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Medicine, South Korea

Sung J.,Cardiac and Vascular Center | Sung J.,Sungkyunkwan University | Woo J.-M.,Inje University | Kim W.,Inje University | And 2 more authors.
Clinical and Experimental Hypertension | Year: 2012

Objective: This article aimed to develop the "forest therapy" program, which is a cognitive behavior therapy (CBT)-based intervention program using forest environment, and investigate its effects on blood pressure (BP), salivary cortisol, and quality of life (QoL) measures in patients with hypertension. Methods: A total of 56 men and women were enrolled for this study, being referred from local health centers in Republic of Korea, from April to October 2009. They were conveniently assigned to either "forest" group participating in the forest therapy program or control group doing self-monitoring of BP. Measurements of salivary cortisol level and QoL were done at initial visits and at 8-week final visits. Results: Both groups did not differ significantly in baseline clinical characteristics. The BP change at week 4 and week 8 did not differ between the two groups. Salivary cortisol level reduction was significantly larger and QoL measures improved significantly more in the forest group at week 8 compared with the control group. Conclusions: The forest therapy program did not induce prolonged systolic blood pressure (SBP) reduction. However, considering the significant decrease in cortisol level and improvement in QoL measures, this may be a useful model of community hypertension management program. © 2012 Informa Healthcare USA, Inc. Source


Choi J.-O.,Sungkyunkwan University | Yun S.-H.,Sungkyunkwan University | Sung K.,Sungkyunkwan University | Lee Y.T.,Sungkyunkwan University | And 8 more authors.
Heart | Year: 2011

Background: In an animal model of viral myocarditis, plasma levels of thioredoxin and adiponectin have been reported to be associated with the severity of inflammation and recovery of ventricular dysfunction, respectively. However, there have been few reports about the clinical significance of these cytokine levels in human myocarditis. Objectives: To examine the hypothesis that cytokine levels correlate with clinical courses of patients with acute fulminant myocarditis (FM). Methods: A total of 33 consecutive patients with biopsy-proven acute myocarditis were evaluated. Twenty patients were ascribed to an FM group and the other 13 patients were grouped as a non-fulminant group (NFM). Plasma cytokine levels at the time of admission and after 2 weeks were evaluated and correlated with the duration of mechanical circulatory support application. Results: Plasma thioredoxin level at admission was raised in the FM group (3.08±2.15 ng/ml) compared with the NFM group (1.63±0.45 ng/ml, p=0.011) and reduced after an initial unstable period. However there was no significant difference in plasma adiponectin level between the two groups. In a multivariable regression model, increased plasma thioredoxin level (OR=5.79, 95% CI 1.67 to 20.1, p=0.006) and reduced plasma adiponectin level (OR=0.16, 95% CI 0.055 to 0.49, p=0.001) were associated with longer duration of mechanical circulatory support application in the patients with FM, which in turn was significantly related to death or cardiac transplantation. Conclusion: In patients with acute myocarditis, the plasma thioredoxin level was increased in the more severe form, and a reduced level of adiponectin was closely correlated with worse short-term outcome in patients with FM. Source


Park H.E.,Seoul National University | Chang S.-A.,Cardiac and Vascular Center | Kim H.-K.,Seoul National University | Shin D.-H.,Seoul National University | And 7 more authors.
Circulation: Cardiovascular Imaging | Year: 2010

Background-The effects of left ventricular (LV) loading conditions on LV dyssynchrony have not been elucidated. We modified LV loading conditions to reveal their effects on echocardiography-derived LV dyssynchrony index (LVdys) in patients with documented nonischemic dilated cardiomyopathy. Methods and Results-Thirty-seven patients were consecutively enrolled. After baseline measurements, pneumatic compression of the lower extremities (Pcom) was used to increase LV afterload. Subsequently, sublingual nitroglycerin (SL-NG) was administered to modify preload. Conventional echocardiographic parameters, LVdys (by speckle-tracking radial strain analysis) and LV end-systolic wall stress (LV-ESWS), were calculated under each condition. LVdys-6 (defined as the maximal difference in time-to-peak radial strain between 6 myocardial segments) and LV-ESWS increased under Pcom (for LVdys-6, 159±117 at baseline versus 239±140 ms under Pcom, P<0.05; for LV-ESWS, 191±63 versus 228±80 g/m2, P<0.05) After SL-NG application, both parameters decreased significantly (for LVdys-6, 239±140 under Pcom versus 147±103 ms after SL-NG, P<0.05; for LV-ESWS, 228±80 under Pcom versus 189±67 g/m2 after SL-NG, P<0.05). When the presence of LV dyssynchrony was defined as the absolute difference in time-to-peak radial strain between the anteroseptal and posterior segments (LVdys-2), the results were unchanged. Using 130 ms as a cutoff value, the proportion of patients with LV dyssynchrony changed significantly (29.7% at baseline, 45.9% under Pcom, and 35.1% after SL-NG). When the presence of LV dyssynchrony was defined as standard deviation of the time to peak radial strain for 6 segments (LVdys-SD), the results were same. LVdys and LV-ESWS showed a modest but significant association with each other (r=0.47, P<0.001 for LVdys-6; r=0.41, P<0.001 for LVdys-2; r=0.46, P<0.001 for LVdys-SD). Conclusions-To the best of our knowledge, the present study provides the first evidence of a significant association between LVdys and LV loading status, reflective of a dynamic nature of LVdys. Accordingly, LV loading conditions should be taken into account when echocardiographic LVdys is used for clinical decision-making of selecting candidates for cardiac resynchronization therapy or when it is used as a surrogate marker of prognosis. © 2010 American Heart Association, Inc. Source


Sung J.,Cardiac and Vascular Center | Sung J.,Sungkyunkwan University | Woo J.-M.,Inje University | Kim W.,Inje University | And 2 more authors.
Yonsei Medical Journal | Year: 2014

Purpose: Blood pressure variability (BPV) is emerging as an important cardiovascular prognostic factor in addition to average blood pressure level. While there have been some suggestions for the determinants of the blood pressure variability, little is known about the relationship between the blood pressure variability and health-related quality of life (QOL). Materials and Methods: Fifty-six men and women with mild hypertension were enrolled from local health centers in Republic of Korea, from April to October 2009. They self-monitored their blood pressure twice daily for 8 weeks. Pharmacological treatment was not changed during the period. Standard deviation and coefficient of variation of blood pressure measurements were calculated as indices of BPV. Measurements of QOL were done at initial and at 8-week follow-up visits. Results: Study subjects had gender ratio of 39:41 (male:female) and the mean age was 64±10 years. The mean home blood pressure's at week 4 and 8 did not differ from baseline. Total score of QOL at follow-up visit and change of QOL among two measurements were negatively correlated to BPV indices, i.e., higher QOL was associated with lower BPV. This finding persisted after adjustment for age, gender and the number of antihypertensive agents. Among dimensions of QOL, physical, mental and hypertension-related dimensions were associated particularly with BPV. Conclusion: QOL may be a significant determinant of BPV. Improvement of QOL may lead to favorable changes in BPV. © Yonsei University College of Medicine 2014. Source


Song B.G.,Cardiac and Vascular Center | Kim T.-E.,Konkuk University | Lee W.G.,Pusan National University | Yang H.S.,Cardiac and Vascular Center
Experimental and Clinical Cardiology | Year: 2014

Background: Fluid status plays an important role in various cardiac indices. We tested the acute impact of hemodialysis on left ventricular twist mechanics. Methods: We evaluated 31 consecutive patients (male 13, mean age 53, diabetes 61%) with routine hemodialysis. We used a Vivid I portable ultrasound system (GE Healthcare, Milwaukee, WI) to acquire 2D and Doppler images before and after hemodialysis, comparing peak systolic longitudinal strain (PSLS), rotation and twist before and after hemodialysis. We compared the patients as two groups according to the amount of net ultrafiltrate loss after hemodialysis (Group I < 2L, Group II = 2L). Results: Among the 31 patients, there was a decrease of mitral E velocity (p=0.003) and PSLS from the long axis view (p=0.059); however, there was an increase of twist (from 14.6±5.5 to 20.3±7.8 degree, p<0.001). Group I contained 15 pts; group II, 16. After hemodialysis, the degrees of twist were similar between the two (26.6±10.0 vs. 26.5±7.0 degrees, p=0.983); however, baseline twist had tendency to be high in group II (18.3±3.8 vs. 21.9±7.1 degrees, p=0.092). The amount of decrease of mitral E wave velocity during the hemodialysis was larger in group II (group I: from 0.65±0.23 to 0.62±0.18 m/s; group II: from 0.78±0.24 to 0.63±0.21 m/s, p=0.041). Change of medial mitral annular e' was not significant regardless of the amount of net fluid removal (p=0.805). Conclusion: There was an increase of twist after hemodialysis overall-it may come from different filling and hemodynamic status in individual cases, not just preload reduction during the hemodialysis. Due to the acute impact of hemodialysis on LV twist, we suggested that LV twist obtained by 2D speckle echocardiography should be applied cautiously in patients with hemodialysis to evaluate LV systolic function. Source

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