• The Korean Journal of Nuclear Medicine
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• v.33 no.1
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• pp.40-48
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• 1999

Purpose: The sensitivity of ST-depression in the electrocardiogram during exercise is influenced by the level of efforts. However, unlike the prevalence of ST-depression on exercise ECG, the degree of exercise is reported to do not influence the diagnostic ability of myocardial perfusion scan. Furthermore, the relation between the prevalence of myocardial ischemia and effort is still controversial. We evaluated the effect of the degree of exercise on the ability of SPECT imaging to detect coronary artery stenosis. Materials and Methods: The patient population was comprised of 111 patients (73 men and 38 women, mean age 56 years) who underwent an exercise test in conjunction with Tc-99m MIBI and cardiac catheterization within 3 months apart each other. The degree of exercise was classified into four groups according to the percentage of maximal predicted heart rate. The sensitivity and specificity was compared between each group. Results: The overall diagnostic sensitivity was significantly higher with Tc-99m MIBI SPECT than exercise ECG. The specificity was not significantly different between two tests. Sensitivity and specificity of Tc-99m MIBI was not different between four groups. Sensitivity for individual coronary stenosis seemed to be lower in subjects who had premature termination of exercise due to early appearance of ST depression. Conclusion: These results suggest that the overall diagnostic sensitivity of Tc-99m MIBI myocardial perfusion SPECT is not significantly affected by the degree of exercise in stable patients undergoing symptom-limited treadmill exercise testing. Myocardial perfusion SPECT imaging should be added to routine exercise stress testing for the detection of coronary artery disease.

• Journal of Life Science
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• v.20 no.1
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• pp.71-76
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• 2010

The purpose of this study was to investigate the changes of long term ECG response in a company with middle-aged male employees. Subjects were 60 men who were 40~55 years old. We enrolled 30 exercise group subjects into a 3-year exercise program. In measurement index, body composition was measured by % body fat and BMI. Exercise stress test analyses were measured using ST/HR slope and QRS vector. Statistical analysis was performed using analysis of repeated ANOVA. Results of this study were as follows: In ST/HR slope, the control group showed symptoms of ischemia after nine minutes of exercise. In the rest frontal axis of the QRS vector, the control group had a tendency towards right axis deviation. In the rest horizontal amplitude of the QRS vector, the control group had a tendency to show a significant decrease, but it was increased significantly in the exercise group. These findings suggest that inactive company workers was showed a decrease of exercise capacity, early diagnosis exercise-induced ST depression, and prolonged deviation of QRS vector, but that cardiac function could be elevated in active middle aged men through regular exercise program participation.

• 대한핵의학회:학술대회논문집
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• 2001.11a
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• pp.38.2-38.2
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• 2001

• Proceedings of the KIEE Conference
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• 2008.07a
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• pp.2005-2006
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• 2008

심박변이도는 자율신경계의 균형 상태를 나타내는 중요한 지표이다. 동적인 환경내에서 항상성을 유지할려는 인체가 각 신경계를 조율하는 수치로 심박의 변화를 시간영역과 주파수영역으로 나누어 그 값을 측정하여 분석하였다. 그 중 심전도의 측정방식에서 간략히 하고자 광학적 방법으로 심장의 박동을 측정하는 PPG 변화량이 심박변이도와 유사하다는 연구가 진행되어 왔다. 하지만, 심전도와 PPG 는 혈압의 영향을 받는다. 본 연구에서 운동부하 실험을 주어 혈압을 상승 시킨뒤, 심전도를 통해 산출한 심박변이도와 PPG를 통해 산출한 맥박변이도를 비교하여 두 상관성에 대하여 연구하였다.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.207-221
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• 2000

Purpose: Cost-effectiveness of myocardial SPECT for the diagnosis of coronary artery disease was investigated considering the present and amended costs of myocardial SPECT and exercise ECG in Korea. Materials and Methods: Four diagnostic tactics such as 1) coronary angiography (CAG) after exercise ECG, 2) CAG after myocardial SPECT, 3) direct CAG, and 4) CAG after myocardial SPECT following exercise ECG were chosen. Costs were calculated using the present costs of various tests and effects represented by Quality Adjusted Life Year (QALY) were estimated. Difference of QALY (${\Delta}QALY$) was calculated by subtracting QALY of diagnosed/treated cases from QALY of undiagnosed cases. $Cost/{\Delta}QALY$ was calculated and compared between four different tactics according to pre-test probability. Results: When pre-test probability was equal to or larger than 0.6, direct CAG was the most cost-effective. When pre-test probability was between 0.2 and 0.6, CAG after myocardial SPECT following exercise ECG was the most cost-effective. CAG after myocardial SPECT was the second most cost-effective. Cost-effectiveness was similar when the costs of exercise ECG were doubled or quadrupled. CAG after exercise ECG was always the least cost-effective. Conclusion: Myocardial SPECT with or without preceding exercise ECG was the most cost-effective method to diagnose coronary artery disease in the present or expected amended cost system.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.199-206
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• 2000

Purpose: Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise $^{99m}Tc$-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. Materials and Methods: We evaluated 301 patients (mean age $52{\pm}10$ years, 166 males and 135 females) with normal exercise $^{99m}Tc$-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subject were evaluated for cardiac events and followed for 8-55 months (mean $19{\pm}10$ months) after imaging. Results: During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patients with positive (n=27) and negative (n=235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Conclusion: Patients with normal exercise $^{99m}Tc$-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.

• 대한핵의학회:학술대회논문집
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• 2002.11a
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• pp.26.1-26.1
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• 2002

• The Korean Journal of Nuclear Medicine
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• v.38 no.3
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• pp.225-232
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• 2004

Purpose : Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Materials and Methods : Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV election fraction (LVEF) was $\geq5%$ lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1 %(non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Results : Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs. 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs. 9.2%, p=0.029; severity 13.5 vs. 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis ($80{\sim}99%$) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Conclusion : Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than patients without post-stress LV dysfunction. All of the patients without perfusion defect in stunning group had significant coronary artery stenosis and needed revascularization. Therefore, we suggest that invasive diagnostic procedures and therapeutic interventions might be needed in patients with post-stress LV dysfunction.

• Proceedings of the Korean Society for Emotion and Sensibility Conference
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• 2009.05a
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• pp.173-176
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• 2009

심박동 변동에 반영되는 자율신경계 활동으로부터 정신적 부하 즉 스트레스 상태를 평가할 수 있다. 또한 일상생활 중에서 지속적인 심전도 모니터링인 가능하다면 심장에 부하를 줄 수 있는 운동 중에도 사전에 급작스러운 심장 이상 증세를 예상할 수 있다. 본 연구에서는 일상생활 속에서도 생체신호 측정이 가능한 무구속, 무자각, 무침습적인 심전도 측정 시스템을 개발하였다. 무선 통신을 사용하여 실시간으로 심장 활동 상태를 모니터링 할 수 있으며, 가슴에 부착이 가능한 패치 타입의 소형 전극 형태이다. 신뢰도 평가를 위하여 임상 심전도 신호와 본 전극으로 측정한 심전도 신호의 유사도를 평가하였으며 동잡음의 영향을 평가한 결과 $0{\sim}6m/h$로 걷는 경우, 심전도 파형이 안정적으로 나타나 일상생환에서의 활용가능성을 보여주었다. 동일한 피험자를 대상으로 HRV에 반영되는 스트레스의 영향을 평가하기 위하여 패치형 전극으로 심전도를 측정하여 불안, 스트레스 항목에 대한 설문지 평가, 스트레스 호르몬양을 측정하였다. 일상 상태와 스트레스 상태를 비교한 결과, 많은 파라미터에서 유의한 차이가 나타났다. 이러한 결과로부터 패치형 전극은 일상생활에서 건강 모니터링 시스템으로 활용도가 높을 것으로 기대된다.

• 대한핵의학회:학술대회논문집
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• 1999.11a
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• pp.33.2-33.2
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• 1999