Yong-Seok Cho

Long-Term Exercise Training Attenuates Age-Related Diastolic Dysfunction: Association of Myocardial Collagen Cross-Linking

The incidence of diastolic heart failure increases dramatically with age. We investigated the impact of long-term exercise training on age-related diastolic dysfunction. Old (25-month-old) male Fischer 344 rats were studied after 12 weeks of treadmill exercise training or sedentary cage life (N=7, in each group). We determined cardiac performance using a pressure-volume conductance catheter and magnetic resonance imaging. Collagen volume fraction (CVF) and myocardial collagen solubility by pepsin as an index of advanced glycation end products (AGEs) cross-linked collagen were measured. The maximal slope of systolic pressure increment (+dP/dt) and the slope of end-systolic pressure-volume relation were higher, and end diastolic volume (EDV), ΔEDV (the percentage of the EDV increment-to-baseline EDV) and the slope of end-diastolic pressure-volume relation were lower in training group. The maximal slope of diastolic pressure decrement (-dP/dt) and time constant of LV pressure decay (τ) had no difference. AGEs cross-linked collagen, not CVF was reduced by exercise training. Long-term exercise training appears to attenuate age-related deterioration in cardiac systolic function and myocardial stiffness and could be reduce in pathologic AGEs cross-linked collagen in myocardium.

Prognostic significance of asymptomatic coronary artery disease in patients with diabetes and need for early revascularization therapy

Aims  Information on the clinical outcome of patients with diabetes with silent myocardial ischaemia is limited. We compared the clinical and angiographic characteristics, and the clinical outcomes of diabetic patients with asymptomatic or symptomatic coronary artery disease (CAD).

The value of brachial-ankle pulse wave velocity as a predictor of coronary artery disease in high-risk patients.

Background and Objectives Arterial stiffness has been known as an independent contributory factor for coronary artery disease (CAD). Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of our study was to test whether baPWV had predictive value for CAD in the subset of patients with high pretest probability. Subjects and Methods We enrolled 174 consecutive patients who were referred for evaluation of suspected CAD, and who underwent both baPWV measurement and computed tomography (CT) for coronary artery calcium scoring (CACS) as part of a diagnostic work-up. Subsequently, 160 of those patients underwent invasive coronary angiography. The CAD indices consisted of 1) CACS, 2) modified Gensini scoring system, and 3) presence of obstructive CAD and 4) multi-vessel obstructive CAD. Results baPWV correlated with CACS (r=0.25, p=0.001), but not with modified Gensini scoring (r=0.10, p=0.19). However, after adjustment for factors influencing PWV, baPWV no longer correlated with CACS (r=0.14, p=0.14). By receiver operating characteristic (ROC) curve analysis, baPWV was neither a sensitive nor specific index for predicting the presence of obstructive CAD or multi-vessel obstructive CAD (sensitivity: 53% and 59%; specificity: 50% and 55%, respectively). Conclusion Our findings demonstrated that baPWV is associated with CACS, however, this may be primarily attributed to common risk factors, such as age. Furthermore, baPWV may be of limited value in identifying patients at risk for CAD.

Images in cardiovascular medicine. Acute myocardial infarction caused by extension of a proximal aortic dissection flap into the right coronary artery: an intracoronary ultrasound image.

A 69-year-old man with a history of hypertension was referred to our institution for management of acute myocardial infarction (AMI) and cardiogenic shock. The ECG showed a marked ST-segment elevation in leads II, III, and aVF and a reciprocal ST-segment depression in leads V2 through V6, suggesting an inferior wall AMI (Figure 1). Immediately after admission, the patient went into sudden cardiac and respiratory arrest and received cardiopulmonary resuscitation (CPR). A temporary pacemaker and an intra-aortic balloon pump were inserted during the CPR procedure, and emergent coronary angiography was performed. The right coronary angiogram showed no …A 69-year-old man with a history of hypertension was referred to our institution for management of acute myocardial infarction (AMI) and cardiogenic shock. The ECG showed a marked ST-segment elevation in leads II, III, and aVF and a reciprocal ST-segment depression in leads V2 through V6, suggesting an inferior wall AMI (Figure 1). Immediately after admission, the patient went into sudden cardiac and respiratory arrest and received cardiopulmonary resuscitation (CPR). A temporary pacemaker and an intra-aortic balloon pump were inserted during the CPR procedure, and emergent coronary angiography was performed. The right coronary angiogram showed no …