• Korean Journal of Radiology
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• 제21권6호
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• pp.756-763
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• 2020

Objective: To evaluate the effects of attenuation threshold on CT pulmonary vascular volume ratios in children and young adults with congenital heart disease, and to suggest an optimal attenuation threshold. Materials and Methods: CT percentages of right pulmonary vascular volume were compared and correlated with percentages calculated from nuclear medicine right lung perfusion in 52 patients with congenital heart disease. The selected patients had undergone electrocardiography-synchronized cardiothoracic CT and lung perfusion scintigraphy within a 1-year interval, but not interim surgical or transcatheter intervention. The percentages of CT right pulmonary vascular volumes were calculated with fixed (80-600 Hounsfield units [HU]) and adaptive thresholds (average pulmonary artery enhancement [PA_avg] divided by 2.50, 2.00, 1.75, 1.63, 1.50, and 1.25). The optimal threshold exhibited the smallest mean difference, the lowest p-value in statistically significant paired comparisons, and the highest Pearson correlation coefficient. Results: The PA_avg value was 529.5 ± 164.8 HU (range, 250.1-956.6 HU). Results showed that fixed thresholds in the range of 320-400 HU, and adaptive thresholds of PA_avg/1.75-1.50 were optimal for quantifying CT pulmonary vascular volume ratios. The optimal thresholds demonstrated a small mean difference of ≤ 5%, no significant difference (> 0.2 for fixed thresholds, and > 0.5 for adaptive thresholds), and a high correlation coefficient (0.93 for fixed thresholds, and 0.91 for adaptive thresholds). Conclusion: The optimal fixed and adaptive thresholds for quantifying CT pulmonary vascular volume ratios appeared equally useful. However, when considering a wide range of PAavg, application of optimal adaptive thresholds may be more suitable than fixed thresholds in actual clinical practice.

• Journal of Cardiovascular Imaging
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• 제30권1호
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• pp.62-75
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• 2022

BACKGROUND: Due to its location very close to the bundle of His, mitral annulus calcification (MAC) might be associated with the development of atrioventricular (AV) conduction disturbances. This study assessed the association between MAC and AV conduction disturbances identified by cardiac implantable electronic device (CIED) use and electrocardiographic parameters. The association between MAC and traditional cardiovascular risk factors was also assessed. METHODS: This cross-sectional study analyzed 14,771 participants, predominantly men aged 60-75 years, from the population-based Danish Cardiovascular Screening trial. Traditional cardiovascular risk factors were obtained. Using cardiac non-contrast computed tomography imaging, MAC scores were measured using the Agatston method and divided into absent versus present and score categories. CIED implantation data were obtained from the Danish Pacemaker and Implantable Cardioverter Defibrillator Register. A 12-lead electrocardiogram was available for 2,107 participants. Associations between MAC scores and AV conduction disturbances were assessed using multivariate regression analyses. RESULTS: MAC was present in 22.4% of the study subjects. Participants with pacemakers for an AV conduction disturbance had significantly higher MAC scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.01-1.23) than participants without a CIED, whereas participants with a CIED for other reasons did not. Prolonged QRS-interval was significantly associated with the presence of MAC (OR, 1.45; 95% CI, 1.04-2.04), whereas prolonged PQ-interval was not. Female sex and most traditional cardiovascular risk factors were significantly associated with high MAC scores. CONCLUSIONS: MAC was associated with AV conduction disturbances, which could improve our understanding of the development of AV conduction disturbances.

• Clinical and Experimental Pediatrics
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• 제52권12호
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• pp.1364-1369
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• 2009

목 적 : 이번 연구에서는 소아기에 흔한 선천성 심장병 환자들을 대상으로 개심술 이후 생긴 반흔과 수술로 인한 용적 또는 압력 과부하 상태의 변화로 초래되는 비정상적인 심실 활성화를 신호 평준화 심전도를 이용하여 분석하고자 하였다. 방 법 : 선천성 심장병으로 개심교정술을 시행한 환자 52명을 대상으로 하였다. 환자군은 우심실 용적 과부하군(심방 중격 결손군, 1군), 좌심실 용적 과부하군(심실 중격 결손군, 2군), 우심실 압력 과부하군(활로씨 4징군, 3군)으로 나누었다. 대상 환자 모두에서 표준 12 유도 심전도와 신호 평준화 심전도 검사를 시행하였고, 평균 QRS 기간, QT와 QTc 간격, f-QRS, HFLA, RMS in terminal 40 ms를 구하였다. 결 과 : 수술 전에는 1군에서 다른 군에 비해 의미 있게 긴 QRS 기간을 보였고(P=0.011), 수술 후에는 3 군에서 다른 군에 비해 QTc 간격이 의미 있는 증가가 있었다(P=0.004). 그러나 신호 평준화 심전도는 수술 전후 환자군 간에 차이가 없었다. 전체 대상 환자 중 신호 평준화 심전도 측정값이 한가지 이상 후전위의 진단 기준에 해당되는 경우가 수술 전 12명(23%)에서 수술 후 21명(40%)로 증가하였다. 특히 2군과 3군에서는 수술 전에 비해 수술 후에 신호 평준화 심전도의 이상 소견을 보이는 경우가 의미있게 많았다(2군: 20% versus 28%, P<0.001, 3군: 14% versus 64%, P<0.001). 결 론 : 비정상적인 신호 평준화 심전도 값은 수술 후 반흔뿐만 아니라 개심술 자체, 심실의 과부하에 의해서도 발생할 수 있다.

• Journal of Chest Surgery
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• 제24권9호
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• pp.843-852
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• 1991

We prospectively studied postoperative cardiac arrhythmia after open heart surgery to analyze the types and incidence of cardiac arrhythmia and to predict preoperative risk factors. And also we evaluated the effectiveness of atrial and ventricular epicardial electrodes which were placed during operation Between March 1990 and August 1990, We had operated on in 211 patients and we studied 201 consecutive patients excluding 10 patients. The study group included 99 males and 102 female patients, ages 1 month to 75 years[Mean$\pm$SD=28.0$\pm$21.7 years]. Postoperatively, all patients were regularly seen by the cardiac surgeon and cardiologist, They had continuous electrocardiographic monitoring for the first 3 days, initially in the intensive care unit and were checked routine electrocardiography on the postoperative 7 days, The postoperative cardiac arrhythmia were analyzed and possible associations of this arrhythmia with various pre, intra, and postoperative factors were studied by univariate and multivariate discriminant analysis, The overall incidence of postoperative cardiac arrhythmia except relative sinus bradycardia was 36.8%;[74/201], The incidence of postoperative cardiac arrhythmia in acyanotic congenital heart disease: 19.4%, cyanotic congenital heart disease: 20.8%, cardiac arrhythmia surgery: 33.3%, acquired valvular heart disease: 60.9% and coronary artery occlusive disease: 38.9%. Both univariate and multivariate studies indicated the pre operative symptom duration[p = 0013], the duration of medication[p=0.003], presence of preoperative arrhythmia[p<0.001] and pre-operative left atrial dimension in echocardiography to be the factor promoting postoperative cardiac arrhythmia. Multivariate discriminant analysis showed that the presence of preoperative cardiac arrhythmia, bypass time and the duration of preoperative symptom duration conveyed considerable risk factor on post-operative arrhythmia. The atrial wire electrodes were used diagnostically in 36 and were used therapeutically in 89 among 201 patients. Atrial pacing were used to treat relative sinus bradycardia, accelerated junctional tachycardia or premature atrial or ventricular contractions in 51 patients. Atrioventricular sequential pacing were used in 16 patients and ventricular pacing were used in 20 patients. Hemodynamics were evaluated in 2 patients of relative sinus bradycardia before and after atrial pacing. The atrial pacing increased the amount of cardiac output to 15% more. Because of their great utility in the diagnosis and treatment of arrhythmias, we conclude that routine placement of atrial and ventricular electrodes at the time of operation is indicated regardless of the nature of the open-heart procedure.

• 대한의용생체공학회:의공학회지
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• 제22권5호
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• pp.469-477
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• 2001

본 논문은 가정에 있는 만성질환자, 퇴원한 환자 및 자신의 건강을 염려하는 정상인 등을 대상으로 매일 측정한 심전도. 혈압. 혈중 산소 포화농도 등과 같은 생리변수와 건강 설문에 대한 응답을 분석하여 건강상태를 지속적으로 파악하고, 비정상적인 상태가 발견될 경우에는 의사가 정확히 확인하여 필요한 조치를 조언하는 재택건강관리서비스에 대해서 기술하고 있다 재택건강관리서비스를 위해서 가입자는 재택건강관리단말기와 인터넷에 연결된 PC를 가정에 구비하여야 한다. 관제센터는 의사와 가입자의 기본정보와 가입자의 건강정보를 저장하기 위한 데이터베이스 시스템, 생체신호와 건강설문을 분석하여 현재상태의 비정상여부를 판단하는 건강상태자동평가시스템, 가입자와 의사들이 웹 브라우저를 사용하여 원하는 건강정보를 데이터베이스에서 검색, 조회하고. 그 내용을 수정. 편집하여 저장할 수 있는 웹 기반 건강정보관리시스템이 필요하다. 또한, 공중전화망 및 무선통신망을 이용한 음성 및 문자 전송과 인터넷을 이용한 전자우편에 의해 의사의 소견을 가입자에게 전달하는 통합 메시징 시스템 (UMS). 종합검진센터에서 의사가 검사결과와 문진 결과를 입력하기 위한 정보입력 PC. 병원에서 의사가 가입자의 정보를 조회하거나 정밀진단결과를 입력하기 위한 인터넷 PC 등이 설치되어야 한다. 일반에게 이러한 서비스를 널리 보급하기 위해서는, 생리변수들의 무구속 및 무자각 측정기술과 지능적인 건강평가 알고리즘의 개발에 대한 연구가 계속 수행되어야 할 것이다.

• 대한핵의학회지
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• 제26권1호
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• pp.72-81
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• 1992

Pharmacologic coronary vasodilation in conjunction with myocardial scintigraphy has become an accepted alternative to dynamic exercise testing for the diagnosis of coronary artery disease. Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life (< 10 seconds). The diagnostic accuracy and safety profile of adenosine $^{99m}Tc-MIBI$ myocardial scintigraphy were evaluated and comparison with exercise $^{99m}Tc-MIBI$ was performed. Twenty-eight subjects underwent $^{99m}Tc-MIBI$ imaging after adenosine infusion and exercise $^{99m}Tc-MIBI$ imaging. Adenosine was infused intravenously at a dose of 0.14mg/kg/body weight per minute for 6 min and MIBI was injected at 3 minute. Adenosine caused an incerease in heart rate ($64{\pm}12$ at baseline versus $74{\pm}16$ beats/min at peak effect, p<0.001), a mild decrease in systolic and diastolic blood pressure and a slightly increase in PR interval(p; NS). Side effects were reported in 92% of patients and were mostly mild in nature and promptly resolved within 1 or 2 minutes of termination of adenosine infusion. Facial flushing (53%), chest pain (36%), mild dyspnea (39%), headache (21%), throat discomfort (21%) were frequent symptoms. ST segment depression (> 1 mm) and second degree AV block in electrocardiography occured in 11% of the patients, respectively. The overall sensitivity and specificity for individual coronary stenoses in 16 patients underwent coronary angiography were 88% and 95%, respectively. The agreement ratio of segmental perfusion between adenosine and exercise images was 92% (Kappa index=0.82). In conclusion, $^{99m}Tc-MIBI$ myocardial perfusion scintigraphy with intravenous adenosine is a feasible, safe and highly accurate noninvasive technique for the detection of coronary artery disease and results are at least comparable with those of exercise $^{99m}Tc-MIBI$ scintigraphy.

• Journal of Preventive Medicine and Public Health
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• 제31권4호
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• pp.728-739
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• 1998

To improve wellness and quality of life by recognizing the health efforts of stress, the author estimated the relationships between stress, subjective symptoms and clinical diagnosis through a questionnaire and a battery of specified laboratory tests; electrocardiography, blood pressure, cholesterol, aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase$(\gamma-GTP)$, fasting blood sugar, gastro-endoscopy or UGI, abdominal sonography, etc. The data was gathered from 337 clients who were undergoing multiphasic screening program at a University Hospital from January to March 1998. The mean age of subjects was $46.5{\pm}11.2$ years and the mean of body mass index was $24.0{\pm}3.7kg/m^2$. The mean vol of stress was $18.5{\pm}6.0$ expressed as the score out of 40. By general characteristics and lift style among male, mean level of stress was significantly higher in case of lower socioeconomic status, habitual drug use, longer daily working time(>10 hours), no regular exercise, drinkers, irregular meal, skip-ping breakfast(p<0.05). In case of female, that was significantly higher in case of lower education, lowe. socioeconomic status, longer daily working time(>10 hours), no regular exercise, drinkers, smokers, irregular meal, skipping breakfast(p<0.05). Significant correlations were observed between stress and subjective symptoms in all kinds of organ system (p<0.01). Correlation coefficients of stress among male were relatively high with neuro-psychiatric symptom$(\gamma=0.476)$ and cardio-vascular symptom$(\gamma=0.361)$ in order, and correlation coefficients of stress among female was highest with neuro-psychiatric symptom$(\gamma=0.371)$. The prevalence of the diagnosis through the battery of laboratory tests was high in upper gastrointestinal disorders and hypercholesterolemia in order in both sex group. Among male the mean score of stress was significantly high in ulcerative peptic disorder of upper gastrointestine and hepatopathy in order (p<0.05) . Among female that was significantly high in diabetes mellitus. In summary, it is likely that there are associations between stress, subjective symptoms and clinical diagnosis. To promote wellness and quality of life it would be of value that periodic stress evaluation program and stress management including apropriate control of smoking and drinking, regular exercise and meal.

• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.383-389
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• 2002

저자들은 미숙아에서 청색증과 무호흡증으로 입원 치료 하던 중 저칼슘혈증으로 인한 경련이 나타난 환아에게서 흉부 X선 사진과 MRI상 흉선을 관찰할 수 없으면서 T 세포수의 감소와 부갑상선 홀몬수치 감소를 나타내고 소악증, 어구, 부리모양의 코 등의 안면 기형과 합지증, 코 역류증, 폐쇄성 수면 무호흡증, 구개 범인두 부전증 등의 증상을 보이며 염색체 22q11 극소결실이 FISH검사에서 확진된 부분형 DiGeorge 증후군 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제46권12호
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• pp.1274-1278
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• 2003

배뇨 후 실신은 신경 매개성 반사에 의한 실신으로 사태실신의 한 종류이며 건강한 남성에서 아침에 기립 배뇨시에 잘 일어난다. 실신의 원인은 다양하기 때문에 배뇨후 실신의 진단을 위해 정확한 병력과 심전도, 운동부하검사, 심초음파, 기립경사검사, 뇌파, 뇌 자기공명영상, 요류 동태 검사 등이 사용된다. 배뇨후 실신의 기전은 부교감 신경계의 반사 자극으로 서맥과 말초혈관 확장이 일어나고 Valsalva 효과에 의해 심실로 정맥환류가 감소하게 되어서 대뇌 혈류감소가 일어나 실신하게 된다. 실신시 뇌파는 대뇌 혈류감소에 의해 고진폭의 서파와 평탄화 소견이 나타나게 되고 심한 허혈시에는 허혈성 경련을 일으킬 수도 있다. 저자들은 9세 남아로 기립배뇨시 실신을 보인 후 저혈압을 보이고 특징적인 뇌파소견을 보인 환아를 경험하였기에 보고하는 바이다.

• 한국의료질향상학회지
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• 제20권1호
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• pp.12-24
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• 2014

Objectives: The aim of this study was to explore whether emergency bell could shorten door to electrocardiograms (ECG) time in chest pain patients presenting to emergency department (ED) by self-transport. Methods: This was a planned 6-month before-and-after interventional study design. We set up the emergency bell in walk-in patients' waiting room. Prior to the change, patients were triaged before an ECG was obtained. In new process, as soon as patient with chest pain push the emergency bell, emergency physicians examined patient and prioritized performing ECG. We analyzed door to electrocardiograms (DTE) times for patients with chest pain and ST segment elevation myocardial infarction (STEMI) patients between two periods. Results: During the enrollment period, a total of 63 patients called emergency bell. The median DTE time was 6 min (interquartile range: 3.0 - 9.0) and 82.5% received an ECG within 10 minutes, and only three patients were STEMI. DTE time in patient with chest pain was not different between two periods (p=0.980). Before intervention period, 15 walk-in patients admitted in ED for STEMI and 53.8% of STEMI patients received an ECG within 10 minutes. After intervention period, total 19 walk-in patients admitted in ED for STEMI. Of these, 89.5% met the time requirement. Conclusion: Because a small portion of patients with chest pain activated the emergency bell, new strategy for promotion of emergency bell must be needed.