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Impact of Gender Differences in Elderly Patients with Acute Myocardial Infarction (고령의 급성 심근경색증 환자에서 성별에 따른 영향)

  • Seol, Soo Young;Jeong, Myung Ho;Lee, Seung Hun;Sohn, Seok-Joon;Cho, Jae Yeong;Kim, Min Chul;Sim, Doo Sun;Hong, Young Joon;Park, Hyung Wook;Kim, Ju Han;Ahn, Youngkeun;Cho, Jeong Gwan;Park, Jong Chun
    • The Korean Journal of Medicine
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    • v.94 no.1
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    • pp.96-106
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    • 2019
  • Background/Aims: It is well known that gender differences are associated with clinical outcomes in patients with acute myocardial infarction (AMI). However, it is not clear whether gender differences affect the prognosis of elderly patients with AMI. Methods: We analyzed the incidence of in-hospital complications and mortality in the Korea Acute Myocardial Infarction Registry-National Institutes of Health from November 2011 to June 2015. This study included elderly patients (≥ 75 years) diagnosed with AMI. Results: A total of 2,953 patients were eligible for this study. Among them, 1,529 (51.8%) patients were female, and the mean age of the female group was older than that of the male group (80.7 ± 4.4 vs. 79.6 ± 4.0 years, respectively, p < 0.001). Elderly females utilized emergency medical services less frequently compared with elderly males (11.5 vs. 15.4%, respectively, p < 0.001). Elderly female AMI patients had a similar rate of in-hospital mortality compared with elderly males (7.1 vs. 8.4%, respectively, p = 0.196). The rate of major cardiac adverse events (MACEs) was lower in elderly females than males during a 12-month follow-up (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.00-1.41, p = 0.045). According to multivariate analysis, the male gender is an independent factor for predicting 1-year MACEs (HR 1.37, 95% CI 1.14-1.65, p < 0.001). Conclusions: No significant differences in peri-procedural complications or in-hospital mortality were observed between male and female elderly patients with AMI. However, elderly female patients had a more favorable prognosis than male patients during a 1-year clinical follow-up.

Estimation of Chlorophyll Contents in Pear Tree Using Unmanned AerialVehicle-Based-Hyperspectral Imagery (무인기 기반 초분광영상을 이용한 배나무 엽록소 함량 추정)

  • Ye Seong Kang;Ki Su Park;Eun Li Kim;Jong Chan Jeong;Chan Seok Ryu;Jung Gun Cho
    • Korean Journal of Remote Sensing
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    • v.39 no.5_1
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    • pp.669-681
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    • 2023
  • Studies have tried to apply remote sensing technology, a non-destructive survey method, instead of the existing destructive survey, which requires relatively large labor input and a long time to estimate chlorophyll content, which is an important indicator for evaluating the growth of fruit trees. This study was conducted to non-destructively evaluate the chlorophyll content of pear tree leaves using unmanned aerial vehicle-based hyperspectral imagery for two years(2021, 2022). The reflectance of the single bands of the pear tree canopy extracted through image processing was band rationed to minimize unstable radiation effects depending on time changes. The estimation (calibration and validation) models were developed using machine learning algorithms of elastic-net, k-nearest neighbors(KNN), and support vector machine with band ratios as input variables. By comparing the performance of estimation models based on full band ratios, key band ratios that are advantageous for reducing computational costs and improving reproducibility were selected. As a result, for all machine learning models, when calibration of coefficient of determination (R2)≥0.67, root mean squared error (RMSE)≤1.22 ㎍/cm2, relative error (RE)≤17.9% and validation of R2≥0.56, RMSE≤1.41 ㎍/cm2, RE≤20.7% using full band ratios were compared, four key band ratios were selected. There was relatively no significant difference in validation performance between machine learning models. Therefore, the KNN model with the highest calibration performance was used as the standard, and its key band ratios were 710/714, 718/722, 754/758, and 758/762 nm. The performance of calibration showed R2=0.80, RMSE=0.94 ㎍/cm2, RE=13.9%, and validation showed R2=0.57, RMSE=1.40 ㎍/cm2, RE=20.5%. Although the performance results based on validation were not sufficient to estimate the chlorophyll content of pear tree leaves, it is meaningful that key band ratios were selected as a standard for future research. To improve estimation performance, it is necessary to continuously secure additional datasets and improve the estimation model by reproducing it in actual orchards. In future research, it is necessary to continuously secure additional datasets to improve estimation performance, verify the reliability of the selected key band ratios, and upgrade the estimation model to be reproducible in actual orchards.

Assessment of Eutrophication Using Trophic State Index and Water Quality Characteristics of Saemangeum Lake (새만금호의 수질 특성 및 영양상태지수를 이용한 부영양화 평가)

  • Jong Gu Kim
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.29 no.6
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    • pp.587-597
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    • 2023
  • We evaluated the eutrophication of Saemangeum Lake, which causes abnormal growth of algae, using the Carlson index. Eutrophication characteristics of Saemangeum Lake were analyzed. For the study, water quality surveys were conducted at 7 stations in Saemangeum Lake every month in 2021. The concentration of Chl.a was slightly higher in the Mankyeong water system in winter, and slightly higher in the Dongjin water system in spring and summer, but overall, except for some periods, the concentration was similar to or lower than the lake water quality environmental standard of class 3. COD showed water quality similar to or above the lake quality environmental standard of grade 4 in both the Mankyeong and Dongjin water systems in the summer and Autumn. TOC concentrations were within lake water quality standard 3 at all sites. Total phosphorus concentrations exceeded the lake water quality standard of Class 4 and were higher in January and August after rainfall. In the correlation analysis between water quality factors, the correlation of organic matter, total phosphorus, and total nitrogen to salinity was relatively high. This reflected the water quality characteristics of freshwater, brackish water, and seawater areas due to seawater inflow through the drainage gate and freshwater inflow through upstream rivers. According to the characteristics of eutrophication fluctuations in Saemangeum Lake by trophic state index, the indices of Chl.a, SD, and TN showed water quality in the early stage of eutrophication, while the TP index showed a severe eutrophication state. The magnitude of the eutrophication index among water quality components was TSI(TP) > TSI(TN) > TSI(SD) > TSI(CHL) in all water systems. Quadrant analysis of the deviation of TSI(CHL) from TSI(TP) and TSI(SD) on a two-dimensional plane showed that there was no limiting effect of total phosphorus on algal growth in all water systems. In addition, the factors af ecting light attenuation appeared to be dominated by small particulate matter from outside sources.

Seasonal Whole-plant Carbon Balance of Phyllospadix iwatensis on the Coast of the Korean Peninsula (한반도 연안에 분포하는 새우말의 탄소수지 계절적 변동)

  • SEUNG HYEON KIM;JONG-HYEOB KIM;HYEGWANG KIM;JIN WOO KU;KI YOUNG KIM;KUN-SEOP LEE
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.29 no.1
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    • pp.28-41
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    • 2024
  • The carbon balance serves as a valuable indicator of a plant's physiological status under diverse environmental conditions. We investigated the photosynthetic and respiratory responses of the Asian surfgrass Phyllospadix iwatensis along the northeast coast of the Korean peninsula in response to changing water temperature (ranging from 5℃ to 30℃) to estimate the seasonal whole-plant carbon balance through a series of incubation experiments. The maximum gross photosynthetic rate (Pmax) showed a significant difference among the temperature treatments, while there was no significant difference in photosynthetic efficiency (α). The maximum gross photosynthetic rate of P. iwatensis reached its peaks at 20℃ treatment (101.65 μmol O2 g-1 DW h-1) but decreased rapidly at 30℃. The saturation irradiance (Ik), compensation irradiance (Ic), and respiration rate (R) of P. iwatensis exhibited significant differences among the temperature treatments. The saturation irradiance increased up to 20-25℃ (121.59-124.50 μmol photons m-2 s-1) and sharply decreased at 30℃. The compensation irradiance and respiration rate increased steadily with rising water temperature. The ratio of Pmax to R (Pmax:R ratio) was the highest at 5℃ but dramatically decreased at 30℃. The whole-plant carbon balance, calculated based on photosynthetic parameters, respiration rates, and biomass, exhibited distinct seasonal variation, increasing during winter and spring and decreasing during summer and fall, which is consistent with the highest in situ growth in spring and severely limited growth at the highest water temperature conditions. Phyllospadix iwatensis displayed a negative carbon balance during late summer, fall, and winter, but demonstrated a positive carbon balance during spring and early summer. Our findings suggest that the rising seawater temperatures associated with climate change may lead to significant alterations in the seagrass ecosystem functioning along the rocky shores of the Korean east coast.

Antimicrobial effect of infrared diode laser utilizing indocyanine green against Staphylococcus aureus biofilm on titanium surface (티타늄 표면에 형성한 Staphylococcus aureus 바이오필름에 대한 인도시아닌 그린을 활용한 광역학치료의 항미생물 효과)

  • Seung Gi Kim;Si-Young Lee;Jong-Bin Lee;Heung-Sik Um;Jae-Kwan Lee
    • Journal of Dental Rehabilitation and Applied Science
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    • v.40 no.2
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    • pp.55-63
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    • 2024
  • Purpose: This study aimed to assess the antimicrobial efficacy of an 810-nm infrared diode laser with indocyanine green (ICG) against Staphylococcus aureus on sandblasted, large grit, and acid-etched (SLA) titanium surfaces, comparing its effectiveness with alternative chemical decontamination modalities. Materials and Methods: Biofilms of S. aureus ATCC 25923 were cultured on SLA titanium disks for 48 hours. The biofilms were divided into five treatment groups: control, chlorhexidine gluconate (CHX), tetracycline (TC), ICG, and 810-nm infrared diode laser with ICG (ICG-PDT). After treatment, colony-forming units were quantified to assess surviving bacteria, and viability was confirmed through confocal laser-scanning microscope (CLSM) imaging. Results: All treated groups exhibited a statistically significant reduction in S. aureus (P < 0.05), with notable efficacy in the CHX, TC, and ICG-PDT groups (P < 0.01). While no statistical difference was observed between TC and CHX, the ICG-PDT group demonstrated superior bacterial reduction. CLSM images revealed a higher proportion of dead bacteria stained in red within the ICG-PDT groups. Conclusion: Within the limitations, ICG-PDT effectively reduced S. aureus biofilms on SLA titanium surfaces. Further investigations into alternative decontamination methods and the clinical impact of ICG-PDT on peri-implant diseases are warranted.

Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study

  • Young Choi;Byounghyun Lim;Song-Yi Yang;So-Hyun Yang;Oh-Seok Kwon;Daehoon Kim;Yun Gi Kim;Je-Wook Park;Hee Tae Yu;Tae-Hoon Kim;Pil-Sung Yang;Jae-Sun Uhm;Jamin Shim;Sung Hwan Kim;Jung-Hoon Sung;Jong-il Choi;Boyoung Joung;Moon-Hyoung Lee;Young-Hoon Kim;Yong-Seog Oh;Hui-Nam Pak;CUVIA-REGAB Investigators
    • Korean Circulation Journal
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    • v.52 no.9
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    • pp.699-711
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    • 2022
  • Background and Objectives: We investigated whether extra-pulmonary vein (PV) ablation targeting a high maximal slope of the action potential duration restitution curve (Smax) improves the rhythm outcome of persistent atrial fibrillation (PeAF) ablation. Methods: In this open-label, multi-center, randomized, and controlled trial, 178 PeAF patients were randomized with 1:1 ratio to computational modeling-guided virtual Smax ablation (V-Smax) or empirical ablation (E-ABL) groups. Smax maps were generated by computational modeling based on atrial substrate maps acquired during clinical procedures in sinus rhythm. Smax maps were generated during the clinical PV isolation (PVI). The V-Smax group underwent an additional extra-PV ablation after PVI targeting the virtual high Smax sites. Results: After a mean follow-up period of 12.3±5.2 months, the clinical recurrence rates (25.6% vs. 23.9% in the V-Smax and the E-ABL group, p=0.880) or recurrence appearing as atrial tachycardia (11.1% vs. 5.7%, p=0.169) did not differ between the 2 groups. The post-ablation cardioversion rate was higher in the V-Smax group than E-ABL group (14.4% vs. 5.7%, p=0.027). Among antiarrhythmic drug-free patients (n=129), the AF freedom rate was 78.7% in the V-Smax group and 80.9% in the E-ABL group (p=0.776). The total procedure time was longer in the V-Smax group (p=0.008), but no significant difference was found in the major complication rates (p=0.497) between the groups. Conclusions: Unlike a dominant frequency ablation, the computational modeling-guided V-Smax ablation did not improve the rhythm outcome of the PeAF ablation and had a longer procedure time.

Satisfaction Evaluation of Diabetic Foot Disease Measurement using AI-based Application (AI기반 에플리케이션을 활용한 당뇨병성 족부질환 측정의 만족도 평가)

  • Hyeun-Woo Choi;Hyo-jin Lee;Min-jeong Kim;Jong-Min Lee;Dong-hyun Kim
    • Journal of the Korean Society of Radiology
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    • v.18 no.4
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    • pp.327-334
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    • 2024
  • The purpose of this study is to develop a customized foot disease analysis and management system for diabetic patients to prevent foot ulcers in diabetic foot disease patients. This system utilizes image analysis technology to measure not only foot pressure, but also ankle deformation, body balance, and foot wounds. Through various data, it is possible to accurately analyze the state of foot deformation, and based on this, the exact state of deformation of the foot of a patient with diabetic foot disease was identified and a customized insole was produced. This study was conducted to examine the satisfaction level of using an application that checks the status of diabetic foot disease wounds and to identify the degenerative status of diabetic foot disease patients and foot disease patients by wearing customized insoles and to survey the satisfaction of wearing insoles. As a result of the study, the knee angle measured for plantar pressure was -0.8 ± 1.3 degrees and ranged from a minimum of -2.4 degrees to a maximum of 1.1 degrees, and there was no significant difference in valgus knee between both lower extremities (p = 0.534). There was a significant difference in tibial angle between both lower extremities (p < 0.001). Ankle angle on the left side was 2.6 ± 2.0 degrees, ranging from a minimum of 0 degrees to a maximum of 6.3 degrees, and on the right, it was 4.5 ± 2.1 degrees, with a distribution of minimum 1.5 degrees to a maximum of 9.1 degrees. There was a significant difference in ankle angle between both lower extremities (p = 0.011). They responded that they felt an average of 4.3 points of satisfaction with the plantar pressure measurement application. Respondents responded that they felt an average of 3.9 points of satisfaction with the use of customized insoles.

The Factors Affecting Attitudes Toward HSDPA Service and Intention to Use: A Cross-Cultural Comparison between Asia and Europe (대영향(对影响)HSDPA복무적태도화사용의도적인소적연구(服务的态度和使用意图的因素的研究): 재아주화구주지간적(在亚洲和欧洲之间的)-개과문화비교(个跨文化比较))

  • Jung, Hae-Sung;Shin, Jong-Kuk;Park, Min-Sook;Jung, Hong-Seob;Hooley, Graham;Lee, Nick;Kwak, Hyok-Jin;Kim, Sung-Hyun
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.4
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    • pp.11-23
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    • 2009
  • HSDPA (High-Speed Downlink Packet Access) is a 3.5-generation asynchronous mobile communications service based on the third generation of W-CDMA. In Korea, it is mainly provided in through videophone service. Because of the diffusion of more powerful and diversified services, along with steep advances in mobile communications technology, consumers demand a wide range of choices. However, because of the variety of technologies, which tend to overflow the market regardless of consumer preferences, consumers feel increasingly confused. Therefore, we should not adopt strategies that focus only on developing new technology on the assumption that new technologies are next-generation projects. Instead, we should understand the process by which consumers accept new forms of technology and devise schemes to lower market entry barriers through strategies that enable developers to understand and provide what consumers really want. In the Technology Acceptance Model (TAM), perceived usefulness and perceived ease of use are suggested as the most important factors affecting the attitudes of people adopting new technologies (Davis, 1989; Taylor and Todd, 1995; Venkatesh, 2000; Lee et al., 2004). Perceived usefulness is the degree to which a person believes that a particular technology will enhance his or her job performance. Perceived ease of use is the degree of subjective belief that using a particular technology will require little physical and mental effort (Davis, 1989; Morris and Dillon, 1997; Venkatesh, 2000). Perceived pleasure and perceived usefulness have been shown to clearly affect attitudes toward accepting technology (Davis et al., 1992). For example, pleasure in online shopping has been shown to positively impact consumers' attitudes toward online sellers (Eighmey and McCord, 1998; Mathwick, 2002; Jarvenpaa and Todd, 1997). The perceived risk of customers is a subjective risk, which is distinguished from an objective probabilistic risk. Perceived risk includes a psychological risk that consumers perceive when they choose brands, stores, and methods of purchase to obtain a particular item. The ability of an enterprise to revolutionize products depends on the effective acquisition of knowledge about new products (Bierly and Chakrabarti, 1996; Rothwell and Dodgson, 1991). Knowledge acquisition is the ability of a company to perceive the value of novelty and technology of the outside (Cohen and Levinthal, 1990), to evaluate the outside technology that has newly appeared (Arora and Gambaradella, 1994), and to predict the future evolution of technology accurately (Cohen and Levinthal, 1990). Consumer innovativeness is the degree to which an individual adopts innovation earlier than others in the social system (Lee, Ahn, and Ha, 2001; Gatignon and Robertson, 1985). That is, it shows how fast and how easily consumers adopt new ideas. Innovativeness is regarded as important because it has a significant effect on whether consumers adopt new products and on how fast they accept new products (Midgley and Dowling, 1978; Foxall, 1988; Hirschman, 1980). We conducted cross-national comparative research using the TAM model, which empirically verified the relationship between the factors that affect attitudes - perceived usefulness, ease of use, perceived pleasure, perceived risk, innovativeness, and perceived level of knowledge management - and attitudes toward HSDPA service. We also verified the relationship between attitudes and usage intention for the purpose of developing more effective methods of management for HSDPA service providers. For this research, 346 questionnaires were distributed among 350 students in the Republic of Korea. Because 26 of the returned questionnaires were inconsistent or had missing data, 320 questionnaires were used in the hypothesis tests. In UK, 192 of the total 200 questionnaires were retrieved, and two incomplete ones were discarded, bringing the total to 190 questionnaires used for statistical analysis. The results of the overall model analysis are as follows: Republic of Korea x2=333.27(p=0.0), NFI=0.88, NNFI=0.88, CFI=0.91, IFI=0.91, RMR=0.054, GFI=0.90, AGFI=0.84, UK x2=176.57(p=0.0), NFI=0.88, NNFI=0.90, CFI=0.93, IFI=0.93, RMR=0.062, GFI=0.90, AGFI=0.84. From the results of the hypothesis tests of Korean consumers about the relationship between factors that affect intention to use HSDPA services and attitudes, we can conclude that perceived usefulness, ease of use, pleasure, a high level of knowledge management, and innovativeness promote positive attitudes toward HSDPA mobile phones. However, ease of use and perceived pleasure did not have a direct effect on intention to use HSDPA service. This may have resulted from the fact that the use of video phones is not necessary for everyday life yet. Moreover, it has been shown that attitudes toward HSDPA video phones are directly correlated with usage intention, which means that perceived usefulness, ease of use, pleasure, a high level of knowledge management, and innovativeness. These relationships form the basis of the intention to buy, contributing to a situation in which consumers decide to choose carefully. A summary of the results of the hypothesis tests of European consumers revealed that perceived usefulness, pleasure, risk, and the level of knowledge management are factors that affect the formation of attitudes, while ease of use and innovativeness do not have an effect on attitudes. In particular, with regard to the effect value, perceived usefulness has the largest effect on attitudes, followed by pleasure and knowledge management. On the contrary, perceived risk has a smaller effect on attitudes. In the Asian model, ease of use and perceived pleasure were found not to have a direct effect on intention to use. However, because attitudes generally affect the intention to use, perceived usefulness, pleasure, risk, and knowledge management may be considered key factors in attitude development from which usage intention arises. In conclusion, perceived usefulness, pleasure, and the level of knowledge management have an effect on attitude formation in both Asian and European consumers, and such attitudes shape these consumers' intention to use. Furthermore, the hypotheses that ease of use and perceived pleasure affect usage intention are rejected. However, ease of use, perceived risk, and innovativeness showed different results. Perceived risk had no effect on attitude formation among Asians, while ease of use and innovativeness had no effect on attitudes among Europeans.

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Efficacy of Pigtail Catheter Drainage in Patients with Thoracic Empyema or Complicated Parapneumonic Effusion (농흉 및 합병된 부폐렴성 흉막 삼출 환자에서 Pigtail 도관 배액의 유용성)

  • Park, Jeong Woo;You, Seung Min;Seol, Won Jong;Paik, Eun Ki;Lee, Kyu Hoon;Seo, Joon Beom;Jeong, Seong Hwan;An, Chang Hyeok;Lim, Youg Hee;Park, Jeong Woong
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.2
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    • pp.219-229
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    • 2003
  • Background : The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. Materials and Methods : 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. Results : Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated, were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion($9.4{\pm}5.25days$ vs. $19.2{\pm}9.42days$, p<0.05) and the duration of hospital admission after catheter insertion($15.9{\pm}10.45days$ vs. $38.6{\pm}11.46days$, p<0.01) of the patients with only PCD treated were more longer than those of the patients treated with surgical procedure after PCD. They were same between the patients treated with urokinase after PCD and the patients treated with surgical procedure after PCD($11.1{\pm}7.35days$ vs. $19.2{\pm}9.42days$, p<0.05, $17.5{\pm}9.17days$ vs. $38.6{\pm}11.46days$, p<0.01). In 16 patients(44.4%) with only PCD treated or PCD and urokinase treated, the amount of effusion at the time of catheter removal was decreased more than 75% and in 17 patients(47.2%) effusion decreased 50~75%. .In one patient effusion decreased 25~50%, in two patients effusion decreased less than 25%. One month after catheter removal, in 35 patients(97.2%, four patients were cast off), the amount of pleural effusion was successfully decreased more than 50%. There were no complications related to pigtail catheter insertion. Conclusion : In this study, PCD seemed to be an early efficacious procedure in treating the patients with complicated parapneumonic effusion or empyema without any serious procedure related complication.

Effects of Percutaneous Balloon Mitral Valvuloplasty on Static Lung Function and Exercise Performance (승모판협착증 환자에서 경피적 풍선확장판막성형술의 폐기능 및 운동부하 검사에 대한 효과)

  • Kim, Yong-Tae;Kim, Woo-Sung;Lim, Chae-Man;Chin, Jae-Yong;Koh, Youn-Suck;Kim, Jae-Joong;Park, Seong-Wook;Park, Seung-Jung;Lee, Jong-Koo;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.1
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    • pp.1-10
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    • 1994
  • Background: Patients with mitral stenosis(MS) have been demonstrated to have a variable degree of pulmonary dysfunction and exercise impairment. The hemodynamic changes of MS can be reversed after percutaneous mitral balloon valvuloplasty(PMV), but the extent and time course of the imporvement in pulmonary function and exercise capacity are not defined. Methods: In order to investigate the early(3 weeks or less)and late(3 months or more) effects of PMV on pulmonary function and determine if the pulmonary dysfunction is reversible even in patients with moderate to severe pulmonary hypertension, we performed the spirometry, measurements of diffusing capacity and lung volumes, and incremental exercise tests in patients with MS before and after PMV. Results: In 46 patients with MS(age: $40{\pm}12$years, male to female ratio: 1:2, mitral valve area: $0.8{\pm}0.2cm^2$) there was a significant increase in FVC(P<0.0025), $FEV_1$(P<0.001), $FEF_{25-75%}$(P<0.001, $FEF_{50%}$(P<0.001), PEF(P<0.0005), MVV(P<0.005), $\dot{V}O_2$max (P<0.0001), and AT(P<0.0001) after average 10 days of PMV. Also there was a significant decrease in DLco(P<0.0001) and DL/VA(P<0.0001). At later($5{\pm}2$months) follow-up in 11 patients, there was no further improvement in any parameters of pulmonary function and exercise test. Twenty nine patients with sinus rhythm were divided into 16 patients with pulmonary arterial pressure(PAP) more than 35mmHg and/or tricuspid regurgitation grade n or more(group A) and 13 patients with PAP less than 35mmHg(group B). Group A Patients had significantly lower FVC(P<0.001), $FEV_1$(P<0.001), DLco(P<0.05), $\dot{V}O_2$ max(P<0.025) and mitral valve area(P<0.025) than group B patients. Group A patients after PMV, showed significant increase in FVC(P<0.001), maximum $O_2$ pulse(P<0.00001) and $\dot{V}O_2$ max(P<0.00025). Both group showed an increase in AT(P<0.0001, P<0.005), but group A showed greater decrease in $\dot{V}E/\dot{V}O_2$ and $\dot{V}E/\dot{V}CO_2$ both at AT(P<0.001, P<0.001) and $\dot{V}O_2$ max(P<0.0001, P<0.0001) after PMV compared with group B. Conclusion: These data suggest that patients with MS can show increased pulmonary function and exercise performance within 1 month after PMV. Patients with moderate to severe pulmonary hypertension had a significant increase in exercise performance compared with those with mild to no pulmonary hypertension and it is thought to be related to a significat decrease of ventilation for a given oxygen consumption at maximum exercise.

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