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Article ; Online: Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it.

Joo, Seung-Jae

2023 Volume 38, Issue 3, Page(s) 251–260

Abstract: Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin- ... ...

Abstract	Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers' benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable. Registry data have not showed the association of oral beta-blocker therapy with decreased mortality in survivors without heart failure or left ventricular systolic dysfunction after AMI. In the Korea Acute Myocardial Infarction Registry-National Institute of Health of in-hospital survivors after AMI, the benefit of beta-blocker therapy at discharge was shown in patients with reduced or mildly reduced EF, but not in those with preserved EF, which provides new information about beta-blocker therapy in patients without reduced EF. However, clinical practice can be changed when the results of appropriate randomized clinical trials are available. Ongoing clinical trials may help to answer the unresolved issues of beta-blocker therapy in patients with AMI.
Language	English
Publishing date	2023-08-31
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3003021-3
ISSN	2586-6060 ; 2586-6052
ISSN (online)	2586-6060
ISSN	2586-6052
DOI	10.4266/acc.2023.00955
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Article ; Online: Arterial stiffness and cardiovascular risk.

Lee, Jae-Geun / Joo, Seung-Jae

The Korean journal of internal medicine

2019 Volume 34, Issue 3, Page(s) 504–506

MeSH term(s)	Ankle Brachial Index ; Cardiovascular Diseases ; Humans ; Pulse Wave Analysis ; Risk Factors ; Vascular Stiffness
Language	English
Publishing date	2019-04-30
Publishing country	Korea (South)
Document type	Editorial ; Comment
ZDB-ID	639023-7
ISSN	2005-6648 ; 1226-3303
ISSN (online)	2005-6648
ISSN	1226-3303
DOI	10.3904/kjim.2019.110
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Article ; Online: Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction.

Yoon, Ho-Min / Joo, Seung-Jae / Boo, Ki Young / Lee, Jae-Geun / Choi, Joon-Hyouk / Kim, Song-Yi / Lee, So Young

PloS one

2024 Volume 19, Issue 4, Page(s) e0300578

Abstract: To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study ... ...

Abstract	To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study aimed to investigate the impact of CR on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) were calculated from the stroke volume and brachial systolic blood pressure. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Pulse wave separation analysis was performed to obtain the reflection magnitude (RM). An exercise-based, outpatient cardiac rehabilitation (CR) program was administered for up to 6 months. Twenty-nine patients were studied. However, eight patients declined to participate in the CR program and were subsequently classified as the non-CR group. At baseline, E' velocity showed significant associations with EAI (beta -0.393; P = 0.027) and VAC (beta -0.375; P = 0.037). There were also significant associations of LV global longitudinal strain (LV GLS) with EAI (beta 0.467; P = 0.011). Follow-up studies after a minimum of 6 months demonstrated a significant increase in E' velocity (P = 0.035), improved EF (P = 0.010), and LV GLS (P = 0.001), and a decreased EAI (P = 0.025) only in the CR group. Changes in E' velocity were significantly associated with changes in EAI (beta -0.424; P = 0.033). Increased aortic afterload and VA mismatch were associated with a negative impact on both LV diastolic and systolic function. The outpatient CR program effectively decreased aortic afterload and improved LV diastolic and systolic dysfunction in patients with AMI and preserved or mildly reduced EF.
MeSH term(s)	Humans ; Ventricular Function, Left/physiology ; Cardiac Rehabilitation ; Stroke Volume/physiology ; Ventricular Dysfunction, Left ; Myocardial Infarction
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0300578
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Article ; Online: Significance of Cycle Ergometer as a Measure of Peak Aerobic Capacity in the Disabled.

Yoon, Ho Min / Han, Eun Young / Joo, Seung-Jae

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2020 Volume 30, Issue 2, Page(s) 105477

Abstract: Background: To compare different physiological responses between treadmill and cycle ergometer in stroke patients in regard to community ambulation, and to determine strong predictors of equipment-dependent VO: Methods: Sixty-three stroke survivors ... ...

Abstract	Background: To compare different physiological responses between treadmill and cycle ergometer in stroke patients in regard to community ambulation, and to determine strong predictors of equipment-dependent VO Methods: Sixty-three stroke survivors were enrolled in this study and were grouped according to the gait speed (32 non-community ambulators <0.8 m/s:31 community ambulators ≥0.8 m/s). All participants performed exercise stress test (EST) with treadmill and cycle ergometer and rehabilitation function tests. Results: Community ambulators achieved higher VO Conclusion: Cycle ergometer might be more appropriate for non-community ambulatory stroke patients to assess the peak aerobic capacity. Gait speed and gait distance could affect equipment-dependent cardiopulmonary performance significantly in the disabled. Therefore, the careful consideration of comprehensive and objective physical function including gait endurance, and speed and prescription of appropriate exercise intensity and equipment depending on the severity should be needed to improve the cardiopulmonary fitness and physical function adequately in stroke rehabilitation.
MeSH term(s)	Aged ; Bicycling ; Disabled Persons ; Exercise Test ; Exercise Tolerance ; Female ; Functional Status ; Gait ; Humans ; Male ; Middle Aged ; Oxygen Consumption ; Physical Fitness ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Stroke/diagnosis ; Stroke/physiopathology ; Walking
Language	English
Publishing date	2020-11-26
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2020.105477
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Article ; Online: Impact of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers on clinical outcomes in hypertensive patients with acute myocardial infarction.

Lee, Jae-Geun / Joo, Seung-Jae / Kim, Song-Yi / Choi, Joon-Hyouk / Boo, Ki Yung / Hwang, Jin-Yong / Hur, Seung-Ho / Jeong, Myung Ho

PloS one

2023 Volume 18, Issue 3, Page(s) e0281460

Abstract: There has been a concern that angiotensin receptor blockers (ARB) may increase myocardial infarction (MI) in hypertensive patients compared with other classes of anti-hypertensive drugs. Angiotensin-converting enzyme inhibitor (ACEI) is recommended as a ... ...

Abstract	There has been a concern that angiotensin receptor blockers (ARB) may increase myocardial infarction (MI) in hypertensive patients compared with other classes of anti-hypertensive drugs. Angiotensin-converting enzyme inhibitor (ACEI) is recommended as a first-line inhibitor of renin-angiotensin system (RASI) in patients with acute MI (AMI), but ARB is also frequently used to control blood pressure. This study investigated the association of ARB vs. ACEI with the long-term clinical outcomes in hypertensive patients with AMI. Among patients enrolled in the nationwide AMI database of South Korea, the KAMIR-NIH, 4,827 hypertensive patients, who survived the initial attack and were taking ARB or ACEI at discharge, were selected for this study. ARB therapy was associated with higher incidence of 2-year major adverse cardiac events, cardiac death, all-cause death, MI than ACEI therapy in entire cohort. After propensity score-matching, ARB therapy was still associated with higher incidence of 2-year cardiac death (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.20-2.14; P = 0.001), all-cause death (HR, 1.81; 95% CI, 1.44-2.28; P < 0.001), and MI (HR, 1.76; 95% CI, 1.25-2.46; P = 0.001) than the ACEI therapy. It was concluded that ARB therapy at discharge in hypertensive patients with AMI was inferior to ACEI therapy with regard to the incidence of CD, all-cause death, and MI at 2-year. These data suggested that ACEI be a more appropriate RASI than ARB to control BP in hypertensive patients with AMI.
MeSH term(s)	Humans ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Angiotensin Receptor Antagonists/therapeutic use ; Myocardial Infarction/complications ; Myocardial Infarction/drug therapy ; Myocardial Infarction/chemically induced ; Hypertension/complications ; Hypertension/drug therapy ; Hypertension/chemically induced ; Death
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Angiotensin Receptor Antagonists
Language	English
Publishing date	2023-03-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0281460
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Article ; Online: Anti-inflammatory effects of statins beyond cholesterol lowering.

Joo, Seung-Jae

Korean circulation journal

2012 Volume 42, Issue 9, Page(s) 592–594

Language	English
Publishing date	2012-09-27
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2557464-4
ISSN	1738-5555 ; 1738-5520
ISSN (online)	1738-5555
ISSN	1738-5520
DOI	10.4070/kcj.2012.42.9.592
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Article ; Online: Mechanisms of Platelet Activation and Integrin αIIβ3.

Joo, Seung-Jae

Korean circulation journal

2012 Volume 42, Issue 5, Page(s) 295–301

Abstract: Platelet aggregation is not only an essential part of hemostasis, but also initiates acute coronary syndrome or ischemic stroke. The precise understanding of the activation mechanism of platelet aggregation is fundamental for the development of more ... ...

Abstract	Platelet aggregation is not only an essential part of hemostasis, but also initiates acute coronary syndrome or ischemic stroke. The precise understanding of the activation mechanism of platelet aggregation is fundamental for the development of more effective agents against platelet aggregation. Adenosine diphosphate, thrombin, and thromboxane A(2) activate platelet integrin αIIbβ3 through G protein-coupled receptors. G protein-mediated signaling pathways, which are initiated by G(q), G(12)/G(13) or G(i), include phospholipase C with calcium signaling, Rho signaling, protein kinase C and phosphatidylinositol 3-kinase. Rap1b, Ca(2+) and diacylglycerol-regulated guanine nucleotide exchange factor I, Rap1-GTP-interacting adaptor molecule, and Akt are important proteins involved in G protein-mediated activation of integrin αIIbβ3. Binding of talin-1 and kindlin-3 to cytoplasmic domains of β3-integrin triggers a conformational change in the extracellular domains that increases its affinity for ligands, such as fibrinogen or von Willebrand factor. Fibrinogens act as bridges between adjacent platelets to generate a platelet aggregate.
Language	English
Publishing date	2012-05-24
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2557464-4
ISSN	1738-5555 ; 1738-5520
ISSN (online)	1738-5555
ISSN	1738-5520
DOI	10.4070/kcj.2012.42.5.295
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Article: Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization.

Kim, Seong Taeg / Ko, Yeekyoung / Beom, Jong-Wook / Boo, Ki Yung / Lee, Jae-Geun / Choi, Joon-Hyouk / Kim, Song-Yi / Joo, Seung-Jae

Clinical hypertension

2021 Volume 27, Issue 1, Page(s) 5

Abstract: Background: Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without ...

Abstract	Background: Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization. Methods: Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery. Results: Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51-0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26-48.02; P = 0.027). Conclusions: Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.
Language	English
Publishing date	2021-05-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2806585-2
ISSN	2056-5909
ISSN	2056-5909
DOI	10.1186/s40885-021-00163-5
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Article ; Online: Determining the necessity for right heart catheterization in pulmonary hypertension associated with connective tissue diseases assessed by echocardiography.

Choi, Joon Hyouk / Joo, Seung-Jae / Kim, Jinseok

International journal of rheumatic diseases

2016 Volume 19, Issue 1, Page(s) 65–73

Abstract: Aim: The prognosis of pulmonary hypertension (PH) in systemic sclerosis (SSC) and in systemic lupus erythematosus (SLE) is different. According to the guidelines, right heart catheterization (RHC) is necessary in pulmonary arterial hypertension (PAH) ... ...

Abstract	Aim: The prognosis of pulmonary hypertension (PH) in systemic sclerosis (SSC) and in systemic lupus erythematosus (SLE) is different. According to the guidelines, right heart catheterization (RHC) is necessary in pulmonary arterial hypertension (PAH) associated with connective tissue diseases (CTD). However, there is little supporting evidence. Therefore, we attempted to determine the necessity for RHC and the causes of differences in prognosis of PH by comparing SSC to SLE. Methods: The inclusion criteria were all patients with SSC or SLE with exertional dyspnea. Echocardiography and carotid Doppler ultrasound were performed. Results: Twenty-three patients with SSC and 23 with SLE participated in this study. There was no difference in the right ventricular systolic pressure (RVSP) between SSC and SLE (33.0 mmHg, range 25.3-41.7 mmHg vs. 32.4 mmHg, range 27.0-37.7 mmHg; P = 0.835). In multiple linear regression analysis, the ratio of peak tricuspid regurgitant velocity to right ventricular outflow tract time-velocity integral, which represents pulmonary vascular resistance (PVR), was correlated with RVSP in SSC (r(2) = 0.928, β = 0.362, P = 0.003), and the independent predictor of increased RVSP was the ratio of early diastolic transmitral filling velocity to early diastolic septal mitral annular velocity, which represents diastolic dysfunction in SLE (R(2) = 0.806, β = 0.803, P = 0.023). Conclusions: PVR was an important cause of PH in SSC. Left ventricular dysfunction was an important cause of PH in SLE. Thus, these findings demonstrate the necessity for RHC and differences in prognosis of PH in CTD.
MeSH term(s)	Adult ; Cardiac Catheterization ; Chi-Square Distribution ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/epidemiology ; Hypertension, Pulmonary/physiopathology ; Linear Models ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Pulse Wave Analysis ; Republic of Korea/epidemiology ; Risk Factors ; Scleroderma, Systemic/diagnosis ; Scleroderma, Systemic/epidemiology ; Scleroderma, Systemic/physiopathology ; Ventricular Dysfunction, Left/diagnosis ; Ventricular Dysfunction, Left/epidemiology ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Function, Left ; Ventricular Function, Right ; Ventricular Pressure
Language	English
Publishing date	2016-01
Publishing country	England
Document type	Comparative Study ; Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.12769
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Article: Clinical Outcome after Everolimus-Eluting Stent Implantation for Small Vessel Coronary Artery Disease: XIENCE Asia Small Vessel Study.

Chonnam medical journal

2024 Volume 60, Issue 1, Page(s) 78–86

Abstract: There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small ... ...

Abstract	There are limited data on outcomes after implantation of everolimus-eluting stents (EES) in East Asian patients with small vessel coronary lesions. A total of 1,600 patients treated with XIENCE EES (Abbott Vascular, CA, USA) were divided into the small vessel group treated with one ≤2.5 mm stent (n=119) and the non-small vessel group treated with one ≥2.75 mm stent (n=933). The primary end point was a patient-oriented composite outcome (POCO), a composite of all-cause death, myocardial infarction (MI), and any repeat revascularization at 12 months. The key secondary end point was a device-oriented composite outcome (DOCO), a composite of cardiovascular death, target-vessel MI, and target lesion revascularization at 12 months. The small vessel group was more often female, hypertensive, less likely to present with ST-elevation MI, and more often treated for the left circumflex artery, whereas the non-small vessel group more often had type B2/C lesions, underwent intravascular ultrasound, and received unfractionated heparin. In the propensity matched cohort, the mean stent diameter was 2.5±0.0 mm and 3.1±0.4 mm in the small and non-small vessel groups, respectively. Propensity-adjusted POCO at 12 months was 6.0% in the small vessel group and 4.3% in the non-small vessel group (p=0.558). There was no significant difference in DOCO at 12 months (small vessel group: 4.3% and non-small vessel group: 1.7%, p=0.270). Outcomes of XIENCE EES for small vessel disease were comparable to those for non-small vessel disease at 12-month clinical follow-up in real-world Korean patients.
Language	English
Publishing date	2024-01-25
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2536217-3
ISSN	2233-7393 ; 2233-7385 ; 0377-9564
ISSN (online)	2233-7393
ISSN	2233-7385 ; 0377-9564
DOI	10.4068/cmj.2024.60.1.78
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