Clinical and Genetic Features of Korean Inherited Arrhythmia Probands

Background and Objectives@#Inherited arrhythmia (IA) is a more common cause of sudden cardiac death in Asian population, but little is known about the genetic background of Asian IA probands. We aimed to investigate the clinical characteristics and analyze the genetic underpinnings of IA in a Korean cohort. @*Methods@#This study was conducted in a multicenter cohort of the Korean IA Registry from 2014 to 2017. Genetic testing was performed using a next-generation sequencing panel including 174 causative genes of cardiovascular disease. @*Results@#Among the 265 IA probands, idiopathic ventricular fibrillation (IVF) and Brugada Syndrome (BrS) was the most prevalent diseases (96 and 95 cases respectively), followed by long QT syndrome (LQTS, n=54). Two-hundred-sixteen probands underwent genetic testing, and 69 probands (31.9%) were detected with genetic variant, with yield of pathogenic or likely pathogenic variant as 6.4%. Left ventricular ejection fraction was significantly lower in genotype positive probands (54.7±11.3 vs. 59.3±9.2%, p=0.005). IVF probands showed highest yield of positive genotype (54.0%), followed by LQTS (23.8%), and BrS (19.5%). @*Conclusions@#There were significant differences in clinical characteristics and genetic yields among BrS, LQTS, and IVF. Genetic testing did not provide better yield for BrS and LQTS. On the other hand, in IVF, genetic testing using multiple gene panel might enable the molecular diagnosis of concealed genotype, which may alter future clinical diagnosis and management strategies.

Community-Dwelling Individuals with Coronary Artery Disease Have Higher Risk of Depression than the General Population in Female, But Not in Male

Background and Objectives@#The aim of this study was to assess sex difference in the association between coronary artery disease (CAD) status and depression in a representative nationwide Korean population. @*Methods@#In total, 4,620 male and 6,151 female aged ≥40 years, who participated in the Korea National Health and Nutrition Examination Survey conducted in 2014, 2016, and 2018, were included in the analysis. Depression was defined as ≥10 points on the 9-item Patient Health Questionnaire. @*Results@#Among male participants, no significant association between CAD status and depression was observed. However, female with CAD had higher odds ratio (OR) for depression (OR, 2.68; 95% confidence interval [CI], 1.78–4.03) compared with those without CAD in a multiple logistic regression analysis after adjustment for covariates. Younger age at diagnosis of CAD was a significant relating factor for depression in female; OR (95% CI) was 1.73 (0.88–3.40), 3.01 (1.52–5.97), and 4.11 (2.04–8.28) for age ≥65 years, 55–64 years, and ≤54 years, respectively, compared with that in non-CAD controls. In addition, shorter duration of CAD was a significant relating factor for depression in female; OR (95% CI) was 2.42 (1.26–4.67), 2.61 (1.32–5.16), and 3.13 (1.54–6.34) for duration ≥10 years, 5-9 years, and ≤4 years, respectively, compared with that in non-CAD controls. @*Conclusions@#Consistent screening and psychosocial supports for depression after discharge are required to improve the mental health care of CAD survivors in the community, especially for female diagnosed at a younger age and recently diagnosed.

A prospective, observational study of rivaroxaban for stroke prevention in atrial fibrillation: the XANAP Korea

Background/Aims@#Atrial fibrillation (AF)-related stroke accounts for 20% of ischemic strokes. Rivaroxaban use in AF patients for preventing stroke and systemic embolism was approved in 2013 in Korea. This study was to investigate the safety and effectiveness of rivaroxaban use in Korean patients with non-valvular AF in a real-world setting. @*Methods@#This was an analysis of the Korean patients in Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific (XANAP), which was a prospective, observational cohort study including patients with non-valvular AF starting rivaroxaban treatment to prevent stroke or non-central nervous system systemic embolism (non-CNS SE), conducted in 10 Asian countries. @*Results@#A total of 844 patients were enrolled in the Korean portion of the XANAP study. In XANAP Korea, the mean age was 70.1 years and 62.6% were males. The mean CHADS2 score was 2.5 and the mean CHA2DS2-VASc score was 3.8. 47% of the patients had experienced prior stroke or non-CNS SE or transient ischemic attack. 73.6% of the patients had CHADS2 score ≥ 2. Incidence proportions of 0.8% of the patients (1.1 per 100 patient-years) developed adjudicated treatment-emergent major bleeding. Death was observed in 1.2% of the patients. The incidence of non-major bleeding as well as thromboembolic event were 8.4% (11.6 per 100 patient-years) and 1.5% (2.0 per 100 patient-years), respectively. @*Conclusions@#This study reaffirmed the consistent safety profile of rivaroxaban. We found consistent results with overall XANAP population for rivaroxaban in terms of safety in non-valvular AF patients for the prevention of stroke and non-CNS SE.

Introduction of Wearable Device in Cardiovascular Field for Monitoring Arrhythmia / 전남의대학술지

There has been increasing adoption of wearable smart devices in health care field and they enable non-invasive continuous monitoring of various cardiac parameters. Lots of studies have demonstrated that ambulatory monitoring devices were able to provide data for reliable diagnostics for arrhythmia. Distinguishing features of wearables such as ubiquitous continuous monitoring make it a convincing alternative to traditional diagnostic devices. Additionally, this revolutionary technology does not only enhance the diagnostic utility of wearable devices, but has also facilitated remote health care using IOT (internet of things) capability. In this review, the authors aim to present the state of current technologic development of smart wearables for detection of arrhythmia and comment on future perspectives with reviewing recent studies focused on clinical utility.

Community-Dwelling Individuals with Coronary Artery Disease Have Higher Risk of Depression than the General Population in Female, But Not in Male

Background and Objectives@#The aim of this study was to assess sex difference in the association between coronary artery disease (CAD) status and depression in a representative nationwide Korean population. @*Methods@#In total, 4,620 male and 6,151 female aged ≥40 years, who participated in the Korea National Health and Nutrition Examination Survey conducted in 2014, 2016, and 2018, were included in the analysis. Depression was defined as ≥10 points on the 9-item Patient Health Questionnaire. @*Results@#Among male participants, no significant association between CAD status and depression was observed. However, female with CAD had higher odds ratio (OR) for depression (OR, 2.68; 95% confidence interval [CI], 1.78–4.03) compared with those without CAD in a multiple logistic regression analysis after adjustment for covariates. Younger age at diagnosis of CAD was a significant relating factor for depression in female; OR (95% CI) was 1.73 (0.88–3.40), 3.01 (1.52–5.97), and 4.11 (2.04–8.28) for age ≥65 years, 55–64 years, and ≤54 years, respectively, compared with that in non-CAD controls. In addition, shorter duration of CAD was a significant relating factor for depression in female; OR (95% CI) was 2.42 (1.26–4.67), 2.61 (1.32–5.16), and 3.13 (1.54–6.34) for duration ≥10 years, 5-9 years, and ≤4 years, respectively, compared with that in non-CAD controls. @*Conclusions@#Consistent screening and psychosocial supports for depression after discharge are required to improve the mental health care of CAD survivors in the community, especially for female diagnosed at a younger age and recently diagnosed.

A prospective, observational study of rivaroxaban for stroke prevention in atrial fibrillation: the XANAP Korea

Background/Aims@#Atrial fibrillation (AF)-related stroke accounts for 20% of ischemic strokes. Rivaroxaban use in AF patients for preventing stroke and systemic embolism was approved in 2013 in Korea. This study was to investigate the safety and effectiveness of rivaroxaban use in Korean patients with non-valvular AF in a real-world setting. @*Methods@#This was an analysis of the Korean patients in Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific (XANAP), which was a prospective, observational cohort study including patients with non-valvular AF starting rivaroxaban treatment to prevent stroke or non-central nervous system systemic embolism (non-CNS SE), conducted in 10 Asian countries. @*Results@#A total of 844 patients were enrolled in the Korean portion of the XANAP study. In XANAP Korea, the mean age was 70.1 years and 62.6% were males. The mean CHADS2 score was 2.5 and the mean CHA2DS2-VASc score was 3.8. 47% of the patients had experienced prior stroke or non-CNS SE or transient ischemic attack. 73.6% of the patients had CHADS2 score ≥ 2. Incidence proportions of 0.8% of the patients (1.1 per 100 patient-years) developed adjudicated treatment-emergent major bleeding. Death was observed in 1.2% of the patients. The incidence of non-major bleeding as well as thromboembolic event were 8.4% (11.6 per 100 patient-years) and 1.5% (2.0 per 100 patient-years), respectively. @*Conclusions@#This study reaffirmed the consistent safety profile of rivaroxaban. We found consistent results with overall XANAP population for rivaroxaban in terms of safety in non-valvular AF patients for the prevention of stroke and non-CNS SE.

Low parathyroid hormone level predicts infection-related mortality in incident dialysis patients: a prospective cohort study

Background/Aims@#Parathyroid hormone (PTH) is an important factor influencing immunologic dysfunction, but the effect of PTH level on infection-related outcomes remains unclear in incident dialysis. @*Methods@#We evaluated a multicenter prospective cohort study of 1,771 incident dialysis patients (1,260 hemodialysis and 511 peritoneal dialysis) in Korea. Patients were divided into three groups based on serum intact PTH (iPTH) level. The primary outcomes were all-cause and infection-related mortality and multivariate Cox regression analysis was performed to evaluate the role of iPTH in all-cause and infection-related mortality. @*Results@#During the follow-up period of 27.3 months, 175 patients (9.9%) died, and infection-related death represented 20% of all-cause mortality. Both all-cause mortality and infection-related mortality rates (p < 0.001 and p = 0.003, by logrank) were markedly higher in patients with serum iPTH < 150 pg/mL than in the other groups. Multivariate Cox regression analysis revealed that patients with serum iPTH < 150 pg/mL remained at higher risk for infection-related mortality than patients in the target range of 150 ≤ iPTH < 300 pg/mL, after adjusting for confounding variables (hazard ratio [HR], 2.52; 95% confidence interval, 1.06 to 5.99; p = 0.04). The HR of infection-related mortality in patients with serum iPTH < 150 pg/mL was significantly higher in patients with low serum phosphorus, low Ca × P product, low serum alkaline phosphatase and those older than 65 years. @*Conclusions@#Low serum iPTH level is an independent predictor of infection-related mortality in incident dialysis patients.

The differential effects of anemia on mortality in young and elderly end-stage renal disease patients

Background@#The aim of this study was to compare the effect of anemia on clinical outcomes according to age in patients with end-stage renal disease (ESRD). @*Methods@#A total of 3,409 patients from the Clinical Research Center for ESRD were included and divided into three groups by age: age < 40 (n = 488), 40 ≤ age < 60 (n = 1,650), and age ≥ 60 (n = 1,271). We compared overall and cardiovascular mortality, and all-cause and cardiovascular hospitalization according to mean hemoglobin (Hb) concentration. @*Results@#Among participants ≥ 60 years of age, the Hb < 10 g/dL group had greater all-cause mortality (adjusted hazard ratio [HR], 2.098; 95% confidence interval [CI], 1.567-2.808; P < 0.001) than the 10 ≤ Hb < 12 g/dL group, whereas among participants < 40 years of age, the Hb ≥ 12 g/dL group had greater mortality than the 10 ≤ Hb < 12 g/dL group. Moreover, in participants ≥ 60 years of age, the HR for all-cause hospitalization for the Hb < 10 g/dL group was significantly greater than that of the 10 ≤ Hb < 12 g/dL group (HR, 1.472; 95% CI, 1.057-2.051; P = 0.022), whereas it was significantly lower in the Hb ≥ 12 g/dL group (HR, 0.544; 95% CI, 0.362-0.820; P = 0.004) However, among participants < 40 years of age, the incidence of all-cause hospitalization did not differ according to the Hb concentration (HR, 1.273; 95% CI, 0.814-1.991; P = 0.290 for the Hb < 10 g/dL group; reference, 10 ≤ Hb < 12 g/dL; HR, 0.787; 95% CI, 0.439-1.410; P = 0.265 for Hb ≥ 12 g/dL group). @*Conclusion@#The impact of anemia on mortality was more significant in elderly ESRD patients. Strict monitoring and management of anemia should be required for elderly ESRD patients.

First Report of Gray Mold Disease on Endangered Species Cypripedium japonicum

Cypripedium japonicum is known to be the indigenous plant to Korea, Japan, and China. However, C. japonicum represents the most critically endangered plant species in South Korea. The plant is esthetically pleasing due to its flower, which is larger than any other orchidaceous species. Disease symptoms relating to gray mold were observed on C. japonicum in May 2019. The suspected pathogen was successfully isolated from the symptomatic leaf tissue and conducted a pure culture of the fungi. The conidia formed consisted of a colorless or light brown single cell, which was either egg or oval-shaped with a size of 7.1 to 13.4 × 5.2 to 8.6 μm. Molecular phylogenetic relationship analysis was also confirmed that the pathogen concerned belonging to the family of Botrytis cinerea. Therefore, the findings confirmed that the pathogen isolated from C. japonicum was consistent with the unique properties of B. cinerea.

Awareness of Early Symptoms and Emergency Responses to Myocardial Infarction and Stroke in People with Diabetes Mellitus Compared to Non-diabetic Population in the Community: A Propensity Score-Matched Analysis / 보건행정학회지

Background@#We determined the differences in awareness of myocardial infarction and stroke according to the presence or absence of diabetes mellitus in the community. @*Methods@#The 2018 Community Health Survey identified 20,812 people with diabetes mellitus aged 40–79 years. Using 1:1 matching by propensity score, 20,812 people without diabetes mellitus but with similar sociodemographic characteristics were selected as a comparison. Outcome variables were awareness of early symptoms of myocardial infarction and stroke and awareness of coping strategies in case of occurrence. @*Results@#There was no significant difference between nondiabetic and diabetic people in terms of recognizing all early symptoms of myocardial infarction (nondiabetic, 42.7%; diabetic, 43.0%; p=0.43) and stroke (nondiabetic, 49.4%; diabetic, 49.4%; p=0.91). In addition, no significant difference was found between nondiabetic and diabetic people in the proportion of knowing correct emergency response to myocardial infarction (nondiabetic, 84.6%; diabetic, 84.4%; p=0.56) and stroke (nondiabetic, 81.3%; diabetic, 81.4%; p=0.77). @*Conclusion@#Since people with diabetes are at greater risk of cardiovascular disease than the general public, it is important to lower the risk of disability and death by improving their awareness of early symptoms and correct emergency response to myocardial infarction and stroke.

Protective Effect of Cilostazol Against Restraint Stress Induced Heart Failure in Post-Myocardial Infarction Rat Model / 전남의대학술지

Cilostazol, a phosphodiesterase III inhibitor, has antiplatelet and vasodilatory effects.It also has pleiotrophic effects including reduction of oxygen free radicals, positive chronotropic effect and inhibition of intracellular Ca2+ associated catecholamine secretion. The study was aimed to examine, in vivo, the effects of cilostazol treatments on myocardial function, myocardial remodeling, and neurohormonal status in myocardial infarction (MI) with restrained stress rat model. Male Sprague Dawley rats, subjected to coronary artery ligation to induce myocardial infarction (MI), received either a standard rat chow alone (control, n=5) or combined with cilostazol (cilostazol, n=5; 5 mg/kg×5 weeks). They were exposed to repeated restraint stress (2 h×2 times/day) for 10 days beginning 1 week after surgery. Left ventricular ejection fraction (LVEF), LV mass by heart weight/body weight ratio and level of tissue brain natriuretic peptide (BNP) expression by immunoblotting were determined. Plasma epinephrine and norepinephrine levels were also measured. Mean LVEF was higher in the cilostazol group than in the control group (66.9±14.3 vs 47.0±17.1, p<0.05) at 5 weeks after MI. However, LV mass and tissue BNP expression were significantly lower in the cilostazol than in the control group (p<0.05). Plasma epinephrine and norepinephrine levels were also lower in the cilostazol group compared with the control (p<0.05). Cilostazol preserves left ventricular systolic function and attenuates stress induced remodeling in postinfarct rats. Its beneficial effects were associated with reduced plasma catecholamine levels during postinfarct remodeling.

Evolution of Smart Health Wearables: Novel Application for Detection of Arrhythmia

No abstract available.

Quality of Anticoagulation and Treatment Satisfaction in Patients with Non-Valvular Atrial Fibrillation Treated with Vitamin K Antagonist: Result from the KORean Atrial Fibrillation Investigation II

BACKGROUND: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction. METHODS: We conducted a multicenter, prospective, non-interventional study. Patients with CHADS2 ≥ 1 and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up. RESULTS: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had CHADS2 ≥ 2 and 83.6% had CHA2DS2-VASc ≥ 2. A total of 852 patients had one or more INR measurement during their follow-up period. Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain. CONCLUSION: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.

Can documented coronary vasospasm be the smoking gun in settling the etiology of sudden cardiac death?

No abstract available.

Carotid Atherosclerosis and Electrocardiographic Left Ventricular Hypertrophy in the General Population: The Namwon Study / 전남의대학술지

This study aimed to investigate the relationship between carotid atherosclerosis and left ventricular hypertrophy on electrocardiogram (ECG-LVH) on adults living in the community. A total of 9,266 adults who participated in the Namwon Study were included in this analysis. Carotid atherosclerosis, including intima-media thickness (IMT) and plaques, were assessed using high-resolution B-mode ultrasound. ECG-LVH was determined using the Sokolow-Lyon voltage (SokV) and Cornell voltage (CorV) criteria. The prevalence of ECG-LVH was 12.7% using the SokV criteria and 9.7% using the CorV criteria. After full adjustment, compared to the lowest quartile of common carotid artery IMT (CCA-IMT), the odds ratios and 95% confidence intervals for ECG-LVH of the carotid IMT quartiles 2, 3, and 4 increased linearly as follows: 1.54 (1.24-1.90), 1.62 (1.31-2.02), and 1.91 (1.54-2.38), respectively, for the SokV criteria (p<0.001); and 1.33 (1.05-1.68), 1.41 (1.11-1.78), and 1.48 (1.16-1.88), respectively, for the CorV criteria (p=0.003). Positive associations between the carotid bulb IMT (CB-IMT) quartiles and the ECG-LVH were also observed, although the magnitudes of association between CB-IMT and ECG-LVH were slightly lower than those of CCA-IMT. However, no significant association between carotid plaques and ECG-LVH as defined by the SokV or CorV criteria was found. The present study demonstrated that increased carotid IMT, but not carotid plaques, is significantly associated with LVH defined by various ECG criteria in a large population.

Management of Lacrimal Fistula during Epicanthoplasty: A Case Report

Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.

Management of Lacrimal Fistula during Epicanthoplasty: A Case Report

Lacrimal fistula (LF) is a rare abnormality of the lacrimal system. Patients with LF are usually asymptomatic, and thus, treatment is unnecessary. During surgery on a patient with LF, the fistula may fall into the range of dissection. In such cases, fistula management becomes important. A 19-year-old woman visited our department to receive incisional blepharoplasty and medial epicanthoplasty, and a preoperative physical examination revealed LF. During surgery, we found the fistula tract to be within the dissection field, and thus, the LF was cut and cauterized. One year after the surgery, inflammation and hypertrophy of the remnant lacrimal duct occurred. The wound was stabilized by creating an opening that reconnected the stump and the overlying skin. Through this case, we hope to establish the appropriate strategy for managing LF detected during medial epicanthoplasty. As seen in our case, cauterization should be avoided because of the high recurrence rate of LF. Instead, as definitive treatment, fistulectomy should be performed, or the fistula should be moved along with the skin flap when a small skin flap is transferred.

Carotid Atherosclerosis and Electrocardiographic Left Ventricular Hypertrophy in the General Population: The Namwon Study / 전남의대학술지

This study aimed to investigate the relationship between carotid atherosclerosis and left ventricular hypertrophy on electrocardiogram (ECG-LVH) on adults living in the community. A total of 9,266 adults who participated in the Namwon Study were included in this analysis. Carotid atherosclerosis, including intima-media thickness (IMT) and plaques, were assessed using high-resolution B-mode ultrasound. ECG-LVH was determined using the Sokolow-Lyon voltage (SokV) and Cornell voltage (CorV) criteria. The prevalence of ECG-LVH was 12.7% using the SokV criteria and 9.7% using the CorV criteria. After full adjustment, compared to the lowest quartile of common carotid artery IMT (CCA-IMT), the odds ratios and 95% confidence intervals for ECG-LVH of the carotid IMT quartiles 2, 3, and 4 increased linearly as follows: 1.54 (1.24-1.90), 1.62 (1.31-2.02), and 1.91 (1.54-2.38), respectively, for the SokV criteria (p<0.001); and 1.33 (1.05-1.68), 1.41 (1.11-1.78), and 1.48 (1.16-1.88), respectively, for the CorV criteria (p=0.003). Positive associations between the carotid bulb IMT (CB-IMT) quartiles and the ECG-LVH were also observed, although the magnitudes of association between CB-IMT and ECG-LVH were slightly lower than those of CCA-IMT. However, no significant association between carotid plaques and ECG-LVH as defined by the SokV or CorV criteria was found. The present study demonstrated that increased carotid IMT, but not carotid plaques, is significantly associated with LVH defined by various ECG criteria in a large population.

Design of Korean Noninvasive Risk Evaluation Study for Sudden Cardiac Death from Infarction or Heart Failure: Myocardial infarction study of K-REDEFINE registry

BACKGROUND AND OBJECTIVES: Despite significant advances in the treatment of acute myocardial infarction (MI), the prevention of sudden cardiac death (SCD), the most common mode of death in patients with MI, remains challenging. Furthermore, previous Korean MI registries did not address the issue of post-MI SCD. Additional risk stratifiers of post-MI SCD are still required to compensate for the limitation of using left ventricular ejection fraction to predict lethal arrhythmic events. SUBJECTS AND METHODS: We designed the first Korean prospective nationwide multicenter registry primarily focused on SCD; the Korean noninvasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (K-REDEFINE). The registry consists of 2 groups of patients presenting with (1) acute MI or (2) acute heart failure (HF) at 25 tertiary referral cardiovascular centers. The primary endpoint of the MI group study of K-REDEFINE registry is the incidence and risk factors of post-MI SCD. In particular, the association between the risk of SCD and non-invasive Holter-based electrocardiogram (ECG) variables will be evaluated, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/variability (a marker of autonomic function). Other secondary study outcomes include atrioventricular arrhythmias, HF-related admission, repeated myocardial ischemic events, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will provide new prospects for the better management of MI patients with high risk of SCD by clarifying the burden and predictors of SCD and the clinical utility of various non-invasive ambulatory ECG-based variables in risk stratification for SCD in this patient population.

The impact of high serum bicarbonate levels on mortality in hemodialysis patients

BACKGROUND/AIMS: The optimal serum bicarbonate level is controversial for patients who are undergoing hemodialysis (HD). In this study, we analyzed the impact of serum bicarbonate levels on mortality among HD patients. METHODS: Prevalent HD patients were selected from the Clinical Research Center registry for End Stage Renal Disease cohort in Korea. Patients were categorized into quartiles according to their total carbon dioxide (tCO₂) levels: quartile 1, a tCO₂ of < 19.4 mEq/L; quartile 2, a tCO₂ of 19.4 to 21.5 mEq/L; quartile 3, a tCO₂ of 21.6 to 23.9 mEq/L; and quartile 4, a tCO₂ of ≥ 24 mEq/L. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) and confidence interval (CI) for mortality. RESULTS: We included 1,159 prevalent HD patients, with a median follow-up period of 37 months. Kaplan-Meier analysis revealed that the all-cause mortality was significantly higher in patients from quartile 4, compared to those from the other quartiles (p = 0.009, log-rank test). The multivariate Cox proportional hazard model revealed that patients from quartile 4 had significantly higher risk of mortality than those from quartile 1, 2 and 3, after adjusting for the clinical variables in model 1 (HR, 1.99; 95% CI, 1.15 to 3.45; p = 0.01) and model 2 (HR, 1.82; 95% CI, 1.03 to 3.22; p = 0.04). CONCLUSIONS: Our data indicate that high serum bicarbonate levels (a tCO₂ of ≥ 24 mEq/L) were associated with increased mortality among prevalent HD patients. Further effort might be necessary in finding the cause and correcting metabolic alkalosis in the chronic HD patients with high serum bicarbonate levels.