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Moon I, Park SY, Kim D, Park M, Park S, Kwon SS, Kong MG, Park HW, Choi HO, Suh J, Cho YH, Lee NH, Seo HS. Incidence of atrial fibrillation in patients with renal infarction: A retrospective cohort analysis of the Korean national health insurance registry. Int J Cardiol 2024; 407:132075. [PMID: 38643801 DOI: 10.1016/j.ijcard.2024.132075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Regarding the pathophysiology of renal infarction (RI), cardioembolic causes could have large proportion. However, there are notable variations in prevalence of atrial fibrillation (AF) among patients with RI across different studies, ranging from 17 to 65%. The primary objective of this study is to analyze the incidence of AF in patients with RI. METHODS This nationwide retrospective cohort study enrolled 5200 patients with RI from the Korean National Institute of Health Services database spanning the years 2013 to 2019. The study accessed the AF incidence rate within 12 months in patients without a prior history of AF. Events occurring within 3 months of RI diagnosis were excluded to mitigate cases diagnosed during the initial screening or those with AF diagnoses that were potentially overlooked in the past. RESULTS AF occurred in 19.1% of patients with RI over the entire period (median: 2.5 years, interquartile range 1.04-4.25 years). The majority of AF cases (16.1%) occured within the first year, resulting in an overall incidence rate of 7.0 per 100 person-years. Patients with newly developed AF were, on average, older than those who did not develop AF (64.1 vs. 57.3 years, P < 0.001). The independent predictors of AF were identified as age, male sex, higher body mass index, current smoking, ischemic heart disease, and heart failure. CONCLUSIONS Physicians should consider the implementation of active rhythm monitoring for patients with RI to identify potential occurrence of subclinical AF, even if not initially diagnosed during the initial screening after RI diagnosis.
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Affiliation(s)
- Inki Moon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Su Yeong Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Dongon Kim
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Minae Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Sojeong Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Seong Soon Kwon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Min Gyu Kong
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hyun Woo Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Nae Hee Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
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Kong MG, Suh J, Lee B, Park HW, Park SY, Moon I, Choi HO, Seo HS, Cho YH, Lee NH, Jang HJ, Kim TH, Kwon SW, Park SD, Oh PC, Moon J, Lee K, Kang WC. Hemo-metabolic impairment in patients with ST-segment elevation myocardial infarction: Data from the INTERSTELLAR registry. Cardiol J 2023:VM/OJS/J/93926. [PMID: 37964646 DOI: 10.5603/cj.93926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Not only hemo-dynamic (HD) factors but also hemo-metabolic (HM) risk factors reflecting multi-organ injuries are considered as important prognostic factors in ST-segment elevation myocardial infarction (STEMI). However, studies regarding HM risk factors in STEMI patients are currently limited. METHOD Under analysis were 1,524 patients with STEMI who underwent primary percutaneous coronary intervention in the INTERSTELLAR registry. Patients were divided into HM (≥ 2 risk factors) and non-HM impairment groups. The primary outcome was in-hospital all-cause mortality, and the secondary outcome was 1-year all-cause mortality. RESULTS Of 1,524 patients, 214 (14.0%) and 1,310 (86.0%) patients were in the HM and non-HM impairment groups, respectively. Patients with HM impairment had a higher incidence of in-hospital mortality than those without (24.3% vs. 2.7%, p < 0.001). After adjusting for confounders, HM impairment was independently associated with in-hospital mortality (inverse probability of treatment weighting [IPTW]-adjusted odds ratio: 1.81, 95% confidence interval: 1.08-3.14). In the third door-to-balloon (DTB) time tertile (≥ 82 min), HM impairment was strongly associated with in-hospital mortality. In the first DTB time tertile ( < 62 min), indicating relatively rapid revascularization, HM impairment was consistently associated with increased in-hospital mortality. CONCLUSIONS Hemo-metabolic impairment is significantly associated with increased risk of in-hospital and 1-year mortality in patients with STEMI. It remains a significant prognostic factor, regardless of DTB time.
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Affiliation(s)
- Min Gyu Kong
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jon Suh
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
| | - Bora Lee
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Hyun Woo Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Su Yeong Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Inki Moon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hye-Sun Seo
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Nae-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ho-Jun Jang
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Hanil General Hospital, Seoul, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Kim DE, Moon I, Park S, Park M, Park S, Kwon SS, Kong MG, Park HW, Choi HO, Seo HS, Cho YH, Lee NH, Suh J. Temporal Trend of the Incidence and Characteristics of Renal Infarction: Korean Nationwide Population Study. J Korean Med Sci 2023; 38:e239. [PMID: 37550807 PMCID: PMC10412037 DOI: 10.3346/jkms.2023.38.e239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/04/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Large-scale studies about epidemiologic characteristics of renal infarction (RI) are few. In this study, we aimed to analyze the incidence and prevalence of RI with comorbidities in the South Korean population. METHODS We investigated the medical history of the entire South Korean adult population between 2013 and 2019 using the National Health Insurance Service database (n = 51,849,591 in 2019). Diagnosis of RI comorbidities were confirmed with International Classification of Disease, Tenth Revision, Clinical Modification codes. Epidemiologic characteristics, distribution of comorbidities according to etiologic mechanisms, and trend of antithrombotic agents were estimated. RESULTS During the 7-years, 10,496 patients were newly diagnosed with RI. The incidence rate increased from 2.68 to 3.06 per 100,000 person-years during the study period. The incidence rate of RI increased with age peaking in the 70s with 1.41 times male predominance. The most common comorbidity was hypertension, followed by dyslipidemia and diabetes mellitus. Regarding etiologic risk factor distribution, high embolic risk group, renovascular disease group, and hypercoagulable state group accounted for 16.6%, 29.1%, and 13.7% on average, respectively. For the antithrombotic treatment of RI, the prescription of antiplatelet agent gradually decreased from 17.0% to 13.0% while that of anticoagulation agent was maintained around 35%. The proportion of non-vitamin K antagonist oral anticoagulants remarkably increased from only 1.4% to 17.6%. CONCLUSION Considering the progressively increasing incidence of RI and high prevalence of coexisting risk factors, constant efforts to raise awareness of the disease are necessary. The current epidemiologic investigation of RI would be the stepping-stone to establishing future studies about clinical outcomes and optimal treatment strategies.
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Affiliation(s)
- Dong-Eon Kim
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Inki Moon
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Suyeong Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Minae Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Sojeong Park
- Department of Data Science, Hanmi Pharm. Co., Ltd., Seoul, Korea
| | - Seong Soon Kwon
- Division of Cardiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Min Gyu Kong
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Woo Park
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hye-Sun Seo
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yoon Haeng Cho
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Nae Hee Lee
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jon Suh
- Division of Cardiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
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Cho MS, Choi HO, Hwang KW, Kim J, Nam GB, Choi KJ. Clinical benefits and risks of anticoagulation therapy according to the degree of chronic kidney disease in patients with atrial fibrillation. BMC Cardiovasc Disord 2023; 23:209. [PMID: 37098477 PMCID: PMC10131393 DOI: 10.1186/s12872-023-03236-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/11/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The clinical benefits and risks of anticoagulation therapy in patients with chronic kidney disease (CKD) are still inconclusive. We describe the outcomes of patients with atrial fibrillation (AF) after anticoagulation therapy according to differences in creatinine clearance (CrCl). We also aimed to determine the patients who could benefit from anticoagulation therapy. METHODS This is a retrospective observational review of patients with AF who were managed at Asan Medical Center (Seoul, Korea) between January 1, 2006, and December 31, 2018. Patients were categorized into groups according to their baseline CrCl by Cockcroft-Gault equation and their outcomes were evaluated (CKD 1, ≥ 90 mL/min; CKD2, 60-89 mL/min; CKD3, 30-59 mL/min; CKD4, 15-29 mL/min; CKD 5, < 15 mL/min). The primary outcome was NACE (net adverse clinical events), defined as a composite of all-cause mortality, thromboembolic events, and major bleeding. RESULTS We identified 12,714 consecutive patients with AF (mean 64.6 ± 11.9 years, 65.3% male, mean CHA2DS2-VASc score 2.4 ± 1.6 points) between 2006 and 2017. In patients receiving anticoagulation therapy (n = 4447, 35.0%), warfarin (N = 3768, 84.7%) was used more frequently than NOACs (N = 673, 15.3%). There was a higher 3-year rate of NACE with renal function deterioration (14.8%, 18.6%, 30.3%, 44.0%, and 48.8% for CKD stages 1-5, respectively).The clinical benefit of anticoagulation therapy was most prominent in patients with CKD 1 (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.37-0.67), 2 (HR 0.64 CI 0.54-0.76), and 3 (HR 0.64 CI 0.54-0.76), but not in CKD 4 (HR 0.86, CI 0.57-1.28) and 5 (HR 0.81, CI 0.47-1.40). Among patients with CKD, the benefit of anticoagulation therapy was only evident in those with a high risk of embolism (CHA2DS2-VASc score ≥ 4, HR 0.25, CI 0.08-0.80). CONCLUSION Advanced CKD is associated with a higher risk of NACE. The clinical benefit of anticoagulation therapy was reduced with the increasing CKD stage.
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Affiliation(s)
- Min Soo Cho
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 170, Jomaru-ro, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea.
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Republic of Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hwang KW, Choi JH, Lee SY, Lee SH, Chon MK, Lee J, Kim H, Kim YG, Choi HO, Kim JS, Park YH, Kim JH, Chun KJ, Nam GB, Choi KJ. Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2023; 23:182. [PMID: 37016321 PMCID: PMC10074893 DOI: 10.1186/s12872-023-03212-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/29/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Evidence and guidelines for Non-vitamin K antagonist oral anticoagulants (NOACs) use when prescribing concurrent rifampin for tuberculosis treatment in patients with non-valvular atrial fibrillation (NVAF) are limited. METHODS Using the Korean National Health Insurance Service database from January 2009 to December 2018, we performed a population-based retrospective cohort study to assess the net adverse clinical events (NACE), a composite of ischemic stroke or systemic embolism and major bleeding, of NOACs compared with warfarin among NVAF patients taking concurrent rifampin administration for tuberculosis treatment. After a propensity matching score (PSM) analysis, Cox proportional hazards regression was performed in matched cohorts to investigate the clinical outcomes. RESULTS Of the 735 consecutive patients selected, 465 (63.3%) received warfarin and 270 (36.7%) received NOACs. Among 254 pairs of patients after PSM, the crude incidence rate of NACE was 25.6 in NOAC group and 32.8 per 100 person-years in warfarin group. There was no significant difference between NOAC and warfarin use in NACE (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.48-1.14; P = 0.172). Major bleeding was the main driver of NACE, and NOAC use was associated with a statistically significantly lower risk of major bleeding than that with warfarin use (HR, 0.63; 95% CI, 0.40-1.00; P = 0.0499). CONCLUSIONS In our population-based study, there was no statically significant difference in the occurrence of NACE between NOAC and warfarin use. NOAC use may be associated with a lower risk of major bleeding than that with warfarin use.
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Affiliation(s)
- Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea.
| | - Jin Hee Choi
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Soo Yong Lee
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Min Ku Chon
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Hasung Kim
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Yong-Giun Kim
- Division of Cardiology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jeong Su Kim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Yong-Hyun Park
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan, Gyeongnam, 626-770, South Korea
| | - Gi-Byoung Nam
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Kim M, Kwon CH, Lee JH, Hwang KW, Choi HO, Kim YG, Lee KN, Ahn J, Park HS, Nam GB. Right bundle branch block-type wide QRS complex tachycardia with a reversed R/S complex in lead V 6: Development and validation of electrocardiographic differentiation criteria. Heart Rhythm 2020; 18:181-188. [PMID: 32927100 DOI: 10.1016/j.hrthm.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Differentiation of supraventricular tachycardia (SVT) with a right bundle branch block (RBBB) pattern from ventricular tachycardia (VT) is difficult, particularly when the R/S ratio in lead V6 is below 1.0. OBJECTIVE We sought to investigate the electrocardiographic criteria for distinguishing between these arrhythmias. METHODS We investigated electrocardiographic parameters from 111 consecutive patients who had RBBB pattern wide QRS complex tachycardia with a reversed R/S ratio in lead V6 (72 VTs, 39 SVTs). Diagnostic criteria from the previous algorithms were compared with our new criterion, the RS/QRS ratio, which was defined as the ratio of the interval from the onset of the QRS complex to the nadir of the S wave, divided by the QRS width in lead V6. The RS/QRS ratio was further tested in a prospective population (31 fascicular VTs, 29 SVTs). RESULTS The diagnostic accuracy of previous criteria (Brugada algorithm, Vereckei algorithm, and R-wave peak time criterion) was only modest. However, the RS/QRS ratio in lead V6 was significantly lower in SVT than in VT (0.36 ± 0.04 vs 0.50 ± 0.08; P < .001). A cutoff value of the RS/QRS ratio >0.41 differentiated VT from SVT with a high diagnostic accuracy (sensitivity 97.2%; specificity 89.7%). When tested in a prospective population with fascicular VT, the diagnostic accuracy of the criteria was maintained (sensitivity 90.3%; specificity 86.2%). CONCLUSION The RS/QRS ratio >0.41 in lead V6 is a simple and reliable index for distinguishing VT from SVT in RBBB pattern wide QRS complex tachycardia with a reversed R/S complex in lead V6. This criterion was particularly useful for the differential diagnosis of fascicular VT from RBBB pattern SVT.
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Affiliation(s)
- Minsu Kim
- Division of Cardiology, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
| | - Chang Hee Kwon
- Division of Cardiology, Konkuk University Medical Center, Seoul, Korea
| | - Ji Hyun Lee
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Won Hwang
- Divison of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Soonchunhyang University Hospital, Bucheon, Korea
| | - Yong-Giun Kim
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang-No Lee
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jinhee Ahn
- Division of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyoung-Seob Park
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gi-Byoung Nam
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Cho SC, Jin ES, Om SY, Hwang KW, Choi HO, Kim KH, Kim SH, Park KM, Kim J, Choi KJ, Kim YH, Nam GB. Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome. Korean Circ J 2020; 50:998-1009. [PMID: 32812404 PMCID: PMC7596208 DOI: 10.4070/kcj.2020.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardia-bradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. METHODS The medical records of 217 patients with TBS were retrospectively assessed. Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. RESULTS During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27; 95% confidence interval [CI], 0.15-0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06-0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71-6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8-2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50-1.66; p=0.769). CONCLUSIONS RFCA is an effective alternative to PM implantation in patients with TBS. In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar.
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Affiliation(s)
- Sang Cheol Cho
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Sun Jin
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Yong Om
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ki Hun Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Hwan Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Jun Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Joon Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - You Ho Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gi Byoung Nam
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Kong MG, Park HW, Choi HO, Seo HS, Suh J, Cho YH, Lee NH. P6445Stress hyperglycemia and in-hospital mortality in patients with ST-segment elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1039] [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
Introduction
Stress hyperglycemia is common in acute ill patients and associated with poor clinical outcomes. Some studies demonstrated the association of stress hyperglycemia and poor outcomes in acute MI. However, current results for the impact of stress hyperglycemia on mortality in acute MI who underwent PCI are insufficient.
Purpose
We aimed to evaluate the impact of stress hyperglycemia on clinical outcomes of patients with STEMI underwent primary PCI in large scale multi-center registry.
Methods
From 2007 to 2014, in 1,538 patients of the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort, 997 patients without diabetes who underwent primary PCI for STEMI were retrospectively analyzed. We defined random glucose more than 200mg/dl at admission without diabetic history or results of HbA1C more than 6.5% as stress hyperglycemia. The primary endpoint was in-hospital all-cause death and the secondary endpoint was all-cause death within 1 year after index PCI.
Results
From 997 nondiabetic cohort population, 117 patients with stress hyperglycemia and 880 patients without stress hyperglycemia were enrolled. Baseline characteristics including age, sex, hypertension, hyperlipidemia, atrial fibrillation, left main disease, and multivessel disease were not significantly different between two groups. However, systolic blood pressure was lower (111.2±39.2 vs. 125.5±28.1, p<0.001) and hypoxic liver injury was frequent (31.0% vs. 20.1%, p=0.007) in stress hyperglycemia. In-hospital and 1-year all-cause mortality were higher in stress hyperglycemia (13.7% vs. 2.7%, p<0.001; 15.4% vs. 3.8%, p<0.001, respectively). However, there is no significant difference in post-discharge mortality rate. Stress hyperglycemia was a significant independent predictor of in-hospital death (adjusted OR: 5.67, 95% CI: 2.40–13.39; p<0.001). Hypotension (defined less than 90mmHg) and left ventricular dysfunction (defined less than 40% of LVEF on echocardiography) were significantly associated with stress hyperglycemia (adjusted OR: 5.72, 95% CI: 3.33–9.82; p<0.001; adjusted OR: 2.38, 95% CI: 1.49–3.82; p<0.001, respectively).
Landmark analysis of all-cause death
Conclusions
In nondiabetic patients who underwent primary PCI for STEMI, stress hyperglycemia is significantly associated with an increased in-hospital all-cause mortality but did not increase post-discharge mortality within 1 year.
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Affiliation(s)
- M G Kong
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - H W Park
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - H O Choi
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - H S Seo
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - J Suh
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - Y H Cho
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
| | - N H Lee
- Soonchunhyang University Hospital, Bucheon, Korea (Republic of)
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Lee SH, Choi HO, Hwang KW. Cavotricuspid isthmus ablation using multimodality imaging in Ebstein anomaly with a mechanical tricuspid valve replacement. HeartRhythm Case Rep 2018; 4:346-349. [PMID: 30116707 PMCID: PMC6092982 DOI: 10.1016/j.hrcr.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Republic of Korea
- Address reprint requests and correspondence: Dr Ki Won Hwang, Department of Internal Medicine, Pusan National University Yangsan Hospital, Geumo St 20, Mulgeum-eup, Yangsan 50612, Republic of Korea.
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Hwang KW, Choi JH, Jung SM, Kim YS, Lee SY, Chon MK, Lee SH, Kim JS, Park YH, Kim JH, Chun KJ, Je HG, Lee SK, Choi HO. P1520Defining the blanking period after maze procedure for atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1520] [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 W Hwang
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - J H Choi
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - S M Jung
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - Y S Kim
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - S Y Lee
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - M K Chon
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - S H Lee
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - J S Kim
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - Y H Park
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - J H Kim
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - K J Chun
- Pusan National University Yangsan Hospital, Division of Cardiology, Department of Internal Medicine, Yansan, Korea Republic of
| | - H G Je
- Pusan National University Yangsan Hospital, Department of Cardiovascular and Thoracic Surgery, Yansan, Korea Republic of
| | - S K Lee
- Pusan National University Yangsan Hospital, Department of Cardiovascular and Thoracic Surgery, Yansan, Korea Republic of
| | - H O Choi
- Soonchunhyang University Hospital, Cardiology, Bucheon, Korea Republic of
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Kim YS, Hwang KW, Choi HO, Jung SM, Choi JH, Lee SY, Chun MK, Lee SH, Kim JS, Je HG, Park YH, Kim JH, Lee SK, Chun KJ. P4815Incidence of incomplete surgical left atrial appendage closure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4815] [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)
- Y S Kim
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - K W Hwang
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - H O Choi
- Soonchunhyang University Hospital, Department of internal medicine, Bucheon, Korea Republic of
| | - S M Jung
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - J H Choi
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - S Y Lee
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - M K Chun
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - S H Lee
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - J S Kim
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - H G Je
- Pusan National University, Department of Cardiovascular and Thoracic Surgery, Yangsan, Korea Republic of
| | - Y H Park
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - J H Kim
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
| | - S K Lee
- Pusan National University, Department of Cardiovascular and Thoracic Surgery, Yangsan, Korea Republic of
| | - K J Chun
- Pusan National University Yangsan Hospital, Department of internal medicine, Yangsan-si, Korea Republic of
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12
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Choi HO, Park HW. High degree heart block following suicide attempt by hanging. Resuscitation 2018; 124:e1-e3. [PMID: 29338901 DOI: 10.1016/j.resuscitation.2018.01.018] [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] [Received: 10/20/2017] [Revised: 12/29/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Hyung Oh Choi
- Department of Cardiology, Bucheon Hospital, Soonchunhyang University, Gyeonggi-do, Republic of Korea.
| | - Hyun Woo Park
- Department of Cardiology, Bucheon Hospital, Soonchunhyang University, Gyeonggi-do, Republic of Korea
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Hwang KW, Nam GB, Han J, Kim YG, Choi HO, Kim J, Choi KJ, Kim YH. Incidence of Atrial Tachyarrhythmias in Patients With Early Repolarization Syndrome. Int Heart J 2017; 58:43-49. [PMID: 28077816 DOI: 10.1536/ihj.16-104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/18/2022]
Abstract
Atrial tachyarrhythmias (ATAs) occur in a significant proportion of Brugada syndrome (BrS) patients and are often an important cause of inappropriate shocks. The aim of this retrospective study was to evaluate the incidence of ATAs and ATA-induced inappropriate shocks in early repolarization syndrome (ERS) patients as compared to BrS patients.We analyzed data from 20 consecutive patients who were diagnosed with ERS and compared them with patients diagnosed with BrS (n = 31). Clinical and ICD interrogation data were collected and analyzed for all events with ICD shocks.Three patients had a history of atrial fibrillation (AF) prior to ICD implantation. One patient had AV reentrant tachycardia and was successfully ablated before ICD implantation. ATAs were newly diagnosed in 4 patients with no prior history of AF. There were no significant differences in gender, age, or left atrial diameter between ATA development. Four (20%) of 20 consecutive patients received inappropriate ICD shocks for ATAs. One suffered from repeat inappropriate shocks triggered by paroxysmal AF and received catheter ablation for AF.ATAs were not infrequent in patients with ERS and seemed to be related to inappropriate ICD therapy. Careful ICD programming is required to reduce ATA-related inappropriate ICD shock in patients with ERS.
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Affiliation(s)
- Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine
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Om SY, Kim SH, Choi SW, Choi HO, Kim YG, Song JM, Jung SH, Kim DH, Kang DH, Song JK, Shim TS. T cell-based assay of pericardial fluid mononuclear cells for the diagnosis of tuberculous pericardial effusion. J Am Coll Cardiol 2014; 64:1966-8. [PMID: 25444151 DOI: 10.1016/j.jacc.2014.07.983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
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Choi HO, Nam GB, Jin ES, Kim KH, Kim SH, Hwang ES, Park KM, Kim J, Rhee KS, Choi KJ, Kim YH. Temporal variation and morphologic characteristics of J-waves in patients with early repolarisation syndrome. Heart 2013; 99:1818-24. [DOI: 10.1136/heartjnl-2013-303731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Song JM, Shim TS, Choi SW, Choi HO, Kim YG, Jung SH, Kim SH, Kim DH, Kang DH, Song JK. DIAGNOSIS OF TUBERCULOUS PERICARDIAL EFFUSION BY T CELL-BASED ASSAYS ON PERIPHERAL BLOOD AND PERICARDIAL FLUID MONONUCLEAR CELLS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choi SW, Song JM, Choi HO, Jung SH, Kim DH, Kang DH, Song JK. CLINICAL FEATURES AND PROGNOSTIC FACTORS IN PATIENTS WITH TUBERCULOUS AND IDIOPATHIC PERICARDIAL EFFUSION. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Kim SH, Nam GB, Baek S, Choi HO, Kim KH, Choi KJ, Joung B, Pak HN, Lee MH, Kim SS, Park SJ, On YK, Kim JS, Oh IY, Choi EK, Oh S, Choi YS, Choi JI, Park SW, Kim YH, Lee MY, Lim HE, Lee YS, Cho Y, Kim J, Lee DI, Cho DK, Kim YH. Circadian and seasonal variations of ventricular tachyarrhythmias in patients with early repolarization syndrome and Brugada syndrome: analysis of patients with implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2012; 23:757-63. [PMID: 22353358 DOI: 10.1111/j.1540-8167.2011.02287.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [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: 11/26/2022]
Abstract
INTRODUCTION The circadian and seasonal patterns of ventricular tachyarrhythmia (VTA) in patients with early repolarization syndrome (ERS) have not been determined. We compared the timing of VTAs in patients with ERS and Brugada syndrome (BS). METHODS AND RESULTS We enrolled patients with ERS (n = 14) and BS (n = 53) who underwent implantable cardioverter defibrillator (ICD) implantation. The timing of VTAs, including cardiac arrest and appropriate shocks, was determined. During follow up of 6.4 ± 3.6 years in the ERS group and 5.0 ± 3.3 years in the BS group, 5 of 14 (36%) ERS and 10 of 53 (19%) BS patients experienced appropriate shocks (P = 0.37). Cardiac arrest showed a trend of nocturnal distribution peaking from midnight to early morning (P = 0.14 in ERS, P = 0.16 in BS). Circadian distribution of appropriate shocks showed a significant nocturnal peak in patients with ERS (P < 0.0001) but a trend toward a nocturnal peak in patients with BS (P = 0.08). There were no seasonal differences in cardiac arrest in patients with ERS and BS. However, patients with ERS showed a seasonal peak in appropriate shocks from spring to summer (P < 0.0001). There was no significant seasonal peak in patients with BS. The timing of VTAs (cardiac arrest plus appropriate shock) showed significant nocturnal distributions in patients with ERS and BS (P < 0.01, respectively). A significant clustering of VTAs was noted from spring to summer (P < 0.01) in patients with ERS, but not in patients with BS (P = 0.42). CONCLUSIONS Incidence of VTAs showed marked circadian variations with night-time peaks in patients with ERS and BS.
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Affiliation(s)
- Sung-Hwan Kim
- Asan Medical Center, University of Ulsan, Seoul, Korea
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Lee PH, Song JK, Park IK, Sun BJ, Lee SG, Yim JH, Choi HO. Takotsubo cardiomyopathy: a case of persistent apical ballooning complicated by an apical mural thrombus. Korean J Intern Med 2011; 26:455-9. [PMID: 22205847 PMCID: PMC3245395 DOI: 10.3904/kjim.2011.26.4.455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 04/10/2008] [Accepted: 05/13/2008] [Indexed: 12/12/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.
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Affiliation(s)
- Pil Hyung Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Keun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Joo Sun
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Geun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hye Yim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Oh Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sun BJ, Lee PH, Choi HO, Ahn JM, Seo JS, Kim DH, Song JM, Choi KJ, Kang DH, Song JK. Prevalence of echocardiographic features suggesting cardiac sarcoidosis in patients with pacemaker or implantable cardiac defibrillator. Korean Circ J 2011; 41:313-20. [PMID: 21779284 PMCID: PMC3132693 DOI: 10.4070/kcj.2011.41.6.313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/01/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Basal septal thinning or localized aneurysmal dilatation without coronary artery disease has been described as a characteristic finding suggestive of cardiac sarcoidosis. We sought to assess the prevalence of this characteristic echocardiographic finding in patients with pacemaker (PM) or implantable cardiac defibrillator (ICD). SUBJECTS AND METHODS Echocardiography of patients who received PM or ICD were retrospectively analyzed. Patients with marked thinning and akinesia confined to the basal septum (type 1), or posterolateral wall resulting in localized aneurysmal outward bulging (type 2) without history of myocardial infarction or significant coronary stenosis were included for analysis. RESULTS Among 1,357 consecutive patients, 21 exhibited suggestive echocardiographic findings (type 1/2=15/6) with a mean ejection fraction of 37±11%. The prevalence was 1.2% in the PM group and 4.0% in the ICD group. Only 3 patients showed histologically confirmable sarcoidosis in lymph nodes, lung and heart, respectively. Endomyocardial biopsy was attempted in 6 patients, but failed to demonstrate sarcoidosis. The 1-, 2-, 4- and 6-year clinical events (death, cardiac transplantation and hospital admission)-free survival rates were 100%, 85.7±7.6%, 75.0±9.7% and 48.6±12.4%, respectively. During follow-up, two patients with PM underwent ICD implantation, and another underwent heart transplantation. CONCLUSION Prevalence of echocardiographic features suggesting prevalence of cardiac sarcoidosis is low in patients who underwent device implantation. However, considering the very low yield of endomyocardial biopsy and the rare extracardiac manifestations in cardiac sarcoidosis, characteristic echocardiographic findings could be an adjunctive diagnostic criterion in these patients.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Choi HO, Song JM, Shim TS, Kim SH, Jung IH, Kang DH, Song JK. Prognostic value of initial echocardiographic features in patients with tuberculous pericarditis. Korean Circ J 2010; 40:377-86. [PMID: 20830251 PMCID: PMC2933462 DOI: 10.4070/kcj.2010.40.8.377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 03/02/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Tuberculous (TB) pericarditis is a major cause of constrictive pericarditis requiring pericardiectomy. We sought to determine initial prognostic factors in patients with TB pericarditis. SUBJECTS AND METHODS We evaluated initial presentation and clinical outcomes (mean follow-up 32±27 months) in 60 consecutive patients newly diagnosed with TB pericarditis. RESULTS Initial presentations were pericardial effusion (PE), effusive-constrictive pericarditis, and constrictive pericarditis in 45 (75%), 9 (15%), and 6 (10%) patients, respectively. Of the 54 patients without initial constrictive pericarditis, 32 (59%) showed echogenic materials in PE, including frond-like exudative coating and fibrinous strands. These patients had a longer disease duration before diagnosis, were initially more symptomatic, in a more advanced state, showed more persistent pericardial constrictions (38% vs. 0%, p<0.001) despite anti-TB medications, and tended to require pericardiectomy more often (19% vs. 0%, p=0.07, p<0.05 by Kaplan-Meier). All patients with effusive-constrictive pericarditis showed echogenic PE. Of the 60 total patients, 10 (17%) underwent pericardiectomies during follow-up. All of these patients showed initial pericardial constrictions, whereas no patient without initial pericardial constriction underwent pericardiectomy (p<0.001). Seven patients showed transient pericardial constrictions that resolved without pericardiectomy. CONCLUSION Initial pericardial constriction and echogenic PE are poor prognostic signs for persistent pericardial constriction and pericardiectomy in patients with newly diagnosed TB pericarditis. These results suggest that early diagnosis and prompt anti-TB medication may be critical.
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Affiliation(s)
- Hyung Oh Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Choi HO, Lee SG, Lee PH, Nam GB. Incessant tachycardia with wide and narrow QRS complexes: what is the mechanism? Heart Rhythm 2008; 6:1063-5. [PMID: 18774755 DOI: 10.1016/j.hrthm.2008.07.017] [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] [Received: 07/07/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Hyung Oh Choi
- Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Park KH, Choi HO, Jang DD, Park YI, Park KC. Downregulation of Bcl-2 and activation of caspase-8 in the UVB-induced apoptosis of a cultured human melanoma cell line. Photodermatol Photoimmunol Photomed 2001; 17:218-22. [PMID: 11555331 DOI: 10.1034/j.1600-0781.2001.170503.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE This study was performed to determine the effect of UV radiation on the activation of apoptosis regulatory proteins using cultured human melanoma cells. METHODS G361 lightly pigmented melanoma cells were irradiated with increasing doses of UVB and analyzed for an apoptotic mechanism using a cell viability test, TEM, FACS, and western blotting analysis. RESULTS TEM and FACS showed apoptotic features of cell death after UVB irradiation. Western blotting disclosed downregulation of Bcl-2 and the activation of caspase-9. Caspase-8, a downstream molecule of Fas/FasL interaction, was also activated. The activation of downstream molecules of both caspase-8 and caspase-9 was also demonstrated. CONCLUSION Our data showed that the regulation of the Bcl-2 family and caspase-8 may work together to activate a caspase-3 mediated apoptotic pathway following UVB irradiation of cultured human melanoma cells.
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Affiliation(s)
- K H Park
- Graduate School of Biotechnology, Korea University, Seoul, Korea
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Affiliation(s)
- K C Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul National University Hospital, Korea
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25
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Park KC, Choi HO, Han WS, Hwang JH, Park KH, Kim KH, Chung JH, Eun HC. Identification of two novel frame shift mutations of the NF1 gene in Korean patients with neurofibromatosis type 1. J Korean Med Sci 2000; 15:542-4. [PMID: 11068991 PMCID: PMC3054687 DOI: 10.3346/jkms.2000.15.5.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neurofibromatos is type 1 (NF1) is one of the most common inherited disorders and is characterized by abnormalities in multiple tissues derived from the neural crest. The NF-1 gene has been cloned and mapped to human chromosome 17q11.2. The NF-1 gene has an open reading frame that predicts a protein consisting of 2,818 amino acids, known as neurofibromin. Here, we report two kinds of novel frame shift mutations of the NF1 gene from 2 out of 56 unrelated Korean NF1 patients. These mutations were detected using polymerase chain reaction and single strand conformational polymorphism analysis. Sequencing analysis revealed four base pair insertion at codon 1270 of exon 22, and a base pair deletion at codon 1398 of exon 24. These mutations resulted in premature termination of the mutant alleles and may encode truncated forms of neurofibromin.
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Affiliation(s)
- K C Park
- Department of Dermatology, Seoul National University, College of Medicine, Korea
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Park KC, Kim DS, Choi HO, Kim KH, Chung JH, Eun HC, Lee JS, Seo JS. Overexpression of HSP70 prevents ultraviolet B-induced apoptosis of a human melanoma cell line. Arch Dermatol Res 2000; 292:482-7. [PMID: 11142769 DOI: 10.1007/s004030000173] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The heat shock response is a highly conserved reaction common to all cells and organisms. It has been reported that hyperthermic treatment can induce the expression of the heat shock protein (HSP) and can protect cells from ultraviolet (UV) B radiation. In this study, we evaluated the effects of induced HSP70 on resistance to UV radiation. G361 amelanotic human melanoma cells were irradiated with increasing doses of UVB. UVB irradiation caused apoptotic cell death in these cells. Following transfection with MFG.hsp70.puro plasmid, the expression of HSP70 was determined. Compared to control vector-transfected cells, hsp70-transfected cells showed significantly elevated levels of HSP70 and were highly resistant to UVB irradiation. In order to investigate the effects of HSP70 on the apoptotic pathway, the changes in caspase-3 and PARP were analyzed. Following UVB irradiation, activation of caspase-3 and cleavage of PARP were observed in control vector-transfected cells, and the changes in these molecules were inhibited in the hsp70-transfected cells. These results suggest that UVB-induced apoptosis of melanoma cells is accompanied by caspase-3 activation and PARP cleavage, which can be prevented by an overexpression of HSP70.
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Affiliation(s)
- K C Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
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Park KC, Choi HO, Park KH, Kim KH, Eun HC. A nonsense mutation at Arg-1947 in the NF1 gene in a case of neurofibromatosis type 1 in a Korean patient. J Hum Genet 2000; 45:84-5. [PMID: 10721668 DOI: 10.1007/s100380050016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of neurofibromatosis (NF) 1 presenting as a C-to-T transition changing an Arg-1947 codon to a stop codon. Because this mutation has been described in multiple Caucasian and Japanese families, the codon CGA for Arg-1947 in the NF1 gene is considered to be a hotspot for mutation in neurofibromatosis type 1 in all ethnic groups.
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Affiliation(s)
- K C Park
- Department of Dermatology, Seoul National University College of Medicine, Chongno-gu, Korea.
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Choi HO, Hwang KJ. Mechanism of ionophoric transport of indium-111 cations through a lipid bilayer membrane. J Nucl Med 1987; 28:91-6. [PMID: 3098933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The use of mobile ionophores to facilitate the transport of 111In through a lipid bilayer membrane has broad applications in liposome technology and cell labeling. However, the mechanism of such ionophore-mediated transport of 111In through a lipid bilayer membrane is not completely clear. The present report describes the correlations of the behaviors of ionophoric loading of 111In into liposomes with the lipophilicity and the indium-binding affinity of three ionophores, namely, 8-hydroxyquinoline, acetylacetone, and tropolone. Our results suggest that the mechanism of the ionophoric transport of 111In through a lipid bilayer membrane involves the rapid exchange of 111In cations among the ionophores in both the aqueous solution and the lipid bilayer. Furthermore, the effectiveness of an ionophore in facilitating the transport of 111In from the external aqueous compartment to the entrapped nitrilotriacetic acid depends not only on the lipophilicity of the [111In]ionophore complex, but also on the lipophilicity of the free ionophore itself and the competition of 111In between nitrilotriacetic acid inside the inner aqueous compartment of the liposome and the ionophore imbedded in the lipid bilayer membrane of the liposome.
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Abstract
Lipophilic chelates such as 8-hydroxyquinoline, acetylacetone, and tropolone are useful to load high levels of radioactive cations into the inner aqueous compartments of liposomes for investigating the fate of liposomes by the technique of gamma imaging or gamma-ray perturbed angular correlation measurements. However, if lipophilic chelates are not completely removed from liposomes the very same lipophilic chelates can also cause leakage of the entrapped cations from liposomes. Thus, it is essential to make sure that all the lipophilic chelates are removed from liposomes after the loading process. The results of the present study show that more than 99.85% of acetylacetone in liposomal suspension can be removed by a minicolumn of AG1-X8 (phosphate form) anion exchange resin. Virtually all the 8-hydroxyquinoline and tropolone in liposomal suspension are adsorbed tightly to the resin. The procedure is rapid, and the dilution of liposomes is minimal. For experiments involving high levels of gamma-emitting radionuclides, the cleaning up process of removing lipophilic chelates from liposomes can be conveniently operated behind a lead glass.
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Choi HO. [A study of conditions in rural public health nursing]. Taehan Kanho 1969; 8:41-8. [PMID: 5262563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Choi HO. [A study of hygiene before and after childbirth]. Taehan Kanho 1969; 8:39-43. [PMID: 5255200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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