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김남균,박훈식,윤재용,조현준,김창연,노재형,배명환,이장훈,양동헌,조용근,채성철,손지현,장세용 대한노인병학회 2017 Annals of geriatric medicine and research Vol.21 No.1
Background: The aim of this study was to investigate the predictive value of estimated glomerular filtration rate (eGFR) calculated with the simplified Modification of Diet in Renal Disease (MDRD) Study and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for prognosis in elderly patients with acute myocardial infarction (AMI). Methods: This study included 1,372 patients (mean age, 64.2±11.8 years; men, 67.9%) entered in the Kyungpook National University Hospital Acute Myocardial Infarction Registry from November 2005 to February 2010. We analyzed 1-year major adverse cardiac events (MACE) according to the eGFR calculated with the simplified MDRD Study and CKD-EPI equations. Results: The mean eGFR values calculated with the MDRD Study and CKD-EPI equations were 81.3±44.4 and 78.5±27.1 mL/(min/1.73 m2), respectively. In receiver operating characteristic curve analysis for prediction of 1-year MACE, the area under the curve based on the CKD-EPI equation was greater than that using the MDRD Study equation (CKD-EPI equation vs. MDRD Study equation: 0.691 vs. 0.674, p=0.041). Multivariate analysis using a Cox proportional hazards model revealed that the eGFR calculated with the CKD-EPI equation was an independent predictor of the occurrence of MACE within 1 year after AMI. However, eGFR calculated with the MDRD Study equation did not have predictive value. Furthermore, the eGFR calculated with the CKD-EPI equation had incremental prognostic value for established risk factors (chi-square=5.78, p=0.016). Conclusion: The eGFR calculated using the CKD-EPI equation was an independent predictor of 1-year MACE in elderly patients with AMI.
Incidence of Hypertension in Korea: 5-Year Follow-up Study
이장훈,양동헌,박훈식,조용근,전재은,박위현,천병렬,신지연,신동훈,이경수,김기식,김권배,김영조,채성철,신동구,원규장,이형우,김혜순,이인규 대한의학회 2011 Journal of Korean medical science Vol.26 No.10
Limited data are available about the incidence of hypertension over the 5-yr in nonhypertensive subjects. The study subjects were 1,806 subjects enrolled in a rural area of Daegu, Korea for a cohort study from August to November 2003. Of them, 1,287 (71.3%)individuals had another examination 5 yr later. To estimate the incidence of hypertension,730 non-hypertensive individuals (265 males; mean age = 56.6 ± 11.1 yr-old) at baseline examination were analyzed in this study. Hypertension was defined as either a new diagnosis of hypertension or self-reports of newly initiated antihypertensive treatment;prehypertension was if the systolic blood pressure was 120-139 mmHg and/or diastolic blood pressure was 80-89 mmHg. During the 5-yr follow-up, 195 (26.7%) nonhypertensive individuals developed incident hypertension. The age-adjusted 5-yr incidence rates of hypertension were 22.9% (95% confidence interval [CI] = 19.9-29.0) in overall subjects, 22.2% (95% CI = 17.2-27.2) in men, and 24.3% (95% CI = 20.4-28.2) in women. The incidence rates of hypertension significantly increased with age. In the multivariate analysis, prehypertension (Odds ratio [OR] 2.25; P < 0.001) and older age (OR 2.26; P = 0.010) were independent predictors for incident hypertension. In this rapidly aging society, population-based preventive approach to decrease blood pressure,particularly in subjects with prehypertension, is needed to reduce hypertension.
Cardiovascular beriberi: rare cause of reversible pulmonary hypertension
송준혁,전상수,배명환,이장훈,양동헌,박훈식,조용근,채성철 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.1
Cardiovascular beriberi is caused by thiamine deficiency and usually presents as high cardiac output failure associated with predominantly right-sided heart failure and rapid recovery after treatment with thiamine. Because of its rarity in developed countries, the diagnosis can often be delayed and missed. We recently experienced a case of cardiovascular beriberi with pulmonary hypertension which successfully treated with thiamine infusion. A 50-year-old man with chronic heavy alcoholics was refered to our department for dyspnea with mental change. Echocardiography showed marked right ventricular (RV) dilatation and flattening of the interventricular septum with a D-shaped deformation of the left ventricle. Moderate tricuspid valve regurgitation was found and estimated RV systolic pressure was 52 mm Hg. Because of his confused mentality and history of chronic alcohol intake, neurological disorder due to thiamine deficiency was suspected and intravenous thiamine was administered and he continuously received a daily dose of 100 mg of thiamine. Follow up echocardiography showed marked reduction of RV dilatation and improvement of a D-shaped deformation of the left ventricle. He finally diagnosed as cardiovascular beriberi on the basis of dramatic response to intravenous thiamine. Thiamine deficiency can cause reversible pulmonary hypertension, and can still be encountered in the clinical setting. Thus high index of suspicion is critically needed for diagnosis.
강정규,이장훈,하수영,배명환,양동헌,박훈식,조용근,채성철,전재은 영남대학교 의과대학 2011 Yeungnam University Journal of Medicine Vol.28 No.1
Methods Between October 2005 and May 2007, 311 overweight or obese patients with an AMI visited Kyungpook National University Hospital. Among them, 216 patients (63±11 years old, 144 males) with ≥1 year of follow-up were included. Results Body weight of all patients showed a significant decrease and 20% showed a >3% weight reduction at 1 year of follow-up. Ninety-six (44%) patients were smoking at baseline, and 52% of them had quit by 1 year of follow-up. Only six smokers were successful with both a >3% weight reduction and smoking cessation. In multivariate analysis, age (OR 1.084, 95% CI 1.028-1.144, p=0.003) and smoking cessation (OR 0.167, 95% CI 0.048-0.575, p=0.005) were independent predictors of weight reduction. Abdominal circumference was a negative predictor of smoking cessation (OR 0.903, 95% CI 0.820-0.994, p=0.037). Conclusions Mean body weight of all patients showed a significant decrease at follow-up. Smoking cessation and age were independent predictors of weight reduction, and abdominal circumference was a negative predictor of smoking cessation. Methods Between October 2005 and May 2007, 311 overweight or obese patients with an AMI visited Kyungpook National University Hospital. Among them, 216 patients (63±11 years old, 144 males) with ≥1 year of follow-up were included. Results Body weight of all patients showed a significant decrease and 20% showed a >3% weight reduction at 1 year of follow-up. Ninety-six (44%) patients were smoking at baseline, and 52% of them had quit by 1 year of follow-up. Only six smokers were successful with both a >3% weight reduction and smoking cessation. In multivariate analysis, age (OR 1.084, 95% CI 1.028-1.144, p=0.003) and smoking cessation (OR 0.167, 95% CI 0.048-0.575, p=0.005) were independent predictors of weight reduction. Abdominal circumference was a negative predictor of smoking cessation (OR 0.903, 95% CI 0.820-0.994, p=0.037). Conclusions Mean body weight of all patients showed a significant decrease at follow-up. Smoking cessation and age were independent predictors of weight reduction, and abdominal circumference was a negative predictor of smoking cessation.