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Chung Hyemoon,Kim Bu Yong,Kim Hyun Soo,Kim Hyung Oh,Lee Jung Myung,Woo Jong Shin,Kim Jin Bae,Kim Woo-Shik,Kim Kwon Sam,Kim Weon 대한영상의학회 2020 Korean Journal of Radiology Vol.21 No.7
Objective: To investigate the predictive value of intraplaque neovascularization (IPN) for cardiovascular outcomes. Materials and Methods: We evaluated 217 patients with coronary artery disease (CAD) (158 men; mean age, 68 ± 10 years) with a maximal carotid plaque thickness ≥ 1.5 mm for the presence of IPN using contrast-enhanced ultrasonography. We compared patients with (n = 116) and without (n = 101) IPN during the follow-up period and investigated the predictors of major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, coronary artery revascularization, and transient ischemic accident/stroke. Results: During the mean follow-up period of 995 ± 610 days, the MACE rate was 6% (13/217). Patients with IPN had a higher maximal thickness than those without IPN (2.86 ± 1.01 vs. 2.61 ± 0.84 mm, p = 0.046). Common carotid artery-peak systolic velocity, left ventricular mass index (LVMI), and ventricular-vascular coupling index were significantly correlated with MACE. However, on multivariate Cox regression analysis, increased LVMI was independently related to MACE (p < 0.05). The presence of IPN could not predict MACE. Conclusion: The presence of IPN was related to a higher plaque thickness but could not predict cardiovascular outcomes better than conventional clinical factors in patients with CAD.
S-165 : Diverse geometric changes related to dynamic LVOT obstruction without overt HCM
( Jung Joon Cha ),( Hyemoon Chung ),( Ji Hyun Yoon ),( Jong Youn Kim ),( Pil Ki Min ),( Young Won Yoon ),( Byoung Kwon Lee ),( Bum Kee Hong ),( Se Joong Rim ),( Hyuck Moon Kwon ),( Eui Young Choi ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Background: Dynamic left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not rarely observed in subjects without overt hypertrophic cardiomyopathy (HCM). However, its geometrical determinants and clinical implication have not been fully investigated. Method: We analyzed echocardiographic images diagnosed as dynamic LVOTO with Valsalva maneuver from 2008 to 2012 in a single tertiary referral hospital. Dynamic LVOTO was defined as trans-LVOT peak pressure gradient (PG) higher than 30 mmHg at resting or provoked by Valsalva maneuver without fixed structural stenosis. Exclusion criteria were patients with classical HCM, acute myocardial infarction, stress induced cardiomyopathy, valvular heart disease and unstable hemodynamics which potentially induce transient-LVOTO. Results: Total 168 patients were studied. Mean age was 71±11 years and 98 were women. They were classified as “pure sigmoid septum” (n=75) defined as basal septal bulging but diastolic thickness less than 12 mm, “sigmoid septum with basal septal hypertrophy (≥12 mm)” (n=24), “prominent papillary muscle (PPM)” (n=20), defined by visually big papillary muscle which occludes LV cavity during systole and “small LV cavity with concentric remodeling” (n=49) groups. PPM group was younger, had higher S`, lower E/e` and left atrial volume index than the others. However, resting and Valsalva-induced LVOT PG were not different. In all groups, higher peak trans-LVOT PG was related to higher basal septal thickness (BST), E/e`, right atrial pressure (RAP) and pulmonary arterial systolic pressure (PASP). In multivariate analysis, resting trans-LVOT PG was correlated to PASP (ß=0.230, p=0.005) after adjustment for E/e`, BST and RAP. Conclusion: Dynamic LVOTO developed from various geometric changes, among them PPM group has distinct characteristics suggesting different etiology. LVOTO relieving medication might potentially reduce pulmonary pressure in this group of patients.
Kim Kihyun,Bang Woo-Dae,Han Kyungdo,Kim Bongseong,Lee Jung Myung,Chung Hyemoon 한국지질동맥경화학회 2021 지질·동맥경화학회지 Vol.10 No.3
Objective: We compared the effects of high-intensity statin monotherapy versus moderateintensity statin and ezetimibe combination therapy on major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). Methods: Using the Korean National Health Insurance Service database, we screened 82,941 patients with AMI who underwent percutaneous coronary intervention (PCI) between 2013 and 2016. Among them, we identified 9,908 patients treated with atorvastatin 40 mg (A40, n=4,041), atorvastatin 20 mg + ezetimibe 10 mg (A20+E10, n=233), rosuvastatin 20 mg (R20, n=5,251), or rosuvastatin 10 mg + ezetimibe 10 mg (R10+E10, n=383). The primary outcome was MACE, a composite of all-cause death, non-fatal myocardial infarction undergoing PCI, repeat revascularization, and ischemic stroke. Multivariable analyses were performed using the inverse probability of treatment weighting method. Results: The incidence rate of MACE in the overall population was 42.97 cases per 1,000 person-years. There was no significant difference in the risk of composite outcomes of MACE between the groups. However, the R10+E10 group showed a higher risk of all-cause death (hazard ratio, 2.07; 95% confidence interval, 1.08–3.94) than the A40 group (reference group) in the weighted multivariable model. Conclusions: In this study, there was no significant difference in the composite outcome of MACE between high-intensity statin monotherapy and moderate-intensity statin and ezetimibe combination therapy.
Choi, Eui-Young,Hwang, Sung Ho,Yoon, Young Won,Park, Chul Hwan,Paek, Mun Young,Greiser, Andreas,Chung, Hyemoon,Yoon, Ji-Hyun,Kim, Jong-Youn,Min, Pil-Ki,Lee, Byoung Kwon,Hong, Bum-Kee,Rim, Se-Joong,Kwo BioMed Central 2013 Journal of cardiovascular magnetic resonance Vol.15 No.-
<P><B>Background</B></P><P>Post-contrast T1 mapping by modified Look-Locker inversion recovery (MOLLI) sequence has been introduced as a promising means to assess an expansion of the extra-cellular space. However, T1 value in the myocardium can be affected by scanning time after bolus contrast injection. In this study, we investigated the changes of the T1 values according to multiple slicing over scanning time at 15 minutes after contrast injection and usefulness of blood T1 correction.</P><P><B>Methods</B></P><P>Eighteen reperfused acute myocardial infarction (AMI) patients, 13 cardiomyopathy patients and 8 healthy volunteers underwent cardiovascular magnetic resonance with 15 minute-post contrast MOLLI to generate T1 maps. In 10 cardiomyopathy cases, pre- and post-contrast MOLLI techniques were performed to generate extracellular volume fraction (Ve). Six slices of T1 maps according to the left ventricular (LV) short axis, from apex to base, were consecutively obtained. Each T1 value was measured in the whole myocardium, infarcted myocardium, non-infarcted myocardium and LV blood cavity.</P><P><B>Results</B></P><P>The mean T1 value of infarcted myocardium was significantly lower than that of non-infarcted myocardium (425.4±68.1 ms vs. 540.5±88.0 ms, respectively, p< 0.001). T1 values of non-infarcted myocardium increased significantly from apex to base (from 523.1±99.5 ms to 561.1±81.1 ms, p=0.001), and were accompanied by a similar increase in blood T1 value in LV cavity (from 442.1±120.7 ms to 456.8±97.5 ms, p<0.001) over time. This phenomenon was applied to both left anterior descending (LAD) territory (from 545.1±74.5 ms to 575.7±84.0 ms, p<0.001) and non-LAD territory AMI cases (from 501.2±124.5 ms to 549.5±81.3 ms, p<0.001). It was similarly applied to cardiomyopathy patients and healthy volunteers. After the myocardial T1 values, however, were adjusted by the blood T1 values, they were consistent throughout the slices from apex to base (from 1.17±0.18 to 1.25±0.13, p>0.05). The Ve did not show significant differences from apical to basal slices.</P><P><B>Conclusion</B></P><P>Post-contrast myocardial T1 corrected by blood T1 or Ve, provide more stable measurement of degree of fibrosis in non-infarcted myocardium in short- axis multiple slicing.</P>