• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.195-202
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• 1993

$^{123}Iodine$-metaiodobenzylguanidine (MIBG) which is a norepinephrine analogue, can be used to evaluate the sympathetic innervation of the heart. In this study, cardiac imaging with $^{123}I-MIBG$ was performed in patients with 9 dilated cardiomyopathy, 2 ischemic cardiomyopathy and 1 acute myocardial infarction to evaluate the sympathetic nervous function. $^{123}I-MIBG$ imaging showed multifocal defects (8), diffuse defect (2), near non-visualization (2). The defects of MIBG scans were found to be larger and more severe on 4 hours image than 30 minutes. Heart to lung, heart to mediastinum ratios were decreased at 4 hours than those at 30 minutes. Measured LVEF values were not correlated with the severity of MIBG uptake. $^{99m}Tc-MIBI$ imaging was also performed in all patients to find the relationship with $^{123}I-MIBG$ scan. $^{99m}Tc-MIBI$ scan showed multifocal defects in 9 patients, diffuse defects in 1 patient and no defect in 2 patients. The defects are similar in size, severity and extent, but more larger and severe on $^{123}I-MIBG$ imaging. Therefore, cardiac $^{123}I-MIBG$ imaging is a useful method to evaluate the sympathetic nervous function in cardiomyopathy.

• Journal of Chest Surgery
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• v.44 no.6
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• pp.399-405
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• 2011

Background: Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. Materials and Methods: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was $63.2{\pm}10$ years (30~85 years). Results: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2~167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. Conclusion: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.

• Journal of Korean Clinical Nursing Research
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• v.25 no.3
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• pp.251-264
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• 2019

Purpose: This study was a systematic review and meta-analysis to explore the factors related to quality of life in heart transplant recipients. Methods: To identify studies that suggested the factors related to the quality of life in heart transplant recipients, we searched the articles published from 1974 to November 2018 using Six databases, PubMed, CINAHL, EMBASE, Cochrane, KMBASE and RISS. A total of 22 studies were selected out of 5,234 for the systematic review and meta-analysis on the basis of the PRISMA flow. The quality of study was assessed by assessment tool form the NIH and meta-analysis was performed using the 'R 3.5.2' version to analyze the correlated effect sizes. Results: Factors related to quality of life in heart transplant recipients were categorized into six domains based on the health-related quality of life model introduced by Ferrans: individual, environmental, biological function, symptoms, functional status, and general health perception. In the meta-analysis, 34 factors were used and 17 factors having significant effect sizes were as follows: self-efficacy, demoralization, perceived control, current occupational status, age, marital status, health promotion life style in the individual characteristics; stress in environmental characteristics; physical function status, creatinine level, left ventricular ejection fraction (LVEF) in biological function; anxiety, depression, symptom frequency and distress in symptoms domain; coping, self-care compliance in functional status. Conclusion: The findings indicate that the multi-dimensional factors influencing the quality of life in heart transplant recipients and provide the evidence for developing effective interventions for improving the quality of life of recipients.

• Journal of Physiology & Pathology in Korean Medicine
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• v.33 no.2
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• pp.82-88
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• 2019

This systematic review evaluates the clinical effectiveness of acupuncture related to improvement in quality of life and problems after Percutaneous Coronary Intervention(PCI). We searched papers in many databases, including National Discovery for Science Leaders(NDSL), Koreanstudies Information Service System(KISS), Oriental Medicine Advanced Searching Integrated System(OASIS), Research Information Sharing Service(RISS), Public/Publisher MEDLINE(Pubmed), Embase, Cochranelibrary, Chinese Academic Journals(CAJ), Japan Science and Technology Agency(J-STAGE). Initially, 161 studies were found. Of these, 141 studies were excluded following abstract screening. After the remaining 20 papers were scanned, 5 RCTs were selected and analyzed. Among these 5 RCTs, HAMD(Hamilton Rating Scale for Depression) is significantly effective in 1 RCT. In 2 RCTs, LVEF(Left Ventricular Ejection Fraction) is significantly effective. In 2 RCTs, 6MWT(Six-Minute Walk Test) is significantly effective. The review of 5 studies suggests that acupuncture after PCI can be effective in many problems occured after PCI. However, This study couldn't conduct a meta-analysis due to the differences in interventions. Therefore, we hope that systematic reviews with meta-analysis will be published.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.604-610
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• 2006

Background: Recent improvements in interventional procedure and medical therapy for congestive heart failure result in an increase of number of patients with ischemic cardiomyopathy considered for coronary artery bypass grafting. We retrospectively review the results of CABG in these patients with decreased LV function to know the early and mid-term follow-up results. Material and Method: Between January 2001 and June 2005, 1,143 patients underwent coronary artery bypass grafting and 144 of these patients had preoperative left ventricular function of equal to or less than 35% ${(LVEF{\leq}\;35%)}$. There were off-pump coronary artery bypass grafting (OPCAB) in 66 cases (45.8%), on-pump beating heart coronary artery bypass grafting in 34 cases (23.6%) and conventional coronary artery bypass grafting in 44 cases (30.6%). The combined operations including mitral annuloplasty were 48 cases in thirty five patients (24.3%). Result: The mean number of dstal anastomosis were $3.5{\pm}1.3$. The median postoperative duration of stay in intensive care unit and hospital was 2 days and 8 days, respectively. There were 6 early death (4.2%) and causes of deaths were ventricular tachycardia in 5 patients, small bowel infarction in one patient. Mean follow-up time was $21{\pm}14$ months $(4{\sim}54\;months)$. The 1-year was $95{\pm}2%$ and 3-year survival rate was $83{\pm}7%$, the 1-year and 3-year cardiac event-free survival were ${88{\pm}3%\;and\;69{\pm}7%}$, respectively. Conclusion: Based on satisfactory early and mid-term results in our study, CABG should be carried out as actively as possible in patients with ischemic cardiomyopathy. Postoperative aggressive management for ventricular arrhythmia would be helpful for better results.

• 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.

• The Korean Journal of Nuclear Medicine
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• v.37 no.3
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• pp.147-152
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• 2003

Purpose: We evaluated radioisotope and sex-specific differences of normal limits for left ventricle volumes (LWs) and ejection fraction (EF) using myocardial perfusion gated SPECT (g-SPECT). Materials and Methods: Rest Tl-201/post-stress Tc-99m MIBI g-SPECT measurements with acquisitions of 8-frame were evaluated for 70 patients (mean age $55{\pm}14.56%$ female) who either had < 10% pretest likelihood of CAD (n = 12) or had normal coronary angiography (EF > 50%) (n = 58). LVEF, LWs were automatically determined by quantitative gated SPECT using QGS program. Results: Similar results were obtained for mean LVEF between Tc-99m MIBI ($62%{\pm}7%$ and Tl-201 ($63%{\pm}8%$) g-SPECT measurements. In Contrast, Tl-201 g-SPECT had significantly lower LWs values ($EDV;\;74{\pm}23mL,\;ESV;\;28{\pm}14mL$) than Tc-99m MIBI g-SPECT ($EDV;\;82{\pm}25mL,\;ESV;\;32{\pm}15mL$) (p<0.05). Women had significantly lower EDV ($Tc-99m\;MIBI;\;71{\pm}18mL,\;Tl-201;\;65{\pm}17mL$), and ESV values ($Tc-99m\;MIBI;\;27{\pm}10mL,\;Tl-201;\;23{\pm}8mL$) compared with EDV ($Tc-99m\;MIBI;\;96{\pm}27mL,\;Tl-201;\;85{\pm}24mL$), and ESV Values ($Tc-99m\;MIBI;\;40{\pm}17mL,\;Tl-201;\;36{\pm}16mL$) of men (p<0.05). Women had significantly higher LV EF Values ($65%{\pm}7%$) than men ($60%{\pm}8%$) by Tl-201 gated SPECT (p<0.05). Conclusion: These data suggest significant differeuces in normal limits for LWs and EF, according to genders and radiopharmaceutical. Therefore, the evaluation of cardiac function in patients should consider radioisotope and sex-matched normal values.

• Journal of Chest Surgery
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• v.34 no.10
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• pp.754-762
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• 2001

Background: To evaluate the efficacy of arterial switch operation for transposition of great arteries, serial echocardiographic studies were performed in 8 patients who underwent the surgery between 1989 and 1998 at Dept. of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital in Daegu City, Korea. Material and Method: Follow-up period ranged from 6 months to 11 years(average of 4.1 years). Body weight ranged from 2.6kg to 4.8kg, with average of 3.6kg. 5 of 8 patients were preoperatively diagnosed as TGA+VSD, and 3 as TGA+IVS. LV function was evaluated by the measurement of LV shortening fraction, LVSTI, and LVEF. RVSTI was also measured. Postoperative function of valve and growth of great vessels were analyzed by the measurement of PSPGV, valvular regurgitation, LA/AO ratio, root dimension of aorta and pulmonary artery, comparing with the age matched controls, respectively. Result: LVEF had an average of 65.0+9.03% which is tended to increase serially. LVAOPG had an average of 15.9mmHg. RVPAPG, 27.5mmHg. From the measurement of aortic root dimension of 6 patients at end-systole, aortic root growth was assumed to increase more than the mean value of normal growth. PA root dimension at end-systole showed a similar growth progress when compared with age matched normal controls. Postoperative pulmonic valve regurgitation was noted in 5 of total 8 patients, in which 1 patient who showed grade 2 and 4 showed below grade 1. AR, in 6 patients and all grade 1 Except 1 patient, all the valvular regurgitations were below grade 1, which was presumed to be clinically insignificant.

• The Korean Journal of Nuclear Medicine
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• v.34 no.4
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• pp.276-284
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• 2000

Purpose: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. Materials and Methods: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. Results: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. Conclusion: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.

• Journal of Chest Surgery
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• v.39 no.3 s.260
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• pp.184-193
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• 2006

Background: Off-pump coronary artery bypass grafting (OPCAB) has been proven to result in less morbidity. The patients who have left ventricular dysfunction may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The present study compared early and midterm outcomes of off-pump versus on-pump coronary artery bypass grafting (On pump CABG) in patients with severe left ventricular dysfunction. Material and Method: Ninety hundred forth six patients underwent isolated coronary artery bypass grafting by one surgeon between January 2001 and Febrary 2005.. Data were collected in 100 patients who had left ventricular ejection fraction (L VEF) less than $35\%$ (68 OPCAB; 32 On pump CABG). Mean age of patients were 62.9$\pm$9.0 years in OPCAS group and 63.8$\pm$8.0 years in On pump CABG group. We compared the preoperative risk factors and evaluated early and midterm outcomes. Result: In OPCAB and On pump CABG group, mean number of used grafts per patient were 2.75$\pm$0.72, 2.78$\pm$0.55 and mean number of distal anastomoses were 3.00$\pm$0.79, 3.16$\pm$0.72 respectively. There was one perioperative death in OPCAB group ($1.5\%$). The operation time, ventilation time, ICU stay time, CK-MB on the first postoperative day, and occurrence rate of complications were significantly low in OPCAB group. Mean follow-up time was 26.6$\pm$12.8 months (4${\~}$54 months). Mean LVEF of OPCAB and On pump CABG group improved significantly from $27.1\pm4.5\%$ to $40.7\pm13.0\%$ and $26.9\pm5.4\%$ to $33.3\pm13.7\%$. The 4-year actuarial survival rate of OPCAB and On pump CABG group were $92.2\%,\;88.3\%$ and the 4-year freedom rates from cardiac death were $97.7\%,\;96.4\%$ respectively. There were no significant differences between two groups in 4 year freedom rate from cardiac event and angina. Conclusion: OPCAS improves myocardial function and favors early and mid-term outcomes in patients with severe left ventricular dysfunction compared to On pump CABG group. Therefore, OPCAB is a preferable operative strategy even in patients with severe left ventricular dysfunction.