Jin-Kyu Park

Clinical significance of arterial stiffness in idiopathic sudden sensorineural hearing loss

To investigate the clinical significance of arterial stiffness in the development and prognosis of idiopathic sudden sensorineural hearing loss (SSNHL).

The Impact of Metabolic Syndrome on Clinical Outcomes After Everolimus-Eluting Stent Implantation

As it is controversial whether metabolic syndrome (MetS) affects cardiovascular outcomes in patients who underwent percutaneous coronary intervention (PCI), we investigated the impact of MetS on clinical outcomes in patients who underwent PCI with everolimus-eluting stents (EESs). Patients who underwent PCI with EESs from 2009 to 2013 were included in this single-center, prospective cohort study. A composite event consisted of repeat revascularization, nonfatal myocardial infarction, and cardiac death. Of 903 patients observed for 4.9xa0years (median 1.8xa0years), 570 were diagnosed with MetS. The MetS group displayed more severe coronary artery disease and underwent more extensive PCIs than didxa0the non-MetS group. The overall composite event rate was not significantly different between the MetS and the non-MetS group (11.9% vs 13.2%, pxa0= 0.572). Kaplan-Meier survival analysis showed no significant difference in the event-free survival of the composite event between the 2 groups (pxa0= 0.700). A multivariable Cox regression analysis showed that MetS was not associated with the composite event, whereas total stent length, decreased renal function, diabetes, and the absence of abdominal obesity were associated with the composite event. Abdominal obesity was associated with decreased risk of the composite event, alleviating unfavorable clinical outcomes of patients with diabetes in the MetS group. In conclusion, MetS has no impact on the clinical outcomes of patients who underwent PCI with EESs, although the MetS group exhibited more severe coronary artery disease and underwent more extensive PCIs. The paradoxical association between obesity and favorable clinical outcomes may explain this result.

Unilateral pulmonary edema: a rare initial presentation of cardiogenic shock due to acute myocardial infarction.

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

Type 2 Myocardial Infarction Following Generalized Tonic-Clonic Seizure

Myocardial infarction is diagnosed when blood levels of biomarkers are increased in the clinical setting of acute myocardial ischemia. Among the biomarkers, troponin I is the preferred biomarker indicative of myocardial necrosis. It is tissue specific for the heart. Myocardial infarction is rarely reported following seizure. We report a case of elevated troponin I in a patient after an episode of generalized tonic-clonic seizure. The diagnosis was type 2 myocardial infarction.

Impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention

BACKGROUNDnSimilar to overt hypothyroidism, subclinical hypothyroidism (SCH) has been reported to increase the risk of cardiovascular disease. However, the influence of SCH on clinical outcomes following percutaneous coronary intervention (PCI) remains unclear.nnnMETHODSnWe performed a prospective cohort study. SCH was defined as a thyroid-stimulating hormone (TSH) level ≥4.5mIU/l and a normal level of free thyroxine (FT4). A composite event was defined as the combination of cardiac death, non-fatal myocardial infarction (MI) and repeat revascularization.nnnRESULTSnOf 936 patients, who were observed for 3.1years, 100 patients (10.7%) were diagnosed with SCH. Repeat revascularization, cardiac death and a composite event occurred more frequently in the SCH group than in the euthyroidism group, while the incidence of non-fatal MI was similar between the two groups. Multiple Cox regression analysis showed that SCH was associated with the risk of a composite event (hazard ratio, 1.52; 95% confidence interval, 1.04-2.22) after adjustment for age, sex, current smoking, ST-segment elevation MI, prior PCI, diabetes, hypertension, renal function, left ventricular ejection fraction, B-type natriuretic peptide, stent numbers, total stent length, stent types, obesity and lipid profiles. Serum TSH levels were also significantly associated with the risk of a composite event. SCH was not associated with repeat PCIs for de novo stenotic lesions but was associated with repeated PCIs for in-stent restenotic lesions.nnnCONCLUSIONSnSCH negatively impacted clinical outcomes following PCIs. Therefore, patients with SCH should be carefully observed after undergoing a PCI.

Accessory papillary muscles and papillary muscle hypertrophy are associated with sudden cardiac arrest of unknown cause

BACKGROUNDnThe present study was performed for elucidating the associations between the morphology of the papillary muscles (PMs) and sudden cardiac arrest (SCA).nnnMETHODSnWe retrospectively reviewed history, laboratory data, electrocardiography, echocardiography, coronary angiography, and cardiac CT/MRI for 190 patients with SCA. The prevalence of accessory PMs and PM hypertrophy in patients with SCA of unknown cause was compared with that in patients with SCA of known causes and 98 age- and sex-matched patients without SCA. An accessory PM was defined as a PM with origins separated from the anterolateral and posteromedial PMs, or a PM that branched into two or three bellies at the base of the anterolateral or posteromedial PM. PM hypertrophy was defined as at least one of the two PMs having a diameter of ≥1.1cm.nnnRESULTSnIn 49 patients (age 49.9±15.9years; 38 men) the cause of SCA was unknown, whereas 141 (age 54.2±16.6years; 121 men) had a known cause. The prevalence of accessory PMs was significantly higher in the unknown-cause group than in the known-cause group (24.5% and 7.8%, respectively; p=0.002) or the no-SCA group (7.1%, p=0.003). The same was true for PM hypertrophy (unknown-cause 12.2%, known-cause 2.1%, p=0.010; no SCA group 1.0%, p=0.006). By logistic regression, accessory PM and PM hypertrophy were independently associated with sudden cardiac arrest of unknown cause.nnnCONCLUSIONSnAn accessory PM and PM hypertrophy are associated with SCA of unknown cause.

Validation study of candidate single nucleotide polymorphisms associated with left ventricular hypertrophy in the Korean population

BackgroundLeft ventricular hypertrophy (LVH) is a valid predictor for cardiovascular mortality and morbidity regardless of age, gender, and race. The HyperGEN study conducted a genome-wide association study and identified twelve single nucleotide polymorphisms (SNPs) associated with LVH. The aim of this study was to validate these candidate SNPs in the Korean population.MethodsAmong 1637 individuals from the Korean Multi-Rural Communities Cohort Study (MRCohort) of the Korean Genome Epidemiology Study (KoGES), we carried out a linear regression analysis with left ventricular mass index (LVMI) and a logistic regression analysis for LVH status.ResultsThe rs4129218 on chromosome 12 tended to be associated with LVM/body surface area (adjusted βu2009=u2009−0.023; pu2009=u20090.036) and LVM/height2.7 (adjusted βu2009=u2009−0.027; pu2009=u20090.016), and was marginally protective against LVH after adjustment for age, sex, body mass index, serum creatinine, systolic blood pressure, heart rate and antihypertensive medication (adjusted odds ratiou2009=u20090.766 and 0.731; pu2009=u20090.027 and 0.007 according to indexation by BSA and height2.7, respectively).ConclusionsIn the Korean population, the minor allele of rs4129218 had borderline association with lower LVM. This study suggests that rs4129218 on chromosome 12 showed consistent tendency of possibly related loci for LVH independent of ethnic background.

E/E′ and D-shaped Left Ventricle Severity in Patients with Increased Pulmonary Artery Pressure

BACKGROUND D-shaped left ventricle (D-LV) is an interesting echocardiographic finding in pulmonary hypertension (PH) and is the result of structural distortion of the interventricular septum. The eccentricity index (EI) is a quantitative measure used to evaluate the severity of D-LV in patients with increased pulmonary artery pressure (PAP). However, D-LV and EIs have rarely been studied in terms of their association with hemodynamic factors. METHODS A total of 526 patients with a maximal tricuspid regurgitation velocity (VmaxTR) > 2.8 m/s on echocardiography identified between January 2012 and December 2017 were enrolled. After exclusion, a total of 289 patients were analyzed. The association between D-LV and hemodynamic factors were analyzed using logistic regression. Furthermore, factors that impacted the severity of the D-LV, as defined by EIs, were also analyzed using the multiple linear regression model. RESULTS In the multivariate logistic regression model, higher pulmonary artery pressure (PAP, p = 0.001), lower tricuspid annular plane systolic excursion (TAPSE, p = 0.048), and E/E′ (p = 0.017) were found to be significant risk factors for the presence of D-LV. Additional analysis with age and body mass index added to independent variables, PAP (p = 0.008), TAPSE (p = 0.028), and age (p < 0.001) were significant risk factors for the presence of D-LV. In patients with D-LV, only E/E′ was independently associated with EIs (R2 = 0.666, p < 0.001). CONCLUSIONS In patients with increased PAP, D-LV is associated with PAP, TAPSE, E/E′, and age. EIs are associated with left ventricular filling pressure, represented as E/E′.

Data on the impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention

This article contains the data showing the different influence of subclinical hypothyroidism (SCH) on the risk of cardiovascular events after percutaneous coronary intervention (PCI) in various subgroups regarding myocardial infarction, previous PCI, the stent generation, total stent length, the extent of coronary artery disease, diabetes mellitus, obesity, a lipid reduction level and a C-reactive protein level. This article also contains the data showing the association between SCH and the risk of receiving repeat PCI for in-stent restenosis or de novo coronary stenosis. The data are supplemental to our original research article titled “Impact of Subclinical Hypothyroidism on Clinical Outcomes Following Percutaneous Coronary Intervention” (Lee et al., 2017) [1].

Mediating effects of nocturnal blood pressure and morning surge on the contributions of arterial stiffness and sodium intake to morning blood pressure: A path analysis.

Abstract Background. The aim of this study was to evaluate the mediating effects of nocturnal blood pressure (BP) and morning surge on the contribution of arterial stiffness and sodium intake to morning BP in a middle-aged general population. Methods. The study included 124 subjects aged 30–59 years, from rural Yeoju County, Gyeonggi Province, South Korea. Ambulatory BP monitoring, 24u2009h urinary sodium excretion (24 h UNa) and brachial–ankle pulse wave velocity (baPWV) measurements were performed in all subjects. Results. The meanu2009±u2009SD age was 48.1u2009±u20098.2 years and the proportion of male subjects was 41.1%. After adjusting for covariates, morning systolic blood pressure (SBP) was significantly correlated with morning surge [coefficientu2009=u20090.761, 95% confidence interval (CI) 0.651–0.872, pu2009<u20090.001], nocturnal SBP (coefficientu2009=u20090.576, 95% CI 0.454–0.698, pu2009<u20090.001) and baPWV (coefficientu2009=u20093.550, 95% CI 1.447–5.653, pu2009=u20090.001). Path analysis modeling revealed that baPWV had significant direct (0.035, pu2009=u20090.013) and indirect effects (0.042, pu2009=u20090.012) on morning SBP. The indirect effect mediated by nocturnal SBP was statistically significant (0.054, pu2009=u20090.005), but the indirect effect mediated by the morning surge was not significant. The 24 h UNa had no significant direct or indirect effects on morning SBP. Conclusion. baPWV had significant direct and indirect effects on morning SBP. The indirect effect was mediated by nocturnal SBP, but not by morning surge. The 24u2009h UNa had neither significant direct nor indirect effects on morning SBP.