발작성 심실상성빈맥의 심전기 생리학적 기전에 대한 임상적 연구

류제영(Jay Young Rhew),배열(Youl Bae),김준우(Jun Yoo Kim),김성희(Sung Hee Kim),김주한(Ju Han Kim),김광채(Gwang Chae Gill),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee 대한내과학회 1997 대한내과학회지 Vol.52 No.2

Objectives: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. Methods: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. Results: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9±17.3 years in AVNRT, 25.5±13.3 years in WPW and 26.3±15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6±23.9 per minute and AVRT was 186.7±38.0 per minute, which were faster than that of AVNRT(161.7±28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. Conclusion: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.

장기적인 우심실 첨부 조율 시 좌심실 기능부전의 발생에 관여하는 인자

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),이승현(Seung Hyun Lee),박옥영(Ok Young Park),김주한(Ju Han Kim),김원(Weon Kim),류제영(Jay Young Rhew),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Ch 대한내과학회 2002 대한내과학회지 Vol.63 No.2

Background It is known that prolonged QRS duration (QRSd) in a 12-lead ECG is associated with decreased left ventricular (LV) systolic function in patients with dilated cardiomyopathy. Development of LV systolic dysfunction and prolongation of paced QRSd are often observed in patients with permanent pacemakers (PPM). However, the significance of prolonged paced QRSd in patients with PPM is not determined. Methods We studied sixty-four patients (male:female=27:37, mean age=57.6±15.4 years) who had been on PPM (DDD: 15, VDD: 18, VVI: 31) for more than one year (mean: 68.2±44.0 months). LV function was normal before implantation of PPM. The 12-lead ECG and echocardiography were recorded prior to implantation, immediately after implantation and at the last follow-up. Results Paced QRSd did not significantly increase during the follow-up period. LVEF at the last follow-up (LVEF-FU) was significantly lower than that prior to implantation (59.3±11.5% vs. 64.9±10.1%, p<0.001). Eleven (17.2%) patients developed LV systolic dysfunction (LVEF<50%) during the follow-up period. Paced QRSd at the last follow-up and diabetes mellitus were correlated with LV systolic dysfunction (R2=0.302, p<0.001). There was a significant negative correlation between the paced QRSd and LVEF-FU (r=-0.451, p<0.01) and between change of paced QRSd and that of LVEF during follow-up (r=-0.419, p<0.01). LVEF-FU was reduced more in patients with paced QRSd ≥180 ms than in patients without (44.4±12.0% vs. 61.7±9.5%, p<0.001). In predicting LV systolic dysfunction with the paced QRSd (cut-off value: 180 ms), sensitivity, specificity, positive and negative predictive values were 60.0%, 88.7%, 50.0% and 99.2%, respectively. The paced QRSd at the last follow-up was significantly correlated with paced QRSd immediately after implantation (r=0.542, p<0.01). Conclusion LV systolic dysfunction after long-term right ventricular apical pacing may develop. Prolongation of paced QRSd ≥180 ms during follow-up may suggest development of LV systolic dysfunction. New technologies to minimize prolongation of paced QRSd should be investigated to prevent LV systolic dysfunction after permanent ventricular pacing. (Korean J Med 63:169-176, 2002)

급성 심근경색증 환자에서 장기 임상경과에 대한 C - Reactive Protein 의 역할

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),박형욱(Hyung Wook Park),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),염주협(Ju Hyup Yum),김원(Weon Kim),김주한(Ju Han Kim),류제영(Jay Young Rhew),안영근(Young Keun A 대한내과학회 2001 대한내과학회지 Vol.61 No.6

Background: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. Methods: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9±9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43±0.14 mg/dL) on admission and Group II (n=122, 59.1±10.4 years, male 83.6%) with elevated CRP ( ≥1.0 mg/dL, mean value=3.50±0.93 mg/dL) on admission. Results: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4±10.5 to 52.0±9.0%, 1.52±1.13 to 2.77±0.55, p<0.001 vs Group II; 50.1±11.2 to 52.7±9.7, 1.55±1.11 to 2.76±0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). Conclusion: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.(Korean J Med 61:606-615, 2001)

관상동맥 중재술을 시술받은 불안정형 협심증 환자에서 저분자량 헤파린의 장기 효과

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),이승현(Seung Hyun Lee),박옥영(Ok Young Park),김주한(Ju Han Kim),김원(Weon Kim),류제영(Jay Young Rhew),안영근(Young Keun Ahn),조정관(Jeong Gwan Cho),박종춘(Jong Chun Park),서순팔(Soon Pa 대한내과학회 2002 대한내과학회지 Vol.63 No.2

Background: Antithrombotic therapy with heparin reduces the rate of ischemic events in patients with acute coronary syndrome. Low-molecular-weight heparin (LMWH), given subcutaneously twice daily, has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer and does not require monitoring. Methods: We prospectively analyzed 180 patients with unstable angina who underwent percutaneous coronary intervention (PCI) between 1999 and 2001 at Chonnam National University Hospital to receive either 120 U/kg of Dalteparin (Fragmin), administered subcutaneously twice daily (group I; n=90, 61.8±8.9 years, male 67.8%), or continuous intravenous unfractionated heparin (group II; n=90, 62.6±9.7 years, male 70.0%). During hospitalization and at 6 month after PCI, major adverse cardiac events such as acute myocardial infarction, target vessel revascularization, death, or restenosis were examined. Results: During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death were not different between two groups. At follow-up coronary angiography at 6 month after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 26/90, 28.8% vs. Group II; 32/90, 35.6%, p=0.041) and the incidence of target vessel revascularization was lower in group I than in group II (Group I; 21/90, 23.3% vs Group II; 27/90, 30.0%, p=0.039). There was no difference in the rate of major and minor hemorrhage, ischemic stroke and thrombocytopenia between two groups. In the multivariate analysis, factors relating to restenosis were lesion length, postprocedural minimal luminal diameter, CRP on admission, diabetes mellitus, type of hepairn, stent use. Conclusion: Dalteparin, a LMWH, is superior to standard unfractionated heparin for reducing restenosis rate and target vessel revascularization without increasing bleeding complications. (Korean J Med 63:158-168, 2002)

급성 심근경색증 환자에서 내원 시 단핵구 증가증과 예후

홍영준 ( Young Joon Hong ),정명호 ( Myung Ho Jeong ),이승현 ( Seung Hyun Lee ),박옥영 ( Ok Young Park ),박우석 ( Woo Seok Park ),김주한 ( Ju Han Kim ),김원 ( Weon Kim ),류제영 ( Jay Young Rhew ),양승호 ( Seung Ho Yang ),안영근 ( 대한내과학회 2002 대한내과학회지 Vol.63 No.5

Background : The inflammation is an important feature of atherosclerotic lesions, and peripheral monocytosis is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). The aim of this study was to determine the significance in clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI) and major adverse cardiac events and event-free survival rate after PCI according to the value of peripheral monocyte on admission. Methods : A total of 127 patients with AMI who underwent PCI between June 2000 and June 2001 at Chonnam National University Hospital were divided into two groups: Group I (n=63, 61.7±10.9 years, male 71.4%) with normal monocyte count (<900/mm3, mean value=536±202/mm3) on admission and Group II (n=64, 61.7±13.4 years, male 78.1%) with elevated monocyte count (≥900/mm3, mean value=1,140±260/mm3) on admission. Results : Baseline ejection fraction was lower in Group II than in Group I (Group I; 53.3±13.0% vs Group II; 45.0±11.7%, p=0.014). The value of C-reactive protein, troponin-T and troponin-I was higher in Group II than in Group I (Group I; 2.8±1.9 mg/dL, 1.98±1.53 ng/mL, 18.3±17.7 ng/mL vs Group II; 5.3±5.0 mg/dL, 3.34±2.54 ng/mL, 43.1±24.0 ng/mL, p=0.034, 0.020, 0.006, respectively). The incidence of target lesion revascularization was higher in Group II than in Group I during hospitalization and during 6-month clinical follow-up after PCI (1.6% vs 12.5%, 19.0% vs 31.3%, p=0.012, 0.015, respectively). The event-free survival rates were lower in Group II than in Group I during hospitalization and during 6-month follow-up after PCI (96.8% vs 84.4%, 71.4% vs 53.1%, p=0.006, 0.008, respectively). Conclusion : Peripheral monocytosis is associated with LV dysfunction and higher incidence of target lesion revascularization and worse mid-term event-free survival during hospitalization and at 6 months after PCI in patients with AMI.(Korean J Med 63:521-531, 2002) Key Words : Coronary Diseases, Myocardial Infarction, Angioplasty, Inflammation

우측 관상동맥 근위부의 심근고리

박옥영(Ok Young Park),정명호(Myung Ho Jeong),이승현(Soeng Hyun Lee),홍영준(Young Jun Hong),정우곤(Woo Gon Jeong),이상록(Sang Rok Lee),김원(Won Kim),염주협(Joo Hyub Yum),김주환(Ju Han Kim),류제영(Jay Young Rhew),조정관(Jeong Gwan Cho 대한내과학회 2002 대한내과학회지 Vol.62 No.6

Myocardial bridge is characterized by systolic compression of a portion of the coronary artery by a segment of overlying myocardium, commonly involves the middle segment of left anterior descending coronary artery. We present a case report of coronary angiographic evidence of systolic short segmental constriction in the proximal right coronary artery (RCA). A 42 year-old man presented with atypical chest discomfort and palpitation. Electrocardiography showed complete AV block with complete AH block on intracardiac electrocardiogram. Myocardial SPECT imaging demonstrated a mild reversible anterior and inferior wall perfusion defect. Diagnostic coronary angiogram revealed short segmental myocardial sling with wedge-shaped systolic compression in the proximal RCA.(Korean J Med 62:675-679, 2002)

증예(症例) : 혈액투석 도관 거치시 발생한 유도도선 (guide wire)의 대퇴정맥 내 삽입

최혜은 ( Hye Eun Choi ),류제영 ( Jay Young Rhew ),선인호 ( In O Sun ),이신은 ( Shin Eun Lee ),이영재 ( Young Jae Lee ),최진화 ( Jin Hwa Choi ),이은영 ( Eun Young Lee ),김정화 ( Jung Wha Kim ),이광영 ( Kwang Young Lee ) 전북대학교 의과학연구소 2006 全北醫大論文集 Vol.30 No.1

When a hemodialysis catheter is placed a guide wire is inserted into a central vein first. The dialysis catheter is advanced over the guide wire. After the insertion of the catheter, the guide wire is removed. We experienced a case of accidental insertion of the entire guide wire, which was not removed by mistake soon after the placement of a temporary hemodialysis catheter into the right femoral vein. After 4 months chest X-ray revealed the guide wire in the right femoral through internal jugular veins. It was removed successfully via nonsurgical percutaneous retrieval with a loop snare with internal jugular approach.

원인 불명 실신에서 기립경사검사 결과의 예측

정은아(Eun A Chung),이승현(Seung Hyun Lee),홍영준(Young Joon Hong),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),이상현(Sang Hyun Lee),강경태(Kyung Tae Kang),류제영(Jay Young Rhew),박종철(Jong Cheol Park),안영근(Yo 대한내과학회 2001 대한내과학회지 Vol.61 No.2

Background : Vasovagal syncope has been believed to account for the majority of syncope of unknown origin (SUO). Head-up tilt test (HUT) has been well recognized as a useful test in the evaluation of SUO. The purpose of this study was to determine the predictors of HUT to develop a less time-consuming test protocol and get an information on the pathophysiology of vasovagal syncope. Methods : Eighty five patients (mean age, 43±18 years: 47 men, 38 women) underwent a 80 degree HUT without or with isoproterenol infusion (2 μg/min and 5 μg/min, each for 6 minutes) for unexplained syncope or pre-syncope. Positive HUT was defined as symptomatic hypotension (systolic blood pressure ≤80 mm Hg) and/or symptomatic bradycardia (≤45/min for ≥10 seconds) or asystole ≥3 seconds. The patients were divided into two groups according to the result of the HUT: Group I included 47 patients (M:F=25:22) with positive result, Group II, 38 patients (M:F=22:16) with negative result. Results : Group I patients had more episodes of syncope than Group II (3.1±2.5/year vs. 2.0±2.1/year, p<0.05). There were no significant differences between the 2 groups in the heart rate (HR), systolic and diastolic blood pressure (BP) at the baseline supine position. BP after tilt was not significantly different between 2 groups except for systolic BP at 6 minutes after tilt, which was significantly lower in Group I than Group II (109.5±17.5 mm Hg vs. 118.1±18.2 mm Hg, p<0.05). However, HR after tilt was significantly faster in Group I than Group II (81.1±15.1/min vs. 74.2±14.9/min, p<0.05 at 2 minutes after tilt; 83.7±14.4/min vs. 74.6±14.7/min, p<0.01 at 4 minutes after tilt). The increase in HR was greater in Group I than Group II (19.9±12.6/min vs. 12.8±10.6/min, p<0.001). In the prediction of positive HUT with HR rise above 14/min during the early 6 minutes of baseline head-up tilting, the specificity, sensitivity, and positive predictive value were 63.2%, 70.2%, and 70.2%, respectively. Conclusion : In patients with SUO, positive HUT can be predicted with the early HR response during head-up tilt. This result shows that vasovagal syncope is triggered by exaggerated HR response to the decreased venous return and allow us to develop a less time-consuming HUT protocol.(Korean J Med 61:133-140, 2001)

혈소판 당단백 2b / 3a 수용체 차단제 부착 스텐트의 돼지 관상동맥 스텐트 재협착 억제 효과

강경태(Kyung Tae Kang),정명호(Myung Ho Jeong),김남호(Nam Ho Kim),류제영(Jay Young Rhew),이상현(Sang Hyun Lee),박종철(Jong Cheol Park),이승욱(Seung Uk Lee),김건형(Kun Hyung Kim),최명자(Myung Ja Choi),안영근(Young Keun Ahn),조정관(Jeon 대한내과학회 2001 대한내과학회지 Vol.60 No.4

Background: The problems of coronary stent thrombosis and restenosis still remain to be solved. The glycoprotein Iib/IIIa receptor blocker, Abciximab (ReoPro), plays import ant roles in the treatment of high-risk patient with acute platelet-rich thrombus and in the inhibition of smooth muscle cell proliferation. The aim of this study was to determine whether the use of ReoPro-coated stents could reduce the neointimal formation in a porcine coronary stent restenosis model. Methods: ReoPro was coated on the surface of stent by means of plasma polymerization followed by chemical grafting. Stent overdilation injury was performed with control bare stent (Group I, n=13), and ReoPro-coated stents (Group II, n=14). Follow-up quantitative coronary angiogram was performed at 4 weeks after stenting and histopathologic assessment were compared in both groups. Results: The diameter stenosis by QCA between two groups was significantly higher in Group I (23±5 % vs. 15±7 %, p=0.003). On histopathologic examination, no in-stent thrombus was observed. The percent area stenosis was significantly higher in Group I than in Group II (48±17 % vs. 30±16 %, p=0.01). The area of neoinima was larger in Group I than in Group II (3.2±1.2 mm vs. 2.0±1.0 mm, p =0.01). By immunocytochemistry, proliferation cell nuclear antigen indices were higher in Group I (4.2±2.1 %, vs 2.4±1.8 % p =0.03). Conclusion: The ReoPro-coated stent is safe and effective in the prevention of in-stent thrombus and restenosis, which may be related with the inhibition of platelet thrombus and neointimal cell proliferation.(Korean J Med 60:314-323, 2001)

18세 남자 환자에서 발생한 급성 심근경색증

김원 ( Weon Kim ),정명호 ( Myung Ho Jeong ),박옥영 ( Ock Young Park ),염주협 ( Ju Hyup Yeon ),김주한 ( Ju Han Kim ),류제영 ( Jay Young Rhew ),안영근 ( Young Keun Ahn ),조정관 ( Jeong Gwan Cho ),박종춘 ( Jong Chun Park ),간정채 ( 대한내과학회 2002 대한내과학회지 Vol.63 No.5

Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking.This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.(Korean J Med 63:572-576, 2002) Key Words : Myocardial infarction, Adolescence, Stents