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나승운,박지영,최병걸,최세연,최재웅,류성기,이세진,김승환,노영균,Raghavender Goud Akkala,Hu Li,Jabar Ali,김지박,이선기,나진오,최철웅,임홍의,김진원,김응주,박창규,서홍석,오동주 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1
Purpose: Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are associated with a decreasedincidence of new-onset diabetes mellitus (NODM). The aim of this study was to compare the protective effect of ACEIversus ARBs on NODM in an Asian population. Materials and Methods: We investigated a total of 2817 patients who did not have diabetes mellitus from January 2004 to September2009. To adjust for potential confounders, a propensity score matched (PSM) analysis was performed using a logistic regressionmodel. The primary end-point was the cumulative incidence of NODM, which was defined as having a fasting bloodglucose ≥126 mg/dL or HbA1c ≥6.5%. Multivariable cox-regression analysis was performed to determine the impact of ACEI versusARB on the incidence of NODM. Results: Mean follow-up duration was 1839±1019 days in all groups before baseline adjustment and 1864±1034 days in the PSMgroup. After PSM (C-statistics=0.731), a total 1024 patients (ACEI group, n=512 and ARB group, n=512) were enrolled for analysisand baseline characteristics were well balanced. After PSM, the cumulative incidence of NODM at 3 years was lower in the ACEIgroup than the ARB group (2.1% vs. 5.0%, p=0.012). In multivariate analysis, ACEI vs. ARB was an independent predictor of thelower incidence for NODM (odd ratio 0.37, confidence interval 0.17–0.79, p=0.010). Conclusion: In the present study, compared with ARB, chronic ACEI administration appeared to be associated with a lower incidenceof NODM in a series of Asian cardiovascular patients.
나승운,Kang-Yin Chen,오동주,Yong-Jian Li,Zhe Jin,Kanhaiya Lal Poddar,Sureshkumar Ramasamy,Yoshiyasu Minami,Amro Elnagar,최병걸,Sang Pyo Hong,Byoung Won Cheon,Sang Ki Moon,Sung Il Im,Sun Won Kim,나진오,홍영준,임홍의,김진원 대한심장학회 2012 Korean Circulation Journal Vol.42 No.6
Background and Objectives: Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. Materials and Methods: Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal siroli-mus-eluting stent (SES, Cypher TM )+proximal paclitaxel-eluting stent (PES, Taxus TM ) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up an-giography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. Results: Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39±0.07) and C+T (0.40±0.20) than that in the T+C (0.06±0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C,p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. Conclusion: Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the im -plantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.
3차원 Non-Contact Mapping으로 관찰한 심방세동의 유발 및 지속의 기전
나승운,김영훈,박희남,박상원,신성희,김응주,박성미,김용현,박미영,임도선,심완주,오동주,노영무 대한심장학회 2004 Korean Circulation Journal Vol.34 No.2
Background and Objectives:We undertook this study to assess the initiation and maintenance mechanisms ofatrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonaryveins (PVs). Subjects and Methods:Thirty-seven patients (33 men, mean age 50, range 25-68 years) with paroxysmalAF (n=29) and persistent AF (n=8) who underwent mapping of the LA and PV using 3D non-contactendocardial mapping system (EnSite 3000) were enrolled. The multielectrode array and ablation catheter werepositioned in the LA via the double transseptal approach. Atrial premature beats (APBs) which triggered initiationof AF that lasted longer than 1 min were mapped and the activation sequence was analyzed on isopotential colormaps. Wave front dynamics and the relationship with the underlying structures were assessed. Results:Morethan half, 56.4%, of APBs from PV were related to the initiation of AF, but not related to the maintenance of AF.A quarter, 25.6%, of APBs from PV not only initiated AF, but also maintained AF without continuous triggering.Mixed type and indeterminate type of AF was 5.0% and 12.8%, respectively. During AF, the mean number ofwavelets was 1.45 (maximum 3 in 76.5%). Anatomical structures showing slow conduction and wavebreakswere mostly located at the septopulmonary bundle (86.5%) and the posterior roof of the LA between the leftsuperior PV and right superior PV (54.1%). Conclusion:Focal repetitive activity from PV played an importantrole in both the initiation and maintenance of AF. Specific anatomical structures such as septopulmonary bundleor posterior roof of the LA were related to the heterogeneous conduction delay and spontaneous wavebreak,which was also important in the maintenance of AF. (Korean Circulation J 2004;34 (2):195-203) 배경 및 목적:본 연구는 심방세동의 유발 및 지속 기전과 해부학적인 구조와의 관계를 규명하기 위하여 시행된 것이다.방 법:37명의 약물에 반응하지 않는 심방세동 환자(남자33명, 평균연령 50세, 25~68세, 발작성 심방세동 29명,지속성 심방세동 8명)을 대상으로 좌심방과 폐정맥을 3차원적 비접촉성 심내막 mapping(EnSite 3000)을 이용하여 분석하였다. 심방세동이 심방기외수축으로 유발되는 시기부터 지속되는 시기(>1분)를 기록하였고 등전위 지도(isopotential map)에서 관찰되는 전기 파동의양상과 좌심방 및 폐정맥의 해부학적인 구조와의 연관관계를 분석하였다. 결 과: 폐정맥에서 기인한 심방기외수축이 심방세동을 유발 하였으나 지속에는 영향을 끼치지 못한 경우가 56.4%, 폐정맥에서 기인한 빠른 전기방출이 심방세동을 유지시 킨 경우가 25.6%, 폐정맥의 전기방출이 심방세동의 유 발과 지속에 모두 기여한 경우가 5.0% 이었으며 다양 한 위치의 전기방출로 인해 심방 세동의 기전을 명확히 규명할 수 없었던 경우가 12.8%이었다. 심방세동이 지 속되는 동안 평균 wavelet의 수는 1.45개(최대 3개인 경우가 76.5%)이었다. 심방 세동이 지속되는 동안 전도 지연과 파동파손은 좌심방 전상벽의 septopulmonary bundle 주위(86.5%)와 좌심방 후상벽(54.1%)에서 반 복적으로 관찰되었다. 결 론: 폐정맥에서 기인한 빠른 전기방출은 심방세동의 유 발과 유지에 중요한 역할을 하였다. Septopulmonary bundle과 같은 좌심방의 특징적 구조물이 전도지연이 나 자발적 파동파손을 유발하여 심방 세동의 지속에 기 여하였다.
나승운,Seung-Hyuk Choi,Doo-Il Kim,Dong Woon Jeon,Jae-Hwan Lee,홍경순,Tae-Joon Cha,Jang-Hyun Cho,Sang Kon Lee,Yong Hwan Park,Woo Jung Park,Hyun-Joo Kim,Young-Joo Kim,Juneyoung Lee,Donghoon Choi 대한심장학회 2018 Korean Circulation Journal Vol.48 No.9
Background and Objectives We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea. Methods This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0.9, 2) lower-extremity artery stenosis on computed tomography angiography ≥50%, or 3) peak-systolic-velocity-ratio (PSVR) on ultrasound ≥2.0. Medical chart review was used to assess patient characteristics/treatment patterns while the history of medical resource consumption and QoL data were collected using a patient survey. QoL was measured using EuroQoL-5-dimensions-3-level (EQ-5D-3L) score system, and the factors associated with QoL were analyzed using multiple linear regression analysis. Results This study included 1,260 patients (age: 69.8 years, male: 77.0%). The most prevalent comorbidities were hypertension (74.8%), hyperlipidemia (51.0%) and diabetes-mellitus (50.2%). The 94.1% of the patients took pharmacotherapy including aspirin (76.2%), clopidogrel (53.3%), and cilostazol (33.6%). The 12.6% of the patients were receiving smoking cessation education/pharmacotherapy. A considerable number of patients (500 patients, 40.0%) had visit history to another hospital before diagnosis/treatment at the current hospital, with visits to orthopedic units (50.4%) being the most common. At the time, 29% (or higher) of the patients were already experiencing symptoms of critical limb ischemia. Baseline EQ-5D index and EQ VAS were 0.64±0.24 and 67.49±18.29. Factors significantly associated with QoL were pharmacotherapy (B=0.05053; p=0.044) compared to no pharmacotherapy, and Fontaine stage improvement/maintain stage I (B=0.04448; p<0.001) compared to deterioration/maintain stage II–IV. Conclusions Increase in disease awareness for earlier diagnosis and provision of adequate pharmacotherapy is essential to reduce disease burden and improve QoL of Korean PAD patients.
나승운,박창규,용환석,서순용,문상기,홍순준,김진원,서홍석,오동주,노영무 대한심장학회 2005 Korean Circulation Journal Vol.35 No.1
An anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA syndrome)syndrome is a rare congenital cardiac anomaly. We report a 65-year old female patient who presented with atypical chest discomfort. Coronary angiography and three-dimensional multidetector computed tomography coronary angiography demonstrated the ectatic right coronary artery (RCA) arising from the aorta, rich collaterals from the RCA to LCA and the ectatic tortuous LCA that originated from the pulmonary trunk.
강준혁,나승운,이대인,김수아,이재형,강승훈,임성윤,최병걸,Amro Elnagar,김선원,임성일,한성우,나진오,최철웅,임홍의,김진원,김응주,박창규,서홍석,오동주 대한심장학회 2012 Korean Circulation Journal Vol.42 No.3
A 0.035-inch guide wire fracture and entrapment in a peripheral artery is a very rare complication, but when it does occur it may lead to lifethreatening complications, such as perforation, thrombus formation, embolization, and subsequent limb ischemia. We describe our experience of successfully retrieving a fractured 0.035-inch Terumo guide wire in the external iliac artery using a biopsy forcep.