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  • Ovid Technologies (Wolters Kluwer Health)  (18)
  • Song, Jong-Min  (18)
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  • Ovid Technologies (Wolters Kluwer Health)  (18)
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  • 1
    Online Resource
    Online Resource
    Impact of Early Surgery on Embolic Events in Patients With Infective Endocarditis
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Circulation Vol. 122, No. 11_suppl_1 ( 2010-09-14)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 122, No. 11_suppl_1 ( 2010-09-14)
    Abstract: Background— Surgical indications to prevent systemic embolism in infective endocarditis (IE) remain controversial. We sought to compare clinical outcomes of early surgery with conventional treatment in IE patients with embolic indications only. Methods and Results— From 1998 to 2006, we prospectively enrolled 132 consecutive patients (86 men; age, 49±17 years) with definite IE. Patients were included if they had a left-sided native valve endocarditis with vegetation. The choice of early surgery or conventional treatment was at the discretion of attending physician. Early surgery was performed on 64 patients (OP group) within 7 days of diagnosis, and conventional management was chosen for 68 patients (CONV group). The OP group had larger vegetations and a higher percentage of patients with severe valvular disease (88% versus 62%, P =0.001). During initial hospitalization, there were no embolic events and 2 in-hospital deaths in the OP group and 14 embolic events and 2 in-hospital deaths in the CONV group. During a median follow-up of 1402 days, there were 2 cardiovascular deaths, 2 embolic events, and 1 recurrence of IE in the CONV group, and 1 cardiovascular death and 2 embolic events in the OP group. The 5-year event-free survival rate was significantly higher in the OP group (93±3%) than in the CONV group (73±5%, P =0.0016). For 44 propensity score–matched pairs, the OP group had a lower event rate (hazard ratio, 0.18; P =0.007). Conclusions— Compared with conventional treatment, an early surgery strategy is associated with improved clinical outcomes by effectively decreasing systemic embolism in patients with IE.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.109.927665
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 2
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    Abstract 18623: Evaluation of Left Ventricular Geometry Changes in Patients with Tight Aortic Stenosis Using Multi-detector Computed Tomography
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Background: Although aortic stenosis (AS) is a prototype of left ventricular hypertrophy (LVH) due to pressure overloading, patterns of LV geometric changes in patients with tight AS and their potential impact remain to be established. Methods: LV mass index (LVMI), LV end-diastolic volume (LVEDV) and regional LV wall thickness in 16 segments were measured in 147 patients with tight AS (indexed aortic valve area [AVA] 〈 0.6 cm 2 /m 2 ) using multi-detector computed tomography and compared with those of 32 normal controls. LVH was defined as LVMI 〉 95 th percentile of normal controls and LV remodeling as increased LVM/LVEDV with normal range of LVMI. Asymmetric remodeling or hypertrophy were used for patients with septal wall thickness 〉 1.5 fold compared to the opposite segment. Patients with increased LVMI but normal range of LVM/LVEDV were classified to have eccentric LVH and those with eccentric LVH and decreased LV systolic function were defined to have de-compensation. Results: AS patients with mean indexed AVA of 0.36 ± 0.08 cm 2 /m 2 showed 7 different patterns of LV geometry including normal LV geometry (n=44), remodeling (n=7), asymmetric remodeling (n=7), concentric hypertrophy (n=16), asymmetric hypertrophy (n=23), eccentric hypertrophy (n=38), and de-compensation (n=12). Peak transaortic velocity (r=0.31, p 〈 0.001) and E/E’ (r=0.29, p 〈 0.001) showed positive correlation with LVMI: compared to other groups, patients with LVH (concentric or asymmetric or eccentric) showed higher peak velocity and E/E’ with smaller AVA (all, p 〈 0.001). Despite similar AVA and mean pressure gradient, patients with E/E’ ≥ 15 (n=110) showed different LV remodeling patterns (p=0.028) with higher LVMI (97.8 ± 21.1 vs 86.4 ± 20.2 g/m 2 , p=0.005). Conclusions: Various remodeling patterns of LV geometry were observed in tight AS and individual variation in LVH severity under similar LV pressure overloading could explain different severity of diastolic dysfunction.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.18623
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 3
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    Diagnostic Performance of Perfusion-Only SPECT/CT for Chronic Thromboembolic Pulmonary Hypertension in Comparison With Ventilation-Perfusion Planar, SPECT, and SPECT/CT Imaging
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Clinical Nuclear Medicine
    Details
    In: Clinical Nuclear Medicine, Ovid Technologies (Wolters Kluwer Health)
    Abstract: The aim of this study was to assess the diagnostic performance of perfusion-only SPECT/CT (Q SPECT/CT) in comparison with that of ventilation/perfusion planar scintigraphy (V/Q planar), perfusion SPECT with ventilation scan (V/Q SPECT), and perfusion SPECT/CT with ventilation scan (V/Q SPECT/CT) in chronic thromboembolic pulmonary hypertension (CTEPH). Patients and Methods Patients with pulmonary hypertension who underwent ventilation-perfusion planar and SPECT/CT were retrospectively recruited. Two nuclear medicine physicians interpreted V/Q planar, V/Q SPECT, V/Q SPECT/CT, and Q SPECT/CT according to the European Association of Nuclear Medicine criteria. The diagnostic accuracy of these modalities for CTEPH was compared using a composite reference standard of pulmonary angiography, imaging test, cardiorespiratory assessment, and follow-up. Results A total of 192 patients were enrolled, including 85 with CTEPH. The sensitivity of Q SPECT/CT was 98.8%, which similar to that of V/Q planar (97.6%), V/Q SPECT (96.5%), or V/Q SPECT/CT (100.0%). In contrast, Q SPECT/CT exhibited significantly lower specificity (73.8%) compared with V/Q planar (86.9%, P = 0.001), V/Q SPECT (87.9%, P 〈 0.001), and V/Q SPECT/CT (88.8%, P 〈 0.001). The significantly lower specificity of Q SPECT/CT, compared with the 3 others, was observed in the subgroup aged ≥50 years ( P 〈 0.001 for all), but not in those 〈 50 years. Conclusions Q SPECT/CT exhibited lower specificity compared with V/Q planar, V/Q SPECT, and V/Q SPECT/CT in diagnosing CTEPH. It might underscore the essential role of a ventilation scan in patients with PH, even with the introduction of SPECT/CT.
    Type of Medium: Online Resource
    ISSN: 1536-0229 , 0363-9762
    URL: Article
    DOI: 10.1097/RLU.0000000000005142
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 2045053-9
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  • 4
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    Abstract 17681: Stress Cardiomyopathy Developed in Patients With Cancer: Clinical Characteristics and Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Sporadic case reports have shown that stress cardiomyopathy (SCM) can happen during treatment of underlying malignancy. However, clinical association between cancer and SCM needs further investigation. Methods: Echocardiographic data base from Jan 2009 to June 2014 was used to identify SCM patients in whom clinical and imaging data information was used to rule out classic myocardial infarction. Clinical characteristics, underlying comorbidities, and outcomes including in-hospital mortality were explored. Results: We retrospectively identified 549 consecutive patients (age, 64±15 years; 328 female) with SCMP in a single tertiary referral hospital. Among them, 210 patients had an active history of cancer (group 1, 38%), whereas the resting 339 did not (group 2). Hematologic malignancy including leukemia, lymphoma and multiple myeloma was the most common (n=44, 21.0%), followed by lung (n=39, 18.6%), stomach (7.6%), ovary (6.2%), and colorectal cancer (5.7%). Group 1 was characterized by younger age (62±13 vs. 65±16 years, p=0.002) with lower frequency of coronary risk factors, lower prevalence of female gender (54±63%, p=0.04), and lower frequency of underlying comorbidities including renal failure, stroke and heart failure. Physical illness associated with underlying medical conditions such as sepsis was the most common triggering event (79%), followed by routine surgery or procedure (18%); SCM triggered by emotional stress is very rare ( 〈 5%). Typical apical ballooning was present in 70% with atypical apical-sparing ballooning in 30% and this pattern did not show any difference between two groups. Left ventricular ejection fraction was lower in group 1 with higher prevalence of right ventricular ballooning, pulmonary hypertension and pericardial effusion. Hospital mortality was higher in group 1 (29% vs 20%, p=0.017) and active history of cancer was an independent factor associated with hospital mortality (odds ratio 1.60, 95% CI 1.063 - 2.410, p = 0.024). SCM development was not associated with history and timing of chemotherapy, which did not affect hospital mortality either. Conclusions: Cancer is an important risk factor of SCM development in a tertiary referral hospital and should be considered a poor prognostic factor.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.17681
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 5
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    Abstract 9763: Effectiveness of Dabigatran versus Conventional Treatment for Prevention of Silent Cerebral Infarct in Aortic and Mitral Valvular Atrial Fibrillation Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Background: Whereas warfarin is the anticoagulation of choice for patients with atrial fibrillation (AF) and rheumatic mitral stenosis (MS), new oral anticoagulants are considered as alternatives in those with other VHD. Hypothesis: This study sought to compare the efficacy and safety of dabigatran therapy compared to the conventional treatment in valvular AF including MS. Methods: In this prospective, randomized controlled trial, we randomly assigned patients with AF and left-sided VHD to receive either dabigatran or conventional treatment. The primary end point was the composite of occurrences of clinical stroke and new cerebral lesion (silent cerebral infarct and microbleed) on brain magnetic resonance imaging (MRI) performed at the 1-year follow-up. Results: Between March 2017 and October 2019, 59 and 60 patients were randomly allocated to dabigatran and conventional treatment group, respectively. In the dabigatran group, all the patients were switched from anticoagulation (n=52), antiplatelet (n=5), or no therapy (n=2) to dabigatran. In the conventional treatment group, all the 42 patients with mitral stenosis continued anticoagulation with warfarin and the remaining 18 patients continued warfarin (n=11) or antiplatelets (n=7). During follow-up, no death or clinical stroke occurred in both groups and 1 major bleeding in the conventional treatment group. At 1-year follow-up brain MRI, silent ischemic infarct and microbleed occurred in 20 and 2 patients in the dabigatran group, and 20 and 4 patients in the conventional treatment group, respectively. The incidence of primary endpoint was not significantly different between the treatment groups (32.2% vs. 36.7%, relative risk [RR] 1.03, 95% confidence interval 0.63-1.31, 0.70-1.51, P=0.608). In the subset of the 82 patients with significant MS, the risk of primary endpoint was also similar between groups (32.5% vs. 33.3%, RR 0.96, 95% CI 0.63-1.54, P=0.936). Conclusions: The rates of primary end point after treatment with dabigatran were similar to those with conventional treatment in AF patients with MS and with other VHD. Thus, dabigatran could be a reasonable alternative to warfarin even in AF associated with MS.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.9763
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 6
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    Abstract 11831: Late Outcome of Percutaneous Mitral Commissurotomy: Randomized Comparison of Inoue versus Double-Balloon Technique
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Percutaneous mitral commissurotomy (PMC) using either the Inoue or the double balloon technique showed similar, excellent 7-year outcomes, but very late results after successful PMC have been unknown. Hypothesis: We assessed late results of PMC up to 20 years in a randomized trial comparing Inoue versus double-balloon technique. Methods: Between 1989 and 1995, a total of 302 patients (77 men, 41±11 years) with severe mitral stenosis were randomly assigned to undergo PMC using Inoue (n=152; group I) or double-balloon technique (n=150; group D). The end points were the composite clinical events of death, mitral surgery, repeat PMC, or deterioration of NYHA class ≥3 that occurred after enrollment. Results: The successful immediate results [post-PMC mitral valve area (MVA) ≥1.5 cm 2 and mitral regurgitation (MR) grade ≤2] were achieved in 127 (84%) patients of group I and 122 (81%) patients of group D (p= NS). During median follow-up of 20.7 years (IQR, 18.9 to 22.9), clinical events occurred in 82 (53.9%) patients of group I (37 deaths, 44 mitral surgeries, 9 repeat PMCs and 3 NYHA class ≥3) and 79 (52.7%) patients of group I (34 deaths, 51 mitral surgeries, 5 repeat PMCs and 4 NYHA class ≥3). The event-free survival rates were not significantly different between group I and group D (49.3% and 55.3% at 20 years, respectively; HR, 1.22; 95% CI, 0.88-1.70; p=0.23) (Figure). On multivariate Cox analysis, absence of commissural MR (HR, 1.75; 95% CI, 1.22-2.51; p=0.002), immediate post-PMC MVA 〈 1.8cm 2 (HR, 1.54; 95% CI, 1.04-2.27; p=0.03), and atrial fibrillation (HR, 1.53; 95% CI, 1.04-2.23; p=0.03) were independently related with clinical events after successful PMC. Conclusions: In this randomized trial, the Inoue and double-balloon methods showed similar, good outcomes up to 20 years, and the achievement of effective commissurotomy with development of commissural MR or immediate post-PMC MVA ≥1.8cm 2 is important in optimizing the late results of PMC.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.11831
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 7
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    Abstract 17041: Impact of Different Patterns of Left Ventricular Ballooning in Patients With Stress (Takotsubo) Cardiomyopathy: Single Center Clinical Experience
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Stress cardiomyopathy (SCMP) is characterized by acute reversible left ventricular (LV) dysfunction, and it is well accepted that SCMP can show various patterns with or without apical involvement. However, clinical data describing characteristics and outcomes according to the patterns of LV ballooning are lacking. Methods: We retrospectively identified 549 consecutive patients (age, 64±15 years; 328 female) with SCMP in a single tertiary hospital from Jan 2009 to June 2014. They were divided into 2 groups with typical apical ballooning (group 1) and atypical patterns sparing the LV apical segment (group 2). Clinical characteristics and outcomes including in-hospital mortality were explored. Results: Apical ballooning was most common (n=394, 71.8%) and group 2 included mid-ventricular ballooning (21.7%), basal ‘inverted’ ballooning (2.9%), global hypokinesia (1.8%), localized ballooning (1.1%), and isolated right ventricular ballooning (0.7%). Group 1 was characterized by higher mean age (67±13 vs. 55±17 years, p 〈 0.001) with higher prevalence of coronary risk factors including obesity, hypertension, hyperlipidemia and diabetes mellitus. Emotional stress was a triggering event in a very limited patients comprising 〈 5%, whereas physical stress associated with underlying medical conditions comprised more than 70%. Distribution of triggering events was similar between groups. ECG abnormalities including T wave inversion, ST segment elevation, QT prolongation and atrial fibrillation were more frequent in group 1 than group 2 with lower LV ejection fraction. However, in-hospital mortality was comparable between groups (24% vs. 21%, p=0.52). Conclusions: Apical sparing ballooning develops in up to 30% of patients with SCMP. Younger age, favorable medical conditions, less severe ECG changes, and higher LV ejection fraction cannot translate to lower mortality in this group. Physicians’ vigilance is needed to improve clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.17041
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 8
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    IMPACT OF ROUTINE BRAIN IMAGING ON THE PROGNOSIS OF PATIENTS WITH LEFT-SIDED VALVE INFECTIVE ENDOCARDITIS WITHOUT NEUROLOGICAL MANIFESTATIONS
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of Hypertension Vol. 41, No. Suppl 3 ( 2023-06), p. e309-
    Details
    In: Journal of Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. Suppl 3 ( 2023-06), p. e309-
    Type of Medium: Online Resource
    ISSN: 0263-6352 , 1473-5598
    URL: Article
    DOI: 10.1097/01.hjh.0000942208.65115.5d
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2017684-3
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  • 9
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    In Vivo Measurement of Mitral Leaflet Surface Area and Subvalvular Geometry in Patients With Asymmetrical Septal Hypertrophy : Insights Into the Mechanism of Outflow Tract Obstruction
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Circulation Vol. 122, No. 13 ( 2010-09-28), p. 1298-1307
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 122, No. 13 ( 2010-09-28), p. 1298-1307
    Abstract: Analyzing the determinants of systolic anterior motion of the mitral valve and consequent left ventricular outflow tract (LVOT) obstruction in patients with asymmetrical septal hypertrophy requires a comprehensive 3-dimensional analysis of mitral leaflet (ML) area, papillary muscle (PM) geometry, and the distribution of left ventricular hypertrophy. Methods and Results— Real-time 3-dimensional echocardiography was performed in 47 patients with asymmetrical septal hypertrophy and 32 normal controls. Patients included 20 with resting LVOT obstruction (group I) and 27 without (group II). Customized software (Omni 4D) provided a validated measure of ML surface area, LVOT area, mitral annular area and nonplanarity, LVOT hypertrophy index by topography (percent area with wall thickness 〉 16 mm), and 3-dimensional PM positions relative to annulus. ML area was more than twice as large in group I than normal and 1.4 times normal in group II ( P 〈 0.001). Group I patients were also characterized by higher LVOT hypertrophy index and medial and anterior displacements of both PMs, resulting in a shorter inter-PM distance. Independent determinants of LVOT obstruction were indexed total ML area (adjusted odds ratio, 5.651; 95% confidence interval, 1.573 to 20.304; P =0.008) and inter-PM distance (adjusted odds ratio, 0.416; 95% confidence interval, 0.203 to 0.854; P =0.0169). Minimal LVOT area during systole correlated well with peak LVOT pressure gradient ( R 2 =0.83, P 〈 0.001); its independent determinants were left ventricular end-systolic volume ( P =0.0183), indexed total ML area ( P =0.0108), inter-PM distance ( P =0.0378), annular height ( P =0.0047), and LVOT hypertrophy index ( P =0.0098). Conclusions— Myocardium is not the only tissue affected in patients with asymmetrical septal hypertrophy, and primary changes of the mitral apparatus, including ML area increase and PM displacement, are independent determinants of LVOT obstruction and provide a comprehensive mechanism that determines leaflet slack and anteriorly directed motion. Abnormal PM–mitral valve geometry assessed by real-time 3-dimensional echocardiography can provide reasonable new targets for individualized intervention.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.109.935551
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
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  • 10
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    Abstract 17048: Prognostic Implication of Enlarged Left Ventricle in Patients Who Underwent Valve Surgery due to Mitral Valve Prolapse or Flail Mitral Valve: Volume versus Dimension
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Left ventricular end-systolic dimension (LVESD) has been being used to guide the optimal timing of surgery in patients with mitral valve prolapse (MVP) or flail mitral valve (FMV). We sought to evaluate whether LVES volume (LVESV) measured by echocardiography can provide additive prognostic information. Methods: Of patients who underwent MV surgery due to MVP or FMV from 2000 to 2014, after exclusion of patients whose rhythm was atrial fibrillation or who needed concomitant maze procedure, aortic valve or coronary bypass surgery, a total of 648 patients (age 51±14 years; ejection fraction 64±7%; LVESD 38±6 mm; LVESV 60±26 mL; repair/replacement = 612/36) was selected. Clinical outcomes included cardiovascular (CV) death, admission due to heart failure (HF) and development of LV dysfunction (EF 〈 45% at the last follow-up). Results: During median follow up of 4.2 years (interquartile range, 1.8-6.6 years), 5 patients died of CV death, 36 admitted for HF, and 38 developed LV dysfunction. Increased LVESD (≥45mm) could not predict CV death. But patients with enlarged LVESV index (LVESV/ body surface area ≥50 ml/m 2 , n=64, 10%) showed higher rate of CV death (p=0.04), HF admission (p=0.04) and composite clinical events (p 〈 0.001). In multivariate regression analysis, enlarged LVESV index was the only independent variable associated with composite clinical events (hazard ratio 2.67, 95% confidence interval 1.39-5.13, p=0.003). Conclusions: In the modern era of MV repair surgery for MVP and FMV, LV volume provides more robust prognostic information than LV dimension.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.17048
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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