Background-We intended to identify proteins that are differentially expressed in human atherosclerotic plaques. Methods and Results-Comparative 2-dimensional electrophoretic analysis on carotid atherosclerotic endarterectomy specimens (nϭ10) revealed that heat shock protein 27 (Hsp27) expression was significantly increased in the nearby normal-appearing area compared with the plaque core area from the same vessel specimen, which was further confirmed by Western blot analysis. The Hsp27 expression in the adjacent normal-appearing vessel areas was much higher than that in nonatherosclerotic reference arteries. The phosphorylation of Hsp27 showed a gradation in the degree of phosphorylation: greatest in the reference arteries, intermediate in the adjacent normal-appearing area, and lowest in plaque core area. Immunohistochemical analysis showed that the phosphorylation of Hsp27 of smooth muscle cells in the carotid endarterectomy specimens was decreased compared with that in the reference artery specimen. The mean plasma level of Hsp27 was significantly higher in patients with acute coronary syndrome (ACS) (nϭ27; 106.1Ϯ74.1 ng/mL) than in the normal reference subjects (nϭ29; 45.8Ϯ29.5 ng/mL; PϽ0.005). The plasma levels of Hsp27 were significantly correlated with those of heat shock protein 70 (Hsp70) (rϭ0.422, PϽ0.0005), with adjustment for ACS/reference status. Conclusions-In the atherosclerotic lesion, Hsp27 expression is increased in the normal-appearing vessel adjacent to atherosclerotic plaque, whereas levels in the plaque itself are significantly decreased. Both plaque and adjacent artery show decreased Hsp27 phosphorylation compared with reference vessel. In ACS, plasma Hsp27 and Hsp70 are increased, and levels of Hsp27 correlate with Hsp70, C-reactive protein, and CD40L levels.

SummaryBackground: N-terminal pro-brain natriuretic peptide (NTproBNP) is increased in patients with hypertrophic cardiomyopathy (HCM); however, the determinants of NT-proBNP level have not been clarified in HCM.Hypothesis: This study was performed to determine the relationship between NT-proBNP levels and various echocardiographic variables of patients with HCM and normal left ventricular ejection fraction (LVEF).Methods: We assessed plasma NT-proBNP levels and echocardiographic variables of 36 patients (19 men, 58 ± 14 years) with HCM and an LVEF of ≥ 55%. Echocardiographic variables measured were LV wall thickness, end-diastolic LV internal dimension (LVIDd) and volume (LVEDV), LV mass, and LV mass index (LV mass/body surface area, LVMI). Left ventricular outflow tract pressure gradient, transmitral E and A velocities, deceleration time (DT) of the transmitral E wave, and septal annular E' velocity were measured by Doppler tech-

A 44-year-old woman underwent surgery for an asymptomatic primary tumor of the heart located in the right atrium. The tumor was detected incidentally during follow-up computed tomography for a resected breast cancer. The mass, lying along the lower portion of the right atrial septum, was homogenous and cystic in nature, as detected by transthoracic and transesophageal echocardiography. Complete resection was performed via a median sternotomy under cardiopulmonary bypass. The postoperative course was uneventful. However, the histological result was surprising: the mass was a cardiac lymphangioma.

Background and Objectives：The goals of this study were to investigate the prevalence and risk factors of carotid atherosclerotic stenosis and also the predictors for the progression of carotid atheroslcerotic stenosis in Korean adults. Subjects and Methods：Carotid ultrasonography was performed for 22,782 adults who volunteered for a routine health check-up. Carotid atheroslcerotic stenosis was defined as a finding of at least one lesion of an intima-media thickness greater than 1.2 mm with atherosclerotic plaque. Among the 22,782 people, 4,077 persons underwent follow-up carotid ultrasonography at an average interval of 27.6 months. The past medical history and information on the cardiovascular risk factors were obtained from standardized questionnaires and the subjects' blood chemistry. Results：Carotid atheroslcerotic stenosis was detected in 1,875 adults (8.2%) and it was significantly associated with a history of stroke, hypertension, heart disease, hyperlipidemia, higher HbA 1 C, older age, a wider pulse pressure, lower HDL-cholesterol and a large amount of smoking (p<0.05). In the subjects without history of stroke (22,444 persons), those with more than 5 risk factors showed a higher prevalence (36.8%) of carotid atherosclerotic stenosis than those with a history of stroke (29.0%). The independent predictors of stenosis progression were older age, male gender, hypertension, a large amount of smoking, a high LDL cholesterol level, a low HDL-cholesterol level and a high fibrinogen level (p<0.05). Conclusion：Carotid ultrasonographic screening for a population with these risk factors will lead to a more efficient screening process and our identification of the predictors of disease progression may help to design therapeutic trials for preventing the progression of carotid atherosclerotic stenosis.

Background and Objectives：Percutaneous cardiopulmonary support (PCPS) provides hemodynamic stability for the treatment of patients suffering with cardiogenic shock or cardiac arrest, and it can be used in a wide variety of clinical settings without the need for chest exploration. In this study, we summarize a single center's experience with performing PCPS in the patients who suffered with severe cardiopulmonary failure. Subjects and Methods： We retrospectively reviewed 30 consecutive patients with cardiac arrest or severe cardiogenic shock who received PCPS for cardiac resuscitation from November 2003 to July 2005. The self-priming, heparin-coated circuit of the Emergency Bypass System ® was used in all the patients. Cannulation was performed via the femoral artery and vein with using an arterial (17 to 21 French) and venous cannula (21 to 28 French), percutaneously or with a small incision. Results：The Indications for PCPS were: ischemic heart disease before coronary revascularization, myocardial disease, PCI-associated complications and post-operative hemodynamic collapse. Of the 30 patients we evaluated, 19 patients (63%) were successfully weaned off of the PCPS; 14 of these patients (47%) were later discharged from the hospital. For the survivors, the time interval from cardiac arrest or severe cardiogenic shock to the onset of PCPS was significantly shorter (p=0.01), and the urine output for the initial 24 hours was significantly higher (p=0.04). Conclusion：This retrospective analysis demonstrates the effectiveness of using PCPS for the treatment of critically unstable patients with cardiac arrest or cardiogenic shock. Larger scale studies of PCPS are now needed to confirm these findings. (Korean Circulation J 2006;36:11-16) KEY WORDS：Shock, cardiogenic；Cardiac arrest.

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A prosthetic valve thrombus that occludes the blood flow or interferes with the valvular function is a rare, but lifethreatening complication after prosthetic valve replacement. The patient's adherence with taking his anticoagulant medication is most critical. However, as seen in this presentation, the location of the prosthetic valve at the supra coronary sinus site may also be important. For the patient in this study, the blood flow and the speed of the flow through the valve were significantly reduced because the flow from the coronary sinus bypassed the prosthetic valve. This particular location of the prosthetic valve may be one of the risk factors that caused the thrombus. The rightsided prosthetic valve thrombus was successfully treated by thrombolysis with using urokinase, and there was no evidence of pulmonary embolism.

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