Publications by authors named "Sung Hee Shin"

87 Publications

Correlation of heart rate recovery and heart rate variability with atrial fibrillation progression.

J Int Med Res 2021 Nov;49(11):3000605211057822

Division of Cardiology, Department of Internal Medicine, 65745Inha University Hospital, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea.

Objective: To examine the combination of heart rate recovery (HRR) and heart rate variability (HRV) in predicting atrial fibrillation (AF) progression.

Methods: Data from patients with a first detected episode of AF who underwent treadmill exercise testing and 24-h Holter electrocardiography were retrospectively analysed. Autonomic dysfunction was verified using HRR values. Sympathetic and parasympathetic modulation was analysed by HRV. AF progression was defined as transition from the first detected paroxysmal episode to persistent/permanent AF.

Results: Of 306 patients, mean LF/HF ratio and HRR did not differ significantly by AF progression regardless of age (< or ≥65 years). However, when the LF/HF ratio was divided into tertiles, in patients aged <65 years, the mid LF/HF (1.60-2.40) ratio was significantly associated with lower AF progression rates and longer maintenance of normal sinus rhythm. For patients aged <65 years, less metabolic equivalents were related to higher AF progression rates. For patients aged ≥65 years, a low HRR was associated with high AF progression rates.

Conclusion: In relatively younger age, high physical capacity and balanced autonomic nervous system regulation are important predictors of AF progression. Evaluation of autonomic function assessed by age could predict AF progression.
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http://dx.doi.org/10.1177/03000605211057822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619754PMC
November 2021

The Association between Korean Clinical Nurses' Workplace Bullying, Positive Psychological Capital, and Social Support on Burnout.

Int J Environ Res Public Health 2021 11 4;18(21). Epub 2021 Nov 4.

College of Nursing Science, Kyung Hee University, Seoul 02447, Korea.

Recurring shortages of nursing peoplepower in recent Korean society have impacted nursing organizations with burnout accounting for a major part of nursing staff turnover. Thus, we studied the associations between workplace bullying, positive psychological capital, and social support and whether they predict nursing burnout. We used hierarchical regression analysis to observe changes in influencing factors by sequentially entering general traits, workplace bullying, positive psychological capital, and social support from 166 clinical nurses at two hospitals. The analysis showed that being female (β = 0.18), working three shifts (β = 0.40), workplace bullying (β = 0.24), and positive psychological capital (β = -0.28) were predictors of burnout ( = 11.25, < 0.001), explaining 44.5% of the variance. An analysis of the correlations between burnout, workplace bullying, positive psychological capital, and social support revealed that workplace bullying was positively correlated with burnout ( = 0.36, < 0.001), and positive psychological capital ( = -0.49, < 0.001) and social support ( = -0.37, < 0.001) were negatively correlated with burnout. Thus, the higher positive psychological capital within an organization, the lower the level of burnout, suggesting that organizations should consider education programs to promote positive psychological capital. In addition, healthy organizational culture should be promoted by monitoring workplace bullying.
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http://dx.doi.org/10.3390/ijerph182111583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583378PMC
November 2021

A Path Model for Burnout in Community Mental Health Professionals.

Int J Environ Res Public Health 2021 09 16;18(18). Epub 2021 Sep 16.

College of Nursing Science, Kyung Hee University, Seoul 02447, Korea.

The purpose of this research is to identify a path model to explain burnout in community mental health professionals based on the compassion satisfaction-compassion fatigue (CS-CF) model. A total of 125 mental health professionals, including nurses, social professionals, and psychologists working in mental health welfare centers in various regions across South Korea were surveyed using a structured questionnaire. A path analysis was conducted using SPSS 24.0 and AMOS 24.0. The results showed that compassion satisfaction and compassion fatigue are significant predictors of burnout (β = -0.20, = 0.011; β = 0.40, < 0.001, respectively). The indirect pathways associated with burnout included occupational stress (β = 0.21, = 0.021) and experience with aggressive behavior in the workplace (β = 0.33, = 0.004) through maladaptive cognitive emotion regulation and compassion satisfaction. The total effect of the variables on burnout via compassion fatigue and compassion satisfaction explained 62.5% of burnout among mental health professionals. These findings indicate that providing nursing interventions might reduce compassion fatigue and increase compassion satisfaction to reduce burnout. Furthermore, intervention programs that help to reduce the use of maladaptive cognitive emotion regulation strategies are necessary to effectively reduce burnout in mental health professionals.
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http://dx.doi.org/10.3390/ijerph18189763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468818PMC
September 2021

Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction.

J Am Heart Assoc 2021 08 30;10(15):e019545. Epub 2021 Jul 30.

Cardiovascular Division Brigham and Women's Hospital and Harvard Medical School Boston MA.

Background Maximal left atrial (LA) volume is reported by most echocardiography laboratories and is associated with clinical outcomes in patients with heart failure (HF). Recent studies suggest that minimal LA volume may better reflect left ventricular filling pressure and may be more prognostic than maximal LA volume. This study assessed the prognostic value of indexed minimal LA volume (LAVImin) in patients with HF with preserved ejection fraction. Methods and Results We assessed the relationship of LAVImin with a primary composite end point of cardiovascular death, aborted cardiac death, or HF hospitalization in 347 patients with HF with preserved ejection fraction enrolled from the Americas region in TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). We compared LAVImin with indexed maximal LA volume with respect to their prognostic values. In addition, we assessed if LA functional parameters provide additional prognostic information over LAVImin. During a median follow-up of 2.5 years, 107 patients (31%) experienced a primary composite end point. LAVImin was associated with increased risk of a primary composite outcome (hazard ratio [HR], 1.35; 95% CI, 1.12-1.61) and HF hospitalization alone (HR, 1.42; 95% CI, 1.17-1.71) after adjusting for clinical confounders and ejection fraction. In contrast, indexed maximal LA volume was not related to the primary composite outcome, but related to HF alone (HR, 1.25; 95% CI, 1.02-1.54). In comparison with indexed maximal LA volume, LAVImin was significantly more prognostic for primary composite outcome ( for comparison=0.032). Both LA emptying fraction and LA strain were prognostic of primary outcome independent of LAVImin (all <0.05). Conclusions In patients with HF with preserved ejection fraction, LAVImin was more predictive of cardiovascular outcome than indexed maximal LA volume, suggesting this measure may be more physiologically relevant and might better identify patients at high risk for cardiovascular events. LA functional parameters provide prognostic information independent of LAVImin. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00094302.
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http://dx.doi.org/10.1161/JAHA.120.019545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475710PMC
August 2021

Epidemiology of Venous Thromboembolism and Treatment Pattern of Oral Anticoagulation in Korea, 2009-2016: a Nationwide Study Based on the National Health Insurance Service Database.

J Cardiovasc Imaging 2021 Jul 26;29(3):265-278. Epub 2021 Apr 26.

Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background: The annual incidence of venous thromboembolism (VTE) is increasing, and the treatment pattern of oral anticoagulants (OACs) has changed with introduction of new oral anticoagulants (NOACs). The aims of this study were to assess the annual incidence of VTE in a Korean population and the change of treatment pattern with availability of NOACs using a population-based database.

Methods: Using the Korean National Health Insurance Services database, we identified patients diagnosed with VTE between 2009 and 2016. The annual prevalence of VTE and clinical characteristics and treatment pattern were investigated. The annual incidence of VTE was calculated using direct and indirect methods using the estimated Korean population in 2009 as the reference.

Results: The annual incidence of VTE in Korean has increased yearly from 23.9 per 100,000 in 2009 to 42.2 in 2016. The overall rate of OAC prescription for VTE treatment increased from 55.9% to 68% in the same time period. The rate of initiation of NOAC treatment greatly increased, particularly from 2013 onwards, with a 20-fold increase from 2009 to 2016 (2.1% vs. 54.3%).

Conclusions: The annual incidence of VTE in Korea increased by almost two-fold from 2009 to 2016. The rate of initiation of NOAC treatment has increased substantially since 2013, and these agents have surpassed VKAs as the anticoagulant of choice for VTE. This temporal pattern of OAC prescription is consistent with the current clinical guidelines, which indicate NOACs over the warfarin in patients with VTE.
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http://dx.doi.org/10.4250/jcvi.2021.0014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318819PMC
July 2021

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction.

J Korean Med Sci 2021 May 17;36(19):e131. Epub 2021 May 17.

Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Korea.

Background: The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods: A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization.

Results: Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI ( = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136-3.339, = 0.015) along with symptom-to balloon time ( = 0.002) and left ventricular dysfunction ( < 0.001).

Conclusion: NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.
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http://dx.doi.org/10.3346/jkms.2021.36.e131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129614PMC
May 2021

Neutrophil-to-Lymphocyte Ratio at Emergency Room Predicts Mechanical Complications of ST-segment Elevation Myocardial Infarction.

J Korean Med Sci 2021 May 17;36(19):e131. Epub 2021 May 17.

Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Korea.

Background: The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods: A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization.

Results: Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI ( = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136-3.339, = 0.015) along with symptom-to balloon time ( = 0.002) and left ventricular dysfunction ( < 0.001).

Conclusion: NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.
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http://dx.doi.org/10.3346/jkms.2021.36.e131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129614PMC
May 2021

Percutaneous Device Closure of Atrial Septal Defect: Neglected Long-Term Effects on the Left Atrium.

Authors:
Sung Hee Shin

J Cardiovasc Imaging 2021 Apr 8;29(2):133-134. Epub 2021 Feb 8.

Division of Cardiology, Inha University College of Medicine, Incheon, Korea.

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http://dx.doi.org/10.4250/jcvi.2020.0232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099575PMC
April 2021

Correlations Between Stress, Depression, Body Mass Index, and Food Addiction Among Korean Nursing Students.

J Addict Nurs 2020 Oct/Dec;31(4):236-242

Hyon Joo Hong, PhD, National Center for Mental Health, Seoul, Korea. Ran Kim, PhD, College of Nursing Science, Kyung Hee University, Seoul, Korea. Ae Sil Kim, PhD(c), School of Nursing, Yeungnam University College, Daegu, Korea. Jung Ho Kim, PhD(c), Department of Nursing, Masan University, Gyeongnam, Korea. Hyun Ji Kim, PhD, Department of Nursing, Songho University, Gangwon, Korea. Ji Hyeun Song, PhD, Department of Nursing, Cheju Halla University, Jeju, Korea. Sung Hee Shin, PhD, College of Nursing Science, East-West Research Institute, Kyung Hee University, Seoul, Korea.

This study examined the relationships between stress, depression, body mass index, and food addiction in South Korean nursing students. Data from 323 nursing students in Seoul, Gangwon-do, Jeollanam-do, Gyeongsangnam-do, and Jeju-do were collected via self-report questionnaires and analyzed using chi-square tests, Mann-Whitney U tests, logistic regression analyses, and the receiver operating characteristic curve using SPSS 21.0. Overall, 7.1% of students were classified as having a food addiction. Stress and depression affected food addiction, and food addiction influenced obesity. Depression and stress combined were predictors of food addiction. These findings suggest that effective stress management and interventions for depression prevention may be beneficial to prevent food addiction in nursing students.
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http://dx.doi.org/10.1097/JAN.0000000000000362DOI Listing
June 2021

Effect of Soft Silicone Foam Dressings on Intraoperatively Acquired Pressure Injuries: A Randomized Study in Patients Undergoing Spinal Surgery.

Wound Manag Prev 2020 11;66(11):22-29

College of Nursing Science, East-West Nursing Research Institute, Kyung Hee University, Seoul, Repulic of Korea.

The use of prophylactic dressings to help prevent intraoperatively acquired pressure injuries (IAPIs) merits further study.

Purpose: To examine how the use of a soft silicone foam dressing affects the development of IAPIs in patients undergoing spinal surgery to obtain baseline data supporting evidence-based nursing care.

Methods: Using a self-controlled study design, 64 patients requiring thoracic or lumbar surgery on a Wilson frame at a hospital in Seoul, South Korea, were recruited between February 12 and September 1, 2018; 50 patients were eligible. Basic demographic, health, and surgical data were obtained. Before surgery, the left or right side chest and iliac crest areas were randomly assigned to be covered with a soft silicone foam dressing. The areas were assessed at 2 time points: immediately after and 30 minutes after surgery. If an IAPI was present at 30 minutes after surgery, all sites were reevaluated after 7 days.

Results: The majority of participants were male (26 participants, 52%). Average patient age was 62.54 (± 13.83) years, with a body mass index of 24.32 (± 4.23) kg/m2. Average length of surgery was 218.4 (± 137) minutes. Immediately after surgery, 26 IAPIs were observed and there was a significant difference between dressed and non-dressed chest areas for the number of IAPIs (4% vs. 28%; P = .002). After 30 minutes, the total number of IAPIs was 20 and the difference between IAPIs in the iliac crest area was significant between dressed and non-dressed areas (0% vs. 14%; P = .012). After 1 week, there were no chest or iliac crest IAPIs in the areas that had been covered by a dressing; however, 8 chest (61.5%) and 4 iliac crest (30.8%) area IAPIs remained when no dressing had been applied. The majority of IAPIs were stage 1 at all assessment times. After 1 week, 1 IAPI had evolved into a stage 3 injury.

Conclusions: The results of this study show that many stage 1 IAPIs do resolve over time and that use of soft silicone foam dressings during spinal surgery can significantly reduce IAPI rates. Additional longitudinal studies are needed to help guide postoperative skin assessment intervals and increase the understanding about the evolution of stage 1 IAPIs.
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November 2020

Ivabradine-Induced Torsade de Pointes in Patients with Heart Failure Reduced Ejection Fraction.

Int Heart J 2020 Sep 12;61(5):1044-1048. Epub 2020 Sep 12.

Department of Cardiology, Inha University Hospital Cardiovascular Center.

Ivabradine is a selective inhibitor of the sinoatrial node "funny" current, prolonging the slow diastolic depolarization. As it has the ability to block the heart rate selectively, it is more effective at a faster heart rate. It is recommended for the treatment of heart failure reduced ejection fraction in the presence of beta-blocker therapy for the further reduction of the heart rate. However, previous reports have shown the association of Torsade de pointes (TdP) with concurrent use of ivabradine and drugs resulting in QT prolongation or blockage of the metabolic breakdown of ivabradine. In this article, we report two cases of patients with heart failure reduced ejection fraction who developed TdP after ivabradine use. Our report highlights the need to exercise caution with the administration of ivabradine in the presence of a reduced repolarization reserve, such as QT prolongation or metabolic insufficiency.
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http://dx.doi.org/10.1536/ihj.20-073DOI Listing
September 2020

What does left atrial structural remodeling mean in cardiac resynchronization therapy?

Authors:
Sung-Hee Shin

Korean J Intern Med 2020 09 28;35(5):1070-1071. Epub 2020 Aug 28.

Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.

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http://dx.doi.org/10.3904/kjim.2020.397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487307PMC
September 2020

Mechanical and Pharmacological Revascularization Strategies for Prevention of Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction: Analysis from Index of Microcirculatory Resistance Registry Data.

J Interv Cardiol 2020 9;2020:5036396. Epub 2020 Jul 9.

Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea.

Objectives: We aimed to identify mechanical and pharmacological revascularization strategies correlated with the index of microcirculatory resistance (IMR) in ST-elevation myocardial infarction (STEMI) patients.

Background: Microvascular dysfunction (MVD) after STEMI is correlated with infarct size and poor long-term prognosis, and the IMR is a useful analytical method for the quantitative assessment of MVD. However, therapeutic strategies that can reliably reduce MVD remain uncertain.

Methods: Patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled. The IMR was measured with a pressure sensor/thermistor-tipped guidewire immediately after primary PCI. High IMR was defined as values ≥66 percentile of IMR in enrolled patients (IMR > 30.9 IU).

Results: A total of 160 STEMI patients were analyzed (high IMR = 54 patients). Clinical factors for Killip class (=0.006), delayed hospitalization from symptom onset (=0.004), peak troponin-I level (=0.042), and multivessel disease (=0.003) were associated with high IMR. Achieving final thrombolysis in myocardial infarction myocardial perfusion grade 3 tended to be associated with low IMR (=0.119), whereas the presence of distal embolization was significantly associated with high IMR (=0.034). In terms of therapeutic strategies that involved adjusting clinical and angiographic factors associated with IMR, preloading of third-generation P2Y12 inhibitors correlated with reducing IMR value ( = -10.30, < 0.001). Mechanical therapeutic strategies including stent diameter/length, preballoon dilatation, direct stenting, and thrombectomy were not associated with low IMR value (all > 0.05), and postballoon dilatation was associated with high IMR ( = 8.30, =0.020).

Conclusions: In our study, mechanical strategies were suboptimal in achieving myocardial salvage. Preloading of third-generation P2Y12 inhibitors revealed decreased IMR value, indicative of MVD prevention.
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http://dx.doi.org/10.1155/2020/5036396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368229PMC
November 2020

Normal Reference Values for Left Atrial Strain and Its Determinants from a Large Korean Multicenter Registry.

J Cardiovasc Imaging 2020 Jul;28(3):186-198

Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Left atrial (LA) strain is a novel parameter of LA function. However, its reference value has not been established, and the determining factors for LA strain remain elusive. We aimed to present LA strain with reservoir, conduit, and contractile components and associated parameters in a large-sized group of healthy individuals.

Methods: The present study was from a prospective multicenter registry in South Korea. Subjects who had no history of cardiovascular disease with adequate images were eligible for inclusion. LA reservoir, conduit, and contractile strains (LAS, LAS and LAS, respectively) were measured. Left ventricular global longitudinal strain (LV GLS) and early and late diastolic strain rates (DSR and DSR, respectively) were also evaluated.

Results: Among a total of 324 subjects (mean age: 49 ± 16 years, 167 females), the mean LAS, LAS, and LAS values were 35.9% ± 10.6%, 21.9% ± 9.3%, and 13.9% ± 3.6%, respectively. Mean LV GLS was -20.4% ± 2.2%, and mean DSR and DSR were 1.6 ± 0.4 s and 0.8 ± 0.3 s, respectively. With aging, LAS and LAS showed significant decreases. Factors showing independent associations with LAS were age (B = -0.425, p < 0.001), DSR (B = 4.706, p = 0.001), and LV GLS (B = -1.081, p < 0.001). Age (B = -0.319, p < 0.001), DSR (B = 4.140, p = 0.002), DSR (B = -3.409, p = 0.018), and LV GLS (B = -0.783, p < 0.001) showed associations with LAS. With LAS, only DSR showed a correlation (R = 0.277, p < 0.001).

Conclusions: We presented LA strain in a large-sized group of healthy subjects. Age is a significant determinant of LA function. Associations of LA strain with diastolic strain rates and LV GLS reflect cardiac mechanics.
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http://dx.doi.org/10.4250/jcvi.2020.0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316554PMC
July 2020

An analysis of vascular properties using pulse wave analysis in patients with vasovagal syncope.

Clin Cardiol 2020 Jul 18;43(7):781-788. Epub 2020 Jun 18.

Department of Cardiology, Inha University Hospital Cardiovascular Center, Incheon, Republic of Korea.

Background: Vasovagal syncope (VVS) is a common cause of recurrent syncope. Nevertheless, the exact hemodynamic mechanism has not been elucidated. Pulse wave analysis (PWA) is widely used to evaluate vascular properties, as it reflects the condition of the entire arterial system.

Hypothesis: Cardiovascular autonomic modulation may influence the hemodynamic mechanism and result in different vascular properties between VVS patients and healthy individuals.

Methods: We enrolled consecutive patients diagnosed with VVS on head-up tilt testing from January 2014 to August 2019. Healthy subjects were enrolled as the control group. We performed PWA on all participants. Using propensity score matching, we assembled a study population with similar baseline characteristics and compared hemodynamic parameters.

Results: A total of 111 VVS patients (43 ± 18 years, 72 females) and 475 healthy control subjects (48 ± 13 years, 192 females) were enrolled. Compared to the healthy control subjects, the VVS patients had a higher augmentation index (AIx) adjusted to a heart rate of 75 beats per minute ([email protected], 20.5 ± 13.1% vs 16.7 ± 11.9%, P = .003). After 1:1 matched comparison (111 matched control), VVS patients consistently showed higher [email protected] (20.5 ± 13.1% vs 16.7 ± 12.9%, P = .02) than the matched control group. According to age distribution, VVS patients showed significantly higher [email protected] (10.6 ± 11.7% vs 2.5 ± 11.1%, P = .01) in a young age (15-33 years) group.

Conclusions: VVS patients had greater arterial stiffness than healthy subjects. This is one of the plausible mechanisms of the pathophysiology of VVS.
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http://dx.doi.org/10.1002/clc.23380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368349PMC
July 2020

Hyperglycaemia, ejection fraction and the risk of heart failure or cardiovascular death in patients with type 2 diabetes and a recent acute coronary syndrome.

Eur J Heart Fail 2020 07 25;22(7):1133-1143. Epub 2020 Mar 25.

Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.

Aims: Chronic hyperglycaemia, assessed by elevated glycated haemoglobin (A1C), is a known risk factor for heart failure (HF) and cardiovascular (CV) death among subjects with diabetes. Whether this risk varies with left ventricular ejection fraction (LVEF) is unknown. This study evaluated whether A1C influences a composite outcome of either HF hospitalization or CV death differently along the spectrum of LVEF.

Methods And Results: We assessed the relationships of baseline A1C and LVEF with a composite outcome of either CV death or HF hospitalization in the 4091 patients with type 2 diabetes and a recent acute coronary syndrome enrolled in the ELIXA trial who had available LVEF. We assessed for interaction between A1C and LVEF as continuous variables with respect to this outcome. During a median follow-up of 25.7 months, 343 patients (8.4%) had HF hospitalization or died of CV causes. In a multivariable model, A1C and LVEF were each associated with an increased risk of HF hospitalization or CV death [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.01-1.21 per 1% higher A1C, and adjusted HR 1.39, 95% CI 1.27-1.51 per 10% lower in LVEF]. Both A1C and LVEF were independently and incrementally associated with risk without evidence of interaction (P for interaction = 0.31). Patients with A1C ≥ 8% and LVEF <40% were at threefold higher risk than those with A1C < 7% and LVEF ≥50% (adjusted HR 3.18, 95% CI 2.03-4.98, P < 0.001).

Conclusion: In a contemporary cohort of patients with type 2 diabetes and acute coronary syndrome, baseline chronic hyperglycaemia was associated with an increased risk of HF hospitalization or CV death independently of LVEF.
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http://dx.doi.org/10.1002/ejhf.1790DOI Listing
July 2020

Improving the Mechanical Durability of Short-Side-Chain Perfluorinated Polymer Electrolyte Membranes by Annealing and Physical Reinforcement.

ACS Omega 2019 Nov 5;4(21):19153-19163. Epub 2019 Nov 5.

Fuel Cell Laboratory, Korea Institute of Energy Research (KIER), 152, Gajeong-ro, Yuseong-gu, Daejeon 34129, Republic of Korea.

Physically reinforced short-side-chain perfluorinated sulfonic acid electrolyte membranes were fabricated by annealing and using a porous support. Five types of solution-cast membranes were produced from commercial perfluorinated ionomers (3M and Aquivion (AQ)) with different equivalent weights, annealed at different temperatures, and characterized in terms of ion conductivity, water uptake, and in-plane/through-plane swelling, while the effect of annealing on physical structure of membranes was evaluated by small-angle X-ray scattering and dynamic mechanical analysis. To create a reinforced composite membrane (RCM), we impregnated a polytetrafluoroethylene porous support with 3M 729 and AQ 720 electrolytes exhibiting excellent proton conductivity and water uptake. The electrolyte impregnation stability for the porous support was evaluated using a solvent resistance test, and the best performance was observed for the 3M 729 RCM annealed at 200 °C. Both annealed and nonannealed 3M 729 RCMs were used to produce membrane electrode assemblies, the durability of which was evaluated by open-circuit voltage combined wet-dry cycling tests. The nonannealed 3M 729 RCM survived 5800 cycles, while the 3M 729 RCM annealed at 200 °C survived 16 600 cycles and thus exhibited improved mechanical durability.
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http://dx.doi.org/10.1021/acsomega.9b02436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868593PMC
November 2019

Impact of gender on heart failure presentation in non-obstructive hypertrophic cardiomyopathy.

Heart Vessels 2020 Feb 3;35(2):214-222. Epub 2019 Sep 3.

Division of Cardiology, Department of Internal Medicine, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea.

Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disease that represents a broad spectrum of morphologic features and clinical presentations. However, little is known about the impact of gender differences in heart failure (HF) development in non-obstructive HCM. We assessed clinical and echocardiographic parameters according to gender in patients with non-obstructive HCM and evaluated the impact of gender on HF presentation and cardiovascular (CV) outcomes in this population. We investigated 202 consecutive patients with non-obstructive HCM. Clinical parameters and conventional echocardiographic measurements including tissue Doppler measurements were evaluated and compared according to gender. Additionally, left ventricular (LV) deformation was assessed with global longitudinal strain (GLS) utilizing 2D speckle tracking software. Of the 202 patients (age = 63 ± 14 years, male: female = 141: 61), 51 patients (24.8%) presented with HF and female patients had HF more frequently (52.5% vs. 12.8%, P < 0.001). Females were older, had a higher prevalence of atrial fibrillation, had increased left atrial volume (LAV), and a higher ratio of early diastolic mitral inflow to early annular velocity (E/e') than males (70 ± 12 years vs. 59 ± 14 years, P < 0.001 for age; 51.4 ± 19.3 mL/m vs. 40.0 [Formula: see text] 13.4 mL/m, P < 0.001 for indexed LAV; 17.2 [Formula: see text] 6.0 vs. 13.0 [Formula: see text] 4.3, P < 0.001 for E/e'). While LV maximal thickness and LV ejection fraction were comparable between men and women, GLS was decreased significantly in female patients (- 13.5 [Formula: see text] 3.4% vs. - 15.6 [Formula: see text] 4.0%, P = 0.001 for GLS). Even after adjusting for clinical factors, female was independently associated with HF presentation (Odd ratio 5.19, 95% CI 2.24-12.03, P < 0.001). During a median follow-up duration 34.0 months, 20 patients (9.9%) had HF hospitalization or CV death. In a multivariable analysis, female gender was associated with higher risk of the composite of HF hospitalization or CV death and HF hospitalization alone than male (Adjusted hazard ratio [HR] = 3.31, 95% CI 1.17-9.35, P = 0.024 for primary composite outcome of HF hospitalization or CV death; adjusted HR = 4.78, 95% CI 1.53-14.96, P = 0.007 for HF hospitalization). In patients with non-obstructive HCM, female patients presented with HF more frequently and showed a higher risk of CV events than male patients. LA volume, E/e' and LV mechanics were different between the genders, suggesting that these might contribute to greater susceptibility to HF in women with HCM.
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http://dx.doi.org/10.1007/s00380-019-01492-0DOI Listing
February 2020

Increasing the Durability of Polymer Electrolyte Membranes Using Organic Additives.

ACS Omega 2018 Sep 14;3(9):11262-11269. Epub 2018 Sep 14.

Fuel Cell Laboratory, Korea Institute of Energy Research (KIER), 152, Gajeong, Yuseong, Daejeon 34129, South Korea.

Herein, we utilize organic radical scavengers to mitigate the chemical degradation of polymer membranes without sacrificing their proton conductivity. Several hydrocarbon composite membranes based on sulfonated poly(arylene ether sulfone) (SPES50, degree of sulfonation = 50%) and containing organic radical scavengers were prepared and characterized in terms of water uptake, ion-exchange capacity, proton conductivity, and oxidative stability, being additionally exposed to hydrogen peroxide for accelerated oxidative stability testing. Precise analysis of the molecular weight and its distribution before and after the above test confirmed that the incorporation of radical scavengers enhanced the chemical durability of membranes while maintaining their proton conductivity. Finally, in an accelerated open circuit voltage durability test, composite membranes showed lifetimes exceeding 1400 h, whereas pristine SPES50 failed after 750 h. On the basis of the above, organic radical scavengers were concluded to be superior to those based on transition-metal compounds, not engaging in any interactions with the sulfonate groups of the membrane polymer and hence not compromising their proton conductivity.
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http://dx.doi.org/10.1021/acsomega.8b01063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6644771PMC
September 2018

Effects of Fumanet exercise on Korean older adults with mild dementia.

Jpn J Nurs Sci 2020 Jan 25;17(1):e12286. Epub 2019 Jul 25.

College of Nursing Science, Kyung Hee University, Seoul, South Korea.

Aim: This study aimed to examine the effects of Fumanet exercise on cognitive function, walking ability, and depression in older adults with mild dementia.

Methods: A quasi-experimental pre- and post-test design with a non-equivalent control group was used. Participants were 45 patients with mild dementia (experimental group = 22, control group = 23). In the experimental group, Fumanet exercise was performed 60 minutes per day, once per week for 8 weeks. Data were analyzed using descriptive statistics, t test, Chi-square, Fisher's exact test, and two-way repeated measures analysis of variance.

Results: Gait ability in the experimental group was significantly improved compared with the control group (F = 9.08, P = .004). There were no significant differences in cognitive function or depression between the experimental and control groups. Although the intervention did not show a reduction in depression, participants exhibited a high participation rate and brighter mood with increasing sessions.

Conclusions: It was confirmed that Fumanet exercise is an effective nursing intervention to improve gait ability among older adults with mild dementia.
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http://dx.doi.org/10.1111/jjns.12286DOI Listing
January 2020

Relation of blood pressure variability to left ventricular function and arterial stiffness in hypertensive patients.

Singapore Med J 2019 Aug 11;60(8):427-431. Epub 2019 Mar 11.

Division of Cardiology, Inha University College of Medicine, Incheon, South Korea.

Introduction: Variability of blood pressure (BP) has been reported to be related to worse cardiovascular outcomes. We examined the impact of daytime systolic BP variability on left ventricular (LV) function and arterial stiffness in hypertensive patients.

Methods: Ambulatory BP monitoring (ABPM) and echocardiography were performed in 116 hypertensive patients. We assessed BP variability as standard deviations of daytime systolic BP on 24-hour ABPM. Conventional echocardiographic parameters, area strain and three-dimensional diastolic index (3D-DI) using 3D speckle tracking were measured. Arterial stiffness was evaluated by acquiring pulse wave velocity (PWV) and augmentation index.

Results: Patients with higher BP variability showed significantly increased left ventricular mass index (LVMI) and late mitral inflow velocity, as well as decreased E/A (early mitral inflow velocity/late mitral inflow velocity) ratio, area strain and 3D-DI than those with lower BP variability (LVMI: p = 0.02; A velocity: p < 0.001; E/A ratio: p < 0.001; area strain: p = 0.02; 3D-DI: p = 0.04). In addition, increased BP variability was associated with higher PWV and augmentation index (p < 0.001). Even among patients whose BP was well controlled, BP variability was related to LV mass, diastolic dysfunction and arterial stiffness.

Conclusion: Increased BP variability was associated with LV mass and dysfunction, as well as arterial stiffness, suggesting that BP variability may be an important determinant of target organ damage in hypertensive patients.
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http://dx.doi.org/10.11622/smedj.2019030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717775PMC
August 2019

[Validity and Reliability of a Korean Version of Yale Food Addiction Scale for Children (YFAS-C)].

J Korean Acad Nurs 2019 Feb;49(1):59-68

College of Nursing Science · East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea.

Purpose: This study evaluated the psychometric properties of the Korean version of Yale Food Addiction Scale for Children (YFAS-C).

Methods: Participants were 419 young adolescent students (11~15 years old). The content validity of the expert group was calculated as the content validity index (CVI) after the translation and reverse translation process of the 25 items of the YFAS-C. The multitrait-multimethod matrix (MTMM) method was used to verify the construct validity; the generalized linear model (GLM) was used to evaluate the concurrent and incremental validity. Reliability was calculated as Kuder-Richardson-20 (KR-20) and Spearman-Brown coefficients.

Results: The CVI of the 25 items was greater than the item-level CVI .80 and the scale-level CVI .90. The Korean version of YFAS-C had verified convergent validity in emotional eating and external eating and discriminant validity in restrained eating. In addition, it had verified concurrent validity in emotional eating and external eating. Finally the incremental validity of the Korean version of YFAS-C was statistically significant on BMI. Reliability was KR-20 α=.69 and the Spearman-Brown coefficient was .64.

Conclusion: The Korean version of YFAS-C is a valid and reliable scale for measuring the severity of food addiction; it can be a useful scale for preventing obesity by predicting food addiction early.
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http://dx.doi.org/10.4040/jkan.2019.49.1.59DOI Listing
February 2019

Angiotensin Receptor Neprilysin Inhibitor for Functional Mitral Regurgitation.

Circulation 2019 03;139(11):1354-1365

Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K., S.L., M.-S.K., J.-M.S., J.-J.K.).

Background: The morbidity and mortality of patients with functional mitral regurgitation (MR) remain high, but no pharmacological therapy has been proven effective. The hypothesis of this study was that sacubitril/valsartan would be superior to valsartan alone in improving functional MR via dual inhibition of the renin-angiotensin system and neprilysin.

Methods: In this double-blind trial, we randomly assigned 118 patients with heart failure with chronic functional MR secondary to left ventricular (LV) dysfunction to receive either sacubitril/valsartan or valsartan, in addition to standard medical therapy for heart failure. The primary end point was the change in effective regurgitant orifice area of functional MR from baseline to the 12-month follow-up. Secondary end points included changes in regurgitant volume, LV end-systolic volume, LV end-diastolic volume, and incomplete mitral leaflet closure area.

Results: The decrease in effective regurgitant orifice area was significantly greater in the sacubitril/valsartan group than in the valsartan group (-0.058±0.095 versus -0.018±0.105 cm; P=0.032) in an intention-to-treat analysis including 117 (99%) patients. Regurgitant volume was also significantly decreased in the sacubitril/valsartan group in comparison with the valsartan group (mean difference, -7.3 mL; 95% CI, -12.6 to -1.9; P=0.009). There were no significant between-group differences regarding the changes in incomplete mitral leaflet closure area and LV volumes, with the exception of LV end-diastolic volume index ( P=0.044). We noted no significant difference in the change of blood pressure between the treatment groups, and 7 patients (12%) in the sacubitril/valsartan group and 9 (16%) in the valsartan group had ≥1 serious adverse events ( P=0.54).

Conclusions: Among patients with secondary functional MR, sacubitril/valsartan reduced MR to a greater extent than did valsartan. Our findings suggest that an angiotensin receptor-neprilysin inhibitor might be considered for optimal medical therapy of patients with heart failure and functional MR.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02687932.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.037077DOI Listing
March 2019

Prognostic Impact of Left Atrial Minimal Volume on Clinical Outcome in Patients with Non-Obstructive Hypertrophic Cardiomyopathy.

Int Heart J 2018 Sep 29;59(5):991-995. Epub 2018 Aug 29.

Division of Cardiology, Department of Internal Medicine, Inha University Hospital.

Maximal left atrial volume (LAVmax) has been suggested to be an important indicator of left ventricular (LV) diastolic function and a prognosticator in patients with hypertrophic cardiomyopathy (HCM). However, LAVmax can be influenced by LV longitudinal systolic function, which causes systolic descent of the mitral plane. We investigated the prognostic role of LAVmin in patients with HCM and tested if LAVmin is better than LAVmax in predicting clinical outcome in these patients. A total of 167 consecutive patients with HCM were enrolled (age = 64.7 ± 13.5 years, male: female = 120:47). Clinical parameters and conventional echocardiographic measurement including tissue Doppler measurement were evaluated. Left atrial maximal and minimal volumes were measured just before mitral valve opening and at mitral valve closure respectively using the biplane disk method. The relationship between LAVmin and the clinical outcome of hospitalization for heart failure (HF), stroke or all-cause mortality was evaluated. During a median follow-up of 25.0 ± 17.8 months, the primary end point of HF hospitalization, stroke or death occurred in 35 patients (21%). Indexed LAVmin was predictive of HF, stroke or death after adjustment for age, diabetes, hypertension, atrial fibrillation, LV ejection fraction, and E/e'in a multivariate analysis (P = 0.001). The model including indexed LAVmin was superior to the model including indexed LAVmax in predicting a worse outcome in patients with HCM (P = 0.02). In conclusion, LAVmin was independently associated with increased risk of HF, stroke, or mortality in patients with HCM and was superior to LAVmax in predicting clinical outcome in this population.
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http://dx.doi.org/10.1536/ihj.17-606DOI Listing
September 2018

Normal reference values of diastolic strain rate in healthy individuals: Chronological trends and the comparison according to genders.

Echocardiography 2018 10 19;35(10):1533-1541. Epub 2018 Jun 19.

Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: Recently, the diastolic strain rate (DSR) utilizing speckle-tracking echocardiography has been proposed as a novel parameter for left ventricular diastolic function. We aimed to present normal reference data for those in a large-sized, selected group of healthy individuals.

Methods: The current study was a part of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL), a prospective nationwide survey from 23 centers in Korea. We analyzed 447 subjects (age 48 ± 15 years, 234 females) without any history of cardiovascular disease and presented the early and late DSRs (SR and SR , respectively) in a total and gender-/age-specified groups.

Results: Among the total subjects, the mean SR and SR were 1.6 ± 0.4 S and 0.8 ± 0.3 S , respectively. With increasing age, there were significant trends of decreasing SR and increasing SR . Although both gender groups showed comparable age, the female group presented significantly higher SR compared to male subjects with age of 20-59 years, which diminished after the age of 60 years. However, the SR was comparable between genders in all age groups. On multiple linear regression, age showed independent associations with both SR (β = -0.132, P = .010) and SR (β = 0.440, P < .001), whereas gender did not show any association with SR or SR .

Conclusion: We present normal reference data of a novel parameter, DSR, in a large-sized selected group with healthy Korean subjects. Additionally, we present significant age-related changes both in SR and SR without the impact of their gender.
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http://dx.doi.org/10.1111/echo.14053DOI Listing
October 2018

Efficacy and Safety of Ezetimibe and Rosuvastatin Combination Therapy Versus Those of Rosuvastatin Monotherapy in Patients With Primary Hypercholesterolemia.

Clin Ther 2018 06 30;40(6):993-1013. Epub 2018 May 30.

Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea. Electronic address:

Purpose: The aim of this study was to evaluate the safety and efficacy of combination treatment of rosuvastatin with ezetimibe in patients with primary hypercholesterolemia.

Methods: This multicenter, randomized, double-blind study comprised a main study and an extension study. In the main study, the efficacy and safety of a combination of rosuvastatin (5, 10, and 20 mg) with ezetimibe (10 mg) were compared with those of rosuvastatin (5, 10, and 20 mg) alone. The subjects who achieved the National Cholesterol Education Program Adult Treatment Panel III LDL-C goal in the main study and agreed to a further study were enrolled for the extension study. In the extension study, ezetimibe 10 mg was also administered to subjects who had received rosuvastatin (5, 10, and 20 mg) alone in the main study, and the same treatment was continued for subjects who had received a combination of rosuvastatin with ezetimibe in the main study.

Findings: At the end of the main study (week 8), LDL-C levels were significantly lower in subjects receiving combination therapy than in those receiving rosuvastatin monotherapy. Other lipid profiles also significantly improved in the combination therapy group. These improvements continued in the extension study. The combination therapy of rosuvastatin and ezetimibe was generally well tolerated. At the end of the main study, more subjects achieved the National Cholesterol Education Program Adult Treatment Panel III LDL-C goal in the combination therapy group than in the monotherapy group. The increased dosage of rosuvastatin was also well tolerated in the combination treatment.

Implications: Combination therapy of ezetimibe 10 mg with varying doses of rosuvastatin that are commonly used in the clinical field improved the lipid profile and allowed more subjects to reach the LDL-C goal in primary hypercholesterolemia compared with rosuvastatin monotherapy. In addition, the efficacy of the combination therapy was maintained for the extended period. Additional beneficial changes were also achieved with combination therapy even in patients who responded well to rosuvastatin monotherapy. ClinicalTrials.gov identifier: NCT03288038.
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http://dx.doi.org/10.1016/j.clinthera.2018.04.015DOI Listing
June 2018

[Actor and Partner Effects of Health Status, Marital Satisfaction and Self Efficacy on Retirement Preparation of Middle Aged Couples: Actor-Partner Interdependence Model Analysis].

J Korean Acad Nurs 2018 Apr;48(2):154-166

College of Nursing Science, Kyung Hee University, Seoul, Korea.

Purpose: This study aimed to identify the actor and partner effects of health status, marital satisfaction, and self efficacy on retirement preparation in middle aged couples using the Actor-Partner Interdependence Model.

Methods: Participants were 121 middle aged couples living in Seoul, Gyeonggi-do and Daegu City, Korea. All measures were self-administered. The collected data were analyzed using SPSS 20.0 and AMOS 20.0.

Results: 1) Wife's self efficacy and marital satisfaction showed direct actor and partner effects on retirement preparation in middle aged couples. Wife's health status showed an indirect actor effect through wife's self efficacy and marital satisfaction on wife's retirement preparation, and showed an indirect partner effect through husband's self efficacy on husband's retirement preparation. 2) Husband's self efficacy and marital satisfaction showed only direct actor effect on retirement preparation. Health status among the husbands showed an indirect actor effect on husband's retirement preparation through their self efficacy and marital satisfaction, and an indirect partner effect through wife's marital satisfaction on wife's retirement preparation. 3) The actor effect size of health status on self efficacy and marital satisfaction was larger among husband's than wife's. Additionally, the partner effect size of health status on self efficacy and marital satisfaction was different between the two groups; however, the actor and partner effect size of self efficacy and marital satisfaction on retirement preparation was the same for husband and wife.

Conclusion: The results of this study indicate that nursing intervention strategies for improving self efficacy and marital satisfaction are strongly needed to enhance retirement preparation of middle aged couples in Korean community.
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http://dx.doi.org/10.4040/jkan.2018.48.2.154DOI Listing
April 2018

[Difficulties in Caring for Psychiatric Patient as Experienced by Non-Psychiatric Nurses].

J Korean Acad Nurs 2017 Feb;47(1):49-59

College of Nursing Science and East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea.

Purpose: The purpose of this study was to identify non-psychiatric nurses' difficulties in caring for patients with mental illness.

Methods: Data were collected from eighteen general medical-surgical nurses working at a university hospital in Seoul, Korea. This study involved two focus group discussions and three in-depth individual interviews. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis.

Results: General medical-surgical nurses experienced difficulties in 3 categories, 9 subcategories, 27 codes. The three categories were 'nurse' related factors, 'patient' related factors, 'resource' related factors. The nine categories were 'unpreparedness', 'nursing barriers due to stigma', 'undervaluing and avoidance of psychiatric nursing', 'eroding into the trap of a vicious cycle', 'facing unapproachable patients', 'dealing with unhelpful family members', 'burdening already overburdened staff', 'obstructive environment', and 'isolation of staff with heavy responsibilities'.

Conclusion: The results of this study indicate the need to develop psychiatric mental health education programs for non-psychiatric nurses. Education about psychiatric mental health and support from institutions for non-psychiatric nurses can reduce their negative attitude toward psychiatric patients and difficulties in caring for psychiatric patients.
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http://dx.doi.org/10.4040/jkan.2017.47.1.49DOI Listing
February 2017

Normal 2-Dimensional Strain Values of the Left Ventricle: A Substudy of the Normal Echocardiographic Measurements in Korean Population Study.

J Cardiovasc Ultrasound 2016 Dec 28;24(4):285-293. Epub 2016 Dec 28.

Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: It is important to understand the distribution of 2-dimensional strain values in normal population. We performed a multicenter trial to measure normal echocardiographic values in the Korean population.

Methods: This was a substudy of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL) study. Echocardiographic specialists measured frequently used echocardiographic indices in healthy people according to a standardized method at 23 different university hospitals. The strain values were analyzed from digitally stored images.

Results: Of a total of 1003 healthy participants in NORMAL study, 2-dimensional strain values were measured in 501 subjects (265 females, mean age 47 ± 15 years old) with echocardiographic images only by GE echocardiographic machines. Interventricular septal thickness, left ventricular (LV) posterior wall thickness, systolic and diastolic LV dimensions, and LV ejection fraction were 7.5 ± 1.0 mm, 7.4 ± 1.0 mm, 29.9 ± 2.8 mm, 48.9 ± 3.6 mm, and 62 ± 4%, respectively. LV longitudinal systolic strain (LS) values of apical 4-chamber (A4C) view, apical 3-chamber (A3C) view, apical 2-chamber (A2C) view, and LV global LS (LVGLS) were -20.1 ± 2.3, -19.9 ± 2.7, -21.2 ± 2.6, and -20.4 ± 2.2%, respectively. LV longitudinal systolic strain rate (LVLSR) values of the A4C view, A3C view, A2C view, and LV global LSR (LVGLSR) were -1.18 ± 0.18, -1.20 ± 0.21, -1.25 ± 0.21, and -1.21 ± 0.21, respectively. Females had lower LVGLS (-21.2 ± 2.2% vs. -19.5 ± 1.9%, < 0.001) and LVGLSR (-1.25 ± 0.18 vs. -1.17 ± 0.15, < 0.001) values than males.

Conclusion: We measured LV longitudinal strain and strain rate values in the normal Korean population. Since considerable gender differences were observed, normal echocardiographic cutoff values should be differentially applied based on sex.
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http://dx.doi.org/10.4250/jcu.2016.24.4.285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234340PMC
December 2016

Prognostic Implications of Newly Developed T-Wave Inversion After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction.

Am J Cardiol 2017 02 16;119(4):515-519. Epub 2016 Nov 16.

Department of Cardiology, Inha University Hospital, Incheon, Republic of Korea.

We investigated the prognostic value of newly developed T-wave inversion after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction. New T-wave inversion was defined as new onset of T-wave inversion after the primary PCI, without negative T waves on the presenting electrocardiogram. The primary end point was the occurrence of major adverse cardiac events (MACE), which consisted of cardiovascular mortality, nonfatal myocardial infarction, and rehospitalization for heart failure. A total of 271 patients were analyzed and followed up for 24 months in this study. New T-wave inversion was observed in 194 patients (72%), whereas the remaining 77 patients (28%) did not show T-wave inversion after the index PCI. Post-PCI Thrombolysis In Myocardial Infarction flow grade 2 or 3 was observed more frequently in patients with new T-wave inversion (97% vs 90%; p = 0.011). The cumulative MACE rate was significantly lower in patients with new T-wave inversion than in those without new T-wave inversion (8% vs 30%; odds ratio 0.197, 95% confidential interval 0.096 to 0.403; p <0.001). In multivariate Cox regression analysis, new T-wave inversion was an independent prognostic factor for MACE (hazard ratio 0.297, 95% confidential interval 0.144 to 0.611; p = 0.001). In conclusion, newly developed T-wave inversion after primary PCI was associated with favorable long-term outcome.
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http://dx.doi.org/10.1016/j.amjcard.2016.10.039DOI Listing
February 2017
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