관동맥 질환 환자에서 Lipoprotein ( a ) 농도와 당내인성과 관련성

두영철(Young Cheoul Doo),최조영(Jo Young Choi),장명국(Myung Kuk Jang),홍성훈(Sung Hun Hong),장명준(Myeong Jun Chang),고순희(Soon Hee Koh),한규록(Kyoo Rok Han),오동진(Dong Jin Oh),유규형(Kyu Hyung Ryu),고영박(Young Bahk Koh),이영(You 대한내과학회 1996 대한내과학회지 Vol.51 No.4

N/A Objectives: A raised Lp (a) lipoprotein concentration is associated with coronary artery disease and impaired glucose intolerance has also been shown to be predictive of coronary artery clisease in some studies. It has been suggested that there is a significant association between impaired glucose tolerance and increased circulating Lp (a) lipoprotein concentration. The object of this study is to determine whether glucose intolerance and raised Lp (a) concentration are associated in subjects with coronary artery disease. Methods: The study group comprised 60 patients with coronary artery disease (M:20, mean age 56+/-13 year) and 70 control subjects without coronary artery disease (M:15, mean age 58+/-10 year). We compared the clinical variables, lipid profile including Lp (a), fasting glucose, and fasting insulin in subjects with coronary artery disease with impaired glucose tolerance and normal glucose tolerance, and in controls. Results: 1) Nine of 60 patients (15%) with coronary artery disease had glucose intolerance. There were no significant difference in the incidence of cardiovascular risk factors, body mass index, left ventricular mass index, the levels of lipid including Lp (a), and the levels of fasting glucose, insulin, and C-peptide except in the incidence of smoking (48% in patients with coronary artery disease vs 24% in normal control, p<0.05) between patients with coronary artery disease and normal controls. 2) Between coronary artery disease patients group with and without glucose intolerance, and normal controls, there were no difference in the level of Lp (a) concentration. Conclusion: The level of fasting glucose and concentration of Lp (a) were no difference in between patients with coronary artery disease and normal controls. There was no difference in concentration of Lp (a) in patients of coronary artery disease with and without glucose intolerance, and so suggest that raised Lp (a) lipoprotein concentration are not responsible for the association between impaired glucose tolerance and coronary artery disease.

제2형 당뇨병에서 관상동맥 질환 유무에 따른 경동맥 내중막 두께 측정의 한계

문정윤,허정은,악설정,박근모,김현정,이동원,이현국,조경임,김태익 한국심초음파학회 2008 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.16 No.4

Background: The measurement of carotid intima-media thickness (IMT) is useful for detection of early atherosclerotic disease. But, IMT are influenced by various factors including hypertension, age, diabetes, etc. We tried to estimate the correlation between carotid IMT and coronary artery disease in diabetics. Methods: The B-mode ultrasonography and coronary angiography was perfomed in 50 as type 2 diabetes and 226 as nondiabetes. Carotid IMT was measured at around carotid bulb. Coronary artery lesions was evaluated based on quantitative coronary analysis (QCA) from coronary angiogram. Results: Type 2 diabetic group (mean age 64.5±8.9 years old) included 21 patients without coronary artery disease and 29 patients with coronary artery disease. Non-diabetic group (mean age 61.0±10.1) included 138 patients without coronary artery disease and 88 patients with coronary artery disease. In type 2 diabetic group, the mean value of measured max IMT of subjects with coronary artery disease was similar to that of subjects without coronary disease (mean Rt. IMT,1.26±0.62 mm vs. 1.03±0.29 mm, respectively, p=0.11, mean Lt IMT, 1.30±0.70 mm vs. 1.17±0.43 mm, respectively, p=0.46). But in non-diabetic group, the mean value of measured max IMT of subjects with coronary artery disease was more than that of subjects without coronary disease, and it is statistically significant (mean Rt. IMT, 1.09± 0.32 mm vs. 0.96±0.25 mm, respectively, p=0.01, mean Lt IMT, 1.19±0.47 mm vs. 1.01±0.32 mm, respectively, p=0.01). Conclusion: This study shows weak correlation power between carotid IMT and coronary artery diseases in diabetics, contrast to non-diabetes. Background: The measurement of carotid intima-media thickness (IMT) is useful for detection of early atherosclerotic disease. But, IMT are influenced by various factors including hypertension, age, diabetes, etc. We tried to estimate the correlation between carotid IMT and coronary artery disease in diabetics. Methods: The B-mode ultrasonography and coronary angiography was perfomed in 50 as type 2 diabetes and 226 as nondiabetes. Carotid IMT was measured at around carotid bulb. Coronary artery lesions was evaluated based on quantitative coronary analysis (QCA) from coronary angiogram. Results: Type 2 diabetic group (mean age 64.5±8.9 years old) included 21 patients without coronary artery disease and 29 patients with coronary artery disease. Non-diabetic group (mean age 61.0±10.1) included 138 patients without coronary artery disease and 88 patients with coronary artery disease. In type 2 diabetic group, the mean value of measured max IMT of subjects with coronary artery disease was similar to that of subjects without coronary disease (mean Rt. IMT,1.26±0.62 mm vs. 1.03±0.29 mm, respectively, p=0.11, mean Lt IMT, 1.30±0.70 mm vs. 1.17±0.43 mm, respectively, p=0.46). But in non-diabetic group, the mean value of measured max IMT of subjects with coronary artery disease was more than that of subjects without coronary disease, and it is statistically significant (mean Rt. IMT, 1.09± 0.32 mm vs. 0.96±0.25 mm, respectively, p=0.01, mean Lt IMT, 1.19±0.47 mm vs. 1.01±0.32 mm, respectively, p=0.01). Conclusion: This study shows weak correlation power between carotid IMT and coronary artery diseases in diabetics, contrast to non-diabetes.

관상동맥질환에서의 당뇨병 환자의 임상적 고찰

이병완,강보현,강한욱,김형훈,김현진,노정현,지재환,하창영,정재훈,민용기,이명식,이문규,김광원 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.3

당뇨병은 관상동맥질환의 중요 위험인자이다. 당뇨병의 유병률의 증가와 더불어 관상동맥질환 환자에서의 당뇨병 환자 비율은 점차 증가추세에 있다. 본 연구에서 관상동맥질환의 위험인자는 당뇨병, 나이, 비만, 고혈압, 흡연 그리고 관상동맥질환의 가족력이었다. 관상동맥질환 환자에 서 당뇨병군과 정상 혈당군간에는 나이, 고혈압, 흡연, 관상동맥질환의 가족력, 고밀도지단백 콜레스테롤, 중성지방, fibrinogen, t-PA, PAI-1이 통계적 유의한 차이가 있었다. 심근경색 환자를 대상으로 시행한 연구에서 당뇨병군과 정상 혈당군간에는 흡연, 지질강하제 복용, homocysteine,t-PA, PAI-I 그리고 CRP가 유의한 차이를 보였다. 혈당조절을 잘된 환자군과 잘되지 못한 환자군의 비교에서는 요산과 고밀도지단백 콜레스테롤만이 유의한 차이를 보였다. 당뇨병 환자에서의 지질 수치 중 고밀도지단백 콜레스테롤이 관상동맥질환의 주요 예측인자이며 위험인자라고 생각된다. 당뇨병 환자에서는 특히 금연과 혈압 그리고 혈당수치를 철저히 조절해야 한다. 당뇨병이 발생한 이후 혈당조절을 잘하는 것이 관상동맥질환의 발생과 사망률을 감소시킬 수 있을 지, 그리고 당뇨병 환자에서 혈당조절 이외의 어느 인자를 교정하는 것이 관상동맥질환을 예방하는데 도움이 될지 앞으로 전향적 연구가 필요하리라 사료된다. Background: Diabetes is a very important risk factor of coronary artery disease. The prevalence of diabetes in Korea is increasing steadily. The objective of this study was to establish the prevalence and cardiovascular risk factors of diabetes in coronary artery disease in Korean type 2 diabetes. Methods: Of the patients enrolled in SMC-coronary artery angiography protocol, we investigated 1143 subjects (from Jan. 1st to Dec.31th, 2001) with suspicious coronary artery disease reflected from symptoms of chest pain, EKG and enzyme abnormalities, and thallium scan. Sociodemographic characteristics and laboratory data were investigated using retrospective analysis. Results: The prevalence of diabetes in coronary artery disease patients was 37.49 %. The risk factors of coronary artery disease were diabetes, old age, obesity, hypertension, smoking and family history of coronary artery disease in our study. Among patients with coronary artery disease, there were significant differences in age, hypertension, smoking, family history of coronary artery disease, and levels of HDL-C, triglyceride, fibrinogen, t-PA, PAI-1 between diabetic patients and normo-glycemic patients. In the comparison of patients with myocardial infarction, there were significant difference in smoking, prescription of lipid-lowering drugs, homocysteine, tPA, PAI-I, and CRP between diabetic patients and normo-glycemic patients. Only the levels of uric acid and HDL-C showed meaningful difference between diabetic patients with well-controlled blood sugar and poorly-controlled blood sugar. Conclusion: With the increase in the prevalence of diabetes, the proportion of diabetic patients in coronary artery disease has also increased. Among patients with coronary artery disease, the risk factors of coronary artery disease were age, hypertension, smoking, family history of coronary artery disease, and levels of HDL-C, triglyceride, fibrinogen, t-PA, PAI-1 in diabetic patients compared to normo-glycemic patients. Diabetic patients must stop smoking and maintain strict control of blood pressure and blood glucose level. In addition, HDL-C was very important predictive risk factor for coronary artery disease.

혈관 조영술을 이용한 관동맥,말초혈관,경동맥의 동맥경화성 협착병변의 빈도

최동훈,편욱범,윤영섭,장양수,심원흠 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.9

Transesophageal Echocardiographic Detection of Thoracic Aortic Plaque Could Noninvasively Predict Significant Obstructive Coronary Artery Disease

(Hee Yeol Kim),(Chong Jin Kim),(Tai Ho Rho),(Ho Jung Youn),(Seong Won Jin),(Hyou Young Rhim),(Ji Won Park),(Heu Kyung Jeon),(Jang Seong Chae),(Jae Hyung Kim),(Soon Jo Hong),(Kyu Bo Choi) 대한내과학회 1999 The Korean Journal of Internal Medicine Vol.14 No.2

N/A Objective:Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. Methods:Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54±12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. Results:Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r=0.74, P<0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. Conclusion:This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.

Arterial Switch Operation in Patients with Intramural Coronary Artery: Early and Mid-term Results

Hyungtae Kim,성시찬,김시호,장윤희,안효영,이형두 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.2

Background: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. Materials and Methods: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was 13.4±10.2 days (4 to 39 days) and mean body weight was 3.48±0.33 kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. Results: There was 1operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was 52.1±43.0 months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. Conclusion: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.

만선신부전 환자에서 관상동맥조영술 소견에 관한 연구

한대희,김성구,박상호,김성한,조원영,방덕원,조윤행,정의룡,은영근,권영구 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Background : Patients with chronic renal fialure have a substantially elevated risk of death from cardiovascular diseases than do the general population. the patients with chronic renal failure are at significantly increased freqeuncy of hypertension, hyperlipidemia, and diabetes mellitus which are known to the risk factors of the coronary artery diseases, and the prevalence of the coronary artery diseases in chronic renal failure patients is highly associated with the hemodynamic disorder and metabolic abnormalities. therefore we expected that the coronary angiographic findings in patients with chronic renal failure should be different from the general population (control groups) and investigated the risk factors contributing to coronary artery diseases. Method : we have retrospectively compared the coronary angiographic findings of 44 patients with chronic renal failure on hemodialysis with that of 88 patients in the general population and investigated the factors contributing to the development and acceleration of coronary artery diseases in patients with chronic renal failure Result : Hypertension and diabetes mellitus which is risk factors for coronary artery disease is significantly increased in patients with chronic renal failure, in coronary angiographic finding the severity of the lesion is worse. the incidence of PCI or CABG of patients with chronic renal failure is more than that of control group but statistically no difference between patients with chronic renal failure and control group. the sex, the duration of disease, the duration of dialysis, serum creatinine in patients with chronic renal failure have no correlation to the prevalence of coronary artery disease and severity of lesion. hyperglycemic patients with chronic renal failure have high incidence of coronary artery disease and are worse in the severity of lesion Conclusions : There is significantly increased the pevalence and severity of involving multiple coronary artery diseses in hyperglycemic patients with CRF.

Prevalence and Significance of Carotid Plaques in Patients With Coronary Atherosclerosis

권택근,김금원,김기영,배장호,박현웅,정지현 대한심장학회 2009 Korean Circulation Journal Vol.39 No.8

Background and Objectives: Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis. Subjects and Methods: The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7±10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm. Results: Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p<0.001) and diabetes mellitus (30.6% vs. 23.5%, p=0.007) was higher in patients with carotid plaques. The patients with carotid plaques were older (65.4±8.9 years vs. 57.2±10.7 years, p<0.0001), had a thicker CIMT (0.89±0.20 mm vs. 0.77±0.16 mm, p<0.001), and higher fasting blood sugar (FBS) levels (132.1 ±60.7 mg/dL vs. 121.6±47.1 mg/dL, p<0.001) than those without carotid plaque. Patients with carotid plaque more frequently presented with acute coronary syndrome (32.4% vs. 23.9%, p<0.001) than those without carotid plaque. Significant coronary artery stenosis by coronary angiography (75.4% vs. 58.3%, p<0.001), especially multivessel disease (46.3% vs. 27.2%, p<0.001), was more frequent in patients with carotid plaques. On multivariate analysis, old age (≥65 years), hypertension, and increased CIMT (≥1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis. Conclusion: Carotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease. Background and Objectives: Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis. Subjects and Methods: The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7±10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm. Results: Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p<0.001) and diabetes mellitus (30.6% vs. 23.5%, p=0.007) was higher in patients with carotid plaques. The patients with carotid plaques were older (65.4±8.9 years vs. 57.2±10.7 years, p<0.0001), had a thicker CIMT (0.89±0.20 mm vs. 0.77±0.16 mm, p<0.001), and higher fasting blood sugar (FBS) levels (132.1 ±60.7 mg/dL vs. 121.6±47.1 mg/dL, p<0.001) than those without carotid plaque. Patients with carotid plaque more frequently presented with acute coronary syndrome (32.4% vs. 23.9%, p<0.001) than those without carotid plaque. Significant coronary artery stenosis by coronary angiography (75.4% vs. 58.3%, p<0.001), especially multivessel disease (46.3% vs. 27.2%, p<0.001), was more frequent in patients with carotid plaques. On multivariate analysis, old age (≥65 years), hypertension, and increased CIMT (≥1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis. Conclusion: Carotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease.

증예(症例) : 모야모야 병과 동반된 관상동맥질환 4 예

박성현 ( Sung Hyun Park ),김기회 ( Ki Hoi Kim ),김정관 ( Jeong Gwan Kim ),송지은 ( Ji Eun Song ),오왕국 ( Wang Guk Oh ),장미영 ( Mi Young Jang ),박종필 ( Jong Pil Park ) 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.2

현재까지 한국에서 모야모야 병과 동반된 관상동맥질환은 매우 드물며 단 4례만이 보고되어 저자들은 이러한 환자 4례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 본 증례들은 모야모야 병이 전신 혈관 질환이라는 주장을 뒷받침할 수 있으며 모야모야 병을 추적관찰 할 때 관상동맥질환의 가능성에 대해 점검할 필요가 있을 것으로 생각하는 바이다. Moyamoya disease is an occlusive intracranial arteriopathy with an abnormal cerebrovascular collateral network at the base of brain. Although the etiology and pathogenesis remains unknown, there are several reports that moyamoya disease should be regarded as a progressive systemic disease. There are many reports which showed this disease is correlated with renal artery stenosis. However, it is rare for it to be associated with coronary artery disease. We experienced four cases of coronary artery disease associated with moyamoya disease in our center. The coronary angiography showed significant stenosis of coronary artery. Three of these patients were underwent percutaneous coronary intervention. One patient had three vessel disease and have been doing medical treatment. We concluded that the patient with moyamoya disease can be affected coronary artery and should be evaluated about the coronary artery disease.

응급실을 내원한 흉통 환자의 원인질환에 따른 흉통의 질 및 관상동맥질환자의 흉통 표현

천선희 (Cheon, Sun Hee),최명애 (Choe, Myoung Ae) 병원간호사회 2008 임상간호연구 Vol.14 No.3

Purpose: The purpose was to identify quality of chest pain according to causal diseases and pain expression of patients with coronary artery diseases. Method: Participants were 1,964 patients with pain who visited the emergency department of A hospital from January to December 2006. Data were collected from nurses' and doctors' records as to causal disease, and quality and expression of chest pain. Results: Causal diseases were coronary artery diseases, non-specific chest pain, respiratory diseases, non-coronary artery heart diseases and digestive diseases in that order of frequency. Every disease except respiratory disease caused mostly dull and tract pain, but 63.7% of patients with coronary artery diseases complained of typical angina pain and 24.9% complained of atypical angina pain. Patients with coronary artery diseases mostly used word 'heaviness' in describing their dull pain, and 'squeezing' for tract pain. Both male and female patients who were diagnosed with coronary artery disease complained mostly frequently of dull pain and tract pain. Conclusion: The most common causal disease for patients with chest pain was coronary artery disease. Patients with other diseases also frequently complained of dull and tract pain, the same as patients with coronary artery diseases. A considerable number of patients complained various types of atypical angina pain in coronary artery diseases.