Background/Aims: We examined the ischemia-modified albumin (IMA) level during exercise in patients with coronary artery disease (CAD).Methods: Forty patients with a history of chest pain underwent both symptom-limited treadmill exercise stress testing and coronary angiography within one week. During the treadmill tests, blood samples were obtained at baseline and 5 min after exercise to measure the serum IMA level.Results: Of the 40 patients, fourteen (35%, CAD group) had significant coronary artery stenosis, while the other 26 (65%, non-CAD group) did not. The baseline and post-exercise IMA levels in the two groups did not differ significantly (105.2±7.2 vs. 107.7±6.7 U/mL at baseline and 93.1±10.1 vs. 94.8±5.7 U/mL at post-exercise in the CAD and non-CAD groups, p=0.29 and 0.57, respectively). The changes in IMA after exercise did not differ either (-10.4±7.5 vs. -14.0±7.6 U/mL in the CAD and non-CAD groups, respectively, p=0.10). Similarly, the change in IMA between the exercise ECG test positive (TMT positive, n=9) and negative (TMT negative, n=20) groups did not differ (-14.63±5.19, vs -8.50±9.01 U/mL, p=0.15, in the TMT positive and negative groups, respectively).Conclusions: Our results suggest that IMA has limitation in detecting myocardial ischemia during symptom-limited exercise stress tests.
Background and Objectives:The pathologic Q wave was once considered to be a sign of transmural myocardial infarction (MI), but the exact meaning of the pathologic Q wave remains to be elucidated. To evaluate the meaning of the pathologic Q wave using magnetic resonance imaging (MRI) investigations, which has recently emerged as a state-of-the-art diagnostic modality within cardiology. Subjects and Methods:Thirty eight consecutive patients with acute myocardial infarction were enrolled in this study. MRI and coronary angiography were performed in all patients during their admission. A 32 segment model was used to analyze the MRI findings. Just before MRI, the electrocardiograms of all the patients were checked and the presence of the pathologic Q wave evaluated. The ischemic territories in each patient were quantified by the number of dysfunctional segments. Myocardial necrosis was determined by the area of delayed hyperenhancement in contrast enhanced MRI, and the myocardial necrosis index per segment was defined as the ratio of the hyperenhanced area to that of the entire segment. The total necrosis index was defined as the sum of all the myocardial necrosis indices in a patient, and the average necrosis index of dysfunctional segment (ANI) was calculated from the total necrosis index/number of dysfunctional segments in a patient. The transmurality of infarction was also assessed. Results:Of all 38 patients, 26 showed a pathologic Q wave on ECG (Group A), whereas the other 12 did not (Group B). The number of dysfunctional segments, total necrosis index and frequency of transmural infarction (defined by infarct transmurality ≥ 75% of wall thickness) were no different between the two groups. The infarct transmurality over 25 or 50% and ANI were significantly different between the two groups. In a multivariate analysis, an infarct transmurality over 50% and ANI were significant factors in determining the presence of a pathologic Q wave. Conclusion:By an in vivo analysis of myocardial necrosis, as determined by MRI in acute myocardial infarction, an infarct transmurality over 50% and average necrosis index of dysfunctional segments (ANI) might be significant factors in the genesis of a pathologic Q wave. (Korean Circulation J 2004; 34(10):945-952) KEY WORDS:Magnetic resonance imaging;Q wave;Myocardial infarction.
Background and Objectives:In the era of stents, lesion length remains an important predictor of restenosis. Drugeluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions. Subjects and Methods: Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions ≥51 mm in length. Results: The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0±18.15% in Group 1, 12.61±21.99% in Group 2, and 19.81±31.26% in Group 3 (p< 0.05). Late lumen loss was 0.17±0.50 mm in Group 1, 0.39±0.66 mm in Group 2, and 0.59±0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm). Conclusion: DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up. (Korean Circ J 2008;38:612-617)
Background Inappropriate sinus tachycardia IST manifests chronic nonparoxysmal sinus tachycardia in healthy individuals and is characterized by consistently elevated heart rate and exaggerated responses to minimal physical activity. Heart rate variability HRV using 24-hour Holter monitoring represents one of the methods of evaluating the harmony of autonomic nervous system activity. So, authors investigate the autonomic nervous system activity by the HRV in patients with IST. Methods We compared the pattern of cardiac sympathetic and parasympathetic activity through the time domain analysis of heart rate variability with 24-hour Holter monitoring between 23 patients with IST and 23 healthy control subjects. None of the patients had organic heart disease as determined by routine laboratory examination and echocardiography. And then, time domain measures mean NN, SDNN, SDANN, SD, rMSSD, pNN50 were analyzed. Results The mean age of patients and control were 38 10 and 37 9 years, respectively p NS . The mean clinical heart rate of patients and control was 104 5/min and 72 5/min, respectively p 0.05 . Among the time domain indices, mean of all normal RR intervals mean NN , standard deviation of all normal RR intervals SDNN , standard deviation of mean RR interval SDANN , mean of standard deviations of all normal RR intervals SD , root mean square successive differences between adjacent normal RR intervals rMSSD , and percent of difference between adjacent normal RR intervals pNN50 in the patient group were significantly shorter compared to control group p 0.01 . Conclusion In IST, cardiac vagal influence on the heart rate is blunted. Korean Circulation J 2000 ; 30 9 : 1133-1138
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