• Korean Journal of Radiology
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• 제22권7호
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• pp.1034-1043
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• 2021

Objective: The purpose of this meta-analysis was to investigate the pooled agreements of the coronary artery calcium (CAC) severities assessed by electrocardiogram (ECG)-gated and non-ECG-gated CT and evaluate the impact of the scan parameters. Materials and Methods: PubMed, EMBASE, and the Cochrane library were systematically searched. A modified Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the quality of the studies. Meta-analytic methods were utilized to determine the pooled weighted bias, limits of agreement (LOA), and the correlation coefficient of the CAC scores or the weighted kappa for the categorization of the CAC severities detected by the two modalities. The heterogeneity among the studies was also assessed. Subgroup analyses were performed based on factors that could affect the measurement of the CAC score and severity: slice thickness, reconstruction kernel, and radiation dose for non-ECG-gated CT. Results: A total of 4000 patients from 16 studies were included. The pooled bias was 62.60, 95% LOA were -36.19 to 161.40, and the pooled correlation coefficient was 0.94 (95% confidence interval [CI] = 0.89-0.97) for the CAC score. The pooled weighted kappa of the CAC severity was 0.85 (95% CI = 0.79-0.91). Heterogeneity was observed in the studies (I² > 50%, p < 0.1). In the subgroup analysis, the agreement between the CAC categorizations was better when the two CT examinations had reconstructions based on the same slice thickness and kernel. Conclusion: The pooled agreement of the CAC severities assessed by the ECG-gated and non-ECG-gated CT was excellent; however, it was significantly affected by scan parameters, such as slice thickness and the reconstruction kernel.

• Korean Journal of Radiology
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• 제21권9호
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• pp.1055-1064
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• 2020

Objective: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain. Materials and Methods: This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05). Conclusion: Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better.

• 비만대사연구학술지
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• 제2권1호
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• pp.29-35
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• 2023

Familial hypercholesterolemia (FH) is a genetic disease that is not well known or diagnosed in Korea. This disease is associated with persistently high levels of low-density lipoprotein cholesterol (LDL-C), which increase the risk of coronary artery disease at a young age. Therefore, early diagnosis and treatment are important; however, there are no global consensus diagnostic criteria. In Korea, the Dutch Lipid Clinic Network diagnostic criteria, and the Simon Broome diagnostic criteria were used for diagnosis of FH according to the agreement announced at the Korean Society of Lipid and Atherosclerosis (KSoLA) in 2022. Recently, the absence of coronary artery calcification has been considered a good prognostic factor, even among patients with very high LDL-C levels who are considered to be at high risk for atherosclerotic cardiovascular disease. We describe throughout this paper the diagnosis and treatment of FH in a young male without coronary artery calcification.

• Tuberculosis and Respiratory Diseases
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• 제74권2호
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• pp.56-62
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• 2013

Background: The purpose of this study was to evaluate the relationship of pulmonary function impairment (PFI) and coronary artery calcification (CAC) by multi-detector computed tomography (MDCT), and the effect of pneumoconiosis on CAC or PFI. Methods: Seventy-six subjects exposed to inorganic dusts underwent coronary artery calcium scoring by MDCT, spirometry, laboratory tests, and a standardized questionnaire. CAC was quantified using a commercial software (Rapidia ver. 2.8), and all the subjects were divided into two categories according to total calcium scores (TCSs), either the non-calcified (<1) or the calcified (${\geq}1$) group. Obstructive pulmonary function impairment (OPFI) was defined as forced expiratory volume in one second/forced vital capacity ($FEV_1$/FVC, %)<70, and as $FEV_1$/FVC (%){\geq}70 and FVC<80 for restrictive pulmonary function impairment (RPFI) by spirometry. All subjects were classified as either the case (profusion${\geq}1/0$) or the control (profusion${\leq}0/1$) group by pneumoconiosis findings on simple digital radiograph. Results: Of the 76 subjects, 35 subjects (46.1%) had a CAC. Age and hypertension were different significantly between the non-calcified and the calcified group (p<0.05). Subjects with pneumoconiosis were more frequent in the calcified group than those in the non-calcified group (p=0.099). $FEV_1$/FVC (%) was significantly correlated with TCSs (r=-0.316, p=0.005). Subjects with OPFI tended to increase significantly with increasing of TCS (4.82, p=0.028), but not significantly in RPFI (2.18, p=0.140). Subjects with OPFI were significantly increased in the case group compared to those in the control group. Conclusion: CAC is significantly correlated with OPFI, and CAC and OPFI may be affected by pneumoconiosis findings.

• 농촌의학ㆍ지역보건
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• 제39권1호
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• pp.25-36
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• 2014

본 연구는 다중절편 방사선단층촬영을 이용하여 관상동맥 석회화와 심혈관질환 위험인자와의 관련성에 관하여 알아보기 위하여 수행되었다. 이를 위하여 일개 대학병원에서 2010년 1월부터 2011년 12월까지 다중절편 방사선단층촬영을 시행한 30~59세의 성인 남성 5,899명을 대상으로 문진, 설문, 신체계측, 혈액검사 등을 시행하였다. 다중절편 방사선단층촬영 영상을 통해 대상자의 관상동맥 칼슘 점수를 확인하고, 기존의 심혈관질환 위험인자에 대해 확인하였다. 대상자 5,899명의 평균 관상동맥 칼슘 점수는 8.20이었고, 773명(13.1%)에서 관상동맥 석회화가 관찰되었다. 관상동맥 석회화 유무와 알려진 심혈관질환 위험인자(나이, 혈압, 공복혈당, 콜레스테롤, 아포지방단백, 비만)는 유의한 관련성을 보였으며, 심혈관질환 발병 위험도평가도구들과도 유의한 관련성이 있었다. 30-39세, 40-49세, 50-59세의 연령 군에서 관상동맥 석회화와 통계적으로 유의한 관련 요인은 각기 다른 양상을 나타냈다. 본 연구를 통하여 관상동맥 석회화와 전통적인 심혈관질환 위험인자와의 관련성 및 심혈관질환 발병위험도 평가도구와의 관련성을 확인할 수 있었다. 또한 연령 군에 따라 각기 다른 양상의 위험인자를 확인할 수 있었다. 따라서 향후 심혈관질환 예방을 위한 관리전략 수립에 연령에 따른 차이를 고려한 접근이 필요할 것으로 사료된다.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.58-61
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• 2017

5-FU로 인한 심장독성은 드물지만 협심증, 심근경색, 심지어 심장 돌연사까지 유발할 수 있다. 그러므로 약물치료를 계획하기 전 환자의 기저 심질환 여부를 정확히 평가해야 하며, 지연반응으로 인해 약물 투여와 증상 발생의 시간적 간격이 늘어날 수도 있으므로 증상과 EKG에서의 변화가 명확하다면 5-FU로 인한 관상동맥의 일시적인 연축으로 볼 수 있다. 심장효소의 상승과 관상동맥 조영술에서 심혈관의 협착 소견이 없더라도 약물을 중단하고 칼슘통로차단제 등의 혈관확장제를 사용하여야 한다. 그리고 재발의 위험성이 매우 높기 때문에 재투여는 피해야 한다.

• 대한수의학회지
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• 제39권4호
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• pp.702-709
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• 1999

The present study was performed to elucidate the effects of extracellular $Ca^{2+}$ on contractile responses in isolated porcine coronary artery ring using by perivascular nerve stimulation (PNS). Especially, the study was focused on the source of $Ca^{2+}$ on $P_{2X}$-purinoceptor mediated muscle contraction which one of $P_2$-purinoceptor subtypes. The following results can be drawn from these studies : 1. The phasic contractions induced by PNS were inhibited with muscarinic receptor antagonist, atropine ($10^{-6}M$). 2. The phasic contractions induced by PNS were significantly inhibited by sequential treatment with atropine and adrenergic neural blocker, guanethidine ($10^{-6}M$). 3. The phasic contractions induced by PNS were inhibited with $P_{2X}$-purinoceptor desensitization by repetitive application of $\alpha$,$\beta$-Me ATP ($10^{-4}M$). 4. The phasic contractions induced by PNS were so weakened in calcium-free medium. 5. The phasic contractions induced by PNS were inhibited with calcium channel blocker, verapamil ($10^{-6}{\sim}5{\times}10^{-6}M$). 6. The phasic contractions induced by PNS on pretreated with verapamil ($10^{-6}{\sim}5{\times}10^{-6}M$) were not changed by $\alpha$,$\beta$-Me ATP ($10^{-4}M$). These results demonstrate that the neurogenic phasic contractions induced by PNS are due to adrenergic-, cholinergic- and $P_{2X}$-purinergic receptors and the origin of $Ca^{2+}$ on $P_{2X}$-purinoceptor mediated muscle contraction is extracellular $Ca^{2+}$ through plasmalemmal $Ca^{2+}$ channels.

• 한국방사선학회논문지
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• 제10권4호
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• pp.285-290
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• 2016

이 연구는 관상동맥 CT 석회화점수 검사를 2회 이상 받은 자 중에서, 이전에 비하여 점수가 낮아진 원인을 후향적으로 분석하였다. 건강검자 환자 100명(남자 85명 $60.6{\pm}6.9$세, 여자 15명 $67.2{\pm}7.3$세)을 대상으로 하였다. 석회화점수 감소가 발생한 경우를 Agatston의 분류 방법에 따라 minimal (1-10), mild(11-100), moderate(101-400), severe (400< ) 4개 그룹으로 분류하였다. Mild 그룹에서 49명으로 가장 많았으며, minimal 그룹에서 감소율 변동이 가장 크게 나타났다. 석회화점수 감소 요인은 Scan location 불일치 51%, Motion artifact 26%, 장비변동 14%, 작업자의 실수 5%, 입력 miss 2%, Image loss 1%, 부정맥 1% 로 나타났다. Scan location의 불일치는 scan된 석회화의 slice 위치에 따른 부분체적 효과로 생각되며, 관상동맥 석회화 점수가 작은 100 이하 그룹에서는 높은 변화폭(19.7%)이 나타났고 100 이상의 그룹에서는 낮은 변화폭(2.2%)을 보여 석회화 점수에 따라 허용될 수 있는 변화폭이 달라진다는 것을 알 수 있었다. Motion artifact 요인은 26%로 나타났으며, 이는 높은 심박동에 의한 것으로 심박동이 높거나 검사 전 폐기능, 운동부하 등 심박동에 영향을 미치는 선행검사와 밀접한 관련이 있었다.

• 공업화학
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• 제29권5호
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• pp.497-502
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• 2018

협심증, 심근경색과 같은 관상동맥 질환은 급속도로 증가하고 있다. 관상동맥 질환은 콜레스테롤과 칼슘과 같은 플라크들이 혈관벽에 흡착되어 발생한다. 심혈관 중재시술은 풍선 카테터와 금속스텐트를 이용하여 좁아진 관상동맥혈관을 확장시키는 비수술적 시술방법이다. 금속재질의 스텐트는 관상동맥질환에 의한 사망자를 감소시키는데 효과적이었지만 영구적으로 혈관에 금속재질 스텐트가 이식되어 있기 때문에 지속적인 염증과 후기 혈전증 등이 발생되었다. 따라서, 스텐트와 같은 영구적 보철물에 의한 합병증과 재협착 등을 해결하기 위한 생체 흡수성 혈관 지지체의 개발은 급속도로 증가되고 있다. 이 리뷰에서는 생체흡수형스텐트의 성공적인 개발을 위한 동향에 대해서 논하고자 한다.

• The Korean Journal of Physiology
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• 제26권1호
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• pp.45-54
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• 1992

Effects of pH, $PCO_2$, and adenosine on the vascular contractility were investigated in the pig coronary arteries. The helical strips of isolated coronary arteries were immersed in the HEPES or $HCO_3^-/CO_2$-buffered Tyrode's solution equilibrated with 100% $O_2\;or\;95%\;O_2-5%\;CO_2\;at\;35^{\circ}C$. The contraction was recorded isometrically using a force transducer. The amplitudes of contraction induced by ACh, high $K^+$, and electrical Held stimulation (EFS) were decreased by elevating extracellular pH (pHo) and were increased by lowering pHo. A shift from $0%\;CO_2\;to\;5%\;CO_2$ at constant pHo (pH 7.4) reduced the contractions induced by ACh, high $K^+$, EFS. However the contraction induced by 100mM $K^+$ was less influenced by the change of pHo or $CO_2$. The contraction induced by ACh in $Ca^{2+}$free Tyrode's solution as well as the contraction developed by the addition of extracellular of $Ca^{2+}$ were decreased by lowering pHo and were increased by elevating pHo. High $K^+$ (25mM) induced contraction at pH 6.8 was not returned to the level of the contraction at pH 7.4 by the elevation of extracellular. calcium $[Ca^{2+}]_o$. Adenosine-induced relaxation was more significant with 5% $CO_2$ than 0% $CO_2$ in the high $K^+$-induced contraction and was more significant with low pHo than high pHo in the contraction induced by EFS. From the above results, it is suggested that $H^+$ and $CO_2$ inhibit $Ca^{2+}$ influx as well as $Ca^{2+}$ release from intracellular $Ca^{2+}$ storage sites and enhance the relaxing effect of adenosine in the pig coronary artery.