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Baek YS. Artificial Intelligence-enhanced Electrocardiogram for Atrial Fibrillation in Embolic Stroke With Undetermined Source: Heroic Detective or Overfitting Alarm? Korean Circ J 2023; 53:772-774. [PMID: 37973387 PMCID: PMC10654416 DOI: 10.4070/kcj.2023.0231] [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: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Korea
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom.
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Baek YS, Kwon S, You SC, Lee KN, Yu HT, Lee SR, Roh SY, Kim DH, Shin SY, Lee DI, Park J, Park YM, Suh YJ, Choi EK, Lee SC, Joung B, Choi W, Kim DH. Artificial intelligence-enhanced 12-lead electrocardiography for identifying atrial fibrillation during sinus rhythm (AIAFib) trial: protocol for a multicenter retrospective study. Front Cardiovasc Med 2023; 10:1258167. [PMID: 37886735 PMCID: PMC10598864 DOI: 10.3389/fcvm.2023.1258167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common arrhythmia, contributing significantly to morbidity and mortality. In a previous study, we developed a deep neural network for predicting paroxysmal atrial fibrillation (PAF) during sinus rhythm (SR) using digital data from standard 12-lead electrocardiography (ECG). The primary aim of this study is to validate an existing artificial intelligence (AI)-enhanced ECG algorithm for predicting PAF in a multicenter tertiary hospital. The secondary objective is to investigate whether the AI-enhanced ECG is associated with AF-related clinical outcomes. Methods and analysis We will conduct a retrospective cohort study of more than 50,000 12-lead ECGs from November 1, 2012, to December 31, 2021, at 10 Korean University Hospitals. Data will be collected from patient records, including baseline demographics, comorbidities, laboratory findings, echocardiographic findings, hospitalizations, and related procedural outcomes, such as AF ablation and mortality. De-identification of ECG data through data encryption and anonymization will be conducted and the data will be analyzed using the AI algorithm previously developed for AF prediction. An area under the receiver operating characteristic curve will be created to test and validate the datasets and assess the AI-enabled ECGs acquired during the sinus rhythm to determine whether AF is present. Kaplan-Meier survival functions will be used to estimate the time to hospitalization, AF-related procedure outcomes, and mortality, with log-rank tests to compare patients with low and high risk of AF by AI. Multivariate Cox proportional hazards regression will estimate the effect of AI-enhanced ECG multimorbidity on clinical outcomes after stratifying patients by AF probability by AI. Discussion This study will advance PAF prediction based on AI-enhanced ECGs. This approach is a novel method for risk stratification and emphasizes shared decision-making for early detection and management of patients with newly diagnosed AF. The results may revolutionize PAF management and unveil the wider potential of AI in predicting and managing cardiovascular diseases. Ethics and dissemination The study findings will be published in peer-reviewed publications and disseminated at national and international conferences and through social media. This study was approved by the institutional review boards of all participating university hospitals. Data extraction, storage, and management were approved by the data review committees of all institutions. Clinical Trial Registration [cris.nih.go.kr], identifier (KCT0007881).
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
- DeepCardio Inc., Incheon, Republic of Korea
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | - Soonil Kwon
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Seng Chan You
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang-No Lee
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So-Ryung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Seung Yong Shin
- Cardiovascular and Arrhythmia Centre, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea
- Division of Cardiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dae In Lee
- Division of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Junbeom Park
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Yae Min Park
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Chul Lee
- DeepCardio Inc., Incheon, Republic of Korea
- Department of Computer Engineering, Inha University, Incheon, Republic of Korea
| | - Boyoung Joung
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Wonik Choi
- DeepCardio Inc., Incheon, Republic of Korea
- Department of Information and Communication Engineering, Inha University, Incheon, Republic of Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
- DeepCardio Inc., Incheon, Republic of Korea
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Baek YS, Jo Y, Lee SC, Choi W, Kim DH. Artificial intelligence-enhanced electrocardiography for early assessment of coronavirus disease 2019 severity. Sci Rep 2023; 13:15187. [PMID: 37704692 PMCID: PMC10499801 DOI: 10.1038/s41598-023-42252-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
Despite challenges in severity scoring systems, artificial intelligence-enhanced electrocardiography (AI-ECG) could assist in early coronavirus disease 2019 (COVID-19) severity prediction. Between March 2020 and June 2022, we enrolled 1453 COVID-19 patients (mean age: 59.7 ± 20.1 years; 54.2% male) who underwent ECGs at our emergency department before severity classification. The AI-ECG algorithm was evaluated for severity assessment during admission, compared to the Early Warning Scores (EWSs) using the area under the curve (AUC) of the receiver operating characteristic curve, precision, recall, and F1 score. During the internal and external validation, the AI algorithm demonstrated reasonable outcomes in predicting COVID-19 severity with AUCs of 0.735 (95% CI: 0.662-0.807) and 0.734 (95% CI: 0.688-0.781). Combined with EWSs, it showed reliable performance with an AUC of 0.833 (95% CI: 0.830-0.835), precision of 0.764 (95% CI: 0.757-0.771), recall of 0.747 (95% CI: 0.741-0.753), and F1 score of 0.747 (95% CI: 0.741-0.753). In Cox proportional hazards models, the AI-ECG revealed a significantly higher hazard ratio (HR, 2.019; 95% CI: 1.156-3.525, p = 0.014) for mortality, even after adjusting for relevant parameters. Therefore, application of AI-ECG has the potential to assist in early COVID-19 severity prediction, leading to improved patient management.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.
- School of Computer Science, University of Birmingham, Birmingham, B15 2TT, UK.
- DeepCardio Inc., 100 Inha-ro, Incheon, 22212, Republic of Korea.
| | - Yoonsu Jo
- DeepCardio Inc., 100 Inha-ro, Incheon, 22212, Republic of Korea
| | - Sang-Chul Lee
- DeepCardio Inc., 100 Inha-ro, Incheon, 22212, Republic of Korea
- Department of Computer Engineering, Inha University, 100 Inha-ro, Incheon, 22212, Republic of Korea
| | - Wonik Choi
- DeepCardio Inc., 100 Inha-ro, Incheon, 22212, Republic of Korea.
- Department of Information and Communication Engineering, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea.
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
- DeepCardio Inc., 100 Inha-ro, Incheon, 22212, Republic of Korea
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Roh SY, Lee DI, Lee KN, Ahn J, Baek YS, Kim DH, Shim J, Choi JI, Kim YH. E/e' Ratio Predicts the Atrial Pacing-Induced Left Atrial Pressure Response in Patients with Preserved Ejection Fraction. Medicina (Kaunas) 2023; 59:medicina59020210. [PMID: 36837412 PMCID: PMC9961402 DOI: 10.3390/medicina59020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
Background and Objectives: Left atrial hypertension is one of the pathophysiologies of heart failure with preserved ejection fraction. We hypothesized that left atrial pressure response (LAPR) to incremental pacing is higher in patients with atrial fibrillation (AF) and can predict left ventricular diastolic dysfunction. Materials and Methods: Patients requiring left atrial access as a part of a therapeutic procedure for AF (n = 204, AF group) or supraventricular tachycardia (n = 34, control group) were analyzed (male n = 183, 54 ± 12 years old). LAPR was measured during incremental pacing. Results: Baseline left atrial pressure and LAPR at all pacing rates were not different between the AF and control groups. They were higher in patients with a high E/e' (≥ 8) than in those with a low E/e' (<8). LAPR at a pacing interval of 400 ms and E/e' were positively correlated (r = 0.373, p < 0.001). Body mass index and a high E/e' were independent predictors of pacing-induced left atrial hypertension. Conclusions: LAPR to incremental pacing was constant regardless of AF. The non-invasive echocardiographic marker E/e' reflected pacing-induced left atrial hypertension.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Republic of Korea
| | - Dae-In Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungju-si 28644, Republic of Korea
| | - Kwang-No Lee
- Department of Cardiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hsopital, Busan 49241, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon 22332, Republic of Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Ewha University Hospital, Seoul 07804, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Republic of Korea
- Correspondence:
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Baek YS, Lee DH, Jo Y, Lee SC, Choi W, Kim DH. Artificial intelligence-estimated biological heart age using a 12-lead electrocardiogram predicts mortality and cardiovascular outcomes. Front Cardiovasc Med 2023; 10:1137892. [PMID: 37123475 PMCID: PMC10133724 DOI: 10.3389/fcvm.2023.1137892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Background There is a paucity of data on artificial intelligence-estimated biological electrocardiography (ECG) heart age (AI ECG-heart age) for predicting cardiovascular outcomes, distinct from the chronological age (CA). We developed a deep learning-based algorithm to estimate the AI ECG-heart age using standard 12-lead ECGs and evaluated whether it predicted mortality and cardiovascular outcomes. Methods We trained and validated a deep neural network using the raw ECG digital data from 425,051 12-lead ECGs acquired between January 2006 and December 2021. The network performed a holdout test using a separate set of 97,058 ECGs. The deep neural network was trained to estimate the AI ECG-heart age [mean absolute error, 5.8 ± 3.9 years; R-squared, 0.7 (r = 0.84, p < 0.05)]. Findings In the Cox proportional hazards models, after adjusting for relevant comorbidity factors, the patients with an AI ECG-heart age of 6 years older than the CA had higher all-cause mortality (hazard ratio (HR) 1.60 [1.42-1.79]) and more major adverse cardiovascular events (MACEs) [HR: 1.91 (1.66-2.21)], whereas those under 6 years had an inverse relationship (HR: 0.82 [0.75-0.91] for all-cause mortality; HR: 0.78 [0.68-0.89] for MACEs). Additionally, the analysis of ECG features showed notable alterations in the PR interval, QRS duration, QT interval and corrected QT Interval (QTc) as the AI ECG-heart age increased. Conclusion Biological heart age estimated by AI had a significant impact on mortality and MACEs, suggesting that the AI ECG-heart age facilitates primary prevention and health care for cardiovascular outcomes.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
- DeepCardio Inc., Incheon, South Korea
- School of Computer Science, University of Birmingham, Birmingham, United Kingdom
| | | | - Yoonsu Jo
- DeepCardio Inc., Incheon, South Korea
| | - Sang-Chul Lee
- DeepCardio Inc., Incheon, South Korea
- Department of Computer Engineering, Inha University, Incheon, South Korea
- Correspondence: Sang-Chul Lee Dae-Hyeok Kim
| | - Wonik Choi
- DeepCardio Inc., Incheon, South Korea
- Department of Information and Communication Engineering, Inha University, Incheon, South Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
- DeepCardio Inc., Incheon, South Korea
- Correspondence: Sang-Chul Lee Dae-Hyeok Kim
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Lee K, Lee SK, Lee J, Jeon BK, Kim TH, Yu HT, Lee JM, Park JK, Baek YS, Kim DH, Shim J, Joung B, Lee MH, Pak HN, Park J. Protocol of BEYOND trial: Clinical BEnefit of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in rhYthm cONtrol of atrial fibrillation in patients with diabetes mellitus. PLoS One 2023; 18:e0280359. [PMID: 36652465 PMCID: PMC9847966 DOI: 10.1371/journal.pone.0280359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
SGLT-2 inhibitor, traditionally used for glycemic control, has several beneficial effects that can help manage heart failure (HF). SGLT-2 inhibitors reduce the risk of cardiovascular mortality in patients with HF. As atrial fibrillation (AF) is closely associated with HF and diabetes mellitus (DM) is a risk factor for AF, we assume that SGLT-2 inhibitors will also show therapeutic benefits regarding AF, especially for rhythm control. This trial has a multicenter, prospective, open, blinded endpoint design. It is a 1:1 randomized and controlled study. A total of 716 patients who are newly diagnosed of AF and DM within 1 year will be enrolled from 7 tertiary medical centers. The trial is designed to compare the effects of SGLT-2 inhibitors and other oral hypoglycemic agents on atrial rhythm control in patients with AF and DM. The primary outcome is the recurrence of AF within a year (including post-antiarrhythmic drugs (AAD) or ablation). The secondary outcomes are the ablation rate within a year, change in AF burden, size of the left atrium, NT-proBNP, the AF symptom score, and the quality of life. This trial will prospectively evaluate the effect and safety of SGLT-2 inhibitors on AF rhythm control in patients with DM. It will provide an invaluable dataset on rhythm control in AF with DM for future studies and offer novel information to assist in clinical decisions. (BEYOND trial, ClinicalTrials.gov number: NCT05029115. https://clinicaltrials.gov/ct2/show/NCT05029115).
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Affiliation(s)
- Kyuhyun Lee
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Soo Kyoung Lee
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Juyeon Lee
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Bo Kyung Jeon
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jung Myung Lee
- Kyung Hee University, Medical Center, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Dong Hyeok Kim
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Jaemin Shim
- Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea
- * E-mail:
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Choi SH, Kim M, Kim H, Kim DH, Baek YS. Cardiovascular and renal protective effects of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation. PLoS One 2022; 17:e0275103. [PMID: 36227869 PMCID: PMC9560050 DOI: 10.1371/journal.pone.0275103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Aim Data on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in relation to the risk of cardiovascular (CV) disease and renal protection among patients with atrial fibrillation (AF), are relatively sparse. We aimed to compare the effectiveness and safety of NOACs with those of warfarin for vascular protection in a large-scale, nationwide Asian population with AF. Methods and results Patients with AF who were prescribed oral anticoagulants according to the Korean Health Insurance Review and Assessment database between 2014 and 2017 were analyzed. The warfarin and NOAC groups were balanced using propensity score weighting. Clinical outcomes included ischemic stroke, myocardial infarction, angina pectoris, peripheral artery disease, chronic kidney disease (CKD), end-stage renal disease (ESRD), CV death, and all-cause death. NOAC use was associated with a lower risk of angina pectoris (HR, 0.79 [95% CI, 0.69–0.89] p<0.001), CKD stage 4 (HR, 0.5 [95% CI, 0.28–0.89], p = 0.02), and ESRD (HR, 0.15[95% CI, 0.08–0.32], p<0.001) than warfarin use. NOACs and warfarin did not significantly differ with respect to stroke reduction (HR, 1.05 [95% CI, 0.88–1.25], p = 0.19). NOAC use was associated with a lower risk of intracranial hemorrhage (HR, 0.6 [95% CI, 0.44–0.83], p = 0.0019), CV death (HR, 0.55 [95% CI, 0.43–0.70], p<0.001), and all-cause death (HR, 0.6 [95% CI, 0.52–0.69], p<0.001) than warfarin use. Conclusion NOACs were associated with a significantly lower risk of adverse CV and renovascular outcomes than warfarin in patients with AF.
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Affiliation(s)
- Seong Huan Choi
- Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Mina Kim
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Hoseob Kim
- Data Science Team, Hanmi Pharm. Co., Ltd., Seoul, Republic of Korea
| | - Dae-Hyeok Kim
- Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Yong-Soo Baek
- Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
- * E-mail:
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Ko KY, Jang JH, Choi SH, Baek YS, Kwon SW, Park SD, Woo SI, Kim DH, Shin SH. Impact of right atrial enlargement on clinical outcome in patients with atrial fibrillation. Front Cardiovasc Med 2022; 9:989012. [PMID: 36211539 PMCID: PMC9537634 DOI: 10.3389/fcvm.2022.989012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLeft atrial (LA) remodeling is associated with adverse cardiovascular events, including heart failure (HF) and stroke in patients with atrial fibrillation (AF). However, there are limited data on the value of right atrial (RA) remodeling in this population. We investigated the prognostic role of RA enlargement in patients with non-valvular AF.Methods and resultsWe analyzed 254 consecutive patients (age = 69 ± 12years, male:female = 165:89, mean left ventricular ejection fraction = 58.0 ± 7.2%) with non-valvular AF who underwent two-dimensional echocardiography from a single center. RA and LA volumes were measured from apical views and indexed to the body surface areas (right atrial volume index [RAVI] and left atrial volume index [LAVI]) and RAVI > 30mL/m2 and LAVI > 34mL/m2 were considered as enlarged. The relationship between RA enlargement and composite clinical outcome of hospitalization for HF (HHF), stroke, systemic embolism, or death from any cause was assessed. Right atrial (RA) enlargement was associated with older age and more frequent prevalence of persistent or permanent AF. During a median follow-up of 47.1 months, 77 patients (30%) had experienced primary composite outcome. In a multivariable model, RA enlargement, but not LA enlargement, was independently associated with adverse clinical outcomes even after adjusting for clinical and echocardiographic factors {adjusted hazard ratio [HR], 1.90 [95% confidence interval (CI), 1.14–3.18], p = 0.014 for primary composite outcome; adjusted HR, 2.70 [95% CI, 1.27–5.67], p = 0.001 for HHF or all cause death}.ConclusionRA enlargement was independently associated with an increased risk of HF, stroke, systemic embolization or death in patients with non-valvular AF, suggesting that RA volume can be helpful in assessing future cardiovascular risk in this population.
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Baek YS, Kwon OS, Lim B, Yang SY, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Kim DH, Lee MH, Park J, Pak HN. Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial. Front Cardiovasc Med 2021; 8:772665. [PMID: 34957255 PMCID: PMC8692944 DOI: 10.3389/fcvm.2021.772665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF. Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group. Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016]. Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF. Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.
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Affiliation(s)
- Yong-Soo Baek
- Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Byounghyun Lim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Dae-Hyeok Kim
- Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Junbeom Park
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
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Jena A, Iqbal M, Baek YS, Lee KN, Rho SY, Shim JM, Choi JI, Kim YH. Unipolar and bipolar electrogram characteristics of recurrent cases of idiopathic ventricular arrhythmias undergoing repeat catheter ablation. Indian Pacing Electrophysiol J 2021; 22:12-16. [PMID: 34823016 PMCID: PMC8811281 DOI: 10.1016/j.ipej.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Activation mapping guided catheter ablation (CA) of ventricular arrhythmias (VAs) is limited in some cases when it is only relied on bipolar electrogram (EGM). We hypothesized that activation mapping with use of combined bipolar and unipolar EGM facilitates to identify the focal origin of VAs and results in reduction of recurrence rate of CA of VAs. Methods We analyzed the data of patients undergoing repeat ablations for idiopathic out-flow tract VAs. The EGM of the 1 st and 2 nd ablations were compared for earliest local activation time (LAT), presence of discrete potentials, and polarity reversal, unipolar potential morphology (QS or non-QS), potential amplitude and activation slope. Results Thirty-seven patients were included. The Local activation time was significantly earlier in the 2nd ablation as compared to the 1st procedure (36.90 msec vs 31.85 msec, P < 0.01). The incidence of discrete potentials and polarity reversal were similar in both procedures (51% vs 57%, P = 0.8 and 62% in both the occasions, respectively). The unipolar voltage was similar in both occasions (6.94 mV vs 7.22 mV in repeat ablations, P = 0.7). The recurrence rate (5.7%) was significantly lower with routine use of combined unipolar and bipolar EGMs, as compared to the use of bipolar EGM alone (16.7%) Conclusions Use of both bipolar and unipolar electrograms helps in better delineation of the sites of earliest activation for effective ablation of VAs. Use of unipolar electrograms in addition to bipolar electrograms is associated with lower long term recurrence rate. In patients undergoing redo ablations for idiopathic OTVAs, a slow-rapid initial QS morphology with its earlier timing prior to onset of QRS on unipolar EGM facilitate identification of early activation sites and improves success of CA. Bipolar EGM chracteristics like polarity reversal and presence of discrete potentials have no additive efficacy in redo CA cases. A slow-rapid initial QS morphology with its earlier timing to QRS onset may improve the success of CA in idiopathic OTVAs.
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Affiliation(s)
- Anupam Jena
- Kalinga Institute of Medical Sciences, Republic of Korea
| | - Mohammad Iqbal
- Korea University Medical Center, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Korea University Medical Center, Seoul, Republic of Korea
| | - Kwang-No Lee
- Korea University Medical Center, Seoul, Republic of Korea
| | | | - Jae Min Shim
- Korea University Medical Center, Seoul, Republic of Korea
| | - Joing Il Choi
- Korea University Medical Center, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea.
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Yoon GS, Choi SH, Kwon SW, Park SD, Shin SH, Woo SI, Kwan J, Kim DH, Baek YS. Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression. J Int Med Res 2021; 49:3000605211057822. [PMID: 34791909 PMCID: PMC8619754 DOI: 10.1177/03000605211057822] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression. Methods Data from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF. Results Of 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60–2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates. Conclusion In relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.
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Affiliation(s)
- Gwang-Seok Yoon
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Seong-Huan Choi
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Sung-Hee Shin
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Seong-Ill Woo
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Jun Kwan
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea
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Lee E, Park HS, Han S, Nam GB, Choi JI, Pak HN, Oh IY, Shin DG, On YK, Park SW, Kim YH, Oh S, Ahn J, Ahn MS, Baek YS, Cha MJ, Cha TJ, Choi EK, Choi HO, Choi JI, Chun KJ, Gwag HB, Han S, Hwang Y, Hyun DW, Jin ES, Kang KW, Kim DH, Kim DK, Kim D, Kim JH, Kim JB, Kim M, Kim SH, Kim YR, Kim YH, Ko JS, Kwak JJ, Lee E, Lee S, Lee SR, Lee SH, Lee YS, Nam GB, Namgung J, Oh IY, Oh S, Oh YS, On YK, Pak HN, Park HC, Park HS, Park HW, Park SW, Park YM, Park YA, Rhee KS, Shim J, Shin DG, Song IG, Sung JH, Yang PS. Catheter ablation of atrial fibrillation in Korea: results from the Korean Heart Rhythm Society Ablation Registry for Atrial Fibrillation (KARA). Int J Arrhythm 2021. [DOI: 10.1186/s42444-021-00047-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to investigate the current status of AF (atrial fibrillation) catheter ablation in Korea.
Methods
The patients who underwent AF catheter ablation from September 2017 to December 2019 were prospectively enrolled from 37 arrhythmia centers. Demographic data, procedural characteristics, the extent of catheter ablation, acute success of the ablation lesion set, rate and independent risk factor for recurrence of AF were analyzed.
Results
A total of 2402 AF patients [paroxysmal AF (PAF) 45.7%, persistent AF (PeAF) 43.1% and redo AF 11.2%] were included. Pulmonary vein isolation (PVI) was performed in 2378 patients (99%) and acute success rate was 97.9%. Additional non-PV ablation (NPVA) were performed in 1648 patients (68.6%). Post-procedural complication rate was 2.2%. One-year AF-free survival rate was 78.6% and the PeAF patients showed poorer survival rate than the ones with other types (PeAF 72.4%, PAF 84.2%, redo AF 80.0%). Additional NPVA did not influence the recurrence of AF in the PAF patients (PVI 17.0% vs. NPVA 14.6%, P value 0.302). However, it showed lower AF recurrence rate in the PeAF patients (PVI 34.9% vs. NPVA 24.4%, P value 0.001). Valvular heart disease, left atrial diameter, PeAF, PVI alone, need of NPVA for terminating AF, and failed ablation were independent predictors of AF recurrence.
Conclusions
Additional NPVA was associated better rhythm outcome in the patients with PeAF, not in the ones with PAF. The independent risk factors for AF recurrence in Korean population were similar to previous studies. Further research is needed to discover optimal AF ablation strategy.
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Roh SY, Ahn J, Lee KN, Baek YS, Kim DH, Lee DI, Shim J, Choi JI, Kim YH. The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias. ACTA ACUST UNITED AC 2021; 57:medicina57060618. [PMID: 34199329 PMCID: PMC8231855 DOI: 10.3390/medicina57060618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Direct current cardioversion (DCCV) is a safe and useful treatment for atrial tachyarrhythmias. In the past, the energy delivered in DCCV was decided upon empirically, based only on the type of tachyarrhythmia. This conventional method does not consider individual factors and may lead to unnecessary electrical damage. Materials and Methods: We performed DCCV in patients with atrial tachyarrhythmias. The impedance and electrical current at the moment of shock were measured. The human thoracic impedance between both defibrillator patches and the electric current that was used were measured. Results: A total of 683 DCCVs were performed on 466 atrial tachyarrhythmia patients. The average impedance was 64 ± 11 Ω and the average successful current was 23 ± 6 mA. The magnitude of the electrical current that was successful depended upon the human impedance (linear regression, B = −0.266, p < 0.001) and the left atrial diameter (B = 0.092, p < 0.001). Impedance was directly proportional to body mass index (BMI) (B = 1.598, p < 0.001) and was higher in females than in males (77 ± 15 Ω vs. 63 ± 11 Ω, p < 0.001). Notably, the high-impedance (>70 Ω) group had a higher BMI (27 ± 4 kg/m2 vs. 25 ± 3 kg/m2, p < 0.001) and a higher proportion of females (37% vs. 9%, p < 0.001) than the low-impedance group (<70 Ω). However, thoracic impedance was not an independent predictor for successful DCCV. Conclusions: Human thoracic impedance was one of the factors that impacted the level of electrical current required for successful DCCV in patients with atrial arrhythmias. In the future, it will be helpful to consider individual predictors, such as BMI and gender, to minimize electrical damage during DCCV.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hsopital, Busan 49241, Korea;
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon 16499, Korea;
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University hospital, Incheon 22332, Korea;
| | - Dong-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Ewha University Hospital, Seoul 07804, Korea;
| | - Dae-In Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungju-si 28644, Korea;
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (S.-Y.R.); (J.S.); (J.-I.C.)
- Correspondence:
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Baek YS, Choi JI, Kim YG, Lee KN, Roh SY, Ahn J, Kim DH, Lee DI, Hwang SH, Shim J, Kim JS, Kim DH, Park SW, Kim YH. Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation. J Clin Med 2020; 9:jcm9103164. [PMID: 33007810 PMCID: PMC7601892 DOI: 10.3390/jcm9103164] [Citation(s) in RCA: 2] [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: 09/14/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022] Open
Abstract
Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age 55 ± 11 years, 20.3% women, and 59.0% paroxysmal AF). Extensive ablation, in addition to circumferential pulmonary vein isolation, was more often accomplished in patients with non-paroxysmal AF than in those with paroxysmal AF (87.4% vs. 25.3%, p < 0.001). During a median follow-up of 54 months, sinus rhythm (SR) was maintained in 67.1% after index procedure. After redo procedures in 418 patients, 83.3% exhibited SR maintenance. Recurrence rates were similar for single and multiple procedures (17.4% vs. 16.7%, p = 0.765). Subanalysis showed that the extent of late gadolinium enhancement (LGE), as assessed by cardiac magnetic resonance, is greater in patients with recurrence than in those without recurrence (36.2 ± 23.9% vs. 21.8 ± 13.7%, p < 0.001). Cox-regression analysis revealed that non-paroxysmal AF (hazard ratio (HR) 2.238, 95% confidence interval (CI) 1.905–2.629, p < 0.001), overweight (HR 1.314, 95% CI 1.107–1.559, p = 0.020), left atrium dimension ≥ 45 mm (HR 1.284, 95% CI 1.085–1.518, p = 0.004), AF duration (HR 1.020 per year, 95% CI 1.006–1.034, p = 0.004), and LGE ≥ 25% (HR 1.726, 95% CI 1.330–2.239, p < 0.001) are significantly associated with AF recurrence after catheter ablation. This study showed that repeated catheter ablation improves the clinical outcomes of patients with non-paroxysmal AF, suggesting that AF substrate based on LGE may underpin the mechanism of recurrence after catheter ablation.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon 22212, Korea; (Y.-S.B.); (D.-H.K.)
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
- Correspondence: ; Tel.: +82-2-920-5445
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Dong-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Dae In Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Seoul 02841, Korea;
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Jin Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon 22212, Korea; (Y.-S.B.); (D.-H.K.)
| | - Sang-Weon Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul 02841, Korea; (Y.G.K.); (K.-N.L.); (S.-Y.R.); (J.A.); (D.-H.K.); (D.I.L.); (J.S.); (J.S.K.); (S.-W.P.); (Y.-H.K.)
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Jang JH, Park JH, Ko KY, Baek YS, Kwon SW, Park SD, Shin SH, Woo SI, Kwan J, Kim DH. An analysis of vascular properties using pulse wave analysis in patients with vasovagal syncope. Clin Cardiol 2020; 43:781-788. [PMID: 32557670 PMCID: PMC7368349 DOI: 10.1002/clc.23380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/08/2020] [Accepted: 04/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Vasovagal syncope (VVS) is a common cause of recurrent syncope. Nevertheless, the exact hemodynamic mechanism has not been elucidated. Pulse wave analysis (PWA) is widely used to evaluate vascular properties, as it reflects the condition of the entire arterial system. HYPOTHESIS Cardiovascular autonomic modulation may influence the hemodynamic mechanism and result in different vascular properties between VVS patients and healthy individuals. METHODS We enrolled consecutive patients diagnosed with VVS on head-up tilt testing from January 2014 to August 2019. Healthy subjects were enrolled as the control group. We performed PWA on all participants. Using propensity score matching, we assembled a study population with similar baseline characteristics and compared hemodynamic parameters. RESULTS A total of 111 VVS patients (43 ± 18 years, 72 females) and 475 healthy control subjects (48 ± 13 years, 192 females) were enrolled. Compared to the healthy control subjects, the VVS patients had a higher augmentation index (AIx) adjusted to a heart rate of 75 beats per minute (AIx@HR75, 20.5 ± 13.1% vs 16.7 ± 11.9%, P = .003). After 1:1 matched comparison (111 matched control), VVS patients consistently showed higher AIx@HR75 (20.5 ± 13.1% vs 16.7 ± 12.9%, P = .02) than the matched control group. According to age distribution, VVS patients showed significantly higher AIx@HR75 (10.6 ± 11.7% vs 2.5 ± 11.1%, P = .01) in a young age (15-33 years) group. CONCLUSIONS VVS patients had greater arterial stiffness than healthy subjects. This is one of the plausible mechanisms of the pathophysiology of VVS.
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Affiliation(s)
- Ji-Hun Jang
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Jin-Hee Park
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Kyu-Yong Ko
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Yong-Soo Baek
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Sung-Woo Kwon
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Sang-Don Park
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Sung-Hee Shin
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Seong-Ill Woo
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Jun Kwan
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
| | - Dae-Hyeok Kim
- Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea
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Choi SH, Lee OH, Yoon GS, Kwon SW, Shin SH, Park SD, Woo SI, Kwan J, Kim DH, Baek YS. The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy. Int J Arrhythm 2020. [DOI: 10.1186/s42444-020-00016-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract
Background and objectives
Takotsubo cardiomyopathy (TTC) occasionally causes life-threatening ventricular arrhythmia. J wave on surface electrocardiography (sECG) has also been associated with idiopathic ventricular fibrillation and cardiac events; therefore, we investigated whether the presence of J wave on sECG is a potential risk factor for ventricular arrhythmia in patients with TTC.
Subjects and methods
We performed a retrospective study in 79 patients who were diagnosed with TTC from 2010 to 2014. Among them, 20 (25.3%) were diagnosed with ventricular tachycardia (VT). The J wave on the sECG was defined as J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads.
Results
A higher prevalence of ventricular tachycardia was observed in patients with J wave. The corrected QT interval (QTc) was significantly longer in the VT group than in the non-VT group. In a multivariate analysis, the presence of J wave appeared to be the only independent predictors of VT [Hazard Ratio (HR) 3.5, p = 0.019].
Conclusion
Our results suggest that the presence of J wave on the sECG is significantly associated with VT, and appear to indicate that the presence of J wave is a strong and independent predictor of VT in patients with TTC.
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Kim YG, Han S, Choi JI, Lee KN, Baek YS, Uhm JS, Shim J, Kim JS, Park SW, Hwang C, Kim YH. Impact of persistent left superior vena cava on radiofrequency catheter ablation in patients with atrial fibrillation. Europace 2019; 21:1824-1832. [PMID: 31578551 DOI: 10.1093/europace/euz254] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/18/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The impact of persistent left superior vena cava (PLSVC) in atrial fibrillation (AF) patients undergoing radiofrequency catheter ablation (RFCA) is not well known. We performed this analysis to evaluate the electrophysiological characteristics of PLSVC and its role in triggering and maintaining AF. METHODS AND RESULTS Patients with AF referred to two tertiary hospitals were screened and patients with PLSVC in pre-RFCA imaging studies were enrolled. Among 3967 patients, PLSVC was present in 36 patients (0.9%). There were four morphological types of PLSVC: type 1, atresia of the right superior vena cava (SVC) (n = 2); type 2A, dual SVCs with an anastomosis between right and left SVCs (n = 15); type 2B, dual SVCs without an anastomosis (n = 16); type 3, PLSVC draining into the left atrium (LA; n = 2); and unclassified in one patient. Thirty-two patients underwent RFCA and electrophysiology study focusing on PLSVC: PLSVC was the trigger of AF in 48.4% of patients and the driver of AF in 46.9% of patients. Cumulatively, PLSVC was a trigger or driver of AF in 22 patients (68.8%). Whether to ablate PLSVC was determined by the results of electrophysiology study, and no significant difference in the late recurrence rate was observed between patients who did and did not have either trigger or driver from PLSVC. CONCLUSION Pre-RFCA cardiac imaging revealed PLSVC in 0.9% of AF patients. This study demonstrated that PLSVC has an important role in initiating and maintaining AF in substantial proportion of patients. Electrophysiology study focusing on PLSVC can help to decide whether to ablate PLSVC.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei Cardiovascular Hospital, Yonsei Health System, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jin Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sang Weon Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Chun Hwang
- Central Utah Medical Clinic Cardiology, Utah Valley Regional Medical Center, 1055 North 500 West, Provo, UT 84006, USA
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Roh SY, Choi JI, Kim MS, Cho EY, Kim YG, Lee KN, Baek YS, Shim J, Kim JS, Park SW, Chugh SS, Kim YH. Trends in the use of implantable cardioverter-defibrillators for prevention of sudden cardiac arrest: A South Korean nationwide population-based study. Pacing Clin Electrophysiol 2019; 42:1086-1094. [PMID: 31197835 DOI: 10.1111/pace.13741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/18/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The benefits of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac arrest (SCA) are well established. However, a significant knowledge gap remains regarding current indications and utilization of ICDs in real-world settings in Asia. METHODS Patients who underwent ICD implantation in South Korea from 2007 to 2015 were identified using the Health Insurance Review and Assessment Service database. We investigated trends in use of ICD for the prevention of SCA. RESULTS A total of 4649 ICDs were implanted during 9 years. ICDs were implanted in 1448 (31.2%) patients for primary prevention and in 3201 (68.8%) for secondary prevention. The proportion of ICDs for primary prevention increased from 6.1% in 2007 to 41.9% in 2015. Primary prevention was more frequent in older (≥40 years) recipients (34.4% vs. 14.6%, P < .0001). The rates of ICD implantation for primary prevention were highest for nonischemic dilated cardiomyopathy (55.1%) and lowest (9.7%) for inherited primary arrhythmia syndrome (IPAS). CONCLUSION Our data showed a trend of progressively increasing rates of ICD implantation in Asia, especially for primary prevention of SCA. Primary prevention as an indication for ICD in patients with IPAS remained low.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Korea University College of Medicine, Korea University Medicine, Guro hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Cho
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin Seok Kim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Weon Park
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sumeet S Chugh
- The Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
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Lee KN, Roh SY, Baek YS, Park HS, Ahn J, Kim DH, Lee DI, Shim J, Choi JI, Park SW, Kim YH. Long-Term Clinical Comparison of Procedural End Points After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation: Elimination of Nonpulmonary Vein Triggers Versus Noninducibility. Circ Arrhythm Electrophysiol 2019; 11:e005019. [PMID: 29431632 DOI: 10.1161/circep.117.005019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 01/25/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is effective for maintenance of sinus rhythm in 50% to 75% of patients with paroxysmal atrial fibrillation, and it is not uncommon for patients to require additional ablation after PVI. We prospectively evaluated the relative effectiveness of 2 post-PVI ablation strategies in paroxysmal atrial fibrillation. METHODS AND RESULTS A total of 500 patients (mean age, 55.7±11.0 years; 74.6% male) were randomly assigned to undergo ablation by 2 different strategies after PVI: (1) elimination of non-PV triggers (group A, n=250) or (2) stepwise substrate modification including complex fractionated atrial electrogram or linear ablation until noninducibility of atrial tachyarrhythmia was achieved (group B, n=250). During a median follow-up of 26.0 months, 75 (32.2%) patients experienced at least 1 episode of recurrent atrial tachyarrhythmia after the single procedure in group A compared with 105 (43.8%) patients in group B (P value in log-rank test of Kaplan-Meier analysis: 0.012). Competing risk analysis showed that the cumulative incidence of atrial tachycardia was significantly higher in group B compared with group A (P=0.007). With the exception of total ablation time, there were no significant differences in fluoroscopic time or procedure-related complications between the 2 groups. CONCLUSIONS Elimination of triggers as an end point of ablation in patients with paroxysmal atrial fibrillation decreased long-term recurrence of atrial tachyarrhythmia compared with a noninducibility approach achieved by additional empirical ablation. The post-PVI trigger test is thus a better end point of ablation for paroxysmal atrial fibrillation.
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Affiliation(s)
- Kwang-No Lee
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Seung-Young Roh
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Yong-Soo Baek
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Hee-Soon Park
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Jinhee Ahn
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Dong-Hyeok Kim
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Dae In Lee
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Jaemin Shim
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Jong-Il Choi
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Sang-Weon Park
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.)
| | - Young-Hoon Kim
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Republic of Korea (K.-N.L., S.-Y.R., Y.-S.B., H.-S.P., J.S., J.-I.C., Y.-H.K.); Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea (J.A.); Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea (D.-H.K., S.-W.P.); and Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.I.L.).
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Park JH, Yoon GS, Choi SH, Baek YS, Kwon SW, Woo SI, Kim DH, Kwan J, Park SD. TCTAP A-108 Predictors of Recurrent Vasospastic Angina: Analysis of Clinical and Angiographic Parameters. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.03.150] [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: 11/15/2022]
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Yoon GS, Choi SH, Park JH, Baek YS, Kwon SW, Park SD, Woo SI, Kim DH, Kwan J. TCTAP A-027 The Benefits of Cardiac Rehabilitation on Clinical Parameters in Patients with Acute Coronary Syndrome. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.03.053] [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: 11/17/2022]
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Shin SH, Jang JH, Baek YS, Kwon SW, Park SD, Woo SI, Kim DH, Kwan J. Relation of blood pressure variability to left ventricular function and arterial stiffness in hypertensive patients. Singapore Med J 2019; 60:427-431. [PMID: 30854570 DOI: 10.11622/smedj.2019030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Variability of blood pressure (BP) has been reported to be related to worse cardiovascular outcomes. We examined the impact of daytime systolic BP variability on left ventricular (LV) function and arterial stiffness in hypertensive patients. METHODS Ambulatory BP monitoring (ABPM) and echocardiography were performed in 116 hypertensive patients. We assessed BP variability as standard deviations of daytime systolic BP on 24-hour ABPM. Conventional echocardiographic parameters, area strain and three-dimensional diastolic index (3D-DI) using 3D speckle tracking were measured. Arterial stiffness was evaluated by acquiring pulse wave velocity (PWV) and augmentation index. RESULTS Patients with higher BP variability showed significantly increased left ventricular mass index (LVMI) and late mitral inflow velocity, as well as decreased E/A (early mitral inflow velocity/late mitral inflow velocity) ratio, area strain and 3D-DI than those with lower BP variability (LVMI: p = 0.02; A velocity: p < 0.001; E/A ratio: p < 0.001; area strain: p = 0.02; 3D-DI: p = 0.04). In addition, increased BP variability was associated with higher PWV and augmentation index (p < 0.001). Even among patients whose BP was well controlled, BP variability was related to LV mass, diastolic dysfunction and arterial stiffness. CONCLUSION Increased BP variability was associated with LV mass and dysfunction, as well as arterial stiffness, suggesting that BP variability may be an important determinant of target organ damage in hypertensive patients.
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Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Ji-Hoon Jang
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Yong-Soo Baek
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Sung-Woo Kwon
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Seong-Ill Woo
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Jun Kwan
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
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Baek YS, Seo JY, Song JY, Lee SY, Kim A, Jeon J. Li-Fraumeni syndrome presenting as cutaneous melanoma in a child: case report and review of literature. J Eur Acad Dermatol Venereol 2019; 33:e174-e175. [PMID: 30653764 DOI: 10.1111/jdv.15430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Y S Baek
- Department of Dermatology, College of Medicine, Korea University, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - J Y Seo
- Department of Dermatology, College of Medicine, Korea University, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - J Y Song
- Department of Dermatology, College of Medicine, Korea University, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - S-Y Lee
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - A Kim
- Department of Pathology, College of Medicine, Korea University, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - J Jeon
- Department of Dermatology, College of Medicine, Korea University, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
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Affiliation(s)
- Sang Won Lee
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Haein Bak
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Yong-Soo Baek
- Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
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Shin SH, Jang JH, Baek YS, Kwon SW, Park SD, Woo SI, Kim DH, Kwan J. Prognostic Impact of Left Atrial Minimal Volume on Clinical Outcome in Patients with Non-Obstructive Hypertrophic Cardiomyopathy. Int Heart J 2018; 59:991-995. [DOI: 10.1536/ihj.17-606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/18/2022]
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Ji-Hoon Jang
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Sung-Woo Kwon
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Sang-don Park
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Seong-Ill Woo
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
| | - Jun Kwan
- Division of Cardiology, Department of Internal Medicine, Inha University Hospital
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Baek YS, Kim DY, Park JH, Yoon GS, Choi SH, Ko KY, Kwon SW, Park SD, Shin SH, Woo SI, Kim DH, Kwan J. P6619Long-term impact of metabolic syndrome management on mortality in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6619] [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 Baek
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - D Y Kim
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - J H Park
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - G S Yoon
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - S H Choi
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - K Y Ko
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - S W Kwon
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - S D Park
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - S H Shin
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - S I Woo
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - D H Kim
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
| | - J Kwan
- Inha University Hospital, Cardiology, Incheon, Korea Republic of
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Baek YS, Yang PS, Kim TH, Uhm JS, Pak HN, Lee MH, Kwan J, Joung BY, Kim DH. P4791Different obesity paradox of ischemic stroke without and with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y S Baek
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - P S Yang
- Yonsei University College of Medicine, Seoul, Korea Republic of
| | - T H Kim
- Yonsei University College of Medicine, Seoul, Korea Republic of
| | - J S Uhm
- Yonsei University College of Medicine, Seoul, Korea Republic of
| | - H N Pak
- Yonsei University College of Medicine, Seoul, Korea Republic of
| | - M H Lee
- Yonsei University College of Medicine, Seoul, Korea Republic of
| | - J Kwan
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - B Y Joung
- Yonsei University College of Medicine, Seoul, Korea Republic of
| | - D H Kim
- Yonsei University College of Medicine, Seoul, Korea Republic of
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Yoon GS, Baek YS, Choi SH, Park JH, Ko KY, Park SD, Kwon SW, Shin SH, Woo SI, Kim DH, Kwan J. P4812Comparison of ischemic stroke risk in atrial fibrillation patients with or without myocardial infarction: a propensity score matched study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4812] [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)
- G S Yoon
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - Y S Baek
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - S H Choi
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - J H Park
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - K Y Ko
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - S D Park
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - S W Kwon
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - S H Shin
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - S I Woo
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - D H Kim
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
| | - J Kwan
- Inha University Hospital, Division of Cardiology, Incheon, Korea Republic of
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Baek YS, Kim DY, Park JH, Yoon GS, Choi SH, Ko KY, Kwon SW, Park SD, Shin SH, Woo SI, Kim DH, Kwan J. P981Long-term clinical impact of sinus rhythm restoration in atrial fibrillation patients with heart failure with mid-ranged ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p981] [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: 11/12/2022] Open
Affiliation(s)
- Y S Baek
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - D Y Kim
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - J H Park
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - G S Yoon
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - S H Choi
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - K Y Ko
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - S W Kwon
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - S D Park
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - S H Shin
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - S I Woo
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - D H Kim
- Inha University Hospital, cardiology, Incheon, Korea Republic of
| | - J Kwan
- Inha University Hospital, cardiology, Incheon, Korea Republic of
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Jang JH, Park JH, Ko KY, Lee M, Baek YS, Kwon SW, Shin SH, Woo SI, Kim DH, Kwan J. TCTAP A-125 Mechanical and Pharmacological Revascularization Strategies for Prevention of Microvascular Dysfunction in ST Segment Elevation Myocardial Infarction: Analysis from Index of Microcirculatory Resistance Registry Data. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kim YG, Choi JI, Kim MN, Cho DH, Oh SK, Kook H, Park HS, Lee KN, Baek YS, Roh SY, Shim J, Park SM, Shim WJ, Kim YH. Non-vitamin K antagonist oral anticoagulants versus warfarin for the prevention of spontaneous echo-contrast and thrombus in patients with atrial fibrillation or flutter undergoing cardioversion: A trans-esophageal echocardiography study. PLoS One 2018; 13:e0191648. [PMID: 29360845 PMCID: PMC5779688 DOI: 10.1371/journal.pone.0191648] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/09/2018] [Indexed: 11/19/2022] Open
Abstract
Spontaneous echo-contrast (SEC) and thrombus observed in trans-esophageal echocardiography (TEE) is known as a strong surrogate marker for future risk of ischemic stroke in patients with atrial fibrillation (AF) or atrial flutter (AFL). The efficacy of non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin to prevent SEC or thrombus in patients with AF or AFL is currently unknown. AF or AFL patients who underwent direct current cardioversion (DCCV) and pre-DCCV TEE evaluation from January 2014 to October 2016 in a single center were analyzed. The prevalence of SEC and thrombus were compared between patients who received NOAC and those who took warfarin. NOAC included direct thrombin inhibitor and factor Xa inhibitors. Among 1,050 patients who were considered for DCCV, 424 patients anticoagulated with warfarin or NOAC underwent TEE prior to DCCV. Eighty patients who were anticoagulated for less than 21 days were excluded. Finally, 344 patients were included for the analysis (180 warfarin users vs. 164 NOAC users). No significant difference in the prevalence of SEC (44.4% vs. 43.9%; p = 0.919), dense SEC (13.9% vs. 15.2%; p = 0.722), or thrombus (2.2% vs. 4.3%; p = 0.281) was observed between the warfarin group and the NOAC group. In multivariate analysis, there was no association between NOAC and risk of SEC (odds ratio [OR]: 1.4, 95% CI: 0.796–2.297, p = 0.265) or thrombus (OR: 3.4, 95% CI: 0.726–16.039, p = 0.120). In conclusion, effectiveness of NOAC is comparable to warfarin in preventing SEC and thrombus in patients with AF or AFL undergoing DCCV. However, numerical increase in the prevalence of thrombus in NOAC group warrants further evaluation.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
- * E-mail:
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Hee-Soon Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Kwang No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Wan Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
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Iqbal M, Jena A, Park HS, Baek YS, Lee KN, Roh SY, Shim JM, Choi JI, Kim YH. Value of adenosine test to reveal dormant conduction or adenosine-induced atrial fibrillation after pulmonary vein isolation. J Arrhythm 2017; 33:602-607. [PMID: 29255508 PMCID: PMC5728995 DOI: 10.1016/j.joa.2017.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/18/2017] [Revised: 07/03/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background Recent studies investigating the implications of additional ablation guided by dormant pulmonary vein (PV) conduction testing using adenosine showed conflicting results, and the data about atrial fibrillation (AF) recurrence after trigger site elimination in adenosine-induced AF are still lacking. Methods Of 846 patients with paroxysmal AF (PAF) who underwent PV isolation (PVI), adenosine test after PVI was performed in 148 patients. Results PVI was successfully achieved in 846 patients. We excluded 58 patients due to loss to the follow-up. A higher rate of AF recurrence was found in the group without adenosine test (136/644, 21%) compared to the group with adenosine test (20/144, 13%, log-rank P=0.047). In multivariate analysis model for AF freedom during the follow-up period, the only significant clinical predictor of AF freedom was adenosine test (hazard ratio [HR] 1.97; 95% confidence interval [CI]: 1.2-3.23; P=0.007).Among 148 patients with adenosine test, 114 (77%) patients showed neither dormant conductions nor AF-induced, 22 (15%) showed positive dormant conductions only, and 12 (8%) revealed adenosine-induced AF (6 of them also showed dormant conduction). After additional ablation in positive dormant conduction group and adenosine-induced AF group, AF recurrence was noted in 4/21 (19%) patients in positive dormant conduction group and 2/11 (18%) patients in adenosine-induced AF group, which was not different from that of patients in negative dormant conduction/ no AF-induced group (14/112, 12%, log-rank P=0.67). Conclusions Adenosine test after PVI to confirm the absence of dormant conduction and triggers initiating AF is beneficial to improve the outcomes after catheter ablation of PAF.
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Affiliation(s)
- Mohammad Iqbal
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea.,Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Jalan Eyckman 38, Bandung 40161, Indonesia
| | - Anupam Jena
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Hee-Soon Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jae-Min Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
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Abstract
BACKGROUND Higher height and weight are known to be associated with higher risk of atrial fibrillation (AF); however, whether the risk of AF is related to abdominal obesity is unclear. METHODS AND RESULTS We studied 501 690 adults (mean age: 47.6±14.3 years; 250 664 women [50.0%]) without baseline AF in the National Sample Cohort released by the National Health Insurance Service in Korea. Body mass index (underweight defined as <18.5; normal, 18.5 to <25.0; overweight, 25.0 to <30.0; and obese, ≥30.0) and waist circumference (abdominal obesity defined as ≥90 cm for men and ≥80 cm for women) were evaluated. During a mean follow-up of 3.9±1.3 years, 3443 participants (1432 women [41.6%]) developed AF. In multivariable models adjusted for clinical variables, the AF risk of underweight, overweight, and obese individuals increased by 21% (95% confidence interval, 1.01-1.45, P=0.043), 14% (95% confidence interval, 1.06-1.23, P<0.001), and 52% (95% confidence interval, 1.30-1.78, P<0.001), respectively, compared with those with normal body mass index. AF risk with confounder-adjusted hazards for abdominal obesity was 18% (95% confidence interval, 1.10-1.27, P<0.001). The increased AF risk was present in abdominally obese individuals regardless of body mass index except for the obese group. In subgroup analysis, abdominal obesity by waist circumference conferred increased risk of new-onset AF, particularly in participants without comorbidities. CONCLUSIONS Abdominal obesity is an important, potentially modifiable risk factor for AF in nonobese Asian persons. These data suggest that interventions to decrease abdominal obesity may reduce the population burden of AF.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Sung Yang
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
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Lee H, Kim TH, Baek YS, Uhm JS, Pak HN, Lee MH, Joung B. The Trends of Atrial Fibrillation-Related Hospital Visit and Cost, Treatment Pattern and Mortality in Korea: 10-Year Nationwide Sample Cohort Data. Korean Circ J 2016; 47:56-64. [PMID: 28154592 PMCID: PMC5287188 DOI: 10.4070/kcj.2016.0045] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/16/2016] [Accepted: 06/07/2016] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives The change of in-hospital and out-hospital treatments, and hospital costs for atrial fibrillation (AF) were not well known in rapidly aging Asian countries. This study is to examine the trends of AF management and outcomes in Korea. Subjects and Methods In the sample cohort from Korean National Health Insurance Data Sample Cohort (K-NHID-Sample Cohort) from 2004 through 2013, we identified patients with AF and hospital visit records using Korean Classification of Diseases, 6th Revision (KCD-6). Hospital cost, prescribed medications, radiofrequency catheter ablation (RFCA), morbidity and mortality were identified. Results AF-related hospitalization and outpatient clinic visits increased by 2.19 and 3.06-fold, respectively. While the total cost increased from 3.6 to 11.3 billion won (p<0.001), the mean cost per patient increased from 0.68 to 0.83 million won (p<0.001). Although the mean CHA2DS2-VASc score increased from 3.5 to 4.4 in the total AF population, the proportion of patients who receive anticoagulation therapy with warfarin showed no significant change for the decade. The proportion of hospitalization for RFCA was increased (0.4% to 1.1%, p<0.001). All-cause mortality (6.7% to 5.0%), cardiovascular mortality (1.4% to 1.1%) and stroke-related death (1.3% to 0.8%) showed a modest decrease from 2004 to 2013. Conclusion During the last decade, AF-related hospitalization and outpatient clinic visits have increased with the increase of many other comorbidities, whereas the rate of anticoagulation did not improved. Although mortality in patients with AF showed a modest decrease from 2004 to 2013, proper anticoagulation therapy is warranted for the improvement of public health.
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Affiliation(s)
- Hancheol Lee
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Park SD, Lee MJ, Baek YS, Kwon SW, Shin SH, Woo SI, Kim DH, Kwan J, Park KS. Randomised trial to compare a protective effect of Clopidogrel Versus TIcagrelor on coronary Microvascular injury in ST-segment Elevation myocardial infarction (CV-TIME trial). EUROINTERVENTION 2016; 12:e964-e971. [PMID: 27721212 DOI: 10.4244/eijv12i8a159] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 11/23/2022]
Abstract
AIMS Ticagrelor has shown greater, more rapid and more consistent platelet inhibition than clopidogrel. However, the superiority of ticagrelor for preventing ischaemic damage in STEMI patients has not been proven. The aim of this trial was to assess whether ticagrelor is superior to clopidogrel in preventing microvascular injury in ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS Patients with STEMI underwent prospective random assignment to receive a loading dose (LD) of clopidogrel 600 mg or ticagrelor 180 mg (1:1 ratio) before primary percutaneous coronary intervention (PCI). As the primary endpoint, the index of microcirculatory resistance (IMR) was measured immediately after primary PCI. The secondary endpoint was the infarct size estimated from the wall motion score index (WMSI). A total of 76 patients were enrolled (clopidogrel group=38, ticagrelor group=38). The IMR in the ticagrelor group was significantly lower than that in the clopidogrel group (22.2±18.0 vs. 34.4±18.8 U, p=0.005). Cardiac enzymes were less elevated in the ticagrelor group than in the clopidogrel group (CK peak; 2,651±1,710 vs. 3,139±2,698 ng/ml, p=0.06). Infarct size, estimated by WMSI, was not different between the ticagrelor and clopidogrel groups at baseline (1.55±0.30 vs. 1.61±0.29, p=0.41) or after three months (1.42±0.33 vs. 1.47±0.33, p=0.57). CONCLUSIONS In patients with STEMI treated by primary PCI, a 180 mg LD of ticagrelor might be more effective in reducing microvascular injury than a 600 mg LD of clopidogrel, as demonstrated by IMR immediately after primary PCI.
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Affiliation(s)
- Sang-Don Park
- Department of Internal Medicine, Inha University Hospital, Incheon, South Korea
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Shin SH, Suh YJ, Baek YS, Lee MJ, Park SD, Kwon SW, Woo SI, Kim DH, Park KS, Kwan J. Impact of area strain by 3D speckle tracking on clinical outcome in patients after acute myocardial infarction. Echocardiography 2016; 33:1854-1859. [DOI: 10.1111/echo.13354] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Young Ju Suh
- Institute of Clinical Research; Inha University College of Medicine; Incheon South Korea
| | - Yong-Soo Baek
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Man-Jong Lee
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Sang-Don Park
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Sung-Woo Kwon
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Seong-Ill Woo
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Dae-Hyeok Kim
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Keum-Soo Park
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
| | - Jun Kwan
- Division of Cardiology; Inha University College of Medicine; Incheon South Korea
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Kim D, Baek YS, Lee M, Uhm JS, Pak HN, Lee MH, Joung B. Remnant Pacemaker Lead Tips after Lead Extractions in Pacemaker Infections. Korean Circ J 2016; 46:569-73. [PMID: 27482268 PMCID: PMC4965438 DOI: 10.4070/kcj.2016.46.4.569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/23/2015] [Accepted: 11/05/2015] [Indexed: 11/11/2022] Open
Abstract
Complete hardware removal is recommended in the case of patients with cardiovascular implantable electronic device (CIED) infections. However, the complete extraction of chronically implanted leads is not always achieved. The outcomes and optimal management of CIED infections with retained material after lead extractions have not been elucidated. In this case report, we present five patients with CIED infections with remnant lead tips even after lead extractions. Two patients had localized pocket infections, and were managed with antibiotics for a period of more than two weeks. The other three patients had infective endocarditis, and were managed with antibiotics for a period of more than four weeks. In one patient, the lead tip migrated to the right pulmonary artery, but did not produce any symptoms or complications. Only one of five patients experienced a resurgence of an infection.
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Affiliation(s)
- Daehoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Soo Baek
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Misol Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Park SD, Lee MJ, Woo SI, Baek YS, Shin SH, Kim DH, Kwan J, Park KS. Epicardial Artery Stenosis with a High Index of Microcirculatory Resistance Is Frequently Functionally Insignificant as Estimated by Fractional Flow Reserve (FFR). Intern Med 2016; 55:97-103. [PMID: 26781006 DOI: 10.2169/internalmedicine.55.4080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Differences in microvascular integrity can diversely influence the functional assessment of epicardial coronary artery disease in each patient. We investigated the relevance of the index of microcirculatory resistance (IMR) and fractional flow reserve (FFR) of intermediate coronary lesions. Methods The IMR and FFR were measured in 67 intermediate coronary lesions of the left anterior descending artery of 67 patients, by using a pressure sensor/thermistor-tipped guidewire. Results To assess the differences in FFR in relationship to the IMR value, patients were divided into tertile IMR groups as follows: Low-IMR (n=22, IMR 14±3), Mid-IMR (n=23, IMR 21±2), and High-IMR (n=22, IMR 36±10). An analysis of variance showed that the High-IMR group had significantly higher FFR values (0.87±0.07) than the Low-IMR group (0.81±0.08) (p=0.03). Functionally significant lesions with FFR ≤0.8 accounted for 9% of lesions in the High-IMR group, 36% in the Low-IMR group and 22% in the Mid-IMR group (p=0.02). In the multivariate logistic analysis, the IMR value was an independent determinant of FFR ≤0.8 (p=0.03). Conclusion In patients with a high IMR, intermediate lesions as identified with visual estimation were more frequently functionally insignificant. The IMR can provide additional information in understanding the mismatch between the anatomical and functional severity of intermediate coronary stenosis.
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Affiliation(s)
- Sang-Don Park
- Department of Internal Medicine, Inha University Hospital, South Korea
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Baek YS, Park SD, Lee MJ, Kwon SW, Shin SH, Woo SI, Kwan J, Kim DH. Relationship between J Waves and Vagal Activity in Patients Who Do Not Have Structural Heart Disease. Ann Noninvasive Electrocardiol 2015; 20:464-73. [PMID: 26417868 DOI: 10.1111/anec.12302] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND J waves are associated with increased vagal activity in patients with idiopathic ventricular fibrillation in several studies to date. However, the relationship between J waves and autonomic nervous activity in patients without structural heart disease remains under investigation. We investigated whether the presence of a J wave on the surface electrocardiogram (ECG) was related to increased vagal activity in patients without structural heart disease. METHODS This retrospective study included 684 patients without structural heart disease who had undergone Holter ECG and surface ECG monitoring. Based on the presence of J waves on the surface ECG, patients were divided into two groups: those with J waves (group 1) and those without J waves (group 2). We compared heart rate variability (HRV), reflecting autonomic nervous activity, using 24-h Holter ECG between the groups. RESULTS J waves were present in 92 (13.4%) patients. Heart rate (HR) in group 1 was significantly lesser than that in group 2 (P = 0.031). The ratio of low-frequency (LF) components to high-frequency (HF) components (LF/HF) in group 1 was significantly lower than that in group 2 (P = 0.001). The square root of the mean squared differences of successive NN intervals in group 1 was also significantly higher than that in group 2 (P = 0.047). In a multivariate regression analysis, male sex, HR, and LF/HF ratio remained independent determinants for the presence of J waves (P = 0.039, P = 0.036, and P < 0.001, respectively). CONCLUSION In patients without structural heart disease, the presence of a J wave was associated with a slow HR, male sex, and increased vagal activity, independently.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Man-Jong Lee
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Sung-Woo Kwon
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Sung-Il Woo
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Jun Kwan
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Inha University Hospital, Incheon, South Korea
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Baek YS, Park SD, Kim SH, Lee MJ, Shin SH, Kim DH, Kwan J, Park KS, Woo SI. Clinical and Angiographic Predictors of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2015; 56:1235-43. [PMID: 26256965 PMCID: PMC4541652 DOI: 10.3349/ymj.2015.56.5.1235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/03/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [<18 U (12.9±2.6 U), n=38], Mid IMR [18-31 U (23.9±4.0 U), n=38], and High IMR [>31 U (48.1±17.1 U), n=37]. RESULTS The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). CONCLUSION Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Soo-Han Kim
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Man-Jong Lee
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Jun Kwan
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Keum-Soo Park
- Division of Cardiology, Inha University Hospital, Incheon, Korea
| | - Seong-Ill Woo
- Division of Cardiology, Inha University Hospital, Incheon, Korea.
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Lee OH, Yoon GS, Choi SH, Shim HI, Baek YS, Shin SH, Kim DH, Woo SI, Park SD. Anomalous origin of the left circumflex artery from the right sinus of valsalva: non-ST-segment elevation myocardial infarction. Intern Med 2015; 54:1053-6. [PMID: 25948346 DOI: 10.2169/internalmedicine.54.2956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An anomalous origin of the left coronary artery from the right sinus of Valsalva (RSV) is rare. We herein report the case of an 80-year-old woman who presented to the emergency department with chest pain. Emergent coronary angiography was performed following a diagnosis of non-ST segment elevation myocardial infarction. A right coronary angiogram showed that the common trunk originating from the RSV branched into the left anterior descending and right coronary arteries. Although the initial angiogram failed to show the left circumflex artery (LCx), considered to be the culprit vessel, computed tomographic angiography demonstrated that the LCx was located immediately below the common trunk and exhibited a retroaortic course. We successfully treated the patient and obtained optimal angiography results.
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Affiliation(s)
- Oh Hyun Lee
- Department of Cardiology, Inha University School of Medicine, Korea
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Kim SH, Park SD, Baek YS, Lee SY, Shin SH, Woo SI, Kim DH, Kwan J. Prasugrel-induced hypersensitivity skin reaction. Korean Circ J 2014; 44:355-7. [PMID: 25278991 PMCID: PMC4180615 DOI: 10.4070/kcj.2014.44.5.355] [Citation(s) in RCA: 8] [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: 08/21/2013] [Revised: 09/04/2013] [Accepted: 10/08/2013] [Indexed: 11/25/2022] Open
Abstract
We report a case of hypersensitivity skin reaction to prasugrel. The patient exhibited a generalized skin rash after treatment with prasugrel, which was resolved after discontinuation of prasugrel and substitution to clopidogrel. Clopidogrel was successfully administered as an alternative to prasugrel without any signs of further hypersensitivity.
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Affiliation(s)
- Soo-Han Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seon-Young Lee
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sung-Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Sung-Il Woo
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jun Kwan
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Baek YS, Jeon J, Kim JH, Oh CH. Severity of acute and chronic urticaria correlates with D-dimer level, but not C-reactive protein or total IgE. Clin Exp Dermatol 2014; 39:795-800. [PMID: 25196271 DOI: 10.1111/ced.12413] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although various scoring systems for measuring urticaria severity have been introduced, most rely on subjective criteria. Therefore, additional objective criteria such as laboratory markers would be helpful adjuncts in making this assessment. AIM To evaluate the usefulness of three laboratory markers [D-dimer, C-reactive protein (CRP), and total IgE] in assessing disease severity of both acute urticaria (AU) and chronic urticaria (CU). METHODS We conducted a retrospective analysis of 94 patients with urticaria. Correlations between the aforementioned laboratory markers and the Urticaria Activity Score (UAS) were calculated. RESULTS A substantial proportion of patients with urticaria (acute 43.5%; chronic 39.6%) had an increased D-dimer level. Additionally, there was a significant correlation between D-dimer level and UAS (AU r = 0.60, P < 0.001; CU r = 0.37, P < 0.05). However, there was no significant correlation between UAS and either CRP or total IgE. CONCLUSIONS D-dimer level could be used as a marker of disease severity for both AU and CU. However, CRP and total IgE are not as reliable in predicting disease severity.
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Affiliation(s)
- Y S Baek
- Department of Dermatology, College of Medicine, Korea University, Seoul, Korea
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Kim SH, Kim DH, Park SD, Baek YS, Woo SI, Shin SH, Kwan J, Park KS. The relationship between J wave on the surface electrocardiography and ventricular fibrillation during acute myocardial infarction. J Korean Med Sci 2014; 29:685-90. [PMID: 24851026 PMCID: PMC4024957 DOI: 10.3346/jkms.2014.29.5.685] [Citation(s) in RCA: 10] [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: 09/04/2013] [Accepted: 03/20/2014] [Indexed: 12/20/2022] Open
Abstract
We investigated whether the presence of J wave on the surface electrocardiography (sECG) could be a potential risk factor for ventricular fibrillation (VF) during acute myocardial infarction (AMI). We performed a retrospective study of 317 patients diagnosed with AMI in a single center from 2009 to 2012. Among the enrolled 296 patients, 22 (13.5%) patients were selected as a VF group. The J wave on the sECG was defined as a J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads. We found that the incidence of J wave on the sECG was significantly higher in the VF group. We also confirmed that several conventional risk factors of VF were significantly related to VF during AMI; time delays from the onset of chest pain, blood concentrations of creatine phosphokinase and incidence of ST-segment elevation. Multiple logistic regression analysis demonstrated that the presence of J wave and the presence of a ST-segment elevation were independent predictors of VF during AMI. This study demonstrated that the presence of J wave on the sECG is significantly related to VF during AMI.
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Affiliation(s)
- Soo-Han Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Dae-Hyeok Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Sang-Don Park
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Yong-Soo Baek
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Seong-Ill Woo
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Sung-Hee Shin
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jun Kwan
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Keum-Soo Park
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
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Baek YS, Shin SH, Yi HG, Kim DH, Woo SI, Park KS, Kwan J. Cardiac involvement in CD56 negative primary pancreatic extranodal NK/T-cell lymphoma, nasal type, presenting with ventricular tachycardia during the early stages of chemotherapy. Intern Med 2014; 53:2333-6. [PMID: 25318798 DOI: 10.2169/internalmedicine.53.2764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 23-year-old man who presented with recurrent pancreatitis and was diagnosed with primary pancreatic extranodal natural killer/T-cell lymphoma, nasal type, involving the right ventricle. The cardiac involvement was screened and confirmed by transthoracic echocardiography (TTE), cardiac magnetic resonance imaging and fluorodeoxyglucose positron emission tomography. Although the patient did not have any cardiac symptoms or evidence of arrhythmia before chemotherapy, he presented with fatal newly developed ventricular tachycardia during the early stages of chemotherapy. The follow-up TTE after his chemotherapy demonstrated markedly decreased thickness of the invaded myocardium, thus suggesting that the myocardium infiltrated by lymphoma cells might become vulnerable to fatal arrhythmia with tumor regression.
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Affiliation(s)
- Yong-Soo Baek
- Division of Cardiology, Inha University College of Medicine, South Korea
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Baek YS, Ryu JS, Hong SB, Yoo SS, Yu HK, Son DW, Kim L, Kang HS, Kim BJ, Lee KH, Cho JH, Yoon YH, Kwak SM, Lee HL, Kim KH. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Following Adjuvant Chemotherapy with Cisplatin plus Paclitaxel in Non-Small Cell Lung Cancer Patient. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.61.6.591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yong-Soo Baek
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Seong-Bin Hong
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Sung-Soo Yoo
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Hyung-Kwon Yu
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Dong-Wook Son
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Lucia Kim
- Department of Pathology, College of Medicine, Inha University, Incheon, South Korea
| | - Hye-Sun Kang
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Beom-Joon Kim
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Kyung-Hee Lee
- Department of Radiology, College of Medicine, Inha University, Incheon, South Korea
| | - Jae-Hwa Cho
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Young-Han Yoon
- Department of Chest Surgery, College of Medicine, Inha University, Incheon, South Korea
| | - Seung-Min Kwak
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Hong-Lyeol Lee
- Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea
| | - Kwang-Ho Kim
- Department of Chest Surgery, College of Medicine, Inha University, Incheon, South Korea
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