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Cha JM, Lim KS, Lee SH, Joo YE, Hong SP, Kim TI, Kim HG, Park DI, Kim SE, Yang DH, Shin JE. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 2013; 45:202-7. [PMID: 23381948 DOI: 10.1055/s-0032-1326104] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Post-polypectomy coagulation syndrome (PPCS) is a well known complication of colonoscopic polypectomy. However, no previous studies have reported on the clinical outcomes or risk factors of PPCS. The aim of the current study was to analyze the clinical outcomes and risk factors of PPCS developing after a colonoscopic polypectomy. PATIENTS AND METHODS Data for all patients who underwent colonoscopic polypectomies and required hospitalization in nine university hospitals were analyzed retrospectively. The incidence, clinicopathological characteristics, and clinical outcomes of PPCS cases were examined. Additionally, patients who developed PPCS were compared with controls who were matched by age and sex, in order to assess for possible risk factors. RESULTS The rate of PPCS that required hospitalization after colonoscopic polypectomy was 0.7/1000. All patients with PPCS were treated medically without the need for surgical interventions. The median durations of therapeutic fasting, hospitalization, and antibiotic use were 3 days, 5.5 days, and 7 days, respectively. The rates of major PPCS and mortality were 2.9 % and 0 %, respectively. On multivariate analysis, hypertension (OR = 3.023, 95 %CI 1.034 - 8.832), large lesion size (OR = 2.855, 95 %CI 1.027 - 7.937), and non-polypoid configuration (OR = 3.332, 95 %CI 1.029 - 10.791) were found to be independent risk factors related to the development of PPCS. CONCLUSIONS In this study, the rates of major PPCS and mortality were only 2.9 % and 0 %, respectively. Hypertension, large lesion size, and non-polypoid configuration of the lesion were independently associated with PPCS. Therefore, patients may be reassured by the excellent prognosis of PPCS, while endoscopists should be especially careful when performing colonoscopic polypectomies in patients with hypertension or large and non-polypoid lesions.
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Kim KH, Yang DH, Kim CY, Kim NK, Choi WS, Bae MH, Lee JH, Park HS, Cho Y, Chae SC. Recurrent syncope episodes and exercise intolerance in hypertrophic cardiomyopathy combined with atrioventricular conduction disturbance. J Cardiovasc Ultrasound 2013; 21:148-51. [PMID: 24198923 PMCID: PMC3816167 DOI: 10.4250/jcu.2013.21.3.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/05/2013] [Accepted: 08/12/2013] [Indexed: 11/25/2022] Open
Abstract
A 30-year-old female patient with known hypertrophic cardiomyopathy (HCMP) was admitted for recurrent syncope episodes. Electrocardiogram (ECG) showed 2 : 1 atrioventricular (AV) block. Stress echocardiography with bicycle showed high grade AV block at high stage of the exercise associated with exercise intolerance and dyspnea. Twenty-four hour ECG monitoring also revealed high grade AV block and 1 episode of non-sustained ventricular tachycardia. Implantable cardioverter/defibrillator-pacemaker (ICD-P) was inserted. After implantation of ICD-P, conduction disturbance and exercise intolerance were improved. AV block is a rare complication HCMP. There are just a few case reports that present symptoms caused by conduction disturbance in HCMP. This case describes repeated syncope episodes and exercise intolerance caused by conduction disturbance during exercise in HCMP patient. For evaluating the cause of syncope in HCMP, stress echocardiography can be helpful to understand the probable mechanism of syncope.
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Jang SY, Cho Y, Song JH, Cheon SS, Park SH, Bae MH, Lee JH, Yang DH, Park HS, Chae SC. Complication rate of transfemoral endomyocardial biopsy with fluoroscopic and two-dimensional echocardiographic guidance: a 10-year experience of 228 consecutive procedures. J Korean Med Sci 2013; 28:1323-8. [PMID: 24015037 PMCID: PMC3763106 DOI: 10.3346/jkms.2013.28.9.1323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 07/16/2013] [Indexed: 12/02/2022] Open
Abstract
Endomyocardial biopsy (EMB) is one of the reliable methods for the diagnosis of various cardiac diseases. However, EMB can cause various complications. The purpose of this study is to evaluate the complication of transfemoral EMB with both fluoroscopic and two-dimensional (2-D) echocardiographic guidance. A total of 228 patients (148 men; 46.0±14.6 yr-old) who underwent EMB at Kyungpook National University Hospital from January 2002 to June 2012 were included. EMB was performed via the right femoral approach with the guidance of both echocardiography and fluoroscopy. Overall, EMB-related complications occurred in 21 patients (9.2%) including one case (0.4%) with cardiac tamponade requiring emergent pericardiocentesis, four cases (1.8%) with small pericardial effusion without pericardiocentesis, two cases (0.9%) with hemodynamically unstable ventricular tachycardia (VT), one case (0.4%) with nonsustained VT, one case (0.4%) with tricuspid regurgitation, twelve cases (5.3%) with right bundle branch block. There was no occurrence of either EMB-related death or cardiac surgery. Left ventricular ejection fraction was significantly lower (32.0±18.7% vs 42.0±19.1%, P=0.023) and left ventricular end-diastolic dimension was larger (60.0±10.0 mm vs 54.2±10.2 mm, P=0.013) in patients with EMB related complications than in those without. It is concluded that transfemoral EMB with fluoroscopic and 2-D echocardiographic guidance is a safe procedure with low complication rate.
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Lee JH, Yang DH, Choi WS, Kim KH, Park SH, Bae MH, Lee JH, Park HS, Cho Y, Chae SC, Jun JE. Prediction of improvement in cardiac function by high dose dobutamine stress echocardiography in patients with recent onset idiopathic dilated cardiomyopathy. Int J Cardiol 2013; 167:1649-50. [DOI: 10.1016/j.ijcard.2012.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 11/01/2012] [Indexed: 11/25/2022]
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Bae MH, Cheon SS, Song JH, Jang SY, Choi WS, Kim KH, Park SH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC. Etiologies and predictors of ST-segment elevation myocardial infarction. Korean Circ J 2013; 43:370-6. [PMID: 23882285 PMCID: PMC3717419 DOI: 10.4070/kcj.2013.43.6.370] [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: 07/06/2011] [Revised: 02/18/2013] [Accepted: 04/30/2013] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for the appropriate management of patients. We investigated the prevalence, etiologies and predictors of false-positive diagnosis of STEMI and subsequent inappropriate catheterization laboratory activation in patients with presumptive diagnosis of STEMI. Subjects and Methods Four hundred fifty-five consecutive patients (62±13 years, 345 males) with presumptive diagnosis of STEMI between August 2008 and November 2010 were included. Results A false-positive diagnosis of STEMI was made in 34 patients (7.5%) with no indication of coronary artery lesion. Common causes for the false-positive diagnosis were coronary spasm in 10 patients, left ventricular hypertrophy in 5 patients, myocarditis in 4 patients, early repolarization in 3 patients, and previous myocardial infarction and stress-induced cardiomyopathy in 2 patients each. In multivariate logistic regression analysis, symptom-to-door time >12 hours {odds ratio (OR) 4.995, 95% confidence interval (CI) 1.384-18.030, p=0.014}, presenting symptom other than chest pain (OR 7.709, 95% CI 1.255-39.922, p=0.027), absence of Q wave (OR 9.082, CI 2.631-31.351, p<0.001) and absence of reciprocal changes on electrocardiography (ECG) (OR 17.987, CI 5.295-61.106, p<0.001) were independent predictors of false-positive diagnosis of STEMI. Conclusion In patients whom STEMI was planned for primary coronary intervention, the false-positive diagnosis of STEMI was not rare. Correct interpretation of ECGs and consideration of ST-segment elevation in conditions other than STEMI may reduce inappropriate catheterization laboratory activation.
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Lee JH, Yang DH, Park HS, Cho Y, Lee WK, Chun BY, Chae SC. Incremental predictive value of high-sensitivity C-reactive protein for incident hypertension: the Hypertension-Diabetes Daegu Initiative study. Clin Exp Hypertens 2013; 36:302-8. [DOI: 10.3109/10641963.2013.810236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee JH, Yang DH, Jang SY, Choi WS, Kim KH, Bae MH, Park HS, Cho Y, Chae SC, Lee WK. Letters to the Editor. Clin Cardiol 2013; 36:E36. [DOI: 10.1002/clc.22189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/01/2013] [Indexed: 11/07/2022] Open
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Bae MH, Jang SY, Choi WS, Kim KH, Park SH, Lee JH, Kim HK, Yang DH, Huh S, Park HS, Cho Y, Chae SC. A new revised cardiac risk index incorporating fragmented QRS complex as a prognostic marker in patients undergoing noncardiac vascular surgery. Am J Cardiol 2013; 112:122-7. [PMID: 23768543 DOI: 10.1016/j.amjcard.2013.02.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate the value of a new Revised Cardiac Risk Index (RCRI) that includes consideration of QRS fragmentation (fQRS) as a predictor of cardiac events in patients undergoing noncardiac vascular surgery. Four hundred sixty-seven consecutive patients admitted for noncardiac vascular surgery were studied. Patients were allocated to RCRI 0, 1, 2, or ≥3 groups according to the sum of diabetes, renal insufficiency, and histories of ischemic heart disease, congestive heart failure, and cerebrovascular disease. They were then reallocated to fragmented RCRI (fRCRI) 0, 1, 2, or ≥3 groups after including a score of 1 or 0 corresponding to the presence or absence of fQRS. A major adverse cardiac event (MACE) was defined as a composite of death, myocardial infarction, congestive heart failure, and percutaneous coronary intervention before noncardiac vascular surgery. During index hospitalization, MACE developed in 38 patients (8.1%). fQRS was present in 169 (36.2%), and it was significantly greater in patients with MACE than in those without MACE (63.2% vs 34.3%, p <0.001). The proportions of RCRI 0, 1, 2, and ≥3 were 46.9% (n = 219), 35.3% (n = 165), 12.4% (n = 58), and 5.4% (n = 25), respectively. When fRCRI data were included, 28 patients (48.3%) in RCRI 2 were reclassified as fRCRI ≥3. By multivariate logistic regression analysis, fRCRI (odds ratio 1.529, 95% confidence interval 1.035 to 2.258, p = 0.033) and a left ventricular ejection fraction <50% independently predicted in-hospital MACE. In conclusion, fRCRI is an independent predictor of in-hospital MACE in patients undergoing noncardiac vascular surgery.
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Lee JH, Yang DH, Jang SY, Choi WS, Kim KH, Lee WK, Bae MH, Park HS, Cho Y, Chae SC. Incremental predictive value of red cell distribution width for 12-month clinical outcome after acute myocardial infarction. Clin Cardiol 2013; 36:336-41. [PMID: 23568781 DOI: 10.1002/clc.22114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/16/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The incremental predictive value of red cell distribution width (RDW) for major adverse cardiac events (MACEs) has not been fully investigated in patients with acute myocardial infarction (AMI). HYPOTHESIS The aim of this study was to determine the incremental value of RDW to the established risk factors in predicting clinical outcomes after AMI. METHODS Between November 2005 and January 2010, 1596 patients with AMI (1070 male; mean age, 64.5 ± 11.9 years) were analyzed in this study. Baseline levels of RDW were measured at the time of admission. The 12-month MACEs were defined as death and nonfatal MI. RESULTS The RDW levels were significantly higher in patients with 12-month MACEs (13.8 ± 1.3% vs 13.3 ± 1.2%, P < 0.001). In a Cox proportional hazards model, RDW (hazard ratio [HR]: 1.19, P = 0.016) was an independent predictor for 12-month MACEs. Adding RDW to established risk factors and hemoglobin levels significantly improved prediction for 12-month MACEs, as shown by the net reclassification improvement (0.297; P = 0.012) and integrated discrimination improvement (0.0143; P = 0.042). The likelihood ratio test showed that RDW added incremental predictive value to the combination of hemoglobin and established risk factors (P = 0.005). Patients were categorized into 4 groups according to quartiles of RDW at baseline. Adjusted HRs for 12-month MACEs were 1 (RDW ≤12.6%, reference), 4.24 (RDW 12.7%-13.1%, P = 0.01), 4.36 (RDW 13.2%-13.9%, P = 0.008), and 6.18 (RDW 13.2%-13.9%, P = 0.001), respectively. CONCLUSIONS In post-myocardial infarction patients, baseline RDW levels at admission could provide incremental predictive value to established risk factors for predicting 12-month MACEs.
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Yoon JY, Song JH, Cheon SS, Cho HJ, Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC. Fabry cardiomyopathy. J Cardiovasc Ultrasound 2013; 21:26-9. [PMID: 23560140 PMCID: PMC3611116 DOI: 10.4250/jcu.2013.21.1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/19/2012] [Accepted: 02/13/2013] [Indexed: 11/22/2022] Open
Abstract
Fabry disease is a progressive X-linked disorder of glycosphingolipid metabolism caused by a deficiency of the α-galactosidase lysosomal enzyme. The partial or complete deficiency of the lysosomal enzyme leads to an accumulation of neutral glycosphingolipids in the vascular endothelium and visceral tissues throughout the body. In the heart, glycosphingolipids deposition causes progressive left ventricular hypertrophy (LVH). We report a case of Fabry disease which was suspected based upon two-dimensional echocardiographic finding of LVH. A 44-year-old man was admitted to evaluation of aggravated exertional dyspnea of two weeks duration. He had been diagnosed with end-stage renal disease of unknown etiology at age 41 followed by renal transplantation that year. He had been treated with oral immunosuppressive agents. On hospital day two, transthoracic echocardiography revealed concentric LVH. Left ventricular systolic function was preserved but diastolic dysfunction was present. Fabry disease was confirmed by demonstration of a low plasma α-galactosidase A (α-Gal A) activity. Analysis of genomic DNA showed α-Gal A gene mutation. The patient was diagnosed with Fabry disease.
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Kang YK, Chang HM, Yook JH, Ryu MH, Park I, Min YJ, Zang DY, Kim GY, Yang DH, Jang SJ, Park YS, Lee JL, Kim TW, Oh ST, Park BK, Jung HY, Kim BS. Adjuvant chemotherapy for gastric cancer: a randomised phase 3 trial of mitomycin-C plus either short-term doxifluridine or long-term doxifluridine plus cisplatin after curative D2 gastrectomy (AMC0201). Br J Cancer 2013; 108:1245-51. [PMID: 23449357 PMCID: PMC3619263 DOI: 10.1038/bjc.2013.86] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This phase 3 study evaluated the efficacy of new adjuvant chemotherapy (MFP), which intensified the mitomycin-C (MMC) plus short-term doxifluridine (Mf) for gastric cancer. PATIENTS AND METHODS A total of 855 patients (424 in Mf, 431 in MFP) with pathological stage II-IV (M0) gastric cancer after D2 gastrectomy were randomly assigned to receive either Mf (MMC 20 mg m(-2), followed by oral doxifluridine 460-600 mg m(-2) per day for 3 months) or MFP (MMC 20 mg m(-2), followed by oral doxifluridine 460-600 mg m(-2) per day for 12 months with 6 monthly infusions of 60 mg m(-2) of cisplatin) chemotherapy. RESULTS With a median follow-up of 6.6 years, there was no difference between the two groups in recurrence-free survival (RFS) (5-year RFS 61.1% in Mf and 57.9% in MFP; hazard ratio 1.10 (95% CI 0.89-1.35); P=0.39) and overall survival (OS) (5-year OS 66.5% in Mf and 65.0% in MFP; hazard ratio 1.11 (95% CI 0.89-1.39); P=0.33). CONCLUSION Intensification of Mf adjuvant chemotherapy by prolonging the duration of oral fluoropyrimidine and adding cisplatin was safe but not effective to improve the survivals in curatively resected gastric cancer patients.
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Park SH, Im CH, Yang DH, Kang JW, Yoon JY, Cho HJ, Park HS, Cho Y, Chae SC, Jun JE. A case of chronic periaortitis with retroperitoneal fibrosis. Korean Circ J 2013; 42:857-60. [PMID: 23323126 PMCID: PMC3539054 DOI: 10.4070/kcj.2012.42.12.857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/24/2012] [Accepted: 05/25/2012] [Indexed: 11/11/2022] Open
Abstract
A 73-year-old man with a history of hypertension and ascending aortic dissection was hospitalized for aggravated abdominal pain and general ache for 3 months. Follow-up CT showed aggravated abdominal aortic hematoma with aneurysm, atherosclerotic periaortitis and bilateral hydronephrosis. An initial laboratory finding showed elevated levels of inflammatory markers and renal dysfunction. Positron emission tomography-CT showed an increased standardized uptake values level in the aortic arch, descending thoracic aorta, major branch, abdominal aorta, and common iliac artery. For bilateral hydronephrosis, a double J catheter insertion was performed. Tissue specimens obtained from previous surgery on the aorta indicated the infiltration of lympho-plasma cells without granuloma formation in the aortic wall. After a combined therapy of high dose steroid therapy with azathioprine, the patient's initial complaints of abdominal pain, weakness and azotemia improved. This case was diagnosed as chronic periaortitis based on aortic inflammation at biopsy, which was complicated with retroperitoneal fibrosis and ureteric obstruction.
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Bae MH, Cheon SS, Song JH, Jang SY, Choi WS, Kim KH, Park SH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC. Erratum: Etiologies and Predictors of False-Positive Diagnosis of ST-Segment Elevation Myocardial Infarction. Korean Circ J 2013. [PMCID: PMC3772307 DOI: 10.4070/kcj.2013.43.8.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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114
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Cho HJ, Yoon JY, Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC, Jun JE. Familial Transthyretin Amyloidosis with Variant Asp38Ala Presenting with Orthostatic Hypotension and Chronic Diarrhea. J Cardiovasc Ultrasound 2012; 20:209-12. [PMID: 23346293 PMCID: PMC3542517 DOI: 10.4250/jcu.2012.20.4.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/04/2012] [Accepted: 11/21/2012] [Indexed: 11/22/2022] Open
Abstract
A 53-year-old man complained of orthostatic, non-rotating dizziness, and chronic watery diarrhea of several years duration. His nerve-conduction velocity test revealed peripheral sensory-motor polyneuropathy and he showed an autonomic function abnormality. Echocardiographic examination showed ventricular and atrial wall thickening with a granular "sparkling" appearance. Left ventricular systolic function was preserved but pseudonormal diastolic dysfunction was present. Coronary angiography showed normal coronary arteries and an endomyocardial biopsy revealed lesions consistent with cardiac amyloidosis. Colonoscopic biopsy also revealed the deposition of amyloid fibrils. Gene analysis found the transthyretin variant Asp38Ala. His son had same mutation, but three daughters did not. In conclusion, we report a case of familial transthyretin amyloidosis with Asp38Ala.
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Lee JH, Bae MH, Chae SC, Cho Y, Choi WS, Jang SY, Jun JE, Kim KH, Park SH, Park HS, Yang DH. TCT-713 The benefit of beta-blocker therapy in hospital survivors receiving primary percutaneous coronary intervention after ST-elevation myocardial infarction from the Korea Acute Myocardial Infarction Registry. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee JH, Bae MH, Chae SC, Cho Y, Cho HJ, Choi WS, Jang SY, Jun JE, Kim KH, Park SH, Park HS, Yang DH. TCT-484 Prognostic value of simple standard 12-lead electrocardiographic parameters for predicting clinical outcomes in hospital survivors after acute myocardial infarction. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.516] [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: 11/16/2022]
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Lee JH, Bae MH, Chae SC, Cho Y, Choi WS, Jang SY, Jun JE, Kim KH, Park SH, Park HS, Yang DH. TCT-225 The role of collateral pressure index assessing collateral function and coronary hemodynamics in patients with total or nearly total occluded coronary lesions. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.248] [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: 11/26/2022]
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Lee SH, Ryu HM, Lee JH, Lee H, Park SH, Bae MH, Yang DH. A case of an anomalous hypertrophied muscle band in the left ventricle. J Cardiovasc Ultrasound 2012; 20:97-9. [PMID: 22787527 PMCID: PMC3391635 DOI: 10.4250/jcu.2012.20.2.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/21/2012] [Accepted: 05/15/2012] [Indexed: 11/22/2022] Open
Abstract
A hypertrophied muscle band (HMB) in the left ventricle (LV), which can be misinterpreted as apical hypertrophic cardiomyopathy, is a rare echocardiographic finding in a patient with normal LV wall thickness. Not only are symptoms produced, but changes in the electrocardiogram (ECG) are limited to the repolarization phase and show no progression even in a large HMB. Hence, we report a case of a 25-year-old woman who visited a local medical clinic due to epigastric discomfort in January 2007. The 24-hour Holter ECG showed multiple premature ventricular complexes. An HMB (3.23 × 10.8 cm) was observed on two-dimensional echocardiography that ran toward the interventricular septum (IVS) across the LV and divided the LV into apical and basal cavities at the apical one-third of the LV. Although LV wall thickness showed normal range, flow acceleration was observed between the HMB and IVS and revealed dagger-shaped with a high pressure gradient up to 30 mmHg in continuous wave Doppler examination. Circumferential band-like myocardial hypertrophy was observed at the LV apex on cardiac magnetic resonance imaging. Myocardial thinning and prominent trabeculae were present from the proximal to distal HMB. However, contractility was normal at the myocardial thinning site, regional wall motion abnormality was not observed in cine images. Focal fatty accumulation was evident at the base of the HMB. Coronary angiography revealed no significant stenosis, whereas left ventriculography showed septation at the apical one-third of the LV. The patient was discharged without any medication.
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Lee DY, Park SH, Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC, Jun JE. Multiple Fistula Emptying into the Left Ventricle through the Entire Left Ventricular Wall. J Cardiovasc Ultrasound 2012; 20:108-11. [PMID: 22787530 PMCID: PMC3391627 DOI: 10.4250/jcu.2012.20.2.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/16/2012] [Accepted: 05/15/2012] [Indexed: 12/05/2022] Open
Abstract
Coronary artery fistulae are usually identified during invasive coronary angiographies. However, in this case, we made the early detection of coronary artery fistulae during non-invasive transthoracic echocardiography, by demonstrating diastolic multiple abnormal color Doppler flows on the entire left ventricular walls including left ventricular free wall, interventricular septum and apex, which were mimicking firecracker on the whole left ventricle. Fistulous communication from the coronary artery to the left ventricle is rare. Moreover, a case of multiple coronary fistulae emptying into the left ventricle through the entire left ventricular walls including left ventricular free wall, interventricular septum and apex is uncommon. We report a case of a 31-year-old woman who was diagnosed with multiple fistula communicating with entire left ventricular wall.
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Kang EJ, Lee KN, Kim I, Chae JM, Kim GJ, Yang DH, Lee J. Spontaneously developed pulmonary arterial intramural hematoma that mimicked thromboembolism. Korean J Radiol 2012; 13:496-9. [PMID: 22778573 PMCID: PMC3384833 DOI: 10.3348/kjr.2012.13.4.496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/10/2011] [Indexed: 11/15/2022] Open
Abstract
A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.
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Hwan Bae M, Hoon Lee J, Heon Yang D, Sik Park H, Cho Y, Chull Chae S, Jun JE. Erroneous computer electrocardiogram interpretation of atrial fibrillation and its clinical consequences. Clin Cardiol 2012; 35:348-53. [PMID: 22644921 DOI: 10.1002/clc.22000] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/28/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the frequency and nature of errors made by computer electrocardiogram (ECG) analysis of atrial fibrillation (AF), and the clinical consequences. HYPOTHESIS Computer software for interpreting ECGs has advanced. METHODS A total of 10279 ECGs were collected, automatically interpreted by the built-in ECG software, and then reread by 2 cardiologists. AF-related ECGs were classified into 3 groups: overinterpreted AF (rhythms other than AF interpreted as AF), misinterpreted AF (AF interpreted as rhythms other than AF), and true AF (AF interpreted as AF by both computer ECG interpretation and cardiologists). RESULTS There were 1057 AF-related ECGs from 409 patients. Among these, 840 ECGs (79.5%) were true AF. Overinterpretation occurred in 98 (9.3%) cases. Sinus rhythm and sinus tachycardia with premature atrial contraction and/or baseline artifact and sinus arrhythmia were commonly overinterpreted as AF. Heart rate ≤60 bpm and baseline artifact significantly increased the likelihood of overinterpreted AF. Misdiagnosis occurred in 119 (11.3%) cases, in which AF was usually misdiagnosed as sinus or supraventricular tachycardia. The presence of tachycardia and low-amplitude atrial activity significantly increased the likelihood of misdiagnosis of AF. Among the erroneous computer ECG interpretations, 17 cases (7.8%) were not corrected by the ordering physicians and/or repeat computer-ECG interpretation; inappropriate follow-up studies or treatments of the patients were undertaken with no serious sequelae. CONCLUSIONS Erroneous computer ECG interpretation of AF was not rare. Attention should be concentrated on educating physicians about ECG appearance and confounding factors of AF, along with ongoing quality control of built-in software for automatic ECG interpretation.
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Bae MH, Choi WS, Kim KH, Park SH, Kim HW, Lee JH, Lee SW, Yang DH, Park HS, Cho Y, Chae SC, Jun JE. The implications of a fragmented QRS complex and newly reclassified revised cardiac risk index including fragmented QRS in patients undergoing non-cardiac vascular surgery. Int J Cardiol 2012; 157:276-8. [DOI: 10.1016/j.ijcard.2012.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 03/03/2012] [Indexed: 11/16/2022]
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Yang DH. Ankylosing spondylitis and cardiac abnormalities. J Cardiovasc Ultrasound 2012; 20:23-4. [PMID: 22509434 PMCID: PMC3324723 DOI: 10.4250/jcu.2012.20.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 11/22/2022] Open
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Lee JH, Kim KH, Choi WS, Park SH, Bae MH, Yang DH, Park HS, Cho Y, Chae SC. ASSOCIATIONS BETWEEN HIGH-SENSITIVITY C-REACTIVE PROTEIN AND ANKLE BRACHIAL INDEX IN ASYMPTOMATIC OLDER ADULTS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61648-9] [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: 11/30/2022]
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Yang DH, Kim NY, Park SH, Bae MH, Lee JH. THE VALVULOARTERIAL IMPEDANCE IS A PROGNOSTIC FACTOR IN PATIENTS WITH AORTIC STENOSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)62026-9] [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: 11/26/2022]
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