Cardiac Resynchronization Therapy and QRS Duration: Systematic Review, Meta-analysis, and Meta-regression

강시혁,오세일,강도윤,차명진,조영진,최의근,한서경,오일영 대한의학회 2015 Journal of Korean medical science Vol.30 No.1

Cardiac resynchronization therapy (CRT) has been shown to reduce the risk of death andhospitalization in patients with advanced heart failure with left ventricular dysfunction. However, controversy remains regarding who would most benefit from CRT. We performeda meta-analysis, and meta-regression in an attempt to identify factors that determine theoutcome after CRT. A total of 23 trials comprising 10,103 patients were selected for thismeta-analysis. Our analysis revealed that CRT significantly reduced the risk of all-causemortality and hospitalization for heart failure compared to control treatment. The oddsratio (OR) of all-cause death had a linear relationship with mean QRS duration (P = 0.009). The benefit in survival was confined to patients with a QRS duration ≥ 145 ms (OR, 0.86;95% CI, 0.74-0.99), while no benefit was shown among patients with a QRS duration of130 ms (OR, 1.00; 95% CI, 0.80-1.25) or less. Hospitalization for heart failure was shownto be significantly reduced in patients with a QRS duration ≥ 127 ms (OR, 0.77; 95% CI,0.60-0.98). This meta-regression analysis implies that patients with a QRS duration ≥ 150ms would most benefit from CRT, and in those with a QRS duration < 130 ms CRTimplantation may be potentially harmful.

고혈압 환자에서의 조조혈압상승과 동맥경직도의 관련성

강시혁,정우영,이숙진,조영석,연태진,채인호,최동주,오병희,박영배 한국지질동맥경화학회(구 한국지질학회) 2007 한국지질동맥경화학회 추계학술발표논문집 Vol.2007 No.-

관상동맥 내 빛간섭단층촬영술을 활용한 관상동맥 내 석회화 병변의 중재시술 후 경과 예측: 전향적 관찰 연구

장지홍,강시혁,조영석,신은석,서정원 순천향대학교 순천향의학연구소 2021 Journal of Soonchunhyang Medical Science Vol.27 No.1

Objective Imaging modalities such as intravascular ultrasonography or computed tomography or angiography have shown limitations in assessing coronary calcification. In this study, we investigated whether quantitative indices of optical coherence tomography (OCT) in calcified lesions are correlated with the late outcome of a coronary stent. Methods We consecutively enrolled patients who had more than grade 2 coronary calcification on fluoroscopy. OCT was performed at baseline, immediately after stenting, and at 9 months after stenting. We analyzed qualitative and quantitative characteristics of plaque, calcification, and stent-related indices. Results All images of 3-time points were available in a total of 10 patients. Calcified lesions were frequently associated with thin cap fibroatheroma (100%), plaque erosion (20%), or rupture (20%) before the procedure. Thrombus was found in 100% of cases in the OCT immediately after stenting. Maximal calcium area before stenting was strongly correlated with late luminal loss assessed by 9-month follow-up OCT (r= 0.766, P= 0.01). Conclusion Preprocedural OCT assessment on calcified coronary lesion may predict high-risk procedure and late stent outcome. Further studies are warranted to confirm these findings.

Differential Prognostic Impacts of Diabetes over Time Course after Acute Myocardial Infarction

김학령,강시혁,윤창환,조영석,연태진,조구영,채인호,김효수,채성철,조명찬,김영조,김주한,안영근,정명호,최동주,김종 대한의학회 2013 Journal of Korean medical science Vol.28 No.12

This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n=21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P=0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P=0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.

Delayed Diagnosis of Traumatic Ventricular Septal Defect in Penetrating Chest Injury: Small Evidence on Echocardiography Makes Big Difference

전기현,임우현,강시혁,조익성,김경희,김형관,김용진,손대원 한국심초음파학회 2010 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.18 No.1

Cardiac trauma from penetrating chest injury is a life-threatening condition. It was reported that < 10% of patients arrives at the emergency department alive. Penetrating chest injury can cause serious damage in more than 1 cardiac structure, including myocardial lacerations, ventricular septal defect (VSD), fistula between aorta and right cardiac chamber and valves. The presence of pericardial effusion (even a small amount) on the initial echocardiography might be the only clue to serious cardiac damage in the absence of definite evidence of anatomical defect in heart. We here present a case, in which clear diagnosis of VSD and pseudoaneurysmal formation was delayed a few days after penetrating chest injury due to the lack of anatomical evidence of damage.

Limus 방출 스텐트를 사용한 환자에서 SYNTAX 점수의 예측력

강지훈,박경우,강시혁,안효석,이해영,강현재,구본권,채인호,연태진,오병희,박영배,김효수 대한내과학회 2012 대한내과학회 추계학술발표논문집 Vol.2012 No.1

Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease

Lee Wonjae,Choi Wonsuk,강시혁,Hwang In-Chang,Choi Hong-Mi,Yoon Yeonyee E.,Cho Goo-Yeong 대한의학회 2021 Journal of Korean medical science Vol.36 No.6

Background: There is an incomplete understanding of the natural course of mild to moderate aortic stenosis (AS). We aimed to evaluate the natural course of patients with mild to moderate AS and its association with coronary artery disease (CAD). Methods: We retrospectively analyzed 787 patients diagnosed with mild to moderate AS using echocardiography between 2004 and 2010. Cardiac death and aortic valve replacement (AVR) for AS were assessed. Results: A median follow-up period was 92 months. Compared to the general population, patients with mild to moderate AS had a higher risk of cardiac death (hazard ratio [HR], 17.16; 95% confidence interval [CI], 13.65–21.59; P < 0.001). Established CAD was detected in 22.4% and associated with a significantly higher risk of cardiac mortality (adjusted HR, 1.62; 95% CI, 1.04–2.53; P = 0.033). The risk of cardiac death was lower when patients were taking statin (adjusted HR, 0.64; 95% CI, 0.41–0.98; P = 0.041), which was clear only after 7 years. Both patients with CAD and on statin tended to undergo more AVR, but the difference was not statistically significant (the presence of established CAD; adjusted HR, 1.63; 95% CI, 0.51–3.51; P = 0.214 and the use of statin; adjusted HR, 1.86; 95% CI, 0.76–4.58; P = 0.177). Conclusion: Mild to moderate AS does not have a benign course. The presence of CAD and statin use may affect the long-term prognosis of patients with mild to moderate AS.

Comparison of thrombus, gut, and oral microbiomes in Korean patients with ST-elevation myocardial infarction: a case–control study

Ju-Seung Kwun,강시혁,이효중,박한기,Lee Won-Jae,윤창환,서정원,조영석,연태진,채인호 생화학분자생물학회 2020 Experimental and molecular medicine Vol.52 No.-

ST-segment elevation myocardial infarction (STEMI) is characterized by thrombotic coronary artery occlusions caused by atherosclerotic plaque rupture. The gut microbiome potentially contributes to the pathogenesis of coronary artery diseases. This study investigated the microbial diversity and composition of coronary thrombi in STEMI patients and the composition of the thrombus microbiome relative to that of the oral and gut microbiomes. A case–control study was performed with 22 STEMI patients and 20 age- and sex-matched healthy controls. Coronary thrombi were acquired from STEMI patients via manual thrombus aspiration during primary coronary intervention. Oral swab and stool samples were collected from both groups, and 16S rRNA sequencing and metagenomic microbiome analyses were performed. Microbial DNA was detected in 4 of 22 coronary thrombi. Proteobacteria ( p ) and Bacteroidetes ( p ) were the most abundant phyla. The oral and gut microbiomes significantly differed between patients and healthy controls. The patient group presented microbial dysbiosis, as follows: a higher relative abundance of Proteobacteria ( p ) and Enterobacteriaceae ( f ) in the gut microbiome and a lower abundance of Firmicutes ( p ) and Haemophilus ( g ) in the oral microbiome. Furthermore, 4 significantly abundant genera were observed in the coronary thrombus in the patients: Escherichia , 1.25%; Parabacteroides , 0.25% ; Christensenella , 0.0%; and Bacteroides , 7.48%. The present results indicate that the relative abundance of the gut and oral microbiomes was correlated with that of the thrombus microbiome.

Intravascular imaging analysis of a drug-eluting balloon followed by a bare metal stent compared to a drug-eluting stent for treatment of de novo lesions

최원석,채인호,박진주,김선화,강시혁,오일영,윤창환,조영석,연태진,최동주 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: After a study comparing drug-eluting stents (DESs) to sequential treatment with drug-eluting balloons (DEBs) and bare metal stents (BMSs), we retrospectively analysed strut malapposition and neointimal hyperplasia in de novo coronary lesions using optical coherence tomography (OCT) or intravascular ultrasonography (IVUS). Methods: We obtained OCT data from 16 patients (eight per group) and IVUS data from 40 patients (20 per group). OCT or IVUS was performed after the index procedure and after 9 months. Parameters including obstruction volume due to neointimal hyperplasia (neointimal hyperplasia volume/stent volume, %), strut malapposition (% of malapposed struts), and intra-individual inhomogeneity of in-stent restenosis were compared. Results: Although obstruction volume due to neointimal hyperplasia was significantly higher in the DEB-BMS group (14.90 ± 15.36 vs. DES 7.03 ± 11.39, p = 0.025), there was no difference in strut malapposition between the two groups (DEB-BMS 1.99 ± 5.37 vs. DES 0.88 ± 2.22, p = 0.856). The DEB-BMS group showed greater intra- individual inhomogeneity of in-stent restenosis pattern than the DES group. Conclusions: Treatment with DEB followed by BMS failed to improve strut malapposition despite higher in-stent neointimal growth, probably because of the inhomogeneous inhibition of in-stent neointimal hyperplasia by DEB. DEB technology should be improved to obtain even drug delivery to the vessel wall and homogeneous prevention of neointimal growth comparable to contemporary DES.

Comparison of Continuous ECG Monitoring by Wearable Patch Device and Conventional Telemonitoring Device

최원석,김선화,이원재,강시혁,윤창환,Tae-Jin Youn,채인호 대한의학회 2020 Journal of Korean medical science Vol.35 No.44

Background: Detection of arrhythmias is crucial for the treatment of cardiovascular diseases. However, conventional devices do not provide sufficient diagnostic accuracy while patients should suffer from bothersome diagnostic process. We sought to evaluate diagnostic capability and safety of the new adhesive electrocardiogram (ECG) monitoring device in patients who need ECG monitoring during admission. Methods: We enrolled 10 patients who admitted to Seoul National University Bundang Hospital and required continuous ECG monitoring between October 31, 2019 and December 18, 2019. New adhesive ECG monitoring device and conventional ECG monitoring device were simultaneously applied to the patients and maintained for 48 hours. From each patient, 48 pairs of ECG signal were collected and analyzed by two cardiologists independently. Discrepancy of diagnosis and frequency of noise or signal loss were compared between the two devices. Results: From analyzable ECG data, discrepancy of arrhythmia diagnosis was not observed between the two devices. Noise rate was higher in conventional ECG monitoring device (2.5% vs. 17.3%, P < 0.001) and signal loss was not observed in new adhesive device while there was 9.4% of signal losses in conventional Holter recorder group. The new device was well-tolerated among 48 hours of monitoring period and no adverse event was observed. Conclusion: A newer adhesive ECG monitoring device demonstrated similar diagnostic accuracy compared to conventional ECG monitoring device.