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Li P, Wu Y, Xie Y, Chen F, Chen SS, Li YH, Lu QQ, Li J, Li YW, Pei DX, Chen YJ, Chen H, Li Y, Wang W, Wang H, Yu HT, Ba Z, Cheng D, Ning LP, Luo CL, Qin XS, Zhang J, Wu N, Xie HJ, Pan JH, Shui J, Wang J, Yang JP, Liu XH, Xu FX, Yang L, Hu LY, Zhang Q, Li B, Liu QL, Zhang M, Shen SJ, Jiang MM, Wu Y, Hu JW, Liu SQ, Gu DY, Xie XB. [HbA1c comparison and diagnostic efficacy analysis of multi center different glycosylated hemoglobin detection systems]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:1047-1058. [PMID: 37482740 DOI: 10.3760/cma.j.cn112150-20221221-01220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective: Compare and analyze the results of the domestic Lanyi AH600 glycated hemoglobin analyzer and other different detection systems to understand the comparability of the detection results of different detectors, and establish the best cut point of Lanyi AH600 determination of haemoglobin A1c (HbA1c) in the diagnosis of diabetes. Methods: Multi center cohort study was adopted. The clinical laboratory departments of 18 medical institutions independently collected test samples from their respective hospitals from March to April 2022, and independently completed comparative analysis of the evaluated instrument (Lanyi AH600) and the reference instrument HbA1c. The reference instruments include four different brands of glycosylated hemoglobin meters, including Arkray, Bio-Rad, DOSOH, and Huizhong. Scatter plot was used to calculate the correlation between the results of different detection systems, and the regression equation was calculated. The consistency analysis between the results of different detection systems was evaluated by Bland Altman method. Consistency judgment principles: (1) When the 95% limits of agreement (95% LoA) of the measurement difference was within 0.4% HbA1c and the measurement score was≥80 points, the comparison consistency was good; (2) When the measurement difference of 95% LoA exceeded 0.4% HbA1c, and the measurement score was≥80 points, the comparison consistency was relatively good; (3) The measurement score was less than 80 points, the comparison consistency was poor. The difference between the results of different detection systems was tested by paired sample T test or Wilcoxon paired sign rank sum test; The best cut-off point of diabetes was analyzed by receiver operating characteristic curve (ROC). Results: The correlation coefficient R2 of results between Lanyi AH600 and the reference instrument in 16 hospitals is≥0.99; The Bland Altman consistency analysis showed that the difference of 95% LoA in Nanjing Maternity and Child Health Care Hospital in Jiangsu Province (reference instrument: Arkray HA8180) was -0.486%-0.325%, and the measurement score was 94.6 points (473/500); The difference of 95% LoA in the Tibetan Traditional Medical Hospital of TAR (reference instrument: Bio-Rad Variant II) was -0.727%-0.612%, and the measurement score was 89.8 points; The difference of 95% LoA in the People's Hospital of Chongqing Liang Jiang New Area (reference instrument: Huizhong MQ-2000PT) was -0.231%-0.461%, and the measurement score was 96.6 points; The difference of 95% LoA in the Taihe Hospital of traditional Chinese Medicine in Anhui Province (reference instrument: Huizhong MQ-2000PT) was -0.469%-0.479%, and the measurement score was 91.9 points. The other 14 hospitals, Lanyi AH600, were compared with 4 reference instrument brands, the difference of 95% LoA was less than 0.4% HbA1c, and the scores were all greater than 95 points. The results of paired sample T test or Wilcoxon paired sign rank sum test showed that there was no statistically significant difference between Lanyi AH600 and the reference instrument Arkray HA8180 (Z=1.665,P=0.096), with no statistical difference. The mean difference between the measured values of the two instruments was 0.004%. The comparison data of Lanyi AH600 and the reference instrument of all other institutions had significant differences (all P<0.001), however, it was necessary to consider whether it was within the clinical acceptable range in combination with the results of the Bland-Altman consistency analysis. The ROC curve of HbA1c detected by Lanyi AH600 in 985 patients with diabetes and 3 423 patients with non-diabetes was analyzed, the area under curve (AUC) was 0.877, the standard error was 0.007, and the 95% confidence interval 95%CI was (0.864, 0.891), which was statistically significant (P<0.001). The maximum value of Youden index was 0.634, and the corresponding HbA1c cut point was 6.235%. The sensitivity and specificity of diabetes diagnosis were 76.2% and 87.2%, respectively. Conclusion: Among the hospitals and instruments currently included in this study, among these four hospitals included Nanjing Maternity and Child Health Care Hospital in Jiangsu Province (reference instrument: Arkray HA8180), Tibetan Traditional Medical Hospital of TAR (reference instrument: Bio-Rad Variant Ⅱ), the People's Hospital of Chongqing Liang Jiang New Area (reference instrument: Huizhong MQ-2000PT), and the Taihe Hospital of traditional Chinese Medicine in Anhui Province (reference instrument: Huizhong MQ-2000PT), the comparison between Lanyi AH600 and the reference instruments showed relatively good consistency, while the other 14 hospitals involved four different brands of reference instruments: Arkray, Bio-Rad, DOSOH, and Huizhong, Lanyi AH600 had good consistency with its comparison. The best cut point of the domestic Lanyi AH600 for detecting HbA1c in the diagnosis of diabetes is 6.235%.
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Affiliation(s)
- P Li
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Y Wu
- Changsha DIAN Medical Laboratory, Changsha 410000, China
| | - Y Xie
- Changsha DIAN Medical Laboratory, Changsha 410000, China
| | - F Chen
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - S S Chen
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Y H Li
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Q Q Lu
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - J Li
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Y W Li
- Department of Laboratory Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou 450002, China
| | - D X Pei
- Department of Laboratory Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou 450002, China
| | - Y J Chen
- Department of Medical Laboratory, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - H Chen
- Department of Clinical Laboratory, the Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Y Li
- Department of Medical Laboratory, the First Affiliated Hospital of Shandong First Medical University, Jinan 250014,China
| | - W Wang
- Department of Laboratory Medicine, Dongguan Chang'an Hospital, Dongguan 523843, China
| | - H Wang
- Department of Laboratory, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - H T Yu
- Department of Laboratory, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Z Ba
- Clinical Laboratory, Tibetan Hospital of Tibet Atonomous Region, Lhasa 850002, China
| | - D Cheng
- Clinical Laboratory, Tibetan Hospital of Tibet Atonomous Region, Lhasa 850002, China
| | - L P Ning
- Department of Clinical Laboratory, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - C L Luo
- Department of Clinical Laboratory, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - X S Qin
- Department of Clinical Laboratory, Shengjing hospital of China Medical University, Shenyang 110004, China
| | - J Zhang
- Department of Clinical Laboratory, Shengjing hospital of China Medical University, Shenyang 110004, China
| | - N Wu
- Department of Medical Laboratory, Hengyang First People's Hospital, Hengyang 421002, China
| | - H J Xie
- Department of Medical Laboratory, Hengyang First People's Hospital, Hengyang 421002, China
| | - J H Pan
- Department of Medical Laboratory, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410004, China
| | - J Shui
- Department of Medical Laboratory, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410004, China
| | - J Wang
- Department of Medical Laboratory, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
| | - J P Yang
- Department of Medical Laboratory, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
| | - X H Liu
- Department of Clinical Laboratory, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
| | - F X Xu
- Department of Clinical Laboratory, Gongli Hospital of Shanghai Pudong New Area, Shanghai 200135, China
| | - L Yang
- Department of Medical Laboratory, the People's Hospital of Chongqing Liang Jiang New Area, Chongqing 401121, China
| | - L Y Hu
- Department of Medical Laboratory, the People's Hospital of Chongqing Liang Jiang New Area, Chongqing 401121, China
| | - Q Zhang
- Department of Medical Laboratory, Taihe Hospital of traditional Chinese Medicine, Taihe County 236600, China
| | - B Li
- Department of Medical Laboratory, Taihe Hospital of traditional Chinese Medicine, Taihe County 236600, China
| | - Q L Liu
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - M Zhang
- Department of Clinical Laboratory, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China
| | - S J Shen
- Department of Medical Laboratory, the First People's Hospitao of Jiashan County, Zhejiang Province, Jiashan County 314100, China
| | - M M Jiang
- Department of Medical Laboratory, the First People's Hospitao of Jiashan County, Zhejiang Province, Jiashan County 314100, China
| | - Y Wu
- Department of Clinical Laboratory, the Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha 410005, China
| | - J W Hu
- Department of Clinical Laboratory, the Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha 410005, China
| | - S Q Liu
- Department of Clinical Laboratory Medicine, the First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421002, China
| | - D Y Gu
- Department of Laboratory Medicine, Shenzhen Second People's Hospital, Shenzhen 518025, China
| | - X B Xie
- Department of Medical Laboratory and Pathology Center, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
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Yu SF, Wang HT, Chang MW, Cheng TT, Chen JF, Lin CL, Yu HT. Determining the Development Strategy and Suited Adoption Paths for the Core Competence of Shared Decision-Making Tasks through the SAA-NRM Approach. Int J Environ Res Public Health 2022; 19:13310. [PMID: 36293890 PMCID: PMC9602580 DOI: 10.3390/ijerph192013310] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Shared decision making (SDM) is an interactive process that involves patients and their healthcare professionals reaching joint decisions about medical care through negotiation. As the initiators of medical decision-making in daily routine, physicians should be aware of and concerned about the SDM process. Thus, professional competency development for SDM has become increasingly critical for physicians' training. Therefore, this study investigates the professional competency and the important competency development aspects/criteria of SDM tasks through expert interviews and literature research. The study adopts the SAA (satisfaction-attention analysis) method to assess the status of competency development aspects/criteria and determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The results demonstrate that the CE (concept and evaluation) aspect is the dominant aspect, and the CR (communication and relationship) aspect is the aspect being dominated. The CE aspect influences the aspects of SP (skill and practice), JM (joint information and decision making) and CR, and the SP aspect affects the aspects of JM and CR. Then, the JM aspect affects the CR aspect. The study also suggests suitable adoption paths of competency development for SDM tasks using the NRM approach. It provides recommendations and strategic directions for SDM competency development and sustainable training programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Meng-Wei Chang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei 105, Taiwan
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Kim SE, Chun KH, Oh J, Yu HT, Lee CJ, Kim TH, Pak HN, Lee MH, Joung B, Kang SM. Prediction of response to cardiac resynchronization therapy using cardiac magnetic resonance imaging in non-ischemic dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1005] [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
Cardiac resynchronization therapy (CRT) is a well-established therapy for symptomatic heart failure with reduced ejection fraction, but the response is different for individuals. Although many modalities have been conducted to predict CRT response, cardiac magnetic resonance (CMR) to predict CRT response has still insufficient usefulness.
Purpose
We determine whether the parameters including late gadolinium enhancement (LGE) identified in CMR could act as predictors of CRT response.
Methods
We retrospectively investigated 124 patients with non-ischemic dilated cardiomyopathy who underwent CMR before CRT implantation between Jan 2010 and July 2021 in a single center. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) >15% on echocardiography after at least 3 months after CRT implantation.
Results
Among the study population (mean age 65.7±11.2 years, mean EF 25±6.5%, 50% of female), 85 (69%) patients were defined as CRT responder. The CRT responders had more left bundle branch block (LBBB) compared with non-responders [79 (92.9%) vs. 23 (59.0%), p<0.001], but there was a no difference of QRS duration (158.7 vs 165.0ms, p=0.054) between two groups. CMR analysis showed that there were no significant differences in the left ventricular (LV) chamber volume and LV ejection fraction between CRT-responder and non-responder. However, the right ventricular (RV) chamber volume was smaller (RV end-diastolic volume index, 86.3 vs 103.5 ml/m2, p=0.039; RV end-systolic volume index, 49.3 vs 68.5 ml/m2, p=0.013) and the RV ejection fraction (RVEF) was higher (46.9 vs 37.6%, p=0.002) in CRT-responders compared with non-responders. The LGE on CMR was more shown in non-responders than in CRT-responders [33 (84.6%) vs 45 (52.9%), p<0.001]. In CMR parameters, RV dysfunction (RVEF <45%) [Odds ratio (OR), 0.21 (0.05–0.93), p=0.045] and LGE [OR, 0.21 (0.05–0.58), p=0.01] were significantly associated with poor CRT response.
Conclusions
The presence of LGE and RV dysfunction on CMR were associated with poor CRT response in patients with non-ischemic dilated cardiomyopathy. Further investigation with CMR for pre-CRT patients is needed to support these results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S E Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - K H Chun
- NHIS Ilsan Hospital, Cardiology , Goyang , Korea (Republic of)
| | - J Oh
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - C J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - S M Kang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Kim MH, Hwang I, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Blunted atrial reverse remodeling a year after catheter ablation for atrial fibrillation and their long-term rhythm outcome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.506] [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: 11/12/2022] Open
Abstract
Abstract
Background
Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA.
Methods
Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA>40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS).
Results
Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p<0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling.
Conclusions
Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea
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Affiliation(s)
- M H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - I Hwang
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J W Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Park H, Yu HT, Kim TH, Park J, Park JK, Kang KW, Shim J, Kim JB, Choi EK, Park HW, Lee YS, Joung B. Oral anticoagulation therapy in atrial fibrillation patients with advanced chronic kidney disease: CODE-AF Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.628] [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 and objectives
Advanced chronic kidney disease (CKD), including end-stage renal disease (ESRD) on dialysis, increases thromboembolic risk among patients with atrial fibrillation (AF). This study examined the comparative safety and efficacy of direct-acting oral anticoagulant (DOAC) compared to warfarin or no OAC among AF patients with advanced CKD or ESRD on dialysis.
Methods
Using data from the COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry, 260 non-valvular AF patients with advanced CKD (defined as estimated glomerular filtration rate [eGFR] <3 0ml/min per 1.73 m2) or ESRD on dialysis were enrolled from June 2016 to July 2020. The study population was categorized into DOAC, warfarin, and no OAC group, and differences in major or clinically relevant non-major (CRNM) bleeding, stroke/systemic embolism (SE), myocardial infarction/critical limb ischemia (CLI), and death were assessed.
Results
During a median 24 months of follow-up, major or CRNM bleeding risk was significantly reduced in the DOAC group compared to the warfarin group (hazard ratio [HR] 0.21, 95% confidence interval [CI] 0.05 to 0.95, p=0.042). In addition, the risk of composite adverse clinical outcome (major or CRNM bleeding, stroke/SE, myocardial infarction/CLI, and death) was significantly reduced in the DOAC group compared to the no OAC group (HR 0.32, 95% CI 0.11 to 0.96, p=0.043).
Conclusion
Among AF patients with advanced CKD or ESRD on dialysis, DOAC was associated with a lower risk of major or CRNM bleeding compared to warfarin and a lower risk of composite adverse clinical outcome compared to no OAC.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI15C1200, HC19C0130)
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Affiliation(s)
- H Park
- Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J Park
- Ewha Womans University School of Medicine , Seoul , Korea (Republic of)
| | - J K Park
- Hanyang university medical center , Seoul , Korea (Republic of)
| | - K W Kang
- Eulji University College of Medicine , Seoul , Korea (Republic of)
| | - J Shim
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - J B Kim
- Kyunghee University , Seoul , Korea (Republic of)
| | - E K Choi
- Seoul National University Hospital , Seoul , Korea (Republic of)
| | - H W Park
- Chonnam National University School of Medicine , Gwangju , Korea (Republic of)
| | - Y S Lee
- Daegu Catholic University Medical Center , Daegu , Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine , Seoul , Korea (Republic of)
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Park Y, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effects of early recurrence and extra-PV triggers on long-term recurrence after catheter ablation for atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.594] [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: 11/13/2022] Open
Abstract
Abstract
Background
Although early recurrence (ER) within 3 months after atrial fibrillation (AF) catheter ablation (AFCA) was recently reported to be a reliable predictor of late recurrence (LR), the mechanism is not clear.
Purpose
We explored the characteristics of patients with ER and compared the long-term late recurrence (LR) pattern depending on the existence of extra-pulmonary vein trigger (ExPV-trigger).
Methods
Among 3643 patients who underwent de novo AFCA, we included 1249 patients (59.2±11.0 years old, 31.3% persistent AF) who underwent isoproterenol provocation and regular follow-up over three years after AFCA. We evaluated the risk factors for ER and compared the patients with ER alone (10.1%), LR alone (16.6%), and ER+LR (15.9%), and the outcome of repeat procedure.
Results
Overall ER (ER alone and ER+LR) was independently associated with persistent AF (OR 1.58 [1.16–2.14], p=0.003), extra-PV triggers (OR 2.80 [1.90–4.13], p<0.001), and empirical extra-PV ablation (OR 1.54 [1.15–2.07], p=0.004). Overall LR (LR alone and ER+LR) risk was significantly higher in the ER with ExPV-trigger group than in ER without ExPV-trigger or no ER groups (Log-rank p<0.001). The rhythm outcome of the second procedure did not differ between ER+LR and LR alone groups (Log-rank p=0.160), but was worse in the ER+LR ExPV-trigger than in ER+LR without ExPV-trigger or LR alone groups (Log-rank p=0.005).
Conclusion
ER was independently associated with LR after de novo AFCA. ExPV-trigger played crucial roles in ER and LR after de novo AFCA and worse rhythm outcome after redo AFCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Park
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine , Seoul , Korea (Republic of)
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7
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Kim D, Yu HT, Kwon OS, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Effect of the epicardial fat volume on the outcomes after a left atrial posterior wall isolation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.595] [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
While the effect of a circumferential pulmonary vein isolation (CPVI) alone is unsatisfactory, that of an additional electrical posterior wall box isolation (POBI) is controversial in persistent atrial fibrillation (PeAF) patients. Increased epicardial adipose tissue (EAT) is associated with higher recurrence rates after AF catheter ablation (AFCA).
Purpose
We investigated the possible effects of a POBI on rhythm outcomes with varying EAT volumes.
Methods
We included 1,187 patients with PeAF undergoing a de novo AFCA (79.6% male, median age 60 years) into two groups including those receiving a CPVI alone (n=687) and those an additional POBI (n=500). The rhythm outcomes at two years post-AFCA were compared in subgroups stratified by the total EAT volume using propensity overlap weighting.
Results
A reduced total EAT volume was linearly associated with more favorable rhythm outcomes for an additional POBI treatment than for a CPVI alone (P for interaction=0.002). Among the patients with smaller EAT volumes (≤116.23 ml, the median value, n=594), an additional POBI was associated with a reduced AF recurrence risk as compared to a CPVI only (weighted hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56–0.99; weighted log-rank P=0.039). In contrast, among the remaining 593 patients with greater EAT volumes (>116.2 3mL), there was no difference in the AF recurrence risk between an additional POBI and CPVI alone (weighted HR 1.13, 95% CI 0.84–1.52; weighted log-rank P=0.410). Among 185 patients with a repeat ablation, the POBI reconnection rate tended to be higher in the large EAT group (75.0%) than small EAT group (55.4%, P=0.060).
Conclusion
While PeAF patients with a smaller EAT volume averted AF recurrence by an additional POBI after the CPVI, no benefit of the POBI was observed in those with a greater EAT volume. The EAT volume might identify AF patients likely to benefit from linear ablation in addition to the CPVI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korean Ministry of Science, ICT & Future Planning (MSIP)Korean Ministry of Health and Welfare
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - O S Kwon
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
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8
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Yu SF, Hsu CM, Wang HT, Cheng TT, Chen JF, Lin CL, Yu HT. Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach. Healthcare (Basel) 2022; 10:healthcare10101844. [PMID: 36292290 PMCID: PMC9601707 DOI: 10.3390/healthcare10101844] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022] Open
Abstract
Shared decision making (SDM) is a collaborative process involving patients and their healthcare workers negotiating to reach a shared decision about medical care. However, various physician stakeholders (attending physicians, medical residents, and doctors in post-graduate years) may have different viewpoints on SDM processes. The purpose of this study is to explore the core competence of physicians in performing SDM tasks and to investigate the significant competency development aspects/criteria by applying the literature research and expert interviews. We adopt the IAA (importance awareness analysis) technique for different stakeholders to evaluate the status of competency development aspects/criteria and to determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The study combines the IAA and NRM methods and suggests using the IAA-NRM approach to evaluate the adoption strategies and common suitable paths for different levels of physicians. Our findings reveal that SDM perception and practice is the primary influencer of SDM competence development for all stakeholders. The current model can help hospital administrators and directors of medical education understand the diverse stakeholders’ perspectives on the core competence of SDM tasks and determine common development plans. It provides strategic directions for SDM competency development and talent cultivation programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan City 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan
| | - Chih-Ming Hsu
- Medical Education Department, Chiayi Chang Gung Memorial Hospital, Puzi City 613, Taiwan
- Department of Business Administration, National Chung Cheng University, Minxiong Township, Chiayi 621, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan City 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei City 111, Taiwan
- Correspondence: (C.-L.L.); (H.-T.Y.)
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei City 105, Taiwan
- Correspondence: (C.-L.L.); (H.-T.Y.)
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9
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Park H, Yu HT, Kim TH, Park J, Park JK, Kang KW, Shim J, Kim JB, Kim J, Choi EK, Park HW, Lee YS, Joung B. Resting heart rate and cardiovascular outcomes in patients with atrial fibrillation: CODE-AF registry. Europace 2022. [DOI: 10.1093/europace/euac053.182] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The prognostic significance of resting heart rate and its therapeutic target in atrial fibrillation (AF) is uncertain.
Purpose
The aim of this study was to investigate the relationships between resting heart rate and cardiovascular outcomes in patients with AF.
Methods
A total of 8,886 patients with AF was included from the COmparison study of Drugs for symptom control and complication prEvention of AF (CODE-AF) registry. Patients were categorized according to baseline heart rate, and cardiovascular outcomes were accessed during a median follow-up of 30 months. The primary outcome was a composite of cardiovascular death, hospitalization due to heart failure, and myocardial infarction/critical limb ischemia.
Results
Compared to heart rate ≥100 beats per minute (bpm), heart rate 80-99 bpm was associated with the lowest risk of primary outcome (adjusted hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.40-0.79, p=0.001). In subgroup of patients with heart failure with preserved ejection fraction (HFpEF), heart rate between 80-99 bpm was associated with reduced risk of primary outcome compared to heart rate ≥100 bpm (HR 0.40, 95% CI 0.16-0.98, p=0.045). However, in patients with heart failure with reduced ejection fraction (HFrEF), there was no association between resting heart rate and cardiovascular outcomes (P for interaction 0.001).
Conclusion
Resting heart rate was associated with cardiovascular outcomes in patients with AF, and those with a resting heart rate between 80-99 bpm had the lowest risk of adverse events. The impact of resting heart rate on adverse events persisted in patients with concomitant HFpEF but was not apparent in those with concomitant HFrEF.
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Affiliation(s)
- H Park
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Park
- Ewha Womans University School of Medicine, Seoul, Korea (Republic of)
| | - JK Park
- Hanyang University Seoul Hospital, Seoul, Korea (Republic of)
| | - KW Kang
- Eulji University College of Medicine, Seoul, Korea (Republic of)
| | - J Shim
- Korea University Medical Center, Seoul, Korea (Republic of)
| | - JB Kim
- Kyung Hee University Hospital, Seoul, Korea (Republic of)
| | - J Kim
- University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - EK Choi
- Seoul National University Hospital, Seoul, Korea (Republic of)
| | - HW Park
- Chonnam National University School of Medicine, Gwangju, Korea (Republic of)
| | - YS Lee
- Daegu Catholic University Medical Center, Daegu, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
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10
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Hwang I, Kwon OS, Hong M, Yang SY, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Association of ZFHX3 genetic polymorphisms and extra-pulmonary vein triggers in patients with atrial fibrillation who underwent catheter ablation. Europace 2022. [DOI: 10.1093/europace/euac053.009] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and Welfare, National Research Foundation of Korea (NRF)
Abstract
Background
The ZFHX3 gene (16q22) is the second most highly associated gene with atrial fibrillation (AF) and is related to inflammation and fibrosis.
Purpose
We hypothesized that ZFHX3 is associated with extra-pulmonary vein (PV) triggers, left atrial (LA) structural remodeling, and poor rhythm outcomes of AF catheter ablation (AFCA).
Methods
We included 1782 patients who underwent a de novo AFCA (73.5% male, 59.4±10.8 years old, 65.9% paroxysmal AF) and genome-wide association study and divided them into discovery (n=891) and replication cohorts (n=891). All included patients underwent isoproterenol provocation tests and LA voltage mapping. We analyzed the ZFHX3, extra-PV trigger-related factors, and rhythm outcomes.
Results
Among 14 single-nucleotide polymorphisms (SNPs) of ZFHX3, rs13336412, rs61208973, rs2106259, rs12927436, and rs1858801 were associated with extra-PV triggers. In the overall patient group, extra-PV triggers were independently associated with the ZFHX3 polygenic risk score (PRS) (OR 1.65 [1.22-2.22], p=0.001, model 1) and a low LA voltage (OR 0.74 [0.56-0.97], p=0.029, model 2). During 49.9±40.3 months of follow-up, clinical recurrence of AF was significantly higher in patients with extra-PV triggers (Log-rank p<0.001, HR 1.89 [1.49-2.39], p<0.001, model 1), large LA dimensions (Log-rank p<0.001, HR 1.03 [1.01-1.05], p=0.002, model 2), and low LA voltages (Log-rank p<0.001, HR 0.73 [0.61-0.86], p<0.001, model 2) but not the ZFHX3 PRS (Log-rank p=0.819).
Conclusions
The extra-PV triggers had significant associations with both ZFHX3 genetic polymorphisms and acquired LA remodeling. Although extra-PV triggers were an independent predictor of AF recurrence after AFCA, the studied AF risk SNPs intronic in ZFHX3 were not associated with AF recurrence.
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Affiliation(s)
- I Hwang
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - O-S Kwon
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - M Hong
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - S-Y Yang
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - J-W Park
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - T-H Kim
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - J-S Uhm
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - M-H Lee
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - H-N Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
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Yang PS, Kim DH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Sung JH, Joung B. Comparative effectiveness of early rhythm control versus rate control for cardiovascular outcomes according to sex in patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.184] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health & Welfare, Republic of Korea
Background
Rhythm control is associated with better cardiovascular outcomes than usual care among patients recently diagnosed with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the effects of early rhythm control compared to rate control on the primary composite outcome of cardiovascular death, ischaemic stroke, hospitalisation for heart failure (HF), or myocardial infarction.
Methods
We conducted a retrospective population-based cohort study including 22635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011-2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used.
Results
Among patients with early AF treatment (initiated within 1 year since diagnosis), compared with rate control, rhythm control was associated with a similar lower risk of the primary composite outcome both women (weighted incidence rate per 100 person-years: 8.68 in rhythm control vs. 10.3 in rate control; hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.69 to 0.90; P<0.001) and men (weighted incidence rate per 100 person-years: 6.33 in rhythm control vs. 8.32 in rate control; HR 0.77, 95% CI 0.67 to 0.88; P<0.001). However, the effective initiation time for rhythm control therapy was within 6 and 11 months after AF diagnosis in female and male patients, respectively. Moreover, the effective times for other outcomes were different between genders (hospitalization for HF; female within 2 months, male within 9 months/ ischemic stroke; female within 11 months, male immediately).
Conclusions
Early initiation of rhythm control was associated with a lower risk of primary outcome in both genders. However, the effective rhythm control treatment initiation time for primary outcome, stroke and HF-related admission was different in both genders. For rhythm control treatment to be effective, women should start treatment earlier than men.
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Affiliation(s)
- PS Yang
- CHA University, Seongnam, Korea (Republic of)
| | - DH Kim
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
| | - JH Sung
- CHA University, Seongnam, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Cardiology, Seoul, Korea (Republic of)
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12
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Hwang I, Hong M, Hwang TH, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Jee SH, Pak HN. Genetic predisposition according to the age at the onset of atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.007] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Health and Welfare National Research Foundation of Korea (NRF)
Background
Although atrial fibrillation (AF) is a heritable disease, multiple comorbid factors, including aging, contribute to its development.
Purpose
We investigated the association between a weighted genetic risk score (wGRS) for AF and the age at onset.
Methods
We included 1,968 patients with AF (Yonsei AF Ablation cohort) and 5,486 controls from the Korean Genome Epidemiology Study (KoGES). After 1:1 matching, 1,416 patients and 1,416 controls were included in the analyses. The age of AF onset was determined by the first electrocardiogram (ECG) documentation.
Results
We selected nine previously reported AF-associated single-nucleotide polymorphisms (SNPs). Among nine proven AF-associated SNPs, 4 genes (PRRX1, PPFIA4, PITX2, and ZFHX3) were independently associated with the age at the onset of AF (p<0.05), but no associated genes were found in the controls. In the quartile and multivariate analyses, the lower quartile age at the onset of AF had a higher wGRS (p<0.001), and a younger age at the onset of AF was independently associated with the wGRS (β -0.29 [-0.57--0.01], p=0.045), but that association was not observed in the control cohort. Contrarily, the higher quartile of the wGRS group had a younger age of AF onset (p<0.001), and the wGRS was independently associated with the age at onset of AF (β -0.02 [-0.03--0.01], p=0.002). In the subgroup analyses, these age-wGRS associations were significant in males (p<0.001) and in those without heart failure (p<0.001) or strokes (p<0.001).
Conclusions
AF-associated genetic loci significantly contributed to the age at the onset of AF, as determined by the first ECG.
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Affiliation(s)
- I Hwang
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - M Hong
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - T H Hwang
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - T-H Kim
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - J-S Uhm
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - M-H Lee
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - S H Jee
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
| | - H-N Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea (Republic of)
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13
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Yu G, Kim TH, Yu HT, Joung BY, Pak HN, Lee MH. Learning curve of left bundle branch area pacing with standard stylet-driven pacing leads: a single center prospective observational study in Korea. Europace 2022. [DOI: 10.1093/europace/euac053.426] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Although cardiac pacing is an essential therapy for bradycardia, conventional right ventricular pacing (CRVP) can cause electrical-mechanical dyssynchrony. Left Bundle Branch Area Pacing (LBBAP) is a new conduction system pacing strategy that includes a normal conduction system and therefore maintains synchronous ventricular contraction. Most of the experience with LBBAP is done in a lumen-less lead with fixed helix design, and this device is not available in sometimes.
Purpose
This study aimed to evaluate the learning curve of LBBAP using standard stylet-driven lead with extendable helix design.
Methods
This study enrolled patients who underwent permanent cardiac pacemaker implantation at a University Hospital in South Korea from December 2020 to October 2021. LBBAP was performed with a 5.6Fr stylet-driven pacing lead with an extendable helix. The learning curve was assessed by analyzing fluoroscopy time and procedure time.
Results
In 65 patients who underwent LBBAP during the observation period, mean fluoroscopy time and procedural time were 17.1 ± 17.2 minutes and 64.2 ± 33.5 minutes, respectively in this study. The learning curve for achieving LBBAP appears to plateau after around 24th case with a progressive reduction in procedure time. This is a significantly shorter period of time when compared to the previously reported learning curves of his bundle pacing (30-50cases), previously developed conduction system pacing strategy.
Conclusion
During initial experience with LBBAP, fluoroscopy and procedural time continue to improve with operator experience. For physicians who are experienced at cardiac pacemaker implantation, the steepest part of the learning curve of LBBAP appears to be over the first 20-25 cases.
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Affiliation(s)
- G Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University, Seoul, Korea (Republic of)
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14
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Chen LH, Chin TH, Huang SY, Yu HT, Chang CL, Huang HY, Wang HS, Soong YK, Wu HM. Supplementation with human menopausal gonadotropin in the gonadotropin-releasing hormone antagonist cycles of women with high AMH: Pregnancy outcomes and serial hormone levels. Taiwan J Obstet Gynecol 2021; 60:739-744. [PMID: 34247817 DOI: 10.1016/j.tjog.2021.05.027] [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] [Accepted: 05/04/2020] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate the value of using both HMG and recombinant FSH (r-FSH) in the GnRH antagonist protocol for women with high AMH. MATERIALS AND METHODS This retrospective, single-center cohort study was conducted from January 2013 to December 2018. Of 277 GnRH antagonist IVF/ICSI cycles in women with anti-Mullerian hormone (AMH) ≥5 μg/L, 170 cycles receiving the combination of r-FSH and HMG (77 with HMG added at the beginning of the GnRH antagonist cycle and 93 with HMG added after GnRH antagonist administration) and 107 cycles receiving r-FSH alone were analyzed. The dynamic hormone profiles and embryonic and clinical outcomes of the patients were evaluated. RESULTS We observed significantly lower serum LH levels in the r-FSH + HMG groups during ovarian stimulation. The serum estradiol and progesterone levels were lower in the r-FSH + HMG groups on the trigger day. Nevertheless, there were no significant differences with respect to the number of oocytes retrieved, maturation, fertilization, blastocyst formation rate or ovarian hyperstimulation syndrome (OHSS). The implantation and live birth rates were increased in the r-FSH + HMG groups compared with the r-FSH alone group, with no statistical significance. CONCLUSIONS HMG for LH supplementation in the GnRH antagonist protocol for patients with high AMH is not significantly superior to r-FSH alone in terms of ovarian response and pregnancy outcome. Nevertheless, HMG supplementation might be appropriate for women with an initially inadequate response to r-FSH or intracycle LH deficiency.
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Affiliation(s)
- Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Tzu-Hsuan Chin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Shang-Yu Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Chia-Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Hsin-Shih Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Yung-Kuei Soong
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan
| | - Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, No. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan.
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15
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Yu HT, Xia T, Wang CF, Fang B, Cai RZ, Chen L, Jin S, Fu C. [Analysis on the difference between life expectancy and healthy life expectancy in Shanghai]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1018-1023. [PMID: 34814500 DOI: 10.3760/cma.j.cn112338-20200417-00591] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To analyze the difference of life expectancy and healthy life expectancy among Shanghai residents of different gender and age groups. Methods: Compare the trends of life expectancy among Shanghai and other longevity countries/regions. With the disability weights of GBD, Sullivan method was applied to calculate the healthy life expectancy in Shanghai and analyze the loss of healthy life years among the population of different age groups and genders. Results: In the past 40 years, life expectancy had increased by 10.86 years in Shanghai. In 2016, the life expectancy of Shanghai residents was 83.18 years old, and 80.83 years old for males and 85.61 years old for females. The healthy life expectancy of Shanghai residents was 69.46 years, and 68.68 years for males and 70.23 years old for females. The gap with life expectancy was 13.72 years old, 12.15 years old and 15.38 years old, respectively. They account for 16.49%, 15.02% and 17.97% of life expectancy, respectively. The healthy life expectancy of women in all age groups is higher than that of men with the average gap of 1.76 years. The difference between the two is as small as 1.36 years at 20-24 years old, and as large as 2.24 years at 70-74 years old. The loss rate of healthy life expectancy increases with age, with women higher than men before age 65 and vice versa after age 65 years old. Conclusions: The life expectancy in Shanghai has reached the world leading level, but the healthy life loss is still large. It is necessary to further improve the life quality with the reducing mortality rate, especially for women and men over 65 years old.
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Affiliation(s)
- H T Yu
- Shanghai Institute of Preventive Medicine, Shanghai 200336, China
| | - T Xia
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - C F Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - B Fang
- Shanghai Institute of Preventive Medicine, Shanghai 200336, China
| | - R Z Cai
- Shanghai Institute of Preventive Medicine, Shanghai 200336, China
| | - L Chen
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - S Jin
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - C Fu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
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16
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Kim D, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Malnutrition and risk of procedural complication in patients with atrial fibrillation undergoing catheter ablation. Europace 2021. [DOI: 10.1093/europace/euab116.226] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and Welfare of Korea Ministry of Science, ICT & Future Planning of Korea
Background
Malnutrition is common in the elderly, even in developed countries, and increases mortality.
Purpose
To investigate the prevalence and prognostic value of malnutrition among patients with atrial fibrillation (AF) which is a type of metabolic disease.
Methods
We included 3,239 patients (age 58.5 ± 10.8 years, 73.2% male, 67.7% paroxysmal type) undergoing de novo AF catheter ablation (AFCA) between 2009 and 2020. Nutritional status was assessed using controlling nutritional status (CONUT) score. The associations between malnutrition and the risk of AFCA complications or long-term rhythm outcome were evaluated by multivariable logistic regression.
Results
Among 3,239 patients, 1,005 (31.0%) patients had malnutrition; 991 (30.6%) with mild (CONUT scores 2-4) and 14 (0.4%) with moderate-to-severe (CONUT scores ≥5) malnutrition. Overall complication rates after AFCA were 3.3% in normal nutrition, 4.2% in mild malnutrition, and 21.4% in moderate to severe malnutrition, respectively (P for trend = 0.031). Major complication rates were 1.9%, 2.6%, and 14.3% in normal nutrition, mild malnutrition, and moderate to severe malnutrition (P for trend = 0.042). After multivariable adjustment, moderate-to-severe malnutrition status was associated with increased risks of overall (OR 8.215 [2.199-30.691], P = 0.002) and major (OR 7.392 [1.568-34.837], P = 0.011) complications compared with normal nutrition. However, CONUT score did not affect the long-term rhythm outcome during the mean follow-up of 40 (interquartile range 18-74) months (log-rank P = 0.760).
Conclusion
Malnutrition is common in patients undergoing AFCA. Those with moderate-to-severe malnutrition status were at substantially higher risk of complications after AFCA. Abstract Figure. Overall and major complication rates
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
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Pak HN, Park JW, Yang SY, Kim M, Yu HT, Kim TH, Uhm JS, Joung BY, Lee MH. Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation. Europace 2021. [DOI: 10.1093/europace/euab116.209] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures.
Methods
Among 3,282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5 ± 10.3 years old, 61.5% paroxysmal AF) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications, and long-term clinical recurrences after propensity score matching.
Results
The LA volume index (43.1 ± 18.6 vs. 35.8 ± 11.6 ml/m2, p < 0.001) was higher, but LA dimension (40.0 ± 6.8 vs. 41.6 ± 6.3mm, p = 0.018), LA voltage (0.94 ± 0.55 vs. 1.20 ± 0.68 mV, p = 0.002), and pericardial fat volume (89.5 ± 43.1 vs. 122.1 ± 53.9 cm3, p < 0.001) lower in women with a repeat ablation than in their male counterparts. The pulmonary vein (PV) reconnections were lower (58.7% vs. 74.9%, p = 0.001), but the proportion of extra-PV triggers (27.5% vs. 17.0%, p = 0.026) and elevated LA pulse pressures (79.7% vs. 63.7%, p = 0.019) was significantly higher in women than men. There was no significant sex difference in the procedure-related complication rate (4.6% vs. 4.2%, p = 0.791). During a 31(8∼60) month median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log rank p = 0.039, antiarrhythmic drug [AAD]-free log rank p < 0.001) and second procedure (log rank p = 0.006, AAD-free log rank p = 0.093). A female sex (HR 1.51 [1.06-2.15], p = 0.023), non-paroxysmal AF (HR 1.78 [1.30-2.34], p < 0.010), and extra-PV triggers (HR 1.88 [1.28-2.75], p = 0.001) were independently associated with clinical recurrences after repeat procedures.
Conclusions
During the repeat AFCA procedures, PV reconnections were lower in women than men, and the existence of extra-PV triggers and an LA pressure elevation was more significant, which resulted in poor rhythm outcomes.
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Affiliation(s)
- HN Pak
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JW Park
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - SY Yang
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - M Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University Health system, Seoul, Korea (Republic of)
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Park JW, Kwon OS, Shim JM, Yu HT, Kim TH, Uhm JS, Kim JY, Choi JI, Joung BY, Lee MH, Kim YH, Pak HN. Artificial intelligence-predicted poor responders to catheter ablation for atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.228] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Although atrial fibrillation (AF) catheter ablation is effective for rhythm control, in some patients it is hard to maintain sinus rhythm in spite of repeated AF catheter ablation (AFCA) procedures and anti-arrhythmic drugs (AADs). We explored the pre-procedural predictors for poor responders to AFCA and tested whether artificial intelligence (AI) assists the prediction of poor responders in the independent cohort by determining the invasive parameters.
Methods
Among 1,214 patients who underwent AFCA and regular rhythm follow-up for 56.2 ± 33.8 months (59 ± 11 years, 73.5% male, 68.6% paroxysmal AF), we differentiated 92 poor responders defined as those with sustained AF despite repeat AFCAs, AADs, or electrical cardioversion. Using the Youden index, we identified advanced LA remodeling with lower LA voltage under 1.109mV. AI model, which was derived from development cohort using medical record, was applied to predict LA voltage <1.109mV in the independent cohort (n = 634, poor responders = 24) using a grad-cam score.
Results
The patients with lower LA voltage under 1.109mV showed significantly poorer rhythm outcomes (Log-rank p < 0.001). We determined invasive parameter LA voltage by using the multiple variables (age, female sex, AF type, CHA2DS2VASc score, LA dimension, E/em, hemoglobin, PR interval) and achieved relatively good prediction power of AI for LA voltage <1.109mV (AUC = 0.734, sensitivity 0.729, specificity 0.643) in the test cohort. In the independent cohort, the AI model showed good discrimination power for poor responders (AUC 0.751, p < 0.001) by estimating LA voltage, which is an invasive variable. The patients with predicted lower LA voltage (grad-cam score <0) showed poorer rhythm outcome after active rhythm control (Log-rank p < 0.001)
Conclusions
The patients with advanced atrial remodeling with low LA voltage, which can be predicted by an AI, showed significantly higher recurrence of AF after AFCA with AADs or cardioversion. AI may assist to select these poor responder patients before the AFCA procedure. Abstract Figure.
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Affiliation(s)
- JW Park
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - OS Kwon
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JM Shim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HT Yu
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JS Uhm
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JY Kim
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - JI Choi
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University Health system, Seoul, Korea (Republic of)
| | - YH Kim
- Korea University, Cardiovascular Center, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University Health system, Seoul, Korea (Republic of)
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Lee J, Kwon OS, Lee JS, Yu HT, Kim TH, Uhm JS, Joung BY, Lee MH, Pak HN. Left atrial wall stress and the outcome of catheter ablation for atrial fibrillation: artificial intelligence-based prediction of clinical outcome. Europace 2021. [DOI: 10.1093/europace/euab116.296] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Left atrial (LA) wall stress (LAW-str) may contribute to the mechanism of atrial fibrillation (AF).
Purpose
We explored the clinical characteristics and the rhythm outcome of AF depending on LAW-str among the patients who underwent AF catheter ablation (AFCA). We also tested whether artificial intelligence (AI) properly estimate LAW-str without invasive parameters.
Methods
We included 2223 patients (72.8% male, 59.0 [52.0–67.0] years old, 28.7% with persistent AF [PeAF]) who underwent radiofrequency catheter ablation (RFCA). LAW-str was calculated by the Law of Laplace using LA diameter (echocardiogram), peak LA pressure, and mean LA wall thickness (computed tomography) measured by customized software. Based on the quartile (Q1–4) or AI-estimated values of LAW-str, we compared clinical characteristics and rhythm outcome.
Results
LAW-str was independently associated with PeAF (p < 0.001), diabetes (p = 0.012) and vascular disease (p = 0.002), body mass index (p < 0.001), E/Em (p < 0.001), and mean LA voltage (p < 0.001). During 26.0 (12.0–52.0) months follow-up, clinical recurrence of AF was significantly higher in the Q4 of LAW-str group (log rank p = 0.001). LAW-str was independently associated with clinical recurrence after AFCA (HR 1.001 [1.000–1.002], p = 0.013). AI-based model using non-invasive parameters predicted Q4 of LAW-str with area under the curve (AUC) 0.734, which was similar to logistic regression based predictive model using all data including invasive parameters (AUC 0.726). Patients in Q4 of LAW-str showed consistently worse rhythm outcome regardless of the type of AF, sex, or AI-based prediction (p = 0.039).
Conclusions
The LAW-str seems to be associated with rhythm outcome of AFCA and AI can predict this complex parameter with moderate accuracy. TableMultivariateβ (95% CI)PPersistent AF31.08 (21.77-40.39)<0.001Diabetes mellitus15.36 (3.35-27.38)0.012Vascular disease22.27 (8.4-36.14)0.002Body mass index2.91 (1.53-4.29)<0.001E/Em4.95 (3.87-6.02)<0.001Mean LA voltage-22.24 (-27.96–16.52)<0.001Linear regression analysis for clinical variables predictive of LA wall stress (10^3 dyn/cm2).Abstract Figure. AF recurrence by LAW-str, AI-prediction
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Affiliation(s)
- J Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - OS Kwon
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HT Yu
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - JS Uhm
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - BY Joung
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea (Republic of)
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20
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Park JW, Yang PS, Yu HT, Kim TH, Jang ES, Pak HN, Lee MH, Joung BY. The reduction of body mass index and risk of incidence of cardiovascular events in the elderly population. Europace 2021. [DOI: 10.1093/europace/euab116.152] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Obesity is known to be risk factor for incidence of cardiovascular (CV) events. However, the association between the reduction of body mass index (BMI) and incidence of cardiovascular event is not well established in elderly Asian population.
Methods
From the National Health Insurance Service-Senior (≥60 years) cohort from 2002 to 2013, 13,038 participants over 75 years old without baseline comorbidities (mean age: 78.4 ± 3.2 years 5243 (40.2%) male) were included in this study. We measured the change of BMI from first to second visit for health check-up within mean 23.6 ± 5.8months of follow-up. We categorized the reduction of BMI as five group according to the amount of change in BMI in overall patients (group 1: BMI change <-10%, group 2: -10%≤BMI change<-3%, group 3: -3% ≤ BMI change < 3%, group 4: 3% ≤BMI change < 10%, group 5: 10% ≤BMI change). We investigated the influence of change in BMI on the incidence of new-onset AF, stroke, acute myocardial infarction (MI), and CV mortality
Results
In the overall patients, new-onset AF, stroke, acute MI, and CV death was occurred in the 494 patients (3.5%), 775 patients (5.9%), 16 patients (0.1%), and 458 patients (3.5%) respectively. The Kaplan-Meier curve showed significant cumulative incidence rate of CV death in group 1 (Log rank p < 0.001). The multivariate cox regression after adjusting for compound clinical covariates showed the risk of stroke (HR 1.43, 95% CI [1.09-1.89], p = 0.01) and CV death (HR 2.06, 95% CI [1.49-2.84] were significant higher in the group 1 as compared with group 3. In the high BMI (≥25) group, the risk of AF was significant higher in the group 5 as compared with group 3 (HR 2.38, 95% CI [1.02-5.54], p = 0.04). In contrast, the risk of stroke (HR 1.70, 95% CI [1.07-2.71], p = 0.02) and CV death (HR 3.27, 95% CI [1.66-6.41], p < 0.001) was significant higher in the group 1 than in group 3.
Conclusions
In the elderly Asian population over 75 years old, the reduction of body weight affected worse effect on the incidence of stroke and CV death in overall patient and high BMI (≥25) group. It needs careful consideration to reduce BMI in the elderly Asian population even with high BMI (≥25) for purpose of CV events.
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Affiliation(s)
- JW Park
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - PS Yang
- Bundang CHA General Hospital, Seongnam, Korea (Republic of)
| | - HT Yu
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - TH Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - ES Jang
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - HN Pak
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - MH Lee
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - BY Joung
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Fang B, Wang CF, Yu HT, Chen L, Cai RZ, Qian NS, Xia T, Wu F. [Analysis on adult health life expectancy in Shanghai]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:846-852. [PMID: 34814477 DOI: 10.3760/cma.j.cn112338-20200327-00456] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To investigate health status and calculate health life expectancy (HE) of residents in Shanghai, analyze health related factors and provided foundation of health policy. Methods: A multi-stage stratified random sampling was used to obtain self-reported health survey in Shanghai. WHO questionnaire was used to evaluate the health quality of life which was designed for the world health survey, Sullivan's method was used to calculate HE. Results: The self-assessment disability measure for adults over 18 years old in Shanghai was 0.25, higher for women (0.28) than for men (0.23). LE was 65.76 years for adults over 18 years old, higher for women (68.22) than for men (63.39). HE for adults over 18 years old was 47.99 years old, higher for men (49.05) than women (47.14). HE's proportion in LE gradually decreases with age. It accounts for 72.97% in the 18 years old and 39.00% in the 85 years old. Conclusions: The health of adult male in Shanghai is higher than that of female, and the proportion of HE loss of elderly is higher than young people. It is necessary to focus on the aging problem and strengthen the long-term care and health support system for the elderly. Improve the prevention and control of major diseases such as chronic diseases,which affect the quality of life expectancy seriously. Promotes the health level and quality of life in Shanghai.
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Affiliation(s)
- B Fang
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China Shanghai Medical College of Fudan University, Shanghai 200032, China
| | - C F Wang
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
| | - H T Yu
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
| | - L Chen
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
| | - R Z Cai
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
| | - N S Qian
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
| | - T Xia
- Shanghai Institute of Preventive Medicine/Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China
| | - F Wu
- Shanghai Medical College of Fudan University, Shanghai 200032, China
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Yu HT, Yang PS, Jang E, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip GYH. P4758Label adherence of non-vitamin K antagonist oral anticoagulants and clinical outcomes in patients with atrial fibrillation: A nationwide study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1134] [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: 11/13/2022] Open
Abstract
Abstract
Background
Dose adjustment of non-vitamin K antagonist oral anticoagulants (NOACs) is indicated in some patients with atrial fibrillation (AF), based on selected patient factors or concomitant medications.
Purpose
We assessed the frequency of label adherence of NOAC dosing among AF patients and the associations between off-label NOAC dosing and clinical outcomes in real-world clinical practice.
Methods
We evaluated 53,649 AF patients treated with a NOAC using Korean National Health Insurance Service database during the period from January 2013 to December 2016. NOAC doses were classified as either underdosed or overdosed, consistent with U.S. Food and Drug Administration labeling. Cox proportional hazards regression was performed to investigate the effectiveness and safety outcomes including stroke or systemic embolism, major bleeding, and all-cause mortality.
Results
Overall, 16,757 NOAC-treated patients (31.2%) were underdosed, 4,492 were overdosed (8.4%), and 32,400 (60.4%) were dosed appropriately according to drug labeling. Compared with patients with label adherence, those who were underdosed or overdosed were older (71±8 and 75±7 years of age vs. 70±9 years of age, respectively; p<0.001), more likely female (39% and 53% vs. 38%, respectively; p<0.001), and had higher CHA2DS2-VASc scores (4.6±1.7 and 5.3±1.7 vs. 4.5±1.8, respectively; p<0.001). NOAC overdosing was associated with increased risk for stroke or systemic embolism (5.76 vs. 4.03 events/100 patient-years, p<0.001), major bleeding (4.77 vs. 2.94 events/100 patient-years, p<0.001), and all-cause mortality (5.43 vs. 3.05 events/100 patient-years, p<0.001) compared with label-adherent use.
Figure 1
Conclusion
In routine clinical practice, a significant proportion (almost 2 in 5) of AF patients received NOAC doses inconsistent with drug labeling. NOAC overdosing is associated with increased risk for stroke or systemic embolism, major bleeding, and all-cause mortality in Asian patient with AF.
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Affiliation(s)
- H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
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Uhm JS, Kim J, Jin MN, Kim IS, Bae HJ, Cho MS, Yu HT, Kim TH, Joung B, Pak HN, Nam GB, Choi KJ, Kim YH, Lee MH. P1012Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0604] [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
Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs.
Methods
Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior valve surgery (total-VS group; age, 34.0 [24.5–45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of valve surgery (no-VS group; age, 40.5 [23.0–54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined.
Results
AP exhibited decremental conduction in four of nine patients in the total-VS group. The number of RFCA attempts was significantly higher in the total-VS group than in the no-VS group (10.0 [4.5–14.5] vs 2.0 [1.0–3.0]; p<0.001). In four patients who underwent mitral valve surgery, successful RFCA was achieved using the transaortic approach, coronary sinus approach, or bipolar ablation. In three patients who underwent tricuspid valve surgery, successful RFCA was achieved using the above-prosthetics or trans-prosthetics approach. In two patients, RFCA failed. The trans-prosthetics approach and bipolar ablation technique were effective. The transaortic and coronary sinus approaches were occasionally effective. The transseptal approach was ineffective. Based on the success rate and accessibility, we suggest a stepwise approach to RFCA of APs at the site of prior mitral or tricuspid valve surgery (Figure).
Stepwise approach to AP at valve surgery
Conclusions
Successful RFCA of APs at the site of prior valve surgery can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.
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Affiliation(s)
- J S Uhm
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - M N Jin
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - I S Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H J Bae
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M S Cho
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - G B Nam
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - K J Choi
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - Y H Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
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24
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Kim IS, Lee BK, Yang PS, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, Kim JY, Joung B. P5660Clinical impact of polycythemia on cardiovascular outcome from the general population: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0603] [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: 11/13/2022] Open
Abstract
Abstract
Background
Although adverse effect of anemia had been reported, effect of polycythemia on cardiovascular outcome from the general population had not been revealed yet.
Methods
We included 451,107 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort from 2009–2013. Medical records were screened from January 2002 to investigate the subjects' disease-free baseline period. They were followed until December 2013. We divided male and female subjects into four categories each based on hemoglobin level (normal, moderate to severe and mild anemia, polycythemia) to assess each outcome.
Results
During 1,735,964 person·years, 12,107 major adverse cardiovascular and cerebrovascular events (MACCE), 862 incident acute myocardial infarction (MI), 5,850 incident ischemic stroke, and 2,430 incident atrial fibrillation (AF) were observed. Compared to normal hemoglobin range group, polycythemia group showed higher MACCE (HR=1.23 [1.12–1.35] in male, HR=1.79 [1.20–2.67] in female, each p<0.001), incident MI (HR=1.37 [1.05–1.79] in male, HR=3.46 [1.06–14.00] in female, each p<0.001), incident ischemic stroke (HR=1.27 [1.10–1.46] in male, HR=1.72 [1.02–2.91] in female, each p<0.001), and incident AF (HR=1.46 [1.21–1.74] in male, HR=2.13 [1.03–4.77] in female, each p<0.001). Each outcome was linearly increased with the increase of hemoglobin among subjects with polycythemia (p<0.001), and with the decrease of hemoglobin among subjects with anemia (each p<0.001, U-shaped relationship). These relationship was more profound in obese female younger than 60-year-old.
Conclusion
Not only anemia but also polycythemia were significantly associated with higher rate of MACCE including death, incident MI, ischemic stroke, and AF among the general population.
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Affiliation(s)
- I.-S Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - B K Lee
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - P S Yang
- Bundang CHA General Hospital, Cardiology Division, Seongnam, Korea (Republic of)
| | - H T Yu
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J Y Kim
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
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Uhm JS, Jin MN, Kim IS, Bae HJ, Yu HT, Kim TH, Kim JY, Joung B, Pak HN, Lee MH. P1875Nonspecific intraventricular conduction delay is associated with future occurrence of atrial fibrillation in patients with structurally normal heart and sinus rhythm. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0624] [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
This study aimed to elucidate long-term prognosis of nonspecific intraventricular conduction delay (NIVCD) in patients with structurally normal heart.
Methods
We included 107,838 patients (age, 52.1±15.5 years; men, 46.8%) who underwent electrocardiography in outpatient clinics or medical checkup (model 1). NIVCD was defined as QRS duration ≥110 ms and incompatibility with bundle branch block. The patients with structurally normal heart and sinus rhythm were assigned to the NIVCD group and normal QRS group according to propensity score with matching variables of age, sex, hypertension, and diabetes (model 2), and additional PR interval (model 3). Baseline characteristics, electrocardiographic parameters, and clinical outcomes were compared in model 1, 2, and 3, respectively.
Results
In model 1, the frequencies of male and preexisting atrial fibrillation (AF) were significantly higher in the NIVCD group than in the normal QRS group. In model 2, sinus rate and PR interval were significantly slower and longer in the NIVCD group than in the normal QRS group. In model 3, cumulative incidence of AF was significantly higher in the NIVCD group than in the normal QRS group during follow-up of 8.8±2.9 years (Figure). NIVCD significantly increased risk of AF (hazard ratio, 2.571; 95% confidence interval, 1.074–6.156; p=0.034). NIVCD did not significantly increase risk of sick sinus syndrome, complete atrioventricular block, and heart failure.
Atrial fibrillation-free survival
Conclusions
NIVCD is associated with slow sinus rate and prolonged PR interval. NIVCD is an independent risk factor of AF in patients with structurally normal heart.
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Affiliation(s)
- J S Uhm
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M N Jin
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - I S Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H J Bae
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Sung JH, Pak HN, Lee MH, Lip GYH, Joung B. 208Effect of hypertension duration and systolic blood pressure on dementia in patients with atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0055] [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: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is associated with a higher risk for cognitive impairment and dementia, with or without a history of clinical stroke. There are a paucity of data on the associations of hypertension duration and blood pressure (BP) level with risk of dementia in patients with AF.
Purpose
We examined associations of duration of hypertension and secondly, systolic blood pressure (SBP) levels with incidence of dementia among patients with AF.
Methods
We enrolled a total 196,388 patients aged ≥50 years who were newly diagnosed as AF and undergoing hypertension treatment from the Korean National Health Insurance Service database (2005–2016). Starting from AF diagnosis, participants were followed up until the date of dementia, death, or December 31, 2016. To incorporate the effect of BP level and hypertension duration changes over time on dementia incidence, we constructed time-updated multivariable Cox models in which BP levels and hypertension duration were updated at each participants' regular national health examination visits (at 0–7 years of follow-up). Similarly, age, BP medications, and health-related behaviors were included as time-varying covariates in these models.
Results
During 1,016,744 person-years of follow-up, there were 32,692 dementia events. A cubic spline curve using continuous hypertension duration measures suggested a linear association between increase of hypertension duration and dementia risk. One-year increase of hypertension duration increased the adjusted risk of dementia with a hazard ratio (HR) of 1.17 [95% confidence interval (CI) 1.13–1.22]. In patients with hypertension duration <6 years, SBP of ≥140 mmHg was significantly associated with higher dementia risk, compared to SBP of <130 mmHg (in patients with hypertension duration <3 years: adjusted HR 1.08, 95% CI 1.01–1.16; and in those with 3 ≤ hypertension duration <6 years: adjusted HR 1.13, 95% CI 1.07–1.20), whereas no significant association between SBP and dementia risk in those with hypertension duration ≥6 years.
SBP and dementia in different duration
Conclusion
In patients with AF, the increase of hypertension duration was strongly associated with increased risk of dementia. Uncontrolled SBP was also associated with higher dementia risk. But, this effect of SBP might be attenuated in patients with longer hypertension duration. These findings suggest more emphasis needed on BP control in AF patients with earlier phase of hypertension (duration <6 years).
Acknowledgement/Funding
The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J H Sung
- CHA University, Seongnam, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
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Kim IS, Yang PS, Yu HT, Kim TH, Uhm JS, Pak HN, Lee MH, Kim JY, Joung B. P5710Clinical applications of machine learning for prediction of incident atrial fibrillation from the general population: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0651] [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: 11/15/2022] Open
Abstract
Abstract
Background
To evaluate the ability of machine learning algorithms to predict incident atrial fibrillation (AF) from the general population using health examination items.
Methods
We included 483,343 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort (NHIS-NSC). We trained deep neural network model (DNN) of a deep learning system and decision tree model (DT) of a machine learning system using clinical variables and health examination items (including age, sex, body mass index, history of heart failure, hypertension or diabetes, baseline creatinine, and smoking and alcohol intake habits) to predict incident AF using a training dataset of 341,771 subjects constructed from the NHIS-NSC database. The DNN and DT were validated using an independent test dataset of 141,572 remaining subjects. C-indices of DNN and DT for prediction of incident AF were compared with that of conventional logistic regression model.
Results
During 1,874,789 person·years (mean±standard-deviation age 47.7±14.4 years, 49.6% male), 3,282 subjects with incident AF were observed. In the validation dataset, 1,139 subjects with incident AF were observed. The c-indices of the DNN and DT for incident AF prediction were 0.828 [0.819–0.836] and 0.835 [0.825–0.844], and were significantly higher (p<0.01) than conventional logistic regression model (c-index=0.789 [0.784–0.794]).
Conclusions
Application of machine learning using simple clinical variables and health examination items was helpful to predict incident AF in the general population. Prospective study is warranted to construct an individualized precision medicine.
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Affiliation(s)
- I.-S Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - P S Yang
- Bundang CHA General Hospital, Cardiology Division, Seongnam, Korea (Republic of)
| | - H T Yu
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - J Y Kim
- Gangnam Severance Hospital, Cardiology Division, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University, Department of Internal Medicine, Cardiology Division, Seoul, Korea (Republic of)
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Sung JH, Pak HN, Lee MH, Lip GYH, Joung B. 64Risk of dementia in patients treated with non-vitamin k antagonist oral anticoagulant or warfarin for nonvalvular atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0010] [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: 11/13/2022] Open
Abstract
Abstract
Background
Evidence is accumulating that use of oral anticoagulants (OACs) decreases the risk of dementia in patients with atrial fibrillation (AF), but it is unclear if there is a difference between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in protecting against dementia.
Purpose
To compare the risk of dementia between patients taking either NOAC or warfarin using a nationwide cohort data covering the entire Korean population.
Methods
Using the Korean national health insurance service database, 68,984 new OAC users with non-valvular AF aged ≥50 years and no prior diagnosis of dementia were identified during the period of 2013–2016 (39,687 NOAC users and 29,297 warfarin users). Starting from OAC initiation, participants were followed up until the date of dementia, death, or December 31, 2016. We compared the rates of dementia in 1:1 propensity score-matched cohorts of NOAC (n=18,925) and warfarin users (n=18,925).
Results
During the 52,259 person-years of follow-up, there were 2,750 dementia events. Use of NOAC was associated with significant lower risk of dementia [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.69–0.81], compared with warfarin. The risk reduction was prominent for vascular dementia (HR 0.60, 95% CI 0.52–0.71), whereas there was no significant difference in the risk of Alzheimer dementia (HR 0.92, 95% CI 0.83–1.02). Restricting the analyses to patients with no stroke diagnosis prior to OAC initiation (primary prevention) showed no significant difference between NOAC and warfarin in any types of dementia, but in the subgroup with prior stroke (secondary prevention), NOAC significantly reduced the risk of overall (HR 0.70, 95% CI 0.63–0.78) and vascular dementia (HR 0.59, 95% CI 0.49–0.69).
Subgroup analysis according to stroke Hx Patient N Overall dementia Alzheimer dementia Vascular dementia HR (95% CI) P for interaction HR (95% CI) P for interaction HR (95% CI) P for interaction Total 37,850 0.75 (0.69–0.81) 0.92 (0.83–1.02) 0.60 (0.52–0.71) Without prior stroke 24,773 0.90 (0.78–1.05) 0.948 0.98 (0.83–1.15) 0.235 0.85 (0.56–1.28) 0.863 With prior stroke 13,077 0.70 (0.63–0.78) 0.90 (0.79–1.03) 0.59 (0.49–0.69) CI, confidence interval; HR, hazard ratio.
KM curves of dementia incidence
Conclusion
In this propensity-weighted nationwide cohort of non-valvular AF patients, NOAC was associated with reduced risk of dementia, compared with warfarin. This association was the most pronounced for vascular dementia in patients with prior stroke.
Acknowledgement/Funding
The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)
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Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - J H Sung
- CHA University, Seongnam, Korea (Republic of)
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea (Republic of)
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Joung B, Yang PS, Sung JH, Jang ES, Yu HT, Kim TH, Pak HN, Lee MH. P345Catheter ablation for atrial fibrillation is associated with lower incidence of stroke, major bleeding and death: data from Korean health registries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0179] [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: 11/13/2022] Open
Abstract
Abstract
Background
Compared with antiarrhythmic drug therapy, catheter ablation of AF reduces the number of AF episodes, prolongs the time in sinus rhythm, and improves quality of life. However, it is still unclear if catheter ablation for atrial fibrillation (AF) affects the prognosis or merely is a symptomatic treatment. Our objective was to compare long-term outcome regarding stroke, major bleeding and death in AF patients with and without ablation, and in relation to long-term exposure to anticoagulants.
Methods
We identified all 800,084 patients with a diagnosis of AF from 2006 to 2015 in the Korean national health insurance service database. During a 10-year period, 10,979 AF ablations were performed among 9,768 individuals. Propensity scores for the likelihood of AF ablation were obtained by logistic regression. Propensity score (PS) matching was used to construct two cohorts of equal size (n=9,768) with similar characteristics in 16 dimensions.
Results
Patients who had undergone catheter ablation were younger (57.2 vs. 65.6 years, P<0.001) and healthier (mean CHA2DS2-VASc scores 2.5±1.7 vs. 3.6±2.1, P<0.001) than other patients with AF. Mean follow-up was 5.5±3.1 years. After propensity score matching, in the ablated group, 472 patients suffered ischemic stroke/systemic embolism (SE) compared with 1,682 in the matched non-ablated (annual rates 2.92 vs. 1.10%, P<0.001). Major bleeding occurred in 439 and 1,219 patients in ablated and non-ablated (annual rates 2.07 vs. 1.01%, P<0.001). A total of 306 ablated and 1,439 non-ablated patients died (annual rates 2.31 vs. 0.69%, P<0.001). After multivariable adjustments, catheter ablation was associated with lower risk of ischemic stroke [hazard ratio (HR) 0.51, 95% confidence interval (CI) 0.38–0.67), lower risk of major bleeding (HR 0.65, 95% CI 0.57–0.75) and with lower mortality risk (HR 0.39, 95% CI 0.34–0.46). The reduction of stroke/SE and mortality was observed after AF ablation regardless thromboembolic risk. Major bleeding was reduced only among patients with CHA2DS2-VASc score ≥2 (HR 0.70, 95% CI 0.59–0.84).
Conclusion
We found a strong association between ablation and survival. Ablation may be associated with lower incidence of ischemic stroke and major bleeding in patients with AF. The reduction of stroke/SE and mortality was observed regardless thromboembolic risk after AF ablation. But the risk of major bleeding was reduced only in patients with high thromboembolic risk factors.
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Affiliation(s)
- B Joung
- Yonsei University, Seoul, Korea (Republic of)
| | - P S Yang
- CHA University, Cardiology, Seongnam, Korea (Republic of)
| | - J H Sung
- CHA University, Cardiology, Seongnam, Korea (Republic of)
| | - E S Jang
- Yonsei University, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University, Seoul, Korea (Republic of)
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30
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Yang PS, Sung JH, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B. P1027The risk of dementia and catheter ablation for atrial fibrillation: a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0618] [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
Atrial fibrillation (AF) is associated with all forms of dementia, including Alzheimer's disease. Catheter ablation of AF reduces the number of AF episodes, prolongs the time in sinus rhythm, and improves quality of life. However, it is still unclear if catheter ablation for AF improve cognitive function and prevent dementia. Our objective was to compare long-term outcome regarding dementia and type of dementia in AF patients with and without ablation, and about long-term exposure to anticoagulants.
Methods
We identified all 801,701 patients with a diagnosis of AF from 2006 to 2015 in the Korean national health insurance service database. During ten years, 10,979 AF ablations were performed among 9,768 individuals. Propensity scores for the likelihood of AF ablation were obtained by logistic regression. Propensity score (PS) matching was used to construct two cohorts of equal size (n=9,768) with similar characteristics in 16 dimensions.
Results
Patients who had undergone catheter ablation were younger (57.2 vs. 65.6 years, P<0.001) and healthier (mean CHA2DS2-VASc scores 2.5±1.7 vs. 3.6±2.1, p<0.001) than other patients with AF. Mean follow-up was 5.5±3.1 years. After propensity score matching, in the ablated group, 184 patients suffered dementia compared with 650 in the matched non-ablated (annual rates 0.42 vs. 1.08%, P<0.001). While a total of 134 ablated and 379 non-ablated patients had Alzheimer disease (annual rates 0.31 vs. 0.62%, p<0.001), 40 ablated and 191 non-ablated patients had vascular disease (annual rates 0.09 vs. 0.31%, p<0.001). After multivariable adjustments, catheter ablation was associated with lower risk of dementia (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.37–0.58), lower risk of Alzheimer disease (HR 0.61, 95% CI 0.46–0.79) and lower risk of vascular dementia (HR 0.27, 95% CI 0.19–0.38). Although the reduction of dementia and Alzheimer disease was observed after AF ablation regardless of thromboembolic risk, vascular dementia was reduced only among patients with CHA2DS2-VASc score ≥2 (HR 0.29, 95% CI 0.20–0.42).
The risk of dementia, RFCA vs. no-RFCA Type Propensity score matched ablation group vs. no ablation group adjusted HR (95% CI) P-value Overall dementia 0.46 (0.37–0.58) <0.001 Alzheimer dementia 0.61 (0.46–0.79) <0.001 Vascular dementia 0.27 (0.19–0.38) <0.001
Conclusion
Ablation may be associated with a lower incidence of dementia and both type of dementia in patients with AF. This finding appears more pronounced in patients with high thromboembolic risk factors.
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Affiliation(s)
- P S Yang
- CHA University, Seongnam, Korea (Republic of)
| | - J H Sung
- CHA University, Seongnam, Korea (Republic of)
| | - E Jang
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - H T Yu
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - T H Kim
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - J S Uhm
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - J Y Kim
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - H N Pak
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - M H Lee
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
| | - B Joung
- Yonsei University Health System, cardiology, Seoul, Korea (Republic of)
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31
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Li CJ, Lin CY, Wang ML, Hou CH, Chang CL, Wu HM, Yu HT, Huang HY, Wang HS, Soong YK. Clinical outcomes and the probability of having one euploidy embryo using aCGH and NGS at different maternal age in PGT-A cycle. Reprod Biomed Online 2019. [DOI: 10.1016/j.rbmo.2019.03.048] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip G. P4795Dabigatran in real-world asian patients with atrial fibrillation with low body weight: nationwide cohort data covering the entire korean population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4795] [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: 11/14/2022] Open
Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - P S Yang
- Bundang CHA General Hospital, Seongnam, Korea Republic of
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - G Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
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33
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Kim K, Yang P, Jang E, Yu HT, Kim T, Uhm J, Kim J, Pak H, Lee M, Joung B, Lip GYH. P5143The increased risk of stroke, bleeding and mortality with new-onset atrial fibrillation in critically ill patients: a nationwide cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5143] [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)
- K Kim
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - P Yang
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - E Jang
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - H T Yu
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - T Kim
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - J Uhm
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - J Kim
- Gangnam Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - H Pak
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - M Lee
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - B Joung
- Severance Hospital, Department of Cardiology, Seoul, Korea Republic of
| | - G Y H Lip
- University of Birmingham, Department of Cardiology, Birmingham, United Kingdom
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Yu HT, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. P1903How long the duration of atrial fibrillation is associated with poor rhythm outcome after catheter ablation? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1903] [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: 11/14/2022] Open
Affiliation(s)
- H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
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Kim BG, Uhm JS, Yang PS, Yu HT, Kim TH, Joung BY, Pak HN, Kim SY, Kim MS, Lee JG, Paik HC, Lee MH. P2884Clinical significance of postoperative atrial arrhythmias in patients who underwent lung transplantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2884] [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 G Kim
- Inje University, Division of Cardiology, Department of Internal Medicine, Seoul Paik Hospital, Seoul, Korea Republic of
| | - J.-S Uhm
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - P.-S Yang
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - H T Yu
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - T.-H Kim
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - B Y Joung
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - H.-N Pak
- Severance Hospital, Cardiology, Seoul, Korea Republic of
| | - S Y Kim
- Severance Hospital, Pulmonology, Seoul, Korea Republic of
| | - M S Kim
- Severance Hospital, Pulmonology, Seoul, Korea Republic of
| | - J G Lee
- Severance Hospital, Thoracic and Cardiovascular Surgery, Seoul, Korea Republic of
| | - H C Paik
- Severance Hospital, Thoracic and Cardiovascular Surgery, Seoul, Korea Republic of
| | - M.-H Lee
- Severance Hospital, Cardiology, Seoul, Korea Republic of
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Kim D, Yang PS, Kim TH, Jang E, Yu HT, Uhm JS, Kim JY, Pak HN, Lee MH, Joung B, Lip G. 2181What is the ideal blood pressure threshold and target for the management of high blood pressure in patients with atrial fibrillation? Nationwide cohort data covering the entire korean population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2181] [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: 11/14/2022] Open
Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - P S Yang
- Bundang CHA General Hospital, Seongnam, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - G Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
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Zhu ZN, Lu Y, Wu CF, Zou SR, Liu H, Wang CF, Luo BZ, Yu HT, Mi M, Wang GQ, Xiong LB, Wang WJ, Luo CY, Zang JJ, Wang ZY, Jia XD, Feng XG, Guo CY, Wu F. [General plan of Shanghai Diet and Health Survey]. Zhonghua Liu Xing Bing Xue Za Zhi 2018; 39:876-879. [PMID: 30060297 DOI: 10.3760/cma.j.issn.0254-6450.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Shanghai Diet and Health Survey (SDHS) was designed to prospectively access local residents' food consumption, energy and nutrient intake, related chemical contaminant exposure, and the seasonal change trend to explore the relationship of diet with health. Data from SDHS can be used as fundamental information and scientific evidences for the development of local nutrition and food safety policies.
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Affiliation(s)
- Z N Zhu
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China
| | - Y Lu
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China
| | - C F Wu
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China
| | - S R Zou
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - H Liu
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - C F Wang
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - B Z Luo
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - H T Yu
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China
| | - M Mi
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China
| | - G Q Wang
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - L B Xiong
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - W J Wang
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China
| | - C Y Luo
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - J J Zang
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - Z Y Wang
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - X D Jia
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - X G Feng
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - C Y Guo
- Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - F Wu
- Study Group of Shanghai Diet and Health Survey, Shanghai Institutes of Preventive Medicine, Shanghai 200336, China; Study Group of Shanghai Diet and Health Survey, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
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Yu HT, Ding XL, Li N, Zhang XY, Zeng XF, Wang S, Liu HB, Wang YM, Jia HM, Qiao SY. Dietary supplemented antimicrobial peptide microcin J25 improves the growth performance, apparent total tract digestibility, fecal microbiota, and intestinal barrier function of weaned pigs. J Anim Sci 2018; 95:5064-5076. [PMID: 29293710 DOI: 10.2527/jas2017.1494] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Microcin J25 (MccJ25) is an antimicrobial peptide produced by a fecal strain of Escherichia coli containing 21 AA. This study was performed primarily to evaluate the effects of MccJ25 as a potential substitute for antibiotics (AB) on growth performance, nutrient digestibility, fecal microbiota, and intestinal barrier function in weaned pigs. In the present study, 180 weaned pigs (7.98 ± 0.29 kg initial BW) were randomly assigned to 1 of 5 treatments, including a basal diet (CON) and CON supplemented with AB (20 mg/kg colistin sulfate; ABD) or 0.5, 1.0, and 2.0 mg/kg MccJ25. On d 0 to 14, dietary supplementation with MccJ25 and ABD had positive effects on ADG, ADFI, diarrhea incidence, and G:F ( < 0.05). Pigs fed the 2.0 mg/kg MccJ25 diet had greater ADG ( < 0.05) and marginally greater G:F ( < 0.10) compared with pigs fed the ABD diet. Compared with the CON diet, the 2.0 mg/kg MccJ25 diet sharply improved ( < 0.05) ADG and G:F and decreased ( < 0.05) diarrhea incidence (d 15 to 28 and d 0 to 28). Apparent digestibility of nutrients in pigs fed 1.0 and 2.0 mg/kg MccJ25 was improved ( < 0.05) compared with that of pigs fed CON and ABD. The serum cytokines IL-6 and IL-1β and tumor necrosis factor-α levels in pigs fed MccJ25 were greater than in pigs fed CON ( < 0.05). Additionally, the IL-10 concentration in pigs fed MccJ25 was sharply increased ( < 0.05) compared with that of pigs fed CON. Pigs fed 1.0 and 2.0 mg/kg MccJ25 diets had remarkably decreased lactate, diamine oxidase, and endotoxin concentrations and fecal numbers ( < 0.05) and improved fecal and numbers ( < 0.05). Compared with the ABD diet, the diet containing 2.0 mg/kg MccJ25 did not increase lactate, diamine oxidase, and endotoxin (d 14) concentrations ( < 0.05) or decrease the and (d 28) numbers ( < 0.05). The diets containing 1.0 and 2.0 mg/kg MccJ25 and ABD (d 28) improved lactate concentration and short-chain fatty acid concentrations, including acetate, propionate, and butyrate, in feces ( < 0.05). Moreover, the pigs fed 2.0 mg/kg MccJ25 had greater lactate, butyrate (d 14), and propionate concentrations than the pigs fed the ABD diet ( < 0.05). In conclusion, dietary supplemented MccJ25 effectively improved performance, attenuated diarrhea and systematic inflammation, enhanced intestinal barrier function, and improved fecal microbiota composition of weaned pigs. Therefore, MccJ25 could be a potential effective alternative to AB for weaned pigs.
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Li L, Yu HT, Wang XD, Zhou F, Wang F, Wang CF. [Analysis of birth defect rate trend of cleft lip and palate in Shanghai from 2007 to 2016]. Zhonghua Kou Qiang Yi Xue Za Zhi 2018; 53:301-306. [PMID: 29972986 DOI: 10.3760/cma.j.issn.1002-0098.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analysis the rate of birth defects of cleft lip and palate among newborns in Shanghai during 2007 and 2016 and describe its change trend, for the purpose of prevention, treatment and nursing of newborns with cleft lip and palate. Methods: Birth registration information in Shanghai during January 2007 and December 2016 were collected. Rate of birth defects, gender ratio and maternal age of newborns with cleft lip and palate were analyzed. Annual percent change was applied to analyze the trend. Results: The total birth defect rate of children with cleft lip and palate was 937/million in the past 10 years in Shanghai, showing an overall decreasing trend, decreased 28.20% compared to the data of 2007. The total birth defect rate of newborns with cleft lip decreased 40.86%. Overall decline rate of newborns with cleft lip and palate was 54.60%, but birth defect rate of newborns with the isolated cleft palate rised 14.34%. The number of female isolated cleft palate newborns were 1.6 times higher than those of male isolated cleft palate newborns, male newborns with cleft lip were 1.8 times higher than that of the female newborns with cleft lip. Male newborns with cleft lip and palate were 1.5 times as much as the female newborns with cleft lip and palate. Maternal age is mainly 25 to 29 years old, accounting for 42.01% of the total number of mothers, the according birth defect rate was lowest as 853/million. When maternal age is too low or too high, the risk of neonatal cleft lip and palate could increase. Birth defects of cleft lip and palate was up to 130.8/million when maternal age is less than 20, while birth defects of cleft lip and palate was up to 188.2/million when maternal age over 40 years old. Conclusions: In recent 10 years, the overall rate of birth defects of cleft lip and palate in Shanghai shows a decreasing trend, with cleft lip and palate declining obviously, but isolate cleft palate has an increasing tendency. Maternal age less than 20 years old or more than 40 years old will increase the risk of birth defects in newborns with cleft lip and palate.
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Affiliation(s)
- L Li
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology & National Clinical Research Center of Stomatology, Shanghai 200011, China
| | - H T Yu
- Department of Health Information, Shanghai Municipal Central for Disease Control and Prevention, Shanghai 200336, China
| | - X D Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology & National Clinical Research Center of Stomatology, Shanghai 200011, China
| | - F Zhou
- Department of Health Information, Shanghai Municipal Central for Disease Control and Prevention, Shanghai 200336, China
| | - F Wang
- Department of Shanghai Xuhui Central for Disease Control and Prevention, Shanghai 200237, China
| | - C F Wang
- Department of Health Information, Shanghai Municipal Central for Disease Control and Prevention, Shanghai 200336, China
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Sung JH, Pak HN, Lee MH, Joung B, Lip GYH. P1195Current and future incidence and prevalence of atrial fibrillation in korea. Europace 2018. [DOI: 10.1093/europace/euy015.677] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - P S Yang
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J H Sung
- Bundang CHA General Hospital, Seongnam, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - GYH Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
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Yu HT, Yang PS, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. 524Poor rhythm outcome of catheter ablation for early onset atrial fibrillation in women: mechanistic insight. Europace 2018. [DOI: 10.1093/europace/euy015.291] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - P S Yang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
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Kim D, Yang PS, Jang E, Yu HT, Kim TH, Uhm JS, Kim JY, Pak HN, Lee MH, Sung JH, Joung B, Lip GYH. P1196Increasing trends in hospital-care burden of atrial fibrillation in korea, 2006 through 2015: implications for healthcare planning. Europace 2018. [DOI: 10.1093/europace/euy015.678] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - P S Yang
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - J H Sung
- Bundang CHA General Hospital, Seongnam, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Department of Internal Medicine, Seoul, Korea Republic of
| | - GYH Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
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Yu HT, Shin DG, Shim J, Nam GB, Yoo WW, Lee JH, Kim TH, Uhm JS, Joung B, Lee MH, Kim YH, Pak HN. P358Efficacy and safety of unilateral groin puncture with single trans-septal catheter ablation for paroxysmal atrial fibrillation: A multi-center prospective randomized study. Europace 2018. [DOI: 10.1093/europace/euy015.169] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - D G Shin
- GangNeung Asan Hospital, GangNeung, Korea Republic of
| | - J Shim
- Korea University Cardiovascular Center, Seoul, Korea Republic of
| | - G B Nam
- Asan Medical Center, Seoul, Korea Republic of
| | - W W Yoo
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J H Lee
- Asan Medical Center, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - Y H Kim
- Korea University Cardiovascular Center, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
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Yu HT, Yang PS, Hwang J, Ryu S, Jang E, Kim TH, Uhm JS, Sung JH, Kim JY, Pak HN, Lee MH, Joung B, Lip GYH. P378Influence of reimbursement of non-vitamin K antagonist oral anticoagulants on overall prescription rates of oral anticoagulation: A nationwide study using the Korean National Health Insurance Data. Europace 2018. [DOI: 10.1093/europace/euy015.189] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H T Yu
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - P S Yang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J Hwang
- Daegu University, Department of Computer Science and Statistics, Gyeongsan, Korea Republic of
| | - S Ryu
- Daegu University, Department of Computer Science and Statistics, Gyeongsan, Korea Republic of
| | - E Jang
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - J H Sung
- CHA University, Seongnam, Korea Republic of
| | - J Y Kim
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - B Joung
- Yonsei University College of Medicine, Division of Cardiology, Seoul, Korea Republic of
| | - GYH Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
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Lim YM, Yang PS, Jang ES, Yu HT, Kim TH, Uhm JS, Sung JH, Kim JY, Pak HN, Lee MH, Joung B, Lip GYH. 1009Body mass index variability and long-term risk of new-onset atrial fibrillation in the general population: a korean nationwide cohort study. Europace 2018. [DOI: 10.1093/europace/euy015.558] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y M Lim
- SAM medical center, Anyang, Korea Republic of
| | - P S Yang
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - E S Jang
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - H T Yu
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - T H Kim
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - J H Sung
- CHA University, Seongnam, Korea Republic of
| | - J Y Kim
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - H N Pak
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - M H Lee
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - B Joung
- Yonsei Cardiovascular Center, Seoul, Korea Republic of
| | - GYH Lip
- University of Birmingham, Birmingham, United Kingdom
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Yu HT, Lee CH, Huang SC, Yu SF. Unsuspected human immunodeficiency virus infection presenting as immunoglobulin G4-related lymphadenopathy: a case report. Int J STD AIDS 2017; 29:92-95. [PMID: 28768471 DOI: 10.1177/0956462417722479] [Citation(s) in RCA: 4] [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] [Indexed: 12/24/2022]
Abstract
Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated condition characterized by infiltration of the involved organs by IgG4-bearing plasma cells. The prevalence of autoimmune diseases, associated with or occurring in patients with human immunodeficiency virus (HIV) infection, has been increasing. We describe a 58-year-old man with an undiagnosed HIV infection, which presented as chronic cervical lymphadenopathy with an elevated serum IgG4 and a very high IgE. Histologically, lymph nodes showed expanded sinusoids and burnt-out germinal centers with increased plasmacytic infiltration and collagen fiber deposition. The absolute number of IgG4+ plasma cells and the IgG4+/IgG+ plasma cell ratio was increased. The lymph nodes were enlarged and clinically the patient improved after steroid treatment. Nine months later, he was diagnosed with acquired immune deficiency syndrome, following presentation with a cavitary left lung lesion. Immunohistochemical studies on the previously resected lymph node revealed complete absence of CD4+ T-lymphocytes and increased CD8+ T-lymphocytes. The pathologic findings met the criteria of both HIV infection and IgG4-related lymphadenopathy. Our case demonstrates that further investigations for underlying HIV infection in a case of IgG4-RD are critical, especially when extremely elevated IgE is concomitantly present.
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Affiliation(s)
- Hsing-Tse Yu
- 1 Department of Obstetrics and Gynecology, 117544 Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chen-Hsiang Lee
- 2 Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Chen Huang
- 3 Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shan-Fu Yu
- 4 Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abstract
The aim of this study was to observe the proliferation of, and cell-cycle changes in, the human lens epithelial cell line HLEC after Toll-like receptor 4 (TLR4) gene silencing. HLEC cells were transfected with four TLR4-short hairpin RNA (shRNA) lentiviral vectors or the control lentivirus (pGCL-GFP-shRP-1, -2, -3, -4, NC). TLR4 silencing was verified in these cells 96 h post-transfection using real-time polymerase chain reaction and western blot. We also observed the change in number of pGCL-GFP-shRP-4-transfected HLEC cells with silenced TLR4 (multiplicity of infection = 10). Cell proliferation was analyzed 48 h after transfection by a standard Cell Counting Kit-8 (CCK-8) assay, and the cell cycle changes were detected by flow cytometry. The number of cells with silenced TLR4 decreased with time. The decrease in TLR4 expression led to decelerated cell proliferation. Cells with silenced TLR4 (for 48 h) were arrested in the G1 phase; that is, the cell cycle was prolonged and cell division was decelerated. Lentivirus-mediated RNA interference effectively silenced TLR4 expression in HLEC cells, which decelerated their proliferation rate and extended the cell cycle.
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Affiliation(s)
- H T Yu
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China.,Department of Ophthalmology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - P R Lu
- Department of Ophthalmology, First Affiliated Hospital of Soochow University, Soochow, Jiangsu, China
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Wang CJ, Chin HY, Yu HT, Ho SY. Laparoscopic management of intraligamentary fibroid originating from the round ligament. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.12.003] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Chen CK, Wu D, Yu HT, Lin CY, Wang ML, Yeh HY, Huang HY, Wang HS, Soong YK, Lee CL. Preimplantation genetic diagnosis by fluorescence in situ hybridization of reciprocal and Robertsonian translocations. Taiwan J Obstet Gynecol 2015; 53:48-52. [PMID: 24767646 DOI: 10.1016/j.tjog.2012.04.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2012] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The presence of reciprocal and Robertsonian chromosomal rearrangement is often related to recurrent miscarriage. Using preimplantation genetic diagnosis, the abortion rate can be decreased. Cases treated at our center were reviewed. MATERIALS AND METHODS A retrospective analysis for either Robertsonian or reciprocal translocations was performed on all completed cycles of preimplantation genetic diagnosis at our center since the first reported case in 2004 until the end of 2010. Day 3 embryo biopsies were carried out, and the biopsied cell was checked by fluorescent in situ hybridization using relevant informative probes. Embryos with a normal or balanced translocation karyotype were transferred on Day 4. RESULTS Thirty-eight preimplantation genetic diagnosis cycles involving 17 couples were completed. A total of 450 (82.6%) of the total oocytes were MII oocytes, and 158 (60.0%) of the two-pronuclei embryos were biopsied. In 41.4% of the fluorescent in situ hybridization analyses, the results were either normal or balanced. Embryos were transferred back after 21 cycles. Three babies were born from Robertsonian translocation carriers and another two from reciprocal translocation carriers. The miscarriage rate was 0%. Among the reciprocal translocation group, the live delivery rate was 8.3% per ovum pick-up cycle and 18.2% per embryo transfer cycle. Among the Robertsonian translocation group, the live delivery rate was 14.3% per ovum pick-up cycle and 20.0% per embryo transfer cycle. CONCLUSION There is a trend whereby the outcome for Robertsonian translocation group carriers is better than that for reciprocal translocation group carriers. Aneuploidy screening may possibly be added in order to improve the outcome, especially for individuals with an advanced maternal age. The emergence of an array-based technology should help improve this type of analysis.
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Affiliation(s)
- Chun-Kai Chen
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Dennis Wu
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Chieh-Yu Lin
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Mei-Li Wang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Hsin-Yi Yeh
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Hsin-Shin Wang
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Yung-Kuei Soong
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital and Medical College, TaoYuan, Taiwan.
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Yu HT, Huang HY, Lee CL, Soong YK, Wang CJ. Side of ovarian endometrioma does not affect the outcome of in vitro fertilization/intracytoplasmic sperm injection in infertile women after laparoscopic cystectomy. J Obstet Gynaecol Res 2014; 41:717-21. [PMID: 25511776 DOI: 10.1111/jog.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/17/2014] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to assess the impact of the laterality of ovarian endometrioma on pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in infertile patients undergoing laparoscopic cystectomy. MATERIAL AND METHODS A total of 103 IVF/ICSI cycles in patients who had undergone laparoscopic cystectomy for unilateral endometriomas were reviewed retrospectively from January 2005 through December 2009. There were 41 cycles where laparoscopic cystectomy had been carried out for right endometriomas and 62 cycles after left-side surgery. Primary outcome measures were ovarian reserve and ovarian response. Secondary outcome measures were the implantation rate, clinical pregnancy rate, and live birth rate. RESULTS There was no difference among the two groups with regard to antral follicle count, number of oocytes retrieved, the dosage of gonadotrophin, estradiol level on human chorionic gonadotrophin day, good-quality embryos for transfer, and fertilization rate. The clinical pregnancy rate and live birth rate were similar between the two groups; however, the implantation rate was significantly lower in the cycles with left-side ovarian endometrioma compared to the right counterpart (10.1% vs 20.2%; P = 0.015). CONCLUSION There were no associations among the laterality of ovarian endometrioma, ovarian reserve and ovarian response in IVF/ICSI cycles. However, left ovarian endometrioma after laparoscopic cystectomy may impair implantation rate as compared to right ovarian endometrioma.
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Affiliation(s)
- Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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