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심부전 환자에서 안정시 심박수의 의의: 전북지역 만성 심부전 등록연구
윤경호,이선화,전성희,고점석,이상재,유남진,김남호,류제영,오석규,김원호,정진원 대한고혈압학회 2012 Clinical Hypertension Vol.18 No.1
Background: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. Methods: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70–80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. Results: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction,ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events. Conclusions: High resting HR (>80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.
윤경호,이상재,고점석 대한심장학회 2017 Korean Circulation Journal Vol.47 No.5
Background and Objectives Ticagrelor is considered a potent antiplatelet agent compared to clopidogrel. However, there are no studies regarding the effect of ticagrelor loading on infarct size in patients with ST-segment elevation myocardial infarction (STEMI) in a primary percutaneous coronary intervention (PCI) setting. Subjects and Methods In this single-center, randomized, open-label study, 188 patients who underwent primary PCI for STEMI were enrolled (92 patients in the clopidogrel group and 96 in the ticagrelor group) and compared the infarct size by technetium-99m (Tc-99m) tetrofosmin single-photon emission computed tomography (SPECT) and serial cardiac biomarker levels between the groups. SPECT was performed at a median of 2 days after PCI. Results Baseline clinical and procedural characteristics were similar between the groups. Infarct size on SPECT, was similar between the 2 groups (28.1%±34.5% vs. 32.8%±29.2%; p=0.169). At all time-points after PCI (8, 24, and 48 hours), the peak levels of creatine kinase-myocardial band (CK-MB) and troponin T were lower in the clopidogrel group. The clopidogrel group showed lower cumulative troponin T levels than the ticagrelor group (12.59±10.66 vs. 17.67±19.51 ng/mL; p=0.029). Conclusion Ticagrelor loading before primary PCI was not associated with reduced myocardial infarct size during the first 48 hours, compared to clopidogrel loading
한국인에서 갑상선 호르몬은 관동맥 죽상동맥경화증의 위험인자인가?
윤경호,정명호,강동구,김계훈,임상엽,이연상,이상현,홍서나,홍영준,김주한,안영근,조정관,박종춘,김남호,오석규,정진원,강정채 대한심장학회 2005 Korean Circulation Journal Vol.35 No.1
Background and Objectives :Overt and subclinical hypothyroidism is known to be associated with developing athe -rosclerosis and adverse changes in blod lipid. There has ben no data regarding the efects of a normal range of thyroid hormone on the presence of coronary atherosclerosis. Subjects and Methods :We studied 125 consecutive patients (age: 60.0± 11.1 years, male: female=84: 4 1) who underwent diagnostic coronary angiography. The clinical diagnoses on 14.4%). The thyroid hormones [thyroid stimulating hormone (TSH), fre thyroxine and fre 3 -iodothyronine], serum lipid levels, high sensitivity C -reactive protein (hsCRP) level, homocysteine and fibrinogen levels were measured. The coronary angiog -raphic results were compared with laboratory findings. Results:The angiographic diagnoses of coronary artery disea -se were no significant stenosis in 4 1in 37 patients (29.6%). The serum TSH levels showed a trend toward higher levels in the patients with multivessel disease compared to the patients with no significant stenosis ( 1.22± 0.96 uIU/mL vs. 0.73 ± 0.53 uIU/mL, respectively, p=0.053). According to the levels of TSH (< 1.0 uIU/mL and ≥1.0 IU/mL), the incidence of multivessel disease was signi-ficantly higher in the patients with high serum TSH levels (23. 1% vs. 40.0%, respectively, p=0.038). A significant corela -1, p=0.005), hsCRP level (r=0.208, p=0.023) and homocysteine level (r=0.279, p=0.002). Conclusion :The high level of serum TSH is asociated with multivesel disease, abnormal inflamatory markers and high homocysteine levels. 배경 및 목적:정상 범위의 갑상선 기능을 보이더라도 갑상선 호르몬의 변화가 관동맥 죽상경화증에 어떤 영향을 미치는지는 아직 알려지지 않았다. 본 연구는 갑상선 질환이 없는 환자들을 대상으로 갑상선 호르몬이 관동맥 죽상경화증의 위험인자가 되는지 알아보고자 하였다.방 법:흉통으로 관동맥 조영술을 시행받기 위해 입원한 125명의 환자(연령 60.0±11.1세, 남자:여자=84:41)를 대상으로 하였다. 대상 환자들의 입원시 임상진단은 안정형 협심증 40명(32.0%), 불안정형 협심증 67명(53.6%), 급성심근경색증이 18명(14.4%) 이었다. TSH, free T4, free T3, 총 콜레스테롤, 중성지방, HDL, LDL 콜레스테롤, Apo A1, Apo B, lipoprotein (a), 단핵구 수, ESR, hsCRP, homocysteine등을 측정하여 관동맥 병변의 정도와 비교하였다. 결 과:관동맥 조영술에서 유의한 협착이 없었던 환자는 41명 (32.8%), 단일혈관질환 47명(37.6%), 두혈관질환 26명 (20.8%), 세혈관질환 11명(8.8%) 이었다. 갑상선 호르몬은 TSH가 다혈관질환일수록 증가하는 경향을 보였으나 통계적인 유의성은 없었다(p=0.056). 혈중 TSH 농도 1.0 uIU/mL 를 기준으로 환자군을 분류했을 때 TSH가 높은 환자들에서 한 혈관 이상 관동맥 질환이 있는 경우가 많았고(57.7% vs.82.2%, p=0.004), 다혈관질환인 경우가 많았다(23.1% vs.40.0%, p=0.038). TSH 농도는 단핵구수(r=0.251, p=0.005), hsCRP(r=0.208, p=0.023), homocysteine(r=0.279, p=0.002)과 유의한 상관관계를 보였다. 관동맥 질환의 존재를 예측하는 독립적인 인자로는 총콜레스테롤, HDL콜레스테롤, Apo A1, Apo B 농도였으며(각각 p=0.034, 0.005, 0.022, 0.025), 갑상선 호르몬의 농도는 예측인자가 되지 못하였다. 결 론:한국인에서 정상 갑상선 기능을 가진 환자라고 하더라도 갑상선 자극 호르몬의 증가는 관동맥 죽상경화증의 중증도를 높일 수 있으며, 이는 혈중 지질 농도 뿐 아니라 염증인자나 homocysteine과도 관련이 있다.