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진무년,송창호,김태훈,엄재선,박희남,이문형,정보영 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.2
Purpose: Despite undergoing successful catheter ablation of typical atrial flutter (AFL), patients remain at increased risk for ischemicstroke. However, data on risk prediction tools for the development of stroke after AFL ablation are lacking. This study investigateswhether CHA2DS2-VASc score is useful for predicting ischemic stroke after successful ablation of typical AFL. Materials and Methods: A total of 293 patients (236 men, mean age 56.1±13.5 years) who underwent successful radiofrequency catheter ablation for typical AFL were included in this study. The clinical end point was occurrence of ischemic stroke during follow-up after AFL ablation. Results: During the follow-up period (60.8±45.9 months), ischemic stroke occurred in 18 (6%) patients at a median of 34 months (interquartile range, 13−65 months). CHA2DS2-VASc score [hazard ratio 2.104; 95% confidence interval (CI), 1.624−2.726; p<0.001] was an independent predictor for the occurrence of stroke after AFL ablation. The area under the receiver operating characteristic curve for CHA2DS2-VASc score was 0.798 (95% CI, 0.691−0.904). The CHA2DS2-VASc score could be used to stratify patients into two groups with different incidences of ischemic stroke (1.6% vs. 14.4%, p<0.001) at a cutoff value of 2. Conclusion: CHA2DS2-VASc score is useful in a prediction model for the risk of stroke after catheter ablation of typical AFL.
The Case of Isolated Double Atrial Septum with Persistent Interatrial Space
김인수,진무년,송창호,김영주,지아영,손정우,장혁재,홍그루,하종원,정남식 한국심초음파학회 2013 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.21 No.4
Double atrial septum is very rare atrial septal malformation which has double layered atrial septum with persistent interatrial space between the two atria. Clinically, most cases of this anomaly are asymptomatic unless manifest as thromboembolic complications, such as stroke, or transient ischemic attack, that thrombus may be originated from this interatrial space. We report a case of a 69-year-old man who was diagnosed with isolated double atrial septum by transthoracic echocardiography.
송창호,정보영,진무년,이정희,김인수,엄재선,박희남,이문형 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1
Purpose: The identification of sick sinus syndrome (SSS) in patients with atrial flutter (AFL) is difficult before the termination of AFL. This study investigated the patient characteristics used in predicting a high risk of SSS after AFL ablation. Materials and Methods: Out of 339 consecutive patients who had undergone radiofrequencyablation for AFL from 1991 to 2012, 27 (8%) had SSS (SSS group). We compared the clinical characteristics of patients with and without SSS (n=312, no-SSS group). Results: The SSS group was more likely to have a lower body mass index (SSS: 22.5±3.2; no-SSS: 24.0±3.0 kg/m2; p=0.02), a history of atrial septal defects (ASD; SSS: 19%; no-SSS: 6%; p=0.01), a history of coronary artery bypass graft surgery (CABG; SSS: 11%; no-SSS: 2%; p=0.002), and a longer fluttercycle length (CL; SSS: 262.3±39.2; no-SSS: 243.0±40; p=0.02) than the no-SSS group. In multivariate analysis, a history of ASD [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.2‒11.4, p=0.02] and CABG (7.1, 95% CI 1.5‒32.8, p=0.01) as well as longer flutter CL (1.1, 95% CI 1.0‒1.2, p=0.04) were independentrisk factors for SSS. Conclusion: A history of ASD and CABG as well as longerflutter CL increased the risk of SSS after AFL ablation. While half of the patientswith SSS after AFL ablation experienced transient SSS, heart failure was associated with irreversible SSS.
김광실,서종권,김병규,진무년,이혜영,김병옥,변영섭 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.4
Purpose: Only a few Asian studies have discussed the impact of statin intensity on clinical outcomes in patients with peripheralartery disease (PAD). We aimed to investigate the clinical impact of statin intensity in patients with PAD after endovascular revascularization. Materials and Methods: From April 2009 to June 2019, 376 patients with lower extremity PAD treated with endovascular revascularizationwere enrolled. They were classified into three groups according to statin intensity: no-statin, low-to-moderate intensity(LMI), and high-intensity (HI). The primary outcomes were major adverse cardiovascular events (MACE) and major adverselimb events (MALE). Results: During the 40-month follow-up, MACE occurred less frequently in the HI and LMI groups than the no-statin group(11.4% vs. 16.0% vs. 39%, p<0.001). In adjusted Cox models, the HI group had the fewest MACE [hazard ratio (HR): 0.447; 95%confidence interval (CI): 0.244–0.834; p=0.018] and MALE (HR: 0.360; 95% CI: 0.129–1.006; p=0.051) events, while the LMI grouphad fewer MACE (HR: 0.571; 95% CI: 0.326–1.0; p=0.050) events than the no-statin group. HI statin therapy was associated withbetter outcomes in terms of MALE (HR: 0.432; 95% CI: 0.223–0.837; p=0.003) than LMI statin therapy after inverse probabilitytreatment weighting analysis. Conclusion: HI and LMI statin use is associated with a significant reduction in MACE events than no-statin use. HI statin use wasassociated with better MALE outcomes than no-statin or LMI statin use.
정상 면역 환자에서 천공과 출혈을 동반한 거대세포바이러스 대장염
김선욱,차윤진,김민환,진무년,이중희,박혜정,장수연,이혁 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2
Cytomegalovirus (CMV) infection in immunocompromised patients is associated with significant morbidity, mortality, and adverse clinical outcome. However, CMV infection in immunocompetent patients has been considered to have subclinical and self-limited course, and does not require treatment. We reports a case of CMV colitis, presented with colon perforation and lower gastrointestinal bleeding in a immunocompetent 31-year-old young male. After conservative treatment, colonoscopy revealed multiple ulcers in transverse colon. CMV colitis was confirmed by microscopic findings and immunohistochemistry. After successful treatment with ganciclovir, the patient improved without invasive procedure.