Severance Cardiovascular Hospital and Cardiovascular Research Institute

Seoul, South Korea

Severance Cardiovascular Hospital and Cardiovascular Research Institute

Seoul, South Korea
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Oh J.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Kang S.-M.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Kim I.-C.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Han S.,Hallym University | And 9 more authors.
Journal of Cardiology | Year: 2017

Background Hemoconcentration (HC) is associated with reduced mortality, whereas hyponatremia (HN) has been associated with an increased risk of adverse outcomes in patients with acute decompensated heart failure (ADHF). We sought to determine if the presence of HN influences the beneficial prognostic value of HC in ADHF patients. Methods We analyzed 2046 ADHF patients from the Korean Heart Failure Registry. We defined HC as an increased hemoglobin level from admission to discharge, and HN as sodium <135 mmol/L at admission. Our primary composite endpoint was all-cause mortality and/or HF re-hospitalization. Results Overall, HC occurred in 889 (43.5%) patients and HN was observed in 418 patients (20.4%). HC offered higher 2-year event-free survival in patients without HN (73.2% vs. 63.1% for no-HC, log-rank p < 0.001), but not in patients with HN (54.2% vs. 58.7% for no-HC, log-rank p = 0.879, p for interaction = 0.003). In a multiple Cox proportional hazard analysis, HC without HN conferred a significant event-free survival benefit (hazard ratio: 0.703, 95% confidence interval 0.542–0.912, p = 0.008) over no-HC with HN. Conclusions Only HC occurring in ADHF without HN was associated with improved clinical outcomes. These results provide further support for the importance of HN as a challenging therapeutic target in ADHF patients. © 2016 Japanese College of Cardiology


Won H.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Kang S.-M.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Kang S.-M.,Yonsei University | Shin M.-J.,Korea University | And 10 more authors.
Yonsei Medical Journal | Year: 2012

Purpose: Plasma adiponectin concentrations are inversely related with metabolic syndrome (MetS), and MetS is associated with increased risk for heart failure (HF). However, the relationship between adiponectin and MetS in HF remains undetermined. Therefore, we tested whether MetS was associated with the degree of plasma adiponectin concentrations in HF patients. Materials and Methods: One hundred twenty eight ambulatory HF patients with left ventricular ejection fraction of <50% (80 males, 61.8±11.9 years old) were enrolled for this cross-sectional study. Echocardiographic measurements were performed, and plasma concentrations of adiponectin, lipoproteins, apolipoproteins (apoB, apoA1) and high sensitive C-reactive protein (hsCRP) were measured. Results: Adiponectin concentrations in HF patients with MetS (n=43) were significantly lower than those without MetS (n=85) (9.7±7.0 vs. 15.8±10.9 μg/mL, p=0.001). Higher concentrations of apoB (p=0.017), apoB/A1 ratio (p<0.001), blood urea nitrogen (p=0.034), creatinine (p=0.003), and fasting insulin (p=0.004) were observed in HF patients with MetS compared with those without MetS. In HF patients with MetS, adiponectin concentrations were negatively correlated with hsCRP (r=-0.388, p=0.015) and positively correlated with the ratio of early mitral inflow velocity to early diastolic mitral annular velocity, E/E' (r=0.399, p=0.015). There was a significant trend towards decreased adiponectin concentrations with an increasing number of components of MetS (p for trend=0.012). Conclusion: Our study demonstrated that adiponectin concentrations decreased in HF patients with MetS, and that relationship between adiponectin, inflammation and abnormal diastolic function, possibly leading to the progression of HF. © Yonsei University College of Medicine 2012.


Hong N.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Hong N.,Yonsei University | Oh J.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | Kang S.-M.,Severance Cardiovascular Hospital and Cardiovascular Research Institute | And 9 more authors.
Clinica Chimica Acta | Year: 2012

Background: Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in cardiovascular diseases. We studied whether RDW is useful to predict early mortality in patients with acute dyspnea at an emergency department (ED). Methods: We retrospectively analyzed 907 patients with acute dyspnea who visited the ED from January 2009 to May 2009. Primary outcome was 30-day mortality. Results: Acute decompensated heart failure (29.9%) was the most common adjudicated discharge diagnosis followed by cancer (14.8%) and pneumonia (12.5%). There was a stepwise increase of 30-day mortality risk from lowest (RDW. <. 12.9%) to highest (RDW. >. 14.3%) RDW tertiles (1.4% vs. 8.3% vs. 18.3%; log-rank P. <. 0.001). In multivariate Cox hazard analysis, RDW was an independent predictor of 30-day mortality after adjusting for other risk factors (HR 1.23; 95% CI 1.11-1.36; P. <. 0.001). Adding RDW to conventional clinical predictors significantly improved prediction for 30-day mortality as measured by the area under the ROC curve (AUC, from 0.873 to 0.885; P. =. 0.023) and the net reclassification improvement (NRI. =. 14.1%; P. <. 0.001)/integrated discrimination improvement (IDI. =. 0.038; P. =. 0.006). Conclusions: Our findings suggest that RDW measured at ED is an independent and additive predictor of early mortality in patients with acute dyspnea. © 2012 Elsevier B.V.


PubMed | Severance Cardiovascular Hospital and Cardiovascular Research Institute
Type: Journal Article | Journal: Clinica chimica acta; international journal of clinical chemistry | Year: 2012

Red blood cell distribution width (RDW) has been shown to predict clinical outcomes in cardiovascular diseases. We studied whether RDW is useful to predict early mortality in patients with acute dyspnea at an emergency department (ED).We retrospectively analyzed 907 patients with acute dyspnea who visited the ED from January 2009 to May 2009. Primary outcome was 30-day mortality.Acute decompensated heart failure (29.9%) was the most common adjudicated discharge diagnosis followed by cancer (14.8%) and pneumonia (12.5%). There was a stepwise increase of 30-day mortality risk from lowest (RDW<12.9%) to highest (RDW>14.3%) RDW tertiles (1.4% vs. 8.3% vs. 18.3%; log-rank P<0.001). In multivariate Cox hazard analysis, RDW was an independent predictor of 30-day mortality after adjusting for other risk factors (HR 1.23; 95% CI 1.11-1.36; P<0.001). Adding RDW to conventional clinical predictors significantly improved prediction for 30-day mortality as measured by the area under the ROC curve (AUC, from 0.873 to 0.885; P=0.023) and the net reclassification improvement (NRI=14.1%; P<0.001)/integrated discrimination improvement (IDI=0.038; P=0.006).Our findings suggest that RDW measured at ED is an independent and additive predictor of early mortality in patients with acute dyspnea.

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