Analysis of Carotid Ultrasound Findings on Cardiovascular Events in Patients with Coronary Artery Disease during Seven-Year Follow-Up

육형빈,박현웅,정익주,김완호,김기홍,양동주,박요한,김용균,송인걸,배장호 대한심장학회 2015 Korean Circulation Journal Vol.45 No.1

Background and Objectives: Both carotid intima-media thickness (CIMT) and carotid plaque are important factors in the primary preventionof cardiac disease. However, it is unclear which one is more important for prognosis, especially in patients with coronary artery disease(CAD). Subjects and Methods: In total, 1426 consecutive CAD patients, proven by angiography, were followed-up for a mean of 85 months. Thestudy population was divided into four groups depending on the CIMT (≥0.83 mm, >95 percentile in Korea) and the presence or absenceof carotid plaque. Results: Patients with carotid plaque and thick CIMT (n=237, 16.6%) had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemiathan those had plaque and thin CIMT (n=213, 14.9%), those without plaque and thick CIMT (n=265, 18.6%) and those withoutplaque and thin CIMT (n=711, 49.9%). The patients with carotid plaque and thick CIMT group had a higher cardiac mortality rate (20.7%vs. 13.1%, 9.4% and 3.9%, respectively, p<0.001) and higher major adverse cardiovascular events (MACE) including death, acute myocardialinfarction, and stroke (27.8% vs. 18.8%, 15.5% and 9.3%, respectively, p<0.001) than any other groups. Multivariate Cox regressionanalysis showed that the presence of carotid plaque with thick CIMT had the highest hazard ratio (HR) compared to other groups (HR 2.23vs. 1.81, 2.01) for cardiac mortality. Also, carotid plaque had a higher HR than CIMT for mortality (HR 1.56 vs. 1.37) and MACE (HR 1.54 vs. 1.36) in the total study population. Conclusion: Carotid plaque is a more important prognostic factor than CIMT in patients with CAD, and adding a thick CIMT to carotidplaque increases the prognostic power for cardiac events.

S-166 : The Morphologic Pattern of Ruptured Plaque; Is Plaque Shoulder Frequently Ruptured Site?

서영훈,김기홍,육형빈,박요한,이충섭,송인걸,박현웅,김완호,권택근,배장호 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background: Plaque rupture site and its clinical significance have not been well studied, although rupture is usually developed near plaque shoulder and it is frequently associated with acute coronary syndrome (ACS). Subjects and Methods: We evaluated 22 patients who had plaque rupture at the culprit lesion defined by VH-IVUS (virtual histology-intravascular ultrasound). The site of plaque rupture is divided by cross sectional view (center, shoulder, unclassified) and longitudinal view (proximal, middle, distal). We also evaluated the association between morphologic features of the ruptured plaque and clinical features. Results: By cross sectional view, there were 11 ruptured plaques (50.0%) at center of the lesion and 8 ruptured plaques (36.4%) were located at shoulder of the lesion. Plaque rupture was mainly located in proximal (72.7%) and middle (27.3%) site of the lesion by longitudinal view. Center-located ruptured plaque had larger plaque area (18.2±3.7 mm2 vs. 11.4±3.0 mm2, p<0.001), fibrous area (8.7±2.5 mm2 vs. 4.5±1.4 mm2, p=0.001), fibrofatty area (2.5±1.0 mm2 vs. 1.6±1.1 mm2, p=0.016) and plaque burden (74.0±8.3% vs. 63.5±10.2%, p=0.023) than shoulder-located ruptured plaque. But ruptured cavity area (2.3±1.5 mm2 vs. 1.2±0.6 mm2, p=0.119) and ACS (57.9% vs. 31.6%, p=0.165) were not different between two groups. Plaque rupture at proximal site of the lesion had less multivessel disease than another plaque rupture sites (20% vs. 75% vs. 75%, p=0.037). ACS (80% vs. 87.5% vs. 100%, p=0.611), plaque burden (73.7±6.7% vs. 67.3±12.9% vs. 71.0±13.0, p=0.445), ruptured cavity area (2.1±1.3 mm2 vs. 1.3±0.7 mm2 vs. 2.2±1.8 mm2, p=0.119) and peak troponin level (15.5±10.8 ng/mL vs. 12.0±11.6 ng/mL vs. 11.5±13.0 ng/mL, p=0.760) were not different among the lesion site by longitudinal view. Conclusion: Plaque rupture was mostly occurred in proximal & middle site of the plaque in patients with ACS. Plaque rupture was equally developed both in center and shoulder of the plaque. The site of plaque rupture did not affect clinical results significantly.

Hypercholesterolemia and In-Vivo Coronary Plaque Composition in Patients with Coronary Artery Disease: A Virtual Histology - Intravascular Ultrasound Study

서영훈,이충섭,육형빈,양동주,박현웅,김기홍,김완호,권택권,배장호 대한심장학회 2013 Korean Circulation Journal Vol.43 No.1

Background and Objectives: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the re-lation between hypercholesterolemia and plaque composition in patients with coronary artery disease. Subjects and Methods: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercho-lesterolemic group (≥200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). Results: Hypercholesterolemic patients were younger (59.7±13.3 years vs. 62.6±11.5 years, p=0.036), than normocholesterolemic patients,whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23±0.85 mm 3 /mm vs. 1.02±0.80 mm 3 /mm, p=0.029) as well as percent necrotic core volume (20.5±8.5% vs. 18.0±9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4±10.5% vs. 18.4±11.3%, p=0.019) and necrotic core area (1.63±1.09 mm 2 vs. 1.40±1.20 mm 2 , p=0.088) were also higher than normocholesterolemic patients. Multi-variate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the cul-prit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coro-nary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). Conclusion: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery dis-ease.

외음부 종창으로 진단된 크론병 1예

변준현,허규찬,육형빈,류기현,구훈섭,송경호,김선문,최용우,강영우,이태희,지은혜,황태현,장한얼 대한내과학회 2017 대한내과학회 추계학술대회 Vol.2017 No.1

S-167 : Obesity Paradox in Korea Patients with Coronary Artery Disease

서영훈,박현웅,김기홍,육형빈,박요한,이충섭,송인걸,김완호,권택근,배장호 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background: Body mass index (BMI) was inversely association with cardiovascular events in patients with coronary artery disease (CAD). However, most of the research was to target the Western people. In this study we examined the association between BMI and cardiovascular events in Korean patients with CAD. Methods: The study population, consisted of 1342 consecutive patients with CAD and divided into four group based on WHO for the Asian population, underweight (Group I: BMI<18.5 kg/m2, n=38); normal weight (Group II: 18.5≤BMI<23.0 kg/m2, n=352); overweight (Group III: 23.0≤BMI<27.5 kg/m2, n=700); and obese (Group IV: BMI≥27.5 kg/m2, n=252).Results: Overweight and obese group were higher incidence of hypertension and dyslipidemia. Underweight group had significantly higher mortality (Group I:28.9%, Group II: 11.4%, Group III: 8.4%, Group IV: 2.4%, p<0.001) and MACE (Group I: 34.2%, Group II: 17.0%, Group III: 14.7%, Group IV: 6.3, p<0.001) compared to other groups. Multivariate analysis showed that the independent predictor of mortality were older age, renal failure, lower EF, and BMI. Obese group was lowest hazard ratio compared to other groups and in increased the BMI, the hazard ratio was decreased (Group II: HR 0.31, 95% CI 0.16-0.63, p=0.001, Group III: HR 0.28, 95% CI 0.14-0.54, p<0.001, Group IV: HR 0.09, 95% CI 0.03-0.24, p<0.001). Conclusion: Underweight and even normal weight group were independently associated with long term mortality and MACE in patients with CAD, suggesting that obesity paradox was also presented in Korean patients with CAD.

S-168 : Which one is more important in prognosis between carotid IMT and plaque in patients with CAD?

서영훈,박현웅,김기홍,육형빈,박요한,이충섭,송인걸,김완호,권택근,배장호 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background: Carotid intima-media thickness (CIMT) and plaque are both important in primary prevention. However, it is still unclear which one is more important in prognosis especially in terms of secondary prevention. Subjects and Methods: The study population, consisted of 1426 consecutive patients with CAD, was followed up for a mean of 85 months. Study population was divided into 4 groups according to the CIMT (0.83mm, >95 percentile in Korea) and the presence of carotid plaque. Results: Patients with plaque and thick CIMT (n=237, 16.6%) were older and had higher prevalence of hypertension, diabetes mellitus and dyslipidemia than those with plaque and thin CIMT (n=213, 14.9%), those without plaque and thick CIMT (n=265, 18.6%) and those without plaque and thin CIMT (n=711, 49.9%). The patients with plaque and thick CIMT had higher mortality (20.7% vs. 13.1%, 9.4% and 3.9%, respectively, p<0.001) and composite MACE (27.8% vs. 18.8%, 15.5%, 9.3%, respectively, p<0.001) than other groups. Multivariate analysis showed that the presence of carotid plaque with thick carotid IMT group was highest hazard ratio compared to other groups (HR 2.23 vs 1.81, 2.01) for cardiac mortality. The carotid plaque was also higher hazard ratio than CIMT for cardiac mortality (HR 1.56 vs 1.37) and MACE (HR 1.54 vs 1.36). Conclusion: Carotid ultrasound findings are important predictor in patients with CAD. Presence of carotid plaque is more important than CIMT in prognostic power, adding a CIMT to carotid plaque increase the prognostic power for cardiac events.

증례 : 혈액종양 ; 본태혈소판증가증 환자에서 골수흡인 및 생검 후 발생한 후복막출혈

정익주 ( Ik Ju Jung ),임승택 ( Seung Taek Lim ),최연석 ( Yeon Seok Choi ),장태수 ( Tae Soo Jang ),오선희 ( Sun Hee Oh ),육형빈 ( Hyung Bin Yuk ),조도연 ( Do Yeun Cho ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5

골수흡인 및 생검은 혈액 질환의 진단, 병기 설정 등을 위해 널리 사용되고 있다. 비교적 안전하고 간단한 시술로 알려져 있으며 시술 후에 국소 출혈, 천자 부위 통증 등의 합병증이 비교적 흔하게 발생한다. 지금까지의 문헌들을 살펴보면 매우 드물게 후복막출혈 등의 대량 출혈이 발생하였으며 응고장애 질환, 골수증식 질환, 항혈소판제제 복용, 항응고제 복용 등이 출혈의 위험 요소로 보고되었다. 저자들은 본태혈소판증가증 환자에서 골수흡인 및 생검 후 발생한 후복막출혈을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Bone marrow examination is useful in the diagnosis and staging of hematologic disease. This procedure is generally considered safe; however, there are several adverse events associated with bone marrow biopsy. The most frequent and serious adverse event is hemorrhage. Risk factors include coagulopathy, myeloproliferative disorders, and anticoagulant or antiplatelet medications. Most hemorrhage is local hematoma; however, infrequently retroperitoneal hemorrhage occurs. In the case of massive hemorrhage, operation or angiographic embolization may be required. We report on a case of retroperitoneal hemorrhage after bone marrow aspiration and biopsy in an essential thrombocythemia patient. (Korean J Med 2015;88:598-601)