Sex differences in clinical characteristics and long-term outcome in patients with heart failure: data from the KorAHF registry

Hyue Mee Kim,Hack-Lyoung Kim,Myung-A Kim,Hae-Young Lee,Jin Joo Park,Dong-Ju Choi 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.1

Background/Aims: Sex differences in the prognosis of heart failure (HF) have yielded inconsistent results, and data from Asian populations are even rare. This study aimed to investigate sex differences in clinical characteristics and long-term prognosis among Korean patients with HF. Methods: A total of 5,625 Korean patients hospitalized for acute HF were analyzed using a prospective multi-center registry database. Baseline clinical characteristics and long-term outcomes including HF readmission and death were compared between sexes. Results: Women were older than men and had worse symptoms with higher N-terminal pro B-type natriuretic peptide levels. Women had a significantly higher proportion of HF with preserved ejection fraction (HFpEF). There were no significant differences in in-hospital mortality and rate of guideline-directed medical therapies in men and women. During median follow- up of 3.4 years, cardiovascular death (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.07–1.78; p = 0.014), and composite outcomes of death and HF readmission (adjusted HR, 1.13; 95% CI, 1.01–1.27; p = 0.030) were significantly higher in men than women. When evaluating heart failure with reduced ejection fraction (HFrEF) and HFpEF separately, men were an independent risk factor of cardiovascular death in patients with HFrEF. Clinical outcome was not different between sexes in HFpEF. Conclusions: In the Korean multi-center registry, despite having better clinical characteristics, men exhibited a higher risk of all-cause mortality and readmission for HF. The main cause of these disparities was the higher cardiovascular mortality rate observed in men compared to women with HFrEF.

Differential Transcriptome Profile and Exercise Capacity in Cardiac Remodeling by Pressure Overload versus Volume Overload

Kyung-Hee Kim,Hyue-Mee Kim,Jin-Sik Park,Yong Jin Kim 한국심초음파학회 2019 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.27 No.1

BACKGROUND We compared the gene expression profiles in the hypertrophied myocardium of rats subjected to pressure overload (PO) and volume overload (VO) using DNA chip technology, and compared the effects on exercise capacity with a treadmill test. METHODS Constriction of the abdominal aorta or mitral regurgitation induced by a hole in the mitral leaflet were used to induce PO (n = 19), VO (n = 16) or PO + VO (n = 20) in rats. Serial echocardiographic studies and exercise were performed at 2-week intervals, and invasive hemodynamic examination by a pressure-volume catheter system was performed 12 weeks after the procedure. The gene expression profiles of the left ventricle (LV) 12 weeks after the procedure were analyzed by DNA chip technology. RESULTS In hemodynamic analyses, the LV end-diastolic pressure and the end-diastolic pressure-volume relationship slope were greater in the PO group than in the VO group. When we compared LV remodeling and exercise capacity, cardiac fibrosis and exercise intolerance developed in the PO group but not in the VO group (exercise duration, 434.0 ± 80.3 vs. 497.8 ± 49.0 seconds, p < 0.05, respectively). Transcriptional profiling of cardiac apical tissues revealed that gene expression related to the inflammatory response and cellular signaling pathways were significantly enriched in the VO group, whereas cardiac fibrosis, cytoskeletal pathway and G-protein signaling genes were enriched in the PO group. CONCLUSIONS We found that many genes were regulated in PO, VO or both, and that there were different regulation patterns by cardiac remodeling. Cardiac fibrosis and cytoskeletal pathway were important pathways in the PO group and influenced exercise capacity. Cardiac fibrosis influences exercise capacity before LV function is reduced.

Elevated On-Treatment Diastolic Blood Pressure and Cardiovascular Outcomes in the Presence of Achieved Systolic Blood Pressure Targets

Dae-Hee Kim,In-Jeong Cho,Woohyeun Kim,Chan Joo Lee,Hyeon-Chang Kim,Jeong-Hun Shin,Si-Hyuck Kang,Mi-Hyang Jung,Chang Hee Kwon,Ju-Hee Lee,Hack Lyoung Kim,Hyue Mee Kim,Iksung Cho,Dae Ryong Kang,Hae-Young 대한심장학회 2022 Korean Circulation Journal Vol.52 No.6

Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated on-treatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10; 95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion: Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

Characterization of Cirrhotic Cardiomyopathy Using Cardiac Magnetic Resonance Imaging: A Prospective Study

( Yun Bin Lee ),( Hyue Mee Kim ),( Sung Won Chung ),( Minseok Albert Kim ),( Sun Woong Kim ),( Jun Sik Yoon ),( Hyo Young Lee ),( Young Chang ),( Eun Ju Cho ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung- H 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Liver cirrhosis is known to decrease the cardiac performance. However, it is unclear whether this change is related to the change in myocardial muscle itself, or is a secondary functional phenomenon. In this study, we aimed to characterize myocardial tissue using cardiovascular magnetic resonance (CMR) imaging in cirrhotic patients. Methods: Thirty-five patients with cirrhosis who were listed for liver transplantation and 20 normal healthy controls were prospectively enrolled. All included subjects underwent conventional echocardiography, speckle-tracking echocardiography, and CMR imaging with T1 mapping and late gadolinium enhancement. Native T1 and extracellular volume (ECV) were measured for assessing myocardial fibrosis. Echocardiography and CMR imaging were performed at just before and 1 year after liver transplantation. Results: Both echocardiography and CMR imaging demonstrated hyperdynamic left ventricular (LV) function in cirrhotic patients. There were no significant differences in LV size, LV wall thickness, LV mass index, E/A ratio, and deceleration time between cirrhotic patients and non-cirrhotic healthy controls (all P>0.1). However, cirrhotic patients showed significantly higher values of native T1 (1230.1±79.0 vs 1173.3±34.7, P=0.001) (Table 1 and Figure 1A) and ECV (31.4±4.9 vs 25.4±1.9, P<0.001) (Table 1 and Figure 1B) compared to non-cirrhotic controls. Specifically, ECV had a significant correlation with Child-Pugh class (26.2±3.4 in Child class A or B vs 33.2±4.3 in Child class C; P=0.001). At 1 year after liver transplantation, native T1 (from 1224.0±55.7 to 1155.8±77.0, P=0.010) and ECV (from 30.9±3.6 to 25.2±2.6, P<0.001) values significantly decreased, but there was no difference in other parameters regarding LV function and LV size. Conclusions: Decreased cardiac performance in cirrhotic patients may result from myocardial change reflected by the increase in native T1 and ECV values, which was normalized after liver transplantation. Native T1 and ECV values of CMR imaging could be more straightforward diagnostic indices for cirrhotic cardiomyopathy.

2023 Korean Society of Echocardiography position paper for diagnosis and management of valvular heart disease, part I: aortic valve disease

Sun Hwa Lee,Se‑Jung Yoon,Byung Joo Sun,Hyue Mee Kim,Hyung Yoon Kim,Sahmin Lee,Chi Young Shim,Eun Kyoung Kim,Dong‑Hyuk Cho,Jun‑Bean Park,Jeong‑Sook Seo,Jung‑Woo Son,In‑Cheol Kim,Sang‑Hyun Lee,Ran Heo,H 한국심초음파학회 2024 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.32 No.-

This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the clinical management of valvular heart diseases with reference to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee tried to reflect the recently published results on the topic of valvular heart diseases and Korean data by a systematic literature search based on validity and relevance. In part I of this article, we will review and discuss the current position of aortic valve disease in Korea

급성 심근경색으로 진단된 진성 적혈구 증가증

김지혜 ( Chee Hae Kim ),김혜미 ( Hyue Mee Kim ),이학승 ( Hak Seung Lee ),정지현 ( Ji Hyun Jung ),서정원 ( Jung Won Suh ) 대한내과학회 2015 대한내과학회지 Vol.88 No.2

Traditional risk factors for acute myocardial infarction are hypertension, diabetes, dyslipidemia, smoking, and a family history of coronary heart disease. Most acute myocardial infarction patients have at least one of these risk factors. Polycythemia vera is a rare etiological factor for acute myocardial infarction. Polycythemia vera leads to hyperviscous milieu of the blood and increased platelet activity, which increases the chance of thrombotic occlusion of coronary arteries. In this article we report a rare case of polycythemia vera presenting as an ST-elevation myocardial infarction without any traditional risk factors for cardiovascular disease. (Korean J Med 2015;88:192-196)

High Incidence and Mortality of Out-of-Hospital Cardiac Arrest on Traditional Holiday in South Korea

Joon-myoung Kwon,전기현,Hyue Mee Kim,Min Jeong Kim,Sung-Min Lim,Kyung-Hee Kim,Pil Sang Song,Jinsik Park,Rak Kyeong Choi,Byung-Hee Oh 대한심장학회 2019 Korean Circulation Journal Vol.49 No.10

Background and Objectives: This study aimed to confirm the effects of traditional holidays on the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) in South Korea. Methods: We studied 95,066 OHCAs of cardiac cause from a nationwide, prospective study from the Korea OHCA Registry from January 2012 to December 2016. We compared the incidence of OHCA, in-hospital mortality, and neurologic outcomes between traditional holidays, Seollal (Lunar New Year's Day) and Chuseok (Korean Thanksgiving Day), and other day types (weekday, weekend, and public holiday). Results: OHCA occurred more frequently on traditional holidays than on the other days. The median OHCA incidence were 51.0 (interquartile range [IQR], 44.0–58.0), 53.0 (IQR, 46.0–60.5), 52.5 (IQR, 45.3–59.8), and 60.0 (IQR, 52.0–69.0) cases/day on weekday, weekend, public holiday, and traditional holiday, respectively (p<0.001). The OHCA occurred more often at home rather than in public place, lesser bystander cardiopulmonary resuscitation (CPR) was performed, and the rate of cessation of CPR within 20 minutes without recovery of spontaneous circulation was higher on traditional holiday. After multivariable adjustment, traditional holiday was associated with higher in-hospital mortality (adjusted hazard ratio [HR], 1.339; 95% confidence interval [CI], 1.058–1.704; p=0.016) but better neurologic outcomes (adjusted HR, 0.503; 95% CI, 0.281–0.894; p=0.020) than weekdays. Conclusions: The incidence of OHCAs was associated with day types in a year. It occurred more frequently on traditional holidays than on other day types. It was associated with higher in-hospital mortality and favorable neurologic outcomes than weekday.

가성동맥류를 동반한 Haemophilus parainfluenzae 인공판막 심내막염

정지현 ( Ji Hyun Jung ),김학령 ( Hack Lyoung Kim ),김혜미 ( Hyue Mee Kim ),이학승 ( Hak Seung Lee ),김지혜 ( Chee Hae Kim ),최홍미 ( Hong Mi Choi ),조주희 ( Joo Hee Zo ) 대한내과학회 2014 대한내과학회지 Vol.87 No.5

Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation. (Korean J Med 2014;87:589-592)

Systemic Inflammation Is Associated With Coronary Artery Calcification and All-Cause Mortality in Chronic Kidney Disease

Hwang, In-Chang,Park, Hyo Eun,Kim, Hack-Lyoung,Kim, Hyue Mee,Park, Jun-Bean,Yoon, Yeonyee E.,Lee, Seung-Pyo,Kim, Hyung-Kwan,Cho, Goo-Yeong,Sohn, Dae-Won UNKNOWN 2016 CIRCULATION JOURNAL Vol.80 No.7

<P>Background: Presence of systemic inflammation in chronic kidney disease (CKD) is associated with advanced coronary artery calcification (CAC). The prognostic significance of this association, however, is unknown. We evaluated the associations between CAC, estimated glomerular filtration rate (eGFR) and all-cause mortality, to determine whether the associations differ according to the presence of systemic inflammation. Methods and Results: We followed 30,703 consecutive individuals who underwent CAC measurement for a median of 79 months (IQR, 65-96 months). Patients were categorized according to baseline CAC score (0, 1-99, 100-399 and >= 400), eGFR (<45, 45-59, 60-74, 75-89, 90-104, and >= 105 ml/min/1.73 m(2)) and high-sensitivity C-reactive protein (hsCRP; <2.0, and >= 2.0 mg/L). Prevalence and extent of CAC were greater in those with lower eGFR and higher hsCRP accordingly, even after adjustment. Lower eGFR was strongly associated with higher CAC score (>= 400), and the association was more significant in patients with higher hsCRP. The greater CAC burden was associated with worse outcome in the CKD patients (eGFR <60 ml/min/1.73 m(2)) only in those with higher hsCRP. Conclusions: Patients with low eGFR and more extensive CAC had greater risk of mortality, and associations differed according to the presence of systemic inflammation. Among the CKD patients, coronary evaluation may be considered for those with elevated hsCRP.</P>

Development and Validation of Deep-Learning Algorithm for Electrocardiography-Based Heart Failure Identification

Joon-myoung Kwon,Kyung-Hee Kim,Ki-Hyun Jeon,Hyue Mee Kim,Min Jeong Kim,Sung-Min Lim,Pil Sang Song,Jinsik Park,Rak Kyeong Choi,Byung-Hee Oh 대한심장학회 2019 Korean Circulation Journal Vol.49 No.7

Background and Objectives: Screening and early diagnosis for heart failure (HF) are critical. However, conventional screening diagnostic methods have limitations, and electrocardiography (ECG)-based HF identification may be helpful. This study aimed to develop and validate a deep-learning algorithm for ECG-based HF identification (DEHF). Methods: The study involved 2 hospitals and 55,163 ECGs of 22,765 patients who performed echocardiography within 4 weeks were study subjects. ECGs were divided into derivation and validation data. Demographic and ECG features were used as predictive variables. The primary endpoint was detection of HF with reduced ejection fraction (HFrEF; ejection fraction [EF]≤40%), and the secondary endpoint was HF with mid-range to reduced EF (≤50%). We developed the DEHF using derivation data and the algorithm representing the risk of HF between 0 and 1. We confirmed accuracy and compared logistic regression (LR) and random forest (RF) analyses using validation data. Results: The area under the receiver operating characteristic curves (AUROCs) of DEHF for identification of HFrEF were 0.843 (95% confidence interval, 0.840–0.845) and 0.889 (0.887–0.891) for internal and external validation, respectively, and these results significantly outperformed those of LR (0.800 [0.797–0.803], 0.847 [0.844–0.850]) and RF (0.807 [0.804–0.810], 0.853 [0.850–0.855]) analyses. The AUROCs of deep learning for identification of the secondary endpoint was 0.821 (0.819–0.823) and 0.850 (0.848–0.852) for internal and external validation, respectively, and these results significantly outperformed those of LR and RF. Conclusions: The deep-learning algorithm accurately identified HF using ECG features and outperformed other machine-learning methods.