Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea.

BACKGROUND: The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. METHODS: From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. RESULTS: Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6-73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. CONCLUSION: This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.

Obesity Fact Sheet in Korea, 2021: Trends in Obesity Prevalence and Obesity-Related Comorbidity Incidence Stratified by Age from 2009 to 2019.

Background: The global public health burden of obesity has increased with socio-economic development. The Korean Society for the Study of Obesity released the 2021 Obesity Fact Sheet to address trends in obesity prevalence and comorbid conditions by different age groups. Methods: Individuals ≥20 years old who underwent a health checkup provided by the Korean National Health Insurance Service between 2009 and 2019 were included. The prevalence of obesity and abdominal obesity was standardized by age and sex based on the 2010 population and housing census. The incidence of obesity-related comorbidities was tracked from 2009 to 2019, and the incidence per 1,000 person-years was calculated using Poisson regression adjusted for age and sex. Results: Obesity and abdominal obesity prevalence has increased for the entire population over the past 11 years. Obesity prevalence has risen rapidly in individuals in their 20s and 80s compared with other age groups. Additionally, class III obesity prevalence in both men and women has significantly increased by nearly threefold. The relative risk of developing type 2 diabetes, myocardial infarction, ischemic stroke, and cancers in people with obesity or abdominal obesity is greater than in people without obesity or abdominal obesity. The relative risk was higher in young and middle-aged individuals than in the older population. Conclusion: The findings based on the 2021 Obesity Fact Sheet suggest the need to better understand obesity characteristics according to age and sex and to establish individualized treatment strategies.

Differences in aortic vortex flow pattern between normal and patients with stroke: qualitative and quantitative assessment using transesophageal contrast echocardiography.

The flow in the aorta forms a vortex, which is a critical determinant of the flow dynamics in the aorta. Arteriosclerosis can alter the blood flow pattern of the aorta and cause characteristic alterations of the vortex. However, this change in aortic vortex has not yet been studied. This study aimed to characterize aortic vortex flow pattern using transesophageal contrast echocardiography in normal and stroke patients. A total of 85 patients who diagnosed with ischemic stroke and 16 normal controls were recruited for this study. The 16 normal control subjects were designated as the control group, and the 85 ischemic stroke patients were designated as the stroke group. All subjects underwent contrast transesophageal echocardiography (TEE), and particle image velocimetry was used to assess aortic vortex flow. Qualitative and quantitative analyses of vortex flow morphology, location, phasic variation, and pulsatility were undertaken and compared between the groups. In the control group, multiple irregularly-shaped vortices were observed in a peripheral location in the descending thoracic aorta. In contrast, the stroke group had a single, round, merged, and more centrally located aortic vortex flow. In the quantitative analysis of vortex, vortex depth, which represents the location of the major vortex in the aorta, was significantly higher in the control group than in the stroke group (0.599 ± 0.159 vs. 0.522 ± 0.101, respectively, P = 0.013). Vortex relative strength, which is the pulsatility parameter of the vortex itself, was significantly higher in the stroke group than in the control group (0.367 ± 0.148 vs. 0.304 ± 0.087, respectively, P = 0.025). It was feasible to visualize and quantify the characteristic morphology and pulsatility of the aortic vortex flow using contrast TEE, and aortic vortex pattern significantly differed between normal and stroke patients.