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Lee J, Oh PC, Jang AY, Ahn CM, Choi D, Ko YG, Kang WC. Long-Term Outcomes of Endovascular Repair Within and Outside the Instructions for Use in Korean Patients With Abdominal Aortic Aneurysm. J Endovasc Ther 2024:15266028241232915. [PMID: 38414229 DOI: 10.1177/15266028241232915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Endovascular aneurysm repair (EVAR) has been used worldwide to treat abdominal aortic aneurysms (AAAs). Outcomes after EVAR within and outside the instruction for use (IFU) remain controversial. We analyzed long-term outcomes of EVAR within-the-IFU compared with that outside-the-IFU and baseline clinical/anatomical characteristics that influence outcomes of EVAR. METHODS The study included 546 patients who underwent EVAR for infrarenal AAA from 1997 to 2021 at 2 Korean medical centers. The primary endpoint was graft-related adverse events (GRAEs), including type 1 or 3 endoleak, reintervention (included open conversion), aneurysm sac enlargement, aneurysm-related mortality (ARM), rupture, stent-graft migration, and stent thrombotic occlusion. RESULTS The patients who underwent EVAR outside the IFU were 287 (52.6%). A neck angle of >60° was most common outside the IFU criteria (n=146, 50.9%). This study revealed that patients outside the IFU had a higher rate of GRAEs compared with patients within the IFU (hazard ratio [HR]: 1.879; 95% confidence interval [CI]: 1.045-2.386). A neck angle of >60° was a significant risk factor for GRAEs (adjusted HR: 2.229; 95% CI: 1.418-3.503), type 1 or 3 endoleak (adjusted HR: 2.640; 95% CI: 1.343-5.189), and reintervention (adjusted HR: 1.891; 95% CI: 1.055-3.388). CONCLUSIONS Our study revealed EVAR with outside the IFU was associated with increased GRAEs, mainly attributed to endoleak and ARM, compared with EVAR with within the IFU. In addition, severe neck angulation was an independent risk factor for GRAEs, type 1 or 3 endoleak, and reintervention. CLINICAL IMPACT Our study revealed endovascular aneurysm repair (EVAR) with outside-the-instruction for use (IFU) was associated with increased graft-related adverse events (GRAEs) compared with EVAR with within-the-IFU. In the low-risk population, the incidence of GRAEs and Aneurysm related mortality were higher in the outside-the-IFU group rather than within-the-IFU group. In addition, severe neck angulation was an independent risk factor for GRAEs, type 1 or 3 endoleak and reintervention.
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Affiliation(s)
- Joonpyo Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Seo J, Park YM, Shin YH, Jang AY, Kang WC, Chung W, Kim Y, Choi IS. Improved intra-atrial conduction delay after successful ablation for atrial fibrillation by scar homogenization in right atrium. Ann Noninvasive Electrocardiol 2023; 28:e13091. [PMID: 37786276 PMCID: PMC10646382 DOI: 10.1111/anec.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/17/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
Atrial fibrosis in the right atrium (RA) presenting as a low-voltage zone might be the mechanism of atrial fibrillation (AF) and intra-atrial conduction delay. The impact of scar homogenization in RA on intra-atrial conduction delay is unknown. We describe a patient with paroxysmal AF and significant intra-atrial conduction delay with repetitive atrial flutter, triggered from the lateral free wall in the RA between the significant low-voltage zone and slow conduction area after pulmonary vein isolation. Linear ablation along the trabeculated lateral free wall in the RA to homogenize the scar was successfully performed, and the intra-atrial conduction delay improved ultimately.
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Affiliation(s)
- Jeongduk Seo
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Yae Min Park
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Yong Hoon Shin
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | | | - Woong Chol Kang
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Wook‐Jin Chung
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
| | - Young‐Hoon Kim
- Cardiology DivisionKorea University Anam HospitalSeoulKorea
| | - In Suck Choi
- Cardiology DivisionGachon University Gil Medical CenterIncheonKorea
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Seo J, Lee J, Shin YH, Jang AY, Suh SY. Acute myocardial infarction after initially diagnosed with unprovoked venous thromboembolism: A case report. World J Clin Cases 2023; 11:7497-7501. [PMID: 37969461 PMCID: PMC10643057 DOI: 10.12998/wjcc.v11.i30.7497] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/03/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Protein C deficiency is typically associated with venous thromboembolism; however, arterial thrombosis has been reported in several cases. We report the case of a patient with pulmonary thromboembolism and deep vein thrombosis following acute myocardial infarction with high thrombus burden. CASE SUMMARY A 40-year-old man was diagnosed with pulmonary thromboembolism and deep vein thrombosis without any provoking factors. The patient was treated with anticoagulants for six months, which were then discontinued. Three months after the discontinuation of anticoagulant therapy, the patient was hospitalized with chest pain and diagnosed with acute myocardial infarction with high thrombus burden. Additional tests revealed protein C deficiency associated with thrombophilia. The patient was treated with anticoagulants combined with dual antiplatelet agents for 1 year after percutaneous coronary intervention, and no recurrent events were reported during a follow-up period of 5 years. CONCLUSION Recurrent thromboembolic events including acute myocardial infarction with thrombus should be considered an alarming sign of thrombophilia.
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Affiliation(s)
- Jeongduk Seo
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
| | - Joonpyo Lee
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
| | - Yong Hoon Shin
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
| | - Soon Yong Suh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 405-760, South Korea
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Shin Y, Jang AY, Won Y, Yang T, Kim J, Lee J, Seo J, Kim M, Oh PC, Chung WJ, Moon J, Kang WC. Long-term clinical outcomes for patients with uncrossable patent foramen ovale. Front Cardiovasc Med 2023; 10:1249259. [PMID: 37900574 PMCID: PMC10611517 DOI: 10.3389/fcvm.2023.1249259] [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: 06/28/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Patent foramen ovale (PFO) closure is performed in selected patients with cryptogenic stroke to prevent recurrence. The prognosis of patients with uncrossable PFO after failed guidewire or catheter passage during the procedure remains unknown. We compared the long-term prognosis between uncrossable PFO and successful PFO closure in patients with high-grade PFO shunts. Methods We analyzed patients who underwent PFO closure for stroke or transient ischemic attack (TIA) prevention at Gachon University Gil Medical Center between April 2010 and March 2022. The primary outcome was a composite of recurrent stroke or TIA. Secondary outcomes included stroke, TIA, all-cause death, and a composite of stroke, TIA, and all-cause death. Results Of 286 patients, 245 were included in the analysis after excluding those with transseptal puncture technique usage or concurrent atrial septal defect. Among them, 82 had uncrossable PFO, and 163 underwent successful PFO closure. Large shunts were more prevalent in the PFO closure group compared to the uncrossable PFO group (62.0% vs. 34.1%, P < 0.001), and resting shunts were also more common in the PFO closure group (17.8% vs. 2.4%, P < 0.001). Stroke or TIA occurred in 2 patients (2.4%) in the uncrossable PFO group and 8 patients (4.9%) in the PFO closure group (hazard ratio, 1.44; 95% confidence interval, 0.30-6.81; P = 0.647). Additionally, no disparities in the occurrence of stroke or TIA were found in subgroups divided by baseline characteristics, RoPE score, or shunt grade. Conclusion Clinical outcomes for patients with uncrossable PFO seem similar to those with successful PFO closure.
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Affiliation(s)
- Yonghoon Shin
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Yoonsun Won
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Taeil Yang
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Joohan Kim
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Joonpyo Lee
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Jeongduk Seo
- Department of Internal Medicine, Cardiovascular Center, Chinjujeil Hospital, Jinju, Republic of Korea
| | - Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Republic of Korea
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An M, Park YM, Seo J, Lee J, Jang AY, Kang WC, Chung WJ, Choi IS. Thromboembolic Events in Patients with Hypertrophic Cardiomyopathy and Atrial Fibrillation During New Oral Anticoagulant Therapy. Anatol J Cardiol 2023; 27:608-610. [PMID: 37599635 PMCID: PMC10541780 DOI: 10.14744/anatoljcardiol.2023.3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Myeonghyun An
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yae Min Park
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jeongduk Seo
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Joonpyo Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - In Suck Choi
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Shin Y, Won Y, Yang T, Kim J, Lee J, Seo J, Jang AY, Kim M, Oh PC, Lee K, Kang WC, Han SH, Suh SY. Safety and Efficacy of Post-Dilation in Percutaneous Coronary Intervention Using Polymer-Free Ultrathin Strut Sirolimus-Probucol Coated Drug-Eluting Stents. Medicina (Kaunas) 2023; 59:1649. [PMID: 37763768 PMCID: PMC10536641 DOI: 10.3390/medicina59091649] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Polymer-free ultrathin strut sirolimus- and probucol-eluting stents (PF-SES) are recognized as safe and effective in diverse patient populations, although the implications of post-dilation during stent implantation remain underexamined. Materials and Methods: In this study, patients implanted with PF-SES at Gachon University Gil Medical Center between December 2014 and February 2018 were evaluated. Major adverse cardiovascular events (MACE), encompassing nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death were identified as primary outcomes, with secondary outcomes including target vessel revascularization (TVR), target lesion revascularization (TLR), and in-stent restenosis (ISR). Results: Of the 384 initial patients, 299 were considered eligible for analysis. The groups, delineated by those undergoing post-dilation (143 patients) and those not (156 patients), exhibited comparable rates of primary outcomes [hazard ratio (HR), 2.17; 95% confidence interval (CI), 0.40 to 11.87; p = 0.37]. The outcomes remained consistent irrespective of the post-dilation status and were similarly unaffected in multivariate analyses (HR, 2.90; 95% CI, 0.52 to 16.34; p = 0.227). Conclusions: These results suggest that the clinical outcomes of patients with post-dilation were similar to that of those without post-dilation in those with the polymer-free sirolimus- and probucol-eluting stents.
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Affiliation(s)
- Yonghoon Shin
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonsun Won
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Taeil Yang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joohan Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joonpyo Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Jeongduk Seo
- Department of Internal Medicine, Cardiovascular Center, Chinjujeil Hospital, Jinju 52709, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Minsu Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Seung Hwan Han
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Soon Yong Suh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
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Kim M, Jang AY, Lee J, Seo J, Shin YH, Oh PC, Suh SY, Lee K, Kang WC, Han SH. Comparison of 7-Year, Real-World Clinical Outcomes between Drug-Coated Balloon Angioplasty versus Drug-Eluting Stent Implantation in Patients with Drug-Eluting Stent In-Stent Restenosis. J Clin Med 2023; 12:4246. [PMID: 37445278 DOI: 10.3390/jcm12134246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
There are no data available comparing the real-world, long-term clinical outcomes of drug-eluting balloon (DEB) angioplasty and drug-eluting stent (DES) implantation in DES in-stent restenosis (ISR) lesions. We aimed to compare the real-world, long-term data available between DEBs and DESs in DES-ISR lesions. We analyzed consecutive DES-ISR lesions (225 lesions from 205 patients; male: 66.3%; mean age: 62.4 years) treated with either DEB or DES. The primary endpoint was target lesion revascularization (TLR), and the primary safety endpoint was the lesion-oriented composite outcome (LOCO). The LOCO is composed of cardiac death, myocardial infarction, and target lesion thrombosis during follow-up. During the 7-year follow-up period, TLR did not differ significantly between the DEB (n = 108) and the DES groups (n = 117) (HR: 1.07; 95% CI: 0.59-1.93, p = 0.83). The LOCO was significantly lower in the DEB group compared to the DES group (HR: 0.40; 95% CI: 0.16-0.98, p = 0.04), which was mainly driven by the lower levels of myocardial infarction (HR: 0.24; 95% CI: 0.06-0.94, p = 0.04) and the absence of target lesion thrombosis in the DEB group (vs. DES group 6%, p = 0.02). Additionally, cardiac death was found to be similar between the DEB and DES groups (HR: 0.56; 95% CI: 0.18-1.75, p = 0.32). DEB angioplasty showed favorable safety with a similar efficacy to that of DES implantation in DES-ISR lesions during the long-term follow-up period.
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Affiliation(s)
- Minsu Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joonpyo Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Jeongduk Seo
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Yong Hoon Shin
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Soon Yong Suh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Seung-Hwan Han
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
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Jang AY, Lee HH, Lee H, Kim HC, Chung WJ. Epidemiology of PAH in Korea: An Analysis of the National Health Insurance Data, 2002–2018. Korean Circ J 2023; 53:313-327. [PMID: 37161745 PMCID: PMC10172270 DOI: 10.4070/kcj.2022.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/11/2022] [Accepted: 01/18/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pulmonary arterial hypertension (PAH) is a rare but fatal disease. Recent advances in PAH-specific drugs have improved its outcomes, although the healthcare burden of novel therapeutics may lead to a discrepancy in outcomes between developing and developed countries. We analyzed how the epidemiology and clinical features of PAH has changed through the rapidly advancing healthcare infrastructure in South Korea. METHODS PAH was defined according to a newly devised 3-component algorithm. Using a nationwide health insurance claims database, we delineated annual trends in the prevalence, incidence, medication prescription pattern, and 5-year survival of PAH in Korea. Cumulative survival and potential predictors of mortality were also assessed among 2,151 incident PAH cases. RESULTS Between 2002 or 2004 and 2018, the prevalence and incidence of PAH increased 75-fold (0.4 to 29.9 per million people) and 12-fold (0.5 to 6.3 per million person-years), respectively. The proportion of patients on combination PAH-specific drug therapy has also steadily increased up to 29.0% in 2018. Among 2,151 incident PAH cases (median [interquartile range] age, 50 [37-62] years; 67.2% female), the 5-year survival rate and median survival duration were 71.8% and 13.1 years, respectively. Independent predictors of mortality were age, sex, etiology of PAH, diabetes, dyslipidemia, and chronic kidney disease. CONCLUSIONS This nationwide study delineated that the prevalence and incidence of PAH have grown rapidly in Korea since the early 2000s. The use of combination therapy has also increased, and the 5-year survival rate of PAH in Korea was similar to those in western countries.
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Affiliation(s)
- Albert Youngwoo Jang
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Albert Youngwoo Jang and Hyeok-Hee Lee contributed equally to the manuscript
| | - Hyeok-Hee Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Albert Youngwoo Jang and Hyeok-Hee Lee contributed equally to the manuscript
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wook-Jin Chung
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Ha K, Jang AY, Shin YH, Lee J, Seo J, Lee SI, Kang WC, Suh SY. Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery: A case report. World J Clin Cases 2022; 10:9897-9903. [PMID: 36186178 PMCID: PMC9516934 DOI: 10.12998/wjcc.v10.i27.9897] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/25/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. When patients having such anomalies receive transradial intervention (TRI), aortic dissection (AD) may occur. Herein, we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient, that was later salvaged by percutaneous angioplasty.
CASE SUMMARY A 73-year-old man presented to our hospital with intermittent chest pain. Coronary computed tomography (CT) angiography revealed significant stenosis in the left anterior descending artery. Diagnostic coronary angiography was performed via the right radial artery without difficulty. However, we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention, while the guidewire tended to go down the descending aorta. The patient suddenly complained of chest and back pain. Emergent CT aortography revealed type B AD propagating to the left renal artery (RA) with preserved renal perfusion. However, after 2 d, the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable. Follow-up CT indicated further progression of dissection to the right external iliac artery (EIA) and left RA with limited flow. We performed percutaneous angioplasty of the right EIA and left RA without complications. Follow-up CT aortography at 8 mo showed optimal results.
CONCLUSION A caution is required during right TRI in ARSA to avoid AD. Percutaneous angioplasty can be a treatment option.
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Affiliation(s)
- Kyungeun Ha
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Yong Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Joonpyo Lee
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Jeongduk Seo
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seok In Lee
- Department of Thoracic and Cardiovascular Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Incheon, South Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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Lee J, Seo J, Shin YH, Jang AY, Suh SY. ST-segment elevation myocardial infarction in Kawasaki disease: A case report and review of literature. World J Clin Cases 2022; 10:9368-9377. [PMID: 36159436 PMCID: PMC9477670 DOI: 10.12998/wjcc.v10.i26.9368] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm (CAA). CAAs are associated with a high rate of adverse cardiovascular events.
CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain. Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram. An aneurysm of the left circumflex (LCX) coronary artery was found with massive thrombi within. A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications. The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7, suggestive of a small aneurysm considering his age, sex, and body surface area. We further present a case series of 19 patients with KD, including the current patient, presenting with acute coronary syndrome (ACS). Notably, none of the cases showed Z scores; only five patients (26%) had been regularly followed up by a physician, and only one patient (5.3%) was being treated with antithrombotic therapy before ACS occurred.
CONCLUSION For KD presenting with ACS, regular follow up and medical therapy may be crucial for improved outcomes.
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Affiliation(s)
- Joonpyo Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Jeongduk Seo
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Yong Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 21565, South Korea
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11
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Jang AY, Kim M, Oh PC, Suh SY, Lee K, Kang WC, Choi KH, Song YB, Gwon HC, Kim HS, Chun WJ, Hur SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Hong SJ, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Nam CW, Koo BK, Han SH. Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions - A Baseline Clinical and Lesion Characteristic-Matched Analysis. Circ J 2022; 86:1365-1375. [PMID: 35896356 DOI: 10.1253/circj.cj-22-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions.Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). CONCLUSIONS The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Medicine, Chungnam National University Hospital
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea
| | - So-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
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12
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Jang AY, Oh PC, Kang JM, Park CH, Kang WC. Extensive complex thoracoabdominal aortic aneurysm salvaged by surgical graft providing landing zone for endovascular graft: A case report. World J Clin Cases 2022; 10:5005-5011. [PMID: 35801037 PMCID: PMC9198850 DOI: 10.12998/wjcc.v10.i15.5005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/07/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical repair of complex abdominal aortic aneurysm is associated with a higher perioperative mortality and morbidity. The advent of endovascular aortic repair (EVAR) has reduced perioperative complications, although the utilization of such techniques is limited by lesion characteristics, such as involvement of the visceral or renal arteries (RA) and/or presence of a sealing zone.
CASE SUMMARY A 60-year-old male presented with a Crawford type IV complex thoracoabdominal aortic aneurysm (CAAA) starting directly distal to the diaphragm extending to both common iliac arteries (CIAs). The CAAA consist of a proximal and distal aneurysmal sac separated by a 1 cm-healthy zone in the infrarenal level. Due to the poor performance of the patient and the expansive disease, we planned a stepwise-combined surgery and EVAR to minimize invasiveness. A branched graft was implanted after surgical debranching of the visceral and RA. Since the patient had renal and liver injury after surgery, the second stage EVAR was performed 10 mo later. The stent graft was implanted from the distal portion of surgical branched graft to both CIAs during EVAR. The patient has been uneventful for 5-years after discharge and is being followed in the outpatient clinic.
CONCLUSION The current case demonstrates that the surgical graft can provide a landing zone for second stage EVAR to avoid aggressive surgery in patients with poor performance with a long hostile CAAA.
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Affiliation(s)
- Albert Youngwoo Jang
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 1198, South Korea
| | - Pyung Chun Oh
- Department of Internal Medicine, Gil Medical Center, Gachon Cardiovascular Research Institute, Gachon University College of Medicine, Incheon 1198, South Korea
| | - Jin Mo Kang
- Division of Vascular Surgery, Gachon University Gil Medical Center, Incheon 1198, South Korea
| | - Chul Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon 1198, South Korea
| | - Woong Chol Kang
- Division of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, Incheon 1198, South Korea
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13
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Yeo J, Shin N, Ahn KJ, Seo M, Jang AY, Kim M, Chung WJ. Pulmonary arterial hypertension due to antiphospholipid syndrome initially mimicking chronic thromboembolic pulmonary hypertension. Clin Hypertens 2022; 28:10. [PMID: 35361265 PMCID: PMC8973988 DOI: 10.1186/s40885-021-00191-1] [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] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is the second most common lung complication in antiphospholipid syndrome (APS) patients. However, the concurrent development of APS-related nonthrombotic PAH is rarely reported. Lack of awareness for group 1 PAH in APS patient may contribute to underdiagnosis of this condition. Herein, we reviewed the case of a 56-year-old female who was diagnosed with PAH related to APS that mimicked chronic thromboembolic pulmonary hypertension (CTEPH). It is crucial to be aware of the possibility of a group 1 PAH diagnosis, even though patients have already been diagnosed with CTEPH. Furthermore, a multidisciplinary approach and serial follow-up right heart catheterization with echocardiography are important to make a timely diagnosis and provide optimal treatment for APS-related PAH in patients with CTEPH-like clinical features.
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Affiliation(s)
- Jina Yeo
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Nami Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Kyung-Jin Ahn
- Department of Pediatrics, Division of Pediatric Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Miryoung Seo
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea.,Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Minsu Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea.,Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Wook-Jin Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea. .,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea. .,Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.
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14
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Jang AY, Seo J, Kang WC, Chung WJ, Park YM. Unexpected paced wide QRS complex rhythm after successful implantation of cardiac resynchronization therapy; what is the mechanism? J Electrocardiol 2022; 73:8-11. [DOI: 10.1016/j.jelectrocard.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/18/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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15
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Jang AY, Kim M, Lee J, Seo J, Shin YH, Oh PC, Suh SY, Lee K, Kang WC, Ahn T, Han SH. Real-World Treatment Selection Factors and 7-Year Clinical Outcomes between Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Left Main Disease. J Clin Med 2022; 11:jcm11030503. [PMID: 35159955 PMCID: PMC8836954 DOI: 10.3390/jcm11030503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/31/2021] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The decision-making factors and long-term clinical outcomes between PCI and CABG in left main (LM) disease are still not well defined in the real world. Methods: We evaluated consecutive patients (n = 230) with LM disease either treated by PCI (n = 118) or CABG (n = 112). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction (MI), stroke, and target vessel revascularization (TVR) for 7 years. Results: In the multivariate-adjusted analysis, the presence of intermediate EuroSCORE II and high SYNTAX scores predisposed to CABG. Isolated LM disease was associated with receiving PCI. The PCI group had a similar rate of MACE (HRadj 0.97, 95% CI [0.48–1.94], p = 0.92) and a lower tendency of hard MACE (HRadj 0.49, 95% CI [0.22–1.07], p = 0.07) compared to the CABG group, mainly due to the balance between a higher rate of TVR (HRadj 9.71, p = 0.02) and a lower rate of stroke (HRadj 0.22, p = 0.09) with the PCI group than in the CABG group. Conclusions: The decision making of treatment strategy was made based on clinical and angiographic factors. The selected patients who received PCI showed similar MACE and trend of a lower rate of composite hard endpoints despite multivariate adjustment.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Joonpyo Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Jeongduk Seo
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Yong Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
| | - Taehoon Ahn
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul 02841, Korea;
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (M.K.); (J.L.); (J.S.); (Y.H.S.); (P.C.O.); (S.Y.S.); (K.L.); (W.C.K.)
- Correspondence: ; Tel.: +82-32-460-3683; Fax: +82-32-460-3117
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16
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Jang AY, Kang WC, Park YM, Ha K, Seo J, Oh PC, Lee K, Moon J. The Thromboembolic Predictability of CHA 2DS 2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation. J Clin Med 2022; 11:jcm11020300. [PMID: 35053995 PMCID: PMC8781364 DOI: 10.3390/jcm11020300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Abstract
The association between congestive heart failure (CHF) of the CHA2DS2-VASc scores and thromboembolic (TE) events in patients with atrial fibrillation (AF) is a topic of debate due to conflicting results. As the importance of diastolic impairment in the occurrence of TE events is increasingly recognized, it is crucial to evaluate the predictive power of CHA2DS2-VASc scores with C criterion integrating diastolic parameters. We analyzed 4200 Korean nonvalvular AF patients (71 years of age, 59% men) to compare multiple echocardiographic definitions of CHF. Various guideline-suggested echocardiographic parameters for systolic or diastolic impairment, including left ventricular ejection fraction (LVEF) ≤ 40%, the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E’) ≥ 11, left atrial volume index > 34 mL/m2, and many others were tested for C criteria. Multivariate-adjusted Cox regression analysis showed that CHA2DS2-VASc score was an independent predictor for composite thromboembolic events only when CHF was defined as E/E’ ≥ 11 (hazard ratio, 1.26; p = 0.044) but not with other criteria including the original definition (hazard ratio, 1.10; p = 0.359). Our findings suggest that C criterion defined as diastolic impairment, such as E/E’ ≥ 11, may improve the predictive value of CHA2DS2-VASc scores.
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Affiliation(s)
| | - Woong Chol Kang
- Correspondence: (W.C.K.); (J.M.); Tel.: +82-32-460-3054 (W.C.K. & J.M.); Fax: +82-32-460-1901 (W.C.K.); +82-32-469-1906 (J.M.)
| | | | | | | | | | | | - Jeonggeun Moon
- Correspondence: (W.C.K.); (J.M.); Tel.: +82-32-460-3054 (W.C.K. & J.M.); Fax: +82-32-460-1901 (W.C.K.); +82-32-469-1906 (J.M.)
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17
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Oh PC, Jang AY, Kang WC. Pulsatile Compression of Stent-Graft by Re-pressurizing Aneurysmal Sac With Type III Endoleak After Endovascular Aneurysm Repair: A Case Report. Korean Circ J 2022; 52:478-480. [PMID: 35656905 PMCID: PMC9160647 DOI: 10.4070/kcj.2021.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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18
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Oh S, Jung JH, Ahn KJ, Jang AY, Byun K, Yang PC, Chung WJ. Stem Cell and Exosome Therapy in Pulmonary Hypertension. Korean Circ J 2022; 52:110-122. [PMID: 35128849 PMCID: PMC8819574 DOI: 10.4070/kcj.2021.0191] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 05/31/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Pulmonary hypertension (PH) is a disease that eventually causes right heart failure by remodeling pulmonary blood vessels. Based on the histopathological characteristics, PH is categorized into five subgroups. Rarely, a severe clinical entity is pulmonary arterial hypertension (PAH), subgroup 1. This disease process results in pulmonary vascular alterations through dysfunction of the pulmonary endothelium and disturbance of immune responses. Although medical treatments based on these pathophysiologic concepts have been applied for more than 30 years, PAH still cannot be cured. This review addresses the feasibility of and perspectives on stem cell therapy, including the role of exosomes in PAH. Pulmonary hypertension is a rare and progressive illness with a devastating prognosis. Promising research efforts have advanced the understanding and recognition of the pathobiology of pulmonary hypertension. Despite remarkable achievements in terms of improving the survival rate, reducing disease progression, and enhancing quality of life, pulmonary arterial hypertension (PAH) is not completely curable. Therefore, an effective treatment strategy is still needed. Recently, many studies of the underlying molecular mechanisms and technological developments have led to new approaches and paradigms for PAH treatment. Management based on stem cells and related paracrine effects, epigenetic drugs and gene therapies has yielded prospective results for PAH treatment in preclinical research. Further trials are ongoing to optimize these important insights into clinical circumstances.
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Affiliation(s)
- Seyeon Oh
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Ji-Hye Jung
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kyung-Jin Ahn
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Division of Pediatric Cardiology, Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
| | - Albert Youngwoo Jang
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyunghee Byun
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Functional Cellular Networks Laboratory, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
- Department of Anatomy and Cell Biology, College of Medicine, Gachon University, Incheon, Korea
| | - Phillip C. Yang
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Wook-Jin Chung
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
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19
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Park YM, Jang AY, Chung WJ, Han SH, Semsarian C, Choi IS. Ventricular fibrillation and sudden cardiac arrest in apical hypertrophic cardiomyopathy: Two case reports. World J Clin Cases 2021; 9:11102-11107. [PMID: 35047624 PMCID: PMC8678876 DOI: 10.12998/wjcc.v9.i35.11102] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/12/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Apical hypertrophic cardiomyopathy (HCM) is considered to have a benign prognosis in terms of cardiovascular mortality. This serial case report aimed to raise awareness of ventricular fibrillation (VF) and sudden cardiac death (SCD) in apical HCM.
CASE SUMMARY Here we describe two rare cases of apical HCM that presented with documented VF and sudden cardiac collapse. These patients were previously not recommended for primary prevention using implantable cardioverter-defibrillator (ICD) therapy based on current guidelines. However, both received ICD therapy for the secondary prevention of SCD.
CONCLUSION These cases illustrate serious complications including VF and aborted sudden cardiac arrest in apical HCM patients who are initially not candidates for primary prevention using ICD implantation based on current guidelines.
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Affiliation(s)
- Yae Min Park
- Department ofCardiology, Gachon University Gil Medical Center, Incheon 21556, South Korea
| | - Albert Youngwoo Jang
- Department ofCardiology, Gachon University Gil Medical Center, Incheon 21556, South Korea
| | - Wook-Jin Chung
- Department ofCardiology, Gachon University Gil Medical Center, Incheon 21556, South Korea
| | - Seung Hwan Han
- Department ofCardiology, Gachon University Gil Medical Center, Incheon 21556, South Korea
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology Centenary Institute, The University of Sydney, Sydney 21556, Australia
| | - In Suck Choi
- Department ofCardiology, Gachon University Gil Medical Center, Incheon 21556, South Korea
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Jang AY, Yu J, Oh PC, Kim M, Suh SY, Lee K, Han SH, Kang WC. Real-World Long-Term Clinical Outcomes of Ultrathin Strut Biodegradable Polymer Drug-Eluting Stents in Korean ST-Segment-Elevation Myocardial Infarction (STEMI) Patients with or without Acute Heart Failure Undergoing Primary Percutaneous Coronary Intervention. J Clin Med 2021; 10:jcm10245898. [PMID: 34945194 PMCID: PMC8708844 DOI: 10.3390/jcm10245898] [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] [Received: 11/24/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Biodegradable polymers (BDPs) and ultrathin struts were recently introduced to drug-eluting stents (DES) to further improve outcomes. In this study, we analyzed and compared the effect of the ultrathin strut BDP-DES (UBDP-DES) with the conventional durable polymer-DES (DP-DES) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). A total of 356 STEMI patients (n = 160 in the UBDP-DES group and n = 196 in the DP-DES group) were enrolled. The primary endpoint was target lesion failure (TLF), including cardiac death, target vessel myocardial infarction, and ischemic-driven, target lesion revascularization (ID-TLR). The mean age was 60.3 ± 12.7 years (male 81.7%), and the median follow-up duration was 63.8 months. TLF was numerically more frequent in the UBDP-DES group (8.1% vs. 4.1%; HR 2.14; 95% CI 0.89-5.18; p = 0.091). Propensity score matching (PSM) was performed to balance discrepancies in the baseline characteristics due to patients in the UBDP-DES group initially having more unstable vital signs. However, after PSM (n = 116 in each group), there was no significant difference in TLF (5.3% vs. 5.3%; HR 1.04, 95% CI 0.34-3.22; p = 0.947) or other secondary endpoints including ID-TLR. In the subgroup analysis, subjects with initial acute heart failure (AHF), defined as Killip class ≥ 3, were associated with 13.6% chance of 30-day mortality (9-fold of those without AHF), although chances of repeat revascularization were low (3.0%). Among patients with AHF, the UBDP-DES group was associated with a numerically higher chance of TLF compared with the DP-DES group. There was no difference in TLF between groups in patients without AHF. This study showed that UBDP-DES has long-term clinical outcomes similar to those of conventional DP-DES in real-world Korean STEMI patients receiving PPCI, especially in those without initial AHF.
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Affiliation(s)
- Albert Youngwoo Jang
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
| | - Jongwook Yu
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Pyung Chun Oh
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
| | - Minsu Kim
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
| | - Soon Yong Suh
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
| | - Kyounghoon Lee
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
| | - Seung Hwan Han
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
| | - Woong Chol Kang
- Cardiology, Gachon University Gil Medical Center, Incheon 21565, Korea; (A.Y.J.); (P.C.O.); (M.K.); (S.Y.S.); (K.L.); (S.H.H.)
- Correspondence: ; Tel.: +82-32-460-3054; Fax: +82-32-460-1901
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Kim M, Jang AY, Oh PC, Suh SY, Lee K, Kang WC, Ahn T, Han SH. Diagnostic and prognostic role of nitroglycerin-induced dilation in patients with suspected vasospastic angina, combined with ergonovine provocation test. Sci Rep 2021; 11:23834. [PMID: 34903772 PMCID: PMC8668896 DOI: 10.1038/s41598-021-03338-0] [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: 06/06/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
The diagnostic and prognostic role of nitroglycerin-induced dilation (NID) combined with ergonovine provocation test in patients with suspected VSA patients is not clear. A total of 438 consecutive patients who underwent the ergonovine provocation test for the diagnosis of vasospastic angina (VSA) were enrolled. Patients with VSA (n = 52) had a significantly greater coronary response to ergonovine (− 84.3 ± 10.5% vs. − 38.4 ± 17.9%, p < 0.001) and NID (26.3 ± 31.0% vs. 12.5 ± 19.0%, p < 0.001) than non-VSA patients. However, positive NID (more than 13.8% dilation, n = 170) showed a poor accuracy (AUC 0.64 [95% CI: 0.56–0.73], p = 0.001, sensitivity 60.4%, specificity 61.3%) for the diagnosis of VSA by ergonovine provocation test. Major adverse cardiovascular events (MACE) occurred more frequently in the VSA group than in the non-VSA group (9.6% vs. 2.2%, p = 0.006). In addition, the positive NID group showed a lower rate of MACE than the negative NID group (1.2% vs. 4.3%, p = 0.021). Interestingly, the group of VSA with negative NID had poor prognosis than any other combinations (Log-rank, p < 0.0001). Although NID had a limited role in the detection of VSA defined by ergonovine provocation test, NID combined with the ergonovine provocation test has an additive prognostic role in the clinical outcomes in patients with suspected VSA.
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Affiliation(s)
- Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Taehoon Ahn
- Division of Cardiovascular Diseases, Department of Internal Medicine, Korea University, Anam Hospital, Seoul, Republic of Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
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Oh PC, Jang AY, Ha K, Kim M, Moon J, Suh SY, Lee K, Han SH, Kang WC. Effect of Atorvastatin (10 mg) and Ezetimibe (10 mg) Combination Compared to Atorvastatin (40 mg) Alone on Coronary Atherosclerosis. Am J Cardiol 2021; 154:22-28. [PMID: 34238445 DOI: 10.1016/j.amjcard.2021.05.039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/20/2022]
Abstract
It remains inconclusive whether the additional low-density lipoprotein cholesterol (LDL-C) lowering effects of ezetimibe added to statin on coronary atherosclerosis and clinical outcomes are similar to those of statin monotherapy in the setting of comparable LDL-C reduction. We aimed to determine whether there were distinguishable differences in their effects on coronary atherosclerosis with intermediate stenosis between the combination of moderate-intensity statin plus ezetimibe and high-intensity statin monotherapy. Forty-one patients with stable angina undergoing percutaneous coronary intervention were randomized to receive either atorvastatin 10 mg plus ezetimibe 10 mg (ATO10/EZE10) or atorvastatin 40 mg alone (ATO40). The intermediate lesions were evaluated using a near-infrared spectroscopy-intravascular ultrasonography at baseline and after 12 months in 37 patients. The primary endpoint was percent atheroma volume (PAV). Mean LDL-C levels were significantly reduced by 40% and 38% from baseline in the ATO10/EZE10 group (n = 18, from 107 mg/dL to 61 mg/dL) and ATO40 group (n = 19, from 101 mg/dL to 58 mg/dL), respectively, without between-group difference. The absolute change of PAV was -2.9% in the ATO10/EZE10 group and -3.2% in the ATO40 group. The mean difference (95% confidence interval) for the absolute change in PAV between the 2 groups was 0.5% (-2.4% to 2.8%), which did not exceed the pre-defined non-inferiority margin of 5%. There was no significant reduction in lipid core burden index in both groups. In conclusion, the combination of atorvastatin 10 mg and ezetimibe 10 mg showed comparable LDL-C lowering and regression of coronary atherosclerosis in the intermediate lesions, compared with atorvastatin 40 mg alone.
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Jang AY, Scherer PE, Kim JY, Lim S, Koh KK. Adiponectin and cardiometabolic trait and mortality: where do we go? Cardiovasc Res 2021; 118:2074-2084. [PMID: 34117867 DOI: 10.1093/cvr/cvab199] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/11/2021] [Indexed: 12/19/2022] Open
Abstract
Adiponectin is an adipocyte-derived cytokine known for its cardioprotective effects in preclinical studies. Early epidemiologic studies replicated these findings and drew great interest. Subsequent large-scale prospective cohorts, however, showed that adiponectin levels seemed not to relate to incident coronary artery disease (CAD). Even more surprisingly, a paradoxical increase of all-cause and cardiovascular (CV) mortality with increased adiponectin levels was reported. The adiponectin-mortality paradox has been explained by some groups asserting that adiponectin secretion is promoted by elevated natriuretic peptides (NP). Other groups have proposed that adiponectin is elevated due to adiponectin resistance in subjects with metabolic syndrome or heart failure (HF). However, there is no unifying theory that can clearly explain this paradox. In patients with HF with reduced ejection fraction (HFrEF), stretched cardiomyocytes secrete NPs, which further promote release of adiponectin from adipose tissue, leading to adiponectin resistance. On the other hand, adiponectin biology may differ in patients with heart failure with preserved ejection fraction (HFpEF), which constitutes 50% of all of HF. Most HFpEF patients are obese, which exerts inflammation and myocardial stiffness, that is likely to prevent myocardial stretch and subsequent NP release. This segment of the patient population may display a different adiponectin biology from its HFrEF counterpart. Dissecting the adiponectin-mortality relation in terms of different HF subtypes may help to comprehensively understand this paradox. Mendelian Randomization (MR) analyses claimed that adiponectin levels are not causally related to CAD or metabolic syndrome. Results from MR studies, however, should be interpreted with great caution because the underlying history of CAD or CHF were not taken into account in these analyses, an issue that may substantially confound the results. Here, we discuss many aspects of adiponectin; cardiometabolic traits, therapeutic interventions, and the ongoing debate about the adiponectin paradox, which were recently described in basic, epidemiologic, and clinical studies.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiovascular Disease, Gachon University Gil Hospital, Incheon, Korea, Gachon Cardiovascular Research Institute, Incheon, Korea
| | - Philipp E Scherer
- Touchstone Diabetes Center, Departments of Internal Medicine and Cell Biology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, ., Dallas, TX, 75390-8549, USA
| | - Jang Young Kim
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Kon Koh
- Division of Cardiovascular Disease, Gachon University Gil Hospital, Incheon, Korea, Gachon Cardiovascular Research Institute, Incheon, Korea
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiovascular Disease, Gachon University Gil Hospital and Gachon Cardiovascular Research Institute
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital
| | - Seung Hwan Han
- Division of Cardiovascular Disease, Gachon University Gil Hospital and Gachon Cardiovascular Research Institute
| | - Kwang Kon Koh
- Division of Cardiovascular Disease, Gachon University Gil Hospital and Gachon Cardiovascular Research Institute
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Kang WC, Park SM, Jang AY, Oh PC, Shin ES, Yu CW, Oh SJ, Kim YH, Won H, Lee SR, Lee SY, Hong YJ, Lee SY, Kim BO, Kim SW. Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY). Angiology 2021; 72:986-993. [PMID: 33982603 DOI: 10.1177/00033197211015534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We evaluated the angiographic parameter and clinical outcomes of drug-coated balloon (DCB) to assess the optimal angiographic criteria in de novo small vessel disease (SVD). Patients (n = 424, mean age: 64.4 ± 11.2 years, men: 69.8%) at 20 sites in Korea were prospectively enrolled. The primary end point was late luminal loss (LLL) at 9-month follow-up angiography. Secondary end points included restenosis rates, target lesion failure (TLF), and DCB-related thrombosis during the 12-month follow-up period. We included 403 patients for analysis excluding 21 patients who required bailout stenting. Baseline mean reference vessel .diameter was 2.52 ± 0.39 mm and mean minimal luminal diameter (MLD) was 0.71 ± 0.40 mm. The mean MLD was 1.54 ± 0.37 mm after DCB. Late luminal loss was -0.01 ± 0.43 mm and restenosis was noted in 26 patients (12.2%). Minimal luminal diameter >1.6 mm and %diameter stenosis (DS) <45% after DCB was associated maintenance of MLD without LLL at 9-months. Multivariate analysis demonstrated that %DS at baseline and post-MLD was associated with the restenosis. During 12-month follow-up, TLF was 2.6% including 1 cardiac death, 1 myocardial infarction, and 10 ischemia-driven target lesion revascularizations. Drug-coated balloon showed a low restenosis and lower LLL despite high in-segment DS. Post-MLD and % DS may be helpful to get optimal results in de novo SVD after DCB.
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Affiliation(s)
- Woong Chol Kang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sang Min Park
- Eulji University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Albert Youngwoo Jang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun-Seok Shin
- Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
| | - Cheol Woong Yu
- Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Yong Hoon Kim
- Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hoyoun Won
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sang-Rok Lee
- Chonbuk National University, School of Medicine, Jeonju, Republic of Korea
| | - Sang Yeub Lee
- Chungbuk National University, School of Medicine, Cheongju, Republic of Korea
| | - Young Joon Hong
- Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sang-Wook Kim
- Chung-Ang University Hospital, Seoul, Republic of Korea
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Ahn KJ, Yu J, Jang AY, Kim DH, Kwan J, Chung WJ. Valsartan Dosage on Ventriculo-Vascular Coupling Index Dose-Dependency in Heart Failure Patients. Yonsei Med J 2021; 62:391-399. [PMID: 33908209 PMCID: PMC8084698 DOI: 10.3349/ymj.2021.62.5.391] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/08/2021] [Accepted: 03/02/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Heart failure (HF) poses significant morbidity and mortality. Recently, the ventriculo-vascular coupling index (VVI) was introduced as an independent prognostic factor reflective of the overall cardiovascular performance index in HF. We aimed to determine the effectiveness of force-titration of valsartan on VVI values in HF patients. MATERIALS AND METHODS In this multicenter and prospective observational trial, the effect of valsartan was stratified according to dosages [non-ceiling dose (NCD) vs. ceiling dose (CD)] in HF patients with left ventricular ejection fraction (LVEF) <55%. Biochemical studies, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography with VVI, the treadmill test, and the activity scale index were assessed at baseline and after 24 weeks of treatment. RESULTS One-hundred thirty-eight patients were force-titrated to either a CD group (n=81) or a NCD group (n=57). The mean age of the study participants was 59 years and 66% were male. After 6 months of follow up, left ventricular mass index (LVMI) values had significantly improved in the CD group but not in the NCD group. Intriguingly, in HF patients with a reduced ejection fraction (HFrEF) (n=52, LVEF <40%), a significant improvement in VVI was only observed in the CD group (from 2.4±0.6 to 1.8±0.5, p<0.001). CONCLUSION CDs of valsartan for 6 months showed better improvement in VVI, as well as LVMI, in patients with HFrEF, compared with NCDs.
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Affiliation(s)
- Kyung Jin Ahn
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Pediatric Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jongwook Yu
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Albert Youngwoo Jang
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Dae Hyeok Kim
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Jun Kwan
- Department of Cardiology, Inha University Hospital, Incheon, Korea
| | - Wook Jin Chung
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea.
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Kim J, Shin MS, Jang AY, Kim S, Heo S, Cha E, An M. Advance Directives and Factors Associated with the Completion in Patients with Heart Failure. Int J Environ Res Public Health 2021; 18:ijerph18041780. [PMID: 33673089 PMCID: PMC7918223 DOI: 10.3390/ijerph18041780] [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] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 12/16/2022]
Abstract
Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred (n = 15) followed by avoiding family burden (n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.
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Affiliation(s)
- JinShil Kim
- College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon 21936, Korea;
| | - Mi-Seung Shin
- Division of Cardiology, Gil Medical Center, Department of Internal Medicine, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea;
- Correspondence: (M.-S.S.); (M.A.); Tel.: +82-32-460-3663 (M.-S.S.); +82-62-530-4944 (M.A.)
| | - Albert Youngwoo Jang
- Division of Cardiology, Gil Medical Center, Department of Internal Medicine, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea;
| | - Shinmi Kim
- Department of Nursing, Changwon National University, 20 Changwondaehakro, Euichanggu, Kyungsangnamdo, Changwon 51140, Korea;
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA;
| | - EunSeok Cha
- College of Nursing, Chungnam National University, 266 MunWharo, Junggu, Daejeon 35015, Korea;
| | - Minjeong An
- College of Nursing, Interdisciplinary Program of Arts & Design Technology, Chonnam National University, 160 Baekseoro, Donggu, Gwangju 61469, Korea
- Correspondence: (M.-S.S.); (M.A.); Tel.: +82-32-460-3663 (M.-S.S.); +82-62-530-4944 (M.A.)
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Heo S, Shin MS, Jang AY, Kim MY, Lopes CT, Kim J. Factors Associated with Changes in Health Perception in Patients with Heart Failure. West J Nurs Res 2021; 43:1125-1131. [PMID: 33559540 DOI: 10.1177/0193945921992540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Determination of modifiable factors associated with changes in health perception can be beneficial for improvement in health perception and health-related quality of life. The purpose of this study was to examine if changes in physical symptoms, functional status, and depressive symptoms were associated with changes in health perception at three months and the mediator effect of physical symptoms. Data were collected at baseline and three months later (N = 65). Process Macro for SPSS was used to analyze the data. Only changes in depressive symptoms (p < .001) were associated with changes in physical symptoms. Then, only changes in physical symptoms (p = .026) were significantly associated with changes in health perception. Changes in physical symptoms played significant roles in changes in health perception directly and also through the mediator role. Clinicians and researchers need to assess and manage these two modifiable factors to improve health perception in this population.
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Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, South Korea
| | - Mi Yeong Kim
- Gachon University Gil Medical Center, Incheon, South Korea
| | - Camila Takao Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
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Jang AY, Suh SY. Extreme venous letting and cupping resulting in life-threatening anemia and acute myocardial infarction: A case report. World J Clin Cases 2020; 8:6432-6436. [PMID: 33392327 PMCID: PMC7760420 DOI: 10.12998/wjcc.v8.i24.6432] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/07/2020] [Accepted: 11/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Wet cupping (WC) is a traditional therapy of skin suction-assisted bloodletting that is widely used in modern alternative medicine in Asia and the Middle East. Herein, we report the case of a male who presented with ST-elevation myocardial infarction (STEMI) and life-threatening anemia and underwent excessive WC.
CASE SUMMARY A 55-year-old male presented with chest pain (30 min) and dyspnea (3 wk). His initial electrocardiogram suggested STEMI in the anterior wall. Furthermore, his laboratory results showed severe anemia with a hemoglobin level of 4.1 g/dL. Of note, the patient underwent regular WC therapy for chronic back pain, which he had recently intensified. His WC practice resulted in life-threatening anemia and eventually STEMI. Percutaneous coronary intervention in the left anterior descending artery was performed to treat the STEMI. His dyspnea dramatically improved after the transfusion, and his hemoglobin level returned to 14.8 g/dL within 2 mo after discharge. He has been uneventful for the last seven years of follow-up.
CONCLUSION The current case demonstrates that excessive WC without adequate medical monitoring can result in severe anemia, which can further develop into STEMI.
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Affiliation(s)
- Albert Youngwoo Jang
- Department of Cardiology, Gachon University Gil Medical Center, Incheon 21565, South Korea
| | - Soon Yong Suh
- Department of Cardiology, Gachon University Gil Hospital, Incheon 21565, South Korea
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Park YM, Kim CY, Seo J, Jang AY, Cha MS, Kang WC, Han SH, Shin MS, Choi IS. Significant reduction in the density of premature ventricular complex with ß-blocker medication in fast rate-dependent premature ventricular complex. Int J Arrhythm 2020. [DOI: 10.1186/s42444-020-00028-2] [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
There is little data regarding types of idiopathic premature ventricular complex (PVC) according to heart rate dependence.
Methods
One hundred and sixty-eight patients with idiopathic PVC were enrolled in this study. Evaluation of the number of PVCs and total ventricular beats, and the density of PVC was done using 24 h Holter monitoring. Patients were divided into groups as having: fast rate-dependent (Group I), slow rate-dependent (Group II), and heart rate-independent PVC (Group III) based on the relationship between the number of hourly PVC and hourly heart rate. After ß-blocker medication, 24 h Holter monitoring was repeated.
Results
Among the 168 subjects, 66 (39.3%) patients were in Group I, 18 (10.7%) in Group II, and 84 (50.0%) in Group III. There were no significant differences in the baseline number of PVCs and total ventricular beats, and the density of PVC among the three groups. The number of PVCs was significantly reduced in patients with Group I (14,030 ± 11,463 beats/day vs. 7401 ± 10,464 beats/day, p < 0.001), and total ventricular beat was significantly reduced in patients with Group I (109,223 ± 17,564 beats/day vs. 96,182 ± 15,594 beats/day, p < 0.001) and Group III (106,515 ± 13,468 beats/day vs. 97,995 ± 12,960 beats/day, p < 0.001) after ß-blocker medication. The density of PVC was significantly reduced only in patients of Group I (12.9 ± 10.3% vs. 7.4 ± 10.3%, p = 0.001) after ß-blocker medication.
Conclusions
The type of PVC according to the heart rate dependence should be considered when treating idiopathic PVC with ß-blockers.
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Jang AY, Kim BG, Kwon S, Seo J, Kim HK, Chang HJ, Chang SA, Cho GY, Rhee SJ, Jung HO, Kim KH, Seo HS, Kim KH, Shin J, Lee JS, Kim M, Lee YJ, Chung WJ. Prevalence and clinical features of bone morphogenetic protein receptor type 2 mutation in Korean idiopathic pulmonary arterial hypertension patients: The PILGRIM explorative cohort. PLoS One 2020; 15:e0238698. [PMID: 32966279 PMCID: PMC7510973 DOI: 10.1371/journal.pone.0238698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/28/2019] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is a progressive chronic disease with poor outcomes. One reason for poor prognosis is the lack of understanding regarding individual variability in response to treatment. Idiopathic PAH (IPAH) patients with bone morphogenetic protein receptor type 2 (BMPR2) mutations have distinct phenotypes that are crucial for individualized therapy but evidence regarding their prevalence and clinical features in the Korean population is lacking. Therefore, the present study aimed to screen Korean IPAH patients for BMPR2 mutations and analyze their clinical phenotypes. Methods We enrolled 73 unrelated IPAH patients for BMPR2 mutation screening between March 2010 to November 2015 from 11 hospitals in Korea. Thirty-three lineal family members from 6 families of BMPR2 mutation carriers were also screened. Results Among 73 patients, 16 (22%) had BMPR2 mutations. Mutation carriers were younger (27 vs. 47 years; p = 0.02) and had a higher mean pulmonary arterial pressure (mPAP) than non-carriers (64 vs. 51 mmHg; p<0.05). Of the 16 individuals with mutations, 5 deletion, 2 splice-site, 6 nonsense, and 3 missense mutations were found, among which, 9 were newly identified mutation types. Patients less than 30 years old had more BMPR2 mutations (44 vs. 14%; p = 0.04) and a higher mPAP (64 vs. 50 mmHg; p = 0.04) compared with those equaled to or over 30 years old. There were no differences in hemodynamic profiles or the proportion of BMPR2 mutation carriers between groups according to sex. Conclusion The prevalence of BMPR2 mutations in Korean IPAH patients was 22%. Mutation carriers were younger and had a poorer hemodynamic profile compared with the non-carriers. Clinical trial registration Clinicaltrials.gov NCT01054105
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Affiliation(s)
- Albert Youngwoo Jang
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
| | - Bo-Gyeong Kim
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Sunkoo Kwon
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jiyoung Seo
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Hyung Kwan Kim
- Division of Cardiology, Section of Cardiovascular Imaging, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Sang Jae Rhee
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Hye Sun Seo
- Department of Cardiology, Soonchunhyang University Hospital, Bucheon, Korea
| | - Kye Hun Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Jun Soo Lee
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Minsu Kim
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
| | - Young Jae Lee
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
- * E-mail: (WJC); (YJL)
| | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- * E-mail: (WJC); (YJL)
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Jang AY, Oh YJ, Lee SI, Lim OK, Suh SY. Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report. BMC Cardiovasc Disord 2020; 20:393. [PMID: 32854617 PMCID: PMC7457300 DOI: 10.1186/s12872-020-01675-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life. Case presentation A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling. Conclusion The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, 405-760, Incheon, Republic of Korea
| | - Young Jun Oh
- Intensive Care Unit, Department of Nursing, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Seok In Lee
- Department of Thoracic Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Oh Kyung Lim
- Department of Physical & Rehabilitation Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, 1198 Guwol-dong, Namdong-gu, 405-760, Incheon, Republic of Korea.
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Abstract
Two decades ago, it was recognized that lipoprotein(a) (Lp(a)) concentrations were elevated in patients with cardiovascular disease (CVD). However, the importance of Lp(a) was not strongly established due to a lack of both Lp(a)-lowering therapy and evidence that reducing Lp(a) levels improves CVD risk. Recent advances in clinical and genetic research have revealed the crucial role of Lp(a) in the pathogenesis of CVD. Mendelian randomization studies have shown that Lp(a) concentrations are causal for different CVDs, including coronary artery disease, calcified aortic valve disease, stroke, and heart failure, despite optimal low-density lipoprotein cholesterol (LDL-C) management. Lp(a) consists of apolipoprotein (apo) B100 covalently bound to apoA. Thus, Lp(a) has atherothrombotic traits of both apoB (from LDL) and apoA (thrombo-inflammatory aspects). Although conventional pharmacological therapies, such as statin, niacin, and cholesteryl ester transfer protein, have failed to significantly reduce Lp(a) levels, emerging new therapeutic strategies using proprotein convertase subtilisin-kexin type 9 inhibitors or antisesnse oligonucleotide technology have shown promising results in effectively lowering Lp(a). In this review we discuss the revisited important role of L(a) and strategies to overcome residual risk in the statin era.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Gachon University Gil Hospital.,Gachon Cardiovascular Research Institute
| | - Seung Hwan Han
- Division of Cardiology, Gachon University Gil Hospital.,Gachon Cardiovascular Research Institute
| | - Il Suk Sohn
- Department of Cardiology, Cardiovascular Center, Kyung Hee University Hospital at Gangdong
| | - Pyung Chun Oh
- Division of Cardiology, Gachon University Gil Hospital.,Gachon Cardiovascular Research Institute
| | - Kwang Kon Koh
- Division of Cardiology, Gachon University Gil Hospital.,Gachon Cardiovascular Research Institute
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Kwon TG, Jang AY, Kim SW, Hong YJ, Bae JH, Lee SY, Kim SH, Han SH. Design and rationale of a randomized control trial testing the effectiveness of combined therapy with STAtin plus FENOfibrate and statin alone in non-diabetic, combined dyslipidemia patients with non-intervened intermediate coronary artery disease - STAFENO study. Trials 2020; 21:353. [PMID: 32321551 PMCID: PMC7178941 DOI: 10.1186/s13063-020-04291-5] [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: 10/25/2019] [Accepted: 03/28/2020] [Indexed: 01/14/2023] Open
Abstract
Background Despite the chronicled success of low-density lipoprotein cholesterol (LDLc)-lowering statin therapy, substantial residual cardiovascular (CV) disease risk remains a problem worldwide, highlighting the need to for combination therapies targeting non-LDLc factors, such as with fenofibrate. Methods/design The STAFENO trial is a prospective, randomized, open-label, multi-center trial to compare the effect of statin plus fenofibrate with statin alone on the reduction and stabilization of plaque in non-diabetic, combined dyslipidemia patients with non-intervened, intermediate coronary artery disease (CAD) using virtual histology-intravascular ultrasound at 12 months. A total of 106 eligible patients are planned to be randomized to receive either a combination therapy (rosuvastatin 10 mg plus fenofibrate 160 mg/day) or monotherapy (rosuvastatin 10 mg/day) for 12 months. The primary endpoint of this study is the percentage change in the necrotic core volume. Secondary endpoints include changes in tissue characteristics and 1-year major CV events, including all-cause mortality, CV mortality, nonfatal myocardial infarction, stroke, and revascularization of the intervened and non-intervened lesions. Discussion The STAFENO trial will address whether combination treatment of statin and fenofibrate has an additive beneficial effect compared to statin alone on the reduction and stabilization of plaque and CV events in non-diabetic, combined dyslipidemia patients with non-intervened intermediate CAD. Trial registration ClinicalTrials.gov, NCT02232360. Registered 9 February 2014. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0004ULE&selectaction=Edit&uid=U00023SZ&ts=2&cx=juppd2
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Affiliation(s)
- Taek-Geun Kwon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea
| | - Sang Wook Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular-Arrhythmia Center, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Young Joon Hong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jang-Ho Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Sung Yun Lee
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine Boramae Medical Center, Seoul, Republic of Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University College of Medicine, Gil Hospital, Incheon, Republic of Korea.
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Jang AY, Ryu J, Oh PC, Moon J, Chung WJ. Feasibility and Applicability of Wireless Handheld Ultrasound Measurement of Carotid Intima-Media Thickness in Patients with Cardiac Symptoms. Yonsei Med J 2020; 61:129-136. [PMID: 31997621 PMCID: PMC6992452 DOI: 10.3349/ymj.2020.61.2.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Routine screening for carotid intima-media thickness (CIMT) and cardiovascular (CV) disease in asymptomatic patients has been criticized for the high costs and large number of patients required for detecting one patient with coronary artery disease (CAD). In order to overcome the low cost-effectiveness thereof, we investigated the feasibility of an economic wireless handheld ultrasound (WHUS) device for CIMT measurement in symptomatic patients. MATERIALS AND METHODS A total of 100 consecutive patients with cardiac symptoms were enrolled. CIMT was measured in all patients. Coronary angiography was performed in 75 patients indicated for the exam. RESULTS The mean of maximal CIMT measured from left/right common carotid artery and bulb (max-CIMT) by the WHUS device showed excellent agreement [intraclass correlation coefficient (ICC)=0.960] with a standard ultrasound device and great interobserver repeatability (ICC>0.9 between all observers). Receiver operating characteristic curve analysis showed that the predictive power for CAD was improved when max-CIMT and plaque information (plaque≥2) was added [area under the curve (AUC): 0.838] to the traditional clinical CV risk factors (AUC: 0.769). The cutoff values for CAD prediction with the standard device and the WHUS device were 1.05 mm (AUC: 0.807, sensitivity: 0.78, specificity: 0.53) and 1.10 mm (AUC: 0.725, sensitivity: 0.98, specificity: 0.27), respectively. CONCLUSION max-CIMT measured by a WHUS device showed excellent agreement and repeatability, compared with standard ultrasound. Combined max-CIMT and plaque information added predictive power to the traditional clinical CV risk factors in detecting high-risk CAD patients.
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Affiliation(s)
- Albert Youngwoo Jang
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
| | - Jeongwon Ryu
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Medical Engineering, School of Medicine, Gachon University, Incheon, Korea
- Healcerion Co., Ltd., Seoul, Korea
| | - Pyung Chun Oh
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
| | - Jeonggeun Moon
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
| | - Wook Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea.
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Jang AY, Shin MS. Echocardiographic Screening Methods for Pulmonary Hypertension: A Practical Review. J Cardiovasc Imaging 2020; 28:1-9. [PMID: 31997604 PMCID: PMC6992915 DOI: 10.4250/jcvi.2019.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/01/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a debilitating condition defined as mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg. The importance of impaired right ventricular (RV) hemodynamics is increasingly being recognized in treatment of patients with PH. In World Health Organization Group 1 patients with pulmonary arterial hypertension, upfront combination therapy has recently been proposed to improve long-term survival. Also, the mPAP in Group 2 and 3 PH patients has been shown to be strongly associated with clinical outcomes. Thus, screening and monitoring of RV hemodynamics are becoming increasingly important. The gold standard for measuring RV hemodynamics is right heart catheterization (RHC). Although RHC can obtain the most accurate results, it is invasive, cumbersome to patients, and often associated with complications, making it unsuitable for a screening or monitoring modality. Echocardiography is useful in estimating hemodynamic parameters that can be obtained from RHC. Accordingly, the role of echocardiography in evaluating such patients with PH is becoming more important. In this article, we review practical echocardiographic methods in approximating RV hemodynamics for PH.
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Affiliation(s)
| | - Mi Seung Shin
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University, College of Medicine, Incheon, Korea.
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Ahn KJ, Jang AY, Park SJ, Chung WJ. 15 years journey of idiopathic pulmonary arterial hypertension with BMPR2 mutation. Clin Hypertens 2019; 25:22. [PMID: 31583114 PMCID: PMC6771102 DOI: 10.1186/s40885-019-0127-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/22/2019] [Accepted: 08/09/2019] [Indexed: 12/23/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is known as one of diseases with the worst prognosis. Recently, targeted PAH drugs have been developed and approved for use; therefore, the treatment strategy and goals have changed, and the prognosis has improved over two decades. We reviewed the case of a female who showed the natural disease course of heritable PAH in treatment with the targeted PAH drugs under the Korean Health Insurance policy. At the age of 15, she visited the outpatient clinic for dyspnea on exertion that occurred 3 years ago. At that time, severe pulmonary hypertension was revealed by an echocardiography and there was no evidence of significant shunt lesion or embolism. After 4 years of loss to follow-up, her performance was WHO functional class III and she still suffered from dyspnea. The initial monotherapy using an endothelin receptor antagonist was started in 2008. After 2 years, BMPR 2 mutation was detected. Her clinical symptoms gradually worsened because of poor compliance. To escalate therapy, combination therapy was given, and finally, triple maximal therapy was maintained. The next step is to consider intravenous prostanoids. Various combinations of targeted therapy have been tried, and several trials have been confirmed that improve the prognosis. Initial upfront combination therapy and a more enthusiastic approach make good a better prognosis. In this area, active support of the government insurance policy is indispensable in Korea.
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Affiliation(s)
- Kyung Jin Ahn
- 1Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea.,2Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Albert Youngwoo Jang
- 1Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea.,3Department of Cardiovascular Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565 Republic of Korea
| | - Su Jung Park
- 1Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea.,3Department of Cardiovascular Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565 Republic of Korea
| | - Wook-Jin Chung
- 1Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea.,3Department of Cardiovascular Medicine, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565 Republic of Korea
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Jang AY, Kim S, Park SJ, Choi H, Oh PC, Oh S, Kim KH, Kim KH, Byun K, Chung WJ. A Nationwide multicenter registry and biobank program for deep phenotyping of idiopathic and hereditary pulmonary arterial hypertension in Korea: the PAH platform for deep phenotyping in Korean subjects (PHOENIKS) cohort. Clin Hypertens 2019; 25:21. [PMID: 31534782 PMCID: PMC6745060 DOI: 10.1186/s40885-019-0126-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary arterial hypertension (PAH) is a progressive, chronic disease without curative treatment. Large registry data of these patient populations have been published, although, phenotypic variants within each subtype of PAH have not been elucidated. As interest towards personalized medicine grows, the need for a PAH cohort with a comprehensive understanding of patient phenotypes through multiomics approaches, called deep phenotyping, is on the rise. The PAH Platform for Deep Phenotyping in Korean Subjects (PHOENIKS) cohort is designed to collect clinical data as well as biological specimens for deep phenotyping in patients with idiopathic PAH (IPAH) and heritable PAH (HPAH) in Korea. Methods A total of 17 regional hospitals are currently working on enrolling up to 100 consecutive IPAH/HPAH patients for obtaining clinical data and biological specimens across Korea. The diagnosis of PAH is based on right heart catheterization. All clinical data is stored in a government-based online database. Each participating hospitals collect a whole blood sample from each patient, through which DNA, RNA, serum, plasma, and peripheral blood mononuclear cells will be extracted from the buffy coat layer for further multiomics analysis. Results Not applicable. Conclusions The PHOENIKS cohort is enrolling IPAH and HPAH patients across Korea to determine the prognosis and drug response in different phenotypic variant. The data generated by this cohort are expected to open new doors for personalized medicine in PAH patients of South Korea. Trial registration ClinicalTrials.gov NCT03933579. Registered on May 1st, 2019.
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Affiliation(s)
- Albert Youngwoo Jang
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,2Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Hospital, Medical Center, Incheon, South Korea
| | - Sungseek Kim
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea
| | - Su Jung Park
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,2Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Hospital, Medical Center, Incheon, South Korea
| | - Hanul Choi
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,2Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Hospital, Medical Center, Incheon, South Korea
| | - Pyung Chun Oh
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,2Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Hospital, Medical Center, Incheon, South Korea
| | - Seyeon Oh
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,3Center for Genomics and Proteomics, Institute for Regenerative Medicine, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, South Korea
| | - Kyung-Hee Kim
- 4Department of Cardiology, Sejong General Hospital, Bucheon, South Korea
| | - Kye Hun Kim
- 5Department of Cardiology, Chonnam University Hospital, Gwangju, South Korea
| | - Kyunghee Byun
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,3Center for Genomics and Proteomics, Institute for Regenerative Medicine, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, South Korea
| | - Wook-Jin Chung
- 1Gachon Cardiovascular Research Institute, College of Medicine, Gachon University, Incheon, South Korea.,2Division of Cardiovascular Disease, Department of Internal Medicine, Gachon University Gil Hospital, Medical Center, Incheon, South Korea.,6Department of Cardiovascular Medicine, School of Medicine, Gachon University, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 21565 Republic of Korea
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Heo S, Kim J, Shin MS, Jang AY. Modifiable Factors Associated with Quality of Life at 3 Months and the Mediator Effect of Functional Status in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Pulmonary arterial hypertension (PAH) is characterized by remodeling of the distal pulmonary arteries resulting in high pulmonary vascular resistance and, eventually, right ventricular heart failure. Although current advances in PAH therapy have improved outcomes, poor survival remains a reality worldwide, including Korea. One of the most important issues in PAH is the late diagnosis, since screening or diagnostic efforts are often overlooked due to the rarity of disease. Data from Korean registries and observational cohorts show that delayed detection leads to increased morbidity. Additionally, low percentages of Korean patients are committed to intensive PAH-targeted therapy. Current Korean health insurance policies' lack of coverage for new PAH-targeted drugs and upfront combination therapy may also hamper the improvement of treatment outcomes. Understanding individual variability in response to therapeutics through deep phenotyping is a novel strategy that should be considered when treating PAH. Overall, early detection of PAH by proactive screening together with early, intensive, individualized PAH therapy using deep phenotyping is crucial for improving prognoses for PAH patients in Korea.
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Affiliation(s)
- Albert Youngwoo Jang
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wook-Jin Chung
- Gachon Cardiovascular Research Institute, Gachon University, Incheon, Korea
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Jang AY, Yu J, Park YM, Shin MS, Chung WJ, Moon J. Cardiac Structural or Functional Changes Associated with CHA 2DS 2-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography. J Cardiovasc Imaging 2018; 26:135-143. [PMID: 30310880 PMCID: PMC6160813 DOI: 10.4250/jcvi.2018.26.e17] [Citation(s) in RCA: 5] [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: 07/25/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND CHA2DS2-VASc is the most widely accepted scoring system for atrial fibrillation (AF) to assess stroke risk, although little has been revealed regarding the accompanying cardiac functional/structural changes. This echocardiography study was undertaken to understand the changes related to CHA2DS2-VASc scores. METHODS A total of 4,795 nonvalvular AF patients were enrolled for the cohort, from which 591 were excluded as they did not meet the inclusion criteria. Based on the CHA2DS2-VASc scores, the remaining 4,204 patients included in the study were divided into 4 groups: 0 to 1 (n = 991); 2 to 3 (n = 1,642); 4 to 6 (n = 1,407); 7 to 9 (n = 164). RESULTS Increase in the left ventricular mass index and prevalence of left ventricular hypertrophy (LVH) were observed with elevating CHA2DS2-VASc scores (p < 0.05 for all). Diastolic parameters such as left atrial volume index (LAVI) and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E′) also increased significantly in the higher CHA2DS2-VASc score groups (p < 0.001 for all), although two-way ANOVA analysis showed that such incremental diastolic impairment was independent of hypertension. LVH (hazard ratio [HR], 3.609; confidence interval [CI], 2.426–5.369; p < 0.001) and E/E′ (HR, 1.087; CI, 1.054–1.121; p < 0.001) were independent risk factors for CHA2DS2-VASc scores 2 or higher. CONCLUSIONS Our findings suggest that increasing CHA2DS2-VASc scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jongwook Yu
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Ye Min Park
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Mi Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jeonggeun Moon
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
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Yu J, Oh PC, Jang AY, Lee K, Kang WC, Han SH. TCT-712 Metabolic parameters as independent markers for coronary endothelial dysfunction in humans. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1930] [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: 11/30/2022]
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Jang AY, O'Brien C, Chung WJ, Oh PC, Yu J, Lee K, Kang WC, Moon J. Routine Indwelling Urethral Catheterization in Acute Heart Failure Patients Is Associated With Increased Urinary Tract Complications Without Improved Heart Failure Outcomes. Circ J 2018; 82:1632-1639. [PMID: 29593145 DOI: 10.1253/circj.cj-17-1113] [Citation(s) in RCA: 5] [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: 11/09/2022]
Abstract
BACKGROUND Indwelling urethral catheters (IUC) are routinely inserted for the purpose of monitoring urine output in patients with acute heart failure (AHF). The benefit of IUC in patients capable of complying with urine collection protocols is unclear, and IUC carry multiple risks. This study describes the impact of IUC on AHF treatment.Methods and Results:A total of 540 records were retrospectively analyzed. After exclusion criteria were applied, 316 patients were propensity matched to establish groups of 100 AHF patients who either did (IUC(+)) or did not receive an IUC (IUC(-)) upon admission. Hospital length of stay (9 vs. 7 days), in-hospital urinary complications (24 vs. 5%), and 1-year urinary tract infection rate (17 vs. 6%; HR, 3.145; 95% CI: 1.240-7.978) were significantly higher in the IUC(+) group (P<0.05 for all). There were no differences in 30-day rehospitalization (6 vs. 6%; HR, 0.981; 95% CI: 0.318-3.058; P=0.986) or major adverse cardiac/cerebrovascular events at 1 year (37 vs. 32%, HR, 1.070; 95% CI: 0.636-1.799; P=0.798). CONCLUSIONS Based on this retrospective analysis, the routine use of IUC may increase length of stay and UTI complications in AHF patients without reducing the risk for major cardiovascular and cerebrovascular events or 30-day rehospitalization rate.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center.,Division of Cardiovascular Medicine, Stanford University
| | - Connor O'Brien
- Division of Cardiovascular Medicine, Stanford University
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Jongwook Yu
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Jeonggeun Moon
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
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