Publications by authors named "Se Yong Jang"

44 Publications

Complications caused by iatrogenic right-to-left shunt after surgical closure of atrial septal defect: a case report.

Eur Heart J Case Rep 2021 Nov 4;5(11):ytab434. Epub 2021 Nov 4.

Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea.

Background: Atrial septal defect (ASD) is a common congenital heart disease. For this condition, surgical treatment can be required depending on the size and type of ASD. This study included a case of a patient who complained of persistent dyspnoea after the surgical treatment for ASD.

Case Summary: A 16-year-old girl who underwent a surgical patch closure for ASD at the age of 2 years presented to the emergency department and was diagnosed with acute stroke. Since childhood, she had suffered from exertional dyspnoea due to an unknown cause. Transthoracic echocardiography revealed normal chambers size and function and no signs of right heart strain. Transoesophageal echocardiography (TOE) revealed a misplaced interatrial patch from the previous surgery, which allowed the whole blood to flow from the inferior vena cava (IVC) to the left atrium (LA), creating a large right-to-left shunt that resulted in stroke and heart failure. The patient underwent surgical treatment, and her symptoms improved significantly. Six months later, she was doing well without neurological complications and dyspnoea.

Discussion: This patient experienced stroke at the age of 16 years and had been suffering from heart failure since childhood. A large right-to-left shunt flow from the IVC to the LA by misplaced interatrial patch was found using TOE, right-sided heart catheterization, and inferior caval venography. This diagnosis should be considered in patients complaining of persistent dyspnoea with hypoxia after the surgical repair of ASD.
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http://dx.doi.org/10.1093/ehjcr/ytab434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669598PMC
November 2021

Clinical course of COVID-19 patients treated with ECMO: A multicenter study in Daegu, South Korea.

Heart Lung 2021 Jan-Feb;50(1):21-27. Epub 2020 Oct 19.

Department of Internal Medicine, Division of Pulmonology, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Republic of Korea.

Background: The COVID-19 pandemic has caused an epidemic of critical patients, some of whom have been treated with extracorporeal membrane oxygenation (ECMO). This purpose of study is to describe the clinical course of COVID-19 patients treated with ECMO.

Methods: A multicentered study of critical patients with COVID-19 treated at six hospitals in Daegu was conducted between January and April 2020.

Results: Among the 80 patients receiving mechanical ventilation support, 19 (24%) were treated with ECMO included (median age 63.0 years). Eight of the 19 patients (42%) were weaned off ECMO (9.8 days, IQR 7.0-13.7). Among them, four patients were also weaned off mechanical ventilation (33.4 days, IQR 29.3 - 35.7), three were still receiving mechanical ventilation (50.9 days), and one expired after ECMO weaning. According to the univariate analysis, the factor that was associated with successful ECMO weaning was vitamin B12 treatment (p = 0.028).

Conclusions: During the COVID-19 epidemic, ECMO weaning and mortality rates were 42% and 58%, respectively.
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http://dx.doi.org/10.1016/j.hrtlng.2020.10.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572066PMC
October 2021

Electrocardiographic Manifestations in Patients with COVID-19: Daegu in South Korea.

Korean Circ J 2021 Oct;51(10):851-862

Division of Cardiology, Daegu Catholic University College of Medicine, Daegu, Korea.

Background And Objectives: As the coronavirus disease 2019 (COVID-19) spreads worldwide, cardiac injury in patients infected with COVID-19 becomes a significant concern. Thus, this study investigates the impact of several electrocardiogram (ECG) parameters and disease severity in COVID-19 patients.

Methods: Seven medical centers in Daegu admitted 822 patients with COVID-19 between February and April 2020. This study examined 267 patients among them who underwent an ECG test and evaluated their biochemical parameters like C-reactive protein (CRP), log N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), cardiac enzyme, and ECG parameters (heart rate, PR interval, QRS interval, T inversion, QT interval, and Tpe [the interval between peak to end in a T wave]).

Results: Those patients were divided into 3 groups of mild (100 patients), moderate (89 patients), and severe (78 patients) according to clinical severity score. The level of CRP, log NT-proBNP, and creatinine kinase-myocardial band were significantly increased in severe patients. Meanwhile, severe patients exhibited prolonged QT intervals (QTc) and Tpe (Tpe-c) compared to mild or moderate patients. Moreover, deceased patients (58; 21.7%) showed increased dispersion of QTc and Tpe-c compared with surviving patients (78.2±41.1 vs. 40.8±24.6 ms and 60.2±37.3 vs. 40.8±24.5 ms, both p<0.05, respectively). The QTc dispersion of more than 56.1 ms could predict the mortality in multivariate analysis (odd ratio, 11.55; 95% confidence interval, 3.746-42.306).

Conclusions: COVID-19 infections could involve cardiac injuries, especially cardiac repolarization abnormalities. A prolonged QTc dispersion could be an independent predictable factor of mortality.
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http://dx.doi.org/10.4070/kcj.2021.0116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8484995PMC
October 2021

Impact of intravascular ultrasound and final kissing balloon dilatation on long-term clinical outcome in percutaneous revascularization with 1-stent strategy for left main coronary artery stenosis in drug-eluting stent era.

Coron Artery Dis 2022 Jan;31(1):9-17

Department of Internal Medicine.

Background: It remains uncertain whether intravascular ultrasound (IVUS) use and final kissing balloon (FKB) dilatation would be standard care of percutaneous coronary intervention (PCI) with a simple 1-stent technique in unprotected left main coronary artery (LMCA) stenosis. This study sought to investigate the impact of IVUS use and FKB dilatation on long-term major adverse cardiac events (MACEs) in PCI with a simple 1-stent technique for unprotected LMCA stenosis.

Methods: Between June 2006 and December 2012, 255 patients who underwent PCI with 1 drug-eluting stent for LMCA stenosis were analyzed. Mean follow-up duration was 1663 ± 946 days. Long-term MACEs were defined as death, nonfatal myocardial infarction (MI) and repeat revascularizations.

Results: During the follow-up, 72 (28.2%) MACEs occurred including 38 (14.9%) deaths, 21 (8.2%) nonfatal MIs and 13 (5.1%) revascularizations. The IVUS examination and FKB dilatation were done in 158 (62.0%) and 119 (46.7%), respectively. IVUS use (20.3 versus 41.2%; log-rank P < 0.001), not FKB dilatation (30.3 versus 26.5%; log-rank P = 0.614), significantly reduced MACEs. In multivariate analysis, IVUS use was a negative predictor of MACEs [hazards ratio 0.51; 95% confidence interval (CI) 0.29-0.88; P = 0.017], whereas FKB dilatation (hazard ratio 1.68; 95% CI, 1.01-2.80; P = 0.047) was a positive predictor of MACEs. In bifurcation LMCA stenosis, IVUS use (18.7 versus 48.0%; log-rank P < 0.001) significantly reduced MACEs. In nonbifurcation LMCA stenosis, FKB dilatation showed a trend of increased MACEs (P = 0.076).

Conclusion: IVUS examination is helpful in reducing clinical events in PCI for LMCA bifurcation lesions, whereas mandatory FKB dilatation after the 1-stent technique might be harmful in nonbifurcation LMCA stenosis.
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http://dx.doi.org/10.1097/MCA.0000000000001101DOI Listing
January 2022

Impact of insulin therapy on the mortality of acute heart failure patients with diabetes mellitus.

Cardiovasc Diabetol 2021 09 8;20(1):180. Epub 2021 Sep 8.

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

Background: Patients with diabetes mellitus (DM) have a higher prevalence of heart failure (HF) than those without it. Approximately 40 % of HF patients have DM and they tend to have poorer outcomes than those without DM. This study evaluated the impact of insulin therapy on mortality among acute HF patients.

Methods: A total of 1740 patients from the Korean Acute Heart Failure registry with DM were included in this study. The risk of all-cause mortality according to insulin therapy was assessed using the Cox proportional hazard models with inverse probability of treatment weighting to balance the clinical characteristics (pretreatment covariates) between the groups.

Results: DM patients had been treated with either oral hypoglycemic agents (OHAs) alone (n = 620), insulin alone (n = 682), or insulin combined with OHAs (n = 438). The insulin alone group was associated with an increased mortality risk compared with the OHA alone group (HR = 1.41, 95 % CI 1.21-1.66]). Insulin therapy combined with OHAs also showed an increased mortality risk (HR = 1.29, 95 % CI 1.14-1.46) compared with the OHA alone group. Insulin therapy was consistently associated with increased mortality risk, regardless of the left ventricular ejection fraction (LVEF) or HF etiology. A significant increase in mortality was observed in patients with good glycemic control (HbA1c < 7.0 %) receiving insulin, whereas there was no significant association in patients with poor glycemic control (HbA1c ≥ 7.0%).

Conclusions: Insulin therapy was found to be associated with increased mortality compared to OHAs. The insulin therapy was harmful especially in patients with low HbA1c levels which may suggest the necessity of specific management strategies and blood sugar targets when using insulin in patients with HF.
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http://dx.doi.org/10.1186/s12933-021-01370-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424885PMC
September 2021

Effectiveness of a new cardiac risk scoring model reclassified by QRS fragmentation as a predictor of postoperative cardiac event in patients with severe renal dysfunction.

BMC Cardiovasc Disord 2021 07 30;21(1):359. Epub 2021 Jul 30.

Department of Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Background: It is difficult to evaluate the risk of patients with severe renal dysfunction before surgery due to various limitations despite high postoperative cardiac events. This study aimed to investigate the value of a newly reclassified Revised Cardiac Risk Index (RCRI) that incorporates QRS fragmentation (fQRS) as a predictor of postoperative cardiac events in patients with severe renal dysfunction.

Methods: Among the patients with severe renal dysfunction, 256 consecutive patients who underwent both a nuclear stress test and noncardiac surgery were evaluated. We reclassified RCRI as fragmented RCRI (FRCRI) by integrating fQRS on electrocardiography. We defined postoperative major adverse cardiac event (MACE) as a composite of cardiac death, nonfatal myocardial infarction, and pulmonary edema.

Results: Twenty-eight patients (10.9%) developed postoperative MACE, and this was significantly frequent in patients with myocardial perfusion defect (41.4% vs. 28.0%, p = 0.031). fQRS was observed 84 (32.8%) patients, and it was proven to be an independent predictor of postoperative MACE after adjusting for the RCRI (odds ratio 3.279, 95% confidence interval (CI) 1.419-7.580, p = 0.005). Moreover, fQRS had an incremental prognostic value for the RCRI (chi-square = 7.8, p = 0.005), and to the combination of RCRI and age (chi-square = 9.1, p = 0.003). The area under curve for predicting postoperative MACE significantly increased from 0.612 for RCRI to 0.667 for FRCRI (p = 0.027) and 23 patients (32.4%) originally classified as RCRI 2 were reclassified as FRCRI 3.

Conclusions: A newly reclassified FRCRI that incorporates fQRS, is a valuable predictor of postoperative MACE in patients with severe renal dysfunction undergoing noncardiac surgery.
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http://dx.doi.org/10.1186/s12872-021-02182-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323309PMC
July 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

Prognostic impact of chromogranin A in patients with acute heart failure.

Yeungnam Univ J Med 2021 Oct 8;38(4):337-343. Epub 2021 Jul 8.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

Backgruound: Chromogranin A (CgA) levels have been reported to predict mortality in patients with heart failure. However, information on the prognostic value and clinical availability of CgA is limited. We compared the prognostic value of CgA to that of previously proven natriuretic peptide biomarkers in patients with acute heart failure.

Methods: We retrospectively evaluated 272 patients (mean age, 68.5±15.6 years; 62.9% male) who underwent CgA test in the acute stage of heart failure hospitalization between June 2017 and June 2018. The median follow-up period was 348 days. Prognosis was assessed using the composite events of 1-year death and heart failure hospitalization.

Results: In-hospital mortality rate during index admission was 7.0% (n=19). During the 1-year follow-up, a composite event rate was observed in 12.1% (n=33) of the patients. The areas under the receiver-operating characteristic curves for predicting 1-year adverse events were 0.737 and 0.697 for N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CgA, respectively. During follow-up, patients with high CgA levels (>158 pmol/L) had worse outcomes than those with low CgA levels (≤158 pmol/L) (85.2% vs. 58.6%, p<0.001). When stratifying the patients into four subgroups based on CgA and NT-proBNP levels, patients with high NT-proBNP and high CgA had the worst outcome. CgA had an incremental prognostic value when added to the combination of NT-proBNP and clinically relevant risk factors.

Conclusion: The prognostic power of CgA was comparable to that of NT-proBNP in patients with acute heart failure. The combination of CgA and NT-proBNP can improve prognosis prediction in these patients.
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http://dx.doi.org/10.12701/yujm.2020.00843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8688787PMC
October 2021

N-terminal pro-brain natriuretic peptide and coronary collateral formation in patients undergoing primary percutaneous coronary intervention.

Heart Vessels 2021 Dec 28;36(12):1775-1783. Epub 2021 May 28.

Department of Internal Medicine, Kyungpook National University Hospital, 130, Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.

There is insufficient information on the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and collateral circulation (CC) formation after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction. We analyzed 857 patients who underwent primary PCI. The serum NT-proBNP levels were measured on the day of admission, and the CC was scored according to Rentrop's classification. Log-transformed NT-proBNP levels were significantly higher in patients with good CC compared to those with poor CC (6.13 ± 2.01 pg/mL versus 5.48 ± 1.97 pg/mL, p < 0.001). The optimum cutoff value of log NT-proBNP for predicting CC was 6.04 pg/mL. Log NT-proBNP ≥ 6.04 pg/mL (odds ratio 2.23; 95% confidence interval 1.51-3.30; p < 0.001) was an independent predictor of good CC. CC development was higher in patients with a pre-TIMI flow of 0 or 1 than those with a pre-TIMI flow of 2 or 3 (22.6% versus 8.8%, p = 0.001). The incidence of left ventricular (LV) dysfunction (< 50%) was greater in patients with a pre-TIMI flow of 0 or 1 (49.8% versus 35.5%, p < 0.001). The release of NT-proBNP was greater in patients with LV dysfunction (34.3% versus 15.6%, p < 0.001). The incidence of good CC was greater in patients with log NT-proBNP levels ≥ 6.04 pg/ml (16.8% versus 26.2%, p = 0.003). The association between NT-proBNP and collateral formation was not influenced by pre-TIMI flow and LV function. NT-proBNP appears to reflect the degree of collateral formation in the early phase of STEMI and might have a new role as a useful surrogate biomarker for collateral formation in patients undergoing primary PCI.
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http://dx.doi.org/10.1007/s00380-021-01866-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556172PMC
December 2021

Derivation and validation of a combined in-hospital mortality and bleeding risk model in acute myocardial infarction.

Int J Cardiol Heart Vasc 2021 Apr 22;33:100732. Epub 2021 Feb 22.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.

Background: In the potent new antiplatelet era, it is important issue how to balance the ischemic risk and the bleeding risk. However, previous risk models have been developed separately for in-hospital mortality and major bleeding risk. Therefore, we aimed to develop and validate a novel combined model to predict the combined risk of in-hospital mortality and major bleeding at the same time for initial decision making in patients with acute myocardial infarction (AMI).

Methods: Variables from the Korean Acute Myocardial Infarction Registry (KAMIR) - National Institute of Health (NIH) database were used to derive (n = 8955) and validate (n = 3838) a multivariate logistic regression model. Major adverse cardiovascular events (MACEs) were defined as in-hospital death and major bleeding.

Results: Seven factors were associated with MACE in the model: age, Killip class, systolic blood pressure, heart rate, serum glucose, glomerular filtration rate, and initial diagnosis. The risk model discriminated well in the derivation (c-static = 0.80) and validation (c-static = 0.80) cohorts. The KAMIR-NIH risk score was developed from the model and corresponded well with observed MACEs: very low risk (0.9%), low risk (1.7%), moderate risk (4.2%), high risk (8.6%), and very high risk (23.3%). In patients with MACEs, a KAMIR-NIH risk score ≤ 10 was associated with high bleeding risk, whereas a KAMIR-NIH risk score > 10 was associated with high in-hospital mortality.

Conclusion: The KAMIR-NIH in-hospital MACEs model using baseline variables stratifies comprehensive risk for in-hospital mortality and major bleeding, and is useful for guiding initial decision making.
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http://dx.doi.org/10.1016/j.ijcha.2021.100732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907424PMC
April 2021

Impact of Cardiovascular Risk Factors and Cardiovascular Diseases on Outcomes in Patients Hospitalized with COVID-19 in Daegu Metropolitan City.

J Korean Med Sci 2021 Jan 11;36(2):e15. Epub 2021 Jan 11.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

Background: Data regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system.

Methods: Patients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained.

Results: Of all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age ( < 0.001). The number of patients requiring intensive care ( < 0.001) and invasive MV ( < 0.001) increased with age. The in-hospital death rate increased with age ( < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; < 0.001) and invasive MV (4.3% vs. 1.7%; < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07-3.01; = 0.027) were independent predictors of in-hospital death after adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51-3.90; < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06-5.87; = 0.049) were independent predictors of in-hospital death.

Conclusion: Based on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage.
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http://dx.doi.org/10.3346/jkms.2021.36.e15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801150PMC
January 2021

Variation in treatment strategy for non-ST segment elevation myocardial infarction: A multilevel methodological approach.

Int J Cardiol 2021 04 2;328:35-39. Epub 2020 Dec 2.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea; School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Background: Variations by hospital and region in the selection of an early invasive strategy (EIS) after non-ST-segment elevation myocardial infarction (NSTEMI) in patients with high-risk criteria are unknown.

Methods: We evaluated the data of 7037 patients with NSTEMI from 20 hospitals of 3 regions from the Korean Acute Myocardial Infarction Registry-National Institute of Health database. We used hierarchical generalized linear mixed-models to estimate region- and hospital-level variation in the selection of an EIS after adjusting for patient-level high-risk criteria. We explored the variation using the median rate ratio (MRR), which estimates the relative difference in the risk ratios of two hypothetically identical patients at two different sites.

Results: An EIS was selected in 84.4% of patients. At the hospital level, the median selection rate was 80.4%. At the region level, the median selection rate was 74.9% in the east region, 81.3% in the north region, and 83.9% in the west region, respectively. After adjusting for patient-level covariates, we found significant hospital- (MRR 2.19, 95% confidence interval [CI]: 1.74-3.03) and region-level (MRR 1.88, 95%CI: 1.26-5.44) variation in the selection of an EIS. Among patient-level factors, male sex, ongoing chest pain, history of coronary artery disease or acute heart failure, and GRACE risk score > 140 were independently associated with the selection of an EIS.

Conclusions: We observed significant hospital- and region-level variation in the selection of an EIS after NSTEMI in high-risk patients. Quality improvement efforts are required to standardize decision making and to improve clinical outcomes.
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http://dx.doi.org/10.1016/j.ijcard.2020.11.059DOI Listing
April 2021

Incremental Predictive Value of Plasma Renin Activity as a Prognostic Biomarker in Patients with Heart Failure.

J Korean Med Sci 2020 Nov 2;35(42):e351. Epub 2020 Nov 2.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

Background: The association of N-terminal pro-B type natriuretic peptide (NT-proBNP) and plasma renin activity (PRA) for the prognosis of the patients with acute heart failure (HF) has not been fully investigated. This study aimed to determine the association between NT-proBNP and PRA and to investigate the incremental value of PRA to NT-proBNP for predicting long term prognosis in patients with acute HF.

Methods: Three hundred and ninety-six patients (mean age, 64.7 ± 15.9 years; 46.5% female) presenting with acute HF were enrolled between December 2004 and July 2013. Patients with newly diagnosed HF as well as patients with acute exacerbated chronic HF were included. The prognosis was assessed with the composite event of all-cause mortality and readmission for HF during a 2-year follow-up period.

Results: The etiology of HF was ischemic in 116 (29.3%) patients. In a Cox proportional hazards model, log-transformed PRA (hazard ratio [HR], 1.205; = 0.007) was an independent predictor of the composite outcome of all-cause mortality and readmission for HF in addition to age (HR, 1.032; = 0.001), white blood cell (WBC) count (HR, 1.103; < 0.001), and left ventricular ejection fraction (LVEF) (HR, 0.978; = 0.013). Adding PRA to age, sex, LVEF, and NT-proBNP significantly improved the prediction for the composite outcome of all-cause mortality and readmission for HF, as shown by the net reclassification improvement (0.47; < 0.001) and integrated discrimination improvement (0.10; < 0.001).

Conclusion: PRA could provide incremental predictive value to NT-proBNP for predicting long term prognosis in patients with acute HF.
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http://dx.doi.org/10.3346/jkms.2020.35.e351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606887PMC
November 2020

Osborn waves during therapeutic hypothermia and recurrence of fatal arrhythmia in patients resuscitated following sudden cardiac arrest.

Pacing Clin Electrophysiol 2020 11 22;43(11):1281-1288. Epub 2020 Sep 22.

Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.

Background: This study investigates the impact of the occurrence of Osborn waves during therapeutic hypothermia (TH) on the recurrence of future fatal arrhythmias in patients resuscitated after sudden cardiac arrest (SCA).

Methods: Of all survivors of out-of-hospital SCA, 100 consecutive patients (mean age, 52 ± 15 years; 80% men) who received TH were included in this study.

Results: The most common first documented arrhythmia was ventricular fibrillation (VF) (77%), and ischemic heart disease (44%) and idiopathic VF (22%) were the most common causes of SCA in resuscitated patients. During TH, Osborn waves developed in 29 patients (29%). Osborn waves occurred more frequently in patients with Brugada syndrome. Patients with Osborn waves had lower in-hospital (10.3% vs 26.8%; P = .072) and 1-year death rates (20.7% vs 39.4%; P = .073) and better cerebral function (cerebral performance category scale, 2.0 ± 1.5 vs 2.7 ± 1.8; P = .053) than those without Osborn waves, although there was no statistical significance. Among 78 in-hospital survivors, 31 (40%) underwent implantable cardioverter-defibrillator (ICD) implantation. Appropriate ICD shocks from fatal arrhythmias were more frequent in patients who had Osborn waves than in those without Osborn waves (43% vs 6%; P = .032).

Conclusions: Osborn waves during TH had no significant effect on the survival and cerebral function of patients resuscitated SCA. However, appropriate ICD shocks due to the recurrence of VF were more frequent in patients with Osborn waves during long-term follow-up.
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http://dx.doi.org/10.1111/pace.14070DOI Listing
November 2020

Perioperative outcomes of interrupted anticoagulation in patients with non-valvular atrial fibrillation undergoing non-cardiac surgery.

Yeungnam Univ J Med 2020 Oct 16;37(4):321-328. Epub 2020 Jul 16.

Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: This study aimed to investigate the incidences of and risk factors for perioperative events following anticoagulant discontinuation in patients with non-valvular atrial fibrillation (NVAF) undergoing non-cardiac surgery.

Methods: A total of 216 consecutive patients who underwent cardiac consultation for suspending perioperative anticoagulants were enrolled. A perioperative event was defined as a composite of thromboembolism and major bleeding.

Results: The mean anticoagulant discontinuation duration was 5.7 (±4.2) days and was significantly longer in the warfarin group (p<0.001). Four perioperative thromboembolic (1.85%; three strokes and one systemic embolization) and three major bleeding events (1.39%) were observed. The high CHA2DS2-VASc and HAS-BLED scores and a prolonged preoperative anticoagulant discontinuation duration (4.4±2.1 vs. 2.9±1.8 days; p=0.028) were associated with perioperative events, whereas the anticoagulant type (non-vitamin K antagonist oral anticoagulants or warfarin) was not. The best cut-off levels of the HAS-BLED and CHA2DS2-VASc scores were 3.5 and 2.5, respectively, and the preoperative anticoagulant discontinuation duration for predicting perioperative events was 2.5 days. Significant differences in the perioperative event rates were observed among the four risk groups categorized according to the sum of these values: risk 0, 0%; risk 1, 0%; risk 2, 5.9%; and risk 3, 50.0% (p<0.001). Multivariate logistic regression analysis showed that the HAS-BLED score was an independent predictor for perioperative events.

Conclusion: Thromboembolic events and major bleeding are not uncommon during perioperative anticoagulant discontinuation in patients with NVAF, and interrupted anticoagulation strategies are needed to minimize these.
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http://dx.doi.org/10.12701/yujm.2020.00353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606955PMC
October 2020

A Case of COVID-19 with Acute Myocardial Infarction and Cardiogenic Shock.

J Korean Med Sci 2020 Jul 13;35(27):e258. Epub 2020 Jul 13.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

A 60-year-old male patient with coronavirus disease-2019 showed new onset ST-segment elevation in V1-V2 leads on electrocardiogram and cardiac enzyme elevation in intensive care unit. He had a history of type 2 diabetes mellitus, hypertension, and dyslipidemia. He was receiving mechanical ventilation and veno-venous extracorporeal membrane oxygenation treatment for severe hypoxia. Two-D echocardiogram showed regional wall motion abnormalities. We performed primary percutaneous coronary intervention for acute myocardial infarction complicating cardiogenic shock under hemodynamic support. He expired on the 16th day of admission because of cardiogenic shock and multi-organ failure. Active surveillance and intensive treatment strategy are important for saving lives of COVID-19 patients with acute myocardial infarction.
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http://dx.doi.org/10.3346/jkms.2020.35.e258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358062PMC
July 2020

Comparison of Patterns of Skill Actions between Analog and Electronic Protectors in Taekwondo: A Log-Linear Analysis.

Int J Environ Res Public Health 2020 06 1;17(11). Epub 2020 Jun 1.

Department of Physical Education, Gachon University, Seongnam 13120, Korea.

The purpose of this study was to compare the patterns of skill actions executed during Taekwondo competitions when wearing and not wearing an electronic protector. To achieve this purpose, 110 matches from two university-level Taekwondo championships were taped and analyzed. The performance skills were composed of 18 detailed skills and grouped into five categories by considering kicks to the target area (chest or head/face). The data were organized in the form of a contingency table that demonstrated the relationship between grouping factors (skills, protectors, win-lose, and weight division). A log-linear analysis was carried out to investigate the effect of the grouping factors (IVs) on the skills (DV) using SPSS Statistics. The results obtained in the present study can be summarized as follows. First, the overall proportion of "points" called by the judge for the general protector (32.3%) was approximately 3.4 times that for the electronic protector (9.5%). Second, for the electronic protector, the proportions of kicks to the chest area were in the following order: Roundhouse kick (R-Kick) (44.7%), Pushing kick (P-kick) (19.3%), Turn kick (T-kick) (8.7%), and Double roundhouse kick (DR-kick) (7.6%). For the general protector, the order differed slightly, with T-kick and P-kick switched around with different proportions. Third, the proportion of kicks to the head/face was higher for the electronic protector (19.8%) than for the general protector (10.4%), and this difference was even more distinct when the light (-68kg) (33.5% (electronic) vs. 6.5% (general)) and heavy (+85kg) (1.4% (electronic) vs. 13.3% (general)) weight divisions were compared. Finally, the match status (win/lose) had no significant effect on the pattern of playing actions for both the protectors. The result from this study suggests that skill frequency of linear simple movement for activating electrical protector's sensor is increased, while the one of rotational complex movement is decreased gradually. Additionally, headgear without sensors, such as for a hit movement to the face/head part, represent characteristics of increased attack skills to the facial area; these scores are provided through subjective judgement, and consequently changes in performance skills can occur.
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http://dx.doi.org/10.3390/ijerph17113927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312946PMC
June 2020

Impact of diabetes mellitus on mortality in patients with acute heart failure: a prospective cohort study.

Cardiovasc Diabetol 2020 05 2;19(1):49. Epub 2020 May 2.

Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.

Background: Although more than one-third of the patients with acute heart failure (AHF) have diabetes mellitus (DM), it is unclear if DM has an adverse impact on clinical outcomes. This study compared the outcomes in patients hospitalized for AHF stratified by DM and left ventricular ejection fraction (LVEF).

Methods: The Korean Acute Heart Failure registry prospectively enrolled and followed 5625 patients from March 2011 to February 2019. The primary endpoints were in-hospital and overall all-cause mortality. We evaluated the impact of DM on these endpoints according to HF subtypes and glycemic control.

Results: During a median follow-up of 3.5 years, there were 235 (4.4%) in-hospital mortalities and 2500 (46.3%) overall mortalities. DM was significantly associated with increased overall mortality after adjusting for potential confounders (adjusted hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.03-1.22). In the subgroup analysis, DM was associated with higher a risk of overall mortality in heart failure with reduced ejection fraction (HFrEF) only (adjusted HR 1.14, 95% CI 1.02-1.27). Inadequate glycemic control (HbA1c ≥ 7.0% within 1 year after discharge) was significantly associated with a higher risk of overall mortality compared with adequate glycemic control (HbA1c < 7.0%) (44.0% vs. 36.8%, log-rank p = 0.016).

Conclusions: DM is associated with a higher risk of overall mortality in AHF, especially HFrEF. Well-controlled diabetes (HbA1c < 7.0%) is associated with a lower risk of overall mortality compared to uncontrolled diabetes. Trial registration ClinicalTrial.gov, NCT01389843. Registered July 6, 2011. https://clinicaltrials.gov/ct2/show/NCT01389843.
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http://dx.doi.org/10.1186/s12933-020-01026-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196232PMC
May 2020

Prognostic Value of Cystatin C-Derived Estimated Glomerular Filtration Rate in Patients with Acute Heart Failure.

Cardiorenal Med 2020 21;10(4):232-242. Epub 2020 Apr 21.

Department of Internal Medicine, School of medicine, Kyungpook National University, Daegu, Republic of Korea.

Background: Renal function is closely related to cardiac function and an important prognostic marker in heart failure.

Objective: We aimed to test the prognostic value of cystatin C (cysC)-derived estimated glomerular filtration rates (eGFR) in comparison with eGFRs from creatinine solely based equations in patients with acute heart failure (AHF).

Methods: This study included 262 patients (65.8 ± 14.9 years old, 126 male) with AHF. Prognostic value of the eGFRs, from cysC-based equations chronic kidney disease epidemiology collaboration (CKD-EPI-cysC and CKD-EPI-creatinine [cr]-cysC equations) were compared with eGFRs calculated from serum creatinine levels only (Modification of Diet in Renal Disease [MDRD]-4 and CKD-EPI-cr equations). Prognosis was evaluated with the composite of all-cause mortality and hospitalization for heart failure within 1 year.

Results: During the follow-up period (mean follow-up period, 264.0 ± 136.1 days), 67 (25.6%) events occurred. Estimated GFR using CKD-EPI-cysC was the best for predicting 1-year outcome using receiver operating characteristic curve analysis (area under curve 0.585, 0.607, 0.669, and 0.652 for eGFRs from MDRD-4, CKD-EPI-cr, CKD-EPI-cysC, and CKD-EPI-cr-cysC respectively). The Kaplan-Meier survival curve analysis showed that only the eGFRs classification from the equations based on cysC significantly predicted 1-year outcome in patients with AHF.

Conclusions: Estimated GFRs calculated with cysC predicted the prognosis more accurately in patients with AHF than the eGFRs from creatinine only equations.
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http://dx.doi.org/10.1159/000504084DOI Listing
August 2021

Usefulness of Calculation of Cardiovascular Risk Factors to Predict Outcomes in Patients With Acute Myocardial Infarction.

Am J Cardiol 2019 09 25;124(6):857-863. Epub 2019 Jun 25.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea; School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Cardiovascular risk factors contribute differently to short-term prognosis of acute myocardial infarction (AMI); hypertension and diabetes increase adverse outcomes, whereas hyperlipidemia, smoking, and obesity seem to paradoxically decrease these in post-MI patients. We aimed to investigate whether a simple calculation of conventional risk factors, PARADOCS (Pressure of ARtery elevAtion, Diabetes, Obesity, Cholesterol, Smoking) score, would improve the ability to predict major adverse cardiac and cerebrovascular events (MACCEs) in post-MI patients. Between November 2011 and December 2015, 13,104 patients with diagnosis of AMI were analyzed in this study from Korean AMI Registry - National Institute of Health database. PARADOCS score was calculated as follows: (number of nonparadoxical risk factors - number of paradoxical risk factors) + 3 where nonparadoxical risk factors are hypertension and diabetes, and paradoxical risk factors are hyperlipidemia, smoking, and obesity. PARADOCS score was significantly greater in patients with 1-year MACCEs compared with those without MACCEs (3.43 ± 1.03 vs 2.88 ± 1.11, p <0.001). In Cox proportional hazards model, PARADOCS score was an independent predictor of 1-year MACCEs (hazards ratio 1.23, 95% confidence interval 1.16 to 1.30; p <0.001) after adjusting for confounding variables. In Kaplan-Meier survival curve, patients with greater PARADOCS score had worse clinical outcome. In conclusion, although it needs more validation, a simple calculation of risk factors, PARADOCS score, could provide useful prognostic information of MI patients to clinicians.
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http://dx.doi.org/10.1016/j.amjcard.2019.06.010DOI Listing
September 2019

Intravascular modality-guided versus angiography-guided percutaneous coronary intervention in acute myocardial infarction.

Catheter Cardiovasc Interv 2020 03 27;95(4):696-703. Epub 2019 May 27.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.

Background: Few data are available for current usage patterns of intravascular modalities such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) in acute myocardial infarction (AMI). Moreover, patient and procedural-based outcomes related to intravascular modality guidance compared to angiography guidance have not been fully investigated yet.

Methods: We examined 11,731 patients who underwent percutaneous coronary intervention (PCI) from the Korea AMI Registry-National Institute of Health database. Patient-oriented composite endpoint (POCE) was defined as all-cause death, any infarction, and any revascularization. Device-oriented composite endpoint (DOCE) was defined as cardiac death, target-vessel reinfarction, and target-lesion revascularization.

Results: Overall, intravascular modalities were utilized in 2,659 (22.7%) patients including 2,333 (19.9%) IVUS, 277 (2.4%) OCT, and 157 (1.3%) FFR. In the unmatched cohort, POCE (5.4 vs. 8.5%; adjusted hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.61-0.93; p = .008) and DOCE (4.6 vs. 7.4%; adjusted HR 0.77; 95% CI 0.61-0.97; p = .028) were significantly lower in intravascular modality-guided PCI compared with angiography-guided PCI. In the propensity-score-matched cohorts, POCE (5.9 vs. 7.7%; HR 0.74; 95% CI 0.60-0.92; p = .006) and DOCE (5.0 vs. 6.8%; HR 0.72; 95% CI 0.57-0.90; p = .004) were significantly lower in intravascular modality guidance compared with angiography guidance. The difference was mainly driven by reduced all-cause mortality (4.4 vs. 7.0%; p < .001) and cardiac mortality (3.3 vs. 5.2%; p < .001).

Conclusion: In this large-scale AMI registry, intravascular modality guidance was associated with an improving clinical outcome in selected high-risk patients.
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http://dx.doi.org/10.1002/ccd.28359DOI Listing
March 2020

KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure.

Korean Circ J 2019 Jan;49(1):22-45

Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.

The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute HF represent distinct disease entities. Here, we introduce the Korean guidelines for the management of acute HF with reduced or preserved ejection fraction. Part II of this guideline covers the treatment of acute HF.
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http://dx.doi.org/10.4070/kcj.2018.0349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331324PMC
January 2019

Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure.

Korean J Intern Med 2019 Jul 31;34(4):811-818. Epub 2018 Dec 31.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

Background/aims: Carbohydrate antigen 125 (CA-125) is an emerging prognostic biomarker for heart failure. We aimed to test the long-term prognostic value of CA-125 in combination with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF).

Methods: This observational study included a total of 413 patients (64.1 ± 15.6 yearold, 214 men) with ADHF. All-cause mortality during the 2-year follow-up was investigated for the prognosis.

Results: During the follow-up (mean follow-up, 591 ± 233 days), 109 deaths (26.0%) were recorded. In the multivariable analysis model, CA-125 was an independent factor associated with all-cause mortality (log CA-125: hazard ratio, 1.23; 95% confidence interval, 1.02 to 1.48; p = 0.030) together with age, sex, New York Heart Association class, β-blocker, and NT-proBNP. The Kaplan-Meier survival analysis demonstrated that the group with both low marker levels showed the best 2-year survival (87.9%) followed by the group with low NT-proBNP and high CA-125 (76.1%), high NT-proBNP and low CA-125 (64.7%) and high NT-proBNP and high CA-125 levels (54.3%) (p < 0.001). Addition of CA-125 in combination with NT-proBNP and established risk factors further increased the predictive power for mortality in patients with ADHF.

Conclusion: CA-125 was an independent factor associated with all-cause mortality in patients with ADHF. Combination of CA-125 with NT-proBNP significantly improved the prediction of mortality in patients with ADHF.
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http://dx.doi.org/10.3904/kjim.2017.313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610187PMC
July 2019

Radial Versus Femoral Access With or Without Vascular Closure Device in Patients With Acute Myocardial Infarction.

Am J Cardiol 2019 03 3;123(5):742-749. Epub 2018 Dec 3.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea; School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Compared with transradial intervention (TRI), it is unclear whether transfemoral intervention (TFI) with vascular closure device (VCD) improves major adverse cardiocerebrovascular events (MACCE) in patients with acute myocardial infarction (AMI). The aim of this study is to compare TRI versus TFI with or without VCD for reducing MACCEs. We examined 11,596 patients who underwent TRI or TFI from the Korean AMI Registry - National Institute of Health database. The MACCE at 1-year was defined as death, nonfatal MI, repeat revascularization, cerebrovascular accident, hospitalizations, and major bleedings. Because the patients were not randomly assigned to vascular access sites, propensity-score (PS) matching was performed. In the PS-matched cohorts, compared with TFI, TRI significantly reduced 1-year MACCEs (7.1% vs 10.1%; log-rank p < 0.001) through a reduction in major bleeding (0.6% vs 2.2%; p < 0.001). Compared with TRI, 1-year MACCEs (11.3% vs 7.9%, log-rank p < 0.001) and major bleedings (0.6% vs 2.2%; p < 0.001) were significantly greater in TFI without VCD, whereas TFI with VCD was comparable in 1-year MACCEs (7.5% vs 8.1%, log-rank p = 0.437) and major bleeding (0.7% vs 1.0%; p = 0.409). In conclusion, the use of VCD could be an alternative to avoid major bleeding and to improve clinical outcomes, particularly in high-risk patients who are not suitable for TRI.
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http://dx.doi.org/10.1016/j.amjcard.2018.11.040DOI Listing
March 2019

Effect of renin-angiotensin system blockade in patients with severe renal insufficiency and heart failure.

Int J Cardiol 2018 Sep;266:180-186

Division of Cardiovascular and Rare Diseases, National Institute of Health, Osong, Republic of Korea.

Background: Renin-angiotensin system blockade (RAB) is the cornerstone in the management of patients with heart failure. However, the benefit of RAB in patients with accompanying severe renal impairment is not clear. We aimed to examine the effect of RAB and the differential effect of RAB depending on renal replacement (RR) in patients with severe renal insufficiency and acute heart failure.

Methods And Results: Among 5625 patients from the Korean Acute Heart Failure registry, 673 in-hospital survivors (70.9 ± 12.8 years, 376 men) who had left ventricular ejection fraction < 40% and estimated glomerular filtration rate < 30 mL/min/1.73 m during hospitalization were analyzed. The inverse probability of treatment weighting (IPTW)-adjusted survival analysis was used to compare the composite of all-cause mortality and rehospitalization between patients with and without pre-discharge RAB. A total of 334 (49.6%) adverse events were observed during the 1-year follow-up. The IPTW-adjusted Kaplan-Meier survival analysis showed that the 1-year event rate was 48.7% and 53.8% for patients with RAB and those without, respectively (log rank p = 0.048). RAB was significantly related to better prognosis in patients receiving RR therapy (hazard ratio [HR] = 0.436 [0.269-0.706], p = 0.001), but not in patients not receiving RR therapy (HR 0.956 [0.731-1.250], p = 0.742) in a weighted cohort (p for interaction = 0.005).

Conclusions: Early RAB treatment in patients with heart failure and severe renal insufficiency was related to better prognosis. The benefit of RAB was particularly prominent in patients receiving RR therapy.
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http://dx.doi.org/10.1016/j.ijcard.2018.03.016DOI Listing
September 2018

The Effect of Door-to-Diuretic Time on Clinical Outcomes in Patients With Acute Heart Failure.

JACC Heart Fail 2018 04;6(4):286-294

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

Objectives: This study sought to examine the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED).

Background: Most patients with AHF present with congestion. Early decongestion with diuretic agents could improve their clinical outcomes.

Methods: The Korea Acute Heart Failure registry enrolled 5,625 consecutive patients hospitalized for AHF. For this analysis, the study included patients who received intravenous diuretic agents within 24 h after ED arrival. Early and delayed groups were defined as D2D time ≤60 min and D2D time >60 min, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time.

Results: A total of 2,761 patients met the inclusion criteria. The median D2D time was 128 min (interquartile range: 63 to 243 min), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the post-discharge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes.

Conclusions: The D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843).
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http://dx.doi.org/10.1016/j.jchf.2017.12.017DOI Listing
April 2018

Korean Guidelines for Diagnosis and Management of Chronic Heart Failure.

Korean Circ J 2017 Sep 18;47(5):555-643. Epub 2017 Sep 18.

Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.

The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea. 
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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http://dx.doi.org/10.4070/kcj.2017.0009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614939PMC
September 2017

Coronary Collaterals Function and Clinical Outcome Between Patients With Acute and Chronic Total Occlusion.

JACC Cardiovasc Interv 2017 03;10(6):585-593

Department of Cardiology, Kyungpook National University Hospital, Daegu, Republic of Korea. Electronic address:

Objectives: This study sought to demonstrate how changes in the collateral function and its clinical significance before and after percutaneous coronary interventions (PCIs) are compared between patients with acute coronary syndrome and total or nearly total occlusions (ATOs) and chronic total occlusions (CTOs).

Background: The functional relevance of the collateral circulation in patients with ATOs and CTOs has not been fully investigated.

Methods: The pressure-derived collateral pressure index (CPI), myocardial fractional flow reserve (FFRmyo), and coronary fractional flow reserve (FFRcor) at maximum hyperemia induced by intravenous adenosine were evaluated in occluded vessels at baseline, after the PCI, and at 1 year in 23 ATO and 74 CTO patients.

Results: The FFRmyo and FFRcor were significantly lower, but the CPI was significantly higher in the CTO than ATO patients at baseline and after the PCI. There were significant increases in the FFRmyo (p < 0.001) and FFRcor (p < 0.001), whereas there was no significant change in the CPI immediately after the PCI in both ATO and CTO patients. In the CTO patients, a post-PCI FFRmyo <0.90 (p = 0.01) and post-PCI CPI <0.25 (p = 0.033) were independent predictors of the clinical outcome. Patients with a high post-PCI CPI had better clinical outcomes in CTO patients with a low post-PCI FFRmyo (log-rank p = 0.009), but not a high post-PCI FFRmyo (log-rank p = 0.492).

Conclusions: Recruitable coronary collateral flow did not regress completely immediately after the PCI both in patients with ATOs and CTOs. Despite good collaterals in CTO patients, aggressive efforts to reduce the ischemic burden might improve the clinical outcome.
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http://dx.doi.org/10.1016/j.jcin.2016.12.009DOI Listing
March 2017

Video-Assisted Thoracoscopic Left Cardiac Sympathetic Denervation in Patients with Hereditary Ventricular Arrhythmias.

Pacing Clin Electrophysiol 2017 Mar 14;40(3):232-241. Epub 2017 Feb 14.

Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.

Background: Left cardiac sympathetic denervation (LCSD) has been underutilized in patients with hereditary ventricular arrhythmia syndromes such as congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). The purpose of this study was to investigate the safety and efficacy of video-assisted thoracoscopic (VATS) LCSD in such patients.

Methods: Fifteen patients (four men, 24.6 ± 10.5 years old) who underwent VATS-LCSD between November 2010 and January 2015 for hereditary ventricular arrhythmia syndromes at Kyungpook National University Hospital were enrolled in this study. The safety and efficacy of VATS-LCSD were evaluated by periprocedural epinephrine tests and assessing the development of complications and cardiac events during follow-up.

Results: Fourteen patients with LQTS and one patient with CPVT underwent VATS-LCSD. Six and one patients developed ventricular tachyarrhythmia during preprocedural and postprocedural epinephrine test, respectively (P = 0.063). No serious complications such as Horner syndrome, pneumothorax, or bleeding developed after LCSD. Mean hospital stay after VATS-LCSD was 3.7 ± 1.5 days. During a mean follow-up of 927 ± 350 days, one LQTS patient and one CPVT patient, neither of whom manifested tachyarrhythmia during post-LCSD epinephrine test, developed torsades de pointes and syncope, respectively. The annual event rates of six patients who were symptomatic during the period preceding LCSD decreased from 0.97 to 0.19 events/year (P = 0.045).

Conclusions: VATS-LCSD was a safe, and effective procedure for patients with hereditary ventricular tachycardia syndrome, with no serious adverse events and with short hospital stay.
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http://dx.doi.org/10.1111/pace.13008DOI Listing
March 2017

Difference in the Prognostic Impact of Left Ventricular Global Longitudinal Strain between Anterior and Nonanterior Myocardial Infarction.

Echocardiography 2016 Jul 18;33(7):984-90. Epub 2016 Jun 18.

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

Background: Speckle tracking-derived global longitudinal strain (GLS) of left ventricle is a potent prognostic marker for patients with ST-segment elevation myocardial infarction (STEMI). The purpose of this study was to investigate the difference of prognostic impact of GLS between anterior and nonanterior myocardial infarction.

Methods: This study included 686 patients who underwent primary percutaneous coronary intervention for their first STEMI between November 2007 and April 2012. Differences in the prognostic impact of GLS between anterior MI group and nonanterior MI group were evaluated. The composite of all-cause mortality and hospitalization for heart failure in 2 years was investigated for outcome.

Results: During the follow-up period, 77 (11.2%) adverse events occurred. The anterior and nonanterior MI groups included 339 and 347 patients, respectively. Among patients with anterior MI, GLS significantly predicted 2-year outcome in an adjusted model (adjusted hazard ratio [HR] 1.186; 95% confidence interval [CI] 1.071-1.314, P = 0.001), whereas the association between GLS and mortality was weaker in the nonanterior MI group (adjusted HR 0.977; 95% CI 0.884-1.081, P = 0.657). The interaction between the infarction territory and GLS was significant (P for interaction = 0.018), indicating that GLS was a more sensitive predictor of mortality in patients with anterior MI than that in those with nonanterior MI.

Conclusions: Speckle tracking-derived GLS of left ventricle more sensitively predicted clinical outcome in patients with anterior MI than in those with nonanterior MI.
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http://dx.doi.org/10.1111/echo.13208DOI Listing
July 2016
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