Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE.The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD.The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only.TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
Abstract Objectives: This study investigated the association between obesity type and obstructive coronary artery disease (CAD) in postmenopausal women. Methods: Study data were obtained from a nation-wide registry, composed of 659 women older than 55 years with chest pain undergoing elective invasive coronary angiography in the suspicion of CAD. Obstructive CAD was defined as angiographic findings of ≥50% diameter stenosis with any major epicardial coronary artery. Overall obesity was defined as a body mass index of ≥25 kg/m 2 , and central obesity was defined as a waist circumference of ≥85 cm. Results: A total of 311 women (47.2%) had obstructive CAD. The incidence of overall obesity was not different between participants with and without obstructive CAD ( P = 0.340), but the prevalence of obstructive CAD was significantly higher in participants with central obesity than those without (55.5% vs 41.0%, P < 0.001). There was no significant difference in body mass index between participants with and without obstructive CAD ( P = 0.373). Multivariable analysis showed that central obesity was associated with obstructive CAD even after controlling for potential confounders (odds ratio, 1.61; 95% confidence interval, 1.10-2.34; P = 0.013). However, overall obesity was not associated with obstructive CAD in the same multivariable analysis ( P = 0.228). Conclusions: Central obesity but not overall obesity is associated with obstructive CAD in postmenopausal women with stable chest pain undergoing invasive coronary angiography. Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A440.
The retrievable type of inferior vena cava filter has been widely used to prevent pulmonary thromboembolism in patients with deep vein thrombosis and contraindication of anticoagulation. Physicians make considerable efforts to remove the filter according to the manufacturer and US Food and Drug Administration safety advisory recommendation. However, forced filter retrieval might cause vascular injury within 3 weeks. Herein, we report pathologic and angiographic findings to suggest filter associated vascular injury during forced retrieval just within recommended period in a patient with deep vein thrombosis.
Background: Serum gamma-glutamyltransferase (GGT) was reported to be associated with type 2 diabetes, various cardiovascular disease risk factors, and individual components of metabolic syndrome.We performed a cross-sectional study to elucidate the relations between GGT and impaired fasting glucose (IFG). Methods:The subject of this study included 693 adults (males 272, females 421) aged 45 years or over who have lived in Chuncheon, a suburban small-sized city.IFG was defined as elevated fasting plasma glucose (FPG) concentration of ≥ 100 and < 126 mg/dl. Results:The risk of IFG appeared to increase with increasing levels of serum GGT even after adjusting for other covariates, such as body mass index and inflammatory markers among men only: adjusted odds ratios of IFG across GGT categories (< 25th, < 50th, < 75th and ≥ 75th) were 1.0, 0.56, 1.57, and 2.79, respectively (P-value for trend 0.022).In women, the association between the risk of IFG and GGT was not statistically significant. Conclusion:This study suggests that elevated level of GGT within the normal range is an independent predictor of impaired fasting glucose in middle-aged or older men but not in women.
Sex-related differences in the influence of metabolic syndrome (MetS) on various cardiovascular diseases have been suggested. The aim of this study was to investigate the effect of sex on the association between MetS and left ventricular (LV) diastolic dysfunction in patients with suspected coronary artery disease (CAD).Two hundred ten patients (105 men and age-matched 105 women; mean age: 56.5 ± 10.9 years) undergoing elective coronary angiography for the evaluation of CAD were studied. MetS was defined according to the International Diabetes Federation criteria. LV diastolic function was assessed using transthoracic echocardiography.The incidence of MetS was 23.8% in men and 14.3% in women (P = 0.079). The incidence of LV diastolic dysfunction was significantly different by MetS in women, but not in men. In multiple linear regression analyses, the number of MetS components was independently associated with septal e' velocity, E/e', and left atrial (LA) diameter in women (P < 0.05 for each). In men, the number of MetS components was associated with only LA size in this analysis. As the number of components of MetS increased, septal e' velocity decreased proportionally in women (P < 0.001), but not in men (P = 0.117).Among middle-aged and elderly Korean patients at high risk of CAD, the impact of MetS on LV diastolic dysfunction was more pronounced in women than in men. This suggests the important role of sex hormonal effects in the development of LV diastolic dysfunction in relation to MetS in this population.
Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
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