Blood glucose variability is receiving considerable attention as a new risk factor for coronary artery disease. This study aimed to investigate the association between blood glucose variability and coronary plaque tissue characteristics.In 57 patients with acute coronary syndrome, integrated backscatter intravascular ultrasound (IB-IVUS) and gray-scale IVUS were performed before balloon dilatation or stent implantation in the culprit vessels. Standard IVUS indices were evaluated for volume index (volume/length), and plaque components were measured by IB-IVUS for percent tissue volume. In addition to conventional glucose indicators, blood glucose variability in a stable state was determined by calculating the mean amplitude of glycemic excursions (MAGE) using a continuous glucose monitoring system.Higher MAGE values were significantly correlated with larger percent plaque volumes (r = 0.32, p = 0.015), and increased lipid (r = 0.44, p = 0.0006) and decreased fibrous (r = -0.45, p = 0.0005) plaque components. In contrast, HbA1c or fasting plasma glucose values were not significantly correlated with plaque volumes and percent plaque components. Homeostasis model assessment of insulin resistance values were positively correlated with vessel (r = 0.35, p = 0.007) and plaque (r = 0.27, p = 0.046) volumes, but not with percent plaque components. In multiple regression analysis, higher MAGE values were independently associated with increased lipid (β = 0.80, p = 0.0035) and decreased fibrous (β = -0.79, p = 0.0034) contents in coronary plaques.Among all glucose indicators studied, only higher blood glucose variability was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting blood glucose variability as one of the important factors related to coronary plaque vulnerability.
Background: Fractional flow reserve (FFR) is an index of the severity of coronary stenosis that has been clinically validated in previous randomized trials. Instantaneous wave-free ratio (iFR) and resting distal coronary artery pressure / aortic pressure (Pd/Pa) are nonhyperemic pressure-derived indices of the severity of stenosis with discordant reports regarding their accuracy compared with FFR. This study sought to examine the correlation between FFR and other parameters including iFR, Pd/Pa and iFR during adenosine administration (iFRa). Methods: iFR, Pd/Pa, iFRa, and FFR were performed in 49 intermediate lesions in 43 patients. iFR and Pd/Pa were measured without hyperemia. iFRa and FFR were measured during maximal hyperemia using intravenous adenosine. We examined the correlation between FFR and each of iFR, Pd/Pa, and iFRa. Using the cut off value of 0.80 by FFR as a gold standard of ischemic threshold, the specific thresholds of iFR, Pd/Pa and iFRa were assessed. Results: Of 49 submitted lesions, 2 (4%) were excluded because of inadequate acquisition of pressure values, leaving 47 for final analysis. The correlation between FFR and iFR, Pd/Pa, and iFRa demonstrated an r of 0.71 (p Conclusions: iFR and Pd/Pa had less accuracy to predict myocardial ischemia as compared with iFRa, indicating that these pressure derived index without vasodilatation might be insufficient to assess coronary stenosis severity.
Primary biliary cholangitis (PBC) patients who are refractory to ursodeoxycholic acid (UDCA) are at risk for progression to cirrhosis and liver failure. Bezafibrate could be an alternative second-line therapeutic option in these patients. This study aimed to evaluate the long-term outcome(s) of combined UDCA and bezafibrate therapy in UDCA-refractory PBC patients and identify prognostic factors.Among 445 patients treated with UDCA, 150 patients inadequately responded to UDCA monotherapy and received long-term UDCA plus bezafibrate (median, 15 years). Data from these patients were used for this retrospective analysis.Combination therapy resulted in significant improvements in serum biochemistry and liver transplantation risk estimated using the UK-PBC-risk and the GLOBE scores. The cumulative normalization rates of alkaline phosphatase, gamma-glutamyltransferase, and immunoglobulin M (IgM) were significantly higher in patients without cirrhosis-related symptoms or liver-related events than in those with them. Overall, IgM constantly emerged as a significant factor associated with cirrhosis-related symptoms and liver-related events at all time points. Cumulative survival rates were significantly lower in patients with IgM ≥ 240 mg/dL than in patients with IgM < 240 mg/dL. Thus, normalization of IgM levels was a good surrogate predictor of long-term prognosis. None of the patients discontinued combination therapy due to any adverse events during the follow-up period.Our findings point to the beneficial effects of long-term UDCA plus bezafibrate combination therapy for UDCA-refractory PBC patients, and IgM response can be a useful predictive biomarker of long-term clinical outcomes.
A case of 7-year-old boy with tetralogy of Fallot associated with DiGeorge syndrome was reported. He had been diagnosed as cardio-facial syndrome with hypoparathyroidism because of hypocalcemia, convulsion, cardiac defect and the characteristic face. But immunologic study showed hypofunction of cellular immunity and cardiac catheterization and angiogram revealed the Tetralogy of Fallot. So we diagnosed as DiGeorge syndrome and performed operation. The thymus was not found and we close the ventricular defect with patch and reconstructed right ventricular outflow tract with transannular patch. We often measured serum ionized calcium level and corrected with calcium gluconate intravenously. Peritoneal dialysis was done due to oliguria and much inotropic support was necessary.
