• Journal of Chest Surgery
• /
• 제52권1호
• /
• pp.16-24
• /
• 2019

Background: Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes. Methods: We analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was $22{\pm}32$ months. Results: There were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134-5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090-0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146-0.757; p=0.009) were correlated with cardiac mortality. Conclusion: CABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.

• 대한임상독성학회지
• /
• 제19권2호
• /
• pp.133-138
• /
• 2021

Glufosinate-containing herbicides is a non-selective herbicide commonly used worldwide. As the use of them increased gradually since paraquat was banned in 2012, the number of suicides by their ingestion is also increasing continuously. Complications of glufosinate-containing herbicide poisoning include various central nervous system (CNS) toxicities such as convulsions, loss of consciousness, memory impairment, and respiratory depression, which may be accompanied by hemodynamic changes such as bradycardia and hypotension. However, it is very rare that arrhythmias other than bradycardia occurred and Takotsubo cardiomyopathy was combined due to cardiotoxicity. A 71-year-old female patient was transferred to our hospital after ingesting 500 mL of glufosinate-containing herbicide and receiving 5 L of gastric lavage at a local hospital. A few hours later, she presented stuporous mentality, respiratory depression, and convulsions, and was accompanied by hypotension and bradycardia. On the second day of admission, electrocardiogram (ECG) showed bradycardia and QTc prolongation with hemodynamic Instability. Accordingly, we conducted the early treatment with continuous renal replacement therapy (CRRT) and the application of temporary cardiac pacemaker. An echocardiogram demonstrated decreased ejection fraction (EF) and Takotsubo cardiomyopathy on the third day of admission. Then, she was discharged safely with conservative treatment. At the follow-up after 1 year, Takotsubo cardiomyopathy, EF and QTc prolongation were recovered on echocardiogram and ECG. Because cardiac toxicity after glufosinate-containing herbicide poisoning may cause life-threatening consequences, caution is required while treating the patient. Therefore, if electrocardiogram changes are seen in the elderly with a large amount of glufosinate herbicide ingestion, additional cardiac function test through echocardiography should be concerned, and early treatment through CRRT or artificial cardiac pacing should be considered.

• Tuberculosis and Respiratory Diseases
• /
• 제85권4호
• /
• pp.332-340
• /
• 2022

Background: Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period. Methods: We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation. Results: Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292). Conclusion: Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

• Korean Journal of Radiology
• /
• 제21권4호
• /
• pp.450-461
• /
• 2020

Objective: We performed a meta-analysis to evaluate the agreement of cardiac computed tomography (CT) with cardiac magnetic resonance imaging (CMRI) in the assessment of right ventricle (RV) volume and functional parameters. Materials and Methods: PubMed, EMBASE, and Cochrane library were systematically searched for studies that compared CT with CMRI as the reference standard for measurement of the following RV parameters: end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), or ejection fraction (EF). Meta-analytic methods were utilized to determine the pooled weighted bias, limits of agreement (LOA), and correlation coefficient (r) between CT and CMRI. Heterogeneity was also assessed. Subgroup analyses were performed based on the probable factors affecting measurement of RV volume: CT contrast protocol, number of CT slices, CT reconstruction interval, CT volumetry, and segmentation methods. Results: A total of 766 patients from 20 studies were included. Pooled bias and LOA were 3.1 mL (-5.7 to 11.8 mL), 3.6 mL (-4.0 to 11.2 mL), -0.4 mL (5.7 to 5.0 mL), and -1.8% (-5.7 to 2.2%) for EDV, ESV, SV, and EF, respectively. Pooled correlation coefficients were very strong for the RV parameters (r = 0.87-0.93). Heterogeneity was observed in the studies (I² > 50%, p < 0.1). In the subgroup analysis, an RV-dedicated contrast protocol, ≥ 64 CT slices, CT volumetry with the Simpson's method, and inclusion of the papillary muscle and trabeculation had a lower pooled bias and narrower LOA. Conclusion: Cardiac CT accurately measures RV volume and function, with an acceptable range of bias and LOA and strong correlation with CMRI findings. The RV-dedicated CT contrast protocol, ≥ 64 CT slices, and use of the same CT volumetry method as CMRI can improve agreement with CMRI.

• Korean Journal of Radiology
• /
• 제22권4호
• /
• pp.525-534
• /
• 2021

Objective: To assess the effect of left atrial appendage (LAA) isolation on LAA emptying and left atrial (LA) function using cardiac MRI in patients who underwent successful catheter ablation of atrial fibrillation (AF). Materials and Methods: This retrospective study included 84 patients (mean age, 59 ± 10 years; 67 males) who underwent cardiac MRI after successful catheter ablation of AF. According to the electrical activity of LAA after catheter ablation, patients showed either LAA isolation or LAA normal activity. The LAA emptying phase (LAA-EP, in the systolic phase [SP] or diastolic phase), LAA emptying flux (LAA-EF, mL/s), and LA ejection fraction (LAEF, %) were evaluated by cardiac MRI. Results: Of the 84 patients, 61 (73%) and 23 (27%) patients showed LAA normal activity and LAA isolation, respectively. Incidence of LAA emptying in SP was significantly higher in LAA isolation (91% vs. 0%, p < 0.001) than in LAA normal activation. LAA-EF was significantly lower in LAA isolation (40.1 ± 16.2 mL/s vs. 80.2 ± 25.1 mL/s, p < 0.001) than in LAA normal activity. Furthermore, LAEF was significantly lower in LAA isolation (23.7% ± 11.2% vs. 31.1% ± 16.6%, p = 0.04) than in LAA normal activity. Multivariate analysis demonstrated that the LAA-EP was independent from LAEF (p = 0.01). Conclusion: LAA emptying in SP may be a critical characteristic of LAA isolation, and it may adversely affect the LAEF after catheter ablation of AF.

• 핵의학기술
• /
• 제22권2호
• /
• pp.92-96
• /
• 2018

핵의학 간담도 검사 시, 담낭의 수축력을 정량적으로 평가하기 위하여 지방식(fatty meal)을 이용한 전면상에서의 담낭박출률(gallbladder ejection fraction ; GB EF%)을 진단에 이용하고 있다. 하지만, 담낭과 다른 구조물이 전면상에서 겹쳐질 경우, 담낭 박출률 평가가 정확히 이루어지지 않는다. 이러한 오차를 줄이기 위해 본 연구에서는 전면상과 우측 측면상에서 계산한 GBEF%의 유의한 차이가 있는 지 알아보고자 한다. 본원에 내원한 임의의 환자 50명을 대상으로 $^{99m}Tc$-Mebrofenin 370 MBq를 정맥주사 후 간담도 검사를 실행하였다. 검사는 SKYLIGHT(Philips, United States)을 이용하여 10분, 20분, 30분, 60분, 그리고 지방식(치즈와 우유)을 시행하고 30분 후에 90분 째, 전면상과 우측 측면 영상을 획득하였다. JETstream workspace 프로그램에서 60분째와 90분째 전면상과 우측 측면상에서 GBEF%을 구하였다. 보다 정확한 관심영역 설정을 위해 CT영상을 참고하였고, 4명의 방사선사가 동일한 영상에서의 GBEF%을 구하여 평균값을 계산하였다. 통계분석프로그램SPSS version23(SPSS Inc. USA)을 이용하여 전면상과 우측 측면상에서 GBEF%의 차이에 유의한 차이가 있는지 평가하였다. 무작위 50명 환자의 전면상에서 GBEF%의 평균값은 63.2고, 우측 측면상에서 GBEF%의 평균값은 62.7으로 전면상 대비 우측 측면상에서 0.5% 감소하였다. 전면상과 우측 측면상에서 GBEF%의 대응표본 t-검정 결과 P>0.05으로 유의한 차이가 없었다. 이를 통해 전면상에서 담낭과 다른 구조물이 분리되지 않아 담낭박출률의 오차가 발생하는 경우, 우측 측면상을 이용하여 GBEF%을계산하면 보다 더 정확한 담낭박출률이 평가되는 것으로 사료된다.

• 대한핵의학회지
• /
• 제34권5호
• /
• pp.381-392
• /
• 2000

목적: Cedars 소프프웨어를 이용한 게이트 SPECT에서 $^{201}Tl$와 $^{99m}Tc$-MIBI 게이트 SPECT 두 방법으로 측정한 좌심실 부피와 구혈률의 재현성을 비교하였다. 대상 및 방법: 휴식 $^{201}Tl$/부하 $^{99m}Tc$-MIBI 심근 관류 SPECT를 촬영한 환자 중에서 무작위로 추출된 30명은 같은 자리에서 휴식 $^{201}Tl$ 게이트 SPECT를, 26명은 부하 후 $^{99m}Tc$-MIBI 게이트 SPECT를 한번 더 촬영하였다. Cedars 소프트웨어를 이용하여 연속해 측정된 좌심실 부피와 구혈률에 대하여 표준편차의 기하학적 평균과 Bland Altman 도표를 이용한 방법으로 $^{201}Tl$과 $^{99m}Tc$-MIBI 게이트 SPECT 방법의 재현성을 각각 평가하여 비교하였다. 결과: 연속 촬영한 $^{99m}Tc$-MIBI 게이트 SPECT로 얻은 확장기말 부피와 수축기말 부피, 구혈률에 대한 Bland Altman 도해의 2 표준편차에 상당하는 범위는 14.1 ml, 9.4 ml, 5.5%로 연속 촬영한 $^{201}Tl$ 게이트 SPECT로 얻은 24.1 ml, 18.6 ml, 10.3%보다 좁았다. 또한, 연속 촬영한 $^{99m}Tc$-MIBI 게이트 SPECT로 얻은 확장기말 부피와 수축기말 부피, 구혈률에 대한 표준편차의 기하학적 평균은 2.1 ml, 2.7 ml, 2.3%로 연속 촬영한 $^{201}Tl$ 게이트 SPECT로 얻은 3.2 ml, 3.5 ml, 5.2% 보다 작았다. 결론: 같은 환자를 같은 위치에서 두번 연속하여 촬영한 게이트 SPECT로 평가한 심근기능의 재현성은 $^{99m}Tc$-MIBI게이트 SPECT 방법에서 더 우수하였다. 그러므로, 기간별 변동과 약제의 효과를 보기 위한 좌심실 부피와 구혈률 측정에서 $^{201}Tl$보다는 $^{99m}Tc$-MIBI 게이트 SPECT 방법을 선택하는 것이 더 좋을 것으로 생각된다.

• 대한방사선기술학회지:방사선기술과학
• /
• 제32권2호
• /
• pp.169-175
• /
• 2009

본 연구는 초음파진단장치의 3.5 MHz 프로브로 20대 정상 성인의 식전 후 쓸개용적과 쓸개벽두께를 시간별로 추적주사하고 이것들의 추이변화를 분석 평가하여 다음과 같은 결론을 얻었다. 1. 식전 평균 쓸개용적은 남자 47.40 $m\ell$(SD 9.05), 여자 35.72 $m\ell$(SD 8.30)이었다. 2. 식전 평균 쓸개벽두께는 남 여 모두 2.3 mm(SD 0.3, SD 0.5)이었다. 3. 평균 쓸개박출계수(%)는 남자 67.20%, 여자 63.95%이었다. 4. 쓸개용적은 남 여 모두 식후 4시간까지는 음상관관계(v = -.487, p < .000, v = -.509, p < .000), 4시간 이후는 순상관관계(v = .434, p < .000, v = .440, p < .000)를 보였다. 5. 쓸개벽두께는 남 여 모두 식후 3시간까지는 순상관관계(t = .310, p < .002, t = .116, p < .246), 3시간 이후는 음상관관계(t = -.288, p < .010, t = -.126, p < 7.10)를 보였다. 6. 남 여 쓸개용량과 벽두께의 시간별 추이는 역상관관계를 나타냈다.

• 핵의학기술
• /
• 제12권1호
• /
• pp.33-38
• /
• 2008

Purpose: The Gated cardiac blood pool scan is non-invasive method that a quantitative evaluation of left ventricular function. Also this scan have shown the value of radionuclide ejection fraction measurements during the course of chemotherapy as a predictor of cardiac toxicity. Therefore a reliable method of monitoring its cardiotoxic effects is necessary. the purpose of this study is to minimize the overestimate of left ventricular ejection fraction (LVEF) by modified body position to reduce the influence of scattered rays from surrounding organs of the heart in the background region of interest. Materials and Methods: Gated cardiac blood pool scan using in vivo $^{99m}Tc$-red blood cell (RBC) was carried out in 20 patients (mean $44.8{\pm}8.6$ yr) with chemotherapy for a breast carcinoma. Data acquisition requires about 600 seconds and 24 frames of one heart cycle by the multigated acquisition mode, Synchronization deteriorates toward the end of the cycle and with the distance from the trigger signal (R-wave) by ECG gating. Gated cardiac blood pool scan was studied with conventional method (supine position and the detector head in $30-45^{\circ}$ left anterior oblique position and caudal $10-20^{\circ}$ tilt) and compared with modified method (left lateral flexion position with 360 mL of drinking water). LVEF analysis was performed by using the automatically computer mode. Results: The ROI counts of modified scan method were lower than LV conventional method ($1429{\pm}251$ versus $1853{\pm}243$, <0.01). And LVEF of modified method was also decrease compared with conventional method ($58.3{\pm}5.6%$ versus $65.3{\pm}6.1%$, <0.01). Imaging analysis indicated that stomach was expanded because of water and spleen position was changed to lateral inferior compared with conventional method. Conclusion: This study shows that the modified method in MUGA reduce the influence of scattered rays from surrounding organs. Because after change the body position to left lateral flexion and drinking water, the location of spleen, left lobe of liver and stomach had changed and they could escaped from background ROI. Therefore, modified method could help to minimize the overestimate LVEF (%).

• 대한핵의학회지
• /
• 제28권1호
• /
• pp.52-61
• /
• 1994

Background : The demand for refinement in noninvasive and quantitative assessment of left ventricular (LV) function is increasing. Purpose : To assess normal values of left ventricular functional parameters during both systole and diastole by scintigraphic method using computerized triple-head gamma camera and to evaluate correlations between these parameters. Methods : ECG gated blood pool scan with $^{99m}Tc$-Human serum albumin was performed in 94 normal Korean subjects. Ejection fraction (EF), systolic parameters [peak emptying rate (PER), average emptying rate (AER), time to peak emptying rate (TPER)], and diastolic parameters [peak filling rate (PFR), average filling rate (AFR), time to peak filling rate (TPFR)] were obtained by analysis of LV time-activity curve, the correlation of these parameters to the age and sex, and the correlation between these parameters were evaluated. Results : 1) Mean value of ejection fraction in study subjects was $59.6{\pm}5.25%$ and showed no significant correlation to age (r=-0.08) and sex but showed most pronounced correlation to PFR (r=0.46, p<0.001), PER (r=0.41, p<0.001), AFR (r=0.34, p<0.001) and AER (r=0.28, p<0.01). 2) Mean values of systolic parameters were as follows: $PER=3.22{\pm}0.50$ end-diastolic volume/sec, $AER=2.22{\pm}0.45$ end-diastolic volume/sec, $TPER=103.5{\pm}29.30$ msec. They showed no significant correlation to age and sex. 3) Mean values of diastolic parameters were as follows: $PFR=2.71{\pm}0.51$ end-diastolic volume/sec, $AFR=1.83{\pm}0.44$ end-diastolic volume/sec, $TPFR=132.1{\pm}33.45$ msec. They showed strong correlation to age (r=0.70, -0.64, 0.37, p<0.001). Conclusions : Left ventricular functional parameters in normal Korean subjects were obtained reliably by computerized scintigraphic method and may be applied to the evaluation of cardiac function in diseased patients.