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Kim BS, Lim YH, Shin JH, Kim SH, Roh S, Choi YW, Shin J, Park JK, Kim KS. The Impact of Aversive Advice During Percutaneous Coronary Intervention on Smoking Cessation in Patients With Acute Coronary Syndrome. Glob Heart 2019; 14:253-257. [PMID: 31103401 DOI: 10.1016/j.gheart.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Smoking cessation is important to prevent recurrence of acute coronary syndrome (ACS), but even in patients with ACS, smoking is hard to quit. OBJECTIVES This study hypothesized that aversive advice during the percutaneous coronary intervention (PCI) procedure works effectively to promote smoking cessation in patients with ACS. METHODS This study was conducted as a prospective, single-blinded, randomized controlled trial. A total of 66 patients were randomly assigned to an aversive advice group or a control group and instructed to visit the outpatient clinic 1, 4, and 24 weeks after discharge. In the aversive advice group, a physician who did not participate in the patient follow-up said the following 3 sentences to the patients during the PCI procedure: "Smoking caused your chest pain"; "If you do not stop smoking right now, this pain will come again"; and "The next time you feel this pain you will probably die." All patients received usual advice on the importance of quitting smoking. RESULTS At 24 weeks after discharge, the smoking cessation rate was higher in the aversive advice group than in the control group. In a multivariable logistic regression analysis, after adjustment for age, smoking quantity, alcohol consumption, and disease severity, the result was maintained (odds ratio = 4.47, 95% confidence interval: 1.50 to 13.34). CONCLUSIONS Aversive advice during a PCI procedure is effective at smoking cessation in patients with ACS. A physician's attention and involvement during the PCI procedure improves the rate of smoking cessation in patients with ACS.
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Lee Y, Jin U, Lee WM, Lim HS, Lim YH. Relationship of body mass index and waist circumference with clinical outcomes following percutaneous coronary intervention. PLoS One 2018; 13:e0208817. [PMID: 30543687 PMCID: PMC6292633 DOI: 10.1371/journal.pone.0208817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/23/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A biphasic, U-shape relationship has been reported between body mass index (BMI) and clinical outcomes following percutaneous coronary intervention (PCI). However, the relationship between waist circumference (WC) and the cardiovascular risk following PCI has not been reported. METHODS A prospective cohort study was performed. A major adverse cardiac event (MACE) was defined as a composite of cardiac death (CD), nonfatal myocardial infarction (NFMI) and target vessel revascularization (TVR). Patients were evenly divided into 4 groups according to BMI (Q1BMI, Q2BMI, Q3BMI and Q4BMI) and WC (Q1WC, Q2WC, Q3WC and Q4WC). RESULTS A total of 1,421 patients were observed for 5 years. The risk of the composite events of CD and NFMI (CD/NFMI) was lower in the Q3WC and Q4WC groups than in the Q1WC group, whereas it was only marginally lower in the Q2BMI group than in the Q1BMI group (ANOVA, p = 0.062). The risk of MACE was highest in the Q1WC group and lowest in the Q3WC group; however, the risk of MACE did not differ among the 4 groups, according to BMI. Multivariate Cox-regression analyses showed that the risk of CD/NFMI gradually decreased with BMI (linear p = 0.030) and with WC (linear p = 0.015). The risks of TVR and MACEs that were driven by TVRs showed a distinguishing biphasic, U-shaped relationship with WC (nonlinear p = 0.009) but not with BMI (nonlinear p = 0.439). Landmark survival analysis showed that the incidences of CD and NFMI were higher in the lower BMI groups and lower WC groups than in the higher BMI groups and higher WC groups, respectively, until 1 year and did not differ afterward. In contrast, the incidence of MACE was highest in Q1WC and lowest in Q3WC (log-rank p = 0.003), whereas the incidence was not different among the groups according to BMI. CONCLUSIONS Both BMI and WC were associated with a lower risk of early episodes of CD and NFMI after PCI. In the late period after PCI, WC demonstrated a biphasic, U-shaped association between cardiovascular outcomes and adiposity, whereas BMI did not.
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Lee Y, Lim YH, Shin JH, Park J, Shin J. Impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention. Int J Cardiol 2018; 253:155-160. [PMID: 29306458 DOI: 10.1016/j.ijcard.2017.09.192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/31/2017] [Accepted: 09/22/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Similar to overt hypothyroidism, subclinical hypothyroidism (SCH) has been reported to increase the risk of cardiovascular disease. However, the influence of SCH on clinical outcomes following percutaneous coronary intervention (PCI) remains unclear. METHODS We performed a prospective cohort study. SCH was defined as a thyroid-stimulating hormone (TSH) level ≥4.5mIU/l and a normal level of free thyroxine (FT4). A composite event was defined as the combination of cardiac death, non-fatal myocardial infarction (MI) and repeat revascularization. RESULTS Of 936 patients, who were observed for 3.1years, 100 patients (10.7%) were diagnosed with SCH. Repeat revascularization, cardiac death and a composite event occurred more frequently in the SCH group than in the euthyroidism group, while the incidence of non-fatal MI was similar between the two groups. Multiple Cox regression analysis showed that SCH was associated with the risk of a composite event (hazard ratio, 1.52; 95% confidence interval, 1.04-2.22) after adjustment for age, sex, current smoking, ST-segment elevation MI, prior PCI, diabetes, hypertension, renal function, left ventricular ejection fraction, B-type natriuretic peptide, stent numbers, total stent length, stent types, obesity and lipid profiles. Serum TSH levels were also significantly associated with the risk of a composite event. SCH was not associated with repeat PCIs for de novo stenotic lesions but was associated with repeated PCIs for in-stent restenotic lesions. CONCLUSIONS SCH negatively impacted clinical outcomes following PCIs. Therefore, patients with SCH should be carefully observed after undergoing a PCI.
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Lee Y, Park JY, Choi YW, Park HK, Cho SH, Cho SH, Lim YH. A Novel Non-contact Heart Rate Monitor Using Impulse-Radio Ultra-Wideband (IR-UWB) Radar Technology. Sci Rep 2018; 8:13053. [PMID: 30158545 PMCID: PMC6115337 DOI: 10.1038/s41598-018-31411-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/16/2018] [Indexed: 12/03/2022] Open
Abstract
We discovered that impulse-radio ultra-wideband (IR-UWB) radar could recognize cardiac motions in a non-contact fashion. Therefore, we measured the heart rate (HR) and rhythms using an IR-UWB radar sensor and evaluated the validity and reliability of the measurements in comparison to electrocardiography. The heart beats were measured in 6 healthy volunteers (18 samples) with normal sinus rhythm (NSR) and 16 patients (36 samples) with atrial fibrillation (AF) using both an IR-UWB radar sensor and electrocardiography simultaneously. The participants hold their breath for 20 seconds during the data acquisition. In subjects with NSR, there was excellent agreement of HR (intraclass correlation coefficient [ICC] 0.856), average R-R interval (ICC 0.997) and individual R-R intervals between the two methods (ICC 0.803). In subjects with AF, HR (ICC 0.871) and average R-R interval (ICC 0.925) from the radar sensor also agreed well with those from electrocardiography, though there was a small disagreement in the individual R-R intervals between the two methods (ICC 0.697). The rhythms computed by the signal-processing algorithm showed good agreement between the two methods (Cohen’s Kappa 0.922). The IR-UWB radar sensor is precise and accurate for assessing HR and rhythms in a non-contact fashion.
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Park JK, Choi YW, Kim BS, Chang KS, Lee YG, Shin JH, Lim YH, Park HC, Shin J. P1880Independent effect of physical activity and resting heart rate on incidence of atrial fibrillation in general population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1880] [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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Lee Y, Park JK, Lim YH, Shin JH, Park HC, Shin J, Kim KS. 5047C-reactive protein and the risk of atrial fibrillation: KOGES 12 years' follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5047] [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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Choi S, Kim YM, Shin J, Lim YH, Choi SY, Choi BY, Oh KW, Lee HM, Woo KJ. Comparison of the accuracy and errors of blood pressure measured by 2 types of non-mercury sphygmomanometers in an epidemiological survey. Medicine (Baltimore) 2018; 97:e10851. [PMID: 29923975 PMCID: PMC6023853 DOI: 10.1097/md.0000000000010851] [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] [Indexed: 11/25/2022] Open
Abstract
A few studies have compared auscultation and oscillometric devices with the mercury sphygmomanometer (MS) reference values for blood pressure (BP) measurement in an epidemiologic survey.Four trained observers recorded BP measurements from 766 subjects from general Korean population in 2014 and 2015. Measurements were repeated 3 times for each device, alternately using an MS and 2 electronic devices (EDs; Greenlight 300 vs Omron HEM-907), together with a randomized device sequence. The BP measurement difference was defined as BP measured by MS minus BP obtained by ED, and the absolute error as the absolute value of the difference.Mean differences in systolic BP (SBP) were -0.52 and -0.62 mmHg and those of diastolic BP (DBP) were -0.78 and 6.23 mmHg (P < .01) in the Greenlight and Omron device group, respectively. The concordance correlation coefficients were 0.97 and 0.94 for SBP and 0.95 and 0.76 for DBP in the Greenlight and Omron group, respectively (P < .05). Kappa values for the Joint National Committee 7 BP classification were 0.84 and 0.74 for Greenlight and Omron group, respectively. The prevalence of normotension, prehypertension and hypertension were 53.5%, 33.9%, and 12.5% with the MS and 59.8%, 29.0%, and 11.2% with the ED in the Omron group (P = .03, McNemar test), whereas they were insignificant in the Greenlight group.The Greenlight 300 may be a good alternative to the MS, and the Omron HEM-907 has good accuracy in SBP measurement. Due to the measurement error in DBP, Omron HEM-907 was inferior to the Greenlight device.
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Kim BS, Heo R, Shin J, Lim YH, Park JK. E/E' and D-shaped Left Ventricle Severity in Patients with Increased Pulmonary Artery Pressure. J Cardiovasc Imaging 2018; 26:85-92. [PMID: 29971270 PMCID: PMC6024832 DOI: 10.4250/jcvi.2018.26.e6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/16/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND D-shaped left ventricle (D-LV) is an interesting echocardiographic finding in pulmonary hypertension (PH) and is the result of structural distortion of the interventricular septum. The eccentricity index (EI) is a quantitative measure used to evaluate the severity of D-LV in patients with increased pulmonary artery pressure (PAP). However, D-LV and EIs have rarely been studied in terms of their association with hemodynamic factors. METHODS A total of 526 patients with a maximal tricuspid regurgitation velocity (VmaxTR) > 2.8 m/s on echocardiography identified between January 2012 and December 2017 were enrolled. After exclusion, a total of 289 patients were analyzed. The association between D-LV and hemodynamic factors were analyzed using logistic regression. Furthermore, factors that impacted the severity of the D-LV, as defined by EIs, were also analyzed using the multiple linear regression model. RESULTS In the multivariate logistic regression model, higher pulmonary artery pressure (PAP, p = 0.001), lower tricuspid annular plane systolic excursion (TAPSE, p = 0.048), and E/E' (p = 0.017) were found to be significant risk factors for the presence of D-LV. Additional analysis with age and body mass index added to independent variables, PAP (p = 0.008), TAPSE (p = 0.028), and age (p < 0.001) were significant risk factors for the presence of D-LV. In patients with D-LV, only E/E' was independently associated with EIs (R2 = 0.666, p < 0.001). CONCLUSIONS In patients with increased PAP, D-LV is associated with PAP, TAPSE, E/E', and age. EIs are associated with left ventricular filling pressure, represented as E/E'.
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Yeo WL, Chew X, Smith DJ, Chan KP, Sun H, Zhao H, Lim YH, Ang EL. Probing the molecular determinants of fluorinase specificity. Chem Commun (Camb) 2018; 53:2559-2562. [PMID: 28184383 DOI: 10.1039/c6cc09213f] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Molecular determinants of FlA1 fluorinase specificity were probed using 5'-chloro-5'-deoxyadenosine (5'-ClDA) analogs as substrates and FlA1 active site mutants. Modifications at F213 or A279 residues are beneficial towards these modified substrates, including 5'-chloro-5'-deoxy-2-ethynyladenosine, ClDEA (>10-fold activity improvement), and conferred novel activity towards substrates not readily accepted by wild-type FlA1.
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Park J, Lee Y, Park HC, Shin JH, Lim YH, Shin J. ASSOCIATION BETWEEN C-REACTIVE PROTEIN AND THE RISK OF ATRIAL FIBRILLATION IN THE GENERAL POPULATION: ANSAN AND ANSUNG COHORT OF THE KOREAN GENOME AND EPIDEMIOLOGY STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30918-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Joo HJ, Ahn SG, Park JH, Park JY, Hong SJ, Kim SY, Choi W, Gwon H, Lim YH, Kim W, Kang WC, Cho YH, Kim YH, Yoon J, Shin W, Hong MK, Garg S, Jang Y, Lim DS. Effects of genetic variants on platelet reactivity and one-year clinical outcomes after percutaneous coronary intervention: A prospective multicentre registry study. Sci Rep 2018; 8:1229. [PMID: 29352151 PMCID: PMC5775197 DOI: 10.1038/s41598-017-18134-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/06/2017] [Indexed: 12/17/2022] Open
Abstract
Clopidogrel is the mainstay for antiplatelet treatment after percutaneous coronary intervention (PCI). The relationship of platelet reactivity and genetic polymorphism with clinical outcomes with newer-generation drug-eluting stents is unclear. We analysed 4,587 patients for the most powerful single-nucleotide polymorphisms (CYP2C19, CYP2C9, ABCB1, PON1, and P2Y12) related to on-treatment platelet reactivity (OPR). The optimal cut-off value of high OPR for major adverse thrombotic events was 266. CYP2C19 was significantly associated with high OPR and the number of CYP2C19*R (*2 or *3) alleles was proportional to the increased risk of high OPR. Death, myocardial infarction (MI), stroke, stent thrombosis, and bleeding events were assessed during a 1-year follow-up period. Primary endpoints were death and non-fatal MI. The cumulative 1-year incidence of death and stent thrombosis was significantly higher in patients with CYP2C19*2/*2, CYP2C19*2/*3, and CYP2C19*3/*3 (Group 3) than in patients with CYP2C19*1/*1 (Group 1). Multivariate Cox proportional hazard model showed that cardiac death risk was significantly higher in Group 3 than in Group 1 (hazard ratio 2.69, 95% confidence interval 1.154–6.263, p = 0.022). No association was reported between bleeding and OPR. Thus, CYP2C19 may exert a significant impact on the prognosis of PCI patients even in the era of newer-generation drug-eluting stents.
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Kim J, Shin MS, Hwang SY, Park E, Lim YH, Shim JL, Kim SH, Kim YH, An M. Memory loss and decreased executive function are associated with limited functional capacity in patients with heart failure compared to patients with other medical conditions. Heart Lung 2018; 47:61-67. [DOI: 10.1016/j.hrtlng.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/28/2022]
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Lee Y, Lim YH, Shin JH, Park J, Shin J. Data on the impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention. Data Brief 2017; 16:630-634. [PMID: 29276739 PMCID: PMC5730377 DOI: 10.1016/j.dib.2017.11.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 02/02/2023] Open
Abstract
This article contains the data showing the different influence of subclinical hypothyroidism (SCH) on the risk of cardiovascular events after percutaneous coronary intervention (PCI) in various subgroups regarding myocardial infarction, previous PCI, the stent generation, total stent length, the extent of coronary artery disease, diabetes mellitus, obesity, a lipid reduction level and a C-reactive protein level. This article also contains the data showing the association between SCH and the risk of receiving repeat PCI for in-stent restenosis or de novo coronary stenosis. The data are supplemental to our original research article titled “Impact of Subclinical Hypothyroidism on Clinical Outcomes Following Percutaneous Coronary Intervention” (Lee et al., 2017) [1].
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Leong MKF, Mujumdar S, Raman L, Lim YH, Chao TC, Anantharaman V. Injury Related Deaths in Singapore. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Injury is the commonest cause of morbidity and mortality amongst the younger age groups. Management of injuries has been identified as one of the major health issues facing our community. The study objective was to define the epidemiology of injury related deaths in Singapore. Methods A nationwide review of all deaths arising as a result of injury in 1995 was conducted. Results There were 913 cases with an injury mortality rate of 27 per 100,000 population. Ninety-seven percent (97%) were due to blunt injury. Falls from heights from deliberate self-harm was the commonest mechanism, followed by motor vehicle collisions (MVC). Fifty-two percent (52%) of MVC deaths were motorcyclists or pillion riders. Sixty-six percent (66%) of all deaths occurred in the prehospital phase. Central nervous system injury was the main cause of hospital deaths. Conclusion Results from this study will help our community focus on the appropriate preventive strategies to reduce mortality and the cost of injuries to our society.
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Lim YH, Hendricks J. A Case of Nonfatal Non-Collapsed Patient with Extreme Hyperkalaemia. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is a report of a non-collapsed patient with nonfatal, extreme hyperkalaemia of 10.7 mmol/L. The patient's hyperkalaemia was initially treated in the Emergency Department and then transferred to the Department of Renal Medicine of another hospital for further stabilisation. There have only been a few reported cases of successful management of extreme hyperkalaemia in excess of 10.0 mmol/L.
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Lim YH, Yeo A, Koh MP, Wong CY. Severely Injured Patients Presenting to the Singapore General Hospital: a one Year Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study objectives To determine the quantity and resource utilisation in management of the severely injured patients presenting at the Singapore General Hospital (SGH). Method All patients who were initially triaged to the hospital Emergency Department's (ED) resuscitation room and all trauma related mortality in the year 1998 were studied. All records were traced and the cases were followed up. Important outcomes studied were mortality and length of hospital stay. Results Three hundred and forty-seven (0.2%) severely injured patients who were initially treated at the ED's resuscitation room were studied. The median age of the patients was 32 years old. Male patients formed 82.1% of the total. The three main causes of trauma in such patients were fall from height, motor vehicle related accidents and penetrating injuries caused by sharp instruments and firearms. Of all the patients, 62.8% were admitted to the ED between 1601 hours to 0759 hours and 30.5% of all severely injured patients were treated at the ED on weekends. One hundred and twenty three (35.4%) patients had emergency surgery within 24 hours of admission to the ED and 42.4% of the patients had an ISS score of 16 or more; 22.8% of patients had ISS score of 25 or more. The mortality of patients with ISS score of 25 or more was 39.2%. Conclusion One percent of all new ED patients with trauma were classified as ‘severely’ injured and these occurred mostly outside “normal working hours”. There was significant mortality in patients with ISS score of 25 or more.
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Lim YH, Anantharaman V. Patients who Self-Discharge from the Emergency Department: a Three-Month Telephone Survey. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790401100105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study objectives To determine the main causes and outcomes of patients who self-discharged from the Emergency Department (ED). Methods Records of all patients who self-discharged from the ED of a tertiary level hospital were traced and telephone interviews were conducted. The duration of the study was from 15 July 2002 to 14 October 2002. Results There were 28,898 new attendances during the period of study and of these, 450 (1.6%) patients signed the self-discharge form. Of the 357 patients recruited into the study, the majority signed the self-discharge form because of refusal of admission to inpatient units (52.1%) or the ED observation ward (43.4%) for further treatment. One hundred and thirteen (31.7%) patients acknowledged that they were unwell during the interview and 85 (23.8%) patients sought some form of medical attention after leaving the ED. Conclusion Most of the patients who self-discharged from the ED were for personal reasons and very few were due to financial reasons.
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Abstract
This is a rare case of sagittal sinus thrombosis occurring in the first trimester of pregnancy. A literature review was performed.
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Shin MS, Kim J, Hwang SY, Park E, Lim YH, Shim JL, Kim S, An M. Memory Loss and Decreased Executive Function are Associated with Functional Limitation in Patients with Heart Failure. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ovejero D, Lim YH, Boyce AM, Gafni RI, McCarthy E, Nguyen TA, Eichenfield LF, DeKlotz CMC, Guthrie LC, Tosi LL, Thornton PS, Choate KA, Collins MT. Cutaneous skeletal hypophosphatemia syndrome: clinical spectrum, natural history, and treatment. Osteoporos Int 2016; 27:3615-3626. [PMID: 27497815 PMCID: PMC6908308 DOI: 10.1007/s00198-016-3702-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/06/2016] [Indexed: 12/01/2022]
Abstract
UNLABELLED Cutaneous skeletal hypophosphatemia syndrome (CSHS), caused by somatic RAS mutations, features excess fibroblast growth factor-23 (FGF23) and skeletal dysplasia. Records from 56 individuals were reviewed and demonstrated fractures, scoliosis, and non-congenital hypophosphatemia that in some cases were resolved. Phosphate and calcitriol, but not skin lesion removal, were effective at controlling hypophosphatemia. No skeletal malignancies were found. PURPOSE CSHS is a disorder defined by the association of epidermal and/or melanocytic nevi, a mosaic skeletal dysplasia, and an FGF23-mediated hypophosphatemia. To date, somatic RAS mutations have been identified in all patients whose affected tissue has undergone DNA sequencing. However, the clinical spectrum and treatment are poorly defined in CSHS. The purpose of this study is to determine the spectrum of the phenotype, natural history of the disease, and response to treatment of hypophosphatemia. METHODS Five CSHS subjects underwent prospective data collection at clinical research centers. A review of the literature identified 45 reports that included a total of 51 additional patients, in whom the findings were compatible with CSHS. Data on nevi subtypes, bone histology, mineral and skeletal disorders, abnormalities in other tissues, and response to treatment of hypophosphatemia were analyzed. RESULTS Fractures, limb deformities, and scoliosis affected most CSHS subjects. Hypophosphatemia was not present at birth. Histology revealed severe osteomalacia but no other abnormalities. Skeletal dysplasia was reported in all anatomical compartments, though less frequently in the spine; there was no clear correlation between the location of nevi and the skeletal lesions. Phosphate and calcitriol supplementation was the most effective therapy for rickets. Convincing data that nevi removal improved blood phosphate levels was lacking. An age-dependent improvement in mineral abnormalities was observed. A spectrum of extra-osseous/extra-cutaneous manifestations that included both benign and malignant neoplasms was present in many subjects, though osteosarcoma remains unreported. CONCLUSION An understanding of the spectrum, natural history, and efficacy of treatment of hypophosphatemia in CSHS may improve the care of these patients.
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Choi S, Shin JH, Park WC, Kim SG, Shin J, Lim YH, Lee Y. Two Distinct Responses of Left Ventricular End-Diastolic Pressure to Leg-Raise Exercise in Euvolemic Patients with Exertional Dyspnea. Korean Circ J 2016; 46:350-64. [PMID: 27275172 PMCID: PMC4891600 DOI: 10.4070/kcj.2016.46.3.350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/19/2015] [Accepted: 11/20/2015] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Few studies have invasively assessed diastolic functional reserve and serial changes in left ventricular hemodynamics in euvolemic patients with exertional dyspnea. In this study, sequential changes in left ventricular end-diastolic pressure (LVEDP) to leg-raise exercise were measured invasively in patients with early heart failure with preserved ejection fraction (HFpEF) to determine the association between these serial changes and echocardiographic results or clinical features. Subjects and Methods During their hospital stay, 181 patients with early HFpEF underwent left cardiac catheterization, coronary angiography, and transthoracic echocardiography (TTE). Leg-raise exercise was performed in two stages: during cardiac catheterization and again during TTE. Results Compared with the initial values, all the invasively measured LVEDP values increased significantly during the leg-raise exercise, whereas the septal e/e' ratio remained unchanged. Active leg-raise led to increased LVEDP, which caused dyspnea. The severity of symptoms correlated with the level and extent of changes in LVEDP. At the end of active leg-raise, LVEDP decreased in 40 patients (22.1%), who were younger and had significantly lower e/e' ratios. On multivariate analysis to predict the response of LVEDP to active leg-raise, age and the septal e/e' ratio remained significant predictors. Conclusion Despite having similar LVEDP values at rest, patients may respond to exercise with different LVEDP levels and clinical manifestations, depending on their diastolic capacity. The leg-raise exercise in early HFpEF can elucidate individual diastolic profiles, and the LVEDP response to the leg-raise test may serve as a useful criterion in stratifying patients with early HFpEF with respect to functional reserve.
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Lim YH, Lee Y, Shin J, Yoon J, Lee SH, Rha SW, Lee JH, Jeong MH, Cho BR, Kim KS. Comparisons of Clinical and Procedural Outcomes Between Transradial and Transfemoral Approaches in Percutaneous Coronary Intervention (from the Korean Transradial Intervention Prospective Registry). Am J Cardiol 2016; 117:1272-81. [PMID: 26899492 DOI: 10.1016/j.amjcard.2016.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
As few studies have reported the impact of transradial interventions (TRIs) versus transfemoral interventions (TFIs) on percutaneous coronary interventions using real-world registry data, we compared the clinical and procedural outcomes between TRIs and TFIs in the Korean Transradial Intervention Prospective Registry. Patients undergoing percutaneous coronary interventions were consecutively registered from February 2014 to July 2014 in this multicenter registry. Composite events were evaluated for all-cause deaths, nonfatal myocardial infarctions, and repeat revascularizations within 30 days. Nonlesion complications included access site complications and bleeding events. A total of 1,225 patients (232 for TFIs and 993 for TRIs) were analyzed. All-cause deaths and composite events were more frequent in the TFI group than in the TRI group. Procedure failures and nonlesion complications were also more frequent in the TFI group, whereas lesion complication rates were similar in the 2 groups. Procedure times were not different between the 2 groups, whereas fluoroscopy times were longer and contrast volumes were larger in the TFI group. However, in a propensity score-matched cohort, all-cause deaths, composite events, procedure failures, and lesion and nonlesion complications were not different between the 2 groups. In contrast, in the matched cohort, the procedure and fluoroscopy times were longer and the contrast volumes were larger in the TFI group. In conclusion, TRI was as effective and safe as TFI in terms of short-term clinical outcomes, procedure success rates, and complication rates, whereas TRI was more effective for reducing procedure times and hazardous exposure to radiation and contrast media.
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Shin JH, Lee HT, Lim YH, Park HC, Shin J, Kim KS, Park JK. Defining Vitamin D Deficiency and Its Relationship to Hypertension in Postmenopausal Korean Women. J Womens Health (Larchmt) 2015; 24:1021-9. [PMID: 26540562 DOI: 10.1089/jwh.2015.5358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Inconsistent results regarding the association between low vitamin D level and hypertension (HTN) have led to uncertainty in clinical practice as to the use of vitamin D cutoff value. The aims of this study were to investigate the association between vitamin D deficiency and HTN in postmenopausal women and to determine the clinically significant cutoff value for vitamin D deficiency. METHODS We analyzed data from the Korean National Health and Nutrition Examination Survey 5 database (4107 postmenopausal women, aged 50-79 years). The cutoff value for vitamin D deficiency was based on the changes in parathyroid hormone (PTH) level according to serum 25(OH)D value. RESULTS PTH levels were significantly higher in groups with serum 25(OH)D <15 ng/mL (p < 0.001). When a serum 25(OH)D value of 15 ng/mL was used as a cutoff value, 35.2% of the subjects were found to be vitamin D deficient. Although the association between 25(OH)D level <15 ng/mL and systolic blood pressure did not remain significant after adjusting for season (p = 0.30), multiple logistic regression analysis revealed that 25(OH)D level <15 ng/mL was an independent risk factor for HTN (adjusted odds ratio [OR] 1.285, 95% confidence interval [CI] 1.024-1.614, p = 0.031). CONCLUSIONS Using serum PTH level, we defined vitamin D deficiency as 25(OH)D <15 ng/mL in postmenopausal women. Vitamin D deficiency [25(OH)D <15 ng/mL] was a significant risk factor for HTN in postmenopausal women.
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Lee JM, Jung JH, Park KW, Shin ES, Oh SK, Bae JW, Rhew JY, Lee N, Kim DB, Kim U, Han JK, Lee SE, Yang HM, Kang HJ, Koo BK, Kim S, Cho YK, Shin WY, Lim YH, Rha SW, Kim SY, Lee SY, Kim YD, Chae IH, Cha KS, Kim HS. Harmonizing Optimal Strategy for Treatment of coronary artery diseases--comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS RCT): study protocol for a randomized controlled trial. Trials 2015; 16:409. [PMID: 26374625 PMCID: PMC4570043 DOI: 10.1186/s13063-015-0925-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 08/24/2015] [Indexed: 11/24/2022] Open
Abstract
Background Antiplatelet treatment is an important component in optimizing the clinical outcomes after percutaneous coronary intervention (PCI) especially in patients with acute coronary syndrome (ACS). Prasugrel, which is a new P2Y12 inhibitor, has been confirmed as efficacious in a large trial in Western countries, and a similar trial is also to be launched in Asian countries. Although a 60-mg loading dose of prasugrel followed by 10 mg per day should be acceptable, there have been no data regarding the optimal dose in Asian patients. Furthermore, serum levels of prasugrel and the rates of platelet inhibition are known to be higher in Asians than Caucasians with the same dose of the drug. Polymer, a key component of drug-eluting stents (DES), has been suggested as the cause of inflammation leading to late complications, and has driven many companies to develop biodegradable-polymer DES. Currently, there are limited data regarding the head-to-head comparison between BP-BES and the biostable polymer CoCr-EES or the newest platinum-chromium everolimus-eluting stent (PtCr-EES). Furthermore, the polymer issue may be more important in ACS where there is ruptured thrombotic plaque where polymer-induced inflammation may affect the local milieu of the stented artery. Therefore, the present study dedicated only to ACS patients, will offer important information on the optimal prasugrel dose in the Asian population by comparing a 10-mg versus a 5-mg maintenance dose beyond 1 month after PCI, as well as giving important insight into the polymer issue by comparing BP-BES versus biostable-polymer PtCr-EES. Method/Design Harmonizing Optimal Strategy for Treatment of coronary artery diseases – comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients (HOST-REDUCE-POLYTECH-ACS) trial is a multicenter, randomized and open-label clinical study with a 2 × 2 factorial design, according to the type of stent (PtCr-EES versus BP-BES) and prasugrel maintenance dose (5 mg versus 10 mg), to demonstrate non-inferiority of PtCr-EES relative to BP-BES or the reduced prasugrel dose relative to conventional dose in an Asian all-comers PCI population presenting with ACS. Approximately 3400 patients will undergo prospective, random assignment separately to either stent or prasugrel arm (1:1 ratio, respectively). When the patients have contraindications to prasugrel, they are categorized into an antiplatelet observation group after stent-randomization. The primary endpoint is the patient-oriented composite outcome, which is a composite of all-cause mortality, any myocardial infarction (MI), any repeat revascularization in the stent arm at 12 months after index PCI. In the prasugrel arm, primary endpoint is any major adverse cardiovascular event, which is a composite of all-cause mortality, any MI, any stent thrombosis (Academic Research Consortium (ARC)-defined), any repeat revascularization, stroke, or bleeding (BARC class ≥ 2). Discussion The HOST-REDUCE-POLYTECH-ACS RCT is the first study exploring the optimal maintenance dose of prasugrel beyond 1 month after PCI for ACS in Asian all-comers. In addition, this is the largest study dedicated only to ACS patients to evaluate the polymer issue in the situation of ACS by directly comparing biostable-polymer PtCr-EES versus BP-BES. Trial registration ClinicalTrials.gov (ID: NCT02193971, 13 July 2014).
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Lee Y, Lim YH, Shin JH, Park J, Shin J, Kim KS. The Impact of Metabolic Syndrome on Clinical Outcomes After Everolimus-Eluting Stent Implantation. Am J Cardiol 2015; 116:717-24. [PMID: 26115900 DOI: 10.1016/j.amjcard.2015.05.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
As it is controversial whether metabolic syndrome (MetS) affects cardiovascular outcomes in patients who underwent percutaneous coronary intervention (PCI), we investigated the impact of MetS on clinical outcomes in patients who underwent PCI with everolimus-eluting stents (EESs). Patients who underwent PCI with EESs from 2009 to 2013 were included in this single-center, prospective cohort study. A composite event consisted of repeat revascularization, nonfatal myocardial infarction, and cardiac death. Of 903 patients observed for 4.9 years (median 1.8 years), 570 were diagnosed with MetS. The MetS group displayed more severe coronary artery disease and underwent more extensive PCIs than did the non-MetS group. The overall composite event rate was not significantly different between the MetS and the non-MetS group (11.9% vs 13.2%, p = 0.572). Kaplan-Meier survival analysis showed no significant difference in the event-free survival of the composite event between the 2 groups (p = 0.700). A multivariable Cox regression analysis showed that MetS was not associated with the composite event, whereas total stent length, decreased renal function, diabetes, and the absence of abdominal obesity were associated with the composite event. Abdominal obesity was associated with decreased risk of the composite event, alleviating unfavorable clinical outcomes of patients with diabetes in the MetS group. In conclusion, MetS has no impact on the clinical outcomes of patients who underwent PCI with EESs, although the MetS group exhibited more severe coronary artery disease and underwent more extensive PCIs. The paradoxical association between obesity and favorable clinical outcomes may explain this result.
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