0.002). Conclusion Oral anticoagulation therapy after PCI may increase hemorrhagic events in Korean AF patients.

The Relationship Between the Acute Changes of the Systolic Blood Pressure and the Brachial-Ankle Pulse Wave Velocity

Background The brachial-ankle pulse wave velocity (baPWV) is a useful parameter to assess arterial stiffness. However, it is difficult to evaluate arterial stiffness in hypertensive patients because the baPWV is affected by the blood pressure itself. This study was designed to estimate the relationship between the change of the blood pressure parameters and the baPWV (ΔbaPWV) when hypertensive patients were subjected to an acute reduction of blood pressure. Methods Thirty patients with essential hypertension and whose blood pressure was higher than 140/90 mmHg were enrolled. In all the patients, the blood pressure and baPWV were measured using an automatic waveform analyzer with the patients at a resting state. When the reduction of blood pressure was more than 10 mmHg after sublingual administration of nifedipine 10 mg, then the blood pressure and baPWV were measured again in the same manner and then they were compared with the baseline values. Spearmans correlation and multiple linear regression tests were performed to estimate the relationship between the change of the blood pressure parameters (ΔSBP, ΔDBP, ΔMAP and ΔPP) and the ΔbaPWV. Results The baPWV was significantly decreased shortly after the administration of nifedipine (1903.6±305.2 cm/sec vs. 1716±252.0 cm/sec, respectively, p<0.01). The ΔbaPWV was correlated with the ΔSBP (r=0.550, p<0.01), ΔDBP (r=0.386, p<0.05), ΔMAP (r=0.441, p<0.05), and ΔPP (r=0.442. p<0.05). On the multiple regression analysis, the ΔSBP was the only significant variable for predicting the ΔbaPWV, and the linear equation was ΔbaPWV=8.7×SBP-48. Conclusions The baPWV is affected by the systolic blood pressure level to a large degree and careful attention must be paid to the blood pressure level when evaluating arterial stiffness with using the baPWV.

Impact of Left Anterior Line on Left Atrial Appendage Contractility in Patients Who Underwent Catheter Ablation for Chronic Atrial Fibrillation

Left anterior line (LAL) has been used as a substitute for mitral isthmus line for catheter ablation of chronic atrial fibrillation (AF). However, it results in left anterolateral conduction delay and might affect left atrial (LA) contractility. We aimed to investigate whether LAL decreases LA appendage function.

Serum Osteoprotegerin Is Associated With Calcified Carotid Plaque: A Strobe-Compliant Observational Study.

AbstractOsteoprotegerin (OPG) is a kind of tumor necrosis factor, which is related to bone metabolism and vascular calcification. The increase of Osteoprotegerin concentration in serum is related to cardiovascular diseases in humans. The purpose of this study was to figure out the relevance between osteoprotegerin in serum and carotid calcification.Serum OPG concentrations were compared in 145 patients who underwent carotid sonography (average age: 68u200a±u200a9 years old, male: femaleu200a=u200a81:64). A calcified plaque (CP) (37 people [27%]), a noncalcified plaque (NCP) (54 people [37%]), and a nonplaque (NP) (54 people [37%]) were classified for this study.No significant differences among 3 groups were demonstrated in the distribution of age, diabetes, high blood pressure, and hyperlipidemia. Serum osteoprotegerin concentrations were significantly increased in CP group rather than NCP group or NP group; (median [interquartile range], 4016 [1410] vs 3210 [1802] pg/mL, Pu200a<u200a0.05 and 4016 [1410] vs 3204 [1754] pg/mL, Pu200a<u200a0.05). Serum osteoprotegerin concentrations did not indicate a significant difference between NCP Group or NP Group.This study had proved that patient group accompanied with carotid calcification in carotid artery disease had an increased serum OPG concentration, so it could consider that OPG plays an important function on calcification related to arteriosclerosis.

Successful Radiofrequency Catheter Ablation for Wolff-Parkinson-White Syndrome Within the Neck of a Coronary Sinus Diverticulum

Posteroseptal accessory pathways are often associated with coronary sinus diverticula. These diverticula contain myocardial coats which serve as a bypass tract. We report a 54-year-old woman who underwent radiofrequency (RF) catheter ablation for Wolff-Parkinson-White (WPW) syndrome. The surface electrocardiography (ECG) demonstrated pre-excitation, indicating a posteroseptal accessory pathway. A catheter ablation via a transaortic approach failed to ablate the accessory pathway. Coronary sinus venography revealed the presence of a diverticulum near the ostium. An electrogram in the neck of the diverticulum showed the coronary sinus myocardial extension potential, which was successfully ablated by delivery of RF energy.

Change of Coronary Flow Velocity During the Cold Pressor Test Is Related to Endothelial Markers in Subjects With Chest Pain and a Normal Coronary Angiogram

Several studies demonstrated that endothelial or atherosclerotic biomarkers, including plasma free insulin‐like growth factor‐I(IGF‐I), soluble CD40 ligand (sCD40L), adiponectin, and leptin have an influence on coronary endothelial function.

Relationship between Resting Electrocardiographic Parameters and Estimated 10-Year Risk for Coronary Heart Disease in Healthy Adults in the USA

Background: Little is known about the relationship between resting electrocardiogram (ECG) parameters and the incidence of coronary heart disease (CHD). We sought to establish the association between ECG parameters and estimated 10‐year risk for CHD.