Yeon Hyeon Choe

Sungkyunkwan University, Sŏul, Seoul, South Korea

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Publications (191)570.52 Total impact

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    ABSTRACT: Rationale and objectives: To evaluate the diagnostic accuracy of semiautomated global quantification of left ventricular myocardial perfusion derived from stress dynamic computed tomography myocardial perfusion imaging (CTMPI) for detection of territorial perfusion deficits (PD). Materials and methods: Dynamic CTMPI datasets of 71 patients were analyzed using semiautomated volume-based software to calculate global myocardial blood flow (MBF), myocardial blood volume, and volume transfer constant. Optimal cutoff values to assess the diagnostic accuracy of these parameters for detection of one- to three-vessel territories with PD in comparison to visual analysis were calculated. Results: Nonsignificant differences (P = 0.694) were found for average global MBF in patients without PD and single-territorial PD. Significant differences were found for mean global MBF in patients with PD in two (P < 0.0058) and three territories (P < 0.0003). Calculated optimal thresholds for global MBF and myocardial blood volume resulted in a sensitivity, specificity, and negative predictive value of 100% for detection of three-vessel territory PD. For detection of ≥2 territories with PD, global MBF was superior to other parameters (sensitivity 81.3%, specificity 90.9%, and negative predictive value 94.3%). Conclusions: Semiautomated global quantification of left ventricular MBF during stress dynamic CTMPI shows high diagnostic accuracy for detection of ≥2 vessel territories with PD, facilitating identification of patients with multi-territorial myocardial PD.
    No preview · Article · Feb 2016 · Academic radiology
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    ABSTRACT: Cardiac involvement is the most important prognostic factor in eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome). The aims of this study were to describe findings of cardiac magnetic resonance (CMR) in patients with active EGPA and to find factors associated with cardiac involvement detected by CMR that could help identify patients who would benefit from the examination. Medical records and CMR images in 16 consecutive EGPA patients (8 women and 8 men, median age of 47 years ranging from 34 to 68 years) were reviewed. Clinical features and results of laboratory tests were compared according to the presence of myocardial late gadolinium enhancement (LGE) on CMR images. The patients were followed for the development of cardiac symptoms and signs (mean follow up duration, 40.5 ± 12.8 months). Among the total of 16 patients, 8 (50 %) had myocardial LGE according to CMR, located in the subendocardial layer in 7 of them (87.5 %). The extent of LGE had a significant negative correlation with left ventricular ejection fraction (LVEF, ρ = -0.723, p = 0.043). The presence of LGE was associated with larger end-systolic left ventricle internal dimension (34 vs. 28 mm, p = 0.027) and presence of diastolic dysfunction (75 vs. 0 %, p = 0.008) on echocardiography, elevated NT-proBNP (75 vs. 12.5 %, p = 0.012), and elevated CK-MB (62.5 vs. 0 %, p = 0.010) compared to the group without LGE. Only one patient (6.3 %) had cardiac symptoms before CMR and another patient (6.3 %) developed heart failure 4 years later during remission. The other 14 patients remained free from cardiac signs and symptoms during the follow-up period. In patients with active EGPA, CMR enables detection of cardiac involvement when cardiac symptoms are not present. Echocardiographic diastolic dysfunction and elevated NT-proBNP or CK-MB may help identify active EGPA patients who can benefit from CMR to detect cardiac involvement without cardiac symptoms.
    No preview · Article · Feb 2016 · The International Journal of Cardiovascular Imaging
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    ABSTRACT: Background and objectives: The diagnosis of ischemic (ICM) and non-ischemic cardiomyopathy (NICM) is conventionally determined by the presence or absence of coronary artery disease (CAD) in the setting of a reduced left systolic function. However the presence of CAD may not always indicate that the actual left ventricular (LV) dysfunction mechanism is ischemia, as other non-ischemic etiologies can be responsible. We investigated patterns of myocardial fibrosis using delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) in ICM and NICM. Subjects and methods: Patients with systolic heart failure who underwent a CMR were prospectively analyzed. The heart failure diagnosis was based on the modified Framingham criteria and LVEF <35%. LV dysfunction was classified as ICM or NICM based on coronary anatomy. Results: A total of 101 subjects were analyzed; 34 were classified as ICM and 67 as NICM. The DHE pattern was concordant with the conventional diagnosis in 27 (79.4%) of the patients with ICM and 62 (92.5%) of the patients with NCIM. A discordant NICM DHE pattern was present in 8.8% of patients with ICM, and an ICM pattern was detected 6.0% of the patients with NICM. Furthermore, 11.8% of the patients with ICM and 1.5% of those with NICM demonstrated a mixed pattern. Conclusion: A subset of patients conventionally diagnosed with ICM or NICM based on coronary anatomy demonstrated a discordant or mixed DHE pattern. CMR-DHE imaging can be helpful to determine the etiology of heart failure in patients with persistent LV systolic dysfunction.
    Preview · Article · Jan 2016 · Korean Circulation Journal
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    ABSTRACT: Background: Atrial fibrillation (AF) is a leading cause of stroke, but not all cases of stroke in patients with AF are due to AF. Objective: The purpose of this study was to determine whether morphometric or volumetric parameters of left atrial appendage (LAA) would be related to the development of cardioembolism in subjects with AF. Methods: A total of 433 consecutive patients with acute ischemic stroke underwent multidetector cardiac computed tomography (MDCT). Of them, 88 with AF were divided into cardioembolic stroke (CES) (n=57) and non-CES (n=31) groups, and 95 age- and sex-matched patients with non-CES without AF served as controls. Clinical factors, echocardiographic findings and MDCT parameters were evaluated. Results: Brain infarct volume, LAA orifice diameter, and LAA volume were larger in patients with CES with AF than in those with non-CES with AF (p<0.05 in all cases), but no difference was observed between patients with non-CES with AF and those with non-CES without AF. MDCT and echocardiographic parameters of left atrial dysfunction were different depending on the presence of AF but not between patients with CES with AF vs. non-CES with AF. After adjusting for covariates, LAA orifice diameter (odds ratio[OR], 1.19; 95% confidence interval[CI], 1.06-1.33; p=0.004) and LAA volume (OR, 12.20; 95% CI, 2.58-57.79; p=0.002) were independently associated with CES with AF, as was infarct volume. Conclusion: In patients with AF, LAA orifice diameter and LAA volume, but not left atrial dysfunction, were determinants of CES and were useful for stratifying non-cardioembolic risk in patients with AF.
    Full-text · Article · Dec 2015 · Heart rhythm: the official journal of the Heart Rhythm Society
  • Yeon Hyeon Choe

    No preview · Article · Oct 2015 · The international journal of cardiovascular imaging
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    ABSTRACT: Transesophageal echocardiography (TEE) is considered relatively safe but semi-invasive. The hypopharyngeal and esophageal injury is infrequent complication of TEE but could be serious, even life-threatening. We present a case of a 74-year-old man who experienced a deep neck infection secondary to hypopharyngeal injury following TEE. The diagnosis was made because of the subcutaneous emphysema developed 3 hours after TEE. In spite of antibiotics therapy with prolonged fasting, a right parapharyngeal and retropharyngeal abscess was developed 5 days later. With ultrasound-guided drainage of abscess and continuous antibiotic treatment, infection was controlled. The patent underwent mitral valve repair after 14 days of antibiotic therapy. The patient recovered uneventfully. For cardiologists performing TEE, it is required to know complications and their risk factors to minimize hypopharyngeal and esophageal injury.
    Full-text · Article · Oct 2015 · Journal of cardiovascular ultrasound
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    ABSTRACT: Background Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. Methods In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. Results Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥2, Collateral Connection Score ≥2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1±10.1 %LV vs 21.8±10.5 %LV, P =.003, area at risk: 33.8±16.8 %LV vs 38.8±15.5 %LV, P =.039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P =.005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P =.007). Conclusions In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity.
    No preview · Article · Oct 2015 · American Heart Journal
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    ABSTRACT: Cross-sectional data suggest that the degree of coronary atherosclerosis is associated with aerobic fitness. However, there are limited longitudinal data addressing whether aerobic fitness is a predictor of coronary atherosclerosis progression. This study investigated whether peak oxygen consumption is related to a longitudinal increase in coronary calcium scores. Study subjects were voluntary participants in a health screening program who underwent a cardiopulmonary function test and repeated coronary calcium scoring. Individuals with clinical cardiovascular disease were excluded. The final sample included 4843 subjects with 14,856 records. The treadmill exercise test was performed using a modified Bruce protocol and Agatston coronary artery calcium (CAC) scores were measured using multi-detector CT. The mean age of the participants was 52 ± 6 years and 4.7 % were female. In a multi-level mixed effect regression model, increased CAC scores over time were significantly less likely in individuals with a higher VO2peak after adjusting for age, gender, hypertension, HbA1c, smoking status and LDL cholesterol levels (p < 0.001). Aerobic fitness has a protective effect on the progression of coronary atherosclerosis in an asymptomatic middle-aged population.
    No preview · Article · Sep 2015 · Heart and Vessels
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    ABSTRACT: A new CT-based diagnostic method of protrusio acetabuli (PA) was introduced. However, prevalence of PA by this method and correlation between PA and other manifestations of Marfan syndrome (MFS) is unknown in Korean MFS patients. This study aimed to investigate the prevalence of PA diagnosed by a CT-based method in Korean patients with MFS, the association of PA with other manifestations of MFS, and the contribution of PA to MFS diagnosis. We retrospectively reviewed the records of 146 MFS patients with the presence of a causative FBN1 mutation and 146 age- and sex-matched controls from a single tertiary care center. All MFS patients underwent a complete assessment of criteria based on the revised Ghent nosology. PA was assessed quantitatively using a CT-based circle-wall distance (CWD) method. PA was diagnosed in 77.4% of patients in the MFS group and in 11.0% of the control group. CWD was significantly different between the two groups (1.50 mm vs. -0.64 mm, P<0.001). The presence of PA did not correlate with the presence of ectopia lentis, aortic root diameter, or history of aortic dissection. The presence of PA did not have a significant impact on the final diagnosis of MFS. Even though the presence of PA does not related to the cardinal clinical features of MFS or influence MFS diagnosis, its presence may be helpful for the suspicion of MFS when aortic dissection or aneurysm is found on CT angiography of the aorta because of the high frequency of PA in MFS patients. Graphical Abstract
    Preview · Article · Sep 2015 · Journal of Korean medical science
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    ABSTRACT: The aim of this study was to investigate whether noninvasive discrimination of chronic total occlusion (CTO), a complete interruption of coronary artery flow, and subtotal occlusion (STO), a functional total occlusion, is feasible using coronary computed tomography angiography (CTA). CTO and STO may be different in pathophysiology and clinical treatment strategy. We included 486 consecutive patients (median age 63 years, 82% male) who showed a total of 553 completely occluded coronary arteries in coronary CTA. The length of occlusion, side branches, shape of proximal stump, and collateral vessels were measured as anatomical findings. Transluminal attenuation gradient, which reflects intraluminal contrast kinetics and functional extent of collateral flow, was measured as a physiological surrogate. All patients were followed by invasive coronary angiography. Coronary arteries with CTO showed longer occlusion length (cutoff ≥15 mm), higher distal transluminal attenuation gradient (cutoff ≥-0.9 Hounsfield units [HU]/10 mm), more frequent side branches, blunted stump, cross-sectional calcification ≥50%, and collateral vessels compared with arteries with STO (p < 0.001, all). The combination of these findings could distinguish CTO from STO (c-statistics = 0.88 [95% confidence interval: 0.94 to 0.90], sensitivity 83%, specificity 77%, positive predictive value 55%, negative predictive value 93%; p < 0.001). Percutaneous coronary intervention (PCI) was attempted in 342 arteries and was successful in 279 arteries (82%). The computed tomography findings could predict the unsuccessful PCI (c-statistics = 0.70 [95% confidence interval: 0.65 to 0.75], sensitivity 63%, specificity 73%, positive predictive value 91%, negative predictive value 31%; p < 0.001). Noninvasive coronary CTA could discern CTO from STO, and also could predict the success of attempted PCI. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · JACC. Cardiovascular Interventions
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    ABSTRACT: Because of frequent tuberculosis in patients with Takayasu arteritis (TA), a possible relationship between TA and tuberculosis has been proposed. However, there are no studies to date that have examined clinical manifestations in patients diagnosed with TA with or without tuberculosis. Two hundred sixty-seven patients were diagnosed with TA according to the 1990 American College of Rheumatology criteria between September 1994 and April 2014. Patients with TA were classified into groups with or without tuberculosis. Among the 267 patients with TA studied, 47 patients (17.7 %) who had a history of previous treatment of tuberculosis (34 patients), concurrent diagnosis of tuberculosis with TA (10 patients), or diagnosis of tuberculosis during the follow-up period for TA (3 patients) were included in the group with tuberculosis. The group with tuberculosis comprised of 33 patients (70.2 %) with pulmonary tuberculosis, 12 patients (25.5 %) with tuberculous lymphadenitis, and 2 patients (4.3 %) with tuberculosis of the skin and colon, respectively. Comorbid disease and patients' signs and symptoms were not significantly different between TA patients with and without tuberculosis. Additionally, the site of disease involvement in angiographic findings and distribution of angiographic type were similar between the two groups. In conclusion, tuberculosis including tuberculous lymphadenitis was frequently observed in patients with TA. Clinical features and angiographic findings in TA were not different according to the presence or absence of concomitant tuberculosis.
    No preview · Article · Aug 2015 · Heart and Vessels
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    ABSTRACT: Apical hypertrophic cardiomyopathy (ApHCM) is thought to have a favourable clinical outcome, compared with other types of HCM. We sought to investigate the clinical and anatomical differences in cardiovascular imaging between ApHCM and non-ApHCM. A total of 350 patients diagnosed with HCM underwent cardiovascular magnetic resonance (CMR) and echocardiography. All enrolled subjects were prospectively followed up for adverse clinical outcomes. Eighty-five patients were classified as ApHCM. On CMR, the amount and proportion of late gadolinium enhancement (LGE) as well as left ventricular volumetric parameters were evaluated. Echocardiographic evaluations included diastolic function and global strain. Patients with ApHCM were less likely to present with history of syncope and have less frequency of family history of sudden cardiac death than those with non-ApHCM. Functional class was also more favourable in ApHCM [frequency of New York Heart Association (NYHA) class I; 89.4 vs. 66.8%, P < 0.001]. LGE was less frequently detected (87.1 vs. 93.9%, P = 0.04), and the amount of LGE was significantly smaller in ApHCM (7.0 ± 6.0 vs. 14.6 ± 10.5%, P < 0.001). The E/e' level and left atrial volume index were also lower in ApHCM patients (all P < 0.001). During follow-up, a composite of adverse clinical events including cardiac death, admission for heart failure, and cerebrovascular accident was higher in patients with ApHCM than those with non-ApHCM (P = 0.01). ApHCM showed a relatively small burden of myocardial fibrosis and less severe diastolic dysfunction and subsequently more favourable clinical manifestations in comparison with other HCMs. This may be one explanation of why most patients with ApHCM show a benign course of disease compared with non-ApHCM. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    No preview · Article · Aug 2015 · European Heart Journal Cardiovascular Imaging
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    ABSTRACT: Increased left ventricular (LV) mass is associated with adverse cardiovascular outcomes, and its accurate assessment is important. The aim of this study was to analyze the degree of difference among various methods of LV mass calculation based on transthoracic echocardiographic (TTE) measurements and cardiovascular magnetic resonance (CMR) measurements, especially in patients with aortic stenosis with varying degrees of LV hypertrophy (LVH). The mechanism underlying this disagreement was also investigated.
    No preview · Article · Jul 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: The purpose of this study was to evaluate differences in the diagnostic accuracy of absolute and relative territorial myocardial blood flow (MBF) derived from stress dynamic CT myocardial perfusion imaging (MPI) for the detection of significant coronary artery stenosis. Dynamic CT MPI and coronary CT angiography (CTA) datasets from a multicenter registry of 137 patients (mean age, 60.9 ± 8.4 years; 88 men) with suspected or known coronary artery disease were retrospectively analyzed. For each coronary territory, absolute MBF and the MBF relative to remote myocardium (MBF ratio) were calculated. Coronary CTA datasets were visually assessed for significant stenosis (≥ 50% luminal narrowing) in consensus by two observers. Significant stenosis was detected in 137 of 411 (33.3%) vessels. Mean absolute MBF and MBF ratio were statistically significantly lower in territories supplied by arteries with stenosis (80.7 ± 33.7 vs 140.0 ± 38.4 mL/100 mL/min and 0.52 vs 0.89, respectively; both p < 0.0001). ROC analysis showed better discrimination by MBF ratio than by absolute MBF (AUC, 0.925 vs 0.882; p = 0.0022) and increased sensitivity (90.7% vs 82.4%; p < 0.04) and specificity (93.1% vs 80.5%; p < 0.03) for MBF ratio and absolute MBF cutoff values of 0.71 or less and 103 mL/100 mL/min or less, respectively. In stress dynamic CT MPI, relative MBF provides superior diagnostic accuracy compared with absolute territorial MBF values for coronary CTA-detected significant coronary artery stenosis.
    No preview · Article · Jul 2015 · American Journal of Roentgenology
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    ABSTRACT: To assess the impact of left ventricular (LV) diastolic dysfunction on left atrial (LA) phasic volume and function using dual-source CT (DSCT) and to find a viable alternative prognostic parameter of CT for LV diastolic dysfunction through quantitative evaluation of LA phasic volume and function in patients with LV diastolic dysfunction. Seventy-seven patients were examined using DSCT and Doppler echocardiography on the same day. Reservoir, conduit, and contractile function of LA were evaluated by measuring LA volume (LAV) during different cardiac phases and all parameters were normalized to body surface area (BSA). Patients were divided into four groups (normal, impaired relaxation, pseudonormal, and restrictive LV diastolic filling) according to echocardiographic findings. The LA phasic volume and function in different stages of LV diastolic function was compared using one-way ANOVA analysis. The correlations between indexed volume of LA (LAVi) and diastolic function in different stages of LV were evaluated using Spearman correlation analysis. LA ejection fraction (LAEF), LA contraction, reservoir, and conduit function in patients in impaired relaxation group were not different from those in the normal group, but they were lower in patients in the pseudonormal and restrictive LV diastolic dysfunction groups (P < 0.05). For LA conduit function, there were no significant differences between the patients in the pseudonormal group and restrictive filling group (P = 0.195). There was a strong correlation between the indexed maximal left atrial volume (LAVmax, r = 0.85, P < 0.001), minimal left atrial volume (LAVmin, r = 0.91, P < 0.001), left atrial volume at the onset of P wave (LAVp, r = 0.84, P < 0.001), and different stages of LV diastolic function. The LAVi increased as the severity of LV diastolic dysfunction increased. LA remodeling takes place in patients with LV diastolic dysfunction. At the same time, LA phasic volume and function parameters evaluated by DSCT indicated the severity of the LV diastolic dysfunction. Quantitative analysis of LA phasic volume and function parameters using DSCT could be a viable alternative prognostic parameter of LV diastolic function.
    Preview · Article · May 2015 · PLoS ONE
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    ABSTRACT: Because Takayasu arteritis (TA) predominantly affects females, few data regarding gender differences have been reported. The aim of the present study is to describe clinical features and angiographic findings of patients with TA according to gender. According to the 1990 American College of Rheumatology criteria, 294 patients were diagnosed with TA between September 1994 and April 2014 at a single tertiary hospital. We reviewed clinical, laboratory, and radiologic data at the time of diagnosis. Among the 294 patients studied, 257 (87.4%) were female (male:female ratio=1:6.9). Female patients had a higher tendency to exhibit blood pressure differences between arms (p=0.595) and a weak pulse at the brachial artery (p=0.063). In male patients, we observed higher serum creatinine levels (p=0.038) and hypertension more frequently (p=0.061) than in females. Females exhibited more common lesions in the thoracic aorta and its branches, while males had more frequent lesions in the abdominal aorta and its branches. An analysis of angiographic classification according to the International TA Conference in Tokyo 1994 classification revealed that male patients had a higher incidence of type IV and females showed a higher incidence of types I, IIa, and IIb. Female patients with TA have more frequent involvement of the thoracic aorta and its branches, whereas involvement of the abdominal aorta and its branches is more common in males. Considering these gender-specific differences, adjustment of diagnostic criteria for TA according to gender may be necessary.
    No preview · Article · May 2015 · Clinical and experimental rheumatology
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    ABSTRACT: Despite technical simplicity and the low cost of brachial-ankle pulse wave velocity (BA-PWV), its use has been hampered by a lack of data supporting its usefulness and reliability. The aim of this study was to evaluate the usefulness of BA-PWV to measure aortic stiffness in comparison to using cardiovascular magnetic resonance (CMR). A total of 124 participants without cardiovascular risk factors volunteered for this study. BA-PWV was measured using a vascular testing device. On the same day, using CMR, cross-sectional areas for distensibility and average blood flow were measured at four aortic levels: the ascending, upper thoracic descending, lower thoracic descending, and abdominal aorta. Compared to PWV measured by CMR, BA-PWV values were significantly higher and the differences therein were similar in all age groups (all p<0.001). There was a significant correlation between BA-PWV and PWV by CMR (r=0.697, p<0.001). Both BA-PWV and PWV by CMR were significantly and positively associated with age (r=0.652 and 0.724, p<0.001). The reciprocal of aortic distensibility also demonstrated a statistically significant positive correlation with BA-PWV (r=0.583 to 0.673, all p<0.001). BA-PWV was well correlated with central aortic PWV and distensibility, as measured by CMR, regardless of age and sex.
    Preview · Article · May 2015 · Yonsei medical journal

  • No preview · Article · Apr 2015 · Journal of thoracic imaging
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    ABSTRACT: It is uncertain that atorvastatin pretreatment can reduce myocardial damage in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the effects of atorvastatin pretreatment on infarct size measured by contrast-enhanced magnetic resonance imaging (CE-MRI) in STEMI patients. Patients undergoing primary PCI for STEMI within 12 hr after symptom onset were randomized to an atorvastatin group (n=30, 80 mg before PCI and for 5 days after PCI) or a control group (n=37, 10 mg daily after PCI). The primary end point was infarct size evaluated as the volume of delayed hyperenhancement by CE-MRI within 14 days after the index event. The median infarct size was 19% (IQR 11.1%-31.4%) in the atorvastatin group vs. 16.3% (7.2%-27.2%) in the control group (P=0.27). The myocardial salvage index (37.1% [26.9%-58.7%] vs. 46.9% [39.9-52.4], P=0.46) and area of microvascular obstruction (1.1% [0%-2.0%] vs. 0.7% [0%-1.8%], P=0.37) did not differ significantly between the groups. Frequency of the hemorrhagic and transmural infarctions was not significantly different in the 2 groups. Pretreatment with a high-dose atorvastatin followed by further treatment for 5 days in STEMI patients undergoing primary PCI failed to reduce the extent of myocardial damage or improve myocardial salvage. Graphical Abstract
    Preview · Article · Apr 2015 · Journal of Korean medical science
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    ABSTRACT: Background: Although left ventricular hypertrophy (LVH) and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS) patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients. Methods and results: A total of 118 consecutive patients (67±9 years; 63 males) with moderate or severe AS (severe 81.4%) underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI) and LV remodeling index (LVRI; LV mass/LV end-diastolic volume) by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1 g/m2 vs. 86.1±29.2 g/m2, p=0.003) and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018), regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA) index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively). Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively). Conclusion: Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.
    Preview · Article · Mar 2015 · PLoS ONE