헤파린 부착 관상동맥 스텐트의 스텐트 재협착 예방에 대한 효과

강정채(Jung Chaee Kang),박창수(Chang Soo Park),정명호(Myung Ho Jeong),조장현(Jang Hyun Cho),김성희(Sung Hee Kim),안영근(Young Keun Ahn),박주형(Joo Hyung Park),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),정상우(Sang Woo Juhng),김준 대한내과학회 1999 대한내과학회지 Vol.57 No.1

N/A The coronary stent reduces acute coronary arterial occlusion and late restenosis during and after coronary intervention. However, stent thrombosis and restenosis are still major limitations in widespread use of coronary stent. Local drug delivery with use of heparin-coated stent will be a new approach reducing the incidence of stent thrombosis and restenosis. In order to evaluate the effects of heparin-coated stent on stent restenosis, heparin-coated stents were compared with control stents in a porcine coronary stent restenosis model. Methods : Stent overdilation injury (stent:artery= 1.3:1.0) was performed with bare Wiktor (Group I, n=10) and heparin-coated Wiktor (Group II, n=20) stents (HEPAMEDTM, Medtronics, U.S.A.) in porcine coronary arteries. Follow-up quantitative coronary angiography (QCA) was performed at 4 weeks after stenting and histopathologic assessments of stented porcine coronary arteries were compared in both groups. Results : 1) On QCA, percent diameter stenosis was significantly higher in Group I than in Group II (16.3±6.62% vs. 9.6±5.06%, p<0.05). 2) Injury score of stented porcine coronary artery was not different in both groups (1.26±0.23 vs. 1.20±0.22). 3) Pathologic area stenosis of stented artery was higher in Group I than in Group II (41.6±12.5% vs. 27.1±9.9%, p<0.005). 4) Neointimal area was higher in Group I than in Group II (4.58±1.41 mm2 vs. 2.57±1.07 mm2, p<0.05). 5) By immunohistochemistry, proliferating cell nuclear antigen (PCNA) index was higher in Group I compared with in Group II (11.2±6.75% vs. 6.3±4.14%, p<0.05). Conclusions : Heparin-coated stent is effective in the prevention of late coronary stent restenosis in a porcine coronary stent restenosis model, which may be related with the inhibition of neointimal cell proliferation.

제49차 대한내과학회 추계학술대회초록집 : 심포지움 ; 심장의 수축기 이완기 기능의 평가 - 심부전증의 진단에 필요한 -

강정채 ( Jung Chaee Kang ) 대한내과학회 1997 대한내과학회지 Vol.53 No.-

방실결절회귀성 빈맥의 성공적인 전극도자 절제의 예측인자

강정채(Jung Chaee Kang),정명호(Myung Ho Jeong),조장현(Jang Hyun Cho),김성희(Sung Hee Kim),안영근(Young Keun Ahn),박주형(Joo Hyung Park),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),이상현(Sang Hyun Lee),김준우(Jun Woo Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.5

N/A Catheter ablation of the AV nodal slow pathway using radiofrequency (RF) energy has been established as the first-line curative therapeutic modality of recurrent symptomatic AV nodal reentrant tachycardia (AVNRT). In contrast to catheter ablation of the AV bypass tract, there was no useful marker to localize succesful site of the pathway. This study was performed to determine predictors of successful catheter ablation of the AV nodal slow pathway in patients with AVNRT. Methods : Forty patients (18 men, 22 women; 47.9±13.3 years) with AVNRT undergoing successful catheter ablation of the AV nodal slow pathway were included in this study, in which 217 attempts were tried to ablate the AV nodal slow pathway. Characteristics of local atrial electrogram, anatomical site at each attempt, junctional rhythm during RF delivery were analyzed (40 successful, 177 failed). Maximum difference and duration of atrial electrograms were measured and local atrial electrograms were classified into 5 types (A1, A2, B1, B2 and C type) according to the type and the degree of fragmentation. Finally, the occurrence of junctional rhythm during RF discharge and its onset time were compared between successful and failed attempts. Results : There was no significant difference in the maximum difference of amplitude and duration of atrial electrograms between successful and failed attempts. The success rate in each type of atrial electrogram was significantly different. And, the success rate in non-C type atrial electrograms (A1, A2, B1, and B2) was significantly higher than that in type C atrial electrograms (25.0% vs 10.3%, p<0.01). No significant difference was noted in success rates according to attempted sites. Junctional rhythms during radiofrequency application occured significantly more frequent in successful attempts than in failed attempts (87.5% vs 47.5%, p<0.001). The time to onset of junctional rhythm was not different between successful and failed attempts (5.2±4.9 sec vs 6.1±5.5 sec). Conclusion : Fragmented local atrial electrogram and junctional rhythm during RF energy delivery may be used to predict successful catheter ablation of AVNRT. It is recommended that RF energy should be applied to the site where fragmented atrial electrogram is recorded and terminated if junctional rhythm does not develop within 15 seconds after starting RF energy delivery. (Korean. J. Med 57:867-874, 1999)

임상강좌 : 심부전증의 치료

강정채 ( Jung Chaee Kang ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

제49차 대한내과학회 추계학술대회초록집 : 심포지움 ; 심장의 수축기 이완기 기능의 평가 - 심부전증의 진단에 필요한

강정채 ( Jung Chaee Kang ) 대한내과학회 1997 대한내과학회지 Vol.53 No.2S

Vacor 유발 당뇨 모래쥐의 심장신경절과 과립함유세포의 미세구조

강정채,윤재룡,유홍석,Kang, Jung-Chaee,Yoon, Jae-Rhyong,You, Hong-Seok 한국현미경학회 1993 Applied microscopy Vol.23 No.2

The ultrastructural changes of the cardiac ganglion and granule-containing cells in the heart of vacor-induced diabetic Mongolian gerbils were studied by electron microscopy. After one month of vacor-induced diabetes the ganglion cells showed increase in numbers of dense bodies and mitochondria compared with the normal cardiac ganglion. Most of the satellite cells were filled with numerous phagosomes containing digested debris. Both electron-dense and lucent types of degenerating axon terminals were observed. The former was characterized by clusters of agranular vesicles and numerous mitochondria. The electron lucent type of degenerating axon terminal contained a few agranular vesicles and swollen mitochondria. Degenerating unmyelinated and myelinated axons contained large numbers of dense bodies, lamellar bodies, and mitochondria. Numerous macrophages containing phagosomes were reveled in the interstitial spaces. Some of the granule-containing cells in the heart showed a variety of degenerative changes and a decreased number of dense-cored vesicles. After three months of vacor-induced diabetes the unmyelinated and myelinated axons showed degenerative changes, whereas no structure changes could be demonstrated in intraatrial ganglion and granule containing cells. The satellite cells containing engulfed debris were observed in the cardiac ganglion cells. These results suggest that the degenerative changes occur in the cardiac ganglion cells of vacor-induced diabetic Mongolian gerbils as well as atrial granule-containing cells.

Contractile Effect of Ultraviolet Light on Isolated Thoracic Aortae of Rats

백영홍,강성돈,강정채,Baik, Yung-Hong,Kang, Seong-Don,Kang, Jung-Chaee The Korean Society of Pharmacology 1993 대한약리학잡지 Vol.29 No.1

Ultraviolet light radiation (UVR) did not affect resting tension of isolated thoracic aortae of rats. In aortic rings contracted with phenylephrine, however, UVR produced contractile and relaxant responses in preparations with and without endothelium, respectively. The contractile response was dependent upon the duration $(10{\sim}320\;sec)$ of irradiation, while the relaxation was not. UVR-induced contractions in endothelium-intact rings were significantly potentiated by increasing the concentrations of phenylephrine from $10^{-7}M$ to $10^{-5}M$, and also by addition of $10^{-6}M$ acetylcholine, $10^{-7}M$ isoproterenol and $3.5{\times}10^{-8}M$ nitroglycerine. However, addition of $10^{-6}M$ phentolamine, or $10^{-7}M$ to $10^{-6}M$ LY83583 inhibited the contraction or reversed the contraction to a relaxation. In endothelium-removed preparations the UVR-induced relaxation was attenuated by increasing concentractions of phenylephrine, and by addition of isoproterenol, nitroglycerin, phentolamine or LY83583. These results suggest that UVR produces contractile and relaxant responses in rat thoracic aortae with and without endothelium, respectively, and that the contractile effect results from the inhibition of endothelium-derived relaxing factor (EDRF) release by UVR the inhibition of and/or is in part re-lated to some endothelium-derived contractile factors (EDCFs). 자외선조사는 흰쥐흉부대동맥의 휴지기장력에 거의 영향을 미치지 못했으나, phenylephrine으로 수축된 표본에서는 자외선조사로 내피세포가 존재하면 수축반응을, 내피세포가 제거되면 이완반응이 나타났다. 이 수축반응은 조사시간의 길이($10{\sim}320$초)에 비례하여 증가하였으나 이완반응은 그렇지 못하였다. 내피세포 존재표본에서 자외선의 수축반응은 phenylephrine농도의 증가($10^{-7}{\sim}10^{-5}M$) 그리고 $acetylcholine(10^{-6}M)$, $isoproterenol(10^{-7}M)$ 및 $nitroglycerin(3.5{\times}10^{-8} M)$의 추가투여시 크게 강화되었다. 그러나 $phentolamine(10^{-6}M)$ 또는 $LY83583(10^{-7},10^{-6}M)$의 추가투여시에는 자외선 수축반응이 억제 또는 이완반응으로 역전되었다. 내피세포 제거표본에서의 자외선 이완반응은 phenylephrine농도의 증가 그리고 isoproterenol, nitroglycerine, phentolamine 및 LY83583의 추가투여시 유의하게 감약되었다. 이상의 성적은 흰쥐 적출 흥부대동맥에서 자외선조사는 내피세포 존재유무에 따라 수축과 이완반응이 각각 나타나며, 수축반응은 자외선에 의한 EDRF 유리억제 또는 부분적으로 어떤 EDCF와도 관련이 있음을 시사하고 있다.

당뇨병환자에서의 심초음파도 소견에 관한 연구

강철민(Cheol Min Kang),최유창(Yoo Chang Choi),정민영(Min Young Chung),이태희(Tai Hee Lee),정명호(Myung Ho Jeong),강정채(Jung Chaee Kang) 대한내과학회 1989 대한내과학회지 Vol.37 No.2

N/A Diabetic cardiomyopathy was recently defined as a myocardial dysfunction due to diabetes mellitus. To evaluate the presence of left ventricular hypertrophy and the left ventricular systolic and diastolic function in diabetic patients, the authors used M-mode and pulsed Doppler echocardiography. Left ventricular mass index, ejection fraction, % fractional shortening, and early and late diastolic mitral valvular filling velocity were measured in 10 normal adults as e control (Group I), 19 diabetic patients without hypertension (Group II), and 10 diabetic patients with hypertension (Group III). The resultes were as follows: 1) Left ventricular mass index for groups I, II, and III was 92.40±23.03 g/m2, 100.19±34.22 g/m2, and 132.43±39.49 g/m2 respectively. Left ventricular mass index was significantly increased in Group III, 2) Ejection fraction as an index of left ventricular systolic function for Groups I, II, and III was 71.28±6.86 %, 73.53±9.5%, and 73.81±10.3% respectively. The % fractional shortening for Groups I, II, and III was 34±5, 37±7, and 37±9 respectively. There were no significant differences among groups. 3) Early (E) and late (A) diastolic filling velocities were measured by pulsed Doppler echocardiography at a mitral valve level for each group. The E/A ratio of Groups I, II, and III was 1.31±0.43, 0.89±0.22, 0.78±0.24 respectively. Groups II and III showed a significant decrease compared to the control group. These results showed that diabetics without hypertension showed no left ventrivular hypertrophy and normal systolic function and diastolic dysfunction, and that diabetics with hypertension showed left ventricular hypertrophy and narmal systolic function and diastolic dysfunction.

돼지 관상동맥 스텐트 재협착에 대한 Endothelin 수용체 차단제 국소 전달요법의 효과

김진우(Jin Woo Kim),강정채(Jung Chaee Kang),박창수(Chang Soo Park),김완(Wan Kim),정명호(Myung Ho Jeong),김용록(Yong Rok Kim),조장현(Jang Hyun Cho),김주한(Ju Han Kim),김성희(Sung Hee Kim),배열,안영근(Young Keun Ahn),박주형(Joo Hyung Pa 대한내과학회 1999 대한내과학회지 Vol.56 No.6

N/A Objectives : Coronary stent is one of the most effective currently available devices in the treatment of coronary artery diseases. But, coronary stent restenosis is one of major limitations in clinical stenting. Local drug delivery may be a new strategy for the prevention of stent restenosis. Endothelin receptor blocker is known to have vasodilatory and antiproliferative activities. To investigate the effects of local endothelin receptor blocker delivery on stent restenosis, local delivery was performed in the porcine model of coronary stent restenosis. Methods : Stent overdilation injury alone was performed in the control porcine coronary arteries (n=4, group A) and local delivery of endothelin receptor blocker prior to stenting was performed in the porcine coronary artery (n=9, group B). Endothelin receptor blocker (TAK-044, Takeda, Japan) was delivered at a rate of 1 ml/min (50 mg/10 ml) using the Dispatch Catheter. Follow-up quantitative coronary angiogram (QCA) and immunohistopathologic assessment were performed 4 weeks after stenting. Results : 1) On QCA, percent diameter stenosis was significantly higher in Group A than in Group B (29.4±6.1 % vs. 14.5±11.6%, p<0.05). 2) Area stenosis was higher in Group A than in Group B (63.5±23.2 % vs. 40.9±13.3 %) measured by histopathologic method (p<0.05). 3) Neointimal area was higher in Group A than in Group B (3.53±1.9 mm2 vs. 1.75±0.8 mm2, p=0.03). 4) By immunocytochemistry, proliferating cell nuclear antigen index was higher in Group A compared with Group B (46.8±5.2 % vs. 31.1±3.7 %, p<0.05). Conclusion : Local delivery of endothelin receptor blocker is effective in the prevention of stent restenosis in a porcine model, which may be related with the partial inhibition of cell proliferation of neointimal cells.

고중성지방혈증과 복부비만이 관상동맥 중재술을 시술받은 급성 심근경색증 환자의 임상경과에 미치는 영향

박종춘 ( Jong Chun Park ),강정채 ( Jung Chaee Kang ),한수경 ( Soo Gyoung Han ),정명호 ( Myung Ho Jeong ),이정애 ( Jung Ae Rhee ),최진수 ( Jin Su Choi ),이기홍 ( Kee Hong Lee ),박근호 ( Keun Ho Park ),심두선 ( Doo Sun Sim ),홍영준 대한내과학회 2014 대한내과학회지 Vol.86 No.2

Background/Aims: Dyslipidemia and obesity are risk factors for the development of acute myocardial infarction (AMI) that affect the clinical outcomes in patients. Methods: We analyzed 2,751 consecutive AMI patients who underwent percutaneous coronary intervention (PCI) (mean age, 63.7 ± 12.1 years). The patients were divided into four groups based on serum triglyceride levels and central obesity [Group Ia: triglycerides < 200 mg/dL and (-) central obesity; Group Ib: triglyceride < 200 mg/dL and (+) central obesity; Group IIa: triglyceride ≥ 200 mg/dL and (-) central obesity; Group IIb: triglyceride ≥ 200 mg/dL and (+) central obesity]. In-hospital outcome was defined as in-hospital mortality and complications. One-year clinical outcome was compared and defined as the composite of 1-year major adverse cardiac events (MACE), including death, recurrent MI, and target vessel revascularization. Results: Total MACE developed in 502 patients (18.2%), while 303 patients (11.0%) died prior to the 1-year follow-up visit. In-hospital complications and in-hospital mortality were not different among the four groups. One-year clinical outcomes based on triglyceride levels (Group I vs. Group II) were not different. In addition, there were no differences in clinical outcomes in patients with a triglyceride level < 200 mg/dL, regardless of central obesity. One-year MACE rates were not significantly different among the four groups. Conclusions: There was no significant difference in the 1-year MACE rate based on the triglyceride level and presence of central obesity in patients with AMI who underwent PCI. (Korean J Med 2014;86:169-178)