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Steegh FMEG, Keijbeck AA, de Hoogt PA, Rademakers T, Houben AJHM, Reesink KD, Stehouwer CDA, Daemen MJAP, Peutz-Kootstra CJ. Capillary rarefaction: a missing link in renal and cardiovascular disease? Angiogenesis 2024; 27:23-35. [PMID: 37326760 DOI: 10.1007/s10456-023-09883-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
Patients with chronic kidney disease (CKD) have an increased risk for cardiovascular morbidity and mortality. Capillary rarefaction may be both one of the causes as well as a consequence of CKD and cardiovascular disease. We reviewed the published literature on human biopsy studies and conclude that renal capillary rarefaction occurs independently of the cause of renal function decline. Moreover, glomerular hypertrophy may be an early sign of generalized endothelial dysfunction, while peritubular capillary loss occurs in advanced renal disease. Recent studies with non-invasive measurements show that capillary rarefaction is detected systemically (e.g., in the skin) in individuals with albuminuria, as sign of early CKD and/or generalized endothelial dysfunction. Decreased capillary density is found in omental fat, muscle and heart biopsies of patients with advanced CKD as well as in skin, fat, muscle, brain and heart biopsies of individuals with cardiovascular risk factors. No biopsy studies have yet been performed on capillary rarefaction in individuals with early CKD. At present it is unknown whether individuals with CKD and cardiovascular disease merely share the same risk factors for capillary rarefaction, or whether there is a causal relationship between rarefaction in renal and systemic capillaries. Further studies on renal and systemic capillary rarefaction, including their temporal relationship and underlying mechanisms are needed. This review stresses the importance of preserving and maintaining capillary integrity and homeostasis in the prevention and management of renal and cardiovascular disease.
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Affiliation(s)
- Floor M E G Steegh
- Department of Pathology, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Anke A Keijbeck
- Department of Pathology, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Patrick A de Hoogt
- Surgery, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Timo Rademakers
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Alfons J H M Houben
- Internal Medicine, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Koen D Reesink
- Biomedical Engineering, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Internal Medicine, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mat J A P Daemen
- Department of Pathology, UMC Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Carine J Peutz-Kootstra
- Department of Pathology, Maastricht University Medical Centre+, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
- Department of Pathology, Gelre Ziekenhuizen, Apeldoorn, The Netherlands.
- , Porthoslaan 39, 6213 CN, Maastricht, The Netherlands.
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Chih S, Tavoosi A, Nair V, Chong AY, Džavík V, Aleksova N, So DY, deKemp RA, Amara I, Wells GA, Bernick J, Overgaard CB, Celiker-Guler E, Mielniczuk LM, Stadnick E, McGuinty C, Ross HJ, Beanlands RSB. Cardiac PET Myocardial Blood Flow Quantification Assessment of Early Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2023:S1936-878X(23)00466-7. [PMID: 37999656 DOI: 10.1016/j.jcmg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Positron emission tomography (PET) has demonstrated utility for diagnostic and prognostic assessment of cardiac allograft vasculopathy (CAV) but has not been evaluated in the first year after transplant. OBJECTIVES The authors sought to evaluate CAV at 1 year by PET myocardial blood flow (MBF) quantification. METHODS Adults at 2 institutions enrolled between January 2018 and March 2021 underwent prospective 3-month (baseline) and 12-month (follow-up) post-transplant PET, endomyocardial biopsy, and intravascular ultrasound examination. Epicardial CAV was assessed by intravascular ultrasound percent intimal volume (PIV) and microvascular CAV by endomyocardial biopsy. RESULTS A total of 136 PET studies from 74 patients were analyzed. At 12 months, median PIV increased 5.6% (95% CI: 3.6%-7.1%) with no change in microvascular CAV incidence (baseline: 31% vs follow-up: 38%; P = 0.406) and persistent microvascular disease in 13% of patients. Median capillary density increased 30 capillaries/mm2 (95% CI: -6 to 79 capillaries/mm2). PET myocardial flow reserve (2.5 ± 0.7 vs 2.9 ± 0.8; P = 0.001) and stress MBF (2.7 ± 0.6 vs 2.9 ± 0.6; P = 0.008) increased, and coronary vascular resistance (CVR) (49 ± 13 vs 47 ± 11; P = 0.214) was unchanged. At 12 months, PET and PIV had modest correlation (stress MBF: r = -0.35; CVR: r = 0.33), with lower stress MBF and higher CVR across increasing PIV tertiles (all P < 0.05). Receiver-operating characteristic curves for CAV defined by upper-tertile PIV showed areas under the curve of 0.74 for stress MBF and 0.73 for CVR. CONCLUSIONS The 1-year post-transplant PET MBF is associated with epicardial CAV, supporting potential use for early noninvasive CAV assessment. (Early Post Transplant Cardiac Allograft Vasculopahty [ECAV]; NCT03217786).
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Affiliation(s)
- Sharon Chih
- Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Anahita Tavoosi
- Cardiac Imaging, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Aun Yeong Chong
- Interventional Cardiology, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Vladimír Džavík
- Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Natasha Aleksova
- Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital Research Institute, Toronto, Ontario, Canada
| | - Derek Y So
- Interventional Cardiology, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert A deKemp
- Cardiac Imaging, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ines Amara
- BEaTS Research, Division of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan Bernick
- Cardiovascular Research Methods Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christopher B Overgaard
- Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Emel Celiker-Guler
- Cardiac Imaging, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Lisa M Mielniczuk
- Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ellamae Stadnick
- Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Caroline McGuinty
- Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research at the Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Rob S B Beanlands
- Cardiac Imaging, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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3
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Ahn JM, Zimmermann FM, Arora S, Solberg OG, Angerås O, Rolid K, Rafique M, Aaberge L, Karason K, Okada K, Luikart H, Khush KK, Honda Y, Pijls NHJ, Lee SE, Kim JJ, Park SJ, Gullestad L, Fearon WF. Prognostic value of comprehensive intracoronary physiology assessment early after heart transplantation. Eur Heart J 2021; 42:4918-4929. [PMID: 34665224 PMCID: PMC8691805 DOI: 10.1093/eurheartj/ehab568] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS We evaluated the long-term prognostic value of invasively assessing coronary physiology after heart transplantation in a large multicentre registry. METHODS AND RESULTS Comprehensive intracoronary physiology assessment measuring fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and coronary flow reserve (CFR) was performed in 254 patients at baseline (a median of 7.2 weeks) and in 240 patients at 1 year after transplantation (199 patients had both baseline and 1-year measurement). Patients were classified into those with normal physiology, reduced FFR (FFR ≤ 0.80), and microvascular dysfunction (either IMR ≥ 25 or CFR ≤ 2.0 with FFR > 0.80). The primary outcome was the composite of death or re-transplantation at 10 years. At baseline, 5.5% had reduced FFR; 36.6% had microvascular dysfunction. Baseline reduced FFR [adjusted hazard ratio (aHR) 2.33, 95% confidence interval (CI) 0.88-6.15; P = 0.088] and microvascular dysfunction (aHR 0.88, 95% CI 0.44-1.79; P = 0.73) were not predictors of death and re-transplantation at 10 years. At 1 year, 5.0% had reduced FFR; 23.8% had microvascular dysfunction. One-year reduced FFR (aHR 2.98, 95% CI 1.13-7.87; P = 0.028) and microvascular dysfunction (aHR 2.33, 95% CI 1.19-4.59; P = 0.015) were associated with significantly increased risk of death or re-transplantation at 10 years. Invasive measures of coronary physiology improved the prognostic performance of clinical variables (χ2 improvement: 7.41, P = 0.006). However, intravascular ultrasound-derived changes in maximal intimal thickness were not predictive of outcomes. CONCLUSION Abnormal coronary physiology 1 year after heart transplantation was common and was a significant predictor of death or re-transplantation at 10 years.
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Affiliation(s)
- Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA
| | - Frederik M Zimmermann
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA
- Catharina Hospital, Eindhoven, the Netherlands
| | - Satish Arora
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Ole-Geir Solberg
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Katrine Rolid
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Muzammil Rafique
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA
| | | | - Sang Eun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
- Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA
- Division of Cardiovascular Medicine, VA Palo Alto Health Care System, CA, USA
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4
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Lee JM, Choi KH, Choi JO, Shin D, Park Y, Kim J, Lee SH, Kim D, Yang JH, Cho YH, Sung K, Choi JY, Park M, Kim JS, Park TK, Song YB, Hahn JY, Choi SH, Gwon HC, Oh JK, Jeon ES. Coronary Microcirculatory Dysfunction and Acute Cellular Rejection After Heart Transplantation. Circulation 2021; 144:1459-1472. [PMID: 34474597 DOI: 10.1161/circulationaha.121.056158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute cellular rejection is a major determinant of mortality and retransplantation after heart transplantation. We sought to evaluate the prognostic implications of coronary microcirculatory dysfunction assessed by index of microcirculatory resistance (IMR) for the risk of acute cellular rejection after heart transplantation. METHODS The present study prospectively enrolled 154 heart transplant recipients who underwent scheduled coronary angiography and invasive coronary physiological assessment 1 month after transplantation. IMR is microcirculatory resistance under maximal hyperemia. By measuring hyperemic mean transit time using 3 injections (4 mL each) of room-temperature saline under maximal hyperemia, IMR was calculated as hyperemic distal coronary pressure×hyperemic mean transit time. The primary end point was biopsy-proven acute cellular rejection of grade ≥2R during 2 years of follow-up after transplantation and was compared by using multivariable Cox proportional hazards regression according to IMR. The incremental prognostic value of IMR, in addition to the model with clinical factors, was evaluated by comparison of C-index, net reclassification index, and integrated discrimination index. RESULTS The mean age of recipients was 51.2±13.1 years (81.2% male), and the cumulative incidence of acute cellular rejection was 19.0% at 2 years. Patients with acute cellular rejection had significantly higher IMR values at 1 month than those without acute cellular rejection (23.1±8.6 versus 16.8±11.1, P=0.002). IMR was significantly associated with the risk of acute cellular rejection (per 5-U increase: adjusted hazard ratio, 1.18 [95% CI, 1.04-1.34], P=0.011) and the optimal cutoff value of IMR to predict acute cellular rejection was 15. Patients with IMR≥15 showed significantly higher risk of acute cellular rejection than those with IMR<15 (34.4% versus 3.8%; adjusted hazard ratio, 15.3 [95% CI 3.6-65.7], P<0.001). Addition of IMR to clinical variables showed significantly higher discriminant and reclassification ability for risk of acute cellular rejection (C-index 0.87 versus 0.74, P<0.001; net reclassification index 1.05, P<0.001; integrated discrimination index 0.20, P<0.001). CONCLUSIONS Coronary microcirculatory dysfunction assessed by IMR measured early after heart transplantation showed significant association with the risk of acute cellular rejection. In addition to surveillance endomyocardial biopsy, early stratification using IMR could be a clinically useful tool to identify patients at higher risk of future acute cellular rejection after heart transplantation. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02798731.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (D.S.)
| | - Yoonjee Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Juwon Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea (S.H.L.)
| | - Darae Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medicine and Critical Care Medicine (J.H.Y.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery (Y.H.C., K.S., J.Y.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery (Y.H.C., K.S., J.Y.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeon Choi
- Department of Thoracic and Cardiovascular Surgery (Y.H.C., K.S., J.Y.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Meesoon Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Department of Pathology and Translational Genomics (J.-S.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae K Oh
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute (J.M.L., K.H.C., J.-O.C., Y.P., J.K., S.H.L., D.K., J.H.Y., M.P., T.K.P., Y.B.S., J.-Y.H., S.-H.C., H.-C.G., J.K.O., E.-S.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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