Seo Na Hong

Carotid artery intima-media thickness in Behcet's disease patients without significant cardiovascular involvement

Background/Aims Behcets disease (BD) is a systemic disorder associated with a characteristic vasculitis that can involve both veins and arteries of all sizes. Endothelial activation or injury is a characteristic feature of BD. Endothelial dysfunction is widely regarded as being the initial lesion in the development of atherosclerosis. The carotid artery intima-media thickness (IMT) is a widely accepted marker of subclinical atherosclerosis. We aimed to determine the carotid IMT in BD patients with using high-resolution B-mode Doppler ultrasonography. Methods We studied 40 patients (24 males, mean age: 39.1±8.5 years) who were diagnosed by the international diagnostic criteria of Behcets disease and 20 healthy controls (13 males, mean age: 40.2±5.1 years), and the two groups were matched by age and gender. No subject in either group had a history of atherosclerosis or its complications. The clinical data, including the age of onset, the duration of disease, a history of medication, the activity score and the laboratory data were analyzed. Results The carotid IMT in the BD group was significantly higher than that in the control group (0.71±0.22 mm vs. 0.59±0.09 mm, respectively, p<0.01). Cardiac and major vessel involvements were not identified in the BD group. However, minor vascular involvements were documented in 2 patients with deep vein thrombosis, in 4 patients with superficial thrombophlebitis and in 2 patients with pseudoaneurysm. The carotid IMT in the patients with posterior uveitis or retinal vasculitis was higher than that of the patients without these findings (0.85±0.21 mm vs. 0.64±0.10 mm, respectively, p=0.007), but there was no difference of the IMT according to minor vascular involvement. Conclusions Despite that there was no significant cardiovascular involvement in the BD patients, the carotid IMT was significantly higher in the BD patients as compared with the healthy controls.

Anti-inflammatory effect of abciximab-coated stent in a porcine coronary restenosis model.

The aim of this study was to examine the anti-inflammatory effect of abciximab-coated stent in a porcine coronary overstretch restenosis model. Ten abciximab-coated stents, ten sirolimus-eluting stents (SES), and ten paclitaxel-eluting stents (PES) were deployed with oversizing (stent/artery ratio 1.3:1) in porcine coronary arteries, and histopathologic analysis was done at 28 days after stenting. There were no significant differences in the neointima area normalized to injury score and inflammation score among the three stent groups (1.58±0.43 mm2, 1.57±0.39 mm2 in abciximab-coated stent group vs. 1.69±0.57 mm2, 1.72±0.49 mm2 in the SES group vs. 1.92±0.86 mm2, 1.79±0.87 mm2 in the PES group, respectively). In the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations were found between the extent of inflammatory reaction and the neointima area (r=0.567, p<0.001) and percent area stenosis (r=0.587, p<0.001). Significant correlations were found between the injury score and neointimal area (r= 0.645, p<0.001), between the injury score and the inflammation score (r=0.837, p<0.001), and between the inflammation score and neointimal area (r=0.536, p= 0.001). There was no significant difference in the inflammatory cell counts normalized to injury score among the three stent groups (75.5±23.1/µL in abciximab-coated stent group vs. 78.8±33.2/µL in the SES group vs. 130.3±46.9/µL in the PES group). Abciximab-coated stent showed comparable inhibition of inflammatory cell infiltration and neointimal hyperplasia with other drug-eluting stents in a porcine coronary restenosis model.

T peak–Tend interval during therapeutic hypothermia can predict upcoming ventricular fibrillation in subjects with aborted arrhythmic sudden cardiac death: 3-years follow-up results

Aims Prolonged Tpeak-Tend interval has been shown to be markers of arrhythmogenesis in various cardiac disorders. However, its dynamicity is one of the obstacles to predict fatal ventricular arrhythmia. This study investigated whether Tpeak-Tend interval during therapeutic hypothermia (TH) is associated with ventricular fibrillation (VF) inducibility and clinical arrhythmia in subjects with aborted arrhythmic sudden cardiac death (SCD). Methods and results The study group included 31 patients (24 males, age 39.1 ± 17.6 years) presenting with arrhythmic SCD in whom Tpeak-Tend interval and J-wave amplitude were measured in electrocardiogram (ECG) of the earliest medical contact and during TH; these patients underwent programmed ventricular stimulation. The summation of J-wave amplitude and QTc interval increased during TH. However, it was not associated with VF inducibility. Patients with inducible VF showed a small Tpeak-Tend interval dispersion in the baseline 12-lead ECG (68.8 ± 24.7 vs. 94.0 ± 55.6 ms, P = 0.044) and a marked increase of the dispersion during the TH (36.2 ± 51.2 vs. -6.1 ± 45.5 ms, P = 0.039). Twenty-four patients underwent implantable cardioverter defibrillator (ICD) implantation. Among them, the patients with long QTc, Tpeak-Tend, and precordial Tpeak-Tend during the TH developed VF more frequently (QTc, 511.9 ± 53.71 ms vs. 566.5 ± 56.08 ms, P = 0.038; Tpeak-Tend interval, 145.6 ± 38.4 ms vs. 185.7 ± 49.95 ms, P = 0.048; precordial Tpeak-Tend interval, 139.3 ± 35.11 ms vs. 185.7 ± 49.95 ms, P = 0.018). The initial VF inducibility was not related with the VF development in follow-up. Conclusion In patients with aborted arrhythmic SCD, long Tpeak-Tend interval and QTc interval during TH could predict VF development in their follow-up.

PREDICTOR, IMPACT, AND PROGNOSTIC FACTOR OF ANGIOGRAPHIC NO-REFLOW PHENOMENON IN PATIENTS TREATED WITH DRUG-ELUTING STENT FOR ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Results: No-reflow phenomenon after DES implantation occurred in 7.9 % of the patients. Patients with no-reflow were older, had higher Killip class, lower left ventricular ejection fraction, and more complex lesions, and needed longer intensive care. The levels of CK-MB, hs-CRP, and NTproBNP were significantly higher in patients with no-reflow than those with normal reflow. Rates of in-hospital adverse events (IHAEs) and MACEs at 1 and 12 months were significantly higher in patients with no-reflow compared with those with normal reflow (IHAEs: 35.2% vs 15.5%, p<0.001; 1-month MACEs: 6.3% vs 2.6%, p=0.001; 12-month MACEs: 21.3% vs 15.3%, p=0.031). In multivariate analysis, no-reflow was an independent predictor of short-term (OR, 2.46, 95% CI 1.41-4.17, p<0.001) and long-term clinical outcomes (OR, 1.51, 95% CI 1.04-2.19, p=0.032). In addition, elevated NT-proBNP (OR, 2.46, 95% CI 1.41-4.17, p<0.001) and preprocedural TIMI grade 0/1 flow (OR, 2.15, 95% CI 1.22-3.79, p= 0.043) were independent predictors of no-reflow. In no-reflow group, additive use of cilostazol lowered 1and 12-month MACEs (OR, 0.59, 95% CI 0.38-0.91, p=0.016; OR, 0.60, 95% CI 0.36-0.99, p=0.043).