Polymorphisms of IGF-1 gene and its receptor gene in Korean people treated With coronary artery stenting

권동아,박진식,장서영,김화평,김효수,손대원,오병희,이명묵,박영배,최윤식 대한내과학회 2004 대한내과학회 추계학술발표논문집 Vol.2004 No.1

중증 삼첨판 폐쇄부전증 환자의 수술 후예후를 예측하는 심초음파 인자

권동아,신동호,정진욱,이승표,김유정,김선영,황석재,박진식,장혁재,김용진,손대원,김기봉,안혁,오병희,박영배,최윤식 대한심장학회 2005 Korean Circulation Journal Vol.35 No.12

Background and Objectives:This study was performed to identify echocardiographic parameters related to postoperativeclinical outcome (PCO) in patients undergoing surgery for severe tricuspid regurgitation (TR) followingmitral valve surgery. The indications for surgery due to severe TR following mitral valve surgery are notwell defined largely because of a lack of knowledge of the prognostic factors of PCO in these patients. Subjectsand Methods:Eighteen patients (male/female; 2/16, mean age 58 years) with severe TR associated with priormitral valve surgery were prospectively enrolled. Comprehensive echocardiographic examinations were performedbefore and 15±7 months after surgery. Favorable PCO was defined as an improvement of ≥1 in New YorkHeart Association (NYHA) functional class or a >25% increase in respiratory variation of IVC diameter. Nonsurvivorsand survivors without a favorable PCO were defined as having an unfavorable PCO. Results:Theoperative mortality was 11% (2/18). Of the 16 survivors, nine (9/16, 56%) achieved a favorable PCO. NYHAfunctional class, age, left ventricular ejection fraction, right ventricular fractional area change, severity of TR andpulmonary artery pressure were not related to PCO. Only systolic tricuspid annulus velocity (ST') was found tobe associated with PCO (favorable vs unfavorable PCO; 12.9±2.1cm/s vs 9.7±1.7cm/s, p<0.05). For ST’ value(9.5 cm/s, the sensitivity, specificity, positive and negative predictive values for predicting an unfavorable PCOwere 67%, 100%, 100% and 75%, respectively. Conclusion:This study shows that ST’ can predict PCO in patientsundergoing surgery for severe TR following mitral valve surgery. 배경 및 목적:중증의 삼첨판 폐쇄부전증의 예후를 예측하는 인자는 잘알려져 있지 않아 치료에 대해 많은 논란이 있으며 이로 인하여 수술의 적응증을 정하기 어렵다. 본 연구는 중증 삼첨판 폐쇄부전증을 가진 환자에서 수술 후 예후를 예측하는 심초음파 인자를 찾기 위하여 시행하였다.방 법:2003년 8월부터 2005년 1월까지 중증의 기능성 삼첨판폐쇄부전증으로 심초음파 검사를 시행하고 삼첨판막 수술을시행한 18명의 환자를 대상으로 연구를 전향적으로 진행하였다. 모든 환자에서 수술 전 일반 심초음파 검사와 함께 조직 도플러 검사를 이용한 삼첨판윤속도 측정을 시행하였다.12명의 환자에서 삼첨판막 치환술을 시행하였고 나머지 환920·Korean Circulation J 2005;35:916-920자에서 성형술을 시행하였다. 수술 후 평균 15±7개월 지난후 심초음파 추적 검사를 시행하였다. 양호한 수술 후 임상결과는 추적 검사에서 NYHA 기능성 분류가 1단계 이상 호전되었거나 호흡에 따른 하대정맥 직경의 변화가 증가된 경우로 정의하였다. 결 과: 수술 후 사망 환자는 2명으로 사망률은 11%이었다. NYHA 기능성 분류, 나이와 좌심실 구혈율, 우심실 면적변화율 등의 일반적인 심초음파 인자는 수술 후 사망률이나 임상 결과와 무관하였다. 오직 수축기 삼첨판윤속도가 수술 후 사망률과 임상 결과와 관련있었다(양호한 임상 결과: 12.9±2.1cm/s, 나쁜 임상 결과: 9.7±1.7 cm/s, p<0.05). 수축기 삼첨판윤속도의 기준을 9.5 cm/s로 할 때 사망 및 나쁜 임상결과를 예측하는 민감도 및 특이도는 각각 67%, 100%이고양성 및 음성 예측율은 각각 100% 및 75%이다. 결 론: 중증의 삼첨판 폐쇄부전증을 가지고 있는 환자에서 수축기 삼첨판윤속도를 측정하여 수술 후 사망률이나 임상 결과를 예측할 수 있어 치료 방침을 결정하는데 도움이 된다.

Late Late Stent Thrombosis after Intracoronary Brachytherapy: Learning from Brachytherapy Experiences in the Drug-Eluting Stent Era

신동호,권동아,정진욱,이승표,장성아,강병수,박경우,강현재,구본권,채인호,김효수,손대원,오병희,이명묵,박영배,최윤식 대한심장학회 2006 Korean Circulation Journal Vol.36 No.4

Stent thrombosis is generally a fatal complication after percutaneous coronary intervention. Combined antiplatelet therapy is recommended to prevent stent thrombosis in those patients who have undergone stenting. However, there are conflicting opinions on the appropriate duration of instituting antiplatelet treatment, especially after intracoronary radiation therapy or drug-eluting stent implantation, which are two situations closely associated with an increased risk of stent thrombosis. We report here on 2 cases of late stent thrombosis that occurred despite giving combined antiplatelet therapy, and these maladies developed more than 4 years after intracoronary brachytherapy. (Korean Circulation J 2006;36:324-327)

우연히 발견된 선천성 좌심방류 1예

이승표,권동아,신동호,정진욱,장혁재,김광일,조영석,연태진,정우영,채인호,최동주,김철호 한국심초음파학회 2005 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.13 No.2

선천성 우심실 게실 1예

정진욱,권동아,신동호,장성아,이승표,강병수,김용진,손대원 한국심초음파학회 2005 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.13 No.4

항문을 침범한 비형 NK/T세포림프종 1예

김선영,김유정,권동아,이세훈,김동완,임석아,김태유,허대석,방영주 대한혈액학회 2005 Blood Research Vol.40 No.3

악성림프종의 항문 침범은 매우 드문현상으로, 일반인구보다 후천성면역결핍증 환자에서 좀더 높은 빈도로 나타나고 대개 B세포계열이다. 비형NK/T세포림프종은 피부와 위장관 침범이 비교적 흔하지만 항문의 침범은 아직 국내에서 보고된 바가 없다. 저자들이 경험한 증례에서는, 23세 남자환자가 발열과 체중감소, 항문주위농양으로 내원하여 항문조직검사에서 NK/T세포림프종을 진단받았고, EBV in situ hybridization에서 양성을 보였으며, 복합항암화학요법에도 불구하고 진단 후 2개월만에 사망하였다. 항문주위병변과 다른부위의 병변을 동반하면서 발열, 오한 등의 B 증상을 발현하는 환자에서는 항문을 침범한 림프종의 가능성이 고려되어야 하겠고 항문의 조직검사가 필요하다.

Celecoxib Does Not Deteriorate Antiplatelet Effects of Aspirin and Clopidogrel in Healthy Volunteers

이원재,조현주,권동아,서정원,양한모,김효수,오병희,박영배 한국지질동맥경화학회(구 한국지질학회) 2008 한국지질동맥경화학회 추계학술발표논문집 Vol.2008 No.-

Celecoxib Does Not Attenuate the Antiplatelet Effects of Aspirin and Clopidogrel in Healthy Volunteers

이원재,서정원,양한모,권동아,조현주,강현재,김효수,오병희 대한심장학회 2010 Korean Circulation Journal Vol.40 No.7

Background and Objectives: The prevalence of arthritis, which is often treated with celecoxib, is high in patients with coronary artery disease. Furthermore, celecoxib has been reported to reduce restenosis after coronary stenting by inhibiting expression of the proto-oncogene Akt. A concern is that celecoxib increases thrombogenicity by inhibiting the synthesis of prostacyclin in endothelial cells. However, it is not known whether the administration of celecoxib will attenuate the antiplatelet effects of aspirin and clopidogrel, which are used after stenting. We addressed this gap in our knowledge. Subjects and Methods: We recruited healthy volunteers (n=40) and randomized them into five subgroups (n=8 for each group: aspirin,celecoxib, aspirin+celecoxib, aspirin+clopidogrel, and aspirin+clopidogrel+celecoxib). Each subject received their medications for 6 days and blood samples were taken on day 0 and day 7. Celecoxib (200 mg twice a day), and/or aspirin (100 mg daily),and/or clopidogrel (75 mg daily) were administered. We compared platelet function among subgroups using light transmittance aggregometry and arachidonic acid metabolite assays. Results: Celecoxib treatment alone did not significantly affect platelet aggregation. The reduction in adenosine diphosphase (ADP)-induced platelet aggregation by aspirin+clopidogrel was not affected by addition of celecoxib (31.3±6.9% vs. 32.4±12.2%, p=0.83). Inhibition of collagen-induced platelet aggregation by aspirin+clopidogrel was not affected by addition of celecoxib (47.6±13.4% vs. 51.6±3.7%, p=0.69). Drug-induced changes in prostacyclin and thromboxane levels did not differ among treatment groups. Conclusion: Celecoxib treatment does not interfere with the antiplatelet effects of aspirin or clopidogrel, suggesting that celecoxib can be safely administered in combination with dual antiplatelet therapy in patients with coronary stenting without increased thrombogenicity.

Systolic Mitral Annular Velocity as A Simple Marker of Left Ventricular Peak Systolic DP/DT in Patients with Significant Mitral Regurgitation

김민석,김영진,김형관,권동아,김대희,서재빈,양한모,최동현,손대원 한국심초음파학회 2008 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.16 No.2

Background: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S’) can be a good marker of LV dP/dt. Methods: We studied 62 patients (25 men, age: 47±15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S’ velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated. Results: Mean LV ejection fraction was 60±6% and regurgitant fraction was 59±15%. S’ velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S’ velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction. Conclusion: Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR. Background: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S’) can be a good marker of LV dP/dt. Methods: We studied 62 patients (25 men, age: 47±15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S’ velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated. Results: Mean LV ejection fraction was 60±6% and regurgitant fraction was 59±15%. S’ velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S’ velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction. Conclusion: Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR.