Role of Dyssynchrony on Functional Mitral Regurgitation in Patients with Idiopathic Dilated Cardiomyopathy: A Comparison Study with Geometric Parameters of Mitral Apparatus

최웅길,김수현,박상돈,백영수,신성희,우성일,김대혁,박금수,이우형,권준 한국심초음파학회 2011 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.19 No.2

Background: Functional mitral regurgitation (FMR) occurs commonly in patients with dilated cardiomyopathy (DCM). This study was conducted to explore the role of left ventricular (LV) dyssynchrony in developing FMR in patients with DCM in comparison with geometric parameters of the mitral apparatus. Methods: Twenty patients without FMR and 33 patients with FMR [effective regurgitant orifice area (ERO) = 0.17 ± 0.10 cm2]were enrolled. MR severity was estimated with ERO area. Dyssynchrony indices (DI) were measured using the standard deviations of time to peak myocardial systolic velocity between eight segments. Using real time 3D echocardiography, mitral valve tenting area (MVTa), anterior (APMD) and posterior papillary muscle distances (PPMD), LV sphericity, and tethering angle of anterior (Aα) and posterior leaflets (Pα) were estimated. All geometrical measurements were corrected (c) by the height of each patient. Results: The patient with FMR had significantly higher cDI, cMVTa, cAPMD and cPPMD, LV sphericity, Aα, and Pα than the patients without FMR (all p < 0.05). With multiple logistic regression analysis, cMVTa (p = 0.017) found to be strongest predictor of FMR development. In patients with FMR, cMVTa (r = 0.868), cAPMD (r = 0.801), cPPMD (r = 0.742), Aα (r =0.454), LV sphericity (r = 0.452), and DI (r = 0.410) showed significant correlation with ERO. On multivariate regression analysis, cMVTa and cAPMD (p < 0.001, p = 0.022, respectively) remained the strongest determinants of the degree of ERO and cAPMD (p < 0.001) remained the strongest determinant of the degree of cMVTa. Conclusion: Displacement of anterior papillary muscle and consequent mitral valve tenting seem to play a major role in developing FMR in DCM, while LV dyssynchrony seems to have no significant role.

흰쥐의 운동이 제한된 골격근에 있어서 결합조직 분포와 Adenosine Triphophatase 활성에 관한 조직화학적 연구

최웅길 부산의대 1974 부산의대잡지 - 부산대학교 의과대학 Vol.14 No.1

Acute Cerebral Infarction Following Intravenous Glycoprotein IIb/IIIa Inhibitor for Acute Myocardial Infarction

최웅길,오세원,김영중,임종구,조윤식 대한심장학회 2011 Korean Circulation Journal Vol.41 No.9

Stroke is a rare but serious complication of acute myocardial infarction (AMI). Currently, glycoprotein (GP) IIb/IIIa inhibitor is used in clinical practice for acute coronary syndromes and percutaneous coronary interventions (PCIs). The incidence of stroke in patients receiving GP IIb/IIIa inhibitor during PCIs is very low. We report the case of a 47-year-old man who presented with AMI and suffered an acute cerebral infarction after infusion of a GP IIb/IIIa inhibitor following primary PCI.

The Impact of Prediabetes on Two-Year Clinical Outcomes in Patients Undergoing Elective Percutaneous Coronary Intervention

최웅길,나승운,최병걸,최세연,변재경,Ahmed Mashaly,박윤지,장원영,김우현,최자연,박은진,나진오,최철웅,김응주,박창규,서홍석 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.4

Purpose: Prediabetes is an independent risk factor for cardiovascular disease. However, data on the long term adverse clinicaloutcomes of prediabetic patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) arescarce. Materials and Methods: The study population comprised 674 consecutive non-diabetic patients who underwent elective PCI betweenApril 2007 and November 2010. Prediabetes was defined as hemoglobin A1c (HbA1c) of 5.7% to 6.4%. Two-year cumulativeclinical outcomes of prediabetic patients (HbA1c of 5.7% to 6.4%, n=242) were compared with those of a normoglycemic group(<5.7%, n=432). Results: Baseline clinical and angiographic characteristics were similar between the two groups, except for higher glucose levels(104.8±51.27 mg/dL vs. 131.0±47.22 mg/dL, p<0.001) on admission in the prediabetes group. There was no significant differencebetween the two groups in coronary angiographic parameters, except for a higher incidence of diffuse long lesion in the prediabetesgroup. For prediabetic patients, trends toward higher incidences of binary restenosis (15.6% vs. 9.8 %, p=0.066) and late loss(0.71±0.70 mm vs. 0.59±0.62 mm, p=0.076) were noted. During the 24 months of follow up, the incidence of mortality in prediabeticpatients was higher than that in normoglycemic patients (5.5% vs. 1.5%, p=0.007). Conclusion: In our study, a higher death rate and a trend toward a higher incidence of restenosis in patients with prediabetes upto 2 years, compared to those in normoglycemic patients, undergoing elective PCI with contemporary DESs.

Response of Functional Mitral Regurgitation during Dobutamine Infusion in Relation to Changes in Left Ventricular Dyssynchrony and Mitral Valve Geometry

최웅길,권준,김수현,김수한,박상돈,백영수,신성희,우성일,김대혁,박금수 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3

Purpose: Functional mitral regurgitation (FMR) and myocardial dyssynchrony commonly occur in patients with dilated cardiomyopathy (DCM). The aim of this study was to elucidate changes in FMR in relation to those in left ventricular (LV) dyssynchrony as well as geometric parameters of the mitral valve (MV) in DCM patients during dobutamine infusion. Materials and Methods: Twenty-nine DCM patients (M:F=15:14; age: 62±15 yrs) with FMR underwent echocardiography at baseline and during peak dose (30 or 40 ug/min) of dobutamine infusion. Using 2D echocardiography, LV end-diastolic volume, end-systolic volume (LVESV), ejectionfraction (EF), and effective regurgitant orifice area (ERO) were estimated. Dyssynchronyindices (DIs), defined as the standard deviation of time interval-to-peak myocardial systolic contraction of eight LV segments, were measured. Using the multi-planar reconstructive mode from commercially available 3D image analysis software, MV tenting area (MVTa) was measured. All geometrical measurements were corrected (c) by the height of each patient. Results: During dobutamine infusion,EF (28±8% vs. 39±11%, p=0.001) improved along with significant decrease in cLVESV (80.1±35.2 mm3/m vs. 60.4±31.1 mm3/m, p=0.001); cMVTa (1.28±0.48 cm2/m vs. 0.79±0.33 cm2/m, p=0.001) was significantly reduced; and DI (1.31±0.51 vs. 1.58±0.68, p=0.025) showed significant increase. Despite significant deteriorationof LV dyssynchrony during dobutamine infusion, ERO (0.16±0.09 cm2 vs. 0.09±0.08 cm2, p=0.001) significantly improved. On multivariate analysis, ΔcMVTa and ΔEF were found to be the strongest independent determinants of ΔERO (R2=0.443, p=0.001). Conclusion: Rather than LV dyssynchrony, MV geometry determined by LV geometry and systolic pressure, which represents the MV closing force, may be the primary determinant of MR severity.

순환기 : 확장성 심근증 환자에서 좌심실 이완기 비동시성 정도가 이완 기능에 미치는 영향 (초)

최웅길,김수현,김수한,이승민,우성일,박금수,이우형,권준 대한내과학회 2008 대한내과학회 추계학술대회 Vol.2008 No.-

포스터 전시 발표 순서 : 순환기 ; 확장성 심근증 환자에서 좌심실 이완기 비동시성 정도가 이완 기능에 미치는 영향 (초)

최웅길,김수현,김수한,이승민,우성일,박금수,이우형,권준 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

우리나라 소방정책의 변동요인에 관한 실증적 연구

최웅길(崔雄吉),이창원(李昌遠) 한국정책과학학회 2013 한국정책과학학회보 Vol.17 No.2

본 연구는 소방정책의 변동요인을 추출하여, 변동요인간의 상대적 중요도를 측정함으로써, 소방정책 추진의 효율성 확보에 기여할 자료를 제시하고자 하였다. 문헌조사 등을 통하여 변동요인을 추출하고, AHP 기법을 활용하여 평가목표, 평가영역, 평가요소 등 3계층의 측정모형을 구성한 후, 학계와 현장전문가 등 2개 전문가 그룹별로 평가 구성요소의 상대적 중요도 및 우선순위에 대한 조사 분석을 실시하였다. 분석 결과를 살펴보면, 두 그룹 모두 4개 평가영역 중에서는 ?재난과 사고?영역, 15개 평가요소 중에서는 ?인적재난의 발생?요소의 중요도가 가장 높은 것으로 평가하였다. 이는 ?재난과 사고? 영역이 소방정책 변동에 가장 큰 영향을 미치고 있다고 인식하는 것으로서 이 분야에 대한 관리가 소방정책관리의 핵심이 되어야 함을 보여주고 있다. 한편, 15개 평가요소중 ?소방정책 관리자의 교체?에 대하여는 소방실무전문가는 2위로, 학계전문가는 11위로 평가하여 극히 상반된 결과를 보였다. 이러한 현상은 정책독점에 따른 소통의 미흡에 따른 결과로 평가될 수 있을 것이다. This study is to provide findings that could ensure efficiency in fire policy implementation by extracting factors of fire policy change and measuring relative importance among them. After extracting the factors through literature review and developing a three-layered evaluation model composed of evaluation goals, categories and factors by using the Analytic Hierarchy Process (AHP), the relative importance and priority among the factors was measured through expert opinion surveys in two groups; an university professors group and a above middle-level fire officials group. According to the result, the category ‘Disaster and Incident’ among four evaluation categories and the factor ‘Outbreak of Man-made Disaster’ among 15 evaluation factors had the highest response in both groups. This means that the experts think the category ‘Disaster and Incident’ has the highest influence on fire policy change, which shows that managing the category should be a key in fire policy management. On the contrary, the factor ‘Replacement of Fire Policy Executive Manager’ among 15 evaluation factors obtained the second highest position from the above middle-level fire officials group but the eleventh position from the university professors group, which could be interpreted as the result of insufficient communication caused by an executive manager’s policy monopoly.

공리주의적 관점에서의 소방서비스에 대한 고찰

최웅길 ( Ung Gil Choi ) 영남대학교 한국균형발전연구소(구 영남대학교 영남지역발전연구소) 2012 한국균형발전연구 Vol.3 No.2

공리주의는 발생할 수 있는 전체의 고통을 최소화하고 쾌락을 최대화하는 것이 바람직한 행위라고 본다. 공리주의는 철학적으로 많은 비판을 받고 그 대안이 제시되기도 하였지만, 실질적으로는 공공정책 수립에 매우 큰 비중으로 영향력을 발휘하고 있다. ‘더 많은 쾌락과 더 적은 고통’이라는 공리주의의 기준은 현실 공공정책 수립에 중요한 가치판단의 기준을 제공하고 있다. 그러나 공리주의적 입장에서 전체의 이익을 따지다보면 소수자나 개인의 입장을 무시할 수 있다는 약점이 있다. 모든 사람에게는 공동의 이익이라는 명분으로 간과되거나 무시할 수 없는 불가침의 권리가 있는 것이다. 본고는 공리주의적 입장에서 조명한 소방정책과 공리주의만으로 해석할 수 없는 불가침의 요소가 담긴 서비스를 철학적 차원에서 해석하였다. 그 결과 공리주의적 입장에 있는 것은 화재의 예방 및 진압과 관련된 것이 많았고, 이와 반대의 입장에 있는 것은 인명구조 활동의 원칙과 약자 및 응급환자의 보호에 관한 것들이었다. Utilitarianism is described as a behavior to maximize social utility and minimize social pains. Many philosophers have criticized it and suggested alternatives. However, Utilitarianism has a big power when a public policy is built in the real world. The standard of Utilitarianism, “More utility, Less pains”, do an important role for value judgement. But it has a weakness to ignore small group`s profit for majority. Everyone has invincible rights not to be infringed in the name of public interests. This paper deals with fire policy supporting Utilitarianism and invincible fire philosophy not to be infringed by Utilitarianism.

공리주의적 관점에서의 소방서비스에 대한 고찰

최웅길(Choi Ung Gil) 영남대학교 한국균형발전연구소(구 지역혁신연구소) 2012 한국균형발전연구 Vol.3 No.1

공리주의는 발생할 수 있는 전체의 고통을 최소화하고 쾌락을 최대화하는 것이 바람직한 행위라고 본다. 공리주의는 철학적으로 많은 비판을 받고 그 대안이 제시되기도 하였지만, 실질적으로는 공공정책 수립에 매우 큰 비중으로 영향력을 발휘하고 있다. '더 많은 쾌락과 더 적은 고통'이라는 공리주의의 기준은 현실 공공정책 수립에 중요한 가치판단의 기준을 제공하고 있다. 그러나 공리주의적 입장에서 전체의 이익을 따지다보면 소수자나 개인의 입장을 무시할 수 있다는 약점이 있다. 모든 사람에게는 공동의 이익이라는 명분으로 간과되거나 무시할 수 없는 불가침의 권리가 있는 것이다. 본고는 공리주의적 입장에서 조명한 소방정책과 공리주의만으로 해석할 수 없는 불가침의 요소가 담긴 서비스를 철학적 차원에서 해석하였다. 그 결과 공리주의적 입장에 있는 것은 화재의 예방 및 진압과 관련된 것이 많았고, 이와 반대의 입장에 있는 것은 인명구조 활동의 원칙과 약자 및 응급환자의 보호에 관한 것들이었다. Utilitarianism is described as a behavior to maximize social utility and minimize social pains. Many philosophers have criticized it and suggested alternatives. However, Utilitarianism has a big power when a public policy is built in the real world. The standard of Utilitarianism, "More utility, Less pains", do an important role for value judgement. But it has a weakness to ignore small group's profit for majority. Everyone has invincible rights not to be infringed in the name of public interests. This paper deals with fire policy supporting Utilitarianism and invincible fire philosophy not to be infringed by Utilitarianism.