Radial artery spasm occurs frequently during the transradial approach for coronary catheterization. Premedications with nitroglycerin and verapamil have been documented to be effective in preventing radial spasms. Verapamil is relatively contraindicated for some patients with left ventricular dysfunction, hypotension and bradycardia. We would like to know whether nitroglycerin alone is sufficient for the prevention of radial artery spasm. We conducted a randomized controlled trial to compare the spasmolytic effect between heparin alone, heparin plus nitroglycerin and heparin plus nitroglycerin and varapamil during transradial cardiac catheterization. In this study, a total of 406 patients underwent transradial cardiac catheterization and intervention. After successful cannulation and sheath insertion of radial arteries, 133 patients in group A received 3,000 units of heparin, 100 µg of nitroglycerin and 1.25 mg of verapamil via sheath, 135 patients in group B received 3,000 units of heparin and 100 µg of nitroglycerin, and 93 patients in group C received 3,000 units of heparin. Five patients in group A (3.8%), 6 patients in group B (4.4%) and 19 patients in group C (20.4%) showed radial spasms. There is no statistically significant difference between groups A and B (p = 0.804), but there are strong statistically significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.003). Intra-arterial premedication with 100 µg nitroglycerin and 3,000 units of heparin is effective in preventing radial spasms during transradial cardiac catheterization.

BackgroundType D (distressed) personality, defined by negative affectivity and social inhibition, is related to cardiovascular outcomes. Little is known about Type D in non-Western cultures. We examined the validity of this construct and its assessment in Taiwanese patients with coronary artery disease (CAD) and adults from the general population.MethodsCAD patients (N = 87) and adults from the general population (N = 421) completed the 14-item Type D Scale- Taiwanese version (DS14-T), State-Trait Anxiety Inventory, Beck Depression Inventory-II, and Chinese Hostility Inventory Short-Form.ResultsBased on the psychometric examination, item #3 of the original DS14, "I often talk to strangers" was replaced by "I don't like to have a lot of people around me" which comes from the “Withdrawal” facet of social inhibition of DS-24. The reliability of Type D assessment in Taiwan was good, with Cronbach’s α for negative affectivity and social inhibition of .86 and .79. Factor analyses confirmed the two-factor model of the Type D construct. The prevalence rate of Type D personality in Taiwan was 20% in CAD patients and 16% in the general population. Negative affectivity was positively associated with anxiety, depression and hostility, and social inhibition was positively associated with suppressive hostility and negatively associated with expressive hostility after controlling for the total hostility. Furthermore, Taiwanese individuals with a Type D personality displayed elevated levels of anxiety, depression and hostility.ConclusionsThe Type D construct and its assessment with the DS14-T is generalizable to an Asian setting, Taiwan. The DS14-T showed good psychometric properties, and the prevalence of Type D personality in Taiwan was similar to the prevalence rates in Western countries and Mainland China, and Type D was associated with anxiety, depression and hostility.

SUMMARYPericardial effusion is frequently found in patients diagnosed with hypothyroidism, yet it is rarely associated with cardiac tamponade. This report presents an atypical case concerning a 60-year-old Taiwanese female, with a history of thyroidectomy surgery due to thyroid cancer, who was later diagnosed with myxedema and cardiac tamponade. Treatment included an immediate pericardiocentesis followed by thyroxine hormone replacement therapy. Postoperative and recovery phases progressed favorably, and the patient's prognosis is good. (Jpn Heart J 2003; 44: 447-450)

PurposeMany studies supported that vegetarians have a lower risk of cardiac diseases and mortality, partly due to better blood pressure and serum cholesterol profiles. However, the inflammatory markers, especially lipoprotein-associated phospholipase A2 (Lp-PLA2), have not been well-studied. This study aimed to compare inflammatory markers and conventional risk factors between vegetarians and omnivores.Materials and MethodsOne hundred and seventy-three vegetarians and 190 omnivores were studied. Fasting blood samples were obtained to compare levels of glucose, total cholesterol, triacylglycerol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, homocysteine, Lp-PLA2 activity, and high-sensitivity C-reactive protein (hs-CRP).ResultsVegetarians had higher serum levels of the following markers: hs-CRP (1.8 ± 3.4 vs. 1.2 1.8 mg/L, respectively; p = 0.05), homocysteine (9.39 ± 3.22 vs. 7.62 ± 2.41 µmol/L, respectively; p < 0.01), and triacylglycerol (96.91 ± 59.56 vs. 84.66 ± 43.24 mg/dL, respectively; p < 0.05). Vegetarians also had lower levels of Lp-PLA2 (18.32 ± 7.19 10-3 µmol/min/mL vs. 20.22 8.13 10-3 µmol/min/mL; p < 0.05), total cholesterol (180.62 ± 36.55 mg/dL vs. 192.73 ± 36.57 mg/dL; p < 0.01), LDL cholesterol (118.15 ± 32.8 vs. 126.41 ± 34.28 mg/dL; p < 0.05), and HDL cholesterol (55.59 ± 13.30 vs. 62.09 ± 14.52 mg/dL, p < 0.01). Multivariate analyses demonstrated that a vegetarian diet increases the chances for high serum hs-CRP and low Lp-PLA2 activity.ConclusionIn addition to lower total cholesterol, LDL-cholesterol, and HDL-cholesterol, Taiwanese female vegetarians have lower serum Lp-PLA2 activity but higher levels of hs-CRP, homocysteine, and triacylglyerol. It might be due to geographic differences of vegetarian diets, and further studies are needed.