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Joon-Han Shin

Publications and source records attributed to Joon-Han Shin.

10 recordsLinked to original sources
PubMed2006

Impact of myocardial perfusion on left atrial remodeling following primary angioplasty for acute myocardial infarction.

OBJECTIVES: To investigate the impact of myocardial perfusion on left atrial remodeling and its determinants after primary percutaneous coronary intervention for acute myocardial infarction. BACKGROUND: Left atrial volume is an important predictor of morbidity and mortality in acute myocardial infarction, while thrombolysis in myocardial infarction (TIMI) myocardial perfusion (TMP) grade is an angiographic index associated with infarct size and mortality. As yet, however, the relationship between TMP grade and left atrial remodeling has not been investigated. METHODS: Conventional transthoracic echocardiography was performed in 105 patients (55+/-13 years old, 92 men) with acute myocardial infarction within 24 h and after 6 months (mean 9+/-4, range 6-29 months) following successful primary percutaneous coronary intervention. Absolute left atrial volume was calculated using an elliptical model. Myocardial perfusion was evaluated, using TMP grade, by visual assessment on the coronary angiogram. Patients were divided into three groups on the basis of myocardial perfusion status, as TMP 0/1 (n=36), TMP 2 (n=36) and TMP 3 (n=33). RESULTS: No difference was observed between baseline and follow-up left atrial volumes in the overall study population (42.5+/-16.1 vs. 43.5+/-17.4 ml, P=0.519). As regards TMP grade, follow-up left atrial volume significantly increased in the TMP 0/1 group (43+/-17 vs. 54.6+/-1.1 ml, P<0.001) and significantly decreased in the TMP 3 group (42.9+/-15.7 vs. 35.5+/-12.2 ml, P=0.001) compared with initial values. No change was observed in left atrial volume in the TMP 2 group. Multivariate analysis showed that TMP grade (P<0.001) and anterior location of myocardial infarction (P<0.001) were independent determinants of left atrial remodeling. CONCLUSIONS: These results suggest that poor myocardial perfusion and anterior location of myocardial infarction can affect left atrial remodeling in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. It appears that adequate myocardial perfusion is crucial to prevent left atrial remodeling, a poor prognostic factor in acute myocardial infarction.

Adult↗
PubMed2006

Effect of distal protection device on the microvascular integrity in acute myocardial infarction during primary percutaneous coronary intervention.

BACKGROUND: The use of a distal protection device during primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) may preserve the microvascular integrity of the myocardium. METHODS AND RESULTS: A total of 58 consecutive patients with AMI, who had undergone primary PCI within 24 h after onset, were enrolled (30 patients with the PercuSurge GuardWire System, 28 without). The coronary flow velocity reserve was not different between the 2 groups. In patients with a distal protection device, the post-PCI Thrombolysis In Myocardial Infarction myocardial perfusion grades (TMP) were more favorable (TMP 0/1: 13.3%, TMP 2: 23.3%, TMP 3: 63.4% vs TMP 0/1: 35.7%, TMP 2: 35.7%, TMP 3: 28.6%, p=0.023). These patients also exhibited lower basal and hyperemic microvascular resistance index levels (4.33+/-2.22 vs 5.55+/-2.36 mmHg . cm(-1) . s, p=0.047; 2.39+/-1.40 vs 3.14+/-1.36 mmHg . cm(-1) . s, p=0.045, respectively), and longer basal diastolic deceleration time (679+/-273 vs 519+/-289 ms, p=0.035) after PCI. CONCLUSION: Distal protection with the PercuSurge GuardWire system may effectively preserve the microvascular integrity of the myocardium during primary PCI in AMI patients.

Adult↗
PubMed2005

Automated mitral annular tracking: a novel method for evaluating mitral annular motion using two-dimensional echocardiography.

We developed an automated mitral annular tracking method based on a digital processing of high frame rate cineloop images of 2-dimensional echocardiography. In this study, its feasibility and accuracy was validated in 11 healthy volunteers and 16 patients with left ventricular (LV) dysfunction. The mitral annular excursion measured by automated mitral annular tracking agreed well with that measured by 3-dimensional echocardiography and correlated with LV ejection fraction. The longitudinal mitral annular excursion was reduced whereas the radial one was preserved for patients with LV dysfunction compared with control subjects. The novel automated mitral annular tracking method is clinically feasible and has potential capability to quantify the comprehensive mitral annular motion for evaluating LV function in a clinical setting.

Adult↗
PubMed2004

Usefulness of real-time three-dimensional echocardiography for evaluation of myectomy in patients with hypertrophic cardiomyopathy.

Real-time 3-dimensional echocardiography was performed in 10 patients with obstructive hypertrophic cardiomyopathy (HC) before and after myectomy and in 6 controls. The exact location of systolic anterior motion of the mitral leaflet was shown in all patients with HC with a predominant involvement of the medial portion in 4 patients and the middle portion in 6 patients. The smallest area of the left ventricular outflow tract was significantly smaller in patients with HC than in controls (1.4 +/- 0.7 vs 5.1 +/- 1.2 cm(2), p <0.01), significantly increased after myectomy (4.8 +/- 1.8 cm2, p <0.01) and was associated with a reduction of the pressure gradient at rest from 63 +/- 41 to 15 +/- 5 mm Hg (p <0.01).

Adult↗
PubMed2004

Endothelial dysfunction in patients with exaggerated blood pressure response during treadmill test.

BACKGROUND: The diagnostic and prognostic importance of exaggerated blood pressure response to exercise is controversial. Endothelial dysfunction has been demonstrated in patients with atherosclerosis and risk factors for coronary artery disease, but there is a paucity of information on patients with exercise-induced hypertension. HYPOTHESIS: We designed the study to evaluate endothelial function in patients with exaggerated blood pressure response during exercise. METHODS: Exercise-induced hypertension was defined as systolic blood pressure > or = 210 mmHg in men and > or = 190 mmHg in women during the treadmill test. Using a high-resolution ultrasound technique, endothelial function of the brachial artery in patients with exercise-induced hypertension (n = 25) and control subjects (n = 25) was investigated. RESULTS: Endothelium-dependent vasodilation was impaired in patients with exercise-induced hypertension compared with controls (7.77 +/- 5.14 vs. 2.81 +/- 2.29%, p < 0.05). On univariate analysis, the extent of vasodilation correlated negatively with age (r = -0.43, p < 0.05) and delta systolic blood pressure (r = -0.39, p < 0.05). Even after adjustment for factors known to affect endothelial function, endothelium-dependent vasodilation was decreased in patients with exercise-induced hypertension (beta = 5.375, p = 0.02). CONCLUSION: Patients with exercise-induced hypertension have impaired endothelium-dependent vasodilation. This study also supports the concept that endothelial dysfunction may play an important role in exercise-induced hypertension.

Adult↗
PubMed2004

A coronary artery fistula with saccular aneurysm mimicking a right atrial cystic mass.

A 16 year-old Korean girl with cardiomegaly was found to have a "right atrial cystic mass" on transthoracic echocardiography. An unusual cystic structure made the diagnosis difficult. However, transesophageal echocardiography and multidetector computed tomography revealed a coronary artery fistula with a distal saccular aneurysm involving the interatrial septum and draining into the right atrium. Multidetector computed tomography provided clear anatomic visualization that fully delineated the abnormal structures. Multidetector computed tomography may be considered as a good alternative for transesophageal echocardiography in assessing a tortuous coronary artery fistula and aneurysm with complex anatomy.

Adolescent↗
PubMed2003

False-positive exercise echocardiograms: impact of sex and blood pressure response.

BACKGROUND: Factors related to false-positive results of exercise echocardiography (ExE) to diagnose coronary disease have not been extensively studied. In addition, previous studies were performed before routine use of digital and tissue harmonic imaging. We evaluated the clinical and echocardiographic predictors of false-positive results during ExE. METHODS: Four hundred sixty-four patients who had both coronary angiography and ExE were enrolled retrospectively. Significant coronary disease was defined by stenoses > or =50% lumen diameter. RESULTS: Fifty-eight (13%) had false-positive results. Thirty-one (53%) of these patients were women, which was significantly higher than the percentage of women (25%) in the true-positive group (P <.001). Average peak systolic blood pressure (BP) in the false-positive group was significantly higher than in the true-positive group. Test specificity was decreased at higher levels of BP without change of sensitivity. Men demonstrated a decrease in specificity at peak systolic BP > or =200 mm Hg, whereas women showed a sharp decrease in specificity at BP > or =180 mm Hg. Wall motion score index (WMSI) after peak exercise and the proportion of high- and intermediate-risk patients according to Duke score were significantly lower in the false-positive than in the true-positive group. CONCLUSIONS: The factors predictive of false-positive results during ExE to diagnose coronary disease were female sex, higher BP at peak exercise, lower risk by Duke score and lower number of abnormal segments and wall motion score index after peak exercise. Women appear to be susceptible to wall motion abnormalities caused by elevated exercise BP. These variables should be considered in the interpretation of ExE.

Adult↗
PubMed2003

The origin of proinflammatory cytokines in patients with idiopathic dilated cardiomyopathy.

Proinflammatory cytokines and their receptors are increased in the peripheral blood of patients with heart failure. We measured cytokines and their receptors in systemic artery (SA), coronary sinus (CS) and infra-renal inferior vena cava (IVC), in order to investigate their origin and influential factors. Thirty patients with idiopathic dilated cardiomyopathy were performed echocardiography at admission, and right heart catheterization after stabilization. Blood was drawn from 3 sites for measurement of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and soluble tumor necrosis factor-alpha receptor (sTNFR) I, II. TNF-alpha at CS (3.25 +/- 0.34 pg/mL) was higher than those of SA (1.81 +/- 0.39 pg/mL) and IVC (1.88 +/- 0.38 pg/mL, p<0.05). IL-6 at CS (18.3 +/- 3.8 pg/mL) was higher than that of SA (5.8 +/- 1.2 pg/mL, p<0.01). The levels of sTNFR I, II showed increasing tendency in sequence of SA, IVC and CS. TNF-alpha and sTNFR I, II from all sites were proportional to worsening of functional classes at admission (p<0.05). E/Ea by Doppler study at admission, which reflects left ventricular end-diastolic pressure (LVEDP) was positively correlated with TNF-alpha from SA (R=0.71, p<0.01), CS (R=0.52, p<0.05) and IVC (R=0.46, p<0.05). Thus, elevated LVEDP during decompensation might cause cytokine release from myocardium in patients with idiopathic dilated cardiomyopathy.

Adult↗