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Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; <40%) versus preserved EF (≥50%). Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P <0.001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

Background and Objectives：Smoking has been known to be an independent risk factor of the coronary morbidity induced by coronary artery endothelial dysfunction, but its detailed impact, including the duration and amount of smoking on coronary artery spasm, has not been clarified yet. We investigated the incidence of acetylcholine (Ach)-induced coronary artery spasm according to smoking and the smoking-related parameters. Subjects and Methods：The study consisted of 306 patients (163 males, age: 56.1±11.2 years), without significant coronary artery disease underwent Ach provocation testing by injecting incremental doses of 20, 50 and 100 ug Ach into the left coronary artery. Significant coronary artery spasm was defined as focal or diffuse severe transient luminal narrowing (>75%) with/without chest pain or ST-T change of the EKG. The impact of conventional risk factors, including smoking and the smoking-related parameters, on coronary artery spasm was analyzed. Results：The conventional risk factors of coronary atherosclerosis, including hypertension, DM and hyperlipidemia, were numerically higher in the provocation (+) group, but the differences were not statistically different between the two groups. Only smoking itself was significantly higher in the provocation (+) group whereas the smoking duration, amount and the duration of quitting smoking were not different between the two groups. Conclusion：Smoking is known to be an independent risk factor of coronary artery spasm, but smoking-related parameters such as the smoking duration, the amount and the duration of quitting smoking were not associated with coronary artery spasm. (Korean Circulation J 2006;36:661-665) KEY WORDS：Acetylcholine；Spasm；Smoking. 서 론 관상동맥의 비정상적인 수축으로 관상동맥의 내경이 국 소적(focal) 또는 미만성(diffuse)으로 의미있게 좁아지는 상태를 관상동맥 경련 또는 연축(coronary artery spasm) 이라 한다. 이 때 전형적인 허혈성 흉통을 호소하며, 심전 논문접수일：2006년 5월 10일 수정논문접수일：2006년 7월 21일 심사완료일：2006년 8월 28일 교신저자：나승운, 152-703 서울 구로구 구로동 80 고려대학교 의과대학 순환기내과학교실, 구로병원 심혈관센터 전화：(02) 818-6387, 6807·전송：(02) 864-3062·E-mail：swrha617@yahoo.co.kr

The minimum clinically important change or difference in the 15D score representing overall HRQoL on a 0-1 scale is 0.015. Differences between and within hospitals were tested by independent and paired samples t-tests and linear regression with some background variables standardized. Results: At baseline, mean 15D score was in KUH (0.752) statistically significantly (p< 0.001) and clinically importantly lower than in VCH (0.831) or HUH (0.830). The mean six-month score was 0.858 in KUH, compared to 0.860 and 0.875 in VCH and HUH, respectively. With gender, age and baseline 15D score standardized, the mean six-month scores were 0.846, 0.879 and 0.877 in KUH, VCH and HUH, respectively and the differences between KUH and both other hospitals became statistically significant (p< 0.001) and clinically important. A clinically important HRQoL improvement was experienced by 85.8, 59.1 and 64.0% and a clinically important deterioration by 6.8, 25.3 and 22.1% in KUH, VCH and HUH, respectively. ConClusions: Treatment indication and effectiveness in terms of HRQoL, i.e., 15D score change and percentage of patients experiencing a clinically important improvement or deterioration, varied between hospitals. HRQoL measurements can be used to compare effectiveness of treatment between hospitals but for fair comparisons standardization of relevant baseline demographic and clinical parameters of patients is needed.

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