BackgroundThe objective of this study was to investigate the association between nonalcoholic fatty liver disease (NAFLD) and carotid artery atherosclerosis beyond metabolic disorders.MethodsWe studied 320 non-diabetic patients with ultrasonographically diagnosed NAFLD and 313 non-diabetic patients without NAFLD who have less than 40 g alcohol/week drinking history. Carotid atherosclerotic burden was assessed by carotid intima-media thickness (IMT) and plaque. All subjects were divided to the metabolic syndrome (MetS) according to International Diabetes Federation criteria.ResultsNAFLD patients had a significantly increased mean carotid IMT (0.79 ± 0.18 vs. 0.73 ± 0.13 mm; p < 0.001) than those without the condition. The prevalence of increased IMT, defined as IMT ≥ 1 mm, and carotid plaque were 52.5% and 34.1% in the patients with NAFLD vs. 35.8% and 18.8% in the patients without this condition (p < 0.001). The difference in IMT and prevalence of plaque was also significant even in patients without MetS as well as those with MetS (all p < 0.05). NAFLD-associated adjusted odds ratio for increased IMT was 1.236 [95% confidence interval (CI), 1.023-1.467, p = 0.016] without MetS and 1.178 (95% CI, 1.059-1.311, p = 0.003) with MetS. NAFLD-associated adjusted odds ratio of carotid plaque was 1.583 (95% CI, 1.309-1.857, p = 0.024) without MetS and 1.536 (95% CI, 0.512-4.604, p = 0.444) with MetS.ConclusionNAFLD is significantly associated with carotid atherosclerosis in non-diabetic outpatients even without MetS. Carotid screening for NAFLD might be beneficial for assessment of future atherosclerotic complications.

Background and ObjectivesIn patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular responses and inducing the arterial wall-stiffening process. We investigated arterial stiffness in FM patients using pulse wave velocity (PWV) and analyzed whether arterial stiffness was affected by the clinical parameters of FM.Subjects and MethodsThis study included 108 female FM patients (51.5±8.9 years) without any known cardiovascular diseases and 76 healthy female controls (50.1±8.9 years). FM patients underwent a manual tender point survey for tender point counts, and completed the visual analogue scale (VAS) of pain and fibromyalgia impact questionnaire (FIQ), which were composed of a physical and feel score. Brachial-ankle pulse-wave velocity (baPWV) was measured with an automated device. The study participants were subdivided into 2 groups based on the sum of the FIQ score (group A: FIQ ≥50, group B: <50).ResultsPatients with FM had significantly higher baPWV than the controls, and significant increase were noted in baPWV values of group A compared with those of group B. BaPWV showed a significant positive correlation (correlation coefficient=6.83, p=0.022) with severity of disease assessed by FIQ.ConclusionThe patients with FM showed significantly increased arterial stiffness, suggesting a pathophysiologic link between FM and endothelial dysfunction. This study provides a basis for clarifying the mechanism by which chronic pain syndrome is associated with an increased risk of vascular stiffness.

In patients with fibromyalgia (FM) syndrome, stress and pain may chronically enhance sympathetic activity, altering cardiovascular response and inducing endothelial dysfunction. We investigated endothelial function in FM patients using echocardiography and analyzed whether endothelial function was affected by the clinical parameters of FM. Fifty-five postmenopausal women with FM and 35 healthy controls were included. Endothelial function was examined by brachial artery flow-mediated dilatation (FMD, endothelium dependent) and response to 40 μg of sublingual nitroglycerine (NTG-induced dilatation, endothelium independent). FM patients underwent manual tender point survey and completed visual analogue scale (VAS) of pain and fibromyalgia impact questionnaire (FIQ). The study participants were subdivided into two groups based on the sum of the FIQ score (group A, FIQ ≥ 50, group B, <50). The FMD value (5.7 ± 3.9% vs. 7.0 ± 1.4%, P = 0.008) and NTG-induced dilatation (12.5 ± 5.1% vs. 14.7 ± 2.5%, P = 0.006) were significantly lower in FM group than healthy control. There were no significant differences in FMD between groups A and B (5.4 ± 3.3% vs. 6.6 ± 3.5%, P = 0.19). However, significant decreases were noted in NTG-induced dilatation values of group A compared with those of group B (11.0 ± 4.4% vs. 14.3 ± 3.8%, P = 0.004). FMD and NTG-induced dilatation showed a significant inverse association with pain VAS and FIQ. Pain exerts a negative effect on endothelial function in FM patients, and that effect was significantly different according to the FIQ score.

Peripheral artery disease (PAD) results from luminal narrowing and stiffening of the arteries supplying the lower limbs, most often due to systemic atherosclerotic disease. Its prevalence is high, and is associated with a high risk for fatal and non-fatal cardiovascular events (death, myocardial infarction and cerebral vascular accident). 1 Accordingly, guidelines and performance measures have been developed for PAD to support aggressive treatment of its risk factors, including hypertension and hyperlipidemia. Diagnosing PAD is very important, as the incidence of acute cardiovascular events is two to three times higher in patients with PAD as compared with people having no atherosclerosis of their peripheral arteries. 2,3 Despite its prevalence and cardiovascular risk implications, only 25% of PAD patients are recognized and treated. 4 Although the majority of PAD patients are asymptomatic, the disease often progresses to cause symptoms that can impact patients' functioning and quality of life. Intermittent claudication is the cardinal symptom of PAD and is a primary treatment target for afflicted patients. It occurs as a result of reduced blood flow to lower extremity skeletal muscle during exercise. The incidence of symptomatic PAD increases with age, affecting 22% of patients with PAD, and the cardiovascular risk factors mentioned contribute to the progression of PAD. 5 AbstractThe Peripheral Artery Questionnaire (PAQ), as developed in US English, is a validated scale to evaluate the health status of patients with peripheral artery disease (PAD). The aim of this study was to translate the PAQ into Korean and to evaluate its reliability and validity. A multi-step process of forward-translation, reconciliation, consultation with the developer, back-translation and proofreading was conducted. The test-retest reliability was evaluated at a 2-week interval using the intra-class correlation coefficient (ICC). The validity was assessed by identifying associations between Korean PAQ (KPAQ) scores and Korean Health Assessment Questionnaire (KHAQ) scores. A total of 100 PAD patients were enrolled: 63 without and 37 with severe claudication. The reliability of the KPAQ was adequate, with an ICC of 0.71. There were strong correlations between KPAQ's subscales. Cronbach's alpha for the summary score was 0.94, indicating good internal consistency and congruence with the original US version. The validity was supported by a significant correlation between the total KHAQ score and KPAQ physical function, stability, symptom, social limitation and quality of life scores (r = -0.24 to -0.90; p < 0.001) as well as between the KHAQ walking subscale and the KPAQ physical function score (r = -0.55, p < 0.001). Our results indicate that the KPAQ is a reliable, valid instrument to evaluate the health status of Korean patients with PAD.

Aneurysm of the mitral valve, although uncommon, occurs most commonly in association with infective endocarditis of the aortic valve and true mitral valve aneurysm is a rare cause of mitral regurgitation. We report a case with perforated mitral valve aneurysm in the posterior leaflet without concurrent infective endocarditis initially mistaken diagnosis of cystic mass, which was confirmed at operation with successful mitral valve annuloplasty.