급성하벽심근경색 환자에서 흉부유도 ST 절하강의 임상적 의의

이성구(Sung Ku Lee),백효종(Hyo Jong Baek),서상문(Sang Moon Suh),천병도(Byung Do Chun),이중기(Choong Ki Lee),김신우(Shin Woo Kim),우언조(Eon Jo Woo),강승완(Seung Wan Kang),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun P 대한내과학회 1992 대한내과학회지 Vol.43 No.4

N/A The prognostic significance of precordial ST segment depression during early stages of acute inferior myocardial infarction is controversial. To examine this problem, electrocardiographic findings on admission were compared with the clinical variables in 50 patients with a first transmural inferior infarction. Patients were classified according to the admission ECG obtained an average of 7.0hours after the onset of chest pain. Twenty-five patients (group I) had≥1.0mm ST depression in at least one of leads V1 to V6 and 25 (group II) did not. There were no significant differences between the two groups in peak creatinine kinase activity, prevalence of in-hospital complications (i, e., congestive heart failure, hypotension, arrhythmias requiring treatment and death), and maximal ST elevation in inferior lead. A weak correlation existed between the quantities (mV) of inferior ST segment elevation and precordial ST depression (r=0.43, p<0.05). Thus, precordial ST depression during acute inferior infarction is not a reliable marker of the extent of myocardial damage or an adverse hospital course. Precordial ST segment depression might represent a benign electrical phenomenon.

(99m)Tc-MIBI 운동부하 심근관류 SPECT에서 정상소견을 보인 환자의 예후 : 운동부하 심전도와 관동맥 조영소견과의 비교

이상우(Sang Woo Lee),이재태(Jae Tae Lee),천경아(Kyung Ah Chun),강도영(Do Young Kang),김동환(Dong Hwan Kim),조용근(Yong Keun Cho),채성철(Shung Chull Chae),이규보(Kyu Bo Lee) 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.3

N/A Purpose: Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise (99m)Tc-MIRI myocardial perfusion single photon emission computed tomography (SPECT) an(l to analyze results with regard to those of exercise. electrocardiography or coronary angiography. Materials and Methods: We evaluated 30) patients (mean age S2±10 years, 166 males and 135 females) with normal exercise (99m)Tc-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subjects were evaluated for cardiac events and followed for 8-55 months (mean 19±10 months) after imaging. Results: During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0,21%: per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patients with positive (n=27) and negative (n-235) exercise electrocardiography (p:NS), There was no cardiac event in ]7 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Conclusion: Patients with normal exercise (99m)Tc-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings. (Korean J Nucl Med 2000;34: 199-206)

Flecainide 독성과 관련된 치명적인 심실상빈맥의 1예

천상수 ( Sang Soo Cheon ),송준혁 ( Joon Hyuk Song ),배명환 ( Myung Hwan Bae ),이장훈 ( Jang Hoon Lee ),양동헌 ( Dong Heon Yang ),박헌식 ( Hun Sik Park ),채성철 ( Shung Chull Chae ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1

평소 말기 신부전으로 혈액투석을 받고 있는 72세 여자 환자가 폐렴에 의한 심부전의 악화로 입원하였으며 발작성 심방세동의 치료를 위해 flecainide 50 mg 하루 세 번이 투여 되었다. 폐렴 및 심부전의 치료 후 회복되어 퇴원을 고려하던중 flecainide 독성으로 인해 wide QRS complex 형태의 빈맥이 발생하였으며 불응성 심인성 쇼크로 진행하였다. 승압제 등 일반적인 치료로 심인성 쇼크 회복되지 않아 bicarbonate 정주하며 체외막 산소공급 및 혈액 관류 실시하였으며 환자는 합병증 없이 성공적으로 회복되어 퇴원하였다. 저자들은 말기신부전 환자에서 flecainide 독성으로 발생한 불응성 심인성 쇼크를 체외막 산소공급 및 혈액관류로 성공적으로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Flecainide acetate is a potent class Ic anti-arrhythmic drug with a major sodium channel-blocking effect. Flecainide toxicity can cause myocardial impairment and precipitate circulatory collapse, particularly in patients with renal failure. Electrical and hemodynamic deterioration during flecainide toxicity may not respond to conventional treatments. We report the successful management of flecainide toxicity using extracorporeal membrane oxygenation (ECMO), hemoperfusion, and bicarbonate administration maintaining alkalinity. (Korean J Med 2014;87:72-76)

국내 10개 대학병원의 관동맥질환자의 고콜레스테롤혈증 치료 현황

성지동 ( Ji Dong Sung ),김상현 ( Sang Hyun Kim ),김영대 ( Young Dae Kim ),백상홍 ( Sang Hong Baek ),안영근 ( Young Keun Ahn ),임도선 ( Do Sun Lim ),조홍근 ( Hong Keun Cho ),채성철 ( Shung Chull Chae ),한기훈 ( Ki Hoon Han ),김효수 대한내과학회 2005 대한내과학회지 Vol.69 No.4

목적 : 기존 연구들은 고콜레스테롤혈증 치료 지침이 충실히 지켜지지 않는 소위 치료 간극(treatment gap)을 보여 주고 있다. 국내에서 어느 정도의 치료 간극이 존재하는가에 대해서는 체계적인 연구가 전혀 없는 실정으로 앞으로 대책 수립을 위해서는 이에 대한 현황 파악이 필요하다. 본 연구는 국내의 10개 대학병원들에서 관동맥질환자의 고콜레스테롤혈증 관리에 있어서 NCEP ATP III 치료 지침에 근거하였을 때 어느 정도의 치료 간극이 존재하는가를 조사하고자 하였다. 방법 : 국내 10개 수련 병원에서 순환기내과 진료를 받은 총 1,048명의 환자에 대하여 의무기록을 조사하였다. 대상 선정 기준은 관동맥조영술 또는 심장부하검사 소견상 관동맥질환자로 판명된 경우, 외래병록지 또는 퇴원요약지 등에 협심증, 심근경색 등의 진단 또는 관동맥 성형술 또는 관동맥우회로술을 받은 병력이 명기되어 있는 경우로 하였다. 각 병원마다 3인 이상의 의사에서 각 의사마다 30인 이상의 환자를 추출하는 것을 기준으로 하여 순차적으로 의무 기록을 검토하도록 하였다. 다른 특정한 연구를 위하여 모집된 명부에서 환자를 추출하는 것은 금지하였다. 사용된 모든 고지혈증치료제의 명칭과 용량을 최초와 가장 최근의 경우로 나누어 기록하였고, 혈중 지질 검사 결과는 약물 복용 이전과 가장 최근의 결과를 기록하였다. 결과 : 연구의 결과는 10~50% 법칙으로 요약될 수 있다. 10% : 약물치료를 시행치 않는 경우의 평균 LDL 콜레스테롤 감소, 20% : 치료 전에 이미 치료 목표에 도달해 있는 비율, 30% : 약물치료시 평균 LDL 콜레스테롤 감소, 40% : 지질저하제 약물치료를 받지 않고 있는 관동맥질환자 비율, 50% : 치료 후 치료 목표에 도달하는 비율 결론 : 관동맥질환자의 고콜레스테롤혈증 치료에 있어서의 치료 간극 현상은 국내의 3차 병원의 순환기내과 의사들의 진료에 있어서도 존재하는 것이 확인되었다. 앞으로 다른 진료 환경에서의 치료 간극에 대한 추가 연구와 함께 치료 목표 달성율을 높이기 위한 조치들이 필요할 것으로 보인다. Background : Previous studies showed treatment gap phenomenon in the treatment of hyperlipidemia, meaning failure to adhere to the recommendation in the treatment guideline. In Korea, systematic research on this issue has never been done. This investigation was to estimate the hypercholesterolemia treatment gap in coronary artery disease (CAD) patients in tertiary care centers according to NCEP ATP-III guideline. Methods : Ten Korean educational hospital participated in the survey, reviewing medical record of 1,048 patients. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or medical history of myocardial infarction, percutaneous coronary intervention or bypass surgery. Thirty or more medical records per each of 3 or more cardiologists were reviewed in each hospital. Sampling was done sequentially based on outpatient or inpatient list. Pharmacological treatment for hyperlipidemia included the first and last records of prescription. Baseline and the most recent lipid profiles were collected. Results : Findings from the survey was summarized as 10 to 50% rule: 10%: mean LDL-cholesterol reduction without lipid-lowering drug, 20%: LDL-cholesterol level at the treatment goal before any treatment, 30%: mean LDL-cholesterol reduction with lipid-lowering drug treatment, 40%: proportion of CAD patients without lipid-lowering drug, 50%: treatment goal achievement after treatment. Conclusions : Significant treatment gap exists in Korean cardiology practice in tertiary care centers. Systematic approach to reduce this gap is warranted.(Korean J Med 69:371-378, 2005)

고혈압 환자의 삶의 질 측정도구 개발

김건엽,감신,이상원,박기수,채성철,천병렬,Kim, Keon-Yeop,Kam, Sin,Lee, Sang-Won,Park, Ki-Soo,Chae, Shung-Chull,Chun, Byung-Yeol 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objectives : To develop a tool for multidimensional measurement of the quality of life, which was psychometrically sound, short, and easy to administer for patients with hypertension. Methods : A sample of 1,115 hypertensive patients aged 20 or above in Cheong-Song County was studied from June 1997 to October 1998. In the development of the instrumental stage, the authors first conceptualized the quality of life. Item generation, item reduction, and questionnaire formatting were followed. Item-level (item descriptive, missing%, item internal consistency, item discriminant validity) analysis, scale-level (scale descriptive, floor and ceiling effect) analysis, and other tests(Cronbach's alpha, inter-dimension correlations, factor analysis, clinical validity) were performed to evaluate the validity and reliability of the new measurement scale. After 1 year, responsiveness and confirmatory factor analysis were performed. Results : The results of both item-level and scale-level analyses were acceptable. An acceptable degree of internal consistency was observed for each of the dimensions (Cronbach's alpha was 0.60 or higher). Inter-dimension correlations were below 0.50 and the factor analysis result was the same as the intended dimension structure. Correlation coefficients between perceived health status, stress and dimensions were proven to be acceptable. The result of comparing dimensional score means among ADL and MMSE-K groups above 60 years was statistically significant(p<0.05). The result of confirmatory factor analysis concluded that the dimensional structure model was well fitted. However, the result of responsiveness test using sensitivity and specificity was unsatisfactory. Conclusions : The newly developed measurement scale is psychometrically reliable and valid instrument for measuring quality of life in hypertensive patients.

급성 심근경색 환자에서 예후 예측인자로 혈청 감마-글루타밀 트랜스퍼라제가 유용한가?

이장훈 ( Jang Hoon Lee ),채성철 ( Shung Chull Chae ),이현상 ( Hyun Sang Lee ),박용휘 ( Yong Whi Park ),류현민 ( Hyeon Min Ryu ),이순학 ( Soon Hak Lee ),배명환 ( Myung Hwan Bae ),양동헌 ( Dong Heon Yang ),박헌식 ( Hun Sik Park ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3

목적: 혈청 감마-글루타밀 트랜스퍼라제(GGT)는 관상동맥 죽상경화반 내의 저밀도 지단백(LDL)의 산화과정을 촉매 하여 관상동맥 질환의 진행에 관여하며, 관상동맥 질환의 과거력이 있는 환자에서 심장사와 재경색의 독립적인 예후 예측인자로 알려져 있다. 저자는 관상동맥 질환의 과거력이 없는 급성 관상동맥 증후군 환자에서 예후 예측인자로서의 혈청 GGT의 효용성을 연구하였다. 방법: 흉통을 주소로 응급실을 방문하여 급성 심근경색으로 진단받은 환자의 혈청 GGT 값을 측정하여 응급실 방문당시 혈청 GGT 값이 정상범위(남자: 8-61 U/L; 여자: 5-31 U/L)에 있었던 192명(남/여=143/49, 평균 연령: 60.8±11.8세)의 환자를 대상으로 하여, 추적기간(16.5±10.8개월) 내 심장사건이 재발한 환자에서의 혈청 GGT 값을 심장사건이 없었던 환자의 혈청 GGT 값과 비교 하였다. 결과: 급성 심근경색 환자 192명중 추적 기간 내 17명의 환자에서 심장사와 재경색이 있었으며, 23명의 환자에서 불안정협심증이 있었다. 이 환자들의 혈청 GGT 값을 심장사건이 없었던 환자의 혈청 GGT 값과 비교하였을 때 통계적으로 유의한 차이를 보였다(29.5±10.0 U/L 대 25.0±11.2 U/L p=0.024). 그러나 다변량 분석에서 혈청 GGT에 영향을 줄 수 있는 혼란변수들과 알려진 심혈관계 질환의 위험인자로 보정하였을 경우 독립적인 예후 예측인자가 되지 못했다. 결론: 심질환의 과거력이 없는 심근경색 환자의 예후 예측인자로 심근경색의 급성기에 측정한 혈청 GGT 값은 통계적으로 유의한 차이는 있으나, 독립적인 예후 예측인자가 되지 못했다. Background: Serum gamma-glutamyl transferase activity (GGT) is able to catalyse low-density lipoprotein oxidation in coronary atherosclerotic plaques and has a role in the pathogenesis of atherosclerosis. GGT has been shown to be an independent risk factor for cardiac mortality in patients with a previous myocardial infarction. The purpose of this study is to determine the prognostic value of GGT within its normal range at an acute stage in patients with acute myocardial infarction. Methods: In a retrospective study, GGT and other cardiac risk factors were evaluated in 192 patients (M/F=143/49; mean age: 60.8±11.8 years) who were diagnosed with an acute myocardial infarction at the emergency room. We compared the serum GGT values for each patient with or without a cardiac event, including cardiac death, non-fetal myocardial infarction and unstable angina, after an acute myocardial infarction for a mean follow-up of 16.5±10.8 months. Results: During the follow-up period, 17 patients underwent cardiac death and experienced an acute myocardial infarction and 23 patients had unstable angina. Although the mean GGT values were significantly different from patients with cardiac events (29.5±10.0 U/L vs 25.0±11.2 U/L, p=0.024), serum GGT was not an independent cardiac risk factor for a cardiac event based on multivariate analysis adjusted for age, sex, alcohol and known cardiovascular risk factors. Conclusions: Serum GGT within its normal range at an acute stage in patients that experienced an acute myocardial infarction is not an independent prognostic marker. (Korean J Med 72:281-289, 2007)

정상 남성에서 음주 및 흡연과 혈청 총 콜레스테롤치와의 관계

정의룡(Eui Ryong Cheong),류재근(Jae Kean Ryu),전상중(Sang Joon Jun),채성철(Shung Chull Chae),전재은(Jae Eun Jun),박의현(Wee Hyun Park) 대한내과학회 1996 대한내과학회지 Vol.50 No.4

N/A Objectives : We conducted our study to establish the mean values of total serum cholesterol in healthy Korean male adults and find out the relationship between the cholesterol levels and life styles(eg. smoking and drinking habits). Methods: Eight hundred seventy-nine men involved in a health screening program in May, 1992, in Kyungpook University Hospital, were studied. The total cholesterol levels are determined by enzymatic method. And the life styles of the study groups were examined by answering written questionnaires. Results: The mean value of total cholesterol 189.6±30.6 mg/dl. The total cholesterol levels are higher in the age groups of fourth and fifth decades than in the age groups of second and third decades. The cholesterol levels show the tendency to increase according to age. The cholesterol levels are 189.8±30.7 mg/dl in smokers and 189.0±30.6 mg/dl in nonsmokers. They are not statistically different in either group. But heavy smokers who smoke more than 20 cigarettes per day have higher total cholesterol values than non-smokers. The cholesterol levels are 19431.0 mg/dl in heavy drinkers who drink alcoholic beverages 3-4 times per week and 187.2±31.7 mg/dl in non-drinkers. The group who are both heavy smoker and drinker have significantly higher cholesterol levels than in the group who do not smoke and drink alcoholic beverage. The cholesterol levels in the former and in the latter group are !?0629.0 mg/dl and 18331.2 mg/dl, respectively. Conclusion : The total cholesterol values somewhat related to the age and the life styles such as smoking and alcohol consumption. Generally speaking, the more increased levels of total cholesterol is shown when the person is getting older, the amounts of cigarettes smoked are increased and the frequencies of alcoholic drinks are increased.

관동맥질환의 진단을 위한 아데노신 Tc-99m sestaMIBI SPECT의 재현성

이덕영 ( Duk Young Lee ),배진호 ( Jin Ho Bae ),이상우 ( Sang Woo Lee ),천경아 ( Kyung Ah Chun ),유정수 ( Jeong Soo Yoo ),안병철 ( Byeong Cheol Ahn ),하정희 ( Jeoung Hee Ha ),채성철 ( Shung Chull Chae ),이규보 ( Kyu Bo Lee ),이재태 대한핵의학회 2006 핵의학 분자영상 Vol.39 No.6

Dipyridamole 부하 T1 - 201 심근스캔에서 폐 / 심장 섭취율과 일과성 좌심실 확장율에 관한 연구

이규보(Kyu Bo Lee),이재태(Jae Tae Lee),정병천(Byung Chun Chung),김상현(Sang Hyun Kim),채성철(Sung Chull Chae) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2

N/A Dipyridamole thallium imaging is one of the most widely accepted means of evaluating patients with suspected or known coronay artery disease. The results of thallium imaging help diagnose coronary artery disesse (CAD), determine the hemodynamic significance of coronary stenosis, evaluate viability of myocardium, assess the outcome of therapeutic interventions and stratify patients according t.o their risk for futher cardiac events. An increased lung thallium uptake and transient LV dilation has been reported as poor prognostic indicator and associated with extensive and severe coronary artery disease. We quantitated lung/heart uptake ratio (L/HUR) and transient left ventricular dilation ratio in 44 patients and 17 controls undertaking dipyridamole thalliurn-201 scintigraphy. The results are as follows: 1) The lung/heart uptake ratio was high in patients with CAD and which became higher according to increasing number of diseased vessel, The L/HUR of patients with low LVEP (<35%) was lower than those with normal LVEF. 2) Transient left ventricular dilation ratio of CAD patients had no close relation between numbers of diseased vessels and was not highqr than normals. But transient left ventricular dilation ratio of patients with myocardial infartion was higher than normals. We concluded that lung/heart uptake ratio seems to be sensitive marker for severity of CAD and myocardial function, but transient left ventricular dilation ratio alone is not sufficient to be a marker for severe and extensive CAD.

내원시 저혈당이 당뇨병을 동반한 심근경색증 환자의 예후에 미치는 영향

김은정 ( Eun Jung Kim ),정명호 ( Myung Ho Jeong ),정인석 ( In Seok Jeong ),오상기 ( Sang Gi Oh ),김상형 ( Sang Hyung Kim ),안영근 ( Young Keun Ahn ),김주한 ( Ju Han Kim ),김영조 ( Young Jo Kim ),채성철 ( Shung Chull Chae ),홍택종 대한내과학회 2014 대한내과학회지 Vol.87 No.5

목적: 당뇨병 환자에게 철저한 혈당 조절은 논란의 여지가 있으며, 이에 당뇨병을 동반한 급성 심근경색증 환자의 내원 시 저혈당과 병원 내 주요 임상 사건 및 사망률 그리고 추적관찰 1년간 사망률과의 관계를 알아보고자 하였다. 방법: 2005년 11월부터 2012년 3월까지 KAMIR에 등록된 당뇨병이 동반된 급성 심근경색증 환자 5,249명을 혈당 수치에 따라서 저혈당을 보인 환자(≤ 70 mg/dL)를 I군(93명, 72.6± 11.0세, 여성 46.2%), 정상혈당을 보인 환자(> 70 and < 140)를 II군(1,262명, 71.3 ± 10.7, 여성 34.3%), 고혈당을 보인 환자(≥ 140)를 III군(3,894명, 70.3 ± 11.1, 여성 36.0%)으로 분류하여, 병원 내 주요 임상사건 및 1년 후 사망률과의 관계를 비교하였다. 결과: 각 군의 평균 연령은 I군(72.6 ± 11.0세), II군(71.3 ±10.7세), III군(70.3 ± 11.1세)으로 I군에서 연령이 높았다(p =0.006). I군에서 내원 시 비전형적인 증상 양상(p = 0.002), Killip class III-IV (p = 0.003), 심초음파을 이용한 좌심실 구혈률 40% 미만의 환자(p = 0.002), NSTEMI가 많았다(p = 0.001). 전체 대상 환자 5,249명 중 344명(6.6%)이 입원 중 사망하였으며, 이 중에서 I군 12명(12.9%), II군 66명(5.2%), III군 266명(6.8%)으로 I군에서 사망률이 유의하게 높았다(p = 0.006).다변량 회귀분석에서 나이(p = 0.001), Killip class III-IV (p =0.001), 뇌혈관 질환(p = 0.002), 만성 신부전증(p = 0.001), 급성 신부전증(p = 0.001), 심인성 쇼크(p = 0.001), 심실성 빈맥증(p = 0.005), 좌심실 구혈률 40% 미만(p = 0.001), 내원시 혈당 70 mg/dL 미만(p = 0.005)은 추적관찰 한 달간 사망률에 독립적인 예측인자이었다. 정상 혈당군에 비하여 저혈당 군에서 사망률이 유의하게 증가하였고(OR 3.571, 95% CI1.465-8.705, p = 0.005). 고혈당군에 비해 저혈당군에서 사망률이 유의하게 증가하였다(OR 4.088, 95% CI 1.757-9.511, p= 0.001). 그러나 추적관찰 1년간에서 내원시 혈당은 사망률의 유의한 예측인자가 아니었다(p = 0.428). 결론: 당뇨병을 동반한 심근경색증 환자의 내원 시 저혈당은 입원중과 추적관찰 한 달간의 사망률을 예측할 수 있는 예후인자였다. Methods: We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I:hypoglycemia (≤ 70 mg/dL), Group II: normoglycemia (70-140 mg/dL) and Group III: hyperglycemia (≥ 140 mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission. Results: The mean age was older in group I at 72.6 ± 11.0 years compared to 71.3 ± 10.7 in group II and 70.3 ± 11.1 in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001). Conclusions: Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus. (Korean J Med 2014;87:565-573)