Seong Woo Han

Relative contributions of different cardiovascular risk factors to significant arterial stiffness

BACKGROUND Although arterial stiffness has been known to be related to many cardiovascular (CV) risk factors, the level of contribution of each risk factor to significant arterial stiffness is not yet clear. METHODS We studied an out-patient cohort of 835 subjects who were without a history of CV disease. Brachial-ankle pulse wave velocity (baPWV) measurement and Framingham risk score (FRS) calculation were performed for all subjects. RESULTS baPWV was well correlated with FRS (r=0.523, P<0.001) and it could independently predict it (P<0.001) after adjusting for the conventional CV risk factors. We defined a baPWV>1710 cm/s as significant arterial stiffness on the basis of its ability to detect a high 10-year risk of coronary heart disease (FRS>20%). Multiple logistic regression analysis revealed that the adjusted odds ratios of significant arterial stiffness for an age >60 years, hypertension, male gender, smoking and diabetes were 6.2 (95% CI 4.4-8.7), 3.4 (95% CI 2.1-5.3), 1.9 (95% CI 1.3-2.8), 1.9 (95% CI 1.2-3.2) and 1.6 (95% CI 1.1-2.4), respectively. Hyperlipidemia and obesity were not statistically significant. CONCLUSIONS Old age and hypertension were the strongest independent predictors of significant arterial stiffness. Male gender, smoking and diabetes followed in order of strength as independent predictors.

A Fractured Sirolimus-Eluting Stent With a Coronary Aneurysm

A 55-year-old man had undergone successful percutaneous intervention with a sirolimus-eluting stent, placed in the right coronary artery (2.5 x 33 mm) and distal left circumflex artery (3.0 x 28 mm) without high pressure ballooning. Twelve months later he presented with unstable angina. Angiography revealed two fracture sites on the right coronary artery-deployed stent, with a large aneurysm and an aneurysmal dilatation of the left circumflex artery without stent fracture. Due to the potential risk of aneurysmal rupture, he underwent coronary artery bypass grafting and ligation of the aneurysm.

A case of native valve endocarditis caused by Burkholderia cepacia without predisposing factors

BackgroundInfective endocarditis is rarely caused by Burkholderia cepacia. This infection is known to occur particularly in immunocompromised hosts, intravenous heroin users, and in patients with prosthetic valve replacement. Most patients with Burkholderia cepacia endocarditis usually need surgical treatment in addition to antimicrobial treatment.Case PresentationHere, we report the case of a patient who developed Burkholderia cepacia-induced native valve endocarditis with consequent cerebral involvement without any predisposing factors; she was successfully treated by antimicrobial agents only.ConclusionIn this report, we also present literature review of relevant cases.

Carotid Intima-Media Thickness and Plaque as a Predictor for Ischemic Etiology in Patients With Severe Left Ventricular Systolic Dysfunction

Background and Objectives Coronary artery disease (CAD) is a major cause of heart failure associated with left ventricular systolic dysfunction (LVSD). The prognosis of LVSD is significantly influenced by the etiology of heart failure and therefore, differentiation of significant CAD from other etiologies is important. Carotid intima-media thickness (IMT) and plaque are useful predictors for cardiovascular events, including stroke and CAD. The purpose of this study was to evaluate the predictive value of carotid IMT and plaque for the diagnosis of CAD in LVSD patients. Subjects and Methods Seventy-three (n= 73, 47 male, 67.6±12.4 years) patients hospitalized for heart failure with severe LVSD were retrospectively enrolled. The severity of CAD was analyzed by the Duke Jeopardy Score system, and carotid IMT and plaque were measured according to the Mannheim Carotid IMT Consensus. Results Significant CAD was found in 41 patients (56.1%, CAD group) on coronary angiography. Mean common carotid artery (CCA) IMT (0.74±0.05 mm vs. 1.04±0.04 mm, p<0.01) was significantly higher in the CAD group. Plaque in CCA (6.25% vs. 19.5%, p<0.01) and plaque in bulb (25.0% vs. 60.9%, p<0.001) were significantly higher in the CAD group. Mean CCA IMT {odds ratio (OR) 2.61, 95% confidence interval (CI) 1.134-4.469, p<0.01} and plaque in bulb (OR 4.69, 95% CI 1.702-12.965, p<0.01) were significant predictors for the diagnosis of CAD according to multivariate logistic regression analysis. Conclusion In patients with severe LVSD, mean CCA IMT and bulb plaque can be useful additional predictors for the diagnosis of CAD.

Coronary ostial stenosis after aortic valvuloplasty (comprehensive aortic root and valve repair)

Comprehensive aortic root and valve repair (CARVAR) surgery using specially designed aortic rings was introduced as a new surgical technique for aortic valve disease. We present five consecutive cases of iatrogenic coronary ostial stenosis after CARVAR surgery in patients with aortic stenosis. The preoperative coronary angiography confirmed that all the patients had normal coronary arteries. They underwent aortic valvuloplasty by aortic leaflet extension and insertion of specially designed inner and outer rings at the level of the sinotubular junction. Within 6 months after surgery, all the patients complained of resting chest pain and dyspnea with changes of electrocardiography. Repeated coronary angiography demonstrated right coronary artery (RCA) ostial stenosis in one patient and left main (LM) ostial stenosis in the other four patients. Intravascular ultrasonography demonstrated severe ostial stenosis and extensive echogenic tissue in the extravascular area. Four patients with LM ostial disease successfully underwent coronary bypass graft surgery, and percutaneous coronary intervention with stenting was performed in one case of RCA ostial stenosis. Because the mechanism of this complication is not fully confirmed, more clinical study is required to confirm the safety issues of CARVAR surgery.

Slow Coronary Flow is Related to Increased Carotid Intima-Media Thickness but Not Pulse Wave Velocity

Background and Objectives Slow coronary flow (SCF) is characterized by delayed contrast dye opacification without significant stenosis of epicardial coronary arteries. However, the pathophysiology and clinical implications of SCF are not fully understood. Some reports have suggested that SCF might be caused by atherosclerosis in the coronary artery microvasculature. Measuring carotid intima-media thickness (IMT) and pulse wave velocity (PWV), which are non-invasive and simple diagnostic tools, was developed to detect subclinical atherosclerosis. Thus, we determined IMT and PWV, and their possible relationship in a SCF group and a normal coronary flow (NCF) group of patients. Subjects and Methods We included 101 patients who complained of chest pain but had a normal coronary angiogram. Thrombolysis in Myocardial Infarction frame count (TIMI frame count, TFC) was evaluated in the left and right coronary arteries. We defined SCF as a TFC of more than 25. Carotid IMT was measured by ultrasonography in both common carotid arteries. PWV was calculated from pulse transit time between the brachial and ankle arteries. Results Fifteen patients were included in the SCF group and 86 patients in the NCF group. Male patients (n=11, 73.3%) were significantly more common in the SCF group than in the NCF group (n=37, 43.0%, p<0.05). The TFC of the SCF and NCF groups were 28.8±3.5 and 15.7±4.5, respectively. The carotid IMT in the SCF group increased significantly compared to that in the NCF group (1.2±0.3 mm vs. 0.8±0.1 mm, p<0.01). However, no significant difference in PWV was observed between the two groups. Conclusion SCF may reflect early atherosclerotic changes in the coronary artery microvasculature.