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Dae-Hee Kim,In-Jeong Cho,Woohyeun Kim,Chan Joo Lee,Hyeon-Chang Kim,Jeong-Hun Shin,Si-Hyuck Kang,Mi-Hyang Jung,Chang Hee Kwon,Ju-Hee Lee,Hack Lyoung Kim,Hyue Mee Kim,Iksung Cho,Dae Ryong Kang,Hae-Young 대한심장학회 2022 Korean Circulation Journal Vol.52 No.6
Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion: Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.
Kim, Yong Hoon,Her, Ae-Young,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Baek, Man Jong,Ryu, Yang Gi,Park, Yoonjee,Mashaly, Ahmed,Jang, Won Young,Kim, Woohyeun,Choi, Jah Yeon,Park, Eun Jin,Na, Ji Williams & Wilkins Co 2018 Medicine Vol.97 No.35
<P><B>Abstract</B></P><P>Left ventricular hypertrophy (LVH) is associated with increased risk for vascular events and mortality. This study investigated 8-year clinical outcomes of hypertensive patients with LVH who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) compared with hypertensive patients without LVH.</P><P>A total of 1704 consecutive hypertensive patients who underwent PCI from 2004 to 2014 were enrolled. We classified them into either the LVH group (n = 406) or the control group (without LVH, n = 1298). LVH was defined by LV mass index > 115 g/m<SUP>2</SUP> in men and > 95 g/m<SUP>2</SUP> in women. After propensity score matched (PSM) analysis, 2 PSM groups (366 pairs, n = 732, c-statistic = 0.629) were generated.</P><P>For up to 8 years, the LVH group showed a higher incidence of cardiac death (4.4% vs 1.2%, log-rank <I>P</I> = .023, hazard ratio: 3.371, 95% confidence interval: 1.109–10.25; <I>P</I> = .032) compared with the control group. However, there were no significant differences between the 2 groups in the incidence of total death, myocardial infarction, revascularization, and major adverse cardiac events up to 8 years.</P><P>LVH in hypertensive patients who underwent successful PCI with DES was associated with higher incidence of cardiac death up to 8 years of follow-up. More careful managements and clinical follow-up are needed and treatment strategies should specifically focus to target prevention and reversal of LVH in hypertensive patients.</P>
Kim, Yong Hoon,Her, Ae-Young,Choi, Byoung Geol,Choi, Se Yeon,Byun, Jae Kyeong,Park, Yoonjee,Baek, Man Jong,Ryu, Yang Gi,Mashaly, Ahmed,Jang, Won Young,Kim, Woohyeun,Park, Eun Jin,Choi, Jah Yeon,Na, Ji Elsevier Science Publishers B.V 2018 Diabetes research and clinical practice Vol.138 No.-
<P><B>Abstract</B></P> <P><B>Aims</B></P> <P>The usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in patients with diabetes is not well understood. We compare 3-year clinical outcomes of RAF and CF in diabetic patients underwent PCI with drug-eluting stents (DES).</P> <P><B>Methods</B></P> <P>A total of 843 patients with diabetes who underwent PCI with DES were enrolled. RAF was performed at 6–9 months after PCI (n = 426). Rest of patients were medically managed and clinically followed (n = 417); symptom-driven events were captured. After propensity score matched analysis, 2 propensity-matched groups (262 pairs, n = 524, C-statistic = 0.750) were generated. The primary endpoint was major adverse cardiac events (MACE), the composite of total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), non-target vessel revascularization (Non-TVR).</P> <P><B>Results</B></P> <P>During the 3-year follow-up period, the cumulative incidence of target lesion revascularization [TLR: hazard ratio (HR), 4.07; 95% confidence interval (CI), 1.18–9.34; p = 0.001], target vessel revascularization (TVR: HR, 4.02; 95% CI, 1.93–8.40; p < 0.001), non-TVR (HR, 4.92; 95% CI, 1.68–14.4; p = 0.004) and major adverse cardiac events (MACE: HR, 2.53; 95% CI, 1.60–4.01, p < 0.001) were significantly higher in the RAF group. However, the incidence of total death, non-fatal MI were similar between the two groups.</P> <P><B>Conclusions</B></P> <P>RAF following index PCI with DES in patients with diabetes was associated with increased incidence of revascularization and MACE without changes of death or re-infarction rates and increased TLR and TVR rates in both first- and second-generation DES.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Usefulness of routine angiographic follow-up (RAF) in diabetes is less well known. </LI> <LI> RAF cause increased incidence of revascularization and major adverse cardiac events. </LI> <LI> Target lesion revascularization also higher in second-generation drug-eluting stents. </LI> </UL> </P>
Retrieval of a Partially Degloved Stent Strut During Percutaneous Coronary Intervention
Woohyeun Kim,Yong Hyun Kim,임상엽,김성환,Jeong Chun Ahn,송우혁 전남대학교 의과학연구소 2012 전남의대학술지 Vol.48 No.2
Although stent entrapment is a rare event during percutaneous coronary intervention,stent entrapment can cause stent breakage or loss, which results in fatal complications such as stent embolism or acute myocardial infarction. We report one case of stent entrapment that was successfully treated by a snare via a contralateral transfemoral approach
Heart Failure as a Risk Factor for Stroke
Woohyeun Kim,Eung Ju Kim 대한뇌졸중학회 2018 Journal of stroke Vol.20 No.1
Heart failure (HF) is one of the major causes of death worldwide. Despite the high incidence of stroke in patients with HF, there has been a controversy as to whether HF itself is a risk factor for stroke. Recently, there is a great deal of evidence that HF itself increases the risk of stroke. In previous studies, the benefit of warfarin for stroke prevention in patients with HF was offset by the risk of bleeding. In the era of non-vitamin K antagonist oral anticoagulants with low bleeding profiles, we can expect a more effective stroke prevention in patients with HF by selective anticoagulation. The purpose of this review is to describe the relationship between stroke and HF, which could be an unconventional risk factor and a potential intervention target for stroke prevention.
Resistant hypertension: consensus document from the Korean society of hypertension
Park Sungha,Shin Jinho,임상현,김광일,Kim Hack-Lyoung,Kim Hyeon Chang,Lee Eun Mi,Lee Jang Hoon,Ahn Shin Young,Cho Eun Joo,Kim Ju Han,Kang Hee-Taik,Lee Hae-Young,Lee Sunki,Kim Woohyeun,Park Jong-Moo 대한고혈압학회 2023 Clinical Hypertension Vol.29 No.-
Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of singlepill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.
Choi, Jah Yeon,Choi, Cheol Ung,Hwang, Soon-Young,Choi, Byoung Geol,Jang, Won Young,Kim, Do Young,Kim, Woohyeun,Park, Eun Jin,Lee, Sunki,Na, Jin Oh,Kim, Jin Won,Kim, Eung Ju,Rha, Seung-Woon,Park, Chang Elsevier 2018 The American Journal of Cardiology Vol.122 No.6
<P>Although statin use in patients with acute myocardial infarction (AMI) is mandatory, it has been suggested to be associated with new-onset diabetes mellitus (NODM). In real world practice, moderate-intensity statin therapy is more commonly used than high-intensity statin therapy. In this study, we investigated the impact of moderate-intensity pitavastatin (2 to 4 mg) compared with moderate-intensity atorvastatin (10 to 20 mg) and rosuvastatin (5 to 10 mg) on the development of NODM during a follow-up period of up to 3years. Between November 2011 and May 2015, 2001 patients with AMI who did not have diabetes mellitus were investigated. The cumulative incidence of NODM was evaluated in all groups. To adjust for potential confounders, multinomial propensity scores were used. Cox proportional hazard models were used to assess the hazard ratio of NODM in the atorvastatin and rosuvastatin groups compared with pitavastatin group. The cumulative incidence of NODM was significantly lower in pitavastatin group compared with the atorvastatin and rosuvastatin groups (3.0% vs 8.4% vs 10.4%, respectively; Log-rank p value = 0.001). After weighting the baseline characteristics of the 3 statin groups by multinomial propensity scores, atorvastatin (hazard ratio: 2.615, 95% confidence interval: 1.163 to 5.879) and rosuvastatin (hazard ratio: 3.906, 95% confidence interval: 1.756 to 8.688) were found to be associated with a higher incidence of NODM compared with pitavastatin therapy on multivariable analysis. Moderate-intensity pitavastatin therapy is associated with a lower incidence of NODM in patients with AMI andhas similar clinical outcomes to moderate-intensity atorvastatin and rosuvastatin therapy.</P>
Two Cases of High Output Heart Failure Caused by Hereditary Hemorrhagic Telangiectasia
조동혁,김수아,Mina Kim,Young Ho Seo,Woohyeun Kim,Seong Hee Kang,Sung Mi Park,심완주 대한심장학회 2012 Korean Circulation Journal Vol.42 No.12
High-output cardiac failure is a rare complication of hereditary hemorrhagic telangiectasia (HHT) usually caused by shunting of blood through atriovenous malformations (AVMs) in the liver. We describe two cases of high output heart failure due to large hepatic AVMs. Clini-cal suspicion of HHT based on detailed history taking and physical examination is essential for early detection and proper management of heart failure associated with HHT.
A Case of Successful Bare Metal Stenting for Aortic Coarctation in an Adult
국형돈,나승운,Dong Hyeok Kim,이선기,Suk-Kyu Oh,Tae Hoon Ahn,Won Heum Shim,Woohyeun Kim 대한심장학회 2013 Korean Circulation Journal Vol.43 No.4
Aortic coarctation is a correctable hypertensive disease. For safety reasons and due to the invasiveness of surgical techniques, percutane-ous interventions have become drastically more popular in recent times. In elderly patients with aortic coarctation who are at risk of an aortic wall aneurysm and rupture, covered stents are preferred but in younger patients, bare metal stenting may be sufficient for long-term safety. Herein we present a 47-year-old typical aortic coarctation patient who was successfully treated with a bare metal stent.
Unusual Polymorphic Ventricular Tachycardia Originating from the Pulmonary Artery
이대인,Sang Weon Park,국형돈,Woohyeun Kim,김동혁,이선기,Suk-Kyu Oh,Young-Hoon Kim 대한심장학회 2013 Korean Circulation Journal Vol.43 No.2
We report a case about a 27-year-old healthy young male who developed syncope during exercise, which was subsequently identified to be attributable to non-sustained polymorphic ventricular tachycardia (VT). Occurrence of polymorphic VT was neither related to a pro-longed QT interval nor a fixed short coupling interval. Standard examinations including echocardiography, coronary angiography, isopro -terenol infusion study, and cardiac MRI showed no structural heart disease. On the electrophysiology study, activation mapping revealed that a discrete potential preceded the premature ventricular complex (PVC) triggered polymorphic VT, which was recorded just above the pulmonary valve. After radiofrequency ablation at this area, PVC and polymorphic VT disappeared and did not recur after a 2 month fol-low up.