Wen-Ter Lai

Association Between Fasting Plasma Glucose and Left Ventricular Mass and Left Ventricular Hypertrophy over 4 Years in a Healthy Population Aged 60 and Older

OBJECTIVES: To test the association between fasting glucose level and left ventricular mass (LVM) and left ventricular hypertrophy (LVH) in people aged 60 and older.

Successful Retrieval of Dislodged Paclitaxel-eluting Stent with a Nitinol Loop Snare: A Case Report

Coronary stent dislodgment or embolization before deployment is a rare but challenging complication in interventional cardiology. Intracoronary embolization of the dislodged stent is associated with a high risk of coronary occlusion, due to thrombus formation and subsequent myocardial infarction. Furthermore, systemic embolization may cause severe cerebrovascular events. Nonsurgical retrieval strategies for this complication have been suggested, but bailout cardiac surgery may be indicated if percutaneous retrieval attempts fail. To our knowledge, this is the first case report of intracoronary drug‐eluting stent dislodgment, and successful retrieval was accomplished by a loop snare technique. With the increasing trend of using drug‐eluting stents in percutaneous coronary intervention, the likelihood of stent dislodgment or embolization may increase. It should be kept in mind, especially by coronary interventionists, how to manage this complication.

An Avoidable Complication of Percutaneous Coronary Intervention—Entrapment of Stent and Disconnected Balloon Catheter

During percutaneous coronary intervention, entrapment of catheter materials is a rare but life‐threatening complication that sometimes requires emergency surgical treatment. Coronary artery stents have been developed to prevent acute coronary closure and reduce restenosis after coronary angioplasty. The most frequently reported complications of coronary stents are related to stent thrombosis and anticoagulation problems. This case study describes a 60‐year‐old female who had stable angina pectoris and underwent stent insertion into the left circumflex artery. Unfortunately, the coronary stent with balloon catheter was entrapped while crossing the angulated segment between the left circumflex and left main coronary artery. The stent catheter was surgically removed, and the patient underwent coronary artery bypass grafting successfully. Physicians should keep in mind that extremely angulated segments may reduce the successful rate of coronary stenting and contribute to the stent entrapment complication.

Lercanidipine and Losartan Effects on Blood Pressure and Fibrinolytic Parameters

Antihypertensive agents may modulate fibrinolysis in addition to reducing blood pressure. We conducted a randomized trial to assess the effects of lercanidipine and losartan on blood pressure (BP) lowering and three fibrinolytic parameters: plasminogen activator inhibitor−1 (PAI‐1), D‐dimer, and fibrinogen. All patients enrolled had essential hypertension and underwent a placebo run‐in period of 2 weeks before randomization to either lercanidipine tablets 10‐20 mg once daily or losartan tablets 50‐100 mg once daily. Twenty‐six patients completed this study. After 8 weeks of treatment, both groups of patients had significantly reduced systolic (SBP) and diastolic BP (DBP) (SBP, p = 0.034 and 0.050, respectively; DBP, p = 0.018 and 0.034 for lercanidipine and losartan, respectively). Both drugs were well tolerated. Only in the group treated with lercanidipine was PAI‐1 concentration significantly reduced (57.1 ± 4.7 to 43.1 ± 4.8 ng/ mL, p = 0.047). No difference was found with D‐dimer and fibrinogen in either group. This study shows that both lercanidipine and losartan are effective antihypertensive drugs in patients with essential hypertension. Lercanidipine may provide additional benefit in fibrinolysis.

Randomized Comparative Study of the Effects of Treatment with Once-Daily, Niacin Extended-Release/Lovastatin and with Simvastatin on Lipid Profile and Fibrinolytic Parameters in Taiwan

Hyperlipidemia can be effectively treated either with niacin or HMG‐CoA reductase inhibitor (statin), or a combination of both. Few reports showed the effects of the combination regimen with niacin and statin on hemostatic functions. We conducted a single‐center, double‐blind, double‐dummy, randomized, two‐arm study to assess the effects of the niacin extended‐release/lovastatin therapy in a fixed‐dose formulation and of simvastatin on lipid lowering and two fibrinolytic parameters, fibrinogen and d‐dimer. All patients were enrolled according to NCEP‐ATP III guidelines and underwent a placebo run‐in period of 4 weeks before being randomized to either niacin extended‐release/lovastatin tablets (500/20 mg) once daily (n = 36) or simvastatin capsule (20 mg) once daily (n = 34). After 16 weeks of treatment, both groups of patients showed significantly reduced low‐density lipoprotein cholesterol and total cholesterol (LDL‐C, p < 0.001 and < 0.001, respectively, p = 0.159 between the groups; TC, p < 0.001 and < 0.001, respectively, p = 0.018 between the groups). Both drugs were well tolerated. Only in the group treated with niacin extended‐release/lovastatin was fibrinogen concentration significantly reduced after treatment (2.48 ± 0.65 to 1.99 ± 0.62 g/L, p = 0.008). No difference was found with d‐dimer in either group. This study shows that both niacin extended‐release/ lovastatin and simvastatin are effective and well‐tolerated lipid‐lowering drugs in Taiwanese patients with dyslipidemia. A combinational treatment with niacin extended‐release/lovastatin may provide additional benefit in fibrinolysis.

Tolerability of Ramipril 10 mg Daily in High-risk Cardiovascular Patients in Taiwan: Experience from Kaohsiung Medical University Chung-Ho Memorial Hospital

The Heart Outcomes Prevention Evaluation (HOPE) study demonstrated that the angiotensin‐converting enzyme inhibitor, ramipril, significantly reduces mortality, myocardial infarction and stroke in high‐risk cardiovascular patients, beyond the benefits from blood pressure lowering. The tolerability of ramipril 10 mg/day has been an important concern when applying these results. Following the same criteria as the HOPE study, we investigated the adverse effects profile and tolerability of 10 mg ramipril in high‐risk patients at our institution. In total, 92 patients with high cardiovascular risk were eligible for this study. Initially, ramipril was prescribed 2.5 mg orally once daily, and then titrated up to 5.0, 7.5, and 10.0 mg/day at 1‐month intervals. The target maintenance dose was 10 mg/day. All adverse events were recorded during at least 3 months of follow‐up. After 4‐6 months of the titration protocol, only 18 patients (25.3%) reached and remained on ramipril 10 mg/day; 11 (15.5%), 22 (30.9%), and 20 patients (28.2%) remained on 2.5, 5.0, and 7.5 mg/day, respectively. Twenty‐one patients (22.6%) had at least one adverse event. Twelve patients (13.0%) stopped treatment because of adverse effects. A total of 23 episodes of adverse events were reported, including cough (15.1%), dizziness (6.0%), and hypotension (2.4%). Ramipril was relatively well tolerated in our study population. However, only one‐quarter of our patients reached the target maintenance dose of 10 mg/day. Dry cough, dizziness, and hypotension were the major side effects. About 15% of our patients discontinued ramipril treatment, which is comparable with previous reports.

Inducible atrioventricular nodal reentrant echo behind organic 2:1 infra-hisian block during sinus rhythm.

A 77‐year‐old male patient with an intermittent 2:1 infra‐Hisian block during sinus rhythm was presented with dizziness and near‐syncope. During electrophysiological (EP) study, dual atrioventricular (AV) nodal pathways and retrograde fast pathway were easily induced by atrial and ventricular programmed stimulation, respectively. A typical slow‐fast AV nodal reentrant echo beat also could be demonstrated by single atrial extrastimulation. Atrioventricular nodal reentrant tachycardia (AVNRT) can occasionally exhibit 2:1 AV block. Conversely, AV nodal reentry property had been rarely reported behind 2:1 infra‐Hisian block. The EP presentation from this case may support the notion that tissues below the His are not part of the reentrant circuit of AVNRT.

ST-segment Elevation Acute Myocardial Infarction in a Patient with Acromegaly: A Case Report and Literature Review

Acromegaly is a disorder caused by the excess production of pituitary growth hormone and is characterized by the enlargement of the hands, feet and head. Increased morbidity and mortality with acromegaly is associated with cardiovascular complications, hypertension, glucose intolerance, cardiomyopathy and coronary artery disease. We report a case of acromegaly, which presented with ST‐segment elevation acute myocardial infarction. The patient received successful primary transluminal coronary angioplasty with stent implantation. Acromegaly was suspected from typical appearance, and confirmed with hormonal examination and imaging of the pituitary mass. We discuss this case in comparison with previous literature.