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Park Jong Sung,Lee Jang Hoon,Hong Chae Moon,Park Bo Eun,Park Yoon Jung,Kim Hong Nyun,Kim Namkyun,Jang Se Yong,Bae Myung Hwan,Yang Dong Heon,Park Hun Sik,Cho Yongkeun 대한의학회 2023 Journal of Korean medical science Vol.38 No.46
Background: Positron emission tomography (PET) viability scan is used to determine whether patients with a myocardial scar on single-photon emission computed tomography (SPECT) may need revascularization. However, the clinical utility of revascularization decision-making guided by PET viability imaging has not been proven yet. The purpose of this study was to investigate the impact of PET to determine revascularization on clinical outcomes. Methods: Between September 2012 and May 2021, 53 patients (37 males; mean age = 64 ± 11 years) with a myocardial scar on MIBI SPECT who underwent PET viability test were analyzed in this study. The primary outcome was a temporal change in echocardiographic findings. The secondary outcome was all-cause mortality. Results: Viable myocardium was presented by PET imaging in 29 (54.7%) patients. Revascularization was performed in 26 (49.1%) patients, including 18 (34.0%) with percutaneous coronary intervention (PCI) and 8 (15.1%) with coronary artery bypass grafting. There were significant improvements in echocardiographic findings in the revascularization group and the viable myocardium group. All-cause mortality was significantly lower in the revascularization group than in the medical therapy-alone group (19.2% vs. 44.4%, log-rank P = 0.002) irrespective of viable (21.4% vs. 46.7%, log-rank P = 0.025) or non-viable myocardium (16.7% vs. 41.7%, log-rank P = 0.046). All-cause mortality was significantly lower in the PCI group than in the medical therapy-alone group (11.1% vs. 44.4%, log-rank P < 0.001). Conclusion: Revascularization improved left ventricular systolic function and survival of patients with a myocardial scar on SPECT scans, irrespective of myocardial viability on PET scans.
S-179 Prognostic Value of Global Longitudinal Strain in Patients with Anterior Myocardial Infarction
( Jong Sung Park ),( Bo Eun Park ),( Yoon Jung Park ),( Se Yong Jang ),( Myung Hwan Bae ),( Jang Hoon Lee ),( Dong Heon Yang ),( Hun Sik Park ),( Yongkeun Cho ),( Shung Chull Chae ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Background: Left ventricular ejection fraction (LVEF) is a potent prognostic parameter in acute myocardial infarction patients. However, global longitudinal systolic strain (GLS) from 2D speckle-tracking echocardiograpy is a potent novel method to estimate the left ventricular systolic function. This study was aimed to evaluate the value of GLS as a predictor for 1 year all-cause mortality in patients with anterior myocardial infarction (MI). Methods: Among the 546 first-STEMI patients, who underwent primary percutaneous coronary intervention (PCI), From November 2007 to December 2011, 216 patients (mean age 60.5±12.4, 171 male) with anterior myocardial infarction were enrolled. Results: Mean LVEF of the patients was 46.1±10.1% and mean GLS was -12.0±3.9%. Receiver operating curve of GLS for 1-year mortality demonstrated that GLS showed excellent prediction for 1-year mortality in anterior MI patients (area under curve [AUC] 0.84, 95% confidence interval [95CI] 0.771 - 0.915). Cutoff value of GLS for mortality prediction was -11.7% (sensitivity 94%, specificity 58%). A Group with high GLS (n=100) showed significantly poor prognosis than low GLS (n=116) group in Kaplan-Meier survival analysis (mortality 16% vs. 0.9%, log rank p<0.001). Compared with left ventricular ejection fraction, GLS showed better prediction for mortality, but not significant (AUC 0.84 vs. 0.79, p=0.31). Univariate analysis showed that age, gender, Killip class, symptom-to-balloon time, systolic blood pressure, estimated GFR, post PCI TIMI flow and GLS were predictors for 1-year mortality. In multivariable anaylsis, GLS was an independent predictor for mortality in anterior MI patients (hazard ratio 1.205, 95CI 1.031-1.408, p=0.019). Addition of GLS on established risk factors (including LVEF) had incremental predictive value in predicting 1-year mortality (global chi-square from 60.5 to 64.5, p=0.045). Conclusions: GLS is an independent predictor of prognosis in patients with anterior myocardial infarction. Adding GLS on established prognostic factors can improve prediction of prognosis in patients with anterior myocardial infarction.
S-299 Prognostic value of E/e`` in patients with severely decreased left ventricular funct ion
( Yoon Jung Park ),( Jong Sung Park ),( Bo Eun Park ),( Se Yong Jang ),( Myung Hwan Bae ),( Jang Hoon Lee ),( Dong Heon Yang ),( Hun Sik Park ),( Yongkeun Cho ),( Shung Chull Chae ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Background: The ratio of early transmitral velocity to tissue Doppler early diastolic velocity (E/e’) is used for estimating pulmonary capillary wedge pressure. However, E/e' may have less sensitive prognostic value in decreased left ventricular (LV) function. We aimed to investigate difference in prognostic impact of E/e’ on long term prognosis between decreased and preserved LV function in patients with acute decompensated heart failure (ADHF). Methods: A total of 836 patients (66.2±14.7 years-old, 442 men) with heart failure between Jan. 2005 and June. 2015 were included. Composite of all-cause mortality and re-hospitalization was recorded during follow-up. Results: During follow-up (22.0 ±18.5 months), 343 (41.0%) events were recorded. In overall patients, E/e’ was an independent prognostic marker for adverse events (hazard ratio [HR] 1.01 [1.00-1.03], p=0.023) together with age, NYHA class, and serum creatinine. Kaplan-Meier analysis revealed that patients with high E/e’ (E/e’ > 15) exhibited significantly worse prognosis (49.7% vs. 25.7%, p<0.001) compared to those with low E/e’ (E/e’ ≤ 15) in patients with preserved LV function (LVEF >30%), whereas there is no significant difference in prognosis between high and low E/E’ group (45.0% vs. 36.4%, p=0.144) in patients with decreased LV function (LVEF ≤ 30%). In crude analysis model, E/e’ significantly predicted prognosis in patients with preserved LV function group (HR 1.05 [1.03-1.07], p<0.001), whereas E/e’ could not (HR 1.00 [0.99-1.02], p=0.611) (p for interaction <0.001). In adjusted model including age, sex, body mass index, heart rate, hypertension, diabetes, serum sodium, serum creatinine and inotropics use, E/e’ still significantly predicted prognosis in patients with preserved LV function (HR 1.04 [1.02-1.06], p<0.001) and it could not in patients with decreased ejection fraction (HR 0.996 [0.98-1.01], p=0.634). There was significant interaction in adjusted model (p for interaction =0.011). Conclusions: E/e’ significantly predicted long-term outcome in patients with heart failure of preserved LV function, whereas it could not in patients with decreased LV function in ADHF.
S-297 Prognostic Value of CA125 with NT-proBNP in Patients with Acute Heart Failure
( Bo Eun Park ),( Yoon Jung Park ),( Jong Sung Park ),( Se Yong Jang ),( Myung Hwan Bae ),( Jang Hoon Lee ),( Dong Heon Yang ),( Hun Sik Park ),( Yongkeun Cho ),( Shung Chull Chae ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Background: Carbohydrate antigen-125 (CA-125) is an emerging prognostic biomarker in heart failure. We aimed to test the long term prognostic value of CA-125 in combination with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure. Methods: A total of 419 patients (64.1±15.6 years-old, 214 men) suffered acute decompensated heart failure between 2005. Jan and 2013. July were retrospectively enrolled. All-cause mortality during 2 years follow-up was investigated for the prognosis of the patients Results: During follow-up, 109 (26.0%) deaths were recorded. In multivariable analysis model, CA-125 was an independent prognostic marker (log CA-125 hazard ratio 1.23 [1.02-1.48], p=0.030) together with age, sex, NYHA class, β-blocker use, inotropics use and NT-proBNP level. We divided the study cohort into 4 groups according to the levels of NT-proBNP (cufoff value 5269 pg/ml for 2-year survival) and CA-125 (cutoff value 54.5 U/ml for 2-year survival). Kaplan-Meier survival analysis demonstrated that the group with both low marker levels showed best 2-year survival (87.9%) followed by the group with low NT-proBNP and high CA-125 level (76.1%), high NT-proBNP and low CA-125 (64.7%) and high NT-proBNP and high CA-125 (54.3%) (p<0.001). Likelihood ratio test showed that addition of NT-proBNP level to established risk factors increase the predictive power for mortality (global chi-square from 130.6 to 138.3, p=0.005. Addition of CA-125 on the top of the combination of NT-proBNP and established risk factors still more increased the predictive power for mortality (global chi-square from 138.2 to 143.3, p=0.026) in patients with acute decompensated heart failure. Conclusions: CA-125 was an independent prognostic marker in patients with acute decompensated heart failure. Combined use of CA-125 and NT-proBNP provided a significant improvement in prediction of mortality in patients with acute decompensated heart failure.
Scattering Optical Elements: Stand-Alone Optical Elements Exploiting Multiple Light Scattering
Park, Jongchan,Cho, Joong-Yeon,Park, Chunghyun,Lee, KyeoReh,Lee, Heon,Cho, Yong-Hoon,Park, YongKeun American Chemical Society 2016 ACS NANO Vol.10 No.7
<P>Optical design and fabrication techniques are crucial for making optical elements. From conventional lenses to diffractive optical elements and to recent metasurfaces, various types of optical elements have been proposed to manipulate light where optical materials are fabricated into desired structures. Here, we propose a scattering optical element (SOE) that exploits multiple light scattering and wavefront shaping. Instead of fabricating optical materials, the SOE consists of a disordered medium and a photopolymer-based wavefront recorder, with shapes impinging on light on demand. With the proposed stand-alone SOEs, we experimentally demonstrate control of various properties of light, including intensity, polarization, spectral frequency, and near field. Due to the tremendous freedom brought about by disordered media, the proposed approach will provide unexplored routes to manipulate arbitrary optical fields in stand-alone optical elements.</P>
Park Bo Eun,Lee Jang Hoon,Park Hyuk Kyoon,Kim Hong Nyun,Jang Se Yong,Bae Myung Hwan,Yang Dong Heon,Park Hun Sik,Cho Yongkeun,Lee Bong Yul,Nam Chang Wook,Lee Jin Bae,Kim Ung,Chae Shung Chull,Daegu COVI 대한의학회 2021 Journal of Korean medical science Vol.36 No.2
Background: Data regarding the association between preexisting cardiovascular risk factors (CVRFs) and cardiovascular diseases (CVDs) and the outcomes of patients requiring hospitalization for coronavirus disease 2019 (COVID-19) are limited. Therefore, the aim of this study was to investigate the impact of preexisting CVRFs or CVDs on the outcomes of patients with COVID-19 hospitalized in a Korean healthcare system. Methods: Patients with COVID-19 admitted to 10 hospitals in Daegu Metropolitan City, Korea, were examined. All sequentially hospitalized patients between February 15, 2020, and April 24, 2020, were enrolled in this study. All patients were confirmed to have COVID-19 based on the positive results on the polymerase chain reaction testing of nasopharyngeal samples. Clinical outcomes during hospitalization, such as requiring intensive care and invasive mechanical ventilation (MV) and death, were evaluated. Moreover, data on baseline comorbidities such as a history of diabetes, hypertension, dyslipidemia, current smoking, heart failure, coronary artery disease, cerebrovascular accidents, and other chronic cardiac diseases were obtained. Results: Of all the patients enrolled, 954 (42.0%) had preexisting CVRFs or CVDs. Among the CVRFs, the most common were hypertension (28.8%) and diabetes mellitus (17.0%). The prevalence rates of preexisting CVRFs or CVDs increased with age (P < 0.001). The number of patients requiring intensive care (P < 0.001) and invasive MV (P < 0.001) increased with age. The in-hospital death rate increased with age (P < 0.001). Patients requiring intensive care (5.3% vs. 1.6%; P < 0.001) and invasive MV (4.3% vs. 1.7%; P < 0.001) were significantly greater in patients with preexisting CVRFs or CVDs. In-hospital mortality (12.9% vs. 3.1%; P < 0.001) was significantly higher in patients with preexisting CVRFs or CVDs. Among the CVRFs, diabetes mellitus and hypertension were associated with increased requirement of intensive care and invasive MV and in-hospital death. Among the known CVDs, coronary artery disease and congestive heart failure were associated with invasive MV and in-hospital death. In multivariate analysis, preexisting CVRFs or CVDs (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.07–3.01; P = 0.027) were independent predictors of in-hospital death after adjusting for confounding variables. Among individual preexisting CVRF or CVD components, diabetes mellitus (OR, 2.43; 95% CI, 1.51–3.90; P < 0.001) and congestive heart failure (OR, 2.43; 95% CI, 1.06–5.87; P = 0.049) were independent predictors of in-hospital death. Conclusion: Based on the findings of this study, the patients with confirmed COVID-19 with preexisting CVRFs or CVDs had worse clinical outcomes. Caution is required in dealing with these patients at triage.