Cardioprotective Potential of an SGLT2 Inhibitor Against Doxorubicin-Induced Heart Failure

BACKGROUND AND OBJECTIVES: Recent studies have shown that sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of heart failure (HF)-associated hospitalization and mortality in patients with diabetes. However, it is not clear whether SGLT2 inhibitors have a cardiovascular benefit in patients without diabetes. We aimed to determine whether empagliflozin (EMPA), an SGLT2 inhibitor, has a protective role in HF without diabetes. METHODS: Cardiomyopathy was induced in C57BL/6J mice using intraperitoneal injection of doxorubicin (Dox). Mice with HF were fed a normal chow diet (NCD) or an NCD containing 0.03% EMPA. Then we analyzed their phenotypes and performed in vitro experiments to reveal underlying mechanisms of the EMPA's effects. RESULTS: Mice fed NCD with EMPA showed improved heart function and reduced fibrosis. In vitro studies showed similar results. Phloridzin, a non-specific SGLT inhibitor, did not show any protective effect against Dox toxicity in H9C2 cells. SGLT2 inhibitor can cause increase in blood ketone levels. Beta hydroxybutyrate (βOHB), which is well known ketone body associated with SGLT2 inhibitor, showed a protective effect against Dox in H9C2 cells and in Dox-treated mice. These results suggest elevating βOHB might be a convincing mechanism for the protective effects of SGLT2 inhibitor. CONCLUSIONS: SGLT2 inhibitors have a protective effect in Dox-induced HF in mice. This implied that SGLT2 inhibitor therapy could be a good treatment strategy even in HF patients without diabetes.ope

Effect of Vascular BRAchytherapy using HolmiuM-166 Liquid Balloon System afterCutting Balloon Angioplasty in Patients with Stent Restenosis(BRAHMS Study)

Background and Objectives：Vascular brachytherapy for stent restenosis has been demonstrated to reduce restenosis and major adverse cardiac events (MACE). However, the angiographic and clinical outcomes after β-radiation, using a 166Holmium (Ho)-DTPA filled balloon, has not been sufficiently evaluated. Subjects and Methods：Between March 2002 and August 2003, 78 consecutive patients (mean age 50 yrs, 53 male) with in-stent restenosis were randomly enrolled for either cutting balloon angioplasty only (control group, n=38) or in combination with vascular brachytherapy using a 166Ho-DTPA filled balloon (brachytherapy group, n=40). The radiation dose applied was 18 Gy, at a depth of 1.0 mm from the vascular lumen. Results：The treated vessels comprised of 50 left anterior descending arteries (64.1%), 23 right coronary arteries (29.5%) and 5 circumflex arteries. The mean radiation dose and time were 375±67.8 mCi/ml and 191±76 seconds, respectively. Six cases were fractionated.The mean lesion length was 18.2±7.9 mm, with no difference between the 2 groups. Eight month follow-up coronary angiography revealed a restenosis rate of 17.1% (6/35) in the brachytherapy group vs. 39.3% (11/27) in the control group(p=0.042). However, there was no difference in the 1 year MACE. Conclusion：In patients with in-stent restenosis, vascular brachytherapy, using a 166Ho-DTPA filled balloon, showed favorable angiographic outcomes at the 8 month follow-up compared to the control groupope

SFA Intervention: Intraluminal or Subintimal?

Subintimal angioplasty (SA) is an endovascular technique to recanalize an occluded arterial segment through an extraluminal channel between the intima and media. Since its introduction in 1989, the technical success rate has improved with the accumulation of procedural experience and the development of retrograde approaches and re-entry devices. To date, no randomized trial has compared SA with intraluminal angioplasty (IA) for chronic total occlusion (CTO) of the superficial femoral artery (SFA). Based on limited data from several registry studies, SA appears to achieve a higher technical success rate than IA, whereas mid-term primary patency rates are comparable for both endovascular wiring strategies for SFA CTO. Additional clinical data are needed to confirm that SA is as effective as IA. The optimal stenting strategy and role of drug-eluting technologies also need to be defined to improve SA outcomes.ope

Coronary Stenting in 15 Year-old Boy with Coronary Artery Stenosis Secondary to Kawasaki Disease

Kawasaki disease is an acute febrile illness frequently developed in infants and children. This disease may involve coronary arteries in 15-25% of the patients and may progress to coronary aneurysms, ischemic cardiac diseases, and sudden cardiac death. Recently we experienced successful balloon angioplasty followed by coronary stenting in a 15-year old boy with unstable angina secondary to Kawasaki disease. He was diagnosed as unstable angina by 24 hours Holter monitoring, treadmill exercise stress test, echocardiography, and Dipyridamole 99mTc-sestamibi scan. And coronary angiogram revealed severe multiple stenosis and aneurysmal changes due to Kawasaki disease. We successfully performed a percutaneous transluminal coronary angioplasty with stent implantation in the left circumflex arterial lesion. (Korean Circulation J 2000;30(10): 1300-1306)ope

Aortic Dissection Complicated with Lower Extremity and Renal Ischemia Treated by Percutaneous Stent Insertion

A 62-year-old woman was admitted due to acute pain in the back and the right lower extremity. CT and angiography showed a chronic dissection of the ascending aorta and a newly developed dissection of the descending aorta complicated with ischemia of the left renal artery and right lower extremity. Therefore, a Wall stent was inserted percutaneously at the descending thoracic aorta and the stenotic left renal artery was opened by percutaneous transluminal renal angioplasty with a Mac (4.0×22 mm, Amg, Korea) stent. Thereafter, renal function was normalized and the blood pressure was better controlled at discharge. A follow up CT scan 3 months after the procedure showed patent true lumen of the descending thoracic aorta and left renal artery.ope

A Case of Myocardial Infarction Caused by a Variant Angina during Treatment with β-blocker of Intramural Hematoma

Variant angina is characterized by repeated attack at rest associated with ST-segment elevation on ECG and caused by the spasm of coronary artery. But, the pathogenesis of spasm is not well known. A 44-year old man was transferred for the management of intramural hematoma at descending thoracic aorta and uncontrolled hypertension. We Sstarted to control hypertension with nitroprusside, propranolol, amlodipine, and doxazocin. At 4th hospital day, severe chest pain, dizziness, and diaphoresis were developed, and ECG showed not only STsegment elevation on lead II, III, aVF but also 2°AV block (Mobitz type II). CK-MB revealed 52.3 ng/dl. When coronary angiography performed emergently, it showed total occlusion of right coronary artery (RCA) and diffuse minimal narrowing of left anterior descending coronary artery (LAD). After nitroglycerin was infused via right coronary catheter, the RCA was opened completely, and reperfusion arrhythmia was developed. Medication were changed to nifedipine, diltiazem, nicorandil, isosorbide mononitrate and he had no more chest pain. (Korean Circulation J 000;30(11):1455-1459)ope

Clinical significance of lactate clearance in patients with cardiogenic shock: results from the RESCUE registry

Background: Limited data are available on the clinical significance of lactate clearance (LC) in patients with cardiogenic shock (CS). This study investigated the prognostic role of LC in CS patients. Methods: We analyzed data from 628 patients in the RESCUE registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. Univariable logistic regression analysis was performed to determine the prognostic implications of 24 h LC, and then patients were divided into two groups according to the cut-off value of 24 h LC (high lactate clearance [HLC] group vs. low lactate clearance [LLC] group). The primary outcome was in-hospital mortality. We also assessed all-cause mortality at 12 month follow-up and compared the prognostic performance of 24 h LC according to initial serum lactate level. Results: In the univariable logistic regression analysis, 24 h LC was associated with in-hospital mortality (odds ratio 0.989, 95% confidence interval [CI] 0.985-0.993, p 5 mmol/L than in those with serum lactate ≤ 5 mmol/L (c-statistics of initial serum lactate > 5 mmol/L = 0.782 vs. c-statistics of initial serum lactate ≤ 5 mmol/L = 0.660, p = 0.011). Conclusions: Higher LC during the early phase of CS was associated with reduced risk of in-hospital and 12 month all-cause mortalities. Patients with LC ≥ 64% during the 24 h after CS onset could expect a favorable prognosis, especially those with an initial serum lactate > 5 mmol/L. Trial registration: RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock), NCT02985008, Registered December 5, 2016-retrospectively and prospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02985008.ope

Inodilators May Improve the In-Hospital Mortality of Patients with Cardiogenic Shock Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

Although inodilators (dobutamine and milrinone) are widely used empirically for cardiogenic shock (CS), the efficacy of inodilators for patients with CS undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is controversial. We evaluated the effects of inodilators on clinical outcomes using the RESCUE (REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock; NCT02985008) registry. We selected and analyzed the clinical outcomes of 496 patients who underwent VA-ECMO and did or did not receive inodilators. Of the 496 patients, 257 (51.8%) died during hospitalization. We selected 191 matched pairs to adjust for baseline clinical characteristics after 1:1 propensity score matching (PSM). The univariate and multivariate analyses showed that the inodilator group had significantly lower in-hospital mortality than the no-inodilator group (unadjusted hazard ratio [HR], 0.768; 95% confidence interval [CI], 0.579-1.018; p = 0.066, adjusted HR, 0.702; 95% CI, 0.552-0.944; p = 0.019). For patients with CS undergoing VA-ECMO, inodilators may improve clinical outcomes.ope

Insulin Sensitivity is Associated with the Presence and Extent of Coronary Artery Disease

Background and Objectives : Insulin resistance has been suggested to be an important risk factor in the development of arteriosclerosis. The correlation between insulin sensitivity and the degree of coronary atherosclerosis in patients with angina pectoris was investigated. Subjects and Methods : The study population consisted of 74 subjects with angina (54 men, 20 women), aged from 31 to 73 years. Coronary angiograms were evaluated by 3 semiquantitative scoring systems (vessel score, stenosis score and extent score) to estimate the extent of focal and diffuse coronary artery disease (CAD). Insulin sensitive insulin tolerance test. Results : There were significant correlations between , (PTT) was determined co an IC,TT and all 3 sres. Multivariate analysis revealed significant and independent correlations between all 3 coronary scores and Km, even in patients without diabetes mellitus. Both HDL cholesterol level and KnT were significantly lower in patients with CAD than in those without. Conclusion : Decreased insulin sensitivity was significantly associated with the presence and extent of CAD. These results suggest the potential benefits of insulin-sensitizing treatment strategies for patients with decreased insulin sensitivity.ope

Two Cases of Compartment Syndrome Complicating Percutaneous Transluminal Peripheral Arterial Intervention

Compartment syndrome is the term used to describe the constellation of clinical symptoms and signs associated with pathophysiologically elevated intracompartmental pressure. It is an infrequent but serious complication of the revascularization of peripheral arterial disease, encountered in surgical bypass and thrombolytic procedures. We present two cases of intraarterial thrombolysis and percutaneous transluminal intervention of the lower extremity arteries, complicated by the development of compartment syndrome.ope