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Hyun-Jin Kim Seung-Pyo Lee Chan Soon Park Jun-Bean Park Yong-Jin Kim Hyung-Kwan Kim Dae-Won Sohn 《The international journal of cardiovascular imaging》2016,32(2):247-259
The present study evaluated change in left ventricle (LV) biomechanics, layer-by-layer, following acute pressure unloading in patients with severe aortic stenosis (AS). In twenty-eight consecutive patients with severe AS who underwent transcatheter aortic valve replacement (TAVR), LV peak global longitudinal and circumferential strains of the endo-, midmyo- and epicardium were evaluated using multilayer speckle tracking echocardiography before, 1 week after, and 1 month after TAVR. Longitudinal and circumferential strains were significantly highest in the endocardium and lowest in the epicardium at baseline. At 1 month following TAVR, longitudinal strain significantly improved in all layers compared with the baseline [endocardium (%) ?16.7 ± 3.8 vs. ?18.6 ± 3.3, P = 0.01; mid-myocardium ?14.4 ± 3.2 vs. ?16.2 ± 3.5, P < 0.01; epicardium ?12.4 ± 2.8 vs. ?13.6 ± 2.6, P = 0.01], whereas LV ejection fraction and circumferential strain remained unchanged. Importantly, only those with LV hypertrophy demonstrated improved longitudinal strain [endocardium (%) ?15.7 ± 3.0 vs. ?18.7 ± 2.9, P < 0.01; mid-myocardium ?13.6 ± 2.7 vs. ?16.0 ± 2.5, P < 0.01; epicardium ?11.8 ± 2.4 vs. ?13.7 ± 2.3, P < 0.01]. The improvement in longitudinal strain was more prominent in the endocardium, which was evident even at an early time point (1 week) after TAVR. Longitudinal strain significantly improved in all three layers following acute pressure unloading, the most prominent of which was observed in the endocardium. Evaluation of multilayer strain may provide new insights into the LV mechanics in the future. 相似文献
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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4.
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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
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Kazuo Hayashi Itaru Mizoguchi Seung-Pyo Lee Brian Reich 《Medical engineering & physics》2010,32(5):423-428
The purpose of this study was to establish a new statistical method for the analysis of masticatory function. The subjects were patients with anterior crossbite who had received orthognathic surgery. Chewing movement was measured by means of an opto-electronic motion-analysis system. This movement was compared with similar movement in control patients. We sought to develop a statistical model to predict the population average curves of the chewing cycles. In this study, the mandibular incisor point was used as a target point of jaw movement. The combination of a spline function with random coefficients and self-modeling regression (SEMOR) extended to three dimensions was used to predict population average curves for each group. Unquestionably, significant differences were present in some areas. The present modeling method that uses the combination of a spline function and SEMOR is one of the best ways to eliminate subjective estimation with regard to predicting representative chewing cycles. 相似文献
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Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test
In-Chang Hwang Yong-Jin Kim Kyung-Hee Kim Dong-Ho Shin Seung-Pyo Lee Hyung-Kwan Kim Dae-Won Sohn 《The American journal of emergency medicine》2014
Objectives
This study investigated the diagnostic yield of invasive coronary angiography (CAG) and the impact of noninvasive test (NIV) in patients presented to emergency department (ED) with acute chest pain.Methods
Patients 50 years or older who visited ED with acute chest pain and underwent CAG were identified retrospectively. Those with ischemic electrocardiogram, elevated cardiac enzyme, known coronary artery disease (CAD), history of cardiac surgery, renal failure, or allergy to radiocontrast were excluded. Diagnostic yields of CAG to detect significant CAD or differentiate the need for revascularization were analyzed according to whether NIV was performed and its result.Results
Among the total 375 consecutive patients, significant CAD was observed in 244 (65.1%). Diagnostic yields of CAG were higher in patients who underwent NIV before CAG, but the discriminative effect was modest (59.7% vs 70.7% [P = .026] for detection of CAD; 45.0% vs 50.5% [P = .285] for revascularization). Positive results of NIV were significantly associated with the presence of CAD and the need for revascularization, when compared with patients without NIV or patients with negative results (P < .001, respectively).Conclusion
The diagnostic yield of CAG was only 65% in low- to intermediate-risk ED patients with acute chest pain. Performing of NIV provided only modest improvement in diagnostic yield of CAG. The unexpectedly low diagnostic yield might be attributable to the underuse of NIV and misinterpretation of physicians. We suggest the use of NIV as a gatekeeper to discriminate patients who require CAG and/or revascularization, and for this, better risk stratification and appropriate application of NIV are required. 相似文献10.
In-Chang Hwang Dae-Hee Kim Yong-Jin Kim Kyung-Hee Kim Seung-Pyo Lee Hyung-Kwan Kim Dae-Won Sohn Byung-Hee Oh Young-Bae Park 《The Canadian journal of cardiology》2013