Cardiac and Vascular Center

Medicine, South Korea

Cardiac and Vascular Center

Medicine, South Korea
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Lee M.,Cardiac and Vascular Center | No H.J.,Cardiac and Vascular Center | Jang S.Y.,Cardiaovascular Imaging Center | Kim N.,Cardiac and Vascular Center | And 4 more authors.
Yonsei Medical Journal | Year: 2012

Purpose: Hereditary thrombophilia (HT) is a major risk factor for idiopathic pulmonary embolism (iPE) and shows different prevalence among ethnic groups. The prevalence and clinical characteristics of HT in Korean patients with iPE were investigated. Materials and Methods: Patients with PE on computed tomography (CT) scan were recruited, and those with malignancy were excluded. Patients were divided into iPE and provoked PE (pPE) groups. The presence of HT in the iPE group was assessed by DNA sequencing of the corresponding gene in patients who had low levels of natural anticoagulants. The clinical characteristics of iPE with HT (iPE/HT+) were compared with those of iPE without HT (iPE/HT-) and pPE. Results: Out of 161 patients, 84 patients had iPE and 77 patients had pPE. Among 54 patients in the iPE group whose coagulation profiles were tested, 28 patients were diagnosed with HT (51.9%; 28/54). Compared with the iPE/HT- and pPE groups, the iPE/HT+ group showed the highest proportion of male patients (71.4%; p<0.001); the youngest mean age (44±14 years; p<0.001); and the highest frequencies for history of venous thromboembolism (64.3%; p<0.001), concurrent deep vein thrombosis (75.0%; p=0.021), and adverse clinical outcomes (42.9%, p<0.001). Protein C deficiency was the most common HT. On molecular genetic tests, causative mutation was identified in 13 patients. Conclusion: In this study of Korean patients, about half of the patients with iPE had HT. Patients with iPE and HT were mostly young males with deep venous thrombosis (DVT), previous venous thromboembolism (VTE), and frequent adverse clinical outcomes. Therefore, Korean patients with iPE should be tested for HT. © Yonsei University College of Medicine 2012.


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.


Jung H.-J.,Cardiac and Vascular Center | Song B.G.,Cardiac and Vascular Center | Heo S.H.,Cardiac and Vascular Center | Kim K.Y.,Cardiac and Vascular Center | Kim Y.-I.,Inje University
Asian Cardiovascular and Thoracic Annals | Year: 2012

Although clinically significant bioprosthetic valve thrombosis is rare, it should be considered a possible cause of valve dysfunction when there is an increasing transvalvular pressure gradient after anticoagulation is terminated.We describe a rare case of bioprosthetic mitral thrombosis in a 77-year-old woman 2 years after valve replacement and a maze procedure. © The Author(s) 2012.


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.


Sung J.,Cardiac and Vascular Center | Sung J.,Sungkyunkwan University | Choi S.H.,Sungkyunkwan University | Choi Y.-H.,Cardiac and Vascular Center | And 3 more authors.
Journal of Hypertension | Year: 2012

Background: Arterial stiffness is increased in hypertension, even at an earlier stage. The blood pressure (BP) response to exercise reflects the future risk of developing hypertension. We investigated the relationship between the pulse wave velocity (PWV) and the BP response to exercise to evaluate whether arterial stiffness is increased in normotensive persons with higher exercise BPs. Methods: The participants of the study were adults with normal BP (SBP < 120 mmHg and DBP < 80 mmHg) without history of clinical cardiovascular diseases, who had undergone health screening. Treadmill exercise tests were done by modified Bruce protocol, and brachial-ankle PWV (baPWV) was measured. Results: The participants were 2156 men and women (69 : 31%) with mean age of 52 ± 5 years. The baPWV correlated significantly to variables such as age, sex, baseline SBP and DBP, pulse pressure, maximal oxygen consumption (VO 2max), SBP at stage 1, at stage 2 and peak exercise and hemoglobin A1c (HbA1c). In multiple regression model, SBP at stage 1 had a significant association with baPWV after an adjustment with age, sex, VO2max and SBP at rest, current smoking and HbA1c. For every 10 mmHg increase in exercise SBP, baPWV increased by 18 ± 0.3 cm/s (P < 0.001). Conclusion: In normotensive individuals, increased arterial stiffness, as reflected by baPWV, is accompanied by higher SBP at the early stage of treadmill exercise test. This finding suggests that arterial stiffening processes are present even in the normotensive setting and are correlated with BP changes during exercise. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Lee S.H.,Heart Vascular Stroke Institute | Lee S.H.,Sungkyunkwan University | Yang J.H.,Heart Vascular Stroke Institute | Yang J.H.,Sungkyunkwan University | And 7 more authors.
Circulation Journal | Year: 2015

Background: Limited data are available on the clinical outcomes of medical therapy (MT) compared with revascularization in elderly patients with coronary chronic total occlusion (CTO). Methods and Results: Between March 2003 and February 2012, we retrospectively analyzed 311 patients aged ≥75 years in the Samsung Medical Center CTO registry. Among these, 153 patients were treated with MT and 158 patients with revascularization by intervention or surgery. Inverse probability of treatment weighting (IPTW) and propensity score-matching were performed. The primary outcome was cardiac death during follow-up. Median followup duration was 34 (interquartile range: 15–58) months. Overall, patients in the MT group were high-risk subjects. Cardiac death of 30 patients (19.6%) occurred in the MT group vs. 17 patients (10.8%) in revascularization group (P=0.027). In the multivariate analysis, there was no significant difference between groups in the rate of cardiac death (hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.86–3.24, P=0.13). After adjustment with IPTW, MT showed comparable risk of cardiac death with revascularization therapy (HR, 1.26; 95% CI, 0.71–2.21, P=0.43). In the propensity score-matched population, there was no significant difference in the rate of cardiac death between the MT and revascularization groups (HR, 1.52; 95% CI, 0.76–3.07, P=0.24). Conclusions: In the treatment of CTO in elderly patients, MT alone did not increase the risk of long-term cardiac death when compared with aggressive revascularization treatment. © 2015, Japanese Circulation Society. All rights reserved.


Kim J.-H.,Cardiac and Vascular Center | Yang J.H.,Cardiac and Vascular Center | Yang J.H.,Sungkyunkwan University | Choi S.-H.,Cardiac and Vascular Center | And 5 more authors.
American Journal of Cardiology | Year: 2014

Contrast-induced acute kidney injury (CI-AKI) is a serious complication that is difficult to predict in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). The aim of this study was to investigate predictors and clinical outcomes of CI-AKI in patients with CKD after PCI. A total of 297 patients with CKD who underwent PCI from September 2006 to December 2011 were enrolled. CI-AKI was defined as serum creatinine level either ≥25% or ≥0.5 mg/dl from baseline within 72 hours after PCI. The primary outcome was all-cause death. The median follow-up duration was 26 months (interquartile range 12 to 40), and CI-AKI occurred in 55 patients (19%). In multivariate logistic regression analyses, the development of CI-AKI was associated with female gender, left ventricular systolic dysfunction, acute myocardial infarction, PCI for left main disease, serum hemoglobin level, and a contrast volume to creatinine clearance ratio >6.0. The development of CI-AKI was significantly associated with increased in-hospital mortality (18.2% vs 3.7%, p = 0.001). Cox proportional-hazard analysis showed that the incidence of all-cause death was significantly higher in patients who developed CI-AKI than in those without CI-AKI (41.8% vs 16.1%, adjusted hazard ratio 3.0, 95% confidence interval 1.6 to 5.6, p <0.001). In conclusion, female gender, left ventricular systolic dysfunction, acute myocardial infarction, PCI for left main disease, serum hemoglobin level, and contrast volume to creatinine clearance ratio >6.0 are independent predictors of CI-AKI. The development of CI-AKI is significantly associated with increased in-hospital and long-term adverse clinical outcomes in patients with CKD undergoing PCI. © 2014 Elsevier Inc. All rights reserved.


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.


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.


PubMed | Cardiac and Vascular Center
Type: Clinical Trial | Journal: Clinical and experimental hypertension (New York, N.Y. : 1993) | Year: 2012

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.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.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.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.

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