개흉술을 받는 한국 성인 판막 환자의 유의한 관상동맥

최웅림 ( Uhng Lim Choi ),이선화 ( Sun Hwa Lee ),박재형 ( Jae Hyeong Park ),성석우 ( Seok Woo Seong ),김준형 ( Jun Hyung Kim ),이재환 ( Jae Hwan Lee ),최시완 ( Si Wan Choi ),정진옥 ( Jin Ok Jeong ),성인환 ( In Whan Seong ),이경석 ( 대한내과학회 2012 대한내과학회지 Vol.83 No.1

목적: 판막 질환으로 수술적 치료를 시행받는 환자들에서 유의한 관상동맥 질환의 유무를 확인하는 것은 동시에 관상 동맥우회술을 시행함으로써 향후의 재개흉술 및 이로 인한 합병증의 예방에 중요하다. 국내의 허혈성 심질환의 빈도는 서구에 비해 낮으나 어떤 환자군에서 관상동맥 조영술을 시행하여야 하는지에 대한 기초 통계자료는 없는 실정이다. 이에 저자들은 국내에서 판막 질환으로 개흉 술을 시행 받는 환자들을 대상으로 하여 관상동맥 조영술의 시행유무 및 유의한 관상동맥 질환의 유병률에 대해 연구하였다. 방법: 2005년 1월부터 2011년 6월까지 충남대학교 병원 및 전북대학교 병원 심장내과와 흉부외과에서 유의한 판막 질환으로 개흉 술을 시행 받은 성인 환자들을 대상으로 후향적 분석을 하였다. 급성 대동맥 박리 증이나 외상으로 인해 응급수술을 시행 받은 경우 및 관상동맥 협착증으로 관상동맥 우회로 술을 시행 받으면서 동시에 판막 질환을 수술한 경우는 제외하였다. 결과: 연구 기간 동안 총 431명의 환자(평균나이 58 ± 13세, 남자 204명)가 연구에 등록되었다. 질환 별로 보면 승모 판막 질환은 241명에서 관찰되었고, 대동맥판 질환은 230명에서 관찰되었다. 관상동맥 조영 술을 시행 받은 환자는 297명(68.9%)으로 이 중 36명(12.1%)에서 유의한 협착증이 관찰되었고, 32명에서 관상동맥 우회로 술이 판막 수술과 동시에 시행되었다. 다변 량 분석결과 관상동맥의 유의한 협착은 65세 이상의 고령 [Odd ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], 심혈관계 위험인자가 많은 경우(≥3) (OR =3.002, 95% CI = 1.386-6.503, p = 0.005) 및 대동맥협착증(OR= 2.763, 95% CI = 1.269-6.013, p = 0.010)과 유의하게 연관되었다. 결론: 한국에서 판막 질환으로 수술적 치료를 시행 받는 성인 환자에서 유의한 관상동맥 질환의 빈도는 12.1%로 주로 고령, 대동맥판막 협착증 및 많은 수의 심혈관계 위험인자를 가진 환자에서 높게 나타났다. Background/Aims: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. Methods: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. Results: During the study period, a total of 431 patients (58 ± 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (≥ 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (≥ 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). Conclusions: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.

심실내 전도장애 환자에서의 99mTc-RBC Gated Blood-Pool Scintigraphy 을 통한 Phase Image Analysis

이강욱(Kang Wook Lee),곽병수(Byeng Su Kwak),최시완(Si Wan Choi),강승식(Seung Sik Kang),박기남(Ki Nam Park),전은석(Eun Seok Jeon),박종훈(Chong Hun Park) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A It is known that the normal His-Purkinje system provides for nearly synchronous activation of right (RV) and left (LV) ventricles. When His-Purkinje conduction is abnorrnal, the resulting sequenee of ventricular contraction must be correspondingly abnormal. These abnormal mechanical consequences were difficult to demonstrate because of the complexity and the rapidity of its events. To determine the relationship of the phase changes and the abnormalities of ventricular conduction, we performed phase image analysis of Tc-RBC gated bJood pool scintigrams in patients with intraventricular conduction disturbances (24 complete left bundle branch block (C-LBBB), 15 complete right bundle branch block (C-RBBB), 13 Wolff-Parkinson-White syndrome (WPW), 10 controls). The results were as follows; 1) The ejection fraction (EF), peak ejection rate (PER), and peak filling rate (PFR) of LV in gated blood pool scintigraphy (GBPS) were significantly lower in patients with C-LBBB than in controls (44.4 +- 13.9% vs 69.9 +- 4.2%, 2.48 +- 0.98 vs 3.51 +- 0,62, 1.76 +- 0.71 vs 3.38 +- 0.92, respectively, p<0.05). 2) In the phase angle analysis of LV, Standard deviation (SD), width of half maximum of phase angle (FWHM), and range of phase angle were significantly increased in patients with C-LBBB than in controls (20.6+ 18.1 vs S.6+ I.8, 22. 5+ 9.2 vs 16.0+ 3.9, 95.7+ 31.7 vs 51.3+5.4, respectively, p< 0.05). 3) There was no significant difference in EF, PER, PFR between patients with the WolffParkinson-White syndrome and controls. 4) Standard deviation and range of phase angle were significantly higher in patients with WPW syndrome than in controls (10.6+2.6 vs 8.6+1.8, p<0.05, 69.8+11.7 vs 51.3+5 4, p < 0.001, respectively), however, there was no difference between the two groups in full width of half maxirnurn. 5) Phase image analysis revealed relatively uniform phase across the both ventriles in patients with normal conduction, but markedly delayed phase in the left ventricle of patients with LBBB. 6) ln 13 cases of WPW syndrome, the site of preexcitation could be localized in 10 cases (77%) by phase image analysis. Therefore, it can be concluded that phase irnage analysis can provide an accurate noninvasive method to detect the mechanical consequences of a wide variety of abnormal

혈청 페리틴 농도와 동맥 경직도의 상관관계

이민수 ( Min Su Lee ),박형서 ( Hyeong Seo Park ),박재형 ( Jae Hyeong Park ),이재환 ( Jae Hwan Lee ),최시완 ( Si Wan Choi ),정진옥 ( Jin Ok Jeong ),구본정 ( Bon Jeong Ku ),김대현 ( Dae Hyun Kim ),김제 ( Jei Kim ),이태용 ( Tae Yong 한국지질동맥경화학회(구 한국지질학회) 2006 韓國脂質學會誌 Vol.16 No.2

Objective: Increased serum ferritin concentration can be associated with elevated oxidative stress and the development of arteriosclerosis. We evaluated the relationship between increased ferritin level and arterial stiffness in a normal population without known coronary and cerebrovascular diseases. Methods: We evaluated a total of 995 subjects (578 females; mean age: 58±8 years). After excluding subjects with known cardiovascular and cerebrovascular disease, we analyzed data from 949 subjects. Risk factors of coronary arterial disease (CAD), serum cholesterol profiles, high-sensitive C-reactive protein, fasting blood sugar (FBS) level, and ferritin concentrations were recorded. Arterial stiffness was assessed by brachial to ankle pulse-wave velocity (baPWV). Results: A univariate analysis revealed the following: baPWV was correlated with conventional clinical variables, including age (R=0.389, P<0.001), sex (R=0.099, P=0.002), blood pressure (systolic (R=0.614, P<0.001), diastolic (R=0.417, P<0.001)), triglyceride concentration (R=0.151, P<0.001), and FBS level (R=0.184, P<0.001). The baPWV was also correlated with the 10-year cardiovascular risk score (R=0.419, P<0.001) and serum ferritin concentration (R=0.184, P<0.001). The multivariate analysis demonstrated that baPWV was significantly correlated with serum ferritin concentration; this was similar to other cardiovascular risk factors, including age, blood pressure, smoking, and FBS concentration. Conclusion: Elevated serum ferritin concentration was associated with increased arterial stiffness in subjects without known coronary and cerebrovascular diseases; this may contribute to increased cardiovascular risk.

지역사회기반 참여연구를 활용한 베하스(BeHaS) 프로그램이 대사증후군 독거노인의 건강행위, 생리적 지수 및 자아존중감에 미치는 효과

김종임(Kim, Jong Im),김선애(Kim, Sun Ae),박금옥(Park, Keumok),김지영(Kim, Jiyoung),이리나(Lee, Lina),최시완(Choi, Si Wan),구본정(Ku, Bon Jeong) 한국간호과학회 2020 Journal of Korean Academy of Nursing Vol.50 No.4

Purpose: This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR). Methods: A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test. Results: The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem. Conclusion: The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

증례 : 갑상샘항진증에서 우심부전을 동반한 중증 삼첨판 폐쇄부전증 1예

장원일 ( Won Il Jang ),김은미 ( Eun Mi Kim ),안계택 ( Kye Taek Ahn ),박재형 ( Jae Hyeong Park ),최시완 ( Si Wan Choi ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2

결론적으로 갑상샘항진증과 연관된 좌심부전의 소견이 없이 우심부전을 동반한 삼첨판 폐쇄 부전증을 보였던 예에서 항갑상샘제제 및 소량의 이뇨제 치료로 호전되었다. 폐동맥 고혈압을 동반한 우심부전과 삼첨판 폐쇄부전이 있을 경우 갑상샘항진증은 이의 가능한 원인으로서 고려되어야 한다. Left-sided heart failure can be complicated in the patient suffering with thyrotoxicosis; however, predominantly right heart failure in thyrotoxic patients is a rare condition. We present here a case of reversible right-heart failure with severe tricuspid regurgitation associated with thyrotoxicosis. A 71-year-old woman was admitted to the hospital because of a 10-day history of shortness of breath and indigestion. On echocardiography, there was a normal-sized left ventricle with preserved systolic and diastolic function. However, the right atrium and ventricle were dilated, and there was incomplete systolic coaptation of the tricuspid leaflets, resulted in severe tricuspid regurgitation. The maximal velocity of tricuspid regurgitation was 3.7 m/sec and the estimated pressure gradient between the right two chambers was 55 mmHg. After treatment that included diuretics and antithyroid drug (methimazole), the symptoms of right heart failure resolved. Four weeks later, a second echocardiogram was obtained revealing a normalized right atrium and ventricle, trivial tricuspid regurgitation and the resting pulmonary hypertension had disappeared.(Korean J Med 73:206-209, 2007)

증례 : Thiamine 결핍에 의해 발생한 가역적인 중증 폐동맥 고혈압증 1예

박형서 ( Hyung Seo Park ),박재형 ( Jae Hyeong Park ),정재욱 ( Chae Uk Chung ),장원일 ( Won Il Jang ),김은미 ( Eun Mi Kim ),최시완 ( Si Wan Choi ),성인환 ( In Whan Seong ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1S

이형성 협심증의 임상상

강정아(Jeong A Kang),이유선(Yeu Seon Lee),정승현(Seung Hyeon Jeong),이정우(Jeong Woo Lee),김보영(Bo Yeong Kim),임대승(Dea Seung Im),이민수(Min Soo Lee),김정희(Jeong Hee Kim),정준용(Jun Young Jeong),최시완(Si Wan Choi),정진옥(Jin Ok J 대한내과학회 2002 대한내과학회지 Vol.63 No.2

목적: 우리나라는 이형성 협심증의 발생 빈도가 높음에도 불구하고 임상상과 예후에 대한 연구가 부족한 실정이다. 이에 본 조사는 이형성 협심증으로 진단을 받은 환자를 대상으로 그 빈도와 임상상 그리고 예후에 대해 연구 조사하였다. 방법: 1995년 1월부터 2000년 7월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥 조영술를 시행한 결과 관상동맥의 내경의 협착이 50% 미만이며 에르고노빈(ergonovine)8, 9) 유발 검사로 이형성 협심증으로 진단된 178명을 대상으로 하였다. 결과: 1) 관상동맥질환자 중 이형성 협심증 환자의 빈도는 13.2%로 높았다 2) 이형성 협심증의 위험인자는 흡연이 가장 많았다. 3) 이형성 협심증의 임상상은 대부분 불안정형 협심증의 양상이었고, 13.2%의 환자는 급성심근경색의 임상상을 보였다. 4) 흉통의 발생 시간대는 대부분 새벽이었고, 흉통의 지속시간 평균 11분으로 일반 협심증보다 길었다. 5) 흉통이 없을 때 검사한 심전도는 대부분에서 정상이었고, 운동부하 심전도검사는 76%에서 음성소견을 보였다. 6) 이형성 협심증의 진단에 에르고노빈 유발 관상동맥 조영술은 안전하고 유용한 검사이다. 7) 이형성 협심증의 치료에 칼슘길항제와 나이트레이트제제는 효과적인 약물이다. 8) 이형성 협심증의 예후는 비교적 양호하나 임의로 약물이 중단된 상태에서 심장사 할 수 있다. 따라서 이형성 협심증 환자는 흉통 발생에 대비한 나이트레이트의 준비가 필요하다. 결론: 본 조사에서는 관상동맥질환자의 13.2%가 이형성 협심증 환자였고, 이들은 약물 치료에 대한 효과와 예후가 비교적 양호하였다. 그러나 2.8%의 환자에서 심정지나 심장사가 발생하여 흉통 발생시에 적절한 나이트레이트제제의 사용이 필요하겠다. Background: Coronary artery spasm plays an important role in the pathogenesis of variant angina. However the precise mechanism (s) and the clinical characteristics of variant angina remain to be elucidated. We investigated the clinical characteristics and diagnostic features of variant angina. Methods: The clinical characteristics and coronary angiographic findings were analyzed in 178 patients with angiographically documented coronary artery spasm, which developed spontaneously or was provoked by the admistration of intravenous ergonovine maleate. All patients were followed for at least 1 year or more or until their death. Results: One hundred and eleven patients complained of chest pain which developed especially at night and in the early morning. One hundred and thirty three patients (74.7%) were smokers. The electrocardiographic findings at the time of admission showed no changes in 147 cases (82.6%), testes showed ST segment elevation in 22 cases (12.4%), ST segment depression in 2 cases (1.1%), T wave inversion in 7cases (3.9%). The treadmill test was performed in 135 cases, ST segment elevation was noted in 6 patients (4.4%) and ST segment depression in 18 patients (13.3%). All of the other results were within normal range. The ergonovine provovative tests for coronary spasms were safe and effective. The right coronary artery was the most prevalent site of coronary artery spasm. Drug treatment was applied initially to all patients, but only 115 patients (64.5%) received the follow-up. Of these three died from cardiac arrest. The rate of cardiac death was low (1.7%) in patient, which made it difficult to know the risk factors for the cardiac deaths. Two (1.1%) had cardiac arrest. They didn't take any medication. Patients with variant angina usually responded well to nitrates and calcium antagonists. Thus nitrates and calcium antagonists are useful in preventing attacks and abolished attacks of variant angina. Conclusion: In this study, 13.2% of coronary artery disease was variant angina. The effectiveness of drug therapy and the prognosis of the patients was quite good in the group. But when chest pain happens, the adequate use of nitrate agents is needed because of cardia arrest or cardiac death in 2.8% of the patients. (Korean J Med 63:195-202, 2002)

좌심실내 혈류 전파 속도에 관한 연구

최시완,정진옥,강승식,성인환,박종훈 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.1

Background : Noninvasive attemps to identify left ventricular relaxation have been hampered because relaxation rate, left atrial filling pressure, and chamber compliance are the major determinants of peak early velocity and filling rate. This study was perfomed to evaluate the relation between the velocity of flow propagation and left ventricular relaxation by using pulsed doppler echocardiography to analize flow propagation in the left ventricle. Method : By using pulsed Doppler echocardiography, the velocity of left ventricular flow propagation was measured from the distance and time difference of flow wave along the long axis propagation of left ventricular inflow during early filling in normal subjects (n=30), and M-mode echocardiographic data were obtained to evaluate mitral annulus long axis movement (mitral annulus relaxation rate) which represents left ventricular relaxation. Results : the peak early velocity was not related to mitral annulus relaxation rate, but, the velocity of flow propagation was related to mitral annulus relaxarate (P<0.005) in normal subjects. Conclusion : the velocity of flow propagation during early filling seems to be highly dependent on the mitral annulus relaxation rate and could be an important noninvasive tool in studying diastolic function.

고혈압 환자에서 도플러 심초음파를 이용한 좌심실내 혈류 전파 속도 측정

최시완,김준경,정준용,류정곤,정진옥,강승식,성인환,전은석,김영건 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.1

Background : Early detection and prevention of cardiac dysfunction is an important goal in the management of hypertensive patients. Doppler echocardiography was used to evaluate the pattern of left ventricular diastolic filling, however, filling indices from mitral sampling are not always nfluenced by factors related to left ventricular relaxation properties. Present study was performed to evaluate the relevance of propagation velocity to patients with hypertension by using pulsed Doppler echocardiography. Method : By using pulsed Doppler echocardiography, the velocity of left ventricular flow propagation velocity was measured from the distance and time difference of flow wave alcng the long axis propagation of left ventricular inflow during early filling in hypertensive patients (n=30 ), and M-mode echocardiographic data were obtained to evaluate mitral annulus long axis movement. Results : The values of E/A ratio, deceleration time, and left ventricular mass index were 0.82 + 0.18, 211 ± 55 msec,152 ±23 gr/m^2 respectively, and those of mitral ann ulus relaxation rate and left ventricular flow propagation velocity were 6.0 ±1.1 cm/sec and 62 ±17 cm/sec respectively. Flow propagation velocity was correlated to Doppler profiles such as E/A ratio ,r=0.47), deceleration time (r= -0.63) and mitral annulus relaxation rate (r=0.87) and also to left ventricular mass index (r= -0.69). Conclusion : left ventricular propagation velocity measurement by using pulsed Doppler echocardiography could be an important noninvasive tool in studying left ventricular diastolic function in patients with hypertension.

Prostacyclin synthase 유전자의 C1117A 다형성과 이형협심증과의 관련성

성인환,임대승,김정희,이재환,최시완,정진옥 대한내과학회 2004 대한내과학회지 Vol.66 No.4

목적 : Thromboxan A2의 혀관수축반응을 저해하는 prostacylin synthase exon 8 C117A의 변이가 관동맥 연축과 관련성이 있는지를 알아보고자 하였다. 방법 : 1998년 1월 1일부터 2000년 12월 31일까지 충남대학교병원 순환기내과에서 관동맥조형술과정맥내 에르고노빈 유발검사를 시행하여 관동맥 연축이 확진된 이형협심증 환자군(45예)과 정상 대조군(59예)을 대상으로 중합효소 연쇄반응법 및 restriction fragment length polymorphism을 이용하여 분석하였다. 결과 : Prostacyclin synthase exon 8 C117A 유전자형의 빈도는 대조군에서 A/A : A/C : C/C =3.4% : 30.5% : 66.1%, 이형협심증 환자군에서 A/A : A/C : C/C = 8.9% : 42.4% : 48.9%로 두 군간에 유의한 차이가 없었다. 대조군에 비해 변이형 협심증 환자군에서 남자의 비율과 흡연률이 높았지만, prostacyclin synthase exon 8 C117A 유전자형에 따른 군에서 당뇨병, 고혈압, 흡연, 고지혈증, 비만 등의 유의한 차이는 없었다. 결론 : 한국인에서 prostacyclin synthase exon 8 C117A 유전자 다형성과 관동맥 연축이 있는 이형협심증과의 유의한 연관성은 발견할 수 없었다. Backround : Coronary artery spasm plays an important role in the pathogenesis of variant angina(VA). Prostacyclin is one of the endothelium derived relaxing factors. The association between the novel single nucleotide polymorphism in the prostacyclin synthase gene and VA is not known. Therefore, we investigated the association between VA and the polymorphysm in the prostacyclin synthase gene. Methods : We compared 45 variant angina patients who had positive intravenous ergonovine test by coronary angiography with 59 control subjects who had negative intravenouis ergonovine test and normal coronary angiogram. Using the polymerase chain reaction-single-strand conformation polymorphism analysis, we identified a single nucleotide polymorphism, C117A, in exon 8. This nucleotide change did not cause an amino acid change in codon 373. Results : There was no significant difference in characteristics between the control group and the VA group, and there was no significant difference in the genotype distributions between the control group and the VA group. Conclusion : The C117A polymorphism in exon 8 of the prostacyclin synthase gene is not associated with variant angina.