Publications by authors named "Jae-Hyeong Park"

181 Publications

Determinants of the survival benefit associated with statins in patients with acute heart failure.

ESC Heart Fail 2021 Oct 5. Epub 2021 Oct 5.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Aims: The benefit of statins in patients with heart failure (HF) remains controversial and the mechanism of action is largely speculative. We investigated the determinants of the survival benefit associated with statins in HF patients.

Methods And Results: We enrolled 1680 acute HF patients receiving statins and 2157 patients not receiving statins admitted between 2009 and 2016. The left ventricular (LV) global longitudinal strain (GLS) was assessed as a measure of myocardial contractility. The primary outcome was 5 year all-cause mortality. Statin therapy was independently associated with improved survival in patients with HF with preserved ejection fraction (HFpEF) [adjusted hazard ratio (HR) 0.781, 95% confidence interval (CI) 0.621-0.981, P = 0.034], but not in those with HF with reduced EF (HFrEF) (adjusted HR 0.881, 95% CI 0.712-1.090, P = 0.244). Mortality reduction associated with statin therapy was significant in patients with ischaemic HF (adjusted HR 0.775, 95% CI 0.607-0.989, P = 0.040), but not in those with non-ischaemic HF (adjusted HR 0.895, 95% CI 0.734-1.092, P = 0.275). The relative magnitude of survival benefit with statin therapy increased as LV-EF and LV-GLS increased, with a steeper dose-response relationship in patients with ischaemic HF. In the subgroup of patients with ischaemic HF, survival benefit with statin therapy was confined to those ≤75 years of age.

Conclusions: Our study suggests that the survival benefit of statins is confined to patients with HFpEF and those with ischaemic HF. Myocardial contractility may modulate the prognostic effects of statins in HF patients, particularly when the aetiology is ischaemic rather than non-ischaemic.
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http://dx.doi.org/10.1002/ehf2.13637DOI Listing
October 2021

Safety, Virologic Efficacy, and Pharmacokinetics of CT-P59, a Neutralizing Monoclonal Antibody Against SARS-CoV-2 Spike Receptor-Binding Protein: Two Randomized, Placebo-Controlled, Phase I Studies in Healthy Individuals and Patients With Mild SARS-CoV-2 Infection.

Clin Ther 2021 Aug 23. Epub 2021 Aug 23.

Division of Infectious Diseases, Chungnam National University School of Medicine, Daejeon, Republic of Korea. Electronic address:

Purpose: Neutralizing antibodies can reduce SARS-CoV-2 cellular entry, viral titers, and pathologic damage. CT-P59 (regdanvimab), a SARS-CoV-2 neutralizing monoclonal antibody, was examined in 2 randomized, double-blind, placebo-controlled, single ascending dose, Phase I studies.

Methods: In study 1.1, healthy adults were sequentially enrolled to receive CT-P59 10, 20, 40, or 80 mg/kg or placebo. In study 1.2, adult patients with mild SARS-CoV-2 infection were enrolled to receive CT-P59 20, 40, or 80 mg/kg or placebo. Primary objectives of both studies were safety and tolerability up to day 14 after infusion. Secondary end points included pharmacokinetic properties. Study 1.2 also measured virology and clinical efficacy.

Findings: Thirty-two individuals were randomized to study 1.1 (6 per CT-P59 dose cohort and 8 in the placebo cohort). By day 14 after infusion, adverse events (AEs) were reported in 2 individuals receiving CT-P59 20 mg/kg (headache and elevated C-reactive protein levels) and 1 receiving CT-P59 40 mg/kg (pyrexia) (all Common Terminology Criteria for Adverse Events grade 1). In study 1.2, 18 patients were randomized (5 per dose cohort and 3 in the placebo cohort). Sixteen AEs were reported in 10 patients receiving CT-P59. No AEs in either study led to study discontinuation. Greater reductions in viral titers were reported with CT-P59 than placebo in those with maximum titers >10 copies/mL. Mean time to recovery was 3.39 versus 5.25 days.

Implications: CT-P59 exhibited a promising safety profile in healthy individuals and patients with mild SARS-CoV-2 infection, with potential antiviral and clinical efficacy in patients with mild SARS-CoV-2 infection. ClinicalTrials.gov identifier: NCT04525079 (study 1.1) and NCT04593641 (study 1.2).
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http://dx.doi.org/10.1016/j.clinthera.2021.08.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380488PMC
August 2021

Impacts of Systemic Hypertension on the Macular Microvasculature in Diabetic Patients Without Clinical Diabetic Retinopathy.

Invest Ophthalmol Vis Sci 2021 Sep;62(12):21

Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.

Purpose: To identify the impact of hypertension (HTN) on macular microvasculature in type 2 diabetes (T2DM) patients without clinical diabetic retinopathy.

Methods: In this retrospective cross-sectional study, subjects were divided into three groups: controls (control group), patients with T2DM (DM group), and patients with both T2DM and HTN (DM + HTN group). The vessel length density (VD) was compared among the groups. Linear regression analyses were performed to identify factors associated with VD.

Results: The VD in the control, DM, and DM + HTN groups was 20.43 ± 1.16, 19.50 ± 1.45, and 18.19 ± 2.06 mm-1, respectively (P < 0.001). The best-corrected visual acuity (B = -9.30; P = 0.002), duration of T2DM (B = -0.04; P = 0.020), HTN (B = -0.51; P = 0.016), signal strength (B = 1.12; P < 0.001), and ganglion cell-inner plexiform layer thickness (B = 0.06; P < 0.001) were significant factors affecting VD in patients with T2DM. Additionally, the hemoglobin A1c (HbA1c) (B = -0.49; P = 0.016) was significantly associated with VD in patients with both T2DM and HTN.

Conclusions: Patients with T2DM had impaired macular microvasculature, and patients with T2DM with HTN exhibited greater impairment of the microvasculature than did patients with T2DM only. Additionally, physicians should be aware that the macular microvasculature would be more vulnerable to hyperglycemic damage under ischemic conditions by HTN.
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http://dx.doi.org/10.1167/iovs.62.12.21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458987PMC
September 2021

Predictors of residual pulmonary vascular obstruction after anticoagulation monotherapy in patients with intermediate-risk pulmonary embolism.

J Thorac Dis 2021 Jul;13(7):4217-4227

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.

Background: Patients with intermediate-risk pulmonary embolism (PE) can be treated with anticoagulation monotherapy. However, clinicians are concerned as to whether anticoagulation monotherapy is sufficient to reduce mortality in patients with a large embolic burden, and to resolve vascular obstruction. We investigated whether anticoagulation monotherapy was appropriate in patients with intermediate risk PE in terms of the occurrence of residual pulmonary vascular obstruction (RPVO), and the factors that independently predict the occurrence of RPVO.

Methods: This was a multicenter retrospective observational study of patients at intermediate risk of PE who were admitted to three hospitals between January 2012 and December 2017.

Results: Of total 91 patients, the median age was 72 years and 37 (40.7%) were male. Twenty-five patients (27.5%) were diagnosed with RPVO during follow-up. Multivariate logistic regression revealed chronic lung disease [odds ratio (OR), 4.14; 95% confidence interval (CI), 1.243-13.797; P=0.021] and the ratio of the diameters of the main pulmonary artery and ascending aorta ratio (P/A ratio) >1.0 documented on a chest computed tomography (CT) at presentation (OR, 3.46; 95% CI, 1.113-10.770; P=0.032) were significant independent predictors of RPVO occurrence. The incidence of RPVO in patients without these two factors was only 9.7%, but in those with the two factors it was 60% (P=0.004).

Conclusions: Anticoagulation monotherapy did not seem to be a sufficient treatment to reduce RPVO, but the outcome was similar to that of patients treated with other therapies. Therefore, considering the risk-benefit ratio, we do not need to change the initial treatment as systemic thrombolytic therapy or catheter-based therapy in patient with intermediate risk PE. Underlying chronic lung disease and a P/A ratio >1 on the initial chest CT predicted the occurrence of RPVO. Therefore, we should carefully assess persistent of dyspnea and exercise limitations using various methods in patients with these risk factors, to detect the occurrence of chronic thromboembolic pulmonary disease (CTEPD) earlier.
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http://dx.doi.org/10.21037/jtd-21-403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339779PMC
July 2021

Pulmonary hypertension in patients with chronic myeloid leukemia.

Medicine (Baltimore) 2021 Aug;100(33):e26975

Division of Hematology/Oncology.

Abstract: Dasatinib, a tyrosine kinase inhibitor (TKI), induces pulmonary hypertension (PH) in patients with chronic myeloid leukemia (CML). However, information on other TKIs is limited.We retrospectively analyzed PH prevalence by reviewing transthoracic echocardiography (TTE) findings in a population of Korean CML patients treated with TKI at a single hospital between 2003 and 2020. PH was defined as a high PH probability according to the European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines.Of the 189 patients treated with TKI(s) during the study period, 112 (59.3%) underwent TTE. Among the 112 patients treated with a TKI for a median of 40.4 months (range: 1.1-167.2 months), PH was found in 12 (10.7%), most frequently in those treated with dasatinib (ie, in 3 [7.5%] of 40 of those treated with imatinib, 1 [3.1%] of 32 of those treated with nilotinib, and 8 [21.6%] of 37 of those treated with dasatinib). PH resolved in 4 (50.0%) of the 8 dasatinib-treated patients after discontinuation of the agent. One nilotinib-treated and all three imatinib-treated patients recovered from PH. In multivariate analyses, age >60 years, dasatinib treatment, and positive cardiopulmonary symptoms/signs at the time of transthoracic echocardiography were statistically significant risk factors for developing PH.These results show that PH is induced not only by dasatinib, but also by imatinib and nilotinib. Careful screening for PH during any TKI treatment may thus be warranted in patients with CML.
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http://dx.doi.org/10.1097/MD.0000000000026975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376321PMC
August 2021

The Korean Hypertension Cohort study: design and baseline characteristics.

Korean J Intern Med 2021 Sep 22;36(5):1115-1125. Epub 2021 Jul 22.

National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea.

Background/aims: Hypertension (HT) has a significant impact on public health and medical expenses. However, HT is a chronic disease that requires the long-term follow-up of a large number of patients.

Methods: The Korean Hypertension Cohort (KHC) study aimed to develop a model for calculating cardiovascular risk in HT patients by linking and utilizing the detailed clinical and longitudinal data from hospitals and the national health insurance claim database, respectively. This cohort had a planned sample size of over 11,000 HT patients and 100,000 non-HT controls. Eligible patients were hypertensive patients, who were presenting for the first time and were diagnosed with HT as a main disease from 2006 to 2011. Long-term survival data over a period of approximately 9 years were obtained from the national health insurance claim and national health examination data.

Results: This cohort enrolled 11,083 patients with HT. The mean age was 58.87 ± 11.5 years, 50.5% were male, and 31.4% were never-treated HT. Of the enrolled patients, 32.9% and 37.7% belonged to the high and moderate cardiovascular risk groups, respectively. Initial blood pressures were 149.4 ± 18.5/88.5 ± 12.5 mmHg. During the 2 years hospital data follow-up period, blood pressures lowered to 130.8 ± 14.1/78.0 ± 9.7 mmHg with 1.9 ± 1.0 tablet doses of antihypertensive medication. Cardiovascular events occurred in 7.5% of the overall patients; 8.5%, 8.8%, and 4.7% in the high, moderate, and low risk patients, respectively.

Conclusion: The KHC study has provided important information on the long-term outcomes of HT patients according to the blood pressure, comorbid diseases, medication, and adherence, as well as health behaviors and health resource use.
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http://dx.doi.org/10.3904/kjim.2020.551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435490PMC
September 2021

Association between Residence Location and Pre-Hospital Delay in Patients with Heart Failure.

Int J Environ Res Public Health 2021 06 21;18(12). Epub 2021 Jun 21.

Department of Internal Medicine, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon 35015, Korea.

Rural residents with heart failure (HF) face more challenges than their urban counterparts in taking action when their symptoms worsen due to limited healthcare resources in rural areas. This may contribute to rural residents' pre-hospital delay in seeking medical care. However, few studies have investigated the relationship between residence locations and pre-hospital delay among patients with HF. Therefore, this study determined whether living in rural areas is associated with pre-hospital delay in patients with HF. A retrospective electronic medical record review was conducted using the data of patients discharged with worsening HF from an academic medical center. Data on postal codes of the patients' residences and their experiences before seeking medical care were obtained. Pre-hospital delay was calculated from the onset of HF symptoms to hospital arrival. A multivariate linear regression analysis was performed to determine the relationship between residence location and pre-hospital delay. The median pre-hospital delay time of all patients was 72 h (N = 253). About half of the patients did nothing to relieve their symptoms before seeking medical care. Living in urban areas was associated with a shorter pre-hospital delay. Patients with HF waited several days after first experiencing worsening of symptoms before getting admitted to a hospital, which may be related to inappropriate interpretation and responses to the worsening of symptoms. Furthermore, we found that rural residents were more vulnerable to pre-hospital delay than their urban counterparts.
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http://dx.doi.org/10.3390/ijerph18126679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296403PMC
June 2021

Left Atrial Strain to Predict Stroke in Patients With Acute Heart Failure and Sinus Rhythm.

J Am Heart Assoc 2021 07 30;10(13):e020414. Epub 2021 Jun 30.

Cardiovascular Center & Department of Internal Medicine Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea.

Background Stroke is a major comorbidity in patients with heart failure (HF), especially in those with decreased left atrial (LA) function, and thus, identifying patients highly at risk of stroke can prevent its occurrence. We evaluated the predictive value of global longitudinal strain of LA (LAGLS) in patients with acute HF and sinus rhythm. Methods and Results In this retrospective study, 2461 patients (53.3% men, 69.7±14.4 years old) with sinus rhythm and LAGLS among 4312 consecutive patients with acute HF from 3 tertiary hospitals were included. HF phenotypes were defined as HF with reduced ejection fraction (EF) (left ventricular EF ≤40%), HF with midrange EF (40%
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http://dx.doi.org/10.1161/JAHA.120.020414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403314PMC
July 2021

Comparison of two digital PCR methods for EGFR DNA and SARS-CoV-2 RNA quantification.

Clin Chim Acta 2021 Oct 16;521:9-18. Epub 2021 Jun 16.

Biomolecular Measurement Team, Korea Research Institute of Standards and Science, Daejeon, Republic of Korea. Electronic address:

Background: The COVID-19 pandemic caused by the severe acute SARS-CoV-2 virus has undeniably highlighted the importance of reliable nucleic acid quantification. Digital PCR (dPCR) is capable of the absolute quantification of nucleic acids.

Method: By using the droplet dPCR (QX200) and the digital real-time PCR (LOAA), the copy numbers were compared via multiple assays for three distinct targerts; EGFR DNA, SARS-CoV-2 and HIV-1 RNA.

Results: The droplet dPCR and digital real-time PCR showed similar copy numbers for both DNA and RNA quantification. When the limit of detection (LOD) and limit of quantitation (LOQ) of each method were estimated for DNA and RNA targets, the digital real-time PCR showed a higher sensitivity and precision especially with low copy number targets.

Conclusion: The breath of nucleic acid testing in diagnostic applications continues to expand. In this study we applied common diagnostic targets to a novel digital real-time PCR methodology. It performed comparably to the established dPCR method with distinctive advantages and disadvantages for implementing in laboratories. These rapidly developing dPCR systems can be applied to benefit the accurate and sensitive nucleic acid testing for various clinical areas.
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http://dx.doi.org/10.1016/j.cca.2021.06.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206622PMC
October 2021

2020 KSC/KATRD Guideline for the Diagnosis and Treatment of Pulmonary Hypertension: Executive Summary.

Tuberc Respir Dis (Seoul) 2021 Jun 4. Epub 2021 Jun 4.

Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.

Pulmonary hypertension (PH) is a condition of increased blood pressure in the pulmonary arteries and is diagnosed with an increased a mean pulmonary artery pressure ≥25 mm Hg. This condition may be associated with multiple clinical situations. Based on pathophysiological mechanisms, clinical presentation, hemodynamic profiles, and treatment strategies, the patients were classified into five clinical groups. Although there have been major advances in the management of PH, it is still associated with significant morbidity and mortality. The diagnosis and treatment of PH have been performed mainly by following European guidelines, even in Korea because the country lacks localized PH guidelines. European treatment guidelines do not reflect the actual status of Korea. Therefore, the European diagnosis and treatment of PH have not been tailored well to suit the needs of Korean patients with PH. To address this issue, we developed this guideline to facilitate the diagnosis and treatment of PH appropriately in Korea, a country where the consensus for the diagnosis and treatment of PH remains insufficient. This is the first edition of the guidelines for the diagnosis and treatment of PH in Korea, and it is primarily based on the '2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension.' with the acceptance and adaptation of recent publications of PH.
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http://dx.doi.org/10.4046/trd.2021.0022DOI Listing
June 2021

Echocardiographic Measurement of Left Atrial Strain - A Key Requirement in Clinical Practice.

Circ J 2021 Jun 5. Epub 2021 Jun 5.

Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital.

Unlike the left ventricle (LV), the left atrium (LA) has a thin-walled structure and has been regarded as a simple conduit chamber. However, the unique function of the LA to modulate LV filling has recently drawn much attention. Because LA structure and function are directly influenced by the LV filling pressure, LA assessment is an essential step in the diagnosis of diastolic dysfunction that can help predict new-onset atrial fibrillation, assess the risk of further embolic events, and identify high-risk patients for adverse cardiovascular events. Even in the recent era of multimodality imaging, 2-dimensional (2D) echocardiography is the most common imaging method and the central modality for evaluation of LA function. LA strain derived from 2D echocardiography can help assess LA function objectively and demonstrates the 3 distinct phasic motions of the LA cycle. Further, LA strain provides invaluable pathophysiologic information and helps to predict clinical prognosis in various cardiovascular diseases. In this review article, we focus on LA strain: basic concepts, advantages over conventional parameters, and some unresolved issues. Additionally, we present a brief history of the clinical evidence for LA strain. Through this review, we suggest echocardiography for LA strain assessment in clinical practice.
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http://dx.doi.org/10.1253/circj.CJ-21-0373DOI Listing
June 2021

Sex-specific impact of diabetes mellitus on left ventricular systolic function and prognosis in heart failure.

Sci Rep 2021 06 3;11(1):11664. Epub 2021 Jun 3.

Department of Internal Medicine, College of Medicine, Seoul National University, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea.

We aimed to investigate the sex differences in associations of diabetes mellitus (DM) with echocardiographic phenotypes and clinical outcomes of heart failure (HF). We studied 4,180 patients admitted for acute HF between 2009 and 2016 (median follow-up, 31.7 months) whose left ventricular global longitudinal strain (LV-GLS) data were available. Patients were compared by sex and DM. Structural equation model (SEM) analysis was performed to evaluate the moderating effects of two causal paths, via ischemic heart disease (IHD) and LV-GLS, linking DM with mortality. Compared to non-diabetic women, diabetic women had significantly lower LV-GLS (11.3% versus 10.1%, p < 0.001), but the difference was attenuated within men (9.7% versus 9.2%, p = 0.014) (p-for-interaction by sex = 0.018). In Cox analyses, DM was an independent predictor for higher mortality in both sexes (women: adjusted hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.15-1.59 versus men: HR 1.24, 95% CI 1.07-1.44, p-for-interaction by sex = 0.699). Restricted cubic spline curves showed that LV-GLS consistently declined, and mortality increased in women with worsening hyperglycemia, but these trends were not evident in men. In SEM analysis, the main driver from DM to mortality differed by sex; men had a stronger effect via IHD than LV-GLS, whereas LV-GLS was the only predominant path in women.
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http://dx.doi.org/10.1038/s41598-021-91170-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175704PMC
June 2021

Effect of Cardiac Rehabilitation on Left Ventricular Diastolic Function in Patients with Acute Myocardial Infarction.

J Clin Med 2021 May 13;10(10). Epub 2021 May 13.

Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon 35015, Korea.

Cardiac rehabilitation (CR) improves symptoms and survival in patients with acute myocardial infarction (AMI). We studied the change of diastolic function and its prognostic impact after CR. After reviewing all consecutive AMI patients from January 2012 to October 2015, we analyzed 405 patients (mean, 63.7 ± 11.7 years; 300 males) with baseline and follow-up echocardiographic examinations. We divided them into three groups according to their CR sessions: No-CR group ( = 225), insufficient-CR group (CR < 6 sessions, = 117) and CR group (CR ≥ 6 sessions, = 63). We compared echocardiographic parameters of diastolic dysfunction including E/e' ratio > 14, septal e' velocity < 7 cm/s, left atrial volume index (LAVI) > 34 mL/m, and maximal TR velocity > 2.8 m/s. At baseline, there were no significant differences in all echocardiographic parameters among the three groups. At follow-up echocardiographic examination, mitral annular e' and a' velocities were higher in the CR group ( = 0.024, and = 0.009, respectively), and mitral E/e' ratio was significantly lower ( = 0.009) in the CR group. The total number of echocardiographic parameters of diastolic dysfunction at the baseline echocardiography was similar (1.29 vs. 1.41 vs. 1.52, = 0.358). However, the CR group showed the lowest number of diastolic parameters at the follow-up echocardiography (1.05 vs. 1.32 vs. 1.50, = 0.017). There was a significant difference between the No-CR group and CR group ( = 0.021). The presence of CR was a significant determinant of major adverse cardiovascular events in the univariate analysis (HR = 0.606, = 0.049). However, the significance disappeared in the multivariate analysis (HR = 0.738, = 0.249). In conclusion, the CR was significantly associated with favorable diastolic function, with the highest mitral e' and a' velocity, and the lowest mitral E/e' ratio and total number of echocardiographic parameters of diastolic dysfunction at the follow-up echocardiographic examinations in AMI patients.
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http://dx.doi.org/10.3390/jcm10102088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152492PMC
May 2021

Heart failure with mid-range ejection fraction and the effect of β-blockers after acute myocardial infarction.

Heart Vessels 2021 May 21. Epub 2021 May 21.

Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.

There is currently an ongoing debate about the 'grey area' of heart failure with mid-range ejection fraction (HFmrEF). We evaluated characteristics, prognosis, and the effect of β-blockers on clinical outcomes in patients with HFmrEF after acute myocardial infarction (AMI). We included a total of 10,785 patients and divided them into three groups: EF 40-49% (HFmrEF; n = 2717; reference); EF < 40% (reduced EF [HFrEF]; n = 1194); and EF ≥ 50% (preserved EF [HFpEF]; n = 6874). The primary outcome was 2-year all-cause mortality. HFmrEF was intermediate between HFrEF and HFpEF for baseline characteristics. The risk of all-cause mortality was lower for HFmrEF patients compared to HFrEF patients (adjusted hazard ratio [HR] 0.710; 95% confidence interval [CI] 0.544-0.927; P = 0.012). However, HFmrEF patients tended to be at higher risk for 2-year all-cause mortality than HFpEF patients (adjusted HR 1.235; 95% CI 0.989-1.511; P = 0.090). β-blockers were associated with reductions in all-cause mortality for the entire cohort (adjusted HR 0.760; 95% CI 0.592-0.975; P = 0.031). β-blockers were effective in patients with HFrEF (adjusted HR 0.667; 95% CI 0.471-0.944; P = 0.022), tended to be effective in patients with HFmrEF (adjusted HR 0.665; 95% CI 0.426-1.038; P = 0.072), but not effective in patients with HFpEF (adjusted HR 0.852; 95% CI 0.548-1.326; P = 0.478; interaction P = 0.026). In conclusion, clinical profiles and prognosis of patients with post-AMI HFmrEF are largely intermediate between HFrEF and HFpEF. β-blockers reduced or tended to reduce 2-year all-cause mortality in patients with HFrEF or HFmrEF, respectively, but not those with HFpEF after AMI.
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http://dx.doi.org/10.1007/s00380-021-01876-1DOI Listing
May 2021

Ortner's Syndrome Discovered by a Routine Echocardiographic Examination: a Huge Aneurysmal Dilatation of the Aortic Arch as a Cause of Hoarseness.

Korean Circ J 2021 Apr;51(4):379-381

Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.

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http://dx.doi.org/10.4070/kcj.2020.0529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022018PMC
April 2021

The Relationship Between Body Awareness and Self-care in Patients With Heart Failure: Moderating Effect of Age.

J Cardiovasc Nurs 2021 Mar 16. Epub 2021 Mar 16.

Kyoung Suk Lee, PhD, RN, MPH Associate Professor, Seoul National University, College of Nursing, the Research Institute of Nursing Science, Seoul, South Korea. Jin-Oh Choi, MD, PhD Associate Professor, Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Eun-Seok Jeon, MD, PhD Professor, Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Jae-Hyeong Park, MD, PhD Professor, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, School of Medicine, Daejeon, South Korea. Mi Sook Jung, PhD, RN Associate Professor, Chungnam National University, College of Nursing, Deajeon, South Korea.

Background: Recognizing changing symptoms is challenging for patients with heart failure (HF), especially older patients. Body awareness involves an attentional focus on and awareness of internal bodily changes. Patients with poor body awareness are unlikely to recognize subtle bodily changes, which may result in improper self-care. Despite the potential benefits of body awareness, its contribution to HF management has not been examined.

Aims: The aims of this study were to examine the relationship between body awareness and self-care in patients with HF and explore whether this relationship varies by age.

Methods: Patients (N = 136) completed the Body Awareness Questionnaire and 2 scales of the Self-care of HF Index (maintenance and management). Linear regression models were constructed to explore the relationship between body awareness and self-care after controlling for covariates. The moderation effect of age on the relationship between body awareness and self-care was examined using the PROCESS macro.

Results: Body awareness was associated with self-care maintenance (unstandardized coefficient = 0.19; 95% confidence interval, 0.05-0.34) but not management. When the interaction effect of body awareness and age was entered in the regression model, neither self-care maintenance nor management was related to this interaction term.

Conclusion: We found that body awareness is conducive to self-care maintenance but not self-care management in patients with HF, and the relationship between body awareness and self-care did not vary by age. Our findings suggest that relying on internal body sensations may be insufficient to facilitate self-care management. Thus, other strategies along with the strategies to enhance body awareness are necessary to improve the full process of self-care in HF patients.
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http://dx.doi.org/10.1097/JCN.0000000000000801DOI Listing
March 2021

Gender Difference of Cardiac Remodeling in University Athletes: Results from 2015 Gwangju Summer Universiade.

Korean Circ J 2021 May 5;51(5):426-438. Epub 2021 Feb 5.

Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.

Background And Objectives: There is little data about cardiac geometry in highly trained young athletes, especially female specific changes. We investigated gender difference on exercise induced cardiac remodeling (EICR) in highly trained university athletes.

Methods: A total of 1,185 university athletes divided into 2 groups; female (n=497, 22.0±2.3 years) vs. male (n=688, 22.6±2.4 years). Remodeling of the left ventricle (LV), left atrium (LA), right ventricle (RV), and any cardiac chamber were compared.

Results: LV, LA, RV, and any remodeling was found in 156 (13.2%), 206 (17.4%), 82 (6.9%), and 379 athletes (31.9%), respectively. LV, LA, and any remodeling were more common in male than female athletes (n=53, 12.1% vs. n=103, 15.5%, p=0.065), (n=65, 13.1% vs. n=141, 20.5%, p<0.001), (n=144, 30.0% vs. n=235, 34.2%, p=0.058), respectively, whereas RV remodeling was significantly more common in female than male athletes (n=56, 11.3% vs. n=26, 3.8%, p<0.001). Interestingly, the development of LV, LA, and RV remodeling were not overlapped in many of athletes, suggesting different mechanism of EICR according to cardiac chamber. Various predictors including sports type, heart rate, muscle mass, fat mass, body surface area, and training time were differently involved in cardiac remodeling, and there were gender differences of these predictors for cardiac remodeling.

Conclusions: EICR was common in both sex and was independently developed among cardiac chambers in highly trained university athletes. LV and LA remodeling were common in males, whereas RV remodeling was significantly more common in females demonstrating gender difference in EICR. The present study also demonstrated gender difference in the predictors of EICR.
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http://dx.doi.org/10.4070/kcj.2020.0484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112176PMC
May 2021

Association between nonalcoholic fatty liver disease and cardiovascular disease revealed after comprehensive control of metabolic risk factors: a nationwide population-based study in Korea.

Eur J Gastroenterol Hepatol 2021 Mar 12. Epub 2021 Mar 12.

Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon Department of Statistics, Kyungpook National University, Daegu Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Objectives: Previous epidemiological studies have limitations in revealing whether cardiovascular disease (CVD) incidence is mediated by interim occurrence of other metabolic diseases in otherwise healthy nonalcoholic fatty liver disease (NAFLD) patients.

Methods: The study population consisted of 334 280 healthy subjects who had had the National Health check-ups in South Korea from 2009 to 2014. The fatty liver index (FLI) was used to identify subjects with NAFLD. CVD was defined as occurrence of a composite of cardiovascular death, myocardial infarction, ischemic stroke, or coronary revascularization. The association between FLI and CVD incidence was analyzed using time-dependent Cox regression analyses.

Results: The study population was categorized into quartile groups according to FLI (range: Q1, 0-4.9; Q2, 5.0-12.5; Q3, 12.6-31.0; Q4, >31.0). The median follow-up duration was 5.4 years, during which subjects with higher FLIs experienced CVD more frequently than did those with lower FLIs [Q1, 215 (0.3%); Q2, 498 (0.6%); Q3, 753 (0.9%); Q4, 981 (1.2%); P < 0.001]. Adjustment of baseline characteristics revealed that a higher FLI was independently associated with an increased risk for CVD [hazard ratio between Q4 and Q1, 1.86; 95% confidence interval (CI), 1.59-2.17; P < 0.001]. The association between them remained statistically significant (hazard ratio between Q4 and Q1, 1.92; 95% CI, 1.63-2.25; P < 0.001) after further adjustment for the interim events (diabetes, hypertension, heart failure, and atrial fibrillation).

Conclusions: Otherwise healthy NAFLD patients progressed to develop CVD independently of the interim occurrence of other metabolic diseases, which emphasizes the importance of NAFLD as a potential therapeutic target for prevention of CVD.
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http://dx.doi.org/10.1097/MEG.0000000000002102DOI Listing
March 2021

Hospital-level variation in follow-up strategies after percutaneous coronary intervention, revealed in health claims data of Korea.

Sci Rep 2021 02 8;11(1):3322. Epub 2021 Feb 8.

Division of Cardiology, Kyungpook National University Hospital, Daegu, Korea.

This study sought to determine hospital variation in the use of follow-up stress testing (FUST) and invasive coronary angiography (FUCAG) after percutaneous coronary intervention (PCI). The claims records of 150,580 Korean patients who received PCI in 128 hospitals between 2008 and 2015 were analyzed. Patient were considered to have undergone FUST and FUCAG, when these testings were performed within two years after discharge from the index hospitalization. Hierarchical generalized linear and frailty models were used to evaluate binary and time-to-event outcomes. Hospital-level risk-standardized FUCAG and FUST rates were highly variable across the hospitals (median, 0.41; interquartile range [IQR], 0.27-0.59; median, 0.22; IQR, 0.08-0.39, respectively). The performances of various models predicting the likelihood of FUCAG and FUST were compared, and the best performance was observed with the models adjusted for patient case mix and individual hospital effects as random effects (receiver operating characteristic curves, 0.72 for FUCAG; 0.82 for FUST). The intraclass correlation coefficients of the models (0.41 and 0.68, respectively) indicated that a considerable proportion of the observed variation was related to individual institutional effects. Higher hospital-level FUCAG and FUST rates were not preventive of death or myocardial infarction. Increased repeat revascularizations were observed in hospitals with higher FUCAG rates.
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http://dx.doi.org/10.1038/s41598-021-82960-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870879PMC
February 2021

Things You Should Know in the Performing Echocardiographic Examination in Patients with COVID-19.

J Cardiovasc Imaging 2021 Jan;29(1):20-30

Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.

Novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and it has become a pandemic problem. Cardiovascular diseases are common in COVID-19 patients, especially in severe forms of infection, and these are associated with higher mortality. SARS-CoV-2 infection can cause cardiovascular disease and worsen preexisting disease by direct invasion, hypoxia associated with pneumonia, and immunologic mechanisms. Because prompt detection and proper treatment can be critical to COVID-19 patients, echocardiographic examinations are essential diagnostic tools in the diagnosis and determination of treatment options. However, because there is an increased risk of infection during echocardiographic examinations, healthcare providers should pay attention to mitigate the risk of infection during the diagnosis and management of COVID-19 patients.
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http://dx.doi.org/10.4250/jcvi.2020.0128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847796PMC
January 2021

The association of deficiencies of water-soluble vitamin intake with health-related quality of life and prognosis in patients with heart failure.

Qual Life Res 2021 Apr 11;30(4):1183-1190. Epub 2021 Jan 11.

College of Nursing, University of Kentucky, Lexington, USA.

Purpose: The purpose of this study was to determine whether deficiencies of water-soluble vitamin intake predicted health-related quality of life (HRQOL) and the composite end point of all-cause mortality or cardiac- or heart failure (HF)-related hospitalization in HF patients. Patients with HF may be at risk for inadequate consumption of water-soluble vitamins due to poor appetite and dietary sodium restriction. Because water-soluble vitamins are important in metabolic processes, inadequate dietary intake of these vitamins may negatively affect health outcomes.

Methods: We consecutively recruited patients with HF from outpatient clinics affiliated with academic medical centers. Patients were referred by providers to investigators who verified their eligibility. Patients with HF completed a four-day food diary to determine dietary deficiencies of water-soluble vitamins and the Minnesota Living with HF questionnaire to assess HRQOL at baseline. Patients were followed to determine an event.

Results: A total of 216 patients were included. Patients with a higher number of dietary deficiencies of water-soluble vitamins had poorer HRQOL (unstandardized coefficient = 4.92, 95% confidence interval 2.20-7.27). Cox regression showed that for each additional deficiency of a water-soluble vitamin intake, there was a 30% increase in risk for an event (95% confidence interval 1.03-1.75), controlling for demographic and clinical variables.

Conclusion: Inadequate dietary consumption of water-soluble vitamins was associated with poor HRQOL and prognosis and in HF. Our findings highlight that clinicians should understand the importance of encouraging patients to consume water-soluble vitamin-rich foods, which may result in enhancing outcomes in HF.
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http://dx.doi.org/10.1007/s11136-020-02725-wDOI Listing
April 2021

Mannitol Enhances the Antinociceptive Effects of Diphenhydramine as an Alternative Local Anesthetic.

Pain Res Manag 2020 26;2020:7934164. Epub 2020 Nov 26.

Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.

Mannitol has recently been reported to be effective in enhancing the antinociceptive efficacy of lidocaine. No single study to date, however, has compared diphenhydramine with and without mannitol for nociceptive processing as an alternative local anesthetic. In this study, we examined the antinociceptive efficacy enhancements of diphenhydramine when combined with mannitol. Male Sprague-Dawley rats weighing 230-260 g were used in a hot plate test to evaluate the antinociceptive effects of diphenhydramine. All chemicals were dissolved in isotonic normal saline and administered subcutaneously into the plantar surface of the right hind paw at 10 min before the hot plate test. A subcutaneous injection of 0.5% or 1% diphenhydramine produced significant inhibition of the withdrawal latency time compared with the vehicle treatment. Antinociceptive effects appeared 10 min after the diphenhydramine injections and persisted for over 30 min. The antinociceptive effects of 1% diphenhydramine were not statistically different from those of 1% lidocaine. Although a subcutaneous injection of a 0.5 M mannitol solution alone did not affect the withdrawal latency time, 1% diphenhydramine with 0.5 M mannitol significantly enhanced antinociception. A subcutaneous injection of 1% diphenhydramine with epinephrine (1 : 100,000) solution did not increase the antinociceptive effect of the diphenhydramine. These results suggest that diphenhydramine with mannitol can be used as an alternative local anesthetic.
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http://dx.doi.org/10.1155/2020/7934164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714595PMC
March 2021

Two Fatal Cases of Stress-induced Cardiomyopathy in COVID-19 Patients.

J Cardiovasc Imaging 2020 Oct;28(4):300-303

Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.

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http://dx.doi.org/10.4250/jcvi.2020.0125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572266PMC
October 2020

Prevalence and Prediction of Aneurysmal Dilatation of the Abdominal Aorta in Koreans: Results of Screening During Transthoracic Echocardiographic Examination.

J Cardiovasc Imaging 2020 Oct;28(4):257-264

Department of Cardiology, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea.

Background: Aortic aneurysm (AA) is an enlargement of the aorta to greater than 1.5 times normal size. Although the US guideline recommends ultrasound screening for abdominal AA (AAA) in men older than 65 years regardless of symptoms, limited data describe the prevalence of AAA in Korea. In this study, we screened patients for AAA during transthoracic echocardiographic examination (TTE).

Methods: We screened for AAA in all consecutive subjects older than 60 years who underwent TTE. We defined AAA as an abdominal aorta with the diameter greater than 30 mm.

Results: We analyzed 5,679 persons (2,272 females, 74 ± 8 years old). The mean size of the abdominal aorta was 19.0 ± 6.1 mm. The prevalence of AAA was 2.9% (165/5,679) and was significantly higher in males (4.7% vs. 1.1%, p < 0.001). AAA was significantly associated with male sex (odds ratio [OR] = 3.098, 95% confidence interval [CI] = 1.971-4.870, p < 0.001), older age (OR = 1.074, 95% CI = 1.050-1.097, p < 0.001), non-diabetes (OR = 1.886, 95% CI = 1.264-2.813, p < 0.001), dyslipidemia (OR = 1.475, 95% CI = 1.019-2.135, p = 0.040), ever-smoker (OR = 2.090, 95% CI = 1.448-3.015, p < 0.001), chronic kidney disease (CKD, OR = 1.757, 95% CI = 1.182-2.612, p = 0.005), and coronary artery disease (CAD, OR = 2.452, 95% CI = 1.742-3.451, p < 0.001). A prediction score with a multivariate model (range: 3.34-10.51) detected AAA with a sensitivity of 79.4% and a specificity of 66.8% with a reference value > 6.8 (area under the curve = 0.799).

Conclusions: In Korea, the prevalence of AAA was 2.9% in subjects older than 60 years during TTE, and AAA was significantly associated with older age, male sex, non-diabetes, dyslipidemia, ever-smoker, CKD, and CAD. Prediction score (> 6.8%) detected AAA with a sensitivity of 79.4% and a specificity of 66.8%.
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http://dx.doi.org/10.4250/jcvi.2020.0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572259PMC
October 2020

H2FPEF Score Reflects the Left Atrial Strain and Predicts Prognosis in Patients With Heart Failure With Preserved Ejection Fraction.

J Card Fail 2021 Feb 7;27(2):198-207. Epub 2020 Oct 7.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.

Background: The HFPEF score is a validated algorithm for the diagnosis of heart failure with preserved ejection fraction (HFpEF). We investigated the associations of the HFPEF score with echocardiographic parameters and prognosis in patients with HFpEF admitted for acute heart failure.

Methods And Results: In total, 4312 patients at 3 tertiary centers were identified. Among 1335 patients with HFpEF, the HFPEF score was available in 1105 patients (39% male) with a median age of 77 years (interquartile range 69-82). The median HFPEF score was 4 (interquartile range 3-6). Patients with higher HFPEF scores had worse left atrial (LA) size, peak atrial longitudinal strain of the left atrium, mitral E/e' ratio, and peak tricuspid regurgitation velocity. Peak atrial longitudinal strain of the left atrium demonstrated a significant association with the HFPEF score, in patients without atrial fibrillation and those without atrial fibrillation. After adjustment for clinical factors and echocardiographic parameters, patients with higher HFPEF scores had a higher risk of mortality and hospitalization for heart failure, regardless of the presence of atrial fibrillation.

Conclusions: The HFPEF score reflects left atrial function in patients with HFpEF admitted for acute heart failure. This association supports the clinical usefulness of the HFPEF score as an indicator of diastolic dysfunction, a diagnostic algorithm for HFpEF, and a prognostic factor in patients with HFpEF.
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http://dx.doi.org/10.1016/j.cardfail.2020.09.474DOI Listing
February 2021

Effect of Ticagrelor on Left Ventricular Remodeling in Patients With ST-Segment Elevation Myocardial Infarction (HEALING-AMI).

JACC Cardiovasc Interv 2020 10;13(19):2220-2234

Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea. Electronic address:

Objectives: The aim of this study was to evaluate the effect of ticagrelor versus clopidogrel on left ventricular (LV) remodeling after reperfusion of ST-segment elevation myocardial infarction (STEMI) in humans.

Background: Animal studies have demonstrated that ticagrelor compared with clopidogrel better protects myocardium against reperfusion injury and improves remodeling after myocardial infarction.

Methods: In this investigator-initiated, randomized, open-label, assessor-blinded trial performed at 10 centers in Korea, patients were enrolled if they had naive STEMI successfully treated with primary percutaneous coronary intervention (PCI) and at least 6-month planned duration of dual-antiplatelet treatment. The coprimary endpoints were LV remodeling index (LVRI) (a relative change of LV end-diastolic volume) measured on 3-dimensional echocardiography and N-terminal pro-B-type natriuretic peptide level at 6 months.

Results: Among initially enrolled patients with STEMI (n = 336), 139 in each group completed the study. LVRI at 6 months was numerically lower with ticagrelor versus clopidogrel (0.6 ± 18.6% vs. 4.5 ± 16.5%; p = 0.095). Ticagrelor significantly reduced the 6-month level of N-terminal pro-B-type natriuretic peptide (173 ± 141 pg/ml vs. 289 ± 585 pg/ml; p = 0.028). These differences were prominent in patients with pre-PCI TIMI (Thrombolysis In Myocardial Infarction) flow grade 0. By multivariate analysis, ticagrelor versus clopidogrel reduced the risk for positive LV remodeling (LVRI >0%) (odds ratio: 0.56; 95% confidence interval: 0.33 to 0.95; p = 0.030). The LV end-diastolic volume index remained unchanged during ticagrelor treatment (from 54.7 ± 12.2 to 54.2 ± 12.2 ml/m; p = 0.629), but this value increased over time during clopidogrel treatment (from 54.6 ± 11.3 to 56.4 ± 13.9 ml/m; p = 0.056) (difference -2.3 ml/m; 95% confidence interval: -4.8 to 0.2 ml/m; p = 0.073). Ticagrelor reduced LV end-systolic volume index (from 27.0 ± 8.5 to 24.7 ± 8.4 ml/m; p < 0.001), whereas no reduction was seen with clopidogrel (from 26.2 ± 8.9 to 25.6 ± 11.0 ml/m; p = 0.366) (difference -1.8 ml/m; 95% confidence interval: -3.5 to -0.1 ml/m; p = 0.040).

Conclusions: Ticagrelor was superior to clopidogrel for LV remodeling after reperfusion of STEMI with primary PCI. (High Platelet Inhibition With Ticagrelor to Improve Left Ventricular Remodeling in Patients With ST Segment Elevation Myocardial Infarction [HEALING-AMI]; NCT02224534).
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http://dx.doi.org/10.1016/j.jcin.2020.08.007DOI Listing
October 2020

Acoustic Matching Layer Films Using B-Stage Thermosetting Polymer Resins for Ultrasound Transducer Applications.

IEEE Trans Ultrason Ferroelectr Freq Control 2020 10 1;67(10):2148-2154. Epub 2020 Jun 1.

Acoustic matching layer films (MLFs) were fabricated using B-stage thermosetting polymer resins with various volume fractions of alumina and tungsten powders. After making certain thickness MLFs, ultrasonic matching layers were fabricated using a simple molding process. The thickness of the matching layers can be precisely adjusted from several micrometer to hundreds of micrometer, without any grinding process. Experimental values of acoustic impedances of the matching layers were in good agreement with theoretical values calculated by the Devaney model. Using the optimized acoustic matching layer by the MLFs, the maximum intensity and the fractional bandwidth of the ultrasonic transducer were increased by 10% and 37% respectively. The effectiveness of the matching layer using MLFs was successfully verified.
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http://dx.doi.org/10.1109/TUFFC.2020.2999178DOI Listing
October 2020

Comparison of Clinical and Echocardiographic Characteristics between Cardiac Myxomas and Masses Mimicking Myxoma.

Korean Circ J 2020 Sep 29;50(9):822-832. Epub 2020 Jun 29.

Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.

Background And Objectives: Cardiac myxoma is the most frequent benign cardiac tumor that can result in cardiac and systemic symptoms. We investigated clinical and echocardiographic characteristics of patients with cardiac masses suggesting myxoma.

Methods: We investigated 265 consecutive patients with an echocardiographic diagnosis of cardiac myxomas in 4 teaching hospitals in Korea.

Results: The mean age was 61±16 years and 169 patients (63.8%) were female. The most frequent referral reason for echocardiography was an evaluation of cardiac symptoms (43.4%). Tumors were incidentally detected in 82 patients (30.9%). Left atrium (LA) was the most frequently involved site (84.5%) and 19 patients (7.2%) had non-atrial tumors. The mean tumor size was 38.7×26.0 mm (range, 4-96 mm). Of 186 patients (70.2%) who had pathological diagnosis, 174 (93.5%) were confirmed with myxoma, 8 (4.3%) with other tumors and 4 (2.2%) with thrombi. Compared to myxoma, smaller size (20.4×12.6 mm vs. 41.4×27.6 mm, p<0.01) and non-LA location (87.5% vs. 10.5%, p<0.001) were associated with non-myxoma tumors, and more frequent atrial fibrillation (AF, 75.0% vs. 7.0%, p<0.001) and larger LA diameter (55.0±14.6 mm vs. 41.3±7.7 mm, p=0.001) were related to thrombi.

Conclusions: Of 265 patients with an echocardiographic diagnosis with cardiac myxomas, 174 (65.7%) were surgically confirmed with myxomas. Compared with cardiac myxoma, other tumors were smaller and more frequently found in non-atrial sites. Thrombi were associated with AF and larger LA diameter.
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http://dx.doi.org/10.4070/kcj.2020.0024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441004PMC
September 2020

Left Atrial Strain as a Predictor of New-Onset Atrial Fibrillation in Patients With Heart Failure.

JACC Cardiovasc Imaging 2020 10 15;13(10):2071-2081. Epub 2020 Jul 15.

Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.

Objectives: This study sought to identify whether left atrial strain can predict new-onset atrial fibrillation (NOAF) in patients with heart failure (HF) and sinus rhythm.

Background: Both HF and atrial fibrillation have common risk factors, and HF is a risk factor for the development of atrial fibrillation and vice versa.

Methods: Among 4,312 consecutive patients with acute HF from 3 tertiary hospitals, 2,461 patients with sinus rhythm and peak atrial longitudinal strain (PALS) were included in the study. Reduced PALS was defined as PALS ≤18%, and the primary endpoint was 5-year NOAF.

Results: During a 5-year follow-up, 397 (16.1%) patients developed NOAF. Patients with reduced PALS had higher NOAF than their counterparts (18.2% vs. 12.7%; p < 0.001). After adjustment for significant covariates, we identified 6 independent predictors of NOAF, including age >70 years (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.12 to 2.00), hypertension (HR: 1.45; 95% CI: 1.10 to 1.91), left atrial volume index ≥40 ml/m (HR: 2.03; 95% CI: 1.48 to 2.77), PALS <18% (HR: 1.60; 95% CI: 1.18 to 2.17), HF with preserved ejection fraction (HR: 1.47; 95% CI: 1.11 to 1.95), and no beta-blocker prescription at discharge (HR: 1.48; 95% CI: 1.14 to 1.92). A weighted score based on these variables was used to create a composite score, HAS-BAP (H = hypertension; A = age; S = PALS; B = no beta-blocker prescription at discharge; A = atrial volume index; P = HF with preserved ejection fraction [range 0 to 6] with a median of 3 [interquartile range: 2 to 4]). The probability of NOAF increased with HAS-BAP score.

Conclusions: In patients with HF and sinus rhythm, 16.1% developed NOAF, and PALS could be used to predict the risk for NOAF. The HAS-BAP score allows determination of the risk of NOAF. (Strain for Risk Assessment and Therapeutic Strategies in Patients With Acute Heart Failure [STRATS-AHF] Registry; NCT03513653).
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http://dx.doi.org/10.1016/j.jcmg.2020.04.031DOI Listing
October 2020

Radial Plus Ipsilateral Femoral Approach is Feasible in Percutaneous Interventions for Iliac Artery Chronic Total Occlusion.

Ann Vasc Surg 2021 Feb 10;71:257-263. Epub 2020 Jul 10.

Department of Cardiology, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.

Background: Compared with conventional bilateral femoral (BF) approach, radial plus ipsilateral femoral (RF) approach may be feasible in the percutaneous intervention for iliac artery chronic total occlusion (CTO).

Methods: We included patients who underwent iliac CTO intervention between August 2009 and July 2018 in a tertiary referral center in Korea.

Results: A total of 83 patients were enrolled in this study. Of them, 51 and 32 patients were categorized into RF and BF initial access groups, respectively. The overall success rates were 98.0% and 96.7% in RF and BF group, respectively, and the techniques were also similar including use of bilateral wiring, stent type and profile, and post balloon but longer procedure time in the BF group. Additional contralateral femoral access was needed in 6 patients for the treatment of contralateral lesions, distal embolization, and due to tortuous right subclavian artery. Periprocedural complications including vascular injury, iliac perforation, and distal embolization occurred similarly in both groups with numerically lower rate of periprocedural bleeding in the RF group (9.8%) than in the BF group (21.9%). Clinical follow-up at 6 months showed there were no difference in the rates of death, cardiovascular death, target-limb reintervention, and unplanned target limb amputation in both groups.

Conclusions: RF approach for iliac CTO intervention was related to similar technical success rate with acceptable periprocedural safety outcomes compared with conventional BF approach.
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http://dx.doi.org/10.1016/j.avsg.2020.07.005DOI Listing
February 2021
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