Introduction: Tissue characterization using cardiac magnetic resonance (CMR) is helpful for risk stratification in non-ischemic dilated cardiomyopathy (NIDCM). Hypothesis: This study aimed to investigate the predictive role of tissue characterization identified by CMR on cardiac resynchronization therapy (CRT) response. Methods: We retrospectively reviewed the patients who underwent CMR within 1 year before CRT implantation in NIDCM patients at a single tertiary center from January 2018 to September 2022. Late gadolinium enhancement (LGE), native T1, T2 and extracellular volume (ECV) were analyzed. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) > 15% or an increase in left ventricular ejection fraction > 5% on TTE after at least 3 months after CRT implantation. Results: Among a total of 101 patients (mean age 66 years, 52.5% of male), 76 (75.2%) patients were defined as CRT responders. CRT responders had more LBBB (96.1% vs. 60.0%, p<0.001) and longer QRS duration (156.0±178.5 vs. 167.0±176.5ms, p=0.005) compared with CRT non-responders. However, LGE burden (34.3 vs. 13.3%, p<0.001), native T1 (1371.6 vs. 1336.8ms, p=0.033), T2 (45.9 vs. 42.1ms, p<0.001), and extracellular volume (ECV, 36.8 vs. 31.0%, p<0.001) were significantly higher in CRT non-responders. The area under the curve (AUC) to predict CRT response is the highest in LGE burden (0.817, 95% confidence interval [CI]: 0.710-0.925), followed by ECV (0.808, 95% CI: 0.711-0.905), T2 (0.779, 95% CI: 0.663-0.895), and native T1 (0.643, 95% CI: 0.520-0.766). After adjustment, LGE burden>20% (odds ratio [OR]: 0.15, 95% CI: 0.02-0.71, p=0.024) and ECV > 34% (OR: 0.13, 95% CI: 0.01-0.78, p=0.037) were independently poor CRT response predictors. Conclusions: The tissue characterization by using CMR is helpful to predict CRT response and clinical outcomes in patients with NIDCM, independently of conventional CRT response predictors.
Background: Orthotopic heart transplant (OHT) recipients are vulnerable to SARS-CoV-2 (COVID-19) infection.However, there are few studies studying the clinical impact of COVID-19 vaccination in OHT patients.We aimed to evaluate the COVID-19 infection and related clinical outcomes following vaccination in OHT recipients.Methods: We retrospectively investigated 180 patients alive who underwent OHT from November 1994 to June 2022 at a single tertiary center.We compared the COVID-19 infection rate and related clinical outcomes between vaccinated and non-vaccinated OHT patients.Results: Of the 180 patients (mean age 49 years, male 62.7%), 111 (61.7%) were vaccinated and 69 (38.3%) were not vaccinated.Among them, a total of 60 (33%) patients were infected by COVID-19.The infection rate of COVID-19 in vaccinated patients was tended to be low compared to non-vaccinated patients (28.8% vs. 40.9%,P=0.143).Then, among patients who received OHT within 1 year, the rate of COVID-19 infection was significantly lower in patients with vaccination than those without vaccination (3.1% vs. 25.0%,P=0.035).A total 21 patients were hospitalized due to pneumonia with COVID-19 infection and one patient died from COVID-19 infection.In hospitalized patients, vaccination was tended to be related to lower risk for pneumonia (38.1% vs. 61.9%,P=0.143). Conclusions:The COVID-19 vaccination seemed to reduce the COVID-19 infection and related pneumonia risk in OHT patients.Especially, in patients who had OHT within 1 year, vaccination could significantly reduce the COVID-19 infection risk.
Objective: In the elderly, the effect of blood pressure on brain structure or cognitive function has not been clear. However, there are limitations in that most of studies was done using serial change in clinic blood pressure. We sought to determine the association of the ambulatory blood pressure over time with the brain structural alterations and cognitive function Design and method: In this study, we sought to examine the association between blood pressure and brain structure/cognitive function in the elderly over the age of 60 by using the 24-hour ambulatory blood pressure information at 2 different visits (mean time interval is 3.4 years). From October 2018, we included participants performed Korean Mini Mental State Exam; older than 60 years old among the participants in Cardiovascular and Metabolic Disease Etiology Research Center-High Risk Cohort. Results: When we divided the 170 participants into two groups according to the control of cumulative average daytime blood pressure, the cortical thickness of frontal lobe was thinner and the average hippocampal volume was smaller in the uncontrolled group (P = 0.002, P = 0.01 respectively). In multivariate linear analysis, the uncontrolled group for cumulative average daytime blood pressure was associated with thinner cortical thickness of frontal lobe and smaller average hippocampal volume (P = 0.007, P = 0.024 respectively). However, the baseline daytime blood pressure had no associations with brain structure or cognitive function. Conclusions: Our observations suggest that serial measurements of 24-hour ambulatory blood pressure may be important to assess the cumulative pressure load and the association with structural changes of the brain.
Objective: Ambulatory blood pressure monitoring has been associated with clinical outcomes better than office blood pressure (BP) monitoring. Recent study reported that morning blood pressure surge (MBPS) was associated with worse cardiovascular outcomes in hypertensive patients. There are not enough studies about the relationship between MBPS and central hemodynamics according to nocturnal hypertension. Design and Method: ABPM, central BP and pulse wave velocity (PWV) were measured in 1064 consecutive subjects enrolled in Cardiovascular and Metabolic Disease Etiology Research Center - HIgh Risk Cohort (CMERC-HI, NCT02003781). MBPS was defined as (mean SBP within 2 hours after awake – lowest night SBP) > 35 mmHg and nocturnal hypertension as mean night SBP > 120 mmHg or DBP > 70 mmHg. Results: MBPS was found in 467 (43.9%) patients and MBPS with nocturnal hypertension was in 262 (24.6%) patients. There were no significant difference in age, gender, hypertension, diabetes and dyslipidemia prevalence between MBPS with and without nocturnal hypertension group. Central SBP/DBP were not significantly different between MBPS and non-MBPS group. However, heart to femoral PWV (hfPWV) were higher (1098 ± 308 vs. 1056 ± 331 cm/s, p = 0.036) in MBPS group. Central SBP (117 ± 16 vs. 112 ± 17 mmHg, p = 0.007), hf PWV (1061 ± 306 vs. 984 ± 240 cm/s, p = 0.011) in MBPS without nocturnal hypertension group were significantly higher than in non-MBPS group. The MBPS patients with nocturnal hypertension had higher central SBP/DBP (127/78 ± 18/11 vs. 117/78 ± 16/8 mmHg, both p < 0.001), hfPWV (948 ± 272 vs. 916 ± 284 cm/s, p = 0.022) compared to those without nocturnal hypertension. Conclusions: We reported that MBPS, especially with nocturnal hypertension was related to higher central BP and increased arterial stiffness. Further studies for assessing whether these differences of MBPS subgroups according to nocturnal hypertension in central hemodynamics relate to clinical outcomes should be warranted.
언론 프레임이 여론에 미치는 영향을 파악하기 위해서는 언론 프레임을 시민들의 의견, 관점, 감정 등 사회 문화적 맥락에서 이해할 필요가 있다. 본 연구는 온라인 기사의 댓글이 사회 문화적 맥락으로 작용할 수 있어, 언론 프레임이 이 맥락에 호응하는 관계성을 ‘언론 프레임의 온라인 문화적 공명’으로 제안한다. 국내외 연구자들이 이 관계성을 다루지 않았다는 점에 주목해, 본 연구는 2016년 6월 13일부터 2016년 9월 10일까지 90일간 〈조선일보〉, 〈중앙일보〉, 〈한겨레〉, 〈경향신문〉이 보도한 김영란법 관련 기사 432건과 댓글 3,321건에 대해 의미 연결망과 군집 분석을 실시했다. 이 결과, ‘경제 여파’, ‘법안 쟁점’, ‘부정적 영향’, ‘청렴 사회’라는 4개 프레임이 기사와 댓글에서 출현했다. 본 연구는 이 프레임들을 시계열 데이터로 구성해 사회 문화적 맥락인 댓글에 내재한 프레임과 기사 프레임 간에 그랜저 인과 관계를 조사했다. ‘법안 쟁점’ 프레임의 경우, 보도 이전에 게재된 댓글이 기사에 영향을 미쳐 기사 프레임의 문화적 공명이 나타났으며, 관련 기사는 보도 이후 실린 댓글에도 영향을 미쳤다. 보수 신문의 ‘법안쟁점’ 프레임이 선행하는 댓글 프레임에 영향을 받았으며, 이 프레임은 뒤따르는 댓글 프레임에 영향을 미쳤다. 진보 신문의 경우, 기사 프레임이 앞선 댓글 프레임에 호응했다. 본 연구는 언론 프레임 선행 연구에 ‘프레임의 온라인 문화적 공명’이라는 개념을 제안해 댓글 프레임과 기사 프레임의 인과성을 분석했다는 점에서 의의가 있다.
Objective: Recent study reported that morning hypertension was associated with worse cardiovascular outcomes in hypertensive patients. There are not enough studies about the inter-relationship between morning hypertension/nocturnal hypertension and central hemodynamics until now. Design and Method: Ambulatory blood pressure monitoring and central BP were measured in 1062 consecutive subjects enrolled in Cardiovascular and Metabolic Disease Etiology Research Center - HIgh Risk Cohort (CMERC-HI, NCT02003781). Morning hypertension was defined as mean systolic BP (SBP) within 2 hours after awake > 135mmHg and nocturnal hypertension as mean night SBP > 120mmHg or diastolic BP (DBP ≥ 70mmHg. We divided morning hypertension into 3 subtypes. 1) morning normotension 2) morning hypertension without nocturnal hypertension and 3) morning hypertension with nocturnal hypertension. Results: Morning hypertension was found in 494 (46.5%) patients and morning hypertension with nocturnal hypertension was in 403 (37.9%) patients. Central SBP/DBP (129/79 ± 21/11 vs. 116/75 ± 17/9mmHg, both p < 0.001), augmentation index (AIx, 30.6 ± 11.4 vs. 27.4 ± 13.3, p < 0.001) and carotid to femoral pulse wave velocity (cfPWV, 986 ± 245 vs. 887 ± 198 cm/s, p < 0.001) were higher in morning hypertension than in morning normotension. There were significant difference in central SBP (120/75 ± 16/8 vs. 116/75 ± 17/9mmHg, p = 0.027 for SBP, p = 0.746 for DBP) and cfPWV (932 ± 220 vs. 887 ± 198 cm/s, p = 0.049) not 24-hour SBP/DBP (p = 0.150/p = 0.219) between morning normotension and morning hypertension without nocturnal hypertension group. The morning hypertensive patients with nocturnal hypertension had higher central SBP/DBP (131/79 ± 21/11 vs. 120/75 ± 16/8mmHg, both p < 0.001) and cfPWV (998 ± 248 vs. 932 ± 220 cm/s, p = 0.020) compared to those without nocturnal hypertension. Conclusions: We reported that morning hypertension, especially with nocturnal hypertension was related to higher central BP and increased arterial stiffness. Further studies for assessing whether morning hypertension with or without nocturnal hypertension relates to clinical outcomes should be warranted.
Significance Programmed cell death 5 (PDCD5) plays a pivotal role in cellular apoptosis. Pathological relevance of PDCD5 is mostly found in human cancers; however, the role of PDCD5 in noncancerous diseases is not fully elucidated. Here we show that mice with endothelial PDCD5 deficiency have elevated serum nitric oxide levels and an atheroprotective effect in blood vessels. In addition, PDCD5 disrupts the HDAC3–protein kinase B (PKB/AKT) interaction and inhibits AKT-eNOS signaling and nitric oxide production in vivo and in vitro. Moreover, serum PDCD5 reflects vascular endothelial status, which is significantly correlated with cardiovascular risk. Our results demonstrate a mechanism of endothelial homeostasis and provide a potential therapeutic target for improving endothelial function.
As a basic work for river restoration, analysis on fluvial geomorphological characteristics is made using past and present data to understand close-to-nature geomorphic status. The Miho and the Naesung Rivers are targets of this study. Fluvial geomorphic variables including valley-floor width, sinuosity, bankfull width, channel gradient, bed material size, bankfull discharge and unit stream power are evaluated with dominant processes. Though common sand-bed rivers with similar catchment area, the Miho and the Naesung Rivers are different in terms of valley-floor width, channel shape variables and dominant processes related with longitudinal location. In addition, analyses on interrelationship among the geomorphological variables are carried. Bankfull width is shown to be proportional to bankfull discharge, as is in a rough agreement with the previous studies. Relationship of bankfull discharge and channel gradient shows meandering and braiding are prevalent in the Miho River, whereas the most of the sub-reaches of the Naesung River fall to braiding. Relationship of channel gradient with width-depth ratio indicates dune-ripple processes are dominant in the Miho River, while the Naesung River shows longitudinal diversity from braiding in the downstream sub-reaches to riffle-pool and plane-bed along the upper ones. Analyses based on the past data on a river in a close-to-nature status are thought to be rather reasonable in comparison with those on the same river in a engineered condition.
Endovascular stent graft placement in Stanford type B aortic dissection has increased as a result of the demonstration of its safety and efficacy. Despite the advantage of reduced mortality and morbidity, the mid-to long-term prognosis and possible complications associated with the procedure are a source of concern. Among the many possible complications, retrograde type A dissection after stent grafting for type B dissection is considered rare; however, this life-threatening event appears to be underrecognized. Here, we report a case that converted to open surgery due to a retrograde type A dissection after endovascular stent graft placement for a Stanford type B dissection. This is the first report of a retrograde type A dissection after endovascular stent graft placement in Korea. (Korean J Med 79:306-310, 2010)
Coronary artery aneurysms are uncommon, are usually associated with atherosclerosis, and rarely involve all three major coronary arteries. The present report describes a rare case of a young female patient presenting with acute myocardial infarction (AMI). Coronary angiography revealed multiple severe aneurysmal and stenotic changes. Based on clinical feature and angiographic findings, it was strongly suspected that the patient had polyarteritis nodosa (PAN) complicated by AMI. The patient was treated with standard cardiac medications and immunosuppressive agents and has remained stable without further complications during a follow-up period of 6 months.
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