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1.
Heesun Lee Jun-Bean Park Yeonyee E. Yoon Eun-Ah Park Hyung-Kwan Kim Whal Lee Yong-Jin Kim Goo-Yeong Cho Dae-Won Sohn Andreas Greiser Seung-Pyo Lee 《JACC: Cardiovascular Imaging》2018,11(7):974-983
Objectives
The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS).Background
Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown.Methods
A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68.8 ± 9.2 years of age, 49.6% male) and 33 age- and sex-matched controls who underwent 3-T CMR. The degree of diffuse myocardial fibrosis was assessed by noncontrast mapping of T1 relaxation time using modified Look-Locker inversion-recovery sequence, and the presence and extent of LGE were also evaluated. The AS patients were divided into 3 groups by the native T1 value. Primary endpoint was a composite of all-cause death and hospitalization for heart failure.Results
Native T1 value was higher in AS patients, compared with control subjects (1,232 ± 53 ms vs. 1,185 ± 37 ms; p = 0.008). During follow-up (median 27.9 months), there were 24 clinical events including 9 deaths (6 pre-operative and 3 post-operative), the majority of which occurred in the patients in the highest T1 tertile group (2.4% vs. 11.6% vs. 42.9% for lowest, mid-, and highest tertile groups; p < 0.001 by log-rank test). The total number of events for both pre- and post-operative events also occurred more frequently in patients in the highest T1 tertile group. EuroSCORE II, the presence and/or extent of LGE, and the native T1 value were predictors of poor prognosis (adjusted hazard ratio for every 20-ms increase of native T1: 1.28; p = 0.003). In particular, the highest native T1 value provided further risk stratification regardless of the presence of LGE.Conclusions
High native T1 value on noncontrast T1 mapping CMR is a novel, independent predictor of adverse outcome in patients with significant AS. 相似文献2.
Lee KH Kim SH Lim HE Kim EJ Kim MK Park WJ Cho GY 《International journal of cardiology》2007,120(1):e9-12
Variant angina usually responds to conventional treatment with nitrates and calcium antagonists. However, severe variant angina refractory to intensive anti-anginal treatment can be catastrophic because prolonged occlusion of a major coronary artery can result in myocardial infarction, severe cardiac arrhythmia, and sudden death. We report a patient with active variant angina which was refractory to conventional treatment including sublingual nitroglycerin and intravenous nitroglycerin administration. Only intravenous administration of nicorandil was consistently effective in eliminating chest pain of the patient. 相似文献
3.
Hack-Lyoung Kim Yong-Jin Kim Yeonyee E. Yoon Seung-Pyo Lee Hyung-Kwan Kim Goo-Yeong Cho Joo-Hee Zo Dong-Ju Choi Dae-Won Sohn 《Journal of Korean medical science》2015,30(9):1273-1278
This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Graphical Abstract
相似文献4.
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Koh JS Park JH Shin DH Youn TJ Oh IY Yoon CH Suh JW Cho YS Cho GY Chae IH Choi DJ 《The American journal of cardiology》2012,109(4):461-465
This study evaluated the risk factors of postprocedure cardiac troponin I (cTnI) increase and its effects on repeat revascularization and on overall clinical outcomes in patients with angina and normal preprocedural cTnI levels who underwent successful drug-eluting stent implantation. Postprocedure cTnI increase (≥0.5 ng/ml) was observed in 207 of 802 patients (25.8%). Patients with cTnI increase had more extensive coronary disease than patients without cTnI increase, which necessitated for the cTnI group more multilesion interventions and a longer total stent length. In multivariate analysis, total stent length (odds ratio 1.02, 1.01 to 1.03, p = 0.001) and use of glycoprotein IIb/IIIa inhibitors (3.07, 1.54 to 6.11, p <0.001) were identified as independent predictors of cTnI increase. During a median follow-up of 42 months, however, there were no significant between-group differences in Kaplan-Meier estimates of any repeat revascularization (24.8% vs 18.4%, hazard ratio 1.085, 0.723 to 1.627, p = 0.694) and major adverse cardiovascular events (27.0% vs 22.4%, 1.022, 0.703 to 1.485, p = 0.911). In conclusion, patients with postprocedure cTnI increase had more severe baseline coronary disease and received more complex interventional procedures. However, cTnI increase after successful drug-eluting stent implantation was not associated with an increased risk of repeat revascularization or of other adverse events. 相似文献
6.
Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging 总被引:6,自引:0,他引:6
Cho GY Chan J Leano R Strudwick M Marwick TH 《The American journal of cardiology》2006,97(11):1661-1666
Two-dimensional (2-D) strain (epsilon2-D) on the basis of speckle tracking is a new technique for strain measurement. This study sought to validate epsilon2-D and tissue velocity imaging (TVI)-based strain (epsilonTVI) with tagged harmonic-phase (HARP) magnetic resonance imaging (MRI). Thirty patients (mean age 62 +/- 11 years) with known or suspected ischemic heart disease were evaluated. Wall motion (wall motion score index 1.55 +/- 0.46) was assessed by an expert observer. Three apical images were obtained for longitudinal strain (16 segments) and 3 short-axis images for radial and circumferential strain (18 segments). Radial epsilonTVI was obtained in the posterior wall. HARP MRI was used to measure principal strain, expressed as maximal length change in each direction. Values for epsilon2-D, epsilonTVI, and HARP MRI were comparable for all 3 strain directions and were reduced in dysfunctional segments. The mean difference and correlation between longitudinal epsilon2-D and HARP MRI (2.1 +/- 5.5%, r = 0.51, p <0.001) were similar to those between longitudinal epsilonTVI and HARP MRI (1.1 +/- 6.7%, r = 0.40, p <0.001). The mean difference and correlation were more favorable between radial epsilon2-D and HARP MRI (0.4 +/- 10.2%, r = 0.60, p <0.001) than between radial epsilonTVI and HARP MRI (3.4 +/- 10.5%, r = 0.47, p <0.001). For circumferential strain, the mean difference and correlation between epsilon2-D and HARP MRI were 0.7 +/- 5.4% and r = 0.51 (p <0.001), respectively. In conclusion, the modest correlations of echocardiographic and HARP MRI strain reflect the technical challenges of the 2 techniques. Nonetheless, epsilon2-D provides a reliable tool to quantify regional function, with radial measurements being more accurate and feasible than with TVI. Unlike epsilonTVI, epsilon2-D provides circumferential measurements. 相似文献
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8.
Cho GY Jeong IK Kim SH Kim MK Park WJ Oh DJ Yoo HJ 《The American journal of cardiology》2007,100(6):1035-1039
This study was conducted to investigate the effect of growth hormone (GH) replacement on cardiac function assessed by standard or tissue Doppler echocardiography in GH deficiency. Ten patients (mean age 47+/-14 years) received GH at a dose of 1.0 IU/day (6 times/week). After 6 months of GH replacement, GH substitution was discontinued. Echocardiography was performed at baseline, after 6 months of therapy, and 1 year after the withdrawal of GH replacement. All parameters were compared with those from 11 healthy controls matched for age, gender, and left ventricular (LV) mass index. After GH replacement, LV ejection fractions were nonsignificantly increased. However, fractional shortening, LV dimensions, and LV volumes did not change. Compared with controls, peak strain (-18.9+/-4.8% vs -15.7+/-6.9%, p<0.01) and strain rate (-1.3+/-0.4/s vs -1.0+/-0.5/s, p<0.01) at baseline were significantly decreased in patients with GH deficiency. Strain and strain rate increased significantly after 6 months of replacement but returned to baseline levels after 12 months off therapy. In conclusion, GH replacement in adult-onset GH deficiency demonstrated beneficial effects on cardiac contractility assessed by strain and strain rate, but these parameters returned to baseline levels after the withdrawal of GH. Strain and strain rate can be used to evaluate subtle changes in myocardium after GH replacement. 相似文献
9.
Kim KI Park KU Chun EJ Choi SI Cho YS Youn TJ Cho GY Chae IH Song J Choi DJ Kim CH 《Journal of Korean medical science》2011,26(9):1178-1184
DKK1 modulates Wnt signaling, which is involved in the atherosclerosis. However, no data exist regarding the usefulness of measuring serum DKK1 concentration in predicting coronary atherosclerosis. A total of 270 consecutive patients (62.8 ± 11.2 yr; 70% male) were included. A contrast-enhanced 64-slice coronary MDCT was performed to identify the presence of atherosclerotic plaques. Agatston calcium scores (CS) were calculated to quantify the coronary artery calcification (CAC). DKK1 concentrations were measured by enzyme-linked immunosorbent assay. For each subsequent DKK1 quartile, there was a significant increase in CAC (P = 0.004) and the number of segments with coronary atherosclerosis (P < 0.001). In addition, DKK1 concentration was significantly higher in patients with atherosclerotic plaques, regardless of plaque composition (P = 0.01). Multivariate analysis identified DKK1 as an independent risk factor for the presence of coronary atherosclerotic plaque. The adjusted odds ratio for coronary atherosclerotic plaque was 4.88 (95% CI, 1.67 to 14.25) for highest versus lowest quartile of the DKK1 levels. Furthermore, patients with DKK1 concentrations ≥ 68.6 pg/mL demonstrated coronary atherosclerotic plaques even when they had low CS. Serum DKK1 concentrations correlate with the coronary atherosclerosis and play an independent role in predicting the presence of coronary atherosclerosis. 相似文献
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