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Ahn HJ, Oh IY, Choi J, Lee KY, Ahn HJ, Kwon S, Choi EK, Oh S, Kim JY, Cha MJ, Kwon CH, Lee SH, Park J, Kim KH, Yang PS, Kim JH, Shim J, Lim HE, Lee SR. Association between body mass index and results of cryoballoon ablation in Korean patients with atrial fibrillation: an analysis from Korean Heart Rhythm Society Cryoablation registry. Europace 2024:euae095. [PMID: 38624037 DOI: 10.1093/europace/euae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Pulmonary vein isolation using cryoablation is effective and safe in patients with atrial fibrillation (AF). Although both obesity and underweight are associated with a higher risk for incident AF, there is limited data on the efficacy and safety following cryoablation according to body mass index (BMI) especially in Asians. METHODS Using the Korean Heart Rhythm Society Cryoablation registry, a multicenter registry of 12 tertiary hospitals, we analyzed AF recurrence and procedure-related complications after cryoablation by BMI (kg/m2) groups (BMI<18.5, underweight, UW; 18.5-23, normal, NW; 23-25, overweight, OW; 25-30, obese Ⅰ, OⅠ; ≥30, obese Ⅱ, OⅡ). RESULTS A total of 2,648 patients were included (median age 62.0 years; 76.7% men; 55.6% non-paroxysmal AF). Patients were categorized by BMI groups; 0.9% UW, 18.7% NW, 24.8% OW, 46.1% OI, and 9.4% OII. UW patients were the oldest, and had least percentage of non-paroxysmal AF (33.3%). During a median follow-up of 1.7 years, atrial arrhythmia recurred in 874 (33.0%) patients (incidence rate, 18.9 per 100 person-year). After multivariable adjustment, the risk of AF recurrence was higher in UW group compared to NW group (adjusted hazard ratio, 95% confidence interval; 2.55, 1.18-5.50, p=0.02). Procedure-related complications occurred in 123 (4.7%) patients and the risk was higher for UW patients (odds ratio, 95% confidence interval; 2.90, 0.94-8.99, p=0.07), mainly due to transient phrenic nerve palsy. CONCLUSION UW patients showed a higher risk of AF recurrence after cryoablation compared to NW patients. Also, careful attention is needed on the occurrence of phrenic nerve palsy in UW patients.
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Affiliation(s)
- Hyun Jin Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - JeongMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Yeon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Youn Kim
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Choi JH, Kwon CH. Timing of critical isthmus from end of P wave and usefulness of activation mapping with window of interest from end to end of P wave in reentrant atrial tachycardia. Heart Vessels 2024; 39:319-327. [PMID: 38015232 DOI: 10.1007/s00380-023-02335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
In activation mapping of reentrant atrial tachycardia (AT), there was no reference for window of interest (WOI). We examined the timing of a successful termination site from end of the P wave and attempted to determine whether the critical isthmus can be identified using activation mapping when WOI was set as end to end of the P wave. Forty patients with 54 reentrant AT who underwent 3D electroanatomic mapping and radiofrequency catheter ablation were evaluated retrospectively. The critical isthmus was defined as a successful termination site. We evaluate critical isthmus timing from end of the P wave and percentage of critical isthmus timing from end of the P wave to tachycardia cycle length. In 54 reentrant AT, Macro-reentry was identified in 46 (85.2%) and micro-reentry was identified in eight (14.8%). The timing of the critical isthmus site from end of the P wave was - 4.0 ± 31.1 ms (Macro-reentry vs. Micro-reentry; - 8.9 ± 29.4 ms vs. 24.0 ± 26.7 ms; P = 0.005). The percentage of critical isthmus timing from end of the P wave/tachycardia cycle length was - 1.4 ± 10.5% (Macro-reentry vs. Micro-reentry; - 3.1 ± 9.8% vs. 8.3 ± 9.3%, P = 0.004) The critical isthmus of reentrant AT is located within 10% backward and forward from end of the P wave to tachycardia cycle length. Setting the WOI from end to end of the P wave is useful for identification of the critical isthmus through activation mapping.
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Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea.
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Choi JH, Kwon CH. Correction to: Timing of critical isthmus from end of P wave and usefulness of activation mapping with window of interest from end to end of P wave in reentrant atrial tachycardia. Heart Vessels 2024; 39:328-329. [PMID: 38240810 DOI: 10.1007/s00380-024-02357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Korea.
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Kim M, Kwon CH. Perioperative Management of Patients with Cardiac Implantable Electronic Devices. Korean J Anesthesiol 2024:kja.23826. [PMID: 38287213 DOI: 10.4097/kja.23826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
The use of cardiac implantable electronic devices (CIEDs) has increased significantly in recent years. Consequently, more patients with CIEDs will undergo surgery during their lifetime, and thus the involvement of anesthesiologists in the perioperative management of CIEDs is increasing. With ongoing advancements in technology, many types of CIEDs have been developed, including permanent pacemakers, leadless pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy-pacemakers/defibrillators, and implantable loop recorders. The functioning of CIEDs exposed to an electromagnetic field can be affected by electromagnetic interference, potential sources of which can be found in the operating room. Thus, to prevent potential adverse events caused by electromagnetic interference in the operating room, anesthesiologists must have knowledge of CIEDs and be able to identify each type. This review focuses on the perioperative management of patients with CIEDs, including indications for CIED implantation to determine the baseline cardiovascular status of patients; concerns associated with CIEDs before and during surgery; perioperative management of CIEDs, including magnet application and device reprogramming; and additional perioperative provisions for patients with CIEDs. As issues such as variations in programming capabilities and responses to magnet application according to device can be challenging, this review provides essential information for the safe perioperative management of patients with CIEDs.
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Affiliation(s)
- Minsu Kim
- Department of Internal Medicine, Division of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Kwon CH, Choi JH, Oh IY, Lee SR, Kim JY, Lee SH, Park J, Kim KH, Yang PS, Kim JH, Shim J, Cha MJ, Lim HE. The impact of early cryoballoon ablation on clinical outcome in patients with atrial fibrillation: From the Korean cryoballoon ablation registry. J Cardiovasc Electrophysiol 2024; 35:69-77. [PMID: 37927151 DOI: 10.1111/jce.16122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Influence of early atrial fibrillation (AF) ablation, particularly cryoballoon ablation (CBA), on clinical outcome during long-term follow-up has not been clarified. The objective was to determine whether an early CBA (diagnosis-to-ablation of ≤6 months) strategy could affect freedom from AF recurrence after index CBA. METHODS The study included 2605 patients from Korean CBA registry data with follow-up >12 months after de novo CBA. The primary outcome was recurrence of atrial tachyarrhythmias (ATs) of ≥30-s after a 3-month blanking period. RESULTS Compared to patients in early CBA group, patients in late CBA group had higher prevalence of diabetes, congestive heart failure, and chronic kidney disease, and higher mean CHA2 DS2 -VAS score. During mean follow-up of >21 months, ATs recurrence was detected in 839 (32.2%) patients. The early CBA group showed a significantly lower 2-year recurrence rate of ATs than the late CBA group (26.1% vs. 31.7%, p = 0.043). In subgroup analysis, the early CBA group showed significantly higher 1-year and 2-year freedom from ATs recurrence than the late CBA group only in paroxysmal atrial fibrillation (PAF) patients in overall and propensity score matched cohorts. Multivariate analysis showed that early CBA was an independent factor for preventing ATs recurrence in PAF (hazard ratio: 0.637; 95% confidence intervals: 0.412-0.984). CONCLUSION Early CBA strategy, resulting in significantly lower ATs recurrence during 2-year follow-up after index CBA, might be considered as an initial rhythm control therapy in patients with paroxysmal AF.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Ji-Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Youn Kim
- Department of Internal Medicine, Heart Vascular and Stroke Institue, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ho Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, College of Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Jeong JH, Lee HS, Choi YY, Kim YG, Choi JI, Kim YH, Lim HE, Oh IY, Cha MJ, Lee SR, Kim JY, Kwon CH, Lee SH, Park J, Kim KH, Yang PS, Kim JH, Shim J. Association of typical atrial flutter and cavotricuspid isthmus ablation on clinical recurrence after cryoballoon ablation for atrial fibrillation. Front Cardiovasc Med 2023; 10:1303635. [PMID: 38162135 PMCID: PMC10755020 DOI: 10.3389/fcvm.2023.1303635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Typical atrial flutter commonly occurs in patients with atrial fibrillation (AF). Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control. This study investigated the association between concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation and the recurrence of atrial arrhythmia. The data were obtained from a multicenter registry of cryoballoon ablation for AF (n = 2,689). Patients who were screened for typical atrial flutter were included in the analysis (n = 1,907). All the patients with typical atrial flutter underwent CTI ablation. The primary endpoint was the late recurrence of atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia. Among the 1,907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had a lower incidence of persistent AF and a smaller size of the left atrium. Patients with atrial flutter had a significantly lower recurrence rate of atrial arrhythmia (19.7% vs. 29.9%, p < 0.001). In patients with atrial flutter, the recurrence rate of atrial tachycardia or atrial flutter was more frequent (7.3% vs. 4.7%, p = 0.028), but the recurrence rate of AF was significantly lower (17.0% vs. 29.4%, p < 0.001). Atrial flutter has been identified as an independent predictor of the primary endpoint (adjusted hazard ratio, 0.704; 95% confidence interval, 0.548-0.906; p = 0.006). Typical atrial flutter in patients with AF may serve as a positive marker of the recurrence of atrial arrhythmia, and performing CTI ablation in this population is associated with a reduced likelihood of AF recurrence. Performing routine screening and ablation procedures for coexisting atrial flutter may improve the clinical outcomes of AF.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Myung-Jin Cha
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Youn Kim
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Ho Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
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Kim BS, Kwon CH, Chang H, Choi JH, Kim HJ, Kim SH. The association of cardiac troponin and cardiovascular events in patients with concomitant heart failure preserved ejection fraction and atrial fibrillation. BMC Cardiovasc Disord 2023; 23:273. [PMID: 37226163 DOI: 10.1186/s12872-023-03302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/14/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Limited data are available for risk stratification in patients with atrial fibrillation (AF) and combined heart failure with preserved ejection fraction (HFpEF). We aimed to explore the prognostic utility of high-sensitivity cardiac troponin I (hs-cTnI) in patients with newly detected AF and concomitant HFpEF. METHODS From August 2014 to December 2016, 2,361 patients with newly detected AF were polled in a retrospective single-center registry. Of which, 634 patients were eligible for HFpEF diagnosis (HFA-PEFF score ≥ 5) and 165 patients were excluded with exclusion criteria. Finally, 469 patients are classified into elevated or non-elevated hs-cTnI groups based on the 99th percentile upper reference limit (URL). The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) during follow-up. RESULTS In 469 patients, 295 were stratified into the non-elevated hs-cTnI group (< 99th percentile URL of hs-cTnI) and 174 were placed in the elevated hs-cTnI group (≥ 99th percentile URL of hs-cTnI). The median follow-up period was 24.2 (interquartile range, 7.5-38.6) months. During the follow-up period, 106 patients (22.6%) in the study population experienced MACCE. In a multivariable Cox regression model, the elevated hs-cTnI group had a higher incidence of MACCE (adjusted hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.08-2.55; p = 0.03) and coronary revascularization-caused readmission (adjusted HR, 3.86; 95% CI, 1.39-15.09; p = 0.02) compared with the non-elevated hs-cTnI group. The incidence of heart failure-caused readmission tended to occur more frequently in the elevated hs-cTnI group (8.5% versus 15.5%; adjusted HR, 1.52; 95% CI, 0.86-2.67; p = 0.08). CONCLUSIONS One-fifth of patients with AF and concomitant HFpEF experienced MACCE during follow-up, and elevated hs-cTnI was independently associated with higher risk of MACCE, as driven by heart failure and revascularization-caused readmission. This finding suggested that hs-cTnI may be a useful tool in individualized risk stratification of future cardiovascular events in patients with AF and concomitant HFpEF.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Haseong Chang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Ji-Hoon Choi
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 05030, Republic of Korea.
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Kwon CH, Lee HY, Lee JH, Kim M, Sung KC. Optimal office blood pressure levels in younger (<50 years old) Korean hypertensive patients: a nationwide cohort study in South Korea. J Hypertens 2022; 40:2449-2458. [PMID: 35983871 DOI: 10.1097/hjh.0000000000003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is unclear what thresholds and targets of office blood pressure (BP) for treatment are appropriate in younger (<50 years old) hypertensive patients. Thus, the aim of this study was to evaluate associations of office BP levels with major cardiovascular events (MACEs) in these patients. METHODS Using the Korean National Health Insurance Service database, data of 98 192 younger (<50 years old) hypertensive patients having BP measurements available without any history of cardiovascular events from 2002 to 2011 were extracted. This cohort study evaluated associations of BP levels (<120/<70, 120-129/70-79, 130-139/80-89, 140-149/90-99, and ≥150/≥100 mmHg) with MACEs. The study outcome was MACE, a composite of cardiovascular death, myocardial infarction, stroke, and heart failure. RESULTS In all patients, those treated with antihypertensive medication accounted for 34.7% and those who achieved BP less than 130/80 mmHg accounted for 35.5%. During a mean follow-up of 9.5 ± 2.8 years, 4918 (5%) MACEs were documented in our cohort. The risk of MACE was the lowest [adjusted hazard ratio: 0.77, 95% confidence interval (CI) 0.66-0.89] for those with BP level of less than 120/less than 70 mmHg. It was the highest (hazard ratio 2.0, 95% CI 1.83-2.19) for those with BP level of at least 150/at least 100 mmHg in comparison with those with BP level of 130-139/80-89 mmHg. These results were consistent for all age groups (20-29, 30-39, and 40-49 years) and both sexes. CONCLUSION Elevated BP level from less than 120 mmHg/less than 70 mmHg is significantly correlated with an increased risk of MACE in younger (<50 years old) Korean hypertensive patients. Lowering BP to less than 120 mmHg/less than 70 mmHg is needed for these patients.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju
| | - Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kim BS, Park JJ, Chang H, Kim SH, Kwon CH, Chung SM, Kim HY, Kim HJ. Association of High-Sensitivity Troponin I with Cardiac and Cerebrovascular Events in Patient after Ischemic Stroke. Cerebrovasc Dis 2022; 52:153-159. [PMID: 35908539 DOI: 10.1159/000525920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Early recognition and risk stratification of cardiovascular events are necessary in patients after ischemic stroke. Recent evidence suggests that elevated high-sensitive cardiac troponin is a predictor of mortality and vascular events. Therefore, we aimed to explore the prognostic role of high-sensitive cardiac troponin I (hs-TnI) on mortality and cardiovascular outcomes in patients after ischemic stroke. <b><i>Methods:</i></b> From August 2014 to July 2017, 1,506 patients with acute ischemic stroke were pulled consecutively in a retrospective single-center registry. Of these, 1,019 patients were selected and classified into the elevated or non-elevated hs-TnI groups according to hs-TnI level of 99th percentile upper reference limit (URL) at the time of admission for ischemic stroke. The primary outcome was a major adverse cardiac and cerebrovascular event (MACCE) during follow-up. <b><i>Results:</i></b> Among 1,019 patients, 708 patients were non-elevated hs-TnI group (<99th percentile URL of hs-TnI) and 311 patients were elevated hs-TnI group (≥99th percentile URL of hs-TnI). The median follow-up period was 22.5 (interquartile range 5.0–38.8) months. In a multivariable Cox regression model, the elevated hs-TnI group has a higher risk of MACCE (adjusted hazard ratio [HR]: 3.12; 95% confidence interval [CI]: 2.33–4.17; <i>p</i> < 0.01), all-cause mortality (adjusted HR: 4.15; 95% CI: 2.47–6.99; <i>p</i> < 0.01) and readmission caused by coronary revascularization (adjusted HR: 3.12; 95% CI: 1.41–6.90; <i>p</i> < 0.01), heart failure (adjusted HR: 2.76; 95% CI: 1.38–5.51; <i>p</i> < 0.01), and stroke (adjusted HR: 1.73; 95% CI: 1.07–2.78; <i>p</i> = 0.02) compared with the non-elevated hs-TnI group. <b><i>Conclusions:</i></b> Elevated hs-TnI is independently associated with higher mortality and cardiac and cerebrovascular events in patients with ischemic stroke and may serve as a valuable prognostic factor in management after ischemic stroke.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea,
| | - Jeong-Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Haseong Chang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sang-Man Chung
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
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10
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Kwon CH, Kim YJ, Kim MJ, Cha MJ, Cho MS, Nam GB, Choi KJ, Kim J. Effect of Sodium-Glucose Cotransporter Inhibitors on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation. Am J Cardiol 2022; 178:35-42. [PMID: 35810007 DOI: 10.1016/j.amjcard.2022.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to lower cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risks. Here, we aimed to evaluate the effect of SGLT2 inhibitors on major adverse cardiovascular events (MACE), a composite of cardiovascular mortality, myocardial infarction, or ischemic stroke and hospitalization for heart failure in patients with T2DM and atrial fibrillation (AF). Using the Korean National Health Insurance Service database, we identified 40,268 patients with T2DM and AF who were newly prescribed oral hypoglycemic drugs (2,977 patients with SGLT2 inhibitors and 37,291 patients without SGLT2 inhibitors) between 2014 and 2018. After 1: 4 propensity score matching, patients who received SGLT2 inhibitors (n = 2,958) and those who did not receive SGLT2 inhibitors (n = 10,691) were enrolled, and followed up until December 31, 2018. During a mean follow-up duration of 2.1 ± 1.4 years, the risk of major adverse cardiovascular events was similar between the 2 groups (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.76 to 1.21). There were no significant differences between the 2 groups for cardiovascular mortality, myocardial infarction, or ischemic stroke. However, patients who received SGLT2 inhibitors had significantly lower risks of hospitalization for heart failure (HR 0.70, 95% CI 0.53 to 0.93) and all-cause mortality (HR 0.74, 95% CI 0.56 to 0.98) than those who did not receive SGLT2 inhibitors. In conclusion, in this real-world cohort of Asian patients with T2DM and AF, use of SGLT2 inhibitors was associated with a lower risk of hospitalization for heart failure.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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11
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Kwon CH. PO-665-07 TIMING OF CRITICAL ISTHMUS AND USEFULNESS OF ACTIVATION MAPPING WITH WINDOW OF INTEREST FROM END TO END OF P WAVE IN COMPLEX SCAR-RELATED ATRIAL TACHYCARDIAS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Cho MS, Kang DY, Oh YS, Lee CH, Choi EK, Lee JH, Kwon CH, Park GM, Park HW, Park KH, Park KM, Hwang J, Yoo KD, Cho YR, Kim YR, Hwang KW, Jin ES, Kim PJ, Kim KH, Park DW, Nam GB. Edoxaban-based long-term antithrombotic therapy in patients with atrial fibrillation and stable coronary disease: Rationale and design of the randomized EPIC-CAD trial. Am Heart J 2022; 247:123-131. [PMID: 35149036 DOI: 10.1016/j.ahj.2022.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anticoagulants are the standard therapy for patients with atrial fibrillation (AF) and antiplatelet therapy for those with coronary artery disease (CAD). However, compelling clinical evidence is still lacking regarding the long-term maintenance strategy with the combination of anticoagulant and antiplatelet drugs in patients with AF and stable CAD. DESIGN The EPIC-CAD trial is an investigator-initiated, multicenter, open-label randomized trial comparing the safety and efficacy of 2 antithrombotic strategies in patients with high-risk AF (CHA2DS2-VASc score ≥ 2 points) and stable CAD (≥6 months after revascularization for stable angina or ≥12 months for acute coronary syndrome; or medical therapy alone). Patients (approximately N = 1,038) will be randomly assigned at a 1:1 ratio to (1) monotherapy with edoxaban (a non-vitamin K antagonist oral anticoagulant) or (2) combination therapy with edoxaban plus a single antiplatelet agent. The primary endpoint is the net composite outcome of death from any cause, stroke, systemic embolism, myocardial infarction, unplanned revascularization, and major or clinically relevant nonmajor bleeding at 1 year after randomization. RESULTS As of December 2021, approximately 901 patients had been randomly enrolled over 2 years at 18 major cardiac centers across South Korea. The completed enrollment is expected at the mid-term of 2022, and the primary results will be available by 2023. CONCLUSIONS EPIC-CAD is a large-scale, multicenter, pragmatic design trial, which will provide valuable clinical insight into edoxaban-based long-term antithrombotic therapy in patients with high-risk AF and stable CAD.
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Bae SJ, Kwon CH, Kim TY, Chang H, Kim BS, Kim SH, Kim HJ. Predictors and prognostic impact of post-operative atrial fibrillation in patients with hip fracture surgery. World J Clin Cases 2022; 10:3379-3388. [PMID: 35611197 PMCID: PMC9048557 DOI: 10.12998/wjcc.v10.i11.3379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia developing in post-operative patients. Limited data are available regarding pre-operative risk factors and prognostic impact of post-operative AF (POAF) following hip fracture surgery (HFS) in Korean population.
AIM We aimed to investigate the incidence, predictors, and hospital prognosis of POAF in HFS patients.
METHODS This study included 245 patients without history of AF who underwent HFS between August 2014 and November 2016. POAF was defined as new-onset AF that occurred during hospitalization after HFS.
RESULTS Twenty patients (8.2%) experienced POAF after HFS. POAF developed on median post-operative day 2 (interquartile range, 1–3). Multivariable logistic regression analysis showed that age [odds ratio (OR), 1.111; 95% confidence interval (CI), 1.022–1.209], chronic obstructive pulmonary disease (COPD) (OR, 6.352; 95%CI, 1.561–25.841) and E/e’ ratio (OR, 1.174; 95%CI, 1.002–1.376) were significant predictors of POAF. Patients with POAF had a significantly higher intensive care unit admission rate (55.0% vs 14.7%, P < 0.001) and incidence of congestive heart failure (45.0% vs 10.7%, P < 0.001). In multivariable logistic regression analysis, POAF was significantly associated with increased incidence of congestive heart failure (OR, 4.856; 95%CI, 1.437–16.411) and intensive care unit admission (OR, 6.615; 95%CI, 2.112–20.718).
CONCLUSION POAF was frequently developed in elderly patients following HFS. Age, COPD and elevated E/e’ ratio were found as significant predictors of POAF in HFS patients. Patients with POAF significantly experienced intensive care unit admission and incident congestive heart failure during hospitalization.
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Affiliation(s)
- Seong Jun Bae
- Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
| | - Tae-Young Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, South Korea
| | - Haseong Chang
- Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
| | - Bum Sung Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
| | - Sung Hea Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
| | - Hyun-Joong Kim
- Department of Internal Medicine, Konkuk University Medical Center, Seoul 05030, South Korea
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14
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Kim DH, Cho IJ, Kim W, Lee CJ, Kim HC, Shin JH, Kang SH, Jung MH, Kwon CH, Lee JH, Kim HL, Kim HM, Cho I, Kang DR, Lee HY, Chung WJ, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Kang SM, Pyun WB, Cho MC, Kim JH, Lee JH, Ihm SH, Sung KC. Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets. Korean Circ J 2022; 52:460-474. [PMID: 35388992 PMCID: PMC9160643 DOI: 10.4070/kcj.2021.0330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022] Open
Abstract
From a nation-wide population-based cohort study comprised 237,592 patients with hypertension treated, we found that elevated on-treatment diastolic blood pressures (DBP) by the Seventh Report of Joint National Committee definition (systolic blood pressure [SBP] <140 mmHg with a DBP ≥90 mmHg) was associated a high risk of major cardiovascular events including mortality, while elevated DBP by the 2017 American College of Cardiology/American Heart Association definition (SBP <130, DBP ≥80 mmHg) was only associated with a higher risk of stroke. The results of this study provide evidence of the value of an DBP target in subjects who have achieved SBP goals. Background and Objectives This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
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Affiliation(s)
- Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon-Chang Kim
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyue Mee Kim
- Heart Research Institute, ChungAng University Hospital, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Korea
| | - Kwang Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, Korea
| | - Sungha Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji Medical School of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Eom JY, Shin JK, Kwon CH. Apixaban use in an atrial fibrillation patient with double mechanical heart valves: a case report. Eur Heart J Case Rep 2021; 5:ytab285. [PMID: 34377918 PMCID: PMC8343445 DOI: 10.1093/ehjcr/ytab285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022]
Abstract
Background Warfarin is the only approved oral anticoagulant for long-term prophylaxis against valve thrombosis and thromboembolism in patients with mechanical heart valves. To date, apixaban for patients with double (aortic and mitral) mechanical heart valves has not been reported in the literature. Case summary We report the case of a 50-year-old female who underwent double (aortic and mitral) mechanical valve replacement in February 2017. Warfarin was prescribed after mechanical valve replacement. However, she complained of side effects of warfarin, including tingling sensation and numbness of legs, urticaria, skin rash, and nausea and voluntarily stopped taking medication. In December 2018, she was admitted to the emergency room due to ongoing chest pain. Coronary angiogram revealed embolic myocardial infarction at the left circumflex coronary artery. Nevertheless, she continued to refuse to take warfarin after anticoagulant therapy for coronary artery embolism. Given the patient’s objection, we prescribed apixaban 5 mg b.i.d. since February 2019. When she was diagnosed with atrial fibrillation in April 2020, no intracardiac thrombosis was confirmed on computed tomography and electrical cardioversion was performed safely. While on apixaban, no evidence of prosthetic valve thrombosis or thrombo-embolic events was observed during a 24-month period. Conclusion We report the efficacy and safety of apixaban in a patient with atrial fibrillation and double mechanical heart valves for preventing prosthetic valve thrombus and systemic embolism.
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Affiliation(s)
- Jae Young Eom
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je Kyoun Shin
- Department of Thoracic & Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea
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Kwon CH, Kim W, Shin JH, Lee CJ, Kim HC, Kang SH, Jung MH, Kim DH, Lee JH, Kim HL, Kim HM, Cho IJ, Cho I, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Kang SM, Cho MC, Kim JH, Lee JH, Kim JY, Pyun WB, Sung KC. Office Blood Pressure Range and Cardiovascular Events in Patients With Hypertension: A Nationwide Cohort Study in South Korea. J Am Heart Assoc 2021; 10:e017890. [PMID: 33739126 PMCID: PMC8174356 DOI: 10.1161/jaha.120.017890] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background It is unclear what office blood pressure (BP) is the optimal treatment target range in patients with hypertension. Methods and Results Using the Korean National Health Insurance Service database, we extracted the data on 479 359 patients with hypertension with available BP measurements and no history of cardiovascular events from 2002 to 2011. The study end point was major cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, or stroke. This cohort study evaluated the association of BP levels (<120/<70, 120–129/70–79, 130–139/80–89, 140–149/90–99, and ≥150/≥100 mm Hg) with MACE. During a median follow‐up of 9 years, 55 401 MACE were documented in our cohort. The risk of MACE was the lowest (adjusted hazard ratio [HR], 0.79; 95% CI, 0.76–0.84) at BP level of <120/<70 mm Hg, and was the highest (HR, 1.32; 95% CI, 1.29–1.36) at ≥150/≥100 mm Hg in comparison with 130 to 139/80 to 89 mm Hg. These results were consistent in all age groups and both sexes. Among patients treated with antihypertensive medication (n=237 592, 49.5%), in comparison with a BP level of 130 to 139/80 to 89 mm Hg, the risk of MACE was significantly higher in patients with elevated BP (≥140/≥90 mm Hg), but not significantly lower in patients with BP of <130/<80 mm Hg. Low BP <120/70 mm Hg was associated with increased risk of all‐cause or cardiovascular death in all age groups. Conclusions BP level is significantly correlated with the risk of MACE in all Korean patients with hypertension. However, there were no additional benefits for MACE amongst those treated for hypertension with BP <120/70 mm Hg.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology Department of Internal Medicine Konkuk University Medical Center Konkuk University School of Medicine Seoul Republic of Korea
| | - Woohyeun Kim
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Si-Hyuck Kang
- Cardiovascular Centre Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine Seoul National University College of MedicineBoramae Medical Center Seoul Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology Department of Internal Medicine Chung-Ang University HospitalChung-Ang University Seoul Republic of Korea
| | - In Jeong Cho
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Iksung Cho
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Dae Ryong Kang
- Department of Precision Medicine Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology Department of Internal Medicine Gil Hospital Gachon University Incheon Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology Department of Internal Medicine Bucheon St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology Department of Internal Medicine Yeouido St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology Department of Internal Medicine Kyung Hee University at Gangdong Seoul Republic of Korea
| | - Sungha Park
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Jinho Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology Department of Internal Medicine Eulji Medical School of Medicine Seoul Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Ju Han Kim
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Jun Hyeok Lee
- Department of Biostatistics Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Jang-Young Kim
- Department of Cardiology Yonsei University Wonju College of Medicine Wonju Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
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Shin JH, Jung MH, Kwon CH, Lee CJ, Kim DH, Kim HL, Kim W, Kang SH, Lee JH, Kim HM, Cho IJ, Cho I, Lee JH, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Kim HC, Park S, Shin J, Kim JH, Ryu SK, Kang SM, Pyun WB, Cho MC, Sung KC. Disparities in Mortality and Cardiovascular Events by Income and Blood Pressure Levels Among Patients With Hypertension in South Korea. J Am Heart Assoc 2021; 10:e018446. [PMID: 33719521 PMCID: PMC8174369 DOI: 10.1161/jaha.120.018446] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Socioeconomic status is associated with differences in risk factors of cardiovascular disease and increased risks of cardiovascular disease and mortality. However, it is unclear whether an association exists between cardiovascular disease and income, a common measure of socioeconomic status, among patients with hypertension. Methods and Results This population‐based longitudinal study comprised 479 359 patients aged ≥19 years diagnosed with essential hypertension. Participants were categorized by income and blood pressure levels. Primary end point was all‐cause and cardiovascular mortality and secondary end points were cardiovascular events, a composite of cardiovascular death, myocardial infarction, and stroke. Low income was significantly associated with high all‐cause (hazard ratio [HR], 1.26; 95% CI, 1.23–1.29, lowest versus highest income) and cardiovascular mortality (HR, 1.31; 95% CI, 1.25–1.38) as well as cardiovascular events (HR, 1.07; 95% CI, 1.05–1.10) in patients with hypertension after adjusting for age, sex, systolic blood pressure, body mass index, smoking status, alcohol consumption, physical activity, fasting glucose, total cholesterol, and the use of aspirin or statins. In each blood pressure category, low‐income levels were associated with high all‐cause and cardiovascular mortality and cardiovascular events. The excess risks of all‐cause and cardiovascular mortality and cardiovascular events associated with uncontrolled blood pressure were more prominent in the lowest income group. Conclusions Low income and uncontrolled blood pressure are associated with increased all‐cause and cardiovascular mortality and cardiovascular events in patients with hypertension. These findings suggest that income is an important aspect of social determinants of health that has an impact on cardiovascular outcomes in the care of hypertension.
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Affiliation(s)
- Jeong-Hun Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center Dongtan Sacred Heart HospitalHallym University College of Medicine Hwaseong Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine Konkuk University Medical Center Konkuk University School of Medicine Seoul Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Hack-Lyoung Kim
- Department of Internal Medicine Seoul National University College of MedicineBoramae Medical Center Seoul Republic of Korea
| | - Woohyeun Kim
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology Department of Internal Medicine Cardiovascular Center Mediplex Sejong Hospital Incheon Republic of Korea
| | - In-Jeong Cho
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Iksung Cho
- Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Jun Hyeok Lee
- Center of Biomedical Data Science Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science Wonju College of MedicineYonsei University Wonju Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology Department of Internal Medicine Seoul National University Hospital Seoul Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology Department of Internal Medicine Gil Hospital Gachon University Incheon Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology Department of Internal Medicine Bucheon St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology Department of Internal Medicine Yeouido St. Mary's Hospital The Catholic University of Korea Seoul Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology Department of Internal Medicine KyungHee University at Gangdong Seoul Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Sungha Park
- Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Jinho Shin
- Division of Cardiology Department of Internal Medicine Hanyang University College of Medicine Seoul Republic of Korea
| | - Ju Han Kim
- Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology Department of Internal Medicine Eulji Medical School of Medicine Seoul Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology Department of Internal Medicine Yonsei University College of Medicine Seoul Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology Department of Internal Medicine Ewha Womans University Medical Center Seoul Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology Department of Internal Medicine Chungbuk National University HospitalChungbuk National University College of Medicine Cheongju Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology Department of Internal Medicine Kangbuk Samsung HospitalSungkyunkwan University School of Medicine Seoul Republic of Korea
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Jung MH, Lee JH, Lee CJ, Shin JH, Kang SH, Kwon CH, Kim DH, Kim WH, Kim HL, Kim HM, Cho IJ, Cho I, Hwang J, Ryu S, Kang C, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Park S, Shin J, Ryu SK, Rhee MY, Kang SM, Pyun WB, Cho MC, Sung KC. Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea. J Clin Hypertens (Greenwich) 2021; 23:879-887. [PMID: 33492766 PMCID: PMC8678844 DOI: 10.1111/jch.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/18/2023]
Abstract
The potential cancer risk associated with long‐term exposure to angiotensin receptor blockers (ARBs) is still unclear. We assessed the risk of incident cancer among hypertensive patients who were treated with ARBs compared with patients exposed to angiotensin‐converting enzyme inhibitors (ACEIs), which are known to have a neutral effect on cancer development. Using the Korean National Health Insurance Service database, we analyzed the data of patients diagnosed with essential hypertension from January 2005 to December 2012 who were aged ≥40 years, initially free of cancer, and were prescribed either ACEI or ARB (n = 293,962). Cox proportional hazard model adjusted for covariates was used to evaluate the risk of incident cancer. During a mean follow‐up of 10 years, 24,610 incident cancers were observed. ARB use was associated with a decreased risk of overall cancer compared with ACEI use (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72‐0.80). Similar results were obtained for lung (HR 0.73, 95% CI 0.64‐0.82), hepatic (HR 0.56, 95% CI 0.48‐0.65), and gastric cancers (HR 0.74, 95% CI 0.66‐0.83). Regardless of the subgroup, greater reduction of cancer risk was seen among patients treated with ARB than that among patients treated with ACEIs. Particularly, the decreased risk of cancer among ARB users was more prominent among males and heavy drinkers (interaction P < .005). Dose‐response analyses demonstrated a gradual decrease in risk with prolonged ARB therapy than that with ACEI use. In conclusion, ARB use was associated with a decreased risk of overall cancer and several site‐specific cancers.
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Affiliation(s)
- Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Si Hyuck Kang
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyeun Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hack Lyoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Heart Research Institute, ChungAng University Hospital, Seoul, Republic of Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea
| | - Soorack Ryu
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea
| | - Chaeyeong Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongbuk, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang Il Kim
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University at Gangdong, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji University Medical Center, Seoul, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kwon CH. Extensive Deep Vein Thrombosis after Electrophysiology Study. Korean Circ J 2020; 50:1129-1130. [PMID: 33150755 PMCID: PMC7707979 DOI: 10.4070/kcj.2020.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
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20
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Kim HL, Kim HM, Kwon CH, Shin JH, Jung MH, Lee CJ, Kim DH, Kim WH, Kang SH, Lee JH, Cho IJ, Cho I, Lee JH, Kang DR, Lee HY, Chung WJ, Ihm SH, Kim KI, Cho EJ, Sohn IS, Kim HC, Shin J, Kim JH, Ryu SK, Kang SM, Pyun WB, Cho MC, Park S, Sung KC. Blood pressure levels and cardiovascular risk according to age in patients with diabetes mellitus: a nationwide population-based cohort study. Cardiovasc Diabetol 2020; 19:181. [PMID: 33076934 PMCID: PMC7574489 DOI: 10.1186/s12933-020-01156-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/10/2020] [Indexed: 02/08/2023] Open
Abstract
Background Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age. Methods Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke. Results Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130–139/80–89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130–139/80–89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130–139/80–89 mmHg and BP 120–129/70–79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130–139/80–89 mmHg at all ages. Conclusions In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130–139/80–89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130–139/80–89 mmHg at the age of ≥ 70.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyang Jung
- Cardiovascular Center, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo-Hyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jun Hyeok Lee
- Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Kwang Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il-Suk Sohn
- Division of Cardiology, Department of Internal Medicine, KyungHee University at Gangdong, Seoul, Republic of Korea
| | - Hyeon-Chang Kim
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji Medical School of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Wook Bum Pyun
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
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Kim M, Kwon CH, Lee JH, Hwang KW, Choi HO, Kim YG, Lee KN, Ahn J, Park HS, Nam GB. Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V 6: Development and validation of electrocardiographic differentiation criteria. Heart Rhythm 2020; 18:181-188. [PMID: 32927100 DOI: 10.1016/j.hrthm.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0. OBJECTIVE We sought to investigate the electrocardiographic criteria for distinguishing between these arrhythmias. METHODS We investigated electrocardiographic parameters from 111 consecutive patients who had RBBB pattern wide QRS complex tachycardia with a reversed R/S ratio in lead V6 (72 VTs, 39 SVTs). Diagnostic criteria from the previous algorithms were compared with our new criterion, the RS/QRS ratio, which was defined as the ratio of the interval from the onset of the QRS complex to the nadir of the S wave, divided by the QRS width in lead V6. The RS/QRS ratio was further tested in a prospective population (31 fascicular VTs, 29 SVTs). RESULTS The diagnostic accuracy of previous criteria (Brugada algorithm, Vereckei algorithm, and R-wave peak time criterion) was only modest. However, the RS/QRS ratio in lead V6 was significantly lower in SVT than in VT (0.36 ± 0.04 vs 0.50 ± 0.08; P < .001). A cutoff value of the RS/QRS ratio >0.41 differentiated VT from SVT with a high diagnostic accuracy (sensitivity 97.2%; specificity 89.7%). When tested in a prospective population with fascicular VT, the diagnostic accuracy of the criteria was maintained (sensitivity 90.3%; specificity 86.2%). CONCLUSION The RS/QRS ratio >0.41 in lead V6 is a simple and reliable index for distinguishing VT from SVT in RBBB pattern wide QRS complex tachycardia with a reversed R/S complex in lead V6. This criterion was particularly useful for the differential diagnosis of fascicular VT from RBBB pattern SVT.
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Affiliation(s)
- Minsu Kim
- Division of Cardiology, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Seoul, Korea
| | - Ji Hyun Lee
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Won Hwang
- Divison of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yong-Giun Kim
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang-No Lee
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jinhee Ahn
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyoung-Seob Park
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gi-Byoung Nam
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Sung KC, Kwon CH, Lee MY, Kwon MJ, Lee JH, Jung MH, Shin JH. Comparison of Low-Density Lipoprotein Cholesterol Concentrations by Direct Measurement and by Friedewald Calculation. Am J Cardiol 2020; 125:866-873. [PMID: 31928718 DOI: 10.1016/j.amjcard.2019.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to compare Friedewald-calculated and directly measured low-density lipoprotein cholesterol (LDL-C) levels. LDL-C is routinely estimated by the Friedewald formula in clinical practice. However, unreliability of the Friedewald-calculated LDL-C appears at lower LDL-C level or high triglyceride levels. We examined 147,143 Korean adults who underwent a comprehensive health examination in 2017. After excluding subjects with calculated Friedewald LDL-C <0 and triglyceride levels ≥400 mg/dL, 145,043 subjects (female; 43%, mean age; 42 ± 8) were analyzed. Friedewald-calculated LDL-C levels were approximately 15 mg/dL lower to directly measured LDL-C. Friedewald measurement had high sensitivity (79.2%, 82.2% of sensitivity in males and 74.5% of sensitivity in females) and specificity (100%) for directly measured LDL-C cut-off value of ≥100 mg/dL in all levels of triglyceride. In 82% of total subjects, LCL-C measured by both methods differed by more than 10 mg/dL. The proportion of reclassification between both methods for National Cholesterol Education Program categories of risk was 50.3% of patients with Friedewald measurement of LDL-C <70 mg/dL, 68% had directly measured LDL-C ≥70 mg/dL. Direct and Freidewald measurements of LDL-C levels are well correlated. However, concordance of both methods is low and reclassification between both is substantial for NECP categories of risk. Thus, it is desirable to make a global consensus on the LDL-C measurement.
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Kim BS, Kwon CH, Chang H, Kim SH, Kim HJ, Hwang HK, Chung SM. Usefulness of High-Sensitivity Troponin I to Predict Outcome in Patients With Newly Detected Atrial Fibrillation. Am J Cardiol 2020; 125:744-750. [PMID: 31883678 DOI: 10.1016/j.amjcard.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 01/15/2023]
Abstract
The prognostic role of high-sensitivity cardiac troponin I (hs-TnI) in patients with newly detected atrial fibrillation (AF) is not well established. We investigate the association of elevated hs-TnI with clinical outcomes and explore the utility of hs-TnI for risk assessment in patients with newly detected AF. From August 2014 to December 2016, 2,361 consecutive patients with newly detected AF were enrolled in a retrospective, single-center registry. Of these, 957 patients were selected and classified into 4 groups according to hs-TnI quartiles. The primary outcome was all-cause death during follow-up. The hs-TnI level was 3.6 ng/L or less in the lowest quartile (Q1), more than 3.6 ng/L to 10.1 ng/L or less in the second quartile (Q2), more than 10.1 ng/L to 22.0 ng/L or less in the third quartile (Q3), and more than 22.0 ng/L in the highest quartile (Q4). The median follow-up period was 19.3 months. In multivariable Cox regression model, Q4 has a higher risk of all-cause death (adjusted hazard ratio [HR]: 3.49; 95% confidence interval [CI]: 1.21 to 10.00; p = 0.02), readmission for heart failure (adjusted HR: 1.75; 95% CI: 1.01-3.05; p = 0.04), and readmission for revascularization (adjusted HR: 3.90; 95% CI: 1.25 to 12.17; p = 0.02) compared with Q1. Independent predictors of all-cause death were renal insufficiency (adjusted HR: 1.96; 95% CI: 1.08 to 3.53; p = 0.02), highest hs-TnI quartile (adjusted HR: 3.30; 95% CI: 1.18 to 9.27; p = 0.02) and anticoagulation therapy (adjusted HR: 0.51; 95% CI: 0.27 to 0.93; p = 0.03). Elevated hs-TnI is independently associated with higher mortality in patients with AF and serves as a valuable prognostic biomarker in patients with newly detected AF.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Haseong Chang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea.
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Hweung Kon Hwang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
| | - Sang-Man Chung
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea
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Kwon CH. External Electrical Cardioversion is an Easy and Safe Intervention for Rhythm Control in Persistent Atrial Fibrillation. Korean Circ J 2020; 50:524-526. [PMID: 32419404 PMCID: PMC7234847 DOI: 10.4070/kcj.2020.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Kwon CH. P5666Impact of metabolic syndrome on the incidence of atrial fibrillation; a nationwide longitudinal cohort study in South Korea. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
There is a lack of studies for the association between the status of metabolic syndrome (MetS) and the risk of atrial fibrillation (AF)
Purpose
The present study aimed to evaluate the impact of MetS status for the incidence of AF in Korean population.
Methods
We used the data obtained from the Korean National Health Insurance Service from 2009 to 2016. This study enrolled a total of 7,830,602 men and women aged between 30 and 69 years without baseline AF who underwent national health examination between January 2009 and December 2009. They were evaluated to determine the risk of AF based on the status of MetS until December 2016. Based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III, the status of MetS was defined into three groups according to number of MetS components: the normal (0), Pre-MetS (1–2), and MetS (3–5).
Results
During follow-up, 20,708 subjects (0.26%) were diagnosed with AF. After multivariable adjustment, the risk of AF was significantly higher according to the status of MetS (hazard ratios [HR] 1.391, 95% confidence interval [CI] 1.322–1.464 in Pre-MetS and HR 1.722, 95% CI 1.621–1.829 in MetS). Among the components of MetS, central obesity (HR 1.316, P<0.001), elevated blood pressure (HR 1.451, P<0.001), and elevated fasting glucose (HR 1.163, P<0.001) were associated with an increased risk of AF.
Conclusion
MetS and pre-MetS are significantly associated with an increased risk of AF in Korean adults. Of the components of MetS, central obesity, elevated blood pressure, and elevated fasting glucose are potent risk factors for the risk of AF in this population.
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Affiliation(s)
- C H Kwon
- Konkuk University Hospital, Internal medicine, Seoul, Korea (Republic of)
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Kwon CH, Kang J, Cho A, Chang Y, Ryu S, Sung KC. Optimal Target Blood Pressure and Risk of Cardiovascular Disease in Low-Risk Younger Hypertensive Patients. Am J Hypertens 2019; 32:833-841. [PMID: 31045225 DOI: 10.1093/ajh/hpz067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/14/2019] [Accepted: 04/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This study aimed to examine longitudinal associations between blood pressure (BP) categories and incident cardiovascular disease (CVD) in treated hypertensive patients without CVD. METHODS A cohort study was performed in Korean adults who underwent a comprehensive health examination from 1 January 2011 to 31 December 2016 and was followed for incident CVD via linkage to the Health Insurance and Review Agency database until the end of 2016, with a median follow-up of 4.3 years. RESULTS Among 263,532 participants, 8,418 treated hypertensive patients free of CVD at baseline were included. The incident CVD end point was defined as new hospitalization for CVD, including ischemic heart disease, stroke, and transient ischemic attack. During 32,975.6 person-years of follow-up, 200 participants developed new-onset CVD (incidence rate of 60.6 per 104 person-years). The multivariable-adjusted hazard ratio (HR; 95% confidence intervals [CI]) for CVD according to systolic blood pressure (SBP) levels (comparing SBP < 110, SBP = 120-129, SBP = 130-139, SBP = 140-149, SBP = 150-159, and SBP ≥160 to SBP 110-119 mm Hg [reference]) were 0.83 (0.53-1.30), 1.31 (0.91-1.89), 1.18 (0.74-1.87), 1.46 (0.79-2.72), 3.19 (1.25-8.12), and 5.60 (2.00-15.70), respectively. In multivariable analysis for CVD according to diastolic blood pressure (DBP) levels, HR (95% CI) of DBP < 60, DBP = 70-79, DBP = 80-89, DBP = 90-99, and DBP ≥100 compared to DBP = 60-69 mm Hg [reference]) were 0.51 (0.12-2.14), 1.13 (0.76-1.67), 1.26 (0.83-1.92), 1.62 (0.89-2.97), and 1.68 (0.51-5.55), respectively. CONCLUSIONS In this large cohort of middle-aged treated hypertensive patients, SBP < 120 mm Hg and/or DBP < 70 mm Hg were acceptable and showed a trend of protection of incident CVD.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ara Cho
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Sung Ho Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Jong-Young Lee
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Seungho Ryu
- Department of Occupational and Environmental Medicine, Sungkyunkwan University School of Medicine
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
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Lee SJ, Lee JY, Lee SW, Lee WS, Han S, Park YK, Kwon CH, Jang JY, Cho YR, Park GM, Ahn JM, Kim WJ, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ, Sung KC. GW29-e0902 Prevalence and Clinical Implications of Newly Revealed, Asymptomatic Abnormal Ankle-Brachial Index in Patients With Significant Coronary Artery Disease — 7-Year Outcomes. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kim BS, Kim TH, Kwon CH, Kim SH, Kim HJ, Hwang HK, Chung SM. P6250Association between preoperative high sensitive troponin I levels and cardiovascular events after non cardiac surgery in the elderly. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B S Kim
- Konkuk University Hospital, Division of Cardiology, Department of Medicine, Seoul, Korea Republic of
| | - T H Kim
- Konkuk University Hospital, Department of Orthopedic surgery, Seoul, Korea Republic of
| | - C H Kwon
- Konkuk University Hospital, Division of Cardiology, Department of Medicine, Seoul, Korea Republic of
| | - S H Kim
- Konkuk University Hospital, Division of Cardiology, Department of Medicine, Seoul, Korea Republic of
| | - H J Kim
- Konkuk University Hospital, Division of Cardiology, Department of Medicine, Seoul, Korea Republic of
| | - H K Hwang
- Konkuk University Hospital, Division of Cardiology, Department of Medicine, Seoul, Korea Republic of
| | - S M Chung
- Konkuk University Hospital, Division of Cardiology, Department of Medicine, Seoul, Korea Republic of
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Kim YG, Choi KJ, Han S, Hwang KW, Kwon CH, Park GM, Won KB, Ann SH, Kim J, Kim SJ, Lee SG, Nam GB, Kim YH. Metabolic Syndrome and the Risk of New-Onset Atrial Fibrillation in Middle-Aged East Asian Men. Circ J 2018; 82:1763-1769. [DOI: 10.1253/circj.cj-18-0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yong-Giun Kim
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | | | - Ki Won Hwang
- Division of Cardiology, Pusan National University Yangsan Hospital, Pusan National University of Medicine
| | - Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Gyung-Min Park
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Ki-Bum Won
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Soe Hee Ann
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Shin-Jae Kim
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Sang-Gon Lee
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - You-Ho Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
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Kwon CH, Kang JG, Lee HJ, Kim NH, Sung JW, Cheong E, Sung KC. C-reactive protein and risk of atrial fibrillation in East Asians. Europace 2018; 19:1643-1649. [PMID: 27915263 DOI: 10.1093/europace/euw298] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022] Open
Abstract
Aims Inflammation has been suggested to play a role in the pathogenesis of atrial fibrillation (AF). It is uncertain whether C-reactive protein, a robust inflammatory marker, is associated with AF incidence in Asians with lower levels of C-reactive protein compared with western population. This study aimed to determine the association between C-reactive protein and risk of AF in a large population of Koreans. Methods and results A total of 402 946 Koreans were enrolled in a health screening programme from January 2002 to December 2013. Among them, 210 208 subjects were analysed during the mean follow-up of 4.59 years (1 062 513 person-years). Atrial fibrillation was identified by electrocardiography at every visits. Atrial fibrillation was identified in 561 subjects (0.1%) at baseline. The median (inter-quartile) baseline C-reactive protein levels were higher in subject with AF than in those without AF [0.9 mg/L (0.4-0.9) vs. 0.4 mg/L (0.2-1.0), P < 0.001]. Subjects in the highest quartile of C-reactive protein had more AF than those in the lowest quartile [adjusted odds ratio (OR) 2.02, 95% confidence interval (CI) 1.45-2.81; P< 0.001]. During a mean follow-up of 4.59 years, AF developed in 261 subjects (0.1%). The highest quartile of baseline C-reactive protein had a 1.68-fold (95% CI 1.06-2.67) increased risk of AF than the lowest quartile in multivariate Cox regression analysis. Conclusion Baseline C-reactive protein levels are significantly associated with the prevalence of AF and the risk of AF in Korean populations even C-reactive protein concentrations are substantially lower than reported in white populations.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Gyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Nan Hee Kim
- Department of Internal Medicine, Gangnam CHA Medical Center, CHA University, School of Medicine, Pocheon, Republic of Korea
| | - Joo-Wook Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea
| | - EunSun Cheong
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108, Pyung Dong, Jongro-Ku, Seoul 110-746, Republic of Korea
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Kim BS, Kim TH, Oh JH, Kwon CH, Kim SH, Kim HJ, Hwang HK, Chung SM. Association between preoperative high sensitive troponin I levels and cardiovascular events after hip fracture surgery in the elderly. J Geriatr Cardiol 2018; 15:215-221. [PMID: 29721000 PMCID: PMC5919809 DOI: 10.11909/j.issn.1671-5411.2018.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVE Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery (HFS). We used high sensitive troponin I (hs-TnI) assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events (MACE) in elderly hip fracture patients. METHOD From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure (HF), new-onset atrial fibrillation (AF), myocardial infarction (MI) and cardiovascular re-hospitalization that occurred within 90 days postoperative. RESULTS Of 262 HFS patients, MACE developed following HFS in 65 (24.8%). Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-TnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher revised cardiac risk index. A preoperative hs-TnI ≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, preoperative independent predictors for MACE were age > 80 years [adjusted hazard ratio (HR): 1.79, 95% confident interval (CI): 1.03-3.13, P = 0.04], left ventricular ejection fraction (LVEF) < 50% (adjusted HR: 3.17, 95% CI: 1.47-6.82, P < 0.01) and hs-TnI > 6.5 ng/L (adjusted HR: 3.75, 95% CI: 2.09-6.17, P < 0.01). CONCLUSION In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.
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Affiliation(s)
- Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Department of Orthopedic surgery, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Jeong-Hwan Oh
- Department of Orthopedic surgery, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Heung Kon Hwang
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
| | - Sang-Man Chung
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120–1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, Republic of Korea
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Park SJ, Kwon CH, Bae BJ, Kim BS, Kim SH, Kim HJ, Hwang HK, Chung SM. Diagnostic value of the corrected QT difference between leads V1 and V6 in patients with acute pulmonary thromboembolism. Medicine (Baltimore) 2017; 96:e8430. [PMID: 29069044 PMCID: PMC5671877 DOI: 10.1097/md.0000000000008430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [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
In acute pulmonary thromboembolism (PTE), right ventricular pressure overload impairs right-sided cardiac conduction and repolarization. We hypothesized that if heterogeneity of repolarization between right and left ventricles occurs in acute PTE, there would be the difference of repolarization between them. Therefore, we aimed to evaluate the diagnostic value of corrected QT interval (QTc) difference between leads V1 and V6 (V1 - V6) in patients with acute PTE.A total of 89 patients with suspected acute PTE who underwent computed tomographic angiography (CTA) were enrolled from January to December 2015. PTE was identified by CTA. We compared electrocardiographic (ECG) parameters, especially QTc difference (V1 - V6) between patients with PTE and those without PTE.Acute PTE was finally diagnosed in 45 patients. Clinical situations including the chief complaint were not different between PTE and non-PTE groups. S1Q3T3, a traditional ECG marker, had no diagnostic value for acute PTE. Patients with PTE had a significantly longer mean QTc in V1 (454.6 ± 44.3 vs 417.5 ± 31.3 ms, P < .001) and larger QTc difference (V1 - V6) (34.8 ± 30.5 vs -12.5 ± 16.6 ms, P < .001) than non-PTE controls. QTc difference (V1 - V6) was negative in all patients without PTE. PTE patients had a higher prevalence of T wave inversion in leads III (51.1% vs 29.5%, P = .038) and V1 (82.2% vs 38.6%, P < .001). A QTc difference (V1 - V6) of ≥20 ms identified PTE with 82.2% sensitivity, 100.0% specificity, and 100.0% positive predictive value.QTc difference (V1 - V6) had an excellent diagnostic value for differentiating patients with and without acute PTE.
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Abstract
The incidence of intraoperative arrhythmia is extremely high, and some arrhythmias require clinical attention. Therefore, it is essential for the anesthesiologist to evaluate risk factors for arrhythmia and understand their etiology, electrophysiology, diagnosis, and treatment. Anesthetic agents reportedly affect normal cardiac electrical activity. In the normal cardiac cycle, the sinoatrial node initiates cardiac electrical activity through intrinsic autonomous pacemaker activity. Sequential atrial and ventricular contractions result in an effective cardiac pumping mechanism. Arrhythmia occurs due to various causes, and the cardiac pumping mechanism may be affected. A severe case may result in hemodynamic instability. In this situation, the anesthesiologist should eliminate the possible causes of arrhythmia and manage the condition, creating hemodynamic stability under proper electrocardiographic monitoring.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Kwon CH, Kang JG, Lee HJ, Kim NH, Sung JW, Cheong E, Sung KC. Absence of association between gallstone and coronary artery calcification. Atherosclerosis 2017; 258:51-55. [PMID: 28192729 DOI: 10.1016/j.atherosclerosis.2017.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Gallstone has been suggested to be associated with cardiovascular disease (CVD). Coronary artery calcification (CAC) is an excellent value to predict future CVD. The aim of this study was to evaluate the association between gallstone and CAC. METHODS Data were analyzed from an occupational cohort of 46,893 subjects (37,557 men and 9336 women) between 2011 and 2014. Participants with cancer or CVD histories or missing data at baseline were excluded from the study. Gallstone was diagnosed by ultrasound-documentation. Multivariate logistic analysis was conducted to examine the relationship between gallstone and CAC. RESULTS The total population who had gallstone was 1426 (3.1%). In multivariate analysis, odds ratios (OR) for gallstone were not different according to CAC score groups in men and women. In addition, gallstone was not associated with higher OR for CAC in men and women. CONCLUSIONS Gallstone was not associated with CAC in both Korean men and women.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Gyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Nan Hee Kim
- Department of Internal Medicine, Gangnam CHA Medical Center, CHA University, School of Medicine, Seoul, Republic of Korea
| | - Joo-Wook Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - EunSun Cheong
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Kwon CH, Choi JH, Kim J, Jo U, Lee JH, Lee WS, Kim YR, Lee SY, Whang KW, Yang J, Kim SH, Oh YS, Park KM, Nam GB, Choi KJ, Kim YH. Complications of Cardiac Perforation and Lead Dislodgement with an MRI-Conditional Pacing Lead: a Korean Multi-Center Experience. J Korean Med Sci 2016; 31:1397-402. [PMID: 27510382 PMCID: PMC4974180 DOI: 10.3346/jkms.2016.31.9.1397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/02/2016] [Indexed: 11/20/2022] Open
Abstract
Medtronic CapSureFix MRI 5086 pacing lead (5086; Medtronic, Inc., Minneapolis, MN, USA) has been reported to be associated with increased cardiac perforation and lead dislodgement. This study aimed to compare the incidence of cardiac perforation and lead dislodgement within 30 days after pacemaker implantation between 5086 MRI lead and previous Medtronic CapSureFix Novus 5076 non-MRI pacing lead. This was a nationwide, multicenter retrospective study in which we compared the incidence of adverse events between 277 patients implanted with 5086 lead and 205 patients implanted with 5076 lead between March 2009 and September 2014. Cardiac perforation within 30 days of pacemaker implantation occurred in 4 patients (1.4%) with the 5086 lead and in no patient with the 5076 lead (P = 0.084). Lead dislodgement occurred in 8 patients (2.9%) with the 5086 lead and in 5 patients (2.4%) with the 5076 lead (P = 0.764). On multivariate logistic regression analysis, age was significantly associated with cardiac perforation. Congestive heart failure and implantation of right atrial (RA) lead at RA free wall or septum were significant factors for the incidence of lead dislodgement and lead revision. The incidence of cardiac perforation and lead dislodgement were not statistically different between the patients with 5086 lead and the patients with 5076 lead. However, careful attention for cardiac perforation may be needed when using the 5086 MRI lead, especially in elderly patients.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Hee Choi
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Uk Jo
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Seok Lee
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Yoo Ri Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Soo Yong Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ki Won Whang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jihyun Yang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gi Byoung Nam
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Joon Choi
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Ho Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim WJ, Kwon CH, Han S, Lee WS, Kang JW, Ahn JM, Lee JY, Park DW, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Role of Coronary Artery Calcium Scoring in Detection of Coronary Artery Disease according to Framingham Risk Score in Populations with Low to Intermediate Risks. J Korean Med Sci 2016; 31:902-8. [PMID: 27247499 PMCID: PMC4853669 DOI: 10.3346/jkms.2016.31.6.902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/28/2016] [Indexed: 11/25/2022] Open
Abstract
Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P < 0.01). The total CAD prevalence was 6.1%. The occult CAD prevalence in the FRS ≤ 5%, 6%-10%, 11%-20%, and > 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P < 0.001). In multivariate logistic regression analysis adjusting, not only the intermediate and high risk groups but also the low risk (FRS 6%-10%) group had significantly increased odds ratio for occult CAD compared to the very low-risk (FRS ≤ 5%) group (1.89 [95% confidence interval, CI, 1.09-3.29] in FRS 6%-10%; 2.48 [95% CI, 1.47-4.20] in FRS 11%-20%; and 3.10 [95% CI, 1.75-5.47] in FRS > 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.
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Affiliation(s)
- Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Chang Hee Kwon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea
| | - Woo Seok Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lee WS, Nam GB, Kim SH, Choi JH, Jo U, Kim WY, Oh YS, Park KN, Seo GW, Kim KH, Jin ES, Rhee KS, Jung L, Hwang KW, Kim YR, Kwon CH, Kim J, Choi KJ, Kim YH. ECG features and proarrhythmic potentials of therapeutic hypothermia. Heart 2016; 102:1558-65. [DOI: 10.1136/heartjnl-2015-308821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/21/2016] [Indexed: 11/03/2022] Open
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Kwon CH, Kim J, Kim MS, Roh JH, Choi JH, Jo U, Lee WS, Kim YR, Nam GB, Choi KJ, Kim YH. Impact of Impaired Renal Function on the Incidence of Atrial Fibrillation following Radiofrequency Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter. Korean Circ J 2015; 45:473-8. [PMID: 26617649 PMCID: PMC4661362 DOI: 10.4070/kcj.2015.45.6.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/26/2015] [Accepted: 06/09/2015] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Atrial fibrillation (AF) occurs frequently after successful radiofrequency ablation (RFA) of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL). Renal impairment has been implicated in the development of AF. The purpose of this study is to clarify the impact of impaired renal function on the incidence of AF after RFA of CTI-AFL. Subjects and Methods Between January 2001 and December 2013, 240 non-dialysis patients with no prior history of AF {mean age 55.9±15.2 years old; male, 192 (80.0%)} who had undergone successful CTI-AFL ablation were included in the present study. The baseline estimated glomerular filtration rate was calculated, and patients were divided into those with impaired renal function (<60 mL/min/1.73 m2) and those with preserved renal function (≥ 60 mL/min/1.73 m2). The incidence of AF was retrospectively analyzed. Results 69 (28.8%) patients experienced new onset AF during a median follow-up duration of 26 months (inter-quartile, 7-53). The incidence of AF was significantly higher in patients with impaired renal function than in those with preserved renal function {13/25 (52.0%) versus 56/215 (26.0%), log rank p=0.019}. Age, CHADS2 score, impaired renal function, and left atrial diameter were significantly associated with the incidence of AF in univariate Cox regression analysis. Multivariate analysis showed that age was the only significant predictor of AF incidence (hazard ratio, 1.024; 95% confidence interval, 1.004-1.044, p=0.020). Conclusion Patients with impaired renal function may require careful attention for the incidence of new onset AF following successful RFA of CTI-AFL.
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Affiliation(s)
- Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Su Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hyung Roh
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Uk Jo
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Seok Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoo Ri Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sohn W, Paik YH, Cho JY, Ahn JM, Choi GS, Kim JM, Kwon CH, Joh JW, Sinn DH, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC. Influence of hepatitis B virus reactivation on the recurrence of HBV-related hepatocellular carcinoma after curative resection in patients with low viral load. J Viral Hepat 2015; 22:539-50. [PMID: 25377516 DOI: 10.1111/jvh.12356] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 09/21/2014] [Indexed: 12/12/2022]
Abstract
It is unclear whether the reactivation of hepatitis B virus (HBV) influences the prognosis of hepatocellular carcinoma (HCC) after resection in patients with chronic hepatitis B. The aim of this study was to identify the influence of HBV reactivation on the recurrence of hepatitis B-related HCC after curative resection in patients with low viral load (HBV DNA <2000 IU/mL). We retrospectively analysed a total of 130 patients who underwent curative resection for HBV-related early stage HCC (single nodule; <5 cm/two or three nodules; <3 cm) with pre-operative HBV DNA levels <2000 IU/mL with serial HBV DNA tests. The predictive factors including HBV reactivation for the recurrence of HBV-related HCC after curative resection were investigated. Fifty-three patients (41%) had HBV reactivation after resection among 130 patients. HBV reactivation was observed in 22 of 53 patients with undetectable baseline HBV DNA and in 31 of 77 patients with detectable baseline HBV DNA. Cumulative recurrence rates after resection at 1, 2 and 3 years were 17.0%, 23.3% and 31.4%, respectively. The multivariable analysis demonstrated that the risk factors for the recurrence were the presence of microvascular invasion (hazard ratio (HR) 2.62, P = 0.003), multinodularity (HR 4.61, P = 0.005), HBV reactivation after resection (HR 2.03, P = 0.032) and HBeAg positivity (HR 2.06, P = 0.044). HBV reactivation after curative resection is associated with the recurrence of HBV-related HCC in patients with low viral load.
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Affiliation(s)
- W Sohn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kwon CH, Cho SW, Song JM, Choo SJ, Chung CH, Lee JW, Kim DH, Kang DH, Song JK. Predictors of Late Improvement of Significant Remnant Tricuspid Regurgitation Detected Early After Tricuspid Annuloplasty. Can J Cardiol 2015; 31:69-75. [DOI: 10.1016/j.cjca.2014.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/07/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022] Open
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Kim YR, Nam GB, Kwon CH, Lee WS, Kim YG, Hwang KW, Kim J, Choi KJ, Kim YH. Second coupling interval of nonsustained ventricular tachycardia to distinguish malignant from benign outflow tract ventricular tachycardias. Heart Rhythm 2014; 11:2222-30. [DOI: 10.1016/j.hrthm.2014.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Indexed: 10/24/2022]
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Kwon CH, Park HJ, Lee JR, Kim HK, Jeon TY, Jo HJ, Kim DH, Kim GH, Park DY. Serpin peptidase inhibitor clade A member 1 is a biomarker of poor prognosis in gastric cancer. Br J Cancer 2014; 111:1993-2002. [PMID: 25211665 PMCID: PMC4229634 DOI: 10.1038/bjc.2014.490] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/24/2014] [Accepted: 08/13/2014] [Indexed: 01/16/2023] Open
Abstract
Background: In a previous study, we reported that serpin peptidase inhibitor clade A member 1 (serpinA1) is upregulated in Snail-overexpressing gastric cancer. Although serpinA1 has been studied in several types of cancer, little is known about its roles and mechanisms of action. In this study, we examined the role of serpinA1 in the migration and invasion of gastric cancers and determined its underlying mechanism. Methods: Expression levels were assessed by western blot analyses and real-time PCR. Snail binding to serpinA1 promoter was analysed by chromatin immunoprecipitation (ChIP) assays. The roles of serpinA1 were studied using cell invasion and migration assays. In addition, the clinicopathologic and prognostic significance of serpinA1 expression were validated in 400 gastric cancer patients using immunohistochemical analysis. Results: Overexpression of Snail resulted in upregulation of serpinA1 in gastric cancer cell lines, AGS and MKN45, whereas knockdown of Snail inhibited serpinA1 expression. Chromatin immunoprecipitation analysis showed that overexpression of Snail increased Snail recruitment to the serpinA1 promoter. Overexpression of serpinA1 increased the migration and invasion of gastric cancer cells, whereas knockdown of serpinA1 decreased invasion and migration. Moreover, serpinA1 increased mRNA levels and release of metalloproteinase-8 in gastric cancer cells. Serpin peptidase inhibitor clade A member 1 was observed in the cytoplasm of tumour cells and the stroma by immunohistochemistry. Enhanced serpinA1 expression was significantly associated with increased tumour size, advanced T stage, perineural invasion, lymphovascular invasion, lymph node metastases, and shorter overall survival. Conclusions: Serpin peptidase inhibitor clade A member 1 induces the invasion and migration of gastric cancer cells and its expression is associated with the progression of gastric cancer. These results may provide a potential target to prevent invasion and metastasis in gastric cancer.
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Affiliation(s)
- C H Kwon
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - H J Park
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - J R Lee
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - H K Kim
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - T Y Jeon
- Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - H-J Jo
- Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - D H Kim
- Department of Surgery, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - G H Kim
- Department of Internal Medicine, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
| | - D Y Park
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, and BioMedical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-Gu, Busan 602-739, Korea
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Nam S, Chang HR, Kim KT, Kook MC, Hong D, Kwon CH, Jung HR, Park HS, Powis G, Liang H, Park T, Kim YH. PATHOME: an algorithm for accurately detecting differentially expressed subpathways. Oncogene 2014; 33:4941-51. [PMID: 24681952 PMCID: PMC4182295 DOI: 10.1038/onc.2014.80] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 12/18/2022]
Abstract
The translation of high-throughput gene expression data into biologically meaningful information remains a bottleneck. We developed a novel computational algorithm, PATHOME, for detecting differentially expressed biological pathways. This algorithm employs straightforward statistical tests to evaluate the significance of differential expression patterns along subpathways. Applying it to gene expression data sets of gastric cancer (GC), we compared its performance with those of other leading programs. Based on a literature-driven reference set, PATHOME showed greater consistency in identifying known cancer-related pathways. For the WNT pathway uniquely identified by PATHOME, we validated its involvement in gastric carcinogenesis through experimental perturbation of both cell lines and animal models. We identified HNF4α-WNT5A regulation in the cross-talk between the AMPK metabolic pathway and the WNT signaling pathway, and further identified WNT5A as a potential therapeutic target for GC. We have demonstrated PATHOME to be a powerful tool, with improved sensitivity for identifying disease-related dysregulated pathways.
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Affiliation(s)
- S Nam
- Cancer Genomics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - H R Chang
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - K-T Kim
- Molecular Epidemiology Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - M-C Kook
- Department of Pathology, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - D Hong
- Cancer Genomics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - C H Kwon
- Cancer Genomics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - H R Jung
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - H S Park
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
| | - G Powis
- Cancer Center, Sanford-Burnham Medical Research Institute, La Jolla, CA, USA
| | - H Liang
- Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T Park
- Department of Statistics, Seoul National University, Kwanak-gu Seoul, Republic of Korea
| | - Y H Kim
- New Experimental Therapeutics Branch, National Cancer Center of Korea, Goyang-si Gyeonggi-do, Republic of Korea
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Lee JY, Lee SW, Lee WS, Han S, Park YK, Kwon CH, Jang JY, Cho YR, Park GM, Ahn JM, Kim WJ, Park DW, Kang SJ, Kim YH, Lee CW, Park SW, Park SJ. Prevalence and Clinical Implications of Newly Revealed, Asymptomatic Abnormal Ankle-Brachial Index in Patients With Significant Coronary Artery Disease. JACC Cardiovasc Interv 2013; 6:1303-13. [DOI: 10.1016/j.jcin.2013.08.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/14/2013] [Indexed: 11/25/2022]
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Lee SW, Lee JY, Ahn JM, Park DW, Han S, Park YK, Lee WS, Jang JY, Kwon CH, Park GM, Cho YR, Kim WJ, Kang SJ, Kim YH, Lee CW, Kim JJ, Park SW, Park SJ. Comparison of dual versus triple antiplatelet therapy after drug-eluting stent according to stent length (from the pooled analysis of DECLARE trials). Am J Cardiol 2013; 112:1738-44. [PMID: 24063835 DOI: 10.1016/j.amjcard.2013.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
There are no practical criteria for the use of triple antiplatelet therapy after drug-eluting stent (DES) implantation. In our present report, pooled analysis of 3 randomized studies in patients with diabetes mellitus (Drug-Eluting Stenting Followed by Cilostazol treatment reduces LAte Restenosis in patients with diabetes mellitus trial) and long coronary narrowings (Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients with Long Coronary Lesions trials I and II) compared triple (aspirin, clopidogrel, and cilostazol; triple group, n = 700) and dual antiplatelet therapies (aspirin and clopidogrel; dual group, n = 699) after DES implantation. Among pooled population (n = 1,399 patients), 1,173 patients with follow-up angiography were divided into 3 stent length categories (≤20, 20 to 40, and >40 mm). There was no statistical significance of in-stent restenosis (ISR) in ≤20- and 20- to 40-mm categories between 2 groups. However, ISR rate was significantly reduced in triple versus dual group in >40-mm stent length category (12.4% vs 22.1%, p = 0.008). In diabetic patients, triple group also showed significant reduction in the ISR rate in >40-mm stent length category (15.4% vs 32.3%, p = 0.003). According to postprocedural minimal lumen diameter, triple group showed a trend toward a lower ISR than that of the dual group in all categories (p = 0.033 for ≤2.5 mm, p = 0.087 for 2.5 to 3.0 mm, and p = 0.119 for >3.0 mm). In conclusion, the triple group had a significantly reduced ISR in patients with >40-mm stent length after DES implantation compared with the dual group. Therefore, this suggestion for use of triple antiplatelet therapy could be easily applied after DES implantation in routine clinical practice.
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Ahn JM, Han S, Park YK, Lee WS, Jang JY, Kwon CH, Park GM, Cho YR, Lee JY, Kim WJ, Park DW, Kang SJ, Lee SW, Kim YH, Lee CW, Kim JJ, Park SW, Park SJ. Differential prognostic effect of intravascular ultrasound use according to implanted stent length. Am J Cardiol 2013; 111:829-35. [PMID: 23273529 DOI: 10.1016/j.amjcard.2012.11.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 11/21/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022]
Abstract
It is unknown whether the use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention can attenuate the stent length effect on clinical outcomes. The aim of the present study was to determine the differential prognostic effect of IVUS according to the implanted stent length. We enrolled 3,244 consecutive patients from the Interventional Cardiology Research In-cooperation Society-Drug-Eluting Stents (IRIS-DES) registry who had undergone single or overlapping stent implantation. The primary end point was major adverse cardiac events (MACE; a composite of death, myocardial infarction, and target vessel revascularization). The study population was divided by the tertiles of implanted stent length and IVUS usage. IVUS use was at the discretion of the operator. After adjusting for significant covariates, the stent length was significantly associated with the risk of MACE in the no-IVUS group (hazard ratio 1.13, 95% confidence interval 1.01 to 1.28, p = 0.042) but not in the IVUS group (hazard ratio 1.08, 95% confidence interval 0.97 to 1.20, p = 0.16). In addition, in patients with an implanted stent length of ≤22 mm (n = 998), the risk of MACE was not significantly different between the IVUS group and the no-IVUS group (hazard ratio 1.06, 95% confidence interval 0.50 to 2.28, p = 0.88). In contrast, in patients with a longer implanted stent length, the risk of MACE was significantly lower in the IVUS group than in the no-IVUS group (hazard ratio 0.47, 95% confidence interval 0.24 to 0.92, p = 0.027 for 23 to 32 mm, n = 1,109; hazard ratio 0.57, 95% confidence interval 0.33 to 0.98, p = 0.042 for ≥33 mm, n = 1,137). In conclusion, IVUS usage can attenuate the detrimental effect of the increase in the implanted stent length, supporting IVUS usage, particularly during percutaneous coronary intervention with long stent implantation.
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Affiliation(s)
- Jung-Min Ahn
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Shin M, Song SH, Kim JM, Kwon CH, Joh JW, Lee SK, Kim SJ. Clinical significance of proteinuria at posttransplant year 1 in kidney transplantation. Transplant Proc 2012; 44:610-5. [PMID: 22483450 DOI: 10.1016/j.transproceed.2011.11.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Proteinuria in the nontransplant population is a progressive renal disease. We analyzed the prevalence and clinical significance of proteinuria as well as factors related to its degree at posttransplant year 1 among kidney transplant recipients. METHODS We measured protein in a 24-hour urine among 644 recipients from January 1996 to December 2010. RESULTS Among 372 male and 272 female recipients, the mean amount of urinary protein was 424.4 ± 1010 mg/d (range, 13.88-8691) including 388 (60.2%) subjects with microproteinuria and the other 256 (39.8%) with overt proteinuria. Nephrotic range proteinuria was observed in 17 (2.6%) and nonnephritic range proteinuria, in 239 (37.1%) recipients. The latter cohort was categorized into low-grade proteinuria (n = 224; 34.8%) and high-grade proteinuria (n = 15; 2.3%). Proteinuria at posttransplant 1 year highly correlated with serum creatinine values at posttransplant years 1 and 2 as well as estimated glomerular filtration rate but not creatinine clearance at postoperative year 2. A greater incidence of graft loss was observed among recipients with more severe proteinuria. Males, recipients with anti-hepatitis C virus antibody, unrelated donors, anti-thymocyte immunoglobulin at the time of reperfusion, maintenance immunosuppression with cyclosporine or without mycophenolate mofetil were strongly associated with the amount of proteinuria. CONCLUSION This study demonstrated the prevalence of proteinuria in kidney transplant recipient to be high. The presence as well as level of proteinuria were predictive markers for inferior allograft function.
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Affiliation(s)
- M Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kim YR, Park DW, Park GM, Hwang KW, Kwon CH, Choi SW, Jang JY, Song HG, Ahn JM, Kim WJ, Lee JY, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park SJ, Park SJ. AS-068 Serum Homocystein Levels for Prediction of Major Cardiovascular Events after Drug-Eluting Stent Implantation. Am J Cardiol 2012. [DOI: 10.1016/j.amjcard.2012.01.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Park YK, Park DW, Lee WS, Kwon CH, Park GM, Song HG, Ahn JM, Kim WJ, Lee JY, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. VALIDATION OF THE GLOBAL RISK CLASSIFICATION FOR PREDICTION OF LONG-TERM OUTCOME AFTER UNPROTECTED LEFT MAIN CORONARY REVASCULARIZATION. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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