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Although uric acid (UA) level has been associated with an increased risk of cardiovascular events, it is unclear whether UA can provide greater prognostic information than N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) in advanced heart failure with nonischemic dilated cardiomyopathy (DCM). UA and NT‐proBNP values were obtained from a total of 122 DCM patients. Development of clinical events during follow‐up was defined as the composite of cardiac death and readmission for heart failure. During follow‐up, there were 18 cardiac events. UA and NT‐proBNP values were significantly higher in patients with events. The receiver operating characteristics curve showed the area under the curve for UA was greater than that for NT‐proBNP. On multivariate analysis, UA remained the only independent predictor of prognosis. UA concentrations ≥8.7 mg/dL rather than NT‐proBNP ≥3800 pg/mL were associated with significantly decreased event‐free survival. The authors' findings demonstrated that UA value could be an informative predictor in nonischemic DCM. Congest Heart Fail. 2010;16:153–158. © 2010 Wiley Periodicals, Inc.

Background and ObjectivesAnticoagulation with vitamin K antagonists (VKAs) such as warfarin provides effective stroke prophylaxis in patients with atrial fibrillation (AF). We conducted a large multicenter survey of Korean patients with AF to determine trends in VKA use.Subjects and MethodsEligible patients were adults with AF that had been prescribed VKAs. Medical records from a total of 5616 patients {mean age 63.6±12.2 years, male 3150 (56.1%)} in 27 hospitals from Jan. 2001 to Oct. 2007 were reviewed.ResultsThe mean international normalized ratio (INR) was 2.04±0.64, and mean dosage of VKA was 3.66±1.50 mg. Individuals in their sixties (1852 patients) accounted for about one third of patients studied. As patients grew older, INR increased and VKA dosage decreased. The dosage of VKA in male patients was larger than that in females for all ages. A total of 2146 (42.4%) patients had an INR of 2-3, and less than 40% patients in their sixties had an INR within optimal range. The dosage of oral anticoagulant for optimal INR level was 3.71 mg.ConclusionIn this study, less than half of the Korean patients with AF on VKA reached the therapeutic range of INR. Mean dosage of VKA was 3.66±1.50 mg, and the dosage of oral anticoagulant for optimal INR level was 3.71 mg, which decreased with age.

Left ventricular (LV) diastolic dysfunction with preserved ejection fraction is frequently encountered in clinical practice. However, the relations between LV filling patterns and myocardial function by using two-dimensional (2D) speckle tracking imaging are not well known. One hundred thirteen individuals (mean age 59 ± 12 years), referred for a clinically indicated echocardiogram, underwent standard and 2D strain echocardiography. The subjects were divided into groups on the basis of diastolic function by using standard Doppler indices, and we compared 2D strain/strain rate parameters between groups. Subjects with mild to moderate LV diastolic dysfunction showed a high left atrial volume index (LAVI) and early mitral inflow to annular velocity ratio. With regard to 2D strain/strain rate, the severity of diastolic dysfunction was associated with low peak strain, and low systolic and early diastolic strain rate of longitudinal, circumferential and radial deformations, whereas the late diastolic strain rate was not. In multivariate analysis, LAVI and circumferential early diastolic strain rate were most associated with the severity of diastolic dysfunction, although longitudinal and circumferential peak strains were also of significant correlation. In addition to LAVI, the circumferential early diastolic strain rate would be a useful parameter in the assessment of the severity of diastolic dysfunction with preserved ejection fraction.

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LV twist was significantly associated with VAC in accordance with LV function; LV twist and VAC decreased progressively as LV systolic function deteriorated, while being enhanced during the well-compensated phase.

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