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수면 무호흡 증후군 환자에 있어서의 심장 리듬의 장애:비강내 지속성 양압호흡 치료법의 효과
나진오,김철영,신철,김용현,박재석,박재형,박미영,신성희,서순용,박희남,노영무,김영훈 대한심장학회 2004 Korean Circulation Journal Vol.34 No.2
Background and Objectives:It has been demonstrated that sleep apnea syndrome predisposes to cardiac rhythmdisturbances and cardiovascular risks such as systemic hypertension. This study was conducted to investigate thetypes and frequency of cardiac arrhythmias which occurred during sleep and the effects of nasal continuous positiveairway pressure (nCPAP) therapy in the patients with sleep apnea syndrome. Subjects and Methods:The subjectswere 197 patients who were referred to the Sleep Research Center of Korea University Medical Center for polysomnographydue to snoring and sleep apnea from Jan. 1st 2000 to July 31st 2002. Of the 197 patients, 44 withsevere sleep apnea syndrome, whose respiratory disturbance index (RDI) exceeded 40/hr, were enrolled. Theirelectrograms on polysomnography before and after nCPAP therapy were analyzed. Results:Of the 44 subjects,32 (72.8%) showed cardiac arrhythmias. The types of arrhythmias were atrial premature beats (APBs, n=17),premature ventricular complexes (PVCs, n=15), sinus bradycardia (heart rate less than 40 per minute, n=6), sinuspause (n=1), and sinoatrial block (n=5). No fatal arrhythmias were identified. Most, 93.2%, of these arrhythmiasarose immediately after hypopneic or apneic episodes, and were accompanied by a significant decrease in SaO2,from 91.4% to 84.7% (p<0.05). After nCPAP therapy, these arrhythmias were completely disappeared in 11 patients(34.4%) and diminished in 15 (46.9%). Hypopneic or apneic episodes were preceded by cardiac arrhythmiasin only 36.4% with nCPAP (p<0.05 vs. before). Conclusion:Cardiac arrhythmias were demonstrated in 72.8% ofcases of severe sleep apnea syndrome, which were mostly benign and preceded by hypopneic or apneic episodes.nCPAP therapy decreased the frequency of hypopnea and apnea with elevated arterial O2 saturation, andeffectively eliminated cardiac arrhythmias. (Korean Circulation J 2004;34 (2):186-194) 배경 및 목적: 수면 무호흡 증후군(sleep apnea syndrome)에서 수 면 중 서맥성 또는 빈맥성 부정맥의 빈도가 높다는 것 은 이미 몇몇 연구를 통해 관찰된 바 있으며 최근에는 수면 무호흡 증후군 환자에서 전신 고혈압 및 심혈관계 질환의 이환률 및 사망률이 높아진다는 보고가 있었다. 그러나 우리나라에서 이에 대한 보고는 아직까지 미미 한 상태로 우리나라의 중증 수면 무호흡 증후군 환자를 대상으로 부정맥의 종류 및 빈도를 알아보고 또한 비강 내 지속성 양압호흡(nasal continuous positive Airway Pressure;nCPAP) 치료 후 이들의 변화를 알아보고 자 하였다. 방 법: 수면 중 호흡장애지수(Respiratory Disturbance Index; RDI)가 40 이상인 중증의 수면 무호흡 증후군 환자 44명을 대상으로 심전도의 변화와 비강내 지속성 양압호흡 치료 후 이들의 변화를 알아보았다. 결 과: 비강내 지속성 양압호흡 치료 전에 시행한 수면다원 검사 심전도상 총 44명의 환자중 32명(72.8%)에서 부 정맥의 발생이 관찰되었으며, 부정맥의 종류는 심방기 외수축, 심실기외수축, 동성서맥, 방실차단, 동휴지 등 이었다. 이들의 93.2%는 수면 중 저호흡 또는 무호흡 과 연관되어 동맥내 산소분압이 저하되면서 발생하였다. 비강내 지속성 양압호흡 치료후에는 총 수면시간 및 수 면효율 등의 유의한 차이는 보이지 않는 상태에서 호흡 장애지수 및 동맥내 산소분압 농도가 유의하게 개선되 었으며 부정맥을 보였던 환자의 26명(81.3%)에서 부 정맥이 소실되거나 빈도가 감소하였다. 치료후 나타나 는 부정맥 중 저호흡 또는 무호흡과 연관되어 나타나는 비율은 36.4%로 치료 전에 비해 현저히 감소하였다 (93.2% vs 36.4%;p<0.05). 또한 치료후에도 남아있 는 부정맥들은 심박동 조율기등의 치료를 요하는 유의 한 서맥은 보이지 않았다. 결 론: 중증 수면 무호흡 증후군 환자에 있어 부정맥의 발현 빈도는 72.8% 였으며 이는 수면 중 무호흡 또는 저호 흡에 따른 동맥내 산소분압 저하와 연관이 있었다. 비 강내 지속성 양압호흡 치료 이후에는 수면 중 무호흡 또는 저호흡의 비율이 줄고 동맥내 산소분압이 상승하 면서 부정맥의 발생이 없어지거나 또는 빈도가 현저히 감소하였다.
Prominent Crista Terminalis in Patients with Embolic Events
나진오,김응주,문선중,최은희,문진희,이혜라,김윤경,용환석 한국심초음파학회 2011 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.19 No.3
A prominent crista terminalis is a normal anatomic variant which consist of thick muscular bridge within the right atrium. However, it could be often misdiagnosed with an abnormal mass on the transthoracic echocardiography. The case report presented here, describe the findings of transthoracic echocardiography that suggested a right atrial mass in patients with pulmonary embolism. However, subsequent transesophageal echocardiography and cardiac computed tomography/magnetic resonance imaging differentiated a true right atrial mass from a prominent crista terminalis.
Pharmacological Strategies beyond Statins: Ezetimibe and PCSK9 Inhibitors
최자연,나진오 한국지질동맥경화학회 2019 지질·동맥경화학회지 Vol.8 No.2
Dyslipidemia, highly elevated, low-density lipoprotein (LDL) cholesterol, is a major cardiovascular risk factor. Statins have been proven to effectively reduce the risk of atherosclerotic cardiovascular disease (ASCVD) and are recommended as a first-line therapy for the primary and secondary prevention of ASCVD. However, statins may not be sufficient in decreasing LDL cholesterol levels and pose a significant on-treatment residual risk of major cardiovascular events (i.e., residual cholesterol risk) according to meta-analyses of statin trials. Current guidelines for cholesterol management to achieve additional LDL cholesterol reduction and reduce ASCVD risk recommend two hyperlipidemic agents besides statins. Use of ezetimibe, a cholesterol absorption inhibitor, leads to additional LCL cholesterol reduction and decreased ASCVD risk, when added to statin therapy, without raising significant safety concerns. Furthermore, in combination with a mild-to-moderate statin intensity, ezetimibe is used in situations of statin-associated adverse effects such as myalgia and the combination therapy is relatively safer. Monoclonal antibody of proprotein convertase subtilisin/kexin type 9 (PCSK9), alirocumab, and evolocumab, have been approved to lower LDL cholesterol level. While there are drawbacks to the use of PCSK9 inhibitors, including high cost and adverse events such as injection site reaction, they significantly decreased serum LDL cholesterol levels and thereby ASCVD risks when added to maximally tolerated statin therapy.
문준성,김남훈,나진오,조재형,In-Kyung Jeong,이순희,목지오,김난희,정동진,조진홍,이동우,이선우,원규장 대한당뇨병학회 2023 Diabetes and Metabolism Journal Vol.47 No.1
Background: To evaluate the safety and effectiveness of empagliflozin in routine clinical settings, we collected and assessed the clinical profiles of Korean patients with type 2 diabetes mellitus.Methods: This was a post-marketing surveillance study of empagliflozin 10 and 25 mg. Information on adverse events and adverse drug reactions (ADRs) was collected as safety data sets. Available effectiveness outcomes, including glycosylated hemoglobin (HbA1c) level, fasting plasma glucose, body weight, and blood pressure, were assessed.Results: The incidence rate of ADRs was 5.14% in the safety dataset (n=3,231). Pollakiuria, pruritis genital, and weight loss were the most common ADRs. ADRs of special interest accounted for only 1.18%, and there were no serious events that led to mortality or hospitalization. In the effectiveness data set (n=2,567), empagliflozin significantly reduced the mean HbA1c level and body weight during the study period by –0.68%±1.39% and –1.91±3.37 kg (both P<0.0001), respectively. In addition, shorter disease duration, absence of dyslipidemia, and higher baseline HbA1c levels were identified as the clinical features characteristic of a “responder” to empagliflozin therapy.Conclusion: Empagliflozin is a safe and potent glucose-lowering drug in routine use among Korean patients with type 2 diabetes mellitus. It is expected to have better glycemic efficacy in Korean patients with poorly controlled type 2 diabetes mellitus.