Cardiac Tamponade Complicated by Acupuncture: Hemopericardium due to Shredded Coronary Artery Injury

허애영,김용훈,류세민,조준휘 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.3

We report a case of 62-year-old man with cardiac tamponade due to coronary artery injury after acupuncture into the substernum. After resuscitation of cardiac arrest,we performed emergent pericardiocentesis. Nevertheless, the cardiac arrest recurred, and the emergent operation on cardiopulmonary bypass was performed. We identified hemopericardium due to shredded acute marginal branch of right coronary artery, and it was ligated leading to termination of bleeding. The patient was discharged without any other complications.

A Comparison of Peri-Procedural Myocardial Infarction between Paclitaxel-Coated Balloon and Drug-Eluting Stent on De Novo Coronary Lesions

허애영,신은석,조경임,Gillian Balbir Singh,Scot Garg,김용훈,구본권 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.1

Purpose: This study compared the impact of paclitaxel-coated balloons (PCB) or drug eluting stents (DES) on peri-procedural myocardial infarction (PMI) on de novo coronary lesion in stable patients. Materials and Methods: In this observational study, we compared the incidence of PMI amongst patients with single vessel de novo coronary lesions who underwent treatment with a PCB or DES. Propensity score-matching analysis was used to assemble a cohort of patients with similar baseline characteristics. PMI was classified as myocardial infarction occurring within 48 hours afterpercutaneous coronary intervention with a threshold of 5 x the 99th percentile upper reference limit of normal for creatine kinase-myocardial band (CK-MB) or troponin T (TnT). Results: One hundred four patients (52 receiving PCB and 52 receiving DES) were enrolled in this study. The peak mean values of CK-MB and TnT were significantly higher in the DES group. There was a significantly higher rate of PMI in the DES group (23.1% vs. 1.9%, p=0.002). Total occlusion of the side-branch occurred in two patients treated with DES, while no patients treated with PCB. In multivariable analysis, DES was the only independent predictor of PMI compared with PCB (odds ratio 42.85, 95% confidenceinterval: 3.44–533.87, p=0.004). Conclusion: Treatment with a PCB on de novo coronary lesion might be associated with a significant reduction in the risk of PMI compared to DES.

Current Management of In-Stent Restenosis

허애영,신은석 대한심장학회 2018 Korean Circulation Journal Vol.48 No.5

Although the use of coronary stents brought about a dramatic improvement in patients' clinical and procedural outcomes, the long-term outcome of stent implantation remains significantly constrained by the risk of developing in-stent restenosis (ISR) over time.1) ISR which is currently defined as a >50% stenosis of a previously stented segment, occurs in as many as 30% of all patients receiving bare metal stents (BMS).2) Despite the advent of the drug-eluting stents (DES) and improved stent design, the rates of ISR in patients treated with DES are as high as 10%.3) Specifically, the widespread adoption of DES for small arteries, long lesions, complex coronary lesions, diabetes, and a history of bypass surgery has in fact been the trigger for significant numbers of patients re-presenting with DES restenosis in contemporary clinical practice.4), 5) The treatment of patients with ISR continues to remain a challenge, and currently available options include angioplasty alone, repeat stenting with DES or drug-coated balloons (DCB).6) Recent meta-analyses have performed comparisons of these available options in an attempt to identify the preferred therapeutic modality. Therefore, this review will discuss the currently available therapeutic strategies for the management of patients with ISR and the evidence supporting their use.

Prediction of Left Atrial Fibrosis With Speckle Tracking Echocardiography in Mitral Valve Disease: A Comparative Study With Histopathology

허애영,최의영,심지영,송병욱,이삭,하종원,임세중,황기철,장병철,정남식 대한심장학회 2012 Korean Circulation Journal Vol.42 No.5

Background and Objectives: Left atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. How -ever, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle track-ing echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery. Subjects and Methods: Speckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measure -ments were repeated within 30 days after surgery (n=50) and 1-year later (n=39). Results: Left atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was in -dependent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confi-dence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant. Conclusion: Left atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.

포스터 전시 : 순환기 ; 노인 백의 고혈압 환자에서의 백의 효과

허애영,김용훈 대한내과학회 2005 대한내과학회 추계학술대회 Vol.69 No.10

Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium

허애영,정영훈,김병극,주형준,장기육,박용휘,송영빈,안성균,서정원,이상엽,조정래,김효수,김무현,임도선,신은석,On Behalf of the PTRG-DES Consortium Investigators 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.5

Purpose: Platelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim ofthe PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronaryartery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients withcoronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel. Materials and Methods: Searching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/orgenotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics,and clinical outcomes to evaluate relationships among them. Results: Nine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient datafrom 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composedof 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRGGenotypecohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochromeP450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (*2 or *3) were 47.9% (intermediatemetabolizers) and 14.2% (poor metabolizers), respectively. Conclusion: The PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotypethat may be important to developing optimal antiplatelet regimens in East Asian patients. Trial Registration: ClinicalTrials.gov Identifier: NCT04734028.

Association of Inter-Arm Systolic Blood Pressure Difference with Coronary Atherosclerotic Disease Burden Using Calcium Scoring

허애영,신은숙,조경임,Scot Garg,김용훈 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.5

Purpose: There are no sufficient data on the correlation between inter-arm blood pressure (BP) difference and coronary atherosclerosisfound using coronary artery calcium score (CACS). We aimed to investigate if the increased difference in inter-arm BP is independently associated with severity of CACS. Materials and Methods: Patients who had ≥3 cardiovascular risk factors or an intermediate Framingham Risk Score (FRS; ≥10) were enrolled. Inter-arm BP difference was defined as the absolute difference in BP in both arms. Quantitative CACS was measuredby using coronary computed tomography angiography with the scoring system. Results: A total of 261 patients were included in this study. Age (r=0.256, p<0.001), serum creatinine (r=0.139, p=0.030), mean of right arm systolic BP (SBP; r=0.172, p=0.005), mean of left arm SBP (r=0.190, p=0.002), inter-arm SBP difference (r=0.152, p=0.014), and the FRS (r=0.278, p<0.001) showed significant correlation with CACS. The increased inter-arm SBP difference (≥6 mm Hg) was significantly associated with CACS ≥300 [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.12–4.22; p=0.022]. In multivariableanalysis, the inter-arm SBP difference ≥6 mm Hg was also significantly associated with CACS ≥300 after adjusting for clinical risk factors (OR 2.34, 95 % CI 1.06–5.19; p=0.036). Conclusion: An increased inter-arm SBP difference (≥6 mm Hg) is associated with coronary atherosclerotic disease burden using CACS, and provides additional information for predicting severe coronary calcification, compared to models based on traditional risk factors.

안정형 협심증 환자에서 혈중 C-반응성 단백질의 농도와 관상동맥 조영술상 병변의 중증도와의 상관관계

허애영 ( Ae Young Her ),김용훈 ( Yong Hoon Kim ) 한국지질동맥경화학회(구 한국지질학회) 2009 韓國脂質學會誌 Vol.19 No.2

증례 : 비소세포 폐암과 합병된 Wegener 육아종증 1예

허애영 ( Ae Young Her ),이희영 ( Hui Young Lee ),강구 ( Gu Kang ),송서영 ( Seo Young Song ) 대한내과학회 2007 대한내과학회지 Vol.73 No.3

저자 등은 객혈, 호흡 곤란을 주소로 내원한 70세 여자 환자에서 비소세포 폐암과 합병되어 눈, 코, 부비동, 신장 등을 침범한 Wegener 육아종증 1예를 경험하였고 이에 대한 국내의 보고가 드물기에 문헌고찰과 함께 보고하는 바이다. Vasculitis may be a manifestation of the paraneoplastic syndrome in association with solid and hematological cancers. There are few reports of paraneoplastic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in patients with solid tumors. Wegener`s granulomatosis is a systemic vasculitis characterized by necrotizing granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis and are ANCA-positive. We experienced a case of Wegener`s granulomatosis complicated by non-small cell lung carcinoma (NSCLC) and we report this case with a brief review of the literature.(Korean J Med 73:336-341, 2007)

Comparison of Paclitaxel-Coated Balloon Treatment and Plain Old Balloon Angioplasty for De Novo Coronary Lesions

신은석,허애영,안소희,Gillian Balbir Singh,김용훈,유상용,Scot Garg,구본권 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.2

Purpose: This study compared the angiographic outcomes of paclitaxel-coated balloon (PCB) versus plain old balloon angioplasty(POBA) treatment for de novo coronary artery lesions. At present, there is no available data comparing the efficacy of PCB versus POBA for the treatment of de novo coronary lesions. Materials and Methods: This multicenter retrospective observational study enrolled patients with de novo coronary lesions with a reference vessel diameter between 2.5 mm and 3.0 mm and lesion length ≤24 mm who were successfully treated with PCB or POBA. Angiographic measurements and quantitative coronary analysis were performed before and after the procedure, and at 9 months follow-up. Results: A total of 72 patients (49 receiving PCB and 23 receiving POBA) were enrolled in this study. Late luminal loss was-0.12±0.30 mm in the PCB group and 0.25±0.50 mm in the POBA group (p<0.001). There was a higher percentage of binary restenosis(diameter stenosis ≥50%) in POBA, compared to PCB (30.4%, n=7 vs. 4.1%, n=2, p<0.001). Target vessel revascularization was higher in the POBA group (13.0%, n=3 vs. 0%, p=0.033). Conclusion: PCB treatment of de novo coronary lesions showed better 9-month angiographic outcomes than POBA treatment alone.