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신동금,손정우,박지영,최재웅,류성기 대한심장학회 2015 Korean Circulation Journal Vol.45 No.1
Background and Objectives: Apical hypertrophic cardiomyopathy (AHCM) is an uncommon variant of hypertrophic cardiomyopathy witha relatively benign course. However, the prognostic factors of AHCM–particularly those associated with coronary artery disease (CAD) andits anatomical subtypes–are not well known. Subjects and Methods: We enrolled 98 consecutive patients with AHCM who underwent coronary angiography or coronary computedtomography scanning at two general hospitals in Korea from January 2002 to March 2012. Patient charts were reviewed for informationregarding cardiovascular (CV) risk factors, symptoms, and occurrence of CV events and/or mortality. We also reviewed echocardiographic dataand angiography records. Results: The mean age at the time of enrollment was 61.45±9.78 years, with female patients comprising 38.6%. The proportions of mixedand pure types of AHCM were 34.4% and 65.6%, respectively. CAD was found in 31 (31.6%) patients. The mean follow-up period was53.1±60.7 months. CV events occurred in 22.4% of patients, and the mortality rate was 5.1%. The mixed-type was more frequent in CV eventgroup although this difference was not statistically significant (50% vs. 30%, p=0.097). The presence of CAD emerged as an independentrisk factor for CV events in univariate and multivariate Cox regression analysis after adjusting for other CV risk factors. Conclusion: Coronary artery disease is an independent risk factor for CV events in AHCM patients. However, AHCM without CAD has a benignnatural course, comparable with the general population.
신동금,정보영,조익성,Briain o Hartaigh,문희선,이혜영,황의석,박진규,엄재선,박희남,이문형 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.6
Purpose: Electric cardioversion has been successfully used in terminating symptomatic atrial fibrillation (AF). Nevertheless, large-scale study about the acute cardiovascular events following electrical cardioversion of AF is lacking. This study was performed to evaluate the incidence, risk factors, and clinical consequences of acute cardiovascular events following electrical cardioversion of AF. Materials and Methods: The study enrolled 1100 AF patients (mean age 60±11 years) who received cardioversion at four tertiary hospitals. Hospitalizations for stroke/transient ischemic attack, major bleedings, and arrhythmic events during 30 days post electriccardioversion were assessed. Results: The mean duration of anticoagulation before cardioversion was 95.8±51.6 days. The mean International Normalized Ratioat the time of cardioversion was 2.4±0.9. The antiarrhythmic drugs at the time of cardioversion were class I (45%), amiodarone (40%), beta-blocker (53%), calcium-channel blocker (21%), and other medication (11%). The success rate of terminating AF via cardioversion was 87% (n=947). Following cardioversion, 5 strokes and 5 major bleedings occurred. The history of stroke/transient ischemic attack (OR 6.23, 95% CI 1.69–22.90) and heart failure (OR 6.40, 95% CI 1.77–23.14) were among predictors of thromboembolicor bleeding events. Eight patients were hospitalized for bradyarrhythmia. These patients were more likely to have had a lower heart rate prior to the procedure (p=0.045). Consequently, 3 of these patients were implanted with a permanent pacemaker. Conclusion: Cardioversion appears as a safe procedure with a reasonably acceptable cardiovascular event rate. However, to preventthe cardiovascular events, several risk factors should be considered before cardioversion.
Simultaneous Neuroendocrine Carcinoma and Adenocarcinoma of the Colon
신동금,박영숙,공수정,김성환,조윤주,안상봉,한준길,김은경 대한장연구학회 2013 Intestinal Research Vol.11 No.2
Neuroendocrine carcinoma of colon is a rare disease entity that is histologically poorly differentiated and immunochemically synaptophysin positive, enabling it to be confirmed by an immunohistochemical stain. Neuroendocrine carcinomas, in almost all cases, have poor prognosis due to a tendency of early metastasis and lack of standardized treatment. The concurrent diag-nosis of neuroendocrine carcinoma and adenocarcinoma is extremely rare. The relation of these two disease entities is not un-derstood. We experienced a patient with a colonic neuroendocrine carcinoma concurrent with adenocarcinoma. A 65-year-old male presented with abdominal pain. Emergent computed tomography suggested a malignant tumor of the ascending colon. Colonoscopy showed an infiltrative lesion in the ascending colon with a luminal narrowing, a large pedunculated lesion at the splenic flexure, and multiple small polyps in the descending colon. The patient underwent a right hemicolectomy including the pedunculated lesion. The pathology confirmed advanced neuroendocrine carcinoma in the ascending colon, adenocarcinoma in proximal descending colon, and multiple metastatic lymph nodes of neuroendocrine carcinomas on abdomen. The patient underwent the postoperative chemotherapy but did not tolerate it well and expired a year after diagnosis. We report this rare case with a review of the literature. (Intest Res 2013;11:137-141)
신동금,김태훈,정현민,Alexander Kim,엄재선,정보영,이문형,Chun Hwang,박희남 대한부정맥학회 2017 International Journal of Arrhythmia Vol.18 No.2
Background and Objectives: Although an anterior linear ablation is an effective lesion set in radiofrequency catheter ablation (RFCA) for longstanding persistent atrial fibrillation (L-PeAF), its durability for bidirectional block (BDB) is only about 60% at repeat procedure. We hypothesized that changes in electrocardiogram (ECG) may predict an anterior line block state and the clinical outcome of L-PeAF ablation. Subjects and Methods: We studied 304 L-PeAF patients (77% male, 60±10yrs), who consistently underwent RFCA Dallas lesion set (circumferential pulmonary vein isolation, posterior box lesion, and anterior line) protocol with subsequent comparison of pre-procedural and post-procedural P wave axes, and one year follow-up (n=205) sinus rhythm (SR) ECGs. Results: 1. P wave axis shifted inferiorly at immediate post-procedure (p<0.001), and was independently correlated with BDB of anterior line (ß=10.4, 95% confidence interval [CI] 2.79–17.94, p=0.008). 2. The degree of post-procedural inferior shift of P wave axis did not reflect clinical recurrence within one-year (n=205, p=0.923), potentially due to conduction recovery of an anterior line. However, among 160 patients without clinical recurrence within one-year, P wave axis at one-year ECG was independently associated with very late recurrence of AF after one-year (n=160, hazard ratio [HR] 0.98; 95% CI 0.97–0.99, p=0.001), during 45.6±16.7 months of follow-up. 3. Among 22 patients who underwent repeat procedures, P wave axis shift was more significant in patients with maintained BDB of an anterior line than in those without (p=0.015). Conclusion: An inferior shift of P wave axis reflects the achievement and the maintenance of an anterior line BDB, and is associated with better long-term clinical outcome after catheter ablation for L-PeAF based on Dallas lesion set.