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1.
J Am Coll Cardiol ; 75(4): 380-390, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32000949

RESUMO

BACKGROUND: It remains unknown whether the noninvasive evaluation of the degree of amyloid deposition in the myocardium can predict the prognosis of patients with light chain (AL) cardiac amyloidosis. OBJECTIVES: The purpose of this study was to demonstrate that 11C-Pittsburgh B compound positron emission tomography (11C-PiB PET) is useful for prognostication of AL cardiac amyloidosis by noninvasively imaging the myocardial AL amyloid deposition. METHODS: This study consecutively enrolled 41 chemotherapy-naïve AL cardiac amyloidosis patients. The amyloid deposit was quantitatively assessed with amyloid P immunohistochemistry in endomyocardial biopsy specimens and was compared with the degree of myocardial 11C-PiB uptake on PET. The primary endpoint was a composite of all-cause death, heart transplantation, and acute decompensated heart failure. RESULTS: The degree of myocardial 11C-PiB PET uptake was significantly higher in the cardiac amyloidosis patients compared with normal subjects and correlated well with the degree of amyloid deposit on histology (R2 = 0.343, p < 0.001). During follow-up (median: 423 days, interquartile range: 93 to 1,222 days), 24 patients experienced the primary endpoint. When the cardiac amyloidosis patients were divided into tertiles by the degree of myocardial 11C-PiB PET uptake, patients with the highest PiB uptake experienced the worst clinical event-free survival (log-rank p = 0.014). The degree of myocardial PiB PET uptake was a significant predictor of clinical outcome on multivariate Cox regression analysis (adjusted hazard ratio: 1.185; 95% confidence interval: 1.054 to 1.332; p = 0.005). CONCLUSIONS: These proof-of-concept results show that noninvasive evaluation of myocardial amyloid load by 11C-PiB PET reflects the degree of amyloid deposit and is an independent predictor of clinical outcome in AL cardiac amyloidosis patients.

2.
PLoS One ; 15(1): e0227012, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929538

RESUMO

Temporal trends of the prevalence and incidence of hypertrophic cardiomyopathy (HCM) have not been well established in Asian populations. Using the Korean National Health Insurance Services database, we identified patients with a confirmed diagnosis of HCM between 2010 and 2016. The annual prevalence and incidence of HCM, and their clinical characteristics were investigated. The prevalence of HCM has increased from 0.016% (n = 6313) in 2010 to 0.031% (n = 13,035) in 2016. During a 7-year period, 13,229 patients were newly diagnosed with HCM. The incidence rate increased from 4.15 (per 100,000 person-years) in 2010 to 5.6 in 2016. The prevalence and incidence of HCM increased with age and peaked during the 70s, with male predominance in all age groups. Chest pain is the most frequent clinical presentation followed by shortness of breath and syncope. Hypertension and dyslipidemia were the two most common comorbidities. Heart failure and atrial fibrillation was diagnosed in about 1/3 and 1/4 of patients with HCM, respectively. The prevalence and incidence of HCM gradually increased from 2010 to 2016, possibly due to heightened recognition of the disease. Given the progressively high incidence of HCM with age and high prevalence of coexisting modifiable risk factors, continued efforts are required to increase awareness regarding HCM-related symptoms and potential complications.

3.
PLoS One ; 14(11): e0224626, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31682638

RESUMO

AIMS: The relationship between nonalcoholic fatty liver disease and incident metabolic syndrome in metabolically healthy subjects is unknown. We aimed to investigate whether nonalcoholic fatty liver disease is a predictor of future metabolic syndrome in metabolically healthy subjects. MATERIALS AND METHODS: Subjects who underwent health evaluation at least twice between 2009 and 2015 from the National Health Insurance Service-National Sample Cohort in South Korea were included. Patients without obesity who had no metabolic syndrome components were finally analyzed (n = 28,880). The definition of nonalcoholic fatty liver disease was based on both the hepatic steatosis and fatty liver indices. The incidence of metabolic syndrome, prediabetes/type 2 diabetes, hypertension, and dyslipidemia was compared between the subjects with and without nonalcoholic fatty liver disease. RESULTS: The presence of nonalcoholic fatty liver disease was associated with a higher risk of incident metabolic syndrome, prediabetes/type 2 diabetes, hypertension, and dyslipidemia in the entire cohort (metabolic syndrome: adjusted hazard ratio, 2.10; 95% confidence interval, 1.18-3.71; prediabetes/type 2 diabetes: adjusted hazard ratio, 1.42; 95% confidence interval, 1.06-1.90; hypertension: adjusted hazard ratio, 2.36; 95% confidence interval, 1.35-4.12; dyslipidemia: adjusted hazard ratio, 1.49; 95% confidence interval, 1.07-2.06). A similar finding was observed in the age-, sex-, smoking status-, and body mass index-based 1:5 propensity score-matched cohort of 1,092 subjects (metabolic syndrome: adjusted hazard ratio, 3.56; 95% confidence interval, 1.79-7.07; prediabetes/type 2 diabetes: adjusted hazard ratio, 1.97; 95% confidence interval, 1.04-3.73; hypertension: adjusted hazard ratio, 2.57; 95% confidence interval, 1.35-4.88; dyslipidemia: adjusted hazard ratio, 1.61; 95% confidence interval, 1.12-2.32). CONCLUSIONS: Nonalcoholic fatty liver disease is an early predictor of metabolic dysfunction even in metabolically healthy populations.

4.
Circ Arrhythm Electrophysiol ; 12(11): e007428, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31661971

RESUMO

BACKGROUND: The association of lifetime exposure to endogenous sex hormone with incident atrial fibrillation (AF) and subsequent ischemic stroke has never been studied. METHODS: This study involved 4 638 299 natural postmenopausal waomen aged ≥40 years without prior history of AF and with national breast cancer check-up between January 1, 2009 and December 31, 2014. The primary end point was incident AF, and the secondary end point was subsequent ischemic stroke once AF has developed. Cox proportional hazard regression analysis was used to estimate the risk of end points. RESULTS: During the mean follow-up of 6.3 years, shorter total reproductive years (<30 years) were associated with 7% increased risk of AF after adjusting for confounding variables (adjusted hazard ratio [aHR], 1.07 [95% CI, 1.05-1.09]). Risk of AF declined progressively with every 5-yearly increment in total reproductive years (P-for-trend <0.001). However, the prolonged (≥2 years) use of hormone replacement therapy after menopause was paradoxically associated with a 3% increase in AF risk (aHR, 1.03 [95% CI, 1.01-1.05]). For the secondary end point analysis, the risk of ischemic stroke after AF development significantly decreased with each 5-yearly increment in total reproductive years (with <30 years as reference; aHR, 0.93 [95% CI, 0.88-0.99] for 30-34 years; aHR, 0.84 [95% CI, 0.79-0.89] for 35-39 years; and aHR, 0.88 [95% CI, 0.80-0.97] for ≥40 years, P-for-trend <0.001). CONCLUSIONS: In women with natural menopause, shorter lifetime exposure to endogenous sex hormone, that is, shorter total reproductive years, was significantly associated with a higher risk of AF and subsequent ischemic stroke. Paradoxically, prolonged exogenous hormone replacement therapy increased the risk of incident AF.

5.
Heart Rhythm ; 16(2): 197-203, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30170225

RESUMO

BACKGROUND: The prognostic efficacy of quantitative platelet activity in atrial fibrillation (AF) remains unclear. OBJECTIVE: The purpose of this study was to evaluate the platelet count (PLT) as a prognostic indicator in patients with nonvalvular AF. METHODS: Data on 10,978 patients with nonvalvular AF were retrieved from a prospective registry of a single medical center in Korea. Cumulative risk for stroke and bleeding events were compared between patients with normal PLT (n = 8322), mild thrombocytopenia (n = 1791), and moderate to severe thrombocytopenia (n = 865) after propensity score matching. Prediction models for stroke were derived by conventional risk factors (model 1) and by combining PLT with model 1 (model 2), and model performance was assessed by area under the receiver operator characteristics curve (AUC). RESULTS: During the follow-up period, 7.3%, 7.0%, and 4.5% had stroke and 7.6%, 10.8%, and 17.2% had bleeding events in the normal PLT, mild, and moderate to severe thrombocytopenia groups, respectively. Compared to the normal PLT group, the moderate to severe thrombocytopenia group showed a lower risk of stroke (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.40-0.80; P = .002). A reverse relationship was found between PLT and bleeding risk (moderate to severe thrombocytopenia: HR 2.19; 95% CI 1.77-2.70; P <.001; mild thrombocytopenia: HR 1.43; 95% CI 1.18-1.73; P <.001). Compared to model 1, model 2 showed significant improvement in risk prediction (AUC 0.628 vs 0.644; P <.001). CONCLUSION: A lower PLT was associated with a lower risk of stroke and a higher risk of bleeding events. PLT combined with conventional risk factors showed significant improvement in prediction for stroke.

6.
Cancer Cell ; 24(6): 751-65, 2013 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-24332043

RESUMO

High-grade serous ovarian carcinoma presents significant clinical and therapeutic challenges. Although the traditional model of carcinogenesis has focused on the ovary as a tumor initiation site, recent studies suggest that there may be additional sites of origin outside the ovary, namely the secretory cells of the fallopian tube. Our study demonstrates that high-grade serous tumors can originate in fallopian tubal secretory epithelial cells and also establishes serous tubal intraepithelial carcinoma as the precursor lesion to high-grade serous ovarian and peritoneal carcinomas in animal models targeting the Brca, Tp53, and Pten genes. These findings offer an avenue to address clinically important questions that are critical for cancer prevention and early detection in women carrying BRCA1 and BRCA2 mutations.


Assuntos
Transformação Celular Neoplásica , Cistadenocarcinoma Seroso/etiologia , Neoplasias das Tubas Uterinas/patologia , Genes BRCA1 , Genes BRCA2 , Neoplasias Ovarianas/etiologia , Lesões Pré-Cancerosas/patologia , Animais , Cistadenocarcinoma Seroso/genética , Cistadenocarcinoma Seroso/patologia , Epitélio/patologia , Feminino , Genes p53 , Integrases/genética , Camundongos , Camundongos Endogâmicos C57BL , Gradação de Tumores , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , Fator de Transcrição PAX8 , PTEN Fosfo-Hidrolase/genética , Fatores de Transcrição Box Pareados/genética , Fatores de Transcrição Box Pareados/fisiologia
7.
Geriatr Gerontol Int ; 13(2): 307-13, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22697208

RESUMO

AIM: Although delusions are one of the most prominent psychiatric symptoms in Alzheimer's disease (AD), research on the subtypes, prevalence and associated factors of delusions, especially in drug (psychotropic)-naïve patients, has been limited. METHODS: Patients (n = 230) with psychotropic-naïve (drug-naïve) probable AD were assessed with the Korean Neuropsychiatric Inventory (K-NPI) delusion subscale at the time of initial presentation. After determining the four delusion subtypes (paranoid, misidentification, mixed and expansive delusion), clinical characteristics and prevalence of each type were compared. RESULTS: Delusions were present in 63 patients (27.4%). Among those patients, paranoid delusions were the most common type of delusion (38, 60.3%), followed by misidentification delusions (12, 19.0%), then mixed delusions (11, 17.5%). Expansive delusions are rare in drug-naïve probable AD patients. Compared with paranoid delusions, misidentification and mixed delusions appeared at a later stage, and were associated with greater cognitive impairment. Mixed delusions were associated with hallucinations. CONCLUSIONS: This study showed that delusions are associated with global cognitive dysfunction. Although paranoid delusions are the most common, misidentification and mixed delusions comprised significant portions of delusions in AD patients, and appeared in the later stages of dementia.


Assuntos
Doença de Alzheimer/complicações , Delusões/etiologia , Atividades Cotidianas , Fatores Etários , Idoso , Doença de Alzheimer/classificação , Síndrome de Capgras/etiologia , Transtornos Cognitivos/etiologia , Delusões/classificação , Feminino , Avaliação Geriátrica , Alucinações/etiologia , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Testes Neuropsicológicos , Transtornos Paranoides/etiologia , Psicotrópicos , República da Coreia
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