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Article ; Online: Prediction of hemorrhagic transformation in acute ischemic stroke: a never-ending endeavor.

Heo, JoonNyung / Sohn, Beomseok

2024

Language	English
Publishing date	2024-01-15
Publishing country	Germany
Document type	Editorial
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-024-10582-1
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Article ; Online: Combined use of anticoagulant and antiplatelet on outcome after stroke in patients with nonvalvular atrial fibrillation and systemic atherosclerosis.

Heo, JoonNyung / Lee, Hyungwoo / Lee, Il Hyung / Lim, In Hwan / Hong, Soon-Ho / Shin, Joonggyeong / Nam, Hyo Suk / Kim, Young Dae

Scientific reports

2024 Volume 14, Issue 1, Page(s) 304

Abstract: This study aimed to investigate whether there was a difference in one-year outcome after stroke between patients treated with antiplatelet and anticoagulation (OAC + antiplatelet) and those with anticoagulation only (OAC), when comorbid atherosclerotic ... ...

Abstract	This study aimed to investigate whether there was a difference in one-year outcome after stroke between patients treated with antiplatelet and anticoagulation (OAC + antiplatelet) and those with anticoagulation only (OAC), when comorbid atherosclerotic disease was present with non-valvular atrial fibrillation (NVAF). This was a retrospective study using a prospective cohort of consecutive patients with ischemic stroke. Patients with NVAF and comorbid atherosclerotic disease were assigned to the OAC + antiplatelet or OAC group based on discharge medication. All-cause mortality, recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and bleeding events within 1 year after the index stroke were compared. Of the 445 patients included in this study, 149 (33.5%) were treated with OAC + antiplatelet. There were no significant differences in all outcomes between groups. After inverse probability of treatment weighting, OAC + antiplatelet was associated with a lower risk of all-cause mortality (hazard ratio 0.48; 95% confidence interval 0.23-0.98; P = 0.045) and myocardial infarction (0% vs. 3.0%, P < 0.001). The risk of hemorrhagic stroke was not significantly different (P = 0.123). OAC + antiplatelet was associated with a decreased risk of all-cause mortality and myocardial infarction but an increased risk of ischemic stroke among patients with NVAF and systemic atherosclerotic diseases.
MeSH term(s)	Humans ; Anticoagulants/adverse effects ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Retrospective Studies ; Prospective Studies ; Stroke/complications ; Myocardial Infarction/drug therapy ; Atherosclerosis/complications ; Atherosclerosis/drug therapy ; Atherosclerosis/chemically induced ; Ischemic Stroke/drug therapy ; Administration, Oral ; Platelet Aggregation Inhibitors/adverse effects
Chemical Substances	Anticoagulants ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-51013-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Impact of Left Atrial or Left Atrial Appendage Thrombus on Stroke Outcome: A Matched Control Analysis.

Heo, JoonNyung / Lee, Hyungwoo / Lee, Il Hyung / Nam, Hyo Suk / Kim, Young Dae

Journal of stroke

2023 Volume 25, Issue 1, Page(s) 111–118

Abstract: Background and purpose: Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus.: ... ...

Abstract	Background and purpose: Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus. Methods: This retrospective study included patients admitted to a single tertiary center in Korea between January 2012 and December 2020. Patients with nonvalvular atrial fibrillation who underwent transesophageal echocardiography or multi-detector coronary computed tomography were included in the study. Poor outcome was defined as modified Rankin Scale score >3 at 90 days. The inverse probability of treatment weighting analysis was performed. Results: Of the 631 patients included in this study, 68 (10.7%) had LA/LAA thrombi. Patients were likely to have a poor outcome when an LA/LAA thrombus was detected (42.6% vs. 17.4%, P<0.001). Inverse probability of treatment weighting analysis yielded a higher probability of poor outcomes in patients with LA/LAA thrombus than in those without LA/LAA thrombus (P<0.001). Patients with LA/LAA thrombus were more likely to have relevant arterial occlusion on angiography (36.3% vs. 22.4%, P=0.047) and a longer hospital stay (8 vs. 7 days, P<0.001) than those without LA/LAA thrombus. However, there was no difference in early neurological deterioration during hospitalization or major adverse cardiovascular events within 3 months between the two groups. Conclusions: Patients with ischemic stroke who had an LA/LAA thrombus were at risk of a worse functional outcome after 3 months, which was associated with relevant arterial occlusion and prolonged hospital stay.
Language	English
Publishing date	2023-01-03
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2814366-8
ISSN	2287-6405 ; 2287-6391
ISSN (online)	2287-6405
ISSN	2287-6391
DOI	10.5853/jos.2022.02068
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Article ; Online: Validation of Machine Learning Models to Predict Adverse Outcomes in Patients with COVID-19: A Prospective Pilot Study.

Kim, Hyung-Jun / Heo, JoonNyung / Han, Deokjae / Oh, Hong Sang

Yonsei medical journal

2022 Volume 63, Issue 5, Page(s) 422–429

Abstract: Purpose: We previously developed learning models for predicting the need for intensive care and oxygen among patients with coronavirus disease (COVID-19). Here, we aimed to prospectively validate the accuracy of these models.: Materials and methods: ... ...

Abstract	Purpose: We previously developed learning models for predicting the need for intensive care and oxygen among patients with coronavirus disease (COVID-19). Here, we aimed to prospectively validate the accuracy of these models. Materials and methods: Probabilities of the need for intensive care [intensive care unit (ICU) score] and oxygen (oxygen score) were calculated from information provided by hospitalized COVID-19 patients (n=44) via a web-based application. The performance of baseline scores to predict 30-day outcomes was assessed. Results: Among 44 patients, 5 and 15 patients needed intensive care and oxygen, respectively. The area under the curve of ICU score and oxygen score to predict 30-day outcomes were 0.774 [95% confidence interval (CI): 0.614-0.934] and 0.728 (95% CI: 0.559-0.898), respectively. The ICU scores of patients needing intensive care increased daily by 0.71 points (95% CI: 0.20-1.22) after hospitalization and by 0.85 points (95% CI: 0.36-1.35) after symptom onset, which were significantly different from those in individuals not needing intensive care ( Conclusion: Our machine learning models showed good performance for predicting the outcomes of COVID-19 patients and could thus be useful for patient triage and monitoring.
MeSH term(s)	COVID-19 ; Hospitalization ; Humans ; Intensive Care Units ; Machine Learning ; Oxygen ; Pilot Projects ; Prospective Studies ; Retrospective Studies
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2022-05-05
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	303740-x
ISSN	1976-2437 ; 0513-5796
ISSN (online)	1976-2437
ISSN	0513-5796
DOI	10.3349/ymj.2022.63.5.422
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Article ; Online: Long-term outcomes of patients with embolic stroke of undetermined source according to subtype.

Lee, Il Hyung / Heo, JoonNyung / Lee, Hyungwoo / Jeong, JaeWook / Kim, Joonho / Han, Minho / Yoo, Joonsang / Kim, Jinkwon / Baik, Minyoul / Park, Hyungjong / Jung, Jae Wook / Kim, Young Dae / Nam, Hyo Suk

Scientific reports

2024 Volume 14, Issue 1, Page(s) 9295

Abstract: The prognosis of patients with embolic stroke of undetermined source (ESUS) may vary according to the underlying cause. Therefore, we aimed to divide ESUS into subtypes and assess the long-term outcomes. Consecutive patients with acute ischemic stroke ... ...

Abstract	The prognosis of patients with embolic stroke of undetermined source (ESUS) may vary according to the underlying cause. Therefore, we aimed to divide ESUS into subtypes and assess the long-term outcomes. Consecutive patients with acute ischemic stroke who underwent a comprehensive workup, including transesophageal echocardiography and prolonged electrocardiography monitoring, were enrolled. We classified ESUS into minor cardioembolic (CE) ESUS, arteriogenic ESUS, two or more causes ESUS, and no cause ESUS. Arteriogenic ESUS was sub-classified into complex aortic plaque (CAP) ESUS and non-stenotic (< 50%) relevant artery plaque (NAP) ESUS. A total of 775 patients were enrolled. During 1286 ± 748 days follow-up, 116 major adverse cardiovascular events (MACE) occurred (4.2 events/100 patient-years). Among the ESUS subtypes, CAP ESUS was associated with the highest MACE frequency (9.7/100 patient-years, p = 0.021). Cox regression analyses showed that CAP ESUS was associated with MACE (hazard ratio 2.466, 95% confidence interval 1.305-4.660) and any stroke recurrence (hazard ratio 2.470, 95% confidence interval, 1.108-5.508). The prognosis of ESUS varies according to the subtype, with CAP ESUS having the worst prognosis. Categorizing ESUS into subtypes could improve patient care and refine clinical trials.
MeSH term(s)	Humans ; Male ; Female ; Embolic Stroke/etiology ; Aged ; Middle Aged ; Prognosis ; Echocardiography, Transesophageal ; Risk Factors ; Ischemic Stroke/etiology ; Plaque, Atherosclerotic/complications ; Plaque, Atherosclerotic/diagnostic imaging ; Follow-Up Studies
Language	English
Publishing date	2024-04-23
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-58292-4
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Article: Association between blood viscosity and early neurological deterioration in lacunar infarction.

Lee, Hyungwoo / Heo, JoonNyung / Lee, Il Hyung / Kim, Young Dae / Nam, Hyo Suk

Frontiers in neurology

2022 Volume 13, Page(s) 979073

Abstract: Background: Understanding the factors related to early neurologic deterioration (END) is crucial in the management of patients with lacunar infarction. Blood viscosity is a significant factor for microvascular perfusion. We investigated the association ... ...

Abstract	Background: Understanding the factors related to early neurologic deterioration (END) is crucial in the management of patients with lacunar infarction. Blood viscosity is a significant factor for microvascular perfusion. We investigated the association between blood viscosity and occurrence of END in lacunar infarction. Methods: We included consecutive patients admitted for lacunar infarction within 72 h from symptoms onset. END was defined as an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥2 within 24 h of admission. Viscosity was measured within 24 h of hospitalization with a scanning capillary tube viscometer. Viscosity measured at a shear rate of 300 s Results: Of the 178 patients included (median age, 65.5; interquartile range [IQR], 56.0, 76.0], END occurred in 33 (18.5%). DBV was significantly higher in patients with END than those without END (13.3 mPa·s [IQR 11.8, 16.0] vs. 12.3 mPa·s [IQR11.0, 13.5]; Conclusions: Blood viscosity at a low shear rate (DBV) was associated with the occurrence of END in patients with lacunar infarction. Blood rheology may be important in pathophysiology of END in patients with lacunar infarction.
Language	English
Publishing date	2022-09-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2022.979073
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Article ; Online: Combined use of anticoagulant and antiplatelet on outcome after stroke in patients with nonvalvular atrial fibrillation and systemic atherosclerosis

JoonNyung Heo / Hyungwoo Lee / Il Hyung Lee / In Hwan Lim / Soon-Ho Hong / Joonggyeong Shin / Hyo Suk Nam / Young Dae Kim

Scientific Reports, Vol 14, Iss 1, Pp 1-

2024 Volume 10

Abstract: Abstract This study aimed to investigate whether there was a difference in one-year outcome after stroke between patients treated with antiplatelet and anticoagulation (OAC + antiplatelet) and those with anticoagulation only (OAC), when comorbid ... ...

Abstract	Abstract This study aimed to investigate whether there was a difference in one-year outcome after stroke between patients treated with antiplatelet and anticoagulation (OAC + antiplatelet) and those with anticoagulation only (OAC), when comorbid atherosclerotic disease was present with non-valvular atrial fibrillation (NVAF). This was a retrospective study using a prospective cohort of consecutive patients with ischemic stroke. Patients with NVAF and comorbid atherosclerotic disease were assigned to the OAC + antiplatelet or OAC group based on discharge medication. All-cause mortality, recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and bleeding events within 1 year after the index stroke were compared. Of the 445 patients included in this study, 149 (33.5%) were treated with OAC + antiplatelet. There were no significant differences in all outcomes between groups. After inverse probability of treatment weighting, OAC + antiplatelet was associated with a lower risk of all-cause mortality (hazard ratio 0.48; 95% confidence interval 0.23–0.98; P = 0.045) and myocardial infarction (0% vs. 3.0%, P < 0.001). The risk of hemorrhagic stroke was not significantly different (P = 0.123). OAC + antiplatelet was associated with a decreased risk of all-cause mortality and myocardial infarction but an increased risk of ischemic stroke among patients with NVAF and systemic atherosclerotic diseases.
Keywords	Medicine ; R ; Science ; Q
Subject code	616 ; 610
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Radiomics using non-contrast CT to predict hemorrhagic transformation risk in stroke patients undergoing revascularization.

Heo, JoonNyung / Sim, Yongsik / Kim, Byung Moon / Kim, Dong Joon / Kim, Young Dae / Nam, Hyo Suk / Choi, Yoon Seong / Lee, Seung-Koo / Kim, Eung Yeop / Sohn, Beomseok

European radiology

2024

Abstract: Objectives: This study explores whether textural features from initial non-contrast CT scans of infarcted brain tissue are linked to hemorrhagic transformation susceptibility.: Materials and methods: Stroke patients undergoing thrombolysis or ... ...

Abstract	Objectives: This study explores whether textural features from initial non-contrast CT scans of infarcted brain tissue are linked to hemorrhagic transformation susceptibility. Materials and methods: Stroke patients undergoing thrombolysis or thrombectomy from Jan 2012 to Jan 2022 were analyzed retrospectively. Hemorrhagic transformation was defined using follow-up magnetic resonance imaging. A total of 94 radiomic features were extracted from the infarcted tissue on initial NCCT scans. Patients were divided into training and test sets (7:3 ratio). Two models were developed with fivefold cross-validation: one incorporating first-order and textural radiomic features, and another using only textural radiomic features. A clinical model was also constructed using logistic regression with clinical variables, and test set validation was performed. Results: Among 362 patients, 218 had hemorrhagic transformations. The LightGBM model with all radiomics features had the best performance, with an area under the receiver operating characteristic curve (AUROC) of 0.986 (95% confidence interval [CI], 0.971-1.000) on the test dataset. The ExtraTrees model performed best when textural features were employed, with an AUROC of 0.845 (95% CI, 0.774-0.916). Minimum, maximum, and ten percentile values were significant predictors of hemorrhagic transformation. The clinical model showed an AUROC of 0.544 (95% CI, 0.431-0.658). The performance of the radiomics models was significantly better than that of the clinical model on the test dataset (p < 0.001). Conclusions: The radiomics model can predict hemorrhagic transformation using NCCT in stroke patients. Low Hounsfield unit was a strong predictor of hemorrhagic transformation, while textural features alone can predict hemorrhagic transformation. Clinical relevance statement: Using radiomic features extracted from initial non-contrast computed tomography, early prediction of hemorrhagic transformation has the potential to improve patient care and outcomes by aiding in personalized treatment decision-making and early identification of at-risk patients. Key points: • Predicting hemorrhagic transformation following thrombolysis in stroke is challenging since multiple factors are associated. • Radiomics features of infarcted tissue on initial non-contrast CT are associated with hemorrhagic transformation. • Textural features on non-contrast CT are associated with the frailty of the infarcted tissue.
Language	English
Publishing date	2024-02-03
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-024-10618-6
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Article ; Online: Acute Brain Infarction in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Korean Single-Center Study.

Ha, Jang Woo / Heo, Joonnyung / Pyo, Jung Yoon / Ahn, Sung Soo / Song, Jason Jungsik / Park, Yong-Beom / Lee, Sang-Won

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2023 Volume 29, Issue 5, Page(s) 217–222

Abstract: Objectives: This study investigated the clinical and radiological features of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with acute brain infarction, using a cohort of Korean patients with AAV.: Methods: This ... ...

Abstract	Objectives: This study investigated the clinical and radiological features of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients with acute brain infarction, using a cohort of Korean patients with AAV. Methods: This study included 263 patients with AAV. Acute brain infarction was defined as infarction that occurred within 7 days or less. The brain territories affected by acute brain infarction were investigated. Active AAV was arbitrarily defined as the highest tertile of Birmingham Vasculitis Activity Score (BVAS). Results: The median age at diagnosis was 59.0 years, and 35.4% were male. Fourteen cases of acute brain infarction occurred in 12 patients (4.6%), which was calculated as 1332.2 per 100,000 patient-years and 10 times higher than the incidence rate in the Korean general population. Patients with AAV with acute brain infarction exhibited significantly older age, increased BVAS at diagnosis, and a more frequent history of prior brain infarction compared with those without. The brain territories affected in AAV patients were middle cerebral artery (50.0%), multiple territories (35.7%), and posterior cerebral artery (14.3%). Lacunar infarction and microhemorrhage were observed in 42.9% and 71.4% of cases, respectively. Prior brain infarction and BVAS at diagnosis were independently associated with acute brain infarction (hazard ratios, 7.037 and 1.089). Patients with AAV with prior brain infarction or BVAS for active AAV exhibited significantly lower cumulative acute brain infarction-free survival rates than those without. Conclusion: Acute brain infarction was observed in 4.6% of AAV patients, and both prior brain infarction and BVAS at diagnosis were independently associated with acute brain infarction.
MeSH term(s)	Female ; Humans ; Male ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/epidemiology ; Antibodies, Antineutrophil Cytoplasmic ; Asian People ; Republic of Korea/epidemiology ; Retrospective Studies ; Brain Infarction/diagnosis ; Brain Infarction/epidemiology ; Brain Infarction/etiology ; Acute Disease ; Middle Aged
Chemical Substances	Antibodies, Antineutrophil Cytoplasmic
Language	English
Publishing date	2023-05-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000001985
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Article: Low Toe-Brachial Index Is Associated With Stroke Outcome Despite Normal Ankle-Brachial Index.

Han, Minho / Kim, Young Dae / Lee, Ilhyung / Lee, Hyungwoo / Heo, Joonnyung / Lee, Hye Sun / Nam, Hyo Suk

Frontiers in neurology

2021 Volume 12, Page(s) 754258

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2021-12-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2021.754258
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