ABSTRACT
Background@#The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI). @*Methods@#A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization. @*Results@#Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001). @*Conclusion@#NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.
ABSTRACT
Background@#The neutrophil-to-lymphocyte ratio (NLR) has been proven to be a reliable inflammatory marker. A recent study reported that elevated NLR is associated with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction (STEMI). We investigated whether NLR at emergency room (ER) is associated with mechanical complications of STEMI undergoing primary percutaneous coronary intervention (PCI). @*Methods@#A total of 744 patients with STEMI who underwent successful primary PCI from 2009 to 2018 were enrolled in this study. Total and differential leukocyte counts were measured at ER. The NLR was calculated as the ratio of neutrophil count to lymphocyte count. Patients were divided into tertiles according to NLR. Mechanical complications of STEMI were defined by STEMI combined with sudden cardiac arrest, stent thrombosis, pericardial effusion, post myocardial infarction (MI) pericarditis, and post MI ventricular septal rupture, free-wall rupture, left ventricular thrombus, and acute mitral regurgitation during hospitalization. @*Results@#Patients in the high NLR group (> 4.90) had higher risk of mechanical complications of STEMI (P = 0.001) compared with those in the low and intermediate groups (13% vs. 13% vs. 23%). On multivariable analysis, NLR remained an independent predictor for mechanical complications of STEMI (RR = 1.947, 95% CI = 1.136–3.339, P= 0.015) along with symptom-to balloon time (P = 0.002) and left ventricular dysfunction (P < 0.001). @*Conclusion@#NLR at ER is an independent predictor of mechanical complications of STEMI undergoing primary PCI. STEMI patients with high NLR are at increased risk for complications during hospitalization, therefore, needs more intensive treatment after PCI.
ABSTRACT
The prevalence of atrial fibrillation (AF) is gradually increasing with the aging of the population, and there is also increasing interest in AF with the development of various single-lead electrocardiography measurement methods for diagnosis. Further, the current diagnosis and treatment policies for AF do not reflect its progression and complexity. In addition, the various factors related to AF diagnosis and treatment are not simple due to the diversification of tools, advances in treatment methods, and complex mechanism of AF. Therefore, there are many challenges to developing a simple AF classification system. To overcome these, there have been a number of attempts to systematically characterize AF according to treatment and prognosis rather than using a uniform classification. Further, as mentioned in the previous AF guidelines, further research is being conducted on an integrated patient–physician approach to AF. Such an approach would be the basis for consistent treatment based on the guidelines, and would help to improve patient outcomes. Further, for the integrated management of AF patients, some changes should be made to the current approach to develop a multidisciplinary approach, including changes to the behavior of team members, patients, their family members, and physicians. The Korean Heart Rhythm will introduce an integrated approach to the classification and structure of AF management, and provide guidelines for its application in clinical practice.
ABSTRACT
Background and objectives@#Takotsubo cardiomyopathy (TTC) occasionally causes life-threatening ventricular arrhythmia. J wave on surface electrocardiography (sECG) has also been associated with idiopathic ventricular fibrillation and cardiac events; therefore, we investigated whether the presence of J wave on sECG is a potential risk factor for ventricular arrhythmia in patients with TTC. @*Subjects and methods@#We performed a retrospective study in 79 patients who were diagnosed with TTC from 2010 to 2014. Among them, 20 (25.3%) were diagnosed with ventricular tachycardia (VT). The J wave on the sECG was defined as J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads. @*Results@#A higher prevalence of ventricular tachycardia was observed in patients with J wave. The corrected QT interval (QTc) was significantly longer in the VT group than in the non-VT group. In a multivariate analysis, the presence of J wave appeared to be the only independent predictors of VT [Hazard Ratio (HR) 3.5, p = 0.019]. @*Conclusion@#Our results suggest that the presence of J wave on the sECG is significantly associated with VT, and appear to indicate that the presence of J wave is a strong and independent predictor of VT in patients with TTC.
ABSTRACT
INTRODUCTION@#Variability of blood pressure (BP) has been reported to be related to worse cardiovascular outcomes. We examined the impact of daytime systolic BP variability on left ventricular (LV) function and arterial stiffness in hypertensive patients.@*METHODS@#Ambulatory BP monitoring (ABPM) and echocardiography were performed in 116 hypertensive patients. We assessed BP variability as standard deviations of daytime systolic BP on 24-hour ABPM. Conventional echocardiographic parameters, area strain and three-dimensional diastolic index (3D-DI) using 3D speckle tracking were measured. Arterial stiffness was evaluated by acquiring pulse wave velocity (PWV) and augmentation index.@*RESULTS@#Patients with higher BP variability showed significantly increased left ventricular mass index (LVMI) and late mitral inflow velocity, as well as decreased E/A (early mitral inflow velocity/late mitral inflow velocity) ratio, area strain and 3D-DI than those with lower BP variability (LVMI: p = 0.02; A velocity: p < 0.001; E/A ratio: p < 0.001; area strain: p = 0.02; 3D-DI: p = 0.04). In addition, increased BP variability was associated with higher PWV and augmentation index (p < 0.001). Even among patients whose BP was well controlled, BP variability was related to LV mass, diastolic dysfunction and arterial stiffness.@*CONCLUSION@#Increased BP variability was associated with LV mass and dysfunction, as well as arterial stiffness, suggesting that BP variability may be an important determinant of target organ damage in hypertensive patients.
ABSTRACT
Non-vitamin K antagonist oral anticoagulants (NOACs) are alternatives to vitamin K antagonists to prevent stroke in patients with non-valvular atrial fibrillation (AF) and have emerged as the preferred choice. The use of NOACs is rapidly increasing in Korea after coverage by insurance since 2015. However, the rate of prescribing anticoagulants in Korean patients with AF remains low compared to other countries. Most of the NOAC anticoagulant prescriptions are issued at hospitals. As the prevalence rate of AF in Korea is expected to increase rapidly with the increase in the elderly population, the need to prescribe NOACs in primary care clinics will also increase. Therefore, The Korean Heart Rhythm Society organized the Korean Atrial Fibrillation Management Guideline Committee and analyzed all available studies based on the 2018 European Heart Rhythm Association Practical Guide on the use of NOACs for managing AF, as well as studies on Korean patients. The authors would like to introduce practical guidelines for NOAC prescriptions in Korean patients with AF.
Subject(s)
Aged , Humans , Anticoagulants , Atrial Fibrillation , Follow-Up Studies , Heart , Insurance , Korea , Prescriptions , Prevalence , Primary Health Care , Stroke , Vitamin KABSTRACT
Non-vitamin K antagonist oral anticoagulants (NOACs) are alternatives to vitamin K antagonists to prevent stroke in patients with non-valvular atrial fibrillation (AF) and have emerged as the preferred choice. The use of NOACs is rapidly increasing in Korea after coverage by insurance since 2015. However, the rate of prescribing anticoagulants in Korean patients with AF remains low compared to other countries. Most of the NOAC anticoagulant prescriptions are issued at hospitals. As the prevalence rate of AF in Korea is expected to increase rapidly with the increase in the elderly population, the need to prescribe NOACs in primary care clinics will also increase. Therefore, The Korean Heart Rhythm Society organized the Korean Atrial Fibrillation Management Guideline Committee and analyzed all available studies based on the 2018 European Heart Rhythm Association Practical Guide on the use of NOACs for managing AF, as well as studies on Korean patients. The authors would like to introduce practical guidelines for NOAC prescriptions in Korean patients with AF.
ABSTRACT
The name of the author was given incorrectly.
ABSTRACT
A number of concomitant conditions and cardiovascular diseases are closely related to the development of atrial fibrillation (AF), AF recurrence, and AF-associated complications. Detection, prevention, and treatment of such conditions are essential for the prevention of AF and its disease burden. This article discusses the clinical conditions and concomitant diseases associated with AF including heart failure, hypertension, diabetes, obesity, chronic respiratory diseases, and kidney disease based on the 2016 European Society of Cardiology guidelines for the management of AF and recently updated clinical data, particularly in patients with heart failure. Furthermore, we provide recommendations for the prevention, diagnosis, and management of these conditions.
Subject(s)
Humans , Atrial Fibrillation , Cardiology , Cardiovascular Diseases , Comorbidity , Diagnosis , Heart Failure , Heart , Hypertension , Kidney Diseases , Obesity , Recurrence , Risk FactorsABSTRACT
Oral anticoagulants (OAC) are necessary to prevent thromboembolism in patients with atrial fibrillation (AF). OACs used in Korea are composed of warfarin and non-vitamin K antagonist OAC. Risk stratification and selection of OACs in patients with AF is usually performed by international guidelines for AF management. However, these guidelines do not always reflect the unique characteristics of AF patients in Korea as they were established based on a small portion of the Asian population and, therefore, have limited application to Korean patients. In addition, under certain conditions, the choice of OACs and doses according to the international guidelines are unsuitable for Korean AF patients. Recently, robust clinical data of Korean AF patients have become available. The Korean AF Management Guideline Committee, as part of the Korean Heart Rhythm Society, analyzed all available studies regarding management of AF including those focusing on Korean patients. Expert consensus and guidelines for optimal management of AF patients in Korea were established following systematic reviews and intensive discussions. This article provides the appropriate choice of OACs and dose for management of Korean AF patients with various clinical conditions.
Subject(s)
Humans , Anticoagulants , Asian People , Atrial Fibrillation , Consensus , Heart , Korea , Stroke , Thromboembolism , WarfarinABSTRACT
BACKGROUND AND OBJECTIVES: The change of in-hospital and out-hospital treatments, and hospital costs for atrial fibrillation (AF) were not well known in rapidly aging Asian countries. This study is to examine the trends of AF management and outcomes in Korea. SUBJECTS AND METHODS: In the sample cohort from Korean National Health Insurance Data Sample Cohort (K-NHID-Sample Cohort) from 2004 through 2013, we identified patients with AF and hospital visit records using Korean Classification of Diseases, 6th Revision (KCD-6). Hospital cost, prescribed medications, radiofrequency catheter ablation (RFCA), morbidity and mortality were identified. RESULTS: AF-related hospitalization and outpatient clinic visits increased by 2.19 and 3.06-fold, respectively. While the total cost increased from 3.6 to 11.3 billion won (p<0.001), the mean cost per patient increased from 0.68 to 0.83 million won (p<0.001). Although the mean CHA₂DS₂-VASc score increased from 3.5 to 4.4 in the total AF population, the proportion of patients who receive anticoagulation therapy with warfarin showed no significant change for the decade. The proportion of hospitalization for RFCA was increased (0.4% to 1.1%, p<0.001). All-cause mortality (6.7% to 5.0%), cardiovascular mortality (1.4% to 1.1%) and stroke-related death (1.3% to 0.8%) showed a modest decrease from 2004 to 2013. CONCLUSION: During the last decade, AF-related hospitalization and outpatient clinic visits have increased with the increase of many other comorbidities, whereas the rate of anticoagulation did not improved. Although mortality in patients with AF showed a modest decrease from 2004 to 2013, proper anticoagulation therapy is warranted for the improvement of public health.
Subject(s)
Humans , Aging , Ambulatory Care Facilities , Asian People , Atrial Fibrillation , Catheter Ablation , Classification , Cohort Studies , Comorbidity , Health Care Costs , Hospital Costs , Hospitalization , Korea , Mortality , National Health Programs , Public Health , WarfarinABSTRACT
Complete hardware removal is recommended in the case of patients with cardiovascular implantable electronic device (CIED) infections. However, the complete extraction of chronically implanted leads is not always achieved. The outcomes and optimal management of CIED infections with retained material after lead extractions have not been elucidated. In this case report, we present five patients with CIED infections with remnant lead tips even after lead extractions. Two patients had localized pocket infections, and were managed with antibiotics for a period of more than two weeks. The other three patients had infective endocarditis, and were managed with antibiotics for a period of more than four weeks. In one patient, the lead tip migrated to the right pulmonary artery, but did not produce any symptoms or complications. Only one of five patients experienced a resurgence of an infection.
Subject(s)
Humans , Anti-Bacterial Agents , Device Removal , Endocarditis , Pacemaker, Artificial , Pulmonary ArteryABSTRACT
PURPOSE: We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We enrolled 113 patients with STEMI (age, 56+/-11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [31 U (48.1+/-17.1 U), n=37]. RESULTS: The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was <90 minutes in all patients, and it was not significantly different between groups. Meanwhile, the symptom-onset-to-balloon time was significantly longer in the High IMR group, compared to the Mid and Low IMR groups (p<0.001). In the high IMR group, the culprit lesion was found in a proximal location significantly more often than in a non-proximal location (p=0.008). In multivariate regression analysis, age and symptom-onset-to-balloon time were independent determinants of a high IMR (p=0.013 and p=0.003, respectively). CONCLUSION: Our data suggest that age and symptom-onset-to-balloon time might be the major predictors of microvascular dysfunction in STEMI patients with a door-to-balloon time of <90 minutes.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angiography/methods , Microcirculation , Myocardial Infarction/physiopathology , Operative Time , Percutaneous Coronary Intervention , Regression AnalysisABSTRACT
We investigated whether the presence of J wave on the surface electrocardiography (sECG) could be a potential risk factor for ventricular fibrillation (VF) during acute myocardial infarction (AMI). We performed a retrospective study of 317 patients diagnosed with AMI in a single center from 2009 to 2012. Among the enrolled 296 patients, 22 (13.5%) patients were selected as a VF group. The J wave on the sECG was defined as a J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads. We found that the incidence of J wave on the sECG was significantly higher in the VF group. We also confirmed that several conventional risk factors of VF were significantly related to VF during AMI; time delays from the onset of chest pain, blood concentrations of creatine phosphokinase and incidence of ST-segment elevation. Multiple logistic regression analysis demonstrated that the presence of J wave and the presence of a ST-segment elevation were independent predictors of VF during AMI. This study demonstrated that the presence of J wave on the sECG is significantly related to VF during AMI.
Subject(s)
Female , Humans , Male , Middle Aged , Arrhythmias, Cardiac/diagnosis , Creatine Kinase/blood , Electrocardiography , Heart Conduction System/abnormalities , Myocardial Infarction/diagnosis , Retrospective Studies , Risk Factors , Ventricular Fibrillation/diagnosisABSTRACT
Coronary artery aneurysms are detected rarely during coronary angiography, and are associated with injury to the mechanical vessel wall during percutaneous coronary intervention. Potential causes also include atherosclerosis, congenital defects, connective tissue disorders, vasculitis, infection, drug-related injury, and trauma; it can also be idiopathic. The complications of coronary artery aneurysms vary, but they rupture only rarely. However, there is no consensus treatment strategy for coronary artery aneurysm after coronary intervention. We report a case of a 55-year-old male who developed a coronary artery aneurysm and in-stent restenosis after percutaneous coronary intervention with a drug-eluting stent. The aneurysm was treated successfully with the implantation of a graft stent.
Subject(s)
Humans , Male , Middle Aged , Aneurysm , Atherosclerosis , Congenital Abnormalities , Connective Tissue , Consensus , Coronary Angiography , Coronary Vessels , Drug-Eluting Stents , Percutaneous Coronary Intervention , Rupture , Stents , Transplants , VasculitisABSTRACT
We report a case of hypersensitivity skin reaction to prasugrel. The patient exhibited a generalized skin rash after treatment with prasugrel, which was resolved after discontinuation of prasugrel and substitution to clopidogrel. Clopidogrel was successfully administered as an alternative to prasugrel without any signs of further hypersensitivity.
Subject(s)
Humans , Exanthema , Hypersensitivity , Skin , Prasugrel HydrochlorideABSTRACT
Primary cardiac lipoma is a rare, benign, well-encapsulated tumor that is typically composed of mature fat cells. It can occur in any part of the heart, but is mostly found incidentally. Although cardiac lipoma does not require specific treatment in most cases, physicians should pay attention to this entity, which may cause arrhythmias, embolization, compression of the coronary arteries, or obstruct blood flow within the heart. In this report, we present the case of a 70-year-old woman who was admitted with a complaint of infectious colitis and incidentally found to have a cardiac lipoma in the posterior papillary muscle of the left ventricle on the basis of two-dimensional echocardiography and cardiac MRI. Given the patient's lack of symptoms and normal cardiac function, we recommended observation without surgical exploration. After six months, the patient was in good health and showed no clinical signs or symptoms of cardiac lipoma.
Subject(s)
Aged , Female , Humans , Adipocytes , Arrhythmias, Cardiac , Colitis , Coronary Vessels , Echocardiography , Heart , Heart Ventricles , Lipoma , Magnetic Resonance Imaging , Papillary MusclesABSTRACT
Fluoroquinolones (FQs) represent a major class of antimicrobials that have a high potential as therapeutic agents. Although FQs are generally safe for the use as antimicrobials, they may induce tendinopathic complications such as tendinitis and tendon rupture. A number of factors have been suggested to further predispose a patient to such injuries. Hitherto, a few published cases on tendon disorders have implicated levofloxacin, a more recently introduced FQ. Here, we report a patient with levofloxacin-induced Achilles tendinitis, who exhibited no known predisposing factors. A 20-year-old man without any history of disease or medication presented with community-acquired pneumonia. Levofloxacin was administered and 3 days later, he complained of pain in the left Achilles tendon and revealed redness and swelling in the area. On suspecting Achilles tendinitis, levofloxacin treatment was discontinued, and the tendinitis subsequently improved. To our knowledge, this is the first case report on FQ-induced Achilles tendinitis in Korea.
Subject(s)
Adult , Humans , Male , Young Adult , Achilles Tendon/drug effects , Anti-Bacterial Agents/adverse effects , Community-Acquired Infections/drug therapy , Disease Susceptibility , Ofloxacin/adverse effects , Pneumonia/drug therapy , Tendinopathy/chemically inducedABSTRACT
BACKGROUND: Studies on immunization in Korea mainly focus to the coverage rates in recipients. The attitudes of health-care providers regarding immunization are rarely evaluated. Therefore, to assess the pattern of vaccine administration by health-care personnel, the vaccine consumption in a university hospital was investigated. MATERIALS AND METHODS: The vaccine consumption in a university hospital during 2 months (September and October) in 2 years (2002 and 2007) was evaluated. September is representative of months when influenza vaccine is not available, whereas October is representative of months when influenza vaccine is available. These monthly data were summarized by departments and vaccines. RESULTS: Vaccine consumption over the 5-year period increased primarily because of the increased use of the influenza and tetanus-diphtheria (Td) vaccines in adults. In 2007, the most frequently administered vaccine during the influenza season was the influenza vaccine, followed by the Td vaccine. In the same year, the Td vaccine was the most frequently administered vaccine during the non-influenza season. Compared to 2002, there was a marked increase in the use of the hepatitis A virus (7-fold), Japanese encephalitis (6-fold), and pneumococcal polysaccharide (3-fold) vaccines in 2007; the Td, meningococcal, and pneumococcal protein-conjugated vaccines were not available in 2002. In adults, pneumococcal vaccination was increasingly prescribed concomitant with the increased influenza vaccination; a similar trend was not observed in children. The use of vaccines in most departments was confined to the influenza vaccine, and the majority of Td vaccine was consumed in the emergency department. As compared to the internal medicine and family medicine departments, fewer vaccines were prescribed by the neurology, surgical, and minor specialty departments, especially in the non-influenza season. CONCLUSION: Although vaccine consumption increased during the 5-year period, the increase was attributed to the increased consumption of the influenza vaccine. Promotion and education regarding the use of non-influenza vaccines are needed.
Subject(s)
Adult , Child , Humans , Emergencies , Encephalitis, Japanese , Health Personnel , Hepatitis A virus , Immunization , Influenza Vaccines , Influenza, Human , Internal Medicine , Korea , Neurology , Pharmacy Service, Hospital , Seasons , Vaccination , VaccinesABSTRACT
BACKGROUND: Studies on immunization in Korea mainly focus to the coverage rates in recipients. The attitudes of health-care providers regarding immunization are rarely evaluated. Therefore, to assess the pattern of vaccine administration by health-care personnel, the vaccine consumption in a university hospital was investigated. MATERIALS AND METHODS: The vaccine consumption in a university hospital during 2 months (September and October) in 2 years (2002 and 2007) was evaluated. September is representative of months when influenza vaccine is not available, whereas October is representative of months when influenza vaccine is available. These monthly data were summarized by departments and vaccines. RESULTS: Vaccine consumption over the 5-year period increased primarily because of the increased use of the influenza and tetanus-diphtheria (Td) vaccines in adults. In 2007, the most frequently administered vaccine during the influenza season was the influenza vaccine, followed by the Td vaccine. In the same year, the Td vaccine was the most frequently administered vaccine during the non-influenza season. Compared to 2002, there was a marked increase in the use of the hepatitis A virus (7-fold), Japanese encephalitis (6-fold), and pneumococcal polysaccharide (3-fold) vaccines in 2007; the Td, meningococcal, and pneumococcal protein-conjugated vaccines were not available in 2002. In adults, pneumococcal vaccination was increasingly prescribed concomitant with the increased influenza vaccination; a similar trend was not observed in children. The use of vaccines in most departments was confined to the influenza vaccine, and the majority of Td vaccine was consumed in the emergency department. As compared to the internal medicine and family medicine departments, fewer vaccines were prescribed by the neurology, surgical, and minor specialty departments, especially in the non-influenza season. CONCLUSION: Although vaccine consumption increased during the 5-year period, the increase was attributed to the increased consumption of the influenza vaccine. Promotion and education regarding the use of non-influenza vaccines are needed.