Value of Utilizing Both Aspects and CT Angiography Collateral Score for Outcome Prediction in Acute Ischemic Stroke

Song, Dongbeom,Lee, Kijeong,Kim, Eun Hye,Kim, Young Dae,Kim, Jinkwon,Song, Tae-Jin,Lee, Hye Sun,Nam, Hyo Suk,Heo, Ji Hoe SAGE Publications 2015 International journal of stroke Vol.10 No.7

<P>Alberta Stroke Program Early CT Score (ASPECTS) represents the extent of irreversibly damaged tissue; while CT angiography collateral score (CTA-CS) denotes the degree of collaterals.</P>

Factors Associated with Early Hospital Arrival in Patients with Acute Ischemic Stroke

Song, Dongbeom,Tanaka, Eijirou,Lee, Kijeong,Sato, Shoichiro,Koga, Masatoshi,Kim, Young Dae,Nagatsuka, Kazuyuki,Toyoda, Kazunori,Heo, Ji Hoe Korean Stroke Society 2015 Journal of stroke Vol.17 No.2

<P><B>Background and Purpose</B></P><P>Factors associated with early arrival may vary according to the characteristics of the hospital. We investigated the factors associated with early hospital arrival in two different stroke centers located in Korea and Japan.</P><P><B>Methods</B></P><P>Consecutive patients with ischemic stroke arrived hospital within 48 hours of onset between January 2011 and December 2012 were identified and the clinical and time variables were retrieved from the prospective stroke registries of Severance Hospital of Yonsei University Health System (YUHS; Seoul, Korea) and National Cerebral and Cardiovascular Center (NCVC; Osaka, Japan). Subjects were dichotomized into early (time from onset to arrival ≤4.5 hours) and late (>4.5 hours) arrival groups. Univariate and multivariate analyses were performed to evaluate factors associated with early hospital arrival.</P><P><B>Results</B></P><P>A total of 1,966 subjects (992 from YUHS; 974 from NCVC) were included in this study. The median time from onset to arrival was 6.1 hours [interquartile range, 1.7-17.8 hours]. In multivariate analysis, the factors associated with early arrival were atrial fibrillation (Odds ratio [OR], 1.505; 95% confidence interval [CI], [1.168-1.939]), higher initial National Institute of Health Stroke Scale scores (OR, 1.037; 95% CI [1.023-1.051]), onset during daytime (OR, 2.799; 95% CI [2.173-3.605]), and transport by an emergency medical service (OR, 2.127; 95% CI [1.700-2.661]). These factors were consistently associated with early arrival in both hospitals.</P><P><B>Conclusions</B></P><P>Despite differences between the hospitals, there were common factors related to early arrival. Efforts to identify and modify these factors may promote early hospital arrival and improve stroke outcome.</P>

Comprehensive code stroke program to reduce reperfusion delay for in-hospital stroke patients

Yoo, Joonsang,Song, Dongbeom,Baek, Jang-Hyun,Lee, Kijeong,Jung, Yohan,Cho, Han-Jin,Yang, Jae Hoon,Cho, Hyun Ji,Choi, Hye-Yeon,Kim, Young Dae,Nam, Hyo Suk,Heo, Ji Hoe SAGE Publications 2016 International journal of stroke Vol.11 No.6

Brachial-Ankle Pulse Wave Velocity Is a Strong Predictor for Mortality in Patients With Acute Stroke

Kim, Jinkwon,Song, Tae-Jin,Song, Dongbeom,Lee, Ki Jeong,Kim, Eun Hye,Lee, Hye Sun,Nam, Chung Mo,Nam, Hyo Suk,Kim, Young Dae,Heo, Ji Hoe American Heart Association, Inc. 2014 Hypertension Vol.64 No.2

<P>Brachial-ankle pulse wave velocity (baPWV) has been proposed as a simple, noninvasive method for estimating arterial stiffness. Although high baPWV was predictive of cardiovascular mortality and morbidity among general population, its predictive value for mortality in patients with acute stroke is unknown. We evaluated the prognostic value of baPWV in 1765 patients who had been admitted for acute ischemic stroke and had completed measurement of baPWV during admission. Primary outcomes were all-cause mortality and vascular mortality (death because of heart diseases, cerebrovascular diseases, or diseases of arteries, arterioles, and capillaries, determined according to the <I>International Classification of Diseases</I>) after stroke. During a mean follow-up period of 3.33±1.57 years, there were 228 all-cause deaths, including 143 vascular deaths. In multivariate Cox hazard regression, patients in the highest tertile of baPWV (>22.63 m/s) were at an increased risk for both all-cause death (adjusted hazard ratio, 1.97; 95% confidence interval, 1.25–3.08) and vascular death (adjusted hazard ratio, 2.39; 95% confidence interval, 1.33–4.29) compared with the lowest tertile (<17.79 m/s). This study suggested that measurement of baPWV during the acute phase of stroke might be useful in identifying patients at a higher risk for mortality.</P>

Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT

Yoo, Joonsang,Song, Dongbeom,Baek, Jang-Hyun,Kim, Kyoungsub,Kim, Jinkwon,Song, Tae-Jin,Lee, Hye Sun,Choi, Donghoon,Kim, Young Dae,Nam, Hyo Suk,Heo, Ji Hoe Elsevier 2017 Atherosclerosis Vol.265 No.-

<P><B>Abstract</B></P> <P><B>Background and aims</B></P> <P>Although stroke patients have a high risk of ischemic heart disease, little information is available on the risk of coronary events in stroke patients with asymptomatic coronary artery disease (CAD). We investigated the long-term vascular outcomes in stroke patients with asymptomatic CAD diagnosed with multi-detector coronary computed tomography (MDCT).</P> <P><B>Methods</B></P> <P>This study was a retrospective analysis using a prospective cohort of ischemic stroke patients. We included consecutive stroke patients without history or symptoms of CAD who underwent MDCT. We investigated the long-term risk of major adverse cardiovascular events (MACE: cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, and urgent coronary revascularization) and composite of MACE/all-cause mortality/elective coronary revascularization. We further investigated the value of MDCT for MACE prediction.</P> <P><B>Results</B></P> <P>Among the 1893 included patients, 1349 (71.3%) patients had some degree of CAD and 654 patients (34.5%) had significant (≥50%) CAD. At follow-up (median, 4.4 years), MACE occurred in 230 patients (12.2%). Event rates of MACE increased with the increasing extent of CAD. After adjustment for age, sex, and risk factors, the hazard ratios for MACE in mild CAD, 1-VD, 2-VD, and 3-VD or left main coronary disease were 1.28 (95% confidence interval [CI]: 0.88–1.87), 1.39 (95% CI: 0.90–2.16), 2.22 (95% CI: 1.39–3.55), and 2.91 (95% CI: 1.82–4.65), respectively (no CAD as a reference). Diagnosis of asymptomatic CAD significantly improved the prediction of MACE.</P> <P><B>Conclusions</B></P> <P>Asymptomatic CAD detected on MDCT was associated with increased risks of vascular events or deaths in acute stroke patients.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Asymptomatic coronary artery disease (CAD) on coronary CT is common in stroke. </LI> <LI> Risks of major adverse cardiovascular events increased in stroke patients with CAD. </LI> <LI> Coronary CT may be useful for noninvasive screening of CAD in stroke patients. </LI> </UL> </P>

Poor Outcome of Stroke Patients With Atrial Fibrillation in the Presence of Coexisting Spontaneous Echo Contrast

Yoo, Joonsang,Song, Dongbeom,Baek, Jang-Hyun,Kim, Young Dae,Nam, Hyo Suk,Hong, Geu-Ru,Kim, Jinkwon,Lee, Hye Sun,Heo, Ji Hoe American Heart Association, Inc. 2016 Stroke Vol.47 No.7

<P>Background and Purpose-Spontaneous echo contrast (SEC) is frequently detected in patients with atrial fibrillation (AF). Coexisting SEC in patients with AF may be associated with heightened thrombogenicity, which affects stroke outcomes. Methods-Consecutive stroke patients with nonvalvular AF who underwent transesophageal echocardiography were included in this study. We compared initial stroke severity and functional outcome at 3 months between the patients with and those without SEC. Results-Of 440 patients with nonvalvular AF who underwent transesophageal echocardiography during a 7-year period, 193 (43.9%) patients had SEC. Stroke was more severe in the patients with SEC than in those without SEC (National Institute of Health Stroke Scale score: median [interquartile range], 5 [2-12] versus 3 [1-8]; P=0.004). The patients with SEC more frequently had poor functional outcomes (modified Rankin scale score of >2) at 3 months than those without SEC (32.3% versus 16.1%; P<0.001). On multivariate analysis, the presence of SEC was an independent factor of poor outcome (odds ratio, 2.09; 95% confidence interval, 1.24-3.53). Conclusions-In the ischemic stroke patients with nonvalvular AF, coexisting SEC was associated with more severe stroke and was predictive of poor long-term functional outcome.</P>

Brachial-Ankle Pulse Wave Velocity for Predicting Functional Outcome in Acute Stroke

Kim, Jinkwon,Song, Tae-Jin,Kim, Eun Hye,Lee, Ki Jeong,Lee, Hye Sun,Nam, Chung Mo,Song, Dongbeom,Nam, Hyo Suk,Kim, Young Dae,Heo, Ji Hoe American Heart Association, Inc. 2014 Stroke Vol.45 No.8

<P><B>Background and Purpose—</B></P><P>We investigated whether the brachial-ankle pulse wave velocity (baPWV) has prognostic value for predicting functional outcome after acute cerebral infarction and whether the prognostic value differs between stroke subtypes.</P><P><B>Methods—</B></P><P>We included 1091 consecutive patients with first-ever acute cerebral infarction who underwent baPWV measurements. Stroke subtypes were classified using the Trial of Org 10172 in Acute Stroke Treatment classification. Poor functional outcomes were defined as modified Rankin Scale score >2 at 3 months after stroke onset.</P><P><B>Results—</B></P><P>We noted that 181 (16.59%) patients had a poor functional outcome. In multivariate logistic regression, patients in the highest tertile of baPWV (>22.25 m/s) were found to be at increased risk for poor functional outcome (adjusted odds ratio, 1.88; 95% confidence interval, 1.06–3.40) compared with those in the lowest tertile (<17.55 m/s). No significant interaction between baPWV and stroke subtype was noted. Receiver operating characteristic curve analysis indicated that the addition of baPWV to the prediction model significantly improved the discrimination ability for poor functional outcome.</P><P><B>Conclusions—</B></P><P>baPWV has an independent prognostic value for predicting functional outcome after acute cerebral infarction. The prognostic value did not differ according to the stroke subtype.</P>

Normal diffusion-weighted MR imaging predicts a good prognosis in extrapontine myelinolysis-induced parkinsonism

Shin, Hae-Won,Song, Dongbeom,Sohn, Young H. Wiley Subscription Services, Inc., A Wiley Company 2009 Movement disorders Vol.24 No.11

도시지역에서의 토지피복 유형별 지표면 온도 현황 분석

김근한 ( Geunhan Kim ),김동범 ( Dongbeom Kim ),송영명 ( Yongmyong Song ),최희선 ( Hee-sun Choi ) 한국지리학회 2021 한국지리학회지 Vol.10 No.3

본 연구에서는 서울시 전체를 대상으로 세분류 토지피복지도의 객체에 대해 토지피복, 지표면 온도, 정규 식생 지수, 표고를 추출하고, 해당 객체들과 지표면 온도와의 관계를 살펴보고자 했다. 세분류 토지피복지도의 객체 전체에 대해 세분류 토지피복유형, 지표면 온도, 정규 식생 지수, 표고의 현황을 살펴본 결과 시가화건조지역이 활엽수림, 침엽수림, 혼효림과 같은 산지, 농경지, 자연초지, 기타 초지와 문화·체육시설 보다 지표면 온도가 높게 나타났으며, 표고가 높을수록 지표면 온도가 낮게 나타났다. 그리고 정규 식생 지수가 높은 기타 초지에서 지표면 온도가 낮게 나타나는 경향을 보였다. 그리고 다른 토지피복 유형보다 정규 식생 지수가 높게 나타나는 산림, 농경지와 자연초지, 기타 초지와 문화·체육시설 중 10,000㎡ 이상의 크기를 가진 객체들을 기준으로 주변 50m 이내의 기타 초지와 단독주거시설, 공동주거시설과 같은 주거시설 및 상업·업무시설의 지표면 온도의 분포 현황을 확인한 결과 정규 식생 지수가 높게 나타나는 지역 인근의 토지피복 객체들에서 지표면 온도가 낮게 나타나는 경향이 있었으며, 동일한 정규 식생 지수의 값을 비교했을 때 정규 식생 지수가 높은 지역 인근의 토지피복 객체들에서 지표면 온도가 더 낮게 나타나는 경향을 보였다. This study aimed at extracting the land cover, land surface temperature, normalized difference vegetation index, and altitude for the sub-divided land cover map for all of Seoul City, and to investigate the relationship between the corresponding objects and land surface temperature. Upon examining the sub-divided land cover type, land surface temperature, normalized difference vegetation index, and altitude for all objects of the sub-divided land cover map, urbanized dry areas had higher land surface temperature compared to mountain areas such as mountainous regions with broad leaf tree forests, coniferous forests and mixed forests, as well as farmlands, natural grasslands, other grasslands, and cultural/sports facilities, and it was also found that land surface temperature lowered when altitude was higher. There was also a tendency for land surface temperature to be lower in other grasslands with a high vegetation index. Furthermore, among forests, farmlands, natural grasslands, other grasslands, and cultural/sports facilities with higher normalized difference vegetation index compared to other land cover types, upon examining the land surface temperature distribution of other grasslands, residential facilities including single homes and apartment facilities, and commercial and work facilities within 50 m of for objects having an area of more than 10,000 ㎡, there was a tendency for land surface temperature to be lower than land cover objects in nearby areas with a high normalized difference vegetation index. And when comparing the value of the same normalized difference vegetation index, there was a tendency for land surface temperature to be lower in land cover objects near regions with a high normalized difference vegetation index.

Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease

Kim, Young Dae,Song, Dongbeom,Nam, Hyo Suk,Choi, Donghoon,Kim, Jung-Sun,Kim, Byeong-Keuk,Chang, Hyuk-Jae,Choi, Hye-Yeon,Lee, Kijeong,Yoo, Joonsang,Lee, Hye Sun,Nam, Chung Mo,Heo, Ji Hoe Yonsei University, College of Medicine 2017 Yonsei medical journal Vol.58 No.1

<P><B>Purpose</B></P><P>Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not.</P><P><B>Materials and Methods</B></P><P>This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (−) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses.</P><P><B>Results</B></P><P>During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (−) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (−) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172–8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (−) group seemed to also have a higher risk of recurrent stroke.</P><P><B>Conclusion</B></P><P>Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.</P>