Sung-Ai Kim

Evaluation of Short-Term Use of N-Acetylcysteine as a Strategy for Prevention of Anthracycline-Induced Cardiomyopathy: EPOCH Trial - A Prospective Randomized Study

Background and Objectives We investigate to determine whether N-acetylcysteine (NAC) can prevent anthracycline-induced cardiotoxicity. Subjects and Methods A total of 103 patients were enrolled in this prospective randomized open label controlled trial. They are patients first diagnosed with breast cancer or lymphoma, who require chemotherapy, including anthracycline like adriamycine or epirubicine. Patients were randomized to the NAC group {n=50; 1200 mg orally every 8 hours starting before and ending after the intravenous infusion of anthracycline in all chemotherapy cycles (3-6)} or the control group (n=53). Primary outcome was the decrease in left ventricular ejection fraction (LVEF) absolutely ≥10% from the baseline and concomitantly <50% at 6-month. Composite of all-cause death, heart failure and readmission were compared. Results The primary outcome was not significantly different in the NAC and control groups {3/47 (6.4%) vs. 1/52 (1.9%), p=0.343}. The mean LVEF significantly decreased in both the NAC (from 64.5 to 60.8%, p=0.001) and control groups (from 64.1 to 61.3%, p<0.001) after the completion of whole chemotherapy. The mean LVEF change did not differ between the two groups (-3.64% in NAC vs. -2.78% in control group, p=0.502). Left ventricular (LV) end systolic dimension increased with higher trend in NAC by 3.08±4.56 mm as compared with 1.47±1.83 mm in the control group (p=0.064). LV end diastolic dimension did not change in each group and change does not differ in both. Peak E, A and E/A ratio change and cardiac enzymes were comparable in two groups. Cumulative 12-month event rate was 6% and 3.8% in the NAC group and the control group, respectively, with no difference (p=0.672). Conclusion We cannot prove that NAC prevents anthracycline-induced cardiomyopathy.

Functional recovery of regional myocardial deformation in patients with takotsubo cardiomyopathy

BACKGROUND Takotsubo cardiomyopathy (TC) is acute, but completely reversible in the absence of significant coronary artery disease. This study aims to assess the functional recovery of regional myocardial deformation in patients with TC using 2-dimensional (2D) speckle tracking echocardiography. METHODS Thirty-three patients diagnosed with TC (mean age 63 years, 26 female) prospectively underwent serial 2D echocardiography on day 1 (initial presentation), day 4 [the middle, interquartile range (IQR), 2-5 days], and day 21 (recovery, IQR 13-32 days). Twenty-one (64%) patients showed classical type of TC with akinesis of mid-left ventricular (LV) and apical segments and 12 (36%) of patients presented with mid-LV variant with apical sparing. Myocardial deformations were serially assessed using 2D strain analysis. All echocardiographic values on day 21 were compared with the corresponding values from 30 controls of similar age and gender. RESULTS LV ejection fraction (EF) gradually improved at follow-up (32±8% on day 1 vs. 62±4% on day 21, p<0.001). Despite no difference in LVEF between the patients with complete recovery (LVEF >60% on day 21) and controls, the patients showed significantly lower global longitudinal strain than controls. On regional analysis of the mid-LV segments, both longitudinal and circumferential strains of patients with TC were similarly diminished on day 1. During recovery, longitudinal strain showed more delayed recovery than circumferential strain compared to the values of controls. In LV apex of controls, circumferential strain normally presented higher value than longitudinal strain. In LV apex of patients with classical TC, the reduced circumferential strain on day 1 rapidly increased with a wide variation to maintain augmented circumferential shortening. CONCLUSIONS Quantifying LV myocardial deformation in patients with TC is informative in the detection of persistent subtle LV dysfunction and improves our understanding of regional myocardial mechanics during recovery.

Alpha-lipoic acid for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography: the ALIVE study - a prospective randomized trial.

Objectives: α-Lipoic acid (ALA) is widely used for diabetic neuropathy due to its antioxidant properties. We evaluated its potential for preventing contrast-induced nephropathy (CIN). Methods: We conducted a prospective randomized controlled trial to evaluate the efficacy of ALA in CIN prevention. Two hundred and two patients with basal renal insufficiency who received elective coronary angiography were randomized to the ALA group [ALA treatment for 2 days (600 mg orally three times a day before and after coronary catheterization, n = 100)] or the control group (n = 102). The primary end point was the maximum increase in serum creatinine (sCr) and the secondary end point was the incidence of CIN defined as an increase in sCr of either ≥25% or ≥44.2 µmol/l. Results: Mean maximum increase in sCr was not different between the ALA and the control group (-1.32 ± 30.5 vs. -1.19 ± 30.1 µmol/l, respectively; p = 0.977). sCr did not significantly change from baseline (120.8 ± 69.8 vs. 122 ± 88.1 µmol/l) in the ALA group and the simple saline hydration group (108.2 ± 37.5 vs. 110 ± 49 µmol/l). There was a lower rate of CIN in the ALA group than in the control group, but the difference was not statistically significant (3.0 vs. 6.9%, respectively; p = 0.332). Conclusion: ALA showed no benefit in CIN prevention.

Rationale and design of STOP DVT study: Rosuvastatin for the prevention of deep vein thrombosis in patients undergoing total knee replacement arthroplasty — A prospective randomized open-label controlled trial☆ , ☆☆ ,★

BACKGROUND Deep vein thrombosis (DVT) frequently occurs in high-risk cardiovascular patients receiving orthopedic surgery, despite prophylactic measures for its prevention. Statins, a class of drugs used to lower cholesterol levels, have been reported to help prevent the development of DVT. METHODS We will conduct a prospective randomized clinical trial to compare the effects of high-dose rosuvastatin plus a low-molecular-weight heparin (LMWH), enoxaparin, with conventional LMWH therapy in the prevention of DVT. Patients will be naive to both statins and anti-coagulants and then underwent total knee replacement arthroplasty (TKRA). In total, 180 patients will be randomized into two groups of 90, consisting of a LMWH group (40 mg enoxaparin subcutaneously beginning at 12h prior to surgery and continuing for 7 days every 24h after surgery) and a statin plus LMWH group (20mg rosuvastatin orally for 14 days, 7 days before and after surgery in combination with LMWH). All patients will undergo computed tomography angiography of both extremities 7 days after index surgery to assess the development of DVT. DISCUSSION DVT remains prevalent despite the use of conventional prophylactic measures, in part because certain patients (particularly the elderly) are unable to receive preventive treatment because of a high risk of bleeding complications and co-morbidity. Statins have been shown to have beneficial effects in arterial atherothrombosis and are frequently administered to elderly patients to treat coronary artery. We hypothesize that peri-operative statin treatment may be beneficial in those patients restricted from the conventional prophylaxis for DVT.

Endothelial Function and Cardiovascular Autonomic Activity in Neurally Mediated Syncope

Objectives: The aim of this study was to investigate endothelial function and cardiovascular autonomic activity in patients with neurally mediated syncope (NMS). Methods: Patients with a typical history of NMS were divided according to the result of a head-up tilt (HUT) test. There were 25 patients each in the HUT-positive (HUT+), HUT-negative (HUT-) and control groups. Flow-mediated dilation (FMD) and 24-hour ambulatory electrocardiography (AECG) were performed before the HUT tests. Results: The HUT+ group had a significantly higher FMD than that of the HUT- group and the control group (8.8 ± 3.3 vs. 6.4 ± 2.9%, p = 0.006, and 8.8 ± 3.3 vs. 5.7 ± 2.2%, p = 0.001, respectively). On a 24-hour AECG, the parasympathetic indexes of time domain, such as rMSSD and the pNN50, were significantly higher in the HUT+ group than in the HUT- group (39.0 ± 9.6 vs. 31.6 ± 9.6 ms, p = 0.016, and 16.5 ± 8.1 vs. 10.2 ± 7.2%, p = 0.002, respectively) and the control group (39.0 ± 9.6 vs. 28.9 ± 9.6%, p = 0.001 and 16.5 ± 8.1 vs. 8.7 ± 6.7%, p = 0.001, respectively). High-frequency spectra (parasympathetic activity) of the frequency domain showed similar results. Conclusions: Not only parasympathetic activity, but also endothelial function may affect the results of HUT tests in patients with NMS.

Functional changes of the myocardium in survivors of high-voltage electrical injury

IntroductionThere are limited long-term follow-up data on functional changes in the myocardium after high-voltage electrical injury (HVEI).MethodsTwenty-three patients who had been exposed to HVEI (>20,000 volts) and preserved left ventricular ejection fraction (≥55%) were enrolled in the study. Echocardiographic parameters, including peak systolic strain (S) and strain rate (SR), were evaluated at baseline, six weeks and six months later. These data were compared with a healthy control group who were matched in terms of age, sex and body mass index.ResultsThe systolic and diastolic blood pressure and the heart rate were significantly higher in the HVEI group compared with the control group at baseline and at six weeks, but not at the six-month follow-up. Conventional echocardiographic data showed no differences between the groups during the study period. In contrast to the S, the baseline and six weeks, SR was significantly increased in the HVEI group compared with the control group. However, at the six-month follow-up, there was no difference in the SR between the groups. Among the 23 patients with HVEI, 17 of the patients had vertical current injury, and 6 patients had horizontal current injury. There was no difference in terms of the conventional echocardiography, S and SR between the patients with vertical injury and those with horizontal injury at baseline and at the six-month follow-up.ConclusionsThe long-term contractile performance of the myocardium is preserved when patient do not experience left ventricular dysfunction in the early stages after HVEI.

[LB.02.15] EXERCISE TRAINING COULD REDUCE INFLAMMATORY ACTIVITY OF VISCERAL FAT IN OVERWEIGHT WOMEN

Objective: Visceral adipose tissue (VAT) is thought to confer increased insulin resistance and cardiovascular risk through leukocyte infiltration and increased adipose macrophage activity. Previous positron emission tomography (PET) studies using fluorodeoxyglucose(FDG) demonstrated that increased FDG uptake could reflect the severity of inflammation in the body. We hypothesized that exercise training could reduce VAT inflammatory activity as well as the body adiposity and it could be detected using combined FDG PET/computed tomography (CT). Figure. No caption available. Design and method: We observed 23 overweight women who participated in civil exercise training program. Anthropometric and lab data and FDG PET/CT were evaluated before and 3 months after an exercise program, consisting of aerobic exercise (45 min/session, 300 Kcal/day) and muscle strength training (20 min/session, 100 Kcal/day) 5 times per week. An one-hour torso PET/CT was performed after injection of FDG (370–555 MBq). The FDG uptake of VAT was measured using volumetric analysis tool of the PET/CT fusion image on a dedicated workstation and the maximum standardized uptake value (max SUV) in the regions of interest (ROI) was calculated. Results: At baseline, VAT SUV was significantly correlated to body weight (r = 0.764, p < 0.001), waist circumference (r = 0.586, p = 0.003) and body mass index (r = 0.821, p < 0.001). Follow-up VAT SUV levels significantly decreased from 1.11 to 0.46 (p < 0.001) along with a reduction in weight, waist circumference, and BMI. Conclusions: These findings suggest that exercise training could reduce not only the body adiposity but also VAT inflammation. FDG PET/CT would be useful to evaluate the inflammatory status of VAT and the effects of therapeutic intervention targeting for that.

Effectiveness of Self Blood Pressure Monitoring on Awareness and Attainment of Target Blood Pressure Goal: Nation-Wide Observational Study

Backgrounds: We investigated self blood pressure monitoring(SBPM) would improve the awareness of importance of blood pressure(BP) control, compliance of antihypertensive medications and the rate of blood pressure control in hypertensive patients. Methods: A total of 7,751 patients who visit out-patients clinic of private and university hospitals in Korea were recommended by duty physicians to measure self BP with automatic electronic BP monitors at home. Office BP changes before and after SBPM was compared. Attainment of target BP and compliance of antihypertensive drugs were also compared before and after SBPM. Patients and duty physicians were interviewed on perception of value of SBPM. Results: Mean BP significantly decreased from 142/88 mmg to 129/80 mmHg (P < 0.001) and target BP attainment rate increase from 5% to 15% (P = 0.02). Drug compliance measured by no medication day/week increased from 0.86 day to 0.53 day (P = 0.013). Only 33% and 57% of patients know the normal BP range and target BP respectively in patients. Awareness of importance of BP control increased from 90% to 98% after SBPM. Ninety two percents of physicians replied SBPM is important, 94% answered SBPM is helpful in controlling BP and 90% recommended their patients to measure SBPM. Conclusions: Self blood pressure monitoring improves BP control rate, drug compliance and knowledge of patients on BP. Most physicians acknowledge the importance and SBPM and recommend it for BP control in Korea.

Combined Traumatic Tricuspid Regurgitation and Acute Myocardial Infarction After Fist Blows to the Chest

A 15-year-old male patient with no previous medical history was brought to the emergency room after an assault. He was mentally confused, and his vital signs were as follows: blood pressure, 80/40 mm Hg; heart rate, 120 bpm; respiration rate, 22 breaths per minute; and body temperature, 36.5°C. The patient suffered multiple contusions all over his body with no evidence of fracture or bleeding. On auscultation, a subtle holosystolic murmur was heard at the left lower parasternal border. A chest x-ray demonstrated mild cardiomegaly, and an ECG showed sinus tachycardia with complete right bundle-branch block (Figure 1). Laboratory test results were as follows: serum creatinine phosphokinase, 5057 IU/L (normal range: 22–269 IU/L); creatinine phosphokinase-MB, 272.6 ng/mL (normal range: 0–7.2 ng/mL); troponin-I, >50 ng/mL (normal range: 0–0.3 ng/mL); serum myoglobin, >1200 ng/mL (normal range: 0–154 ng/mL); and urine myoglobin, >4000 ng/mL (normal range: 0–10 ng/mL). Transthoracic echocardiography revealed a moderate tricuspid regurgitation (TR) with a flail septal leaflet caused by chordae rupture (Figure 2 and Movie I in the online-only Data Supplement). However, …