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관상동맥 경련이 의심되는 한국인에서 0.4㎎ Ergonovine Maleate 단일괴 사용법에 의한 유발 검사
고광곤,윤진,이기형,우재순,김치열,김영범,조철호,조상균,김삼수 대한내과학회 1992 대한내과학회지 Vol.42 No.2
관상동맥 경련은 허혈성 심질환의 다양한 임상상에 역할을 한다. 관상동맥조영검사가 경련을 진단 내리는데 유일한 직접적인 검사 방법이다. 경련을 유발시키기 위해서 여러 검사 방법들이 사용되었지만, ergometrine이 경련을 유발시키는데 가장 효과적 약물이라고 발표되었다. 여러 사람들이 다양한 용량과 다양한 방법으로 ergonovine을 사용해왔다. 하지만 ergonovine의 dose-response curve는 누적용량(0.1+0.2+0.3+0.4㎎)이 0.4㎎의 단일 용량과 똑같은 효과를 보였고, 용량 중강 방법이 시간 소비적이am로 0.4㎎ ergometrine 단일괴를 사용하여 검사한 결과, 위험성이 용량 중강 방법과 차이가 없다고 발표되었다. 방법 : 비전형적 흉통을 주소로 하는 6명과 급성 심근경색증 1명 모두 7명을 A군, 임상적으로 이형협심증이 강력히 의심되는 환자 6명을 B군으로 나누어 13명 환자들에게 단일괴 0.4㎎ ergonovine을 정주하여 검사하였다. 결과 : A군 환자들에게 관상동백조영검사상 30% 이하의 미만성 혈관수축을 관찰하였고, 흉통이나 심전도 변화는 없었다. B군 환자들에게 관상동맥조영검사상 2명에서 우측 관상동맥이 각각 100%, 95% 협착, 1명에서 좌전하행지 완전 협착, 1명에서 좌측 회선지 완전 협착, 2명에서 50에서 75%에 이르는 미만성 삼혈관상동맥 협착 소견을 관찰하였다. 6명 모두 전형적 협심증을 호소하였고, 6명중 2명에서 ST-T분절 변화 소견을 보였다. 저자들은 이형협심증이 의심되는 한국인에서 단일괴 0.4㎎ ergonovine 검사 방법을 치명적인 부정맥이나 심경색증, 사망 등의 합병증 없이 좋은 결과를 얻고 시행하였다. 결론 : 0.4㎎ 단일괴 ergonovine 유발 검사는 관상동맥 환자들은 진단내리는 데 예민하고 특이적이고 임상적으로 유용한 방법이며, 대상과 금기 사항을 잘 가기고 주의사항을 잘 알고 이행하며, 한국인에서도 안전하고 정확하게 시행될 수 있는 방법이라고 생각된다. Background. Many tests have been proposed for the provocation of coronary arterial spasm. But, ergonovine maleate has been known to be most effective for the provocation. Although ergonovine testing is usually safe, a number of complications have been described. Therefore, several investigators recommend the use of incremental doses starting with an intravenous injecion of 0.05~0.1㎎ followed by small incremdents of 0.1~0.15㎎ at 2~5 min intervals up to a maximum of 0.4㎎. By a dose-response curre of ergonovine, the cumulative doses (0.1+0.2+0.3+0.4㎎) have the same effects that a single dose of 0.4㎎ Methods. Because the technique with incremental doses is time-consuming, we performed using a single bolus of 0.4㎎ ergonovine intravenously without any increments in 13 patients who were divided clinically into 2 groups: group A: 7 patients with atypical chest pain (6) and acute myocardial infarction (1). group B: 6 patients with strongly suspected variant angina. Results. In group A patients coronary angiography demonstrated less than 30% diffuse vasoconstriction not accompanied by chest pain or electrocardiographic changes. In group B patients coronary angiography demonstrated right coronary artery 100%, 95% stenosis in 2 patient, total occlusion of left circumflex coronary artery in 1 patients and more than 50% to 75% stenosis of diffuse three vessel coronary in 2 patients. All six patients complained of typical angina and 2 of 6 patients showed ST-T segment changes. We performed using a single bolus of 0.4㎎ ergonovine to provoke coronary arterial spasm in Korean patients without major arrhythmia, myocardial infarction or sudden death. Conclusion. Provocative testing with a single bolus of 0.4㎎ ergonovine maleate in Korean is safe, time-saving and radiation exposure-reducing if precautions and contraindications are used.
Hypertriglyceridemia and Cardiovascular Diseases: Revisited
고광곤,한승환,Stephen J Nicholls,Ichiro Sakuma,Dong Zhao 대한심장학회 2016 Korean Circulation Journal Vol.46 No.2
Residual cardiovascular risk and failure of high density lipoprotein cholesterol raising treatment have refocused interest on targeting hypertriglyceridemia. Hypertriglyceridemia, triglyceride-rich lipoproteins, and remnant cholesterol have demonstrated to be important risk factors for cardiovascular disease; this has been demonstrated in experimental, genetic, and epidemiological studies. Fibrates can reduce cardiovascular event rates with or without statins. High dose omega-3 fatty acids continue to be evaluated and new specialized targeting treatment modulating triglyceride pathways, such as inhibition of apolipoprotein C-III and angiopoietin-like proteins, are being tested with regard to their effects on lipid profiles and cardiovascular outcomes. In this review, we will discuss the role of hypertriglyceridemia, triglyceride-rich lipoproteins and remnant cholesterol on cardiovascular disease, and the potential implications for treatment stargeting hypertriglyceridemia.
고광곤,Ichiro Sakuma,Kazunori Shimada,Toshio Hayashi,Michael J. Quon 대한심장학회 2017 Korean Circulation Journal Vol.47 No.4
Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.