Soon-Jo Hong

The Glu298Asp polymorphism in the endothelial nitric oxide synthase gene is strongly associated with coronary spasm.

Background Coronary spasm seems to be associated with coronary nitric oxide deficiency. Objectives We investigated whether the Glu298Asp polymorphism in the endothelial nitric oxide synthase (eNOS) gene is a definite risk factor for coronary spasm and whether diffuse spasm involving normal‐looking coronary artery correlates significantly with the Glu298Asp polymorphism, in contrast with focal spasm superimposed on an atherosclerotic plaque. Methods A polymerase chain reaction followed by restriction fragment length polymorphism analysis was performed in 118 control participants and in 102 patients with variant angina and a similar degree of atherosclerotic burden. Patients with coronary spasm were divided into diffuse spasm and focal spasm subgroups according to morphological criteria. Results There was a significantly higher incidence of the Glu298Asp polymorphism in the coronary spasm group than in the control group (21.5% compared with 8.5%, P =0.006). Multiple logistic regression analysis using risk factors and the Glu298Asp polymorphism showed that the most important predictive factor for coronary spasm was the Glu298Asp polymorphism (odds ratio 2.83, 95% confidence interval 1.25‐6.41, P = 0.009). The diffuse spasm subgroup had a significantly higher frequency of the Glu298Asp polymorphism than the control group (25.9% compared with 8.5%, P = 0.002). However, the focal spasm subgroup did not differ from the control group in the frequency of Glu298Asp polymorphism. Conclusion The Glu298Asp polymorphism in the eNOS gene is a definite risk factor for coronary spasm, especially for diffuse coronary spasm. This result supports the notion that diffuse coronary spasm is significantly associated with endothelial dysfunction, in contrast to focal spasm. Coron Artery Dis 14:293‐299

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.

Cardiac myxoma: clinical experiences with twenty-five patients in Korea.

Cardiac myxomas are histologically benign but and pulmonary edema in seventeen (68%) patients. may be lethal because of their strategic position. It Sixteen (64%) patients had abnormal electrocarmay mimic every cardiovascular or systemic disease, diographic findings that included sinus tachycardia, and can be missed without a high index of suspicion nonspecific ST-T wave change, left atrial enlarge[1]. Rapid advances have been made in cardiovascument, right bundle branch block, atrial fibrillation. In lar imaging, particularly in echocardiography, which laboratory findings, anemia was observed in eighteen is the most important modality in the preoperative (72%) patients, and leukocytosis was noted in six diagnosis of cardiac myxomas. We reviewed twenty(24%) patients. An erythrocyte sedimentation rate five patients with cardiac myxoma who underwent was found to be elevated in twelve of fifteen(80%) excision of the tumor at Catholic University Medical patients. In all of the patients, preoperative diagnosis Center between 1984 and 1999. The patients’ medical was confirmed by echocardiography, and surgical records were reviewed retrospectively, and special excision of the myxoma was performed as soon as attention was given to clinical presentation, physical possible without further diagnosis. The tumor size examination, chest X-ray, electrocardiogram, laborawas from 131.732.7 to 3.536.538 cm and from 18 tory findings, echocardiographic findings, operative to 200 g in weight. The stalk of tumors was found in findings, and postoperative course. The study group 18 (72%) patients, and hemorrhage and calcification consisted of six male (24%) and nineteen female of tumors in twenty (80%) and nine (36%) patients, (76%) patients. The patients’ ages ranged from 23 to respectively. Most myxomas in the left atrium were 64 years (mean 48) at the time of diagnosis. There located at the border of the oval fossa [sixteen (64%) were twenty-three (92%) left atrial and two (8%) patients] and the others at the base of interatrial right atrial myxomas. The most common symptoms septum, posterior atrial wall, and anterior atrial wall were associated with mitral obstruction in nineteen in descending order of frequency. There was no (76%) patients such as dyspnea on exertion, palpitaperioperative mortality. Early postoperative complition, and recurrent syncope. Embolic episodes cations controlled with medical treatment occurred in occurred in five (20%) patients. Twenty (80%) five patients: wound infection in two; Torsades de patients had abnormal findings at their cardiac aupointes in one; atrial fibrillation in one and acute scultation, systolic murmur in twelve, diastolic murrenal failure in one patient. Most patients were mur in eight, and tumor plop in four patients. Chest discharged within 2 weeks of the operation. In X-ray showed cardiomegaly, left atrial enlargement, sixteen (64%) patients who could be reevaluated, follow-up ranged from 4 months to 15 years. One *Corresponding author. Cardiology Department, St. Mary’s Hospital, patient who underwent tricuspid annuloplasty for No. 62 Yoido-dong, Youngdungpo-Ku 150-713, Seoul, South Korea. Tel.: severe tricuspid valve regurgitation died of intractable 182-2-3779-1325; fax: 182-2-3779-1374. E-mail address: younhj@cmc.cuk.ac.kr (H.-J. Youn). right heart failure and pulmonary hypertension 5

Takayasu's arteritis treated by percutaneous transluminal angioplasty with stenting in the descending aorta.

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3-dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasus arteritis was made according to the new angiographic classification of Takayasus arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up.

Demonstration of supravalvar aortic stenosis by different cardiac imaging modalities in Williams syndrome

A 31 year old man was admitted for evaluation of dyspnoea and heart murmur. He had had exertional dyspnoea for several years. He had a typical posture with short stature and elfin face typical of Williams syndrome, characterised by protruded forehead, …

Tumour feeding vessel in metastatic intracardiac mass demonstrated by transthoracic Doppler echocardiography

A 65 year old man was admitted for evaluation of recent onset of weight loss and heart murmur. Physical examination revealed a regular heart rate of 62 beats/min and a blood pressure of 110/70 mm Hg. On cardiac auscultation, a grade 4/6 systolic murmur was heard over the …

Digitized QT dispersion by the Valsalva maneuver in hypertensive patients.

Background Hypertension is an important risk factor for sudden cardiac death, of which the incidence increases with increases in blood pressure. Prolonged QT dispersion has been identified to indicate increased risk of life-threatening ventricular arrhythmia and sudden cardiac death. In this study, QT dispersion was investigated in hypertensive patients during the strain phase of the Valsalva maneuver. Methods The study population included 75 subjects: 25 with normal blood pressure (Control), 25 with stage I hypertension (Group A), and 25 with stage II hypertension (Group B). Electrocardiography for QT dispersion was recorded at 25 mm/sec paper speeds before and during the Valsalva maneuver. Results The patients in Group B were significantly older than the controls (p<0.05). Differences in sex, smoking, diabetes, angina, and hyperlipidemia were not statistically significant between the three groups. The basal QT dispersion was 25.3±18.3 ms in the controls, 39.0±17.8 ms in Group A, and 36.8±18.8 ms in Group B. The QT dispersion was significantly higher in group A patients than the controls (p<0.05). In Group B only, a significant increase in QT dispersion was observed during the Valsalva maneuver, compared to conditions prior to the Valsalva maneuver (p<0.05). Conclusion The conditions that increase intrathoracic pressure may increase QT dispersion and severe hypertensive patients should avoid these conditions.