About Advanced School for Core Investigators (ASCI Cube) & Speaker Bureau 2023

Yeonyee E. Yoon 아시아심장혈관영상의학회 2023 Cardiovascular Imaging Asia Vol.7 No.3

In 2010, the Advanced School for Core Investigators from ASCI was established, commonly referred to as the ASCI2 Project. The project’s primary mission was to pinpoint budding ASCI members showing remarkable potential and nurture them to become Asia’s foremost scholars and speakers for international annual conferences. In 2018, we rebranded ASCI2 to ASCI Cube (ASCI3) with the introduction of the Asian School of Cardiovascular Imaging of ASCI (ASCI2). This new initiative comprised the Speaker Bureau, Joint Symposium, Practical Tutorial, and the Advanced School for Core Investigators (ASCI3).

Artificial Intelligence and Echocardiography

Yeonyee E. Yoon,Sekeun Kim,장혁재 한국심초음파학회 2021 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.29 No.3

Artificial intelligence (AI) is evolving in the field of diagnostic medical imaging, including echocardiography. Although the dynamic nature of echocardiography presents challenges beyond those of static images from X-ray, computed tomography, magnetic resonance, and radioisotope imaging, AI has influenced all steps of echocardiography, from image acquisition to automatic measurement and interpretation. Considering that echocardiography often is affected by inter-observer variability and shows a strong dependence on the level of experience, AI could be extremely advantageous in minimizing observer variation and providing reproducible measures, enabling accurate diagnosis. Currently, most reported AI applications in echocardiographic measurement have focused on improved image acquisition and automation of repetitive and tedious tasks; however, the role of AI applications should not be limited to conventional processes. Rather, AI could provide clinically important insights from subtle and non-specific data, such as changes in myocardial texture in patients with myocardial disease. Recent initiatives to develop large echocardiographic databases can facilitate development of AI applications. The ultimate goal of applying AI to echocardiography is automation of the entire process of echocardiogram analysis. Once automatic analysis becomes reliable, workflows in clinical echocardiographic will change radically. The human expert will remain the master controlling the overall diagnostic process, will not be replaced by AI, and will obtain significant support from AI systems to guide acquisition, perform measurements, and integrate and compare data on request.

Prediction of Subclinical Coronary Artery Disease With Breast Arterial Calcification and Low Bone Mass in Asymptomatic Women : Registry for the Women Health Cohort for the BBC Study

Yoon, Yeonyee E.,Kim, Kyoung Min,Han, Jong Soo,Kang, Si-Hyuck,Chun, Eun Ju,Ahn, Soyeon,Kim, Sun Mi,Choi, Sang Il,Yun, Bo La,Suh, Jung-Won American College of Cardiology 2019 JACC CARDIOVASCULAR IMAGING Vol.12 No.7

<P><B>Graphical abstract</B></P><P>[Figure]</P><P><B>Abstract</B></P><P><B>Objectives</B></P><P>This study sought to determine whether evaluations of breast arterial calcification (BAC) and low bone mass (LBM) could improve the ability to predict subclinical coronary artery disease (CAD) in asymptomatic women.</P><P><B>Background</B></P><P>An improved risk stratification strategy beyond the measurement of conventional risk factors is needed to identify women at high risk of CAD.</P><P><B>Methods</B></P><P>The BBC (Women Health Registry Study for Bone, Breast, and Coronary Artery Disease) enrolled 2,100 asymptomatic women who underwent dual-energy X-ray absorptiometry, digital mammography, and coronary computed tomography angiography. We assessed the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk and evaluated the presence and severity of BAC, LBM, coronary artery calcification (CAC), and coronary atherosclerotic plaque (CAP).</P><P><B>Results</B></P><P>CAC and CAP were found in 11.2% and 15.6% of participants, respectively. In women with CAC or CAP, increasing trends in the presence and severity of both BAC and LBM were observed. Both BAC and LBM were found to be associated with the presence of CAC (unadjusted odds ratios [OR]: 3.54 and 2.22, respectively) and CAP (unadjusted OR: 3.02 and 1.91, respectively). However, in multivariate analysis, only the presence of BAC and BAC score remained as independent predictors. For the prediction of CAC and CAP, addition of the BAC presence to the 10-year ASCVD risk significantly increased the areas under the curve (area under the curve: 0.71 to 0.72; p = 0.016; and area under the curve: 0.66 to 0.68; p = 0.010; respectively) and resulted in net reclassification index improvements (area under the curve: 0.304; p <0.001; and area under the curve: 0.245; p <0.001; respectively).</P><P><B>Conclusions</B></P><P>The presence and severity of BAC and LBM were significantly associated with the risk of subclinical CAD in asymptomatic women. BAC evaluation especially provides an independent and incremental value over conventional risk algorithms. (Women Health Cohort for Breast, Bone and Coronary Artery Disease [BBC]; NCT03235622)</P>

Prediction of infarct size and adverse cardiac outcomes by tissue tracking-cardiac magnetic resonance imaging in ST-segment elevation myocardial infarction

Yoon, Yeonyee E.,Kang, Si-Hyuck,Choi, Hong-Mi,Jeong, Seonji,Sung, Ji Min,Lee, Sang-Eun,Cho, Injeong,Cho, Goo-Yeong,Chang, Hyuk-Jae,Chun, Eun Ju Springer-Verlag 2018 EUROPEAN RADIOLOGY Vol.28 No.8

<P>aEuro cent In particular, GLS by TT-CMR had independent prognostic value in MI patients.</P>

Association between Bone Mineral Density and Coronary Atherosclerotic Plaque According to Plaque Composition: Registry for the Women Health Cohort for Bone, Breast, and Coronary Artery Disease Study

김경민,Yeonyee E. Yoon,Bo La Yun,Jung-Won Suh 대한골대사학회 2022 대한골대사학회지 Vol.29 No.2

Background: Although biological links are unclear, low bone density and atherosclerosis are inversely associated. This study evaluated the association between bone mineral density (BMD) and coronary computed tomographic angiography (CCTA) findings, including coronary artery calcification (CAC) score and the presence, extent, and composition of coronary atherosclerotic plaque (CAP) in asymptomatic women. Methods: A symptomatic women aged ≥40 years (N=2, 100; median age, 52 years; range, 40-80 years) were selected from a retrospective observational cohort and stratified into normal, osteopenia, and osteoporosis groups according to BMD T-score grades. We evaluated CAC score and assessed the presence, extent, and stenosis severity of CAP on CCTA. Additionally, CAP was categorized as calcified, mixed, or non-calcified according to calcified component valiums (>130 Hounsfield units). Results: Osteopenia and osteoporosis were found in 28.8% and 5.3% of participants, respectively. CAC score and CAC severity significantly increased with decreased BMD grades (from normal to osteoporosis). The presence of CAP (overall, 15.6%; normal, 12.6%; osteopenia, 20.2%; osteoporosis, 28.8%; P<0.001) and number of segments with CAP significantly increased with decreased BMD grades. Furthermore, the number of segments with calcified or mixed plaques, excluding non-calcified plaques, increased with decreased BMD grades. Although most associations were attenuated or disappeared after adjusting for age and other covariates, calcified plaques showed a strong and age-independent association with BMD grades. Conclusions: The presence and severity of CAC and CAP were significantly associated with BMD severity in asymptomatic women, particularly for the presence of calcified plaques. Further studies are required to determine the association between vascular calcification and bone health status.

Evaluation of Coronary Artery Calcium Progression in Asymptomatic Individuals with an Initial Score of Zero

Wonjae Lee,Yeonyee E. Yoon,Ohkyung Kwon,이희선,Hyo Eun Park,Eun Ju Chun,Su-Yeon Choi,Goo-Yeong Cho,Hyuk-Jae Chang 대한심장학회 2019 Korean Circulation Journal Vol.49 No.5

Background and Objectives: Coronary artery calcium (CAC) scoring in the asymptomatic population can improve cardiovascular risk prediction. We aimed to assess CAC progression and the impact of coronary risk factors on the CAC progression rate in asymptomatic Korean individuals with a baseline CAC score of zero. Methods: The study population was derived from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry: a retrospective, single ethnicity, multicenter registry of asymptomatic individuals who underwent CAC scoring as a part of a health checkup. Individuals with at least two CAC scores and an initial score of zero were included. CAC progression was defined as [√CAC score (follow-up) − √CAC score (baseline)] ≥2.5. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated. Results: Among 6,268 participants (mean age, 48.0±7.1 years; male, 80.5%), 719 (11.5%) experienced CAC progression during follow-up (median, 109 months; interquartile range, 78–208 months). The CAC progression rate was 0.3%, 1.9%, 4.3%, 8.6%, and 16.7% in years 1–5, respectively. The chance of CAC progression at 5 years was 13.1%, 22.0%, and 27.9% for individuals with a 10-year ASCVD risk of <5%, ≥5% but <7.5%, and ≥7.5%, respectively. A multivariable analysis revealed age, male sex, waist circumference, diabetes, and low-density lipoprotein cholesterol level as independently associated with annualized CAC progression (p<0.001, p=0.017, p=0.025, p=0.032, and p=0.003, respectively). Conclusions: The probability of CAC progression is very low in Korean individuals with a CAC score of zero. However, the risk of CAC progression increases nonlinearly over time, and increases as the 10-year ASCVD risk increases.

Noncontrast Myocardial T1 Mapping by Cardiac Magnetic Resonance Predicts Outcome in Patients With Aortic Stenosis

Lee, Heesun,Park, Jun-Bean,Yoon, Yeonyee E.,Park, Eun-Ah,Kim, Hyung-Kwan,Lee, Whal,Kim, Yong-Jin,Cho, Goo-Yeong,Sohn, Dae-Won,Greiser, Andreas,Lee, Seung-Pyo Elsevier Science B.V. Amsterdam 2018 JACC CARDIOVASCULAR IMAGING Vol.11 No.7

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS).</P> <P><B>Background</B></P> <P>Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown.</P> <P><B>Methods</B></P> <P>A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68.8 ± 9.2 years of age, 49.6% male) and 33 age- and sex-matched controls who underwent 3-T CMR. The degree of diffuse myocardial fibrosis was assessed by noncontrast mapping of T1 relaxation time using modified Look-Locker inversion-recovery sequence, and the presence and extent of LGE were also evaluated. The AS patients were divided into 3 groups by the native T1 value. Primary endpoint was a composite of all-cause death and hospitalization for heart failure.</P> <P><B>Results</B></P> <P>Native T1 value was higher in AS patients, compared with control subjects (1,232 ± 53 ms vs. 1,185 ± 37 ms; p = 0.008). During follow-up (median 27.9 months), there were 24 clinical events including 9 deaths (6 pre-operative and 3 post-operative), the majority of which occurred in the patients in the highest T1 tertile group (2.4% vs. 11.6% vs. 42.9% for lowest, mid-, and highest tertile groups; p < 0.001 by log-rank test). The total number of events for both pre- and post-operative events also occurred more frequently in patients in the highest T1 tertile group. EuroSCORE II, the presence and/or extent of LGE, and the native T1 value were predictors of poor prognosis (adjusted hazard ratio for every 20-ms increase of native T1: 1.28; p = 0.003). In particular, the highest native T1 value provided further risk stratification regardless of the presence of LGE.</P> <P><B>Conclusions</B></P> <P>High native T1 value on noncontrast T1 mapping CMR is a novel, independent predictor of adverse outcome in patients with significant AS.</P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease

Lee Wonjae,Choi Wonsuk,강시혁,Hwang In-Chang,Choi Hong-Mi,Yoon Yeonyee E.,Cho Goo-Yeong 대한의학회 2021 Journal of Korean medical science Vol.36 No.6

Background: There is an incomplete understanding of the natural course of mild to moderate aortic stenosis (AS). We aimed to evaluate the natural course of patients with mild to moderate AS and its association with coronary artery disease (CAD). Methods: We retrospectively analyzed 787 patients diagnosed with mild to moderate AS using echocardiography between 2004 and 2010. Cardiac death and aortic valve replacement (AVR) for AS were assessed. Results: A median follow-up period was 92 months. Compared to the general population, patients with mild to moderate AS had a higher risk of cardiac death (hazard ratio [HR], 17.16; 95% confidence interval [CI], 13.65–21.59; P < 0.001). Established CAD was detected in 22.4% and associated with a significantly higher risk of cardiac mortality (adjusted HR, 1.62; 95% CI, 1.04–2.53; P = 0.033). The risk of cardiac death was lower when patients were taking statin (adjusted HR, 0.64; 95% CI, 0.41–0.98; P = 0.041), which was clear only after 7 years. Both patients with CAD and on statin tended to undergo more AVR, but the difference was not statistically significant (the presence of established CAD; adjusted HR, 1.63; 95% CI, 0.51–3.51; P = 0.214 and the use of statin; adjusted HR, 1.86; 95% CI, 0.76–4.58; P = 0.177). Conclusion: Mild to moderate AS does not have a benign course. The presence of CAD and statin use may affect the long-term prognosis of patients with mild to moderate AS.

Diagnostic accuracy of manual office blood pressure measurement in ambulatory hypertensive patients in Korea

Sehun Kim,Jin Joo Park,Seung-Ah Lee,Youngjin Cho,Yeonyee E. Yoon,Il-Young Oh,Chang-Hwan Yoon,Jung-Won Suh,Young-Seok Cho,Doo Ryeon Chung,Goo-Yeong Cho,In Ho Chae,Hae-Young Lee,Jinho Shin,Sungha Park,D 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.1

Background/Aims: Currently, office blood pressure (OBP) is the most widely used method of measuring blood pressure (BP) in daily clinical practice. However, data on the diagnostic accuracy of OBP in reference to ambulatory blood pressure (ABP) are scarce in Korea. Methods: In retrospective and prospective cohorts, manual OBP and ABP measurements were compared among ambulatory hypertensive patients. Hypertension was defined as systolic OBP ≥ 140 mmHg and/or diastolic OBP ≥ 90 mmHg, and systolic ABP ≥ 130 mmHg and/or diastolic ABP ≥ 80 mmHg. Results: In the retrospective cohort (n = 903), the mean OBP1 (before ABP measurement) was higher than ABP in both systolic (138 ± 17 mmHg vs. 123 ± 13 mmHg, p < 0.001) and diastolic (84 ± 12 mmHg vs. 78 ± 11 mmHg, p < 0.001) measurements. Interestingly, there was only a weak correlation between OBP and ABP (r2 = 0.038, p < 0.001). The overall discordance rate of OBP compared to ABP, which is the reference method for measuring BP, was 43.9%. The prospective cohort (n = 57) showed similar results. In a subgroup analysis, male patients had higher false negative results (masked or under-treated hypertension) than did female patients (26.1% vs. 17.8%, p = 0.003), whereas female patients had a higher false positive rate (white-coat or over-treated hypertension) than did male patients (28.7% vs. 15.2%, p < 0.001). Conclusions: The diagnostic accuracy of manual OBP is low in reference to ABP. Men and women have different patterns of discordance. These findings indicate that management of hypertensive patients with manual OBP measurements may be suboptimal and encourages the use of ABP in ambulatory hypertensive patients.

Three-Dimensional Myocardial Strain for the Prediction of Clinical Events in Patients With ST-Segment Elevation Myocardial Infarction

Wonsuk Choi,Chi-Hoon Kim,In-Chang Hwang,Chang-Hwan Yoon,Hong-Mi Choi,Yeonyee E. Yoon,In Ho Chae,Goo-Yeong Cho 한국심초음파학회 2022 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.30 No.3

BACKGROUND: Two-dimensional (2D) strain provides more predictive power than ejection fraction (EF) in patients with ST-elevation myocardial infarction (STEMI). 3D strain and EF are also expected to have better clinical usefulness and overcome several inherent limitations of 2D strain. We aimed to clarify the prognostic significance of 3D strain analysis in patients with STEMI. METHODS: Patients who underwent successful revascularization for STEMI were retrospectively recruited. In addition to conventional parameters, 3D EF, global longitudinal strain (GLS), global area strain (GAS), as well as 2D GLS were obtained. We constructed a composite outcome consisting of all-cause death or re-hospitalization for acute heart failure or ventricular arrhythmia. RESULTS: Of 632 STEMI patients, 545 patients (86.2%) had a reliable 3D strain analysis. During median follow-up of 49.5 months, 55 (10.1%) patients experienced the adverse outcome. Left ventricle EF, 2D GLS, 3D EF, 3D GLS, and 3D GAS were significantly associated with poor outcomes. (all, p < 0.001) The maximum likelihood-ratio test was performed to evaluate the additional prognostic value of 2D GLS or 3D GLS over the prognostic model consisting of clinical characteristics and EF, and the likelihood ratio was 15.9 for 2D GLS (p < 0.001) and 1.49 for 3D GLS (p = 0.22). CONCLUSIONS: The predictive power of 3D strain was slightly lower than the 2D strain. Although we can obtain 3D strains, volume, and EF simultaneously in same cycle, the clinical implications of 3D strains in STEMI need to be investigated further.