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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)
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
급성 ST 분절 상승 심근경색증 환자에서 관상동맥 조영술 전 TIMI 혈류가 관상동맥 중재술 후 임상경과에 미치는 영향
홍영준 ( Young Joon Hong ),정명호 ( Myung Ho Jeong ),임지현 ( Ji Hyun Lim ),박형욱 ( Hyung Wook Park ),김한균 ( Han Gyun Kim ),박옥영 ( Ok Young Park ),김주한 ( Ju Han Kim ),김원 ( Weon Kim ),안영근 ( Young Keun Ahn ),조정관 ( Je 대한내과학회 2005 대한내과학회지 Vol.69 No.2
Background : Epicardial infarct-related artery patency is reliably assessed by the Thrombolysis In Myocardial Infarction flow grade (TFG), and this index is associated with clinical outcomes after fibrinolytics or primary angioplasty in patients with acute myocardial infarction (AMI). The aim of this study was to examine long-term clinical outcomes according to the pre-procedural TFG in AMI after percutaneous coronary intervention (PCI). Methods : A total of 132 patients with AMI who underwent PCI between July 2001 and December 2001 at Chonnam National University Hospital were divided into two groups according to the pre-procedural TFG: Group I (n=60, 62.7±9.2 years, male 66.7%) with TFG 0-1 and Group II (n=72, 61.6±11.1 years, male 68.1%) with TFG 2-3. Results : Hypertension was more prevalent in Group I than that in Group II (56.7% vs. 27.8%, p=0.001) and cardiogenic shock on admission was more frequently observed in Group I than that in Group II (20.0% vs. 5.6%, p=0.011). The left ventricular ejection fraction was lower in Group I than that in Group II (42.6±10.5% vs. 50.5±12.1%, p=0.022). The levels of inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, white blood cell and monocyte counts were higher in Group I than in Group II. On diagnostic coronary angiogram, complex lesion was more frequently observed in Group I than that in Group II (53.4% vs. 36.2%, p<0.001). During 1-year clinical follow-up, the mortality was higher in Group I than that in Group II (10.0% vs. 1.4%, p=0.028), however, there were no significant differences in the incidences of restenosis and target lesion revascluarization between the two groups. The event-free survival rate was lower in Group I than that in Group II (60.0% vs. 79.2%, p=0.016). The independent predictors for major adverse cardiac events were cardiogenic shock, CRP ≥ 0.5 mg/dL, age ≥ 70 years, triple vessel disease, low pre-interventional TFG (0-1) and post-interventional TFG (0-2). Conclusion : Low pre-procedural TFG is associated with hypertension, cardiogenic shock, left ventricular dysfunction, and high mortality, and low event-free survival during one-year clinical follow-up after PCI in AMI.(Korean J Med 69:157-166, 2005)
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 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)
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)
다혈관 관상동맥 중재술을 시술받은 급성 심근경색증 환자에서 내원 시 상승된 Troponin 1 수치의 의의
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 ),안영근 ( Young Keun Ahn ),조정관 ( Jeong Gwan Cho ),서순팔 ( 대한내과학회 2003 대한내과학회지 Vol.65 No.1
Background : Cardiac troponin I (cTnI) is a sensitive and specific biomarker for myocardial injury. The aim of this study was to determine the significance of clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI)
작은 관상동맥질환자에 대한 BiodivYsio Phosphorylcholine - coated Coronary Stent 의 임상 효과
홍영준(Young Joon Hong),정명호(Myung Ho Jeong),심두선(Doo Sun Shim),임상엽(Sang Yup Lim),양보라(Bo Ra Yang),이상현(Sang Hyun Lee),이승현(Seung Hyun Lee),박옥영(Ok Young Park),박우석(Woo Seok Park),김주한(Joo Han Kim),최명자(Myung Ja 대한내과학회 2002 대한내과학회지 Vol.63 No.3
Background : The BiodivYsio stent is a balloon-expandable stent coated with phosphorylcholine designed to reduce the formation of thrombus and the risk of restenosis. Methods : We prospectively studied 20 patients who underwent implantation of BiodivYsio stent (group I; 60.8±9.3 years, male 60.0%) and compared to 20 patients who underwent balloon angioplasty alone (group II; 60.3±7.9 years, male 45.0%) for small coronary arterial lesions (target arterial diameter was between 2.0 mm and 2.8 mm) between February 2001 and October 2001. Major adverse cardiac events such as acute myocardial infarction, target vessel revascularization and death were evaluated during hospital admission and at 6-months after percutaneous coronary intervention (PCI). Results : During hospitalization, the incidence of acute myocardial infarction, target vessel revascularization and death was not different between the two groups. At follow-up coronary angiography 6 months after PCI, the incidence of restenosis was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 9/20, 45.0%, p=0.032) and the incidence of target vessel revascularization (TLR) was lower in group I than in group II (Group I; 3/20, 15.0% vs Group II; 8/20, 40.0%, p=0.041). Conclusion : Coronary BiodivYsio stenting in small coronary artery leads to excellent short- and mid-term clinical outcomes.(Korean J Med 63:251-260, 2002)
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)