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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. Ann Rehabil Med 2019; 43:355-443. [PMID: 31311260 PMCID: PMC6637050 DOI: 10.5535/arm.2019.43.3.355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Lee BK, Kim JS, Lee OH, Min PK, Yoon YW, Hong BK, Shin DH, Kang TS, Kim BO, Cho DK, Jeon DW, Woo SI, Choi S, Kim YH, Kang WC, Kim S, Kim BK, Hong MK, Jang Y, Kwon HM. Safety of six-month dual antiplatelet therapy after second-generation drug-eluting stent implantation: OPTIMA-C Randomised Clinical Trial and OCT Substudy. EUROINTERVENTION 2019; 13:1923-1930. [PMID: 29104179 DOI: 10.4244/eij-d-17-00792] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS There are few randomised studies concerning the optimal duration of dual antiplatelet therapy (DAPT) for patients who receive a second-generation drug-eluting stent (DES). This trial aimed to investigate the safety of six-month compared with 12-month DAPT maintenance after second-generation DES implantation. METHODS AND RESULTS A prospective, randomised, multicentre trial was performed at 10 medical centres. The 1,368 patients included in the study received a biolimus-eluting stent (BES) or a zotarolimus-eluting stent (ZES). The primary outcome measured was the composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), or ischaemia-driven target lesion revascularisation at the 12-month follow-up. The secondary outcome was the percentage of uncovered struts at six months in 60 patients (30 ZES, 30 BES) using optical coherence tomography (OCT) assessment. Each patient was randomly assigned to six-month (n=684) or 12-month DAPT (n=684). Major adverse cardiac events at 12 months occurred in eight patients (1.2%) in the six-month DAPT group and in four patients (0.6%) in the 12-month DAPT group (risk difference 0.6%; 95% confidence interval [CI]: -0.4-1.6%; p=0.24). The upper 95% CI limit was lower than the pre-specified limit of 4% non-inferiority (p for non-inferiority <0.05). The percentage of uncovered struts was 3.16±4.30% at six months in 60 stents of 60 patients. CONCLUSIONS After second-generation DES implantation, six-month DAPT was not inferior to 12-month DAPT in terms of MACE occurrence over the 12-month follow-up period. OCT examination revealed favourable stent strut coverage at six months after stent implantation.
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Kim GS, Oh HH, Kim SH, Kim BO, Byun YS. Association between prediabetes (defined by HbA1 C, fasting plasma glucose, and impaired glucose tolerance) and the development of chronic kidney disease: a 9-year prospective cohort study. BMC Nephrol 2019; 20:130. [PMID: 30992067 PMCID: PMC6469043 DOI: 10.1186/s12882-019-1307-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/21/2019] [Indexed: 01/03/2023] Open
Abstract
Background The aim of the present study was to investigate the clinical impact of prediabetes on the development of incident chronic kidney disease (CKD) in a Korean adult population, using data from the Korea Genome and Epidemiology Study. Methods This prospective cohort study included 7728 Korean adults without baseline CKD and type 2 diabetes. Prediabetes was defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and HbA1C level. CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2. We assessed the predictive value of prediabetes for the incidence of CKD, and investigated the incidence of cardiovascular disease including coronary artery disease and stroke. Results Over a median follow-up period of 8.7 years, 871 of 7728 (11.3%) subjects developed incident CKD. Patients with prediabetes, as defined by IGT or HbA1C, developed incident CKD more frequently than the non-prediabetic group did. The risk of CKD development at follow-up was analyzed according to different prediabetes definitions. Compared with the non-prediabetic group, the IGT- (Hazard ratio [HR] = 1.135, 95% confidence interval [CI] = 1.182–1.310, P = 0.043) and HbA1C-defined prediabetic groups (HR = 1.391, 95% CI = 1.213–1.595, P < 0.001) were significantly associated with incident CKD after adjusting for traditional CKD risk factors; however, IFG was not associated with incident CKD. Conclusion IGT- or HbA1C-defined prediabetes is an independent predictor of incident CKD. The measurement of these parameters might enable early detection of CKD risk, allowing physicians to initiate preventive measures and improve patient outcomes.
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Kim GS, Byun YS, Lee HY, Jung IH, Rhee KJ, Kim BO. Difference in SBP between arms is a predictor of chronic kidney disease development in the general Korean population. J Hypertens 2019; 37:790-794. [PMID: 30817460 DOI: 10.1097/hjh.0000000000001931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An increased inter-arm SBP difference (IASBPD) is associated with mortality and cardiovascular events, as well as peripheral vascular disease, which is attributed to subclavian stenosis. The aim of the present study was to investigate the association between the IASBPD and incident chronic kidney disease (CKD) in the Korean population. METHODS A retrospective cohort study was performed on 8780 Korean adults without baseline CKD. The bilateral blood pressure was measured sequentially and repeatedly at the first visit. IASBPD was defined as a BP at least 15 mmHg according to the National Institutes for Health and Clinical Excellence guidelines, and CKD was defined as an estimated glomerular filtration rate less than 60 ml/min per 1.73 m. We assessed the value of IASBPD to predict the incidence of CKD and investigated cardiovascular disease, including coronary heart disease and stroke. RESULTS Over a mean follow-up period of 8.5 years, 96 of 581 (16.5%) patients in the IASBPD group and 1037 of 8199 (12.6%) patients in the non-IASBPD group developed incident CKD. Compared with the non-IASBPD, an IASBPD was associated with incident CKD [hazard ratio (HR): 1.336, 95% confidence interval (CI): 1.08-1.65, P = 0.007]. After adjusting for potential confounders, including age, sex, hypertension, diabetes, and obesity, we found that the hazard ratio was also robust (hazard ratio 1.275, 95% CI 1.03-1.58, P = 0.024). CONCLUSION Increased IASBPD is an independent predictor of incident CKD in the general population.
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Lee SJ, Koh S, Kim BO, Kim B, Kim C. Effect of Type D Personality on Short-Term Cardiac Rehabilitation in Patients With Coronary Artery Disease. Ann Rehabil Med 2018; 42:748-757. [PMID: 30404424 PMCID: PMC6246854 DOI: 10.5535/arm.2018.42.5.748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/13/2018] [Indexed: 01/20/2023] Open
Abstract
Objective To investigate the effect of type D personality on cardiac rehabilitation (CR) participation rates and the effect of a short-term CR program. Methods Study participants included patients diagnosed with acute coronary syndrome who underwent percutaneous coronary intervention. Patients completed the Type D personality Scale (DS-14) and the Hospital Anxiety and Depression Scale (HADS) at program entry. Subjects were recommended participation in 6 weeks of CR exercise training. Cardiopulmonary exercise test (CPET) was conducted before and after completion of the training. CR participation refers to completion of the 6-week CR exercise program and performance of the secondary CPET. Drop-out refers to the subjects who were unable to participate in the 6-week CR exercise program or to perform the secondary CPET. Results At baseline, type D personality was evident in 21 of 63 patients (33.3%). Type D patients were more often depressed (57.1%) and anxious (38.1%) than non-type D patients (31.0% and 9.5%, respectively). At baseline, participants with type D personality showed a decreased body mass index (24.6 vs. 26.1 kg/m2, p=0.025). The type D group displayed a lower CR participation rate (5/21, 23.8%) compared with the non-type D group of (22/42, 52.4%). Logistic regression analysis revealed the association of type D personality with CR drop-out rate (odds ratio=3.87; 95% confidence interval, 1.2–12.5; p<0.05). Conclusion Type D personality was independently associated with drop-out from CR program and with significantly higher levels of anxiety and depressive mood.
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Kim BO, Seo JK, Kim GS, Lee HY. P3515Systolic blood pressure difference between arms and chronic kidney disease in the community based 10-year cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kim GS, Kim BO, Seo JK, Lee HY, Jung IH, Byun YS. P1280Non-alcoholic fatty liver disease and hypertension in the community based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Li H, Rha SW, Choi BG, Shim MS, Choi SY, Choi CU, Kim EJ, Oh DJ, Cho BR, Kim MH, Kim DI, Jeong MH, Yoo SY, Jeong SS, Kim BO, Hyun MS, Youn YJ, Yoon J. Transradial versus transfemoral intervention in ST-segment elevation myocardial infarction patients in Korean population. Korean J Intern Med 2018; 33:716-726. [PMID: 28859467 PMCID: PMC6030401 DOI: 10.3904/kjim.2016.316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/09/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIMS Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). METHODS A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). RESULTS After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. CONCLUSIONS In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.
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Gwon HC, Jeon DW, Kang HJ, Jang JS, Park DW, Shin DH, Moon KW, Kim JS, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Han KR, Kim HS. The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:320-327. [PMID: 28567082 PMCID: PMC5449526 DOI: 10.4070/kcj.2017.0070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. Materials and Methods The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. Results The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. Conclusion We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.
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Jang JS, Han KR, Moon KW, Jeon DW, Shin DH, Kim JS, Park DW, Kang HJ, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Gwon HC, Kim HS. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:328-340. [PMID: 28567083 PMCID: PMC5449527 DOI: 10.4070/kcj.2017.0071] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. MATERIALS AND METHODS Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. RESULTS A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. CONCLUSION These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.
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Gwon HC, Jeon DW, Kang HJ, Jang JS, Park DW, Shin DH, Moon KW, Kim JS, Kim J, Bae JW, Hur SH, Kim BO, Choi D, Han KR, Kim HS. Erratum: The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry. Korean Circ J 2017; 47:541. [PMID: 28765752 PMCID: PMC5537162 DOI: 10.4070/kcj.2016.0446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Sung JM, Hong SJ, Chung IH, Lee HY, Lee JH, Kim HJ, Byun YS, Kim BO, Rhee KJ. Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement. Yonsei Med J 2017; 58:248-251. [PMID: 27873520 PMCID: PMC5122644 DOI: 10.3349/ymj.2017.58.1.248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/29/2015] [Accepted: 10/28/2015] [Indexed: 11/27/2022] Open
Abstract
Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.
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Lee SH, Jeong MH, Han KR, Sim DS, Yoon J, Youn YJ, Cho BR, Cha KS, Hyon MS, Rha SW, Kim BO, Shin WY, Park KS, Cheong SS. Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome and Anemia. Am J Cardiol 2016; 117:1582-1587. [PMID: 27018932 DOI: 10.1016/j.amjcard.2016.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
Anemia is an independent predictor of bleeding complications and poor clinical outcomes after percutaneous coronary intervention. Percutaneous coronary transradial intervention (TRI) is better than percutaneous coronary transfemoral intervention (TFI) in terms of reducing bleeding complications that can affect the prognosis. This study aims to investigate the clinical outcomes between TRI and TFI for patients with anemia. We analyzed periprocedure complications, in-hospital mortality, and major adverse cardiac events for one year in the Korean TRI registry from January 2013 to April 2014. Patients with chronic kidney disease for whom TFI is preferred were excluded. Anemia was defined as hemoglobin <13 g/dl for men and <12 g/dl for women. A total of 1,279 patients were finally enrolled. Of these, 348 patients had anemia. Among them, 253 patients (72.7%) underwent TRI and 95 patients (27.3%) underwent TFI. There were no significant differences of baseline demographic characteristics between the TRI and TFI groups, except for the incidence of dyslipidemia (TRI 23.7% vs TFI 12.6%, p = 0.023). Multivariate logistic regression analysis revealed lower incidence of composite severe bleeding complications (hazard ratio 0.34, 95% CI 0.12 to 0.99, p = 0.049) and lower incidence of in-hospital mortality than TFI group (hazard ratio 0.74, 95% CI 0.62 to 0.88, p = 0.042). In conclusion, this study suggests that the TRI for patients with anemia may be translated into better prognosis in terms of lower rates of bleeding complications and in-hospital mortality.
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Seo J, Ahn Y, Zheng Z, Kim BO, Choi MJ, Bang D, Kim DY. Clinical significance of serum YKL-40 in Behçet disease. Br J Dermatol 2016; 174:1337-44. [PMID: 26708309 DOI: 10.1111/bjd.14376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Serum YKL-40 is an inflammatory biomarker of endothelial dysfunction and may play a role in the inflammatory process of Behçet disease (BD). OBJECTIVES Serum YKL-40 levels were evaluated in patients with BD in order to identify associations with other inflammatory cytokines and establish laboratory parameters. Serum YKL-40 levels were also compared with BD clinical features and disease activity. METHODS In total, 112 patients with BD and 45 age- and sex-matched healthy volunteers were included. Disease activity was assessed with BD Current Activity Form score and Electronic Medical Record-based Activity Index (EMRAI) score. RESULTS Serum YKL-40 levels were significantly higher in patients with BD (median 41·88, range 12·52-171·30 ng mL(-1) ) than in healthy volunteers (median 20·92, range 5·01-64·20 ng mL(-1) ; P < 0·01). The cut-off value for YKL-40 (30·005 ng mL(-1) ) was determined from the receiver operating characteristic curve. EMRAI scores and the proportion of patients in the active phase of BD presenting with two or more major criteria were significantly higher in patients with elevated YKL-40 levels (P = 0·04 and P = 0·04, respectively). A statistically significant elevation in YKL-40 levels was observed in patients with active BD compared with patients with inactive BD (P = 0·05). Serum YKL-40 values were positively correlated with interleukin-6 and EMRAI scores (both P = 0·04), indicating that serum YKL-40 levels are increased in patients with BD and positively correlate with disease activity. CONCLUSIONS YKL-40 may play a role in the pathophysiology of BD and provide a useful marker for monitoring patients with BD.
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Cho SW, Kim BG, Kim BO, Byun YS, Goh CW, Rhee KJ, Kwon HM, Lee BK. Hemorheological and Glycemic Parameters and HDL Cholesterol for the Prediction of Cardiovascular Events. Arq Bras Cardiol 2015; 106:56-61. [PMID: 26690693 PMCID: PMC4728596 DOI: 10.5935/abc.20150146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/14/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. OBJECTIVE To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. METHODS 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. RESULTS Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. CONCLUSION Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients.
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Kim BG, Cho SW, Lee HY, Kim DH, Byun YS, Goh CW, Rhee KJ, Kim BO. Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test. J Arrhythm 2015; 31:196-200. [PMID: 26336559 DOI: 10.1016/j.joa.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT. METHODS We evaluated 40 patients with suspected vasovagal syncope. Beat-to-beat changes in blood pressure, heart rate (HR), cardiac index (CI), and systemic vascular resistance (SVR) during HUTT were measured with thoracic impedance cardiography and a plethysmographic finger arterial pressure monitoring device. RESULTS None of the 40 patients complained of presyncopal symptoms during passive HUTT. However, after the administration of NTG 28 patients showed presyncopal symptoms (NTG+ group) and the remaining 12 patients did not (NTG- group). HR, CI, and the stroke index did not significantly differ between the two groups, whereas mean arterial pressure and SVR were significantly lower in the NTG+ group. CONCLUSIONS Presyncopal symptoms during NTG-stimulated HUTT are SVR mediated, not cardiac output mediated. This study challenges the conventional idea of a decrease in cardiac output mediated by NTG as the overriding cause of presyncopal symptoms during HUTT.
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Kim BG, Cho SW, Kim DH, Kim JH, Byun YS, Goh CW, Rhee KJ, Lee BK, Kim BO. Stent length is a contributing factor of suboptimal stent expansion in drug-eluting stents. Kardiol Pol 2015; 73:598-605. [PMID: 25733175 DOI: 10.5603/kp.a2015.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/24/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Failure to achieve optimal stent expansion poses a risk of treatment failure in percutaneous coronary intervention (PCI). Although intravascular ultrasound provides useful information for suboptimal stent expansion, a substantial portion of PCIs are currently being performed under angiographic guidance only. AIM In order to evaluate the adequacy of stent expansion of four widely used drug-eluting stents in angiography-guided PCI, we performed a retrospective analysis of lesions undergoing PCI using quantitative coronary angiography. METHODS A total of 112 de novo lesions were analysed. Minimal lumen diameter (MLD) was measured at peak pressure during stent deployment (MLD1), after stent deployment (MLD2), and after postdilatation (MLD3). Stent underexpansion, stent elastic recoil, and stent deficit were calculated. Optimal stent deployment was defined as final MLD ≥ 90% of predicted diameter. RESULTS For deploying a stent balloon, higher than nominal pressure was used in 83% of cases (93/112). However, optimal deployment was observed in only 32% (36/112). Adjuvant post-dilatation was performed in 59% (45/76) of lesions with suboptimal expansion, which increased the optimal deployment rate by 60% (27/45). Final optimal stent deployment rate was achieved in 56% (63/112). We found that the MLD1 (p = 0.04), MLD3 (p = 0.02), final MLD (p = 0.04), and optimal stent deployment rate (p = 0.036) were significantly reduced in longer stent deployment lesions (≥ 20 mm) compared to shorter lesions (< 20 mm). CONCLUSIONS Stent length may be a contributing factor of suboptimal stent expansion in angiography-guided PCI.
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Cho SW, Kim BG, Kim DH, Kim BO, Byun YS, Rhee KJ, Lee BK, Goh CW. Prediction of Coronary Artery Disease in Patients With Lower Extremity Peripheral Artery Disease. Int Heart J 2015; 56:209-12. [DOI: 10.1536/ihj.14-284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cho SW, Kim BG, Kim DH, Kim BO, Goh CW, Rhee KJ, Byun YS. Three-dimensional echocardiographic views of bicuspid pulmonic valve. J Cardiovasc Ultrasound 2014; 22:162-3. [PMID: 25309698 PMCID: PMC4192419 DOI: 10.4250/jcu.2014.22.3.162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/26/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022] Open
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Shin JS, Tahk SJ, Yang HM, Yoon MH, Choi SY, Choi BJ, Lim HS, Lee YH, Seo KW, Park SJ, Choi YW, Yoon J, Youn YJ, Cho BR, Cha KS, Han KR, Hyon MS, Rha SW, Kim BO, Shin WY, Park KS, Cheong SS, Jeong MH. Impact of female gender on bleeding complications after transradial coronary intervention (from the Korean Transradial Coronary Intervention registry). Am J Cardiol 2014; 113:2002-6. [PMID: 24793670 DOI: 10.1016/j.amjcard.2014.03.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 12/20/2022]
Abstract
Besides poor clinical outcomes, female gender has been known as a high-risk factor for bleeding complications. This study aimed to investigate the impact of gender on clinical outcomes and bleeding complications after transradial coronary intervention (TRI). The Korean TRI registry is a retrospective multicenter registry with 4,890 patients who underwent percutaneous coronary intervention in 2009 at 12 centers. To compare clinical outcomes and bleeding complications between the male and female groups, we performed a propensity score matching in patients who received TRI. A total of 1,194 patients (597 in each group) were studied. The primary outcome was 1-year major adverse cardiac events, including all-cause mortality, myocardial infarction, target vessel revascularization, and stroke. The secondary outcome was major bleeding (composite of bleeding requiring transfusion of ≥2 units of packed cells or bleeding that was fatal). The proportion of major adverse cardiac events was similar between the 2 groups (6.2% vs 4.7%, p = 0.308). The female group had a greater incidence of major bleeding (0.3% vs 3.2%, p <0.001). On multivariate analysis, female gender (odds ratio [OR] 7.748, 95% confidence interval [CI] 1.767 to 13.399), age ≥75 years (OR 5.824, 95% CI 2.085 to 16.274), and chronic kidney disease (OR 7.264, 95% CI 2.369 to 12.276) were independent predictors of major bleeding. In conclusion, the female gender had a tendency for more bleeding complications than male gender after TRI without difference in the clinical outcome.
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Park JY, Rha SW, Choi BG, Oh DJ, Choi JW, Ryu SK, Jeong MH, Jung SS, Kim MH, Yang HM, Yoon J, Park KS, Han KR, Cho BR, Cha KS, Kim BO, Hyun MS, Shin WY, Choe H, Bae JW, Kim HY. TCTAP A-001 Twelve-month Clinical Outcomes of Transradial Coronary Artery Intervention: Comparison of the Right and Left Radial Artery Approach. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Park KH, Jeong MH, Ahn Y, Jung SS, Kim MH, Yang HM, Yoon J, Rha SW, Park KS, Han KR, Cho BR, Cha KS, Kim BO, Hyon MS, Shin WY, Choe H, Bae JW, Kim HY. The impact of vascular access for in-hospital major bleeding in patients with acute coronary syndrome at moderate- to very high-bleeding risk. J Korean Med Sci 2013; 28:1307-15. [PMID: 24015035 PMCID: PMC3763104 DOI: 10.3346/jkms.2013.28.9.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 07/11/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.
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Kwon SW, Kim BO, Kim MH, Lee SJ, Yoon JH, Chung H, Shim CY, Cho DK, Ryu SK, Yoon SJ, Yoon YW, Chang HJ, Rim SJ, Kwon HM, Jang Y, Hong BK. Diverse left ventricular morphology and predictors of short-term outcome in patients with stress-induced cardiomyopathy. Int J Cardiol 2013; 168:331-7. [DOI: 10.1016/j.ijcard.2012.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/19/2012] [Accepted: 09/15/2012] [Indexed: 01/27/2023]
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Cho SW, Kim BK, Kim JH, Byun YS, Goh CW, Rhee KJ, Ahn HS, Lee BK, Kim BO. Non-invasively measured aortic wave reflection and pulse pressure amplification are related to the severity of coronary artery disease. J Cardiol 2013; 62:131-7. [PMID: 23731925 DOI: 10.1016/j.jjcc.2013.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/12/2013] [Accepted: 03/18/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Augmentation index (AIx) and pulse pressure amplification (PPA, here the aortic/brachial pulse pressure ratio) are an age-related emerging risk factor for cardiovascular disease. However, it has not been clearly shown that AIx and PPA predict a high risk of coronary artery disease (CAD). OBJECTIVES The aim of the study was to investigate the association between non-invasively measured aortic wave reflection (AWR) and PPA and CAD. METHODS The study group consisted of 80 patients who were admitted to our institute for elective coronary angiography. We non-invasively measured augmentation pressure (AP), AIx, and PPA using radial applanation tonometry. RESULTS When the extent of CAD was divided by no or minimal CAD, 1- or 2- and 3-vessel disease (VD), there was a significant association between the extent of CAD and AIx and PPA in patients aged <65 years, but not in patients aged ≥ 65 years. In multivariate regression analysis after controlling the traditional risk factors, the odds ratio of having 3VD was significant in patients aged <65 years: 2.15 (1.04-4.44; p=0.039) per 5% increase of AIx and 2.02 (1.15-3.55; p=0.015) per 0.05 increase of PPA, but not in patients aged ≥ 65 years. The severity of CAD expressed as a Gensini score showed a significant correlation with AP, AIx, and PPA in patients aged <65 years, but not in patients aged ≥ 65 years. CONCLUSION Increasing of non-invasively measured AWR and PPA is related to the severity of CAD, particularly in younger patients up to 65 years of age.
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Cho SW, Kim BK, Hwang JT, Kim JH, Kim BO, Goh CW, Rhee KJ, Ahn HS, Kim HJ, Byun YS. A case of primary cardiac lymphoma mimicking acute coronary and aortic syndrome. Korean Circ J 2012; 42:776-80. [PMID: 23236331 PMCID: PMC3518713 DOI: 10.4070/kcj.2012.42.11.776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/19/2012] [Accepted: 04/30/2012] [Indexed: 12/03/2022] Open
Abstract
Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.
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