Background: β-blockers (BBs) are considered primary therapy in stable heart failure (HF) with reduced ejection fraction (HFrEF) without atrial fibrillation (AF); evidence-based benefits of BB on outcome have been documented. However, BBs have not been shown to improve mortality or reduce hospital admissions in HF patients with AF. This study assessed the relationship between BBs at discharge and relevant clinical outcomes in acute heart failure (AHF) patients with AF. Methods: From the Korean Acute Heart Failure Registry, 936 HFrEF and 639 HF patients with preserved ejection fraction (HFpEF) and AF were selected. Propensity score (PS) matching accounted for BB selection bias when assessing associations. Results: BB-untreated patients in the overall cohort of HFrEF and HFpEF had greater deteriorated clinical and laboratory characteristics. In the 670 PS-matched cohort of HFrEF patients, incidences of all clinical events at 60 days and 1 year were not different according to use of BBs. In the 470 PS-matched cohort of HFpEF, rehospitalization and composite outcome at 6 months and 1 year more frequently occurred in non-users of BBs. After adjusting for covariates in the multivariable Cox model of matched cohorts, BB was not associated with clinical outcomes at 60 days and 1 year in HFrEF with AF patients. In HFpEF patients with AF, BB use was associated with reduced 6-month (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.20–0.74) and 1-year rehospitalization (HR, 0.53; 95% CI, 0.34–0.82). Conclusion In the HFrEF with AF PS-matched cohort, the use of BBs at discharge was not associated with clinical outcome. However, in HFpEF with AF, the use of BB was associated with reduced rehospitalization during the 6-month and 1-year follow up.

BACKGROUND AND OBJECTIVES: The relationship between ejection fraction (EF), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and renal function is unknown as stratified by heart failure (HF) type. We investigated their relation and the prognostic value of renal function in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction (HFrEF). MATERIALS AND METHODS: NT-proBNP, glomerular filtration rate (GFR), and EF were obtained in 1,932 acute heart failure (AHF) patients. HFrEF was defined as EF<50%, and renal dysfunction as GFR<60 mL/min/1.73 m² (mild renal dysfunction: 30≤GFR<60 mL/min/1.73 m²; severe renal dysfunction: GFR<30 mL/min/1.73 m²). The primary outcome was 12-month all-cause death. RESULTS: There was an inverse correlation between GFR and log NT-proBNP level (r=−0.298, p<0.001), and between EF and log NT-proBNP (r=−0.238, p<0.001), but no correlation between EF and GFR (r=0.017, p=0.458). Interestingly, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF (49% vs. 52%, p=0.210). Patients with renal dysfunction had higher 12-month mortality in both HFpEF (7.9% vs. 15.2%, log-rank p=0.008) and HFrEF (8.6% vs. 16.8%, log-rank p<0.001). Multivariate analysis showed severe renal dysfunction was an independent predictor of 12-month mortality (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.40–3.11). When stratified according to EF: the prognostic value of severe renal dysfunction was attenuated in HFpEF patients (HR, 1.46; 95% CI, 0.66–3.21) contrary to HFrEF patients (HR, 2.43; 95% CI, 1.52–3.89). CONCLUSION: In AHF patients, the prevalence of renal dysfunction did not differ between HFpEF and HFrEF patients. However, the prognostic value of renal dysfunction was attenuated in HFpEF patients.
Glomerular Filtration Rate ; Heart Failure* ; Heart* ; Humans ; Mortality ; Multivariate Analysis ; Prevalence ; Prognosis

BACKGROUND AND OBJECTIVES: Metabolic syndrome (MetS) increases the risk of heart failure (HF). The purpose of this study was to identify the prevalence of MetS in patients with HF and determine the syndrome's association with HF in clinical and laboratory parameters. SUBJECTS AND METHODS: A total of 3200 HF patients (67.6+/-14.5 years) enrolled in a nationwide prospective Korea HF Registry between Jan. 2005 and Oct. 2009. Patients were divided into two groups according to the presence or absence of MetS at admission: group I (presence, n=1141) and group II (absence, n=2059). RESULTS: The prevalence of MetS was 35.7% across all subjects and was higher in females (56.0%). The levels of white blood cells, platelets, creatinine, glucose, and cholesterol were significantly higher in group I than in group II. Left ventricular dimension and volume was smaller and ejection fraction was higher in group I than in group II. An ischemic cause of HF was more frequent in group I. The rates of valvular and idiopathic cause were lower in group I than in group II. The rate of mortality was lower in group I than in group II (4.9% vs. 8.3%, p<0.001). CONCLUSION: Despite the increased cardiovascular risks in MetS, MetS was found to be associated with decreased mortality in HF.
Blood Platelets ; Cholesterol ; Creatinine ; Female ; Glucose ; Heart ; Heart Failure ; Humans ; Korea ; Leukocytes ; Prevalence ; Prospective Studies

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis. It is characterized by peripheral eosinophilia, asthma, neuropathy, skin manifestation, and less frequently gastrointestinal tract symptoms. Here we report a case of CSS which is initially manifested as acute acalculous cholecystitis. A 67-year-old asthmatic woman visited Emergency Room because of acute abdominal pain. Computed tomography showed acalculous cholecystitis and laparoscopic cholecystectomy was done. Pathology of gallbladder showed marked eosinophilic infiltration with necrotizing vasculitis and granuloma. On the basis of asthma, sinusitis, lung infiltration, combined peripheral eosinophilia and neuropathy, the patient was diagnosed as CSS. To our knowledge, this is the first case of pathologically proven eosinophilic cholecystitis in Korea.
Abdominal Pain ; Acalculous Cholecystitis* ; Aged ; Asthma ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Churg-Strauss Syndrome* ; Emergencies ; Eosinophilia ; Eosinophils ; Female ; Gallbladder ; Gastrointestinal Tract ; Granuloma ; Humans ; Korea ; Lung ; Pathology ; Sinusitis ; Skin Manifestations ; Systemic Vasculitis ; Vasculitis

The aim of this study was to describe the incidence of metabolic syndrome and to identify five components as metabolic syndrome predictors. The final study included 1,095 subjects enrolled in a rural part of Daegu Metropolitan City, Korea for a cohort study in 2003. Of these, 762 (69.6%) subjects had participated in the repeat survey. During the five-year follow-up, incidence density was significantly higher for women than for men (men, 30.0/1,000 person-years; women, 46.4/1,000 person-years). In both men and women, incidence of metabolic syndrome showed a significant increase with increasing number of metabolic syndrome components at baseline. Compared with individuals presenting none of components at baseline, relative risks were increased 1.22 (men; 95% CI, 0.43-3.51), 2.21 (women; 95% CI, 0.98-4.97) times more for individuals with one component of metabolic syndrome and 5.30 (men; 95% CI, 2.31-12.13), 5.53 (women; 95% CI, 2.78-11.01) times more for those who had two components. In multivariate analysis, the most powerful risk factor for metabolic syndrome was abdominal obesity in men and low HDL-cholesterol in women (adjusted relative risk, 3.28, 2.53, respectively). Consequently, finding a high risk group for metabolic syndrome according to gender and prevention of metabolic syndrome through lifestyle modification are essential.
Adult ; Aged ; Cholesterol, HDL/blood ; Cohort Studies ; Diabetes Mellitus, Type 2/complications ; Female ; Follow-Up Studies ; Humans ; Hypertension/complications ; Hypertriglyceridemia/complications ; Incidence ; Male ; Metabolic Syndrome X/complications/*epidemiology ; Middle Aged ; Multivariate Analysis ; Obesity, Abdominal/complications ; Republic of Korea/epidemiology ; Risk Factors

Asthma is characterized by airway inflammation induced by immune dysfunction to inhaled antigens. Although respiratory viral infections are the most common cause of asthma exacerbation, immunologic mechanisms underlying virus-associated asthma exacerbation are controversial. Clinical evidence indicates that nitric oxide (NO) levels in exhaled air are increased in exacerbated asthma patients compared to stable patients. Here, we evaluated the immunologic mechanisms and the role of NO synthases (NOSs) in the development of virus-associated asthma exacerbation. A murine model of virus-associated asthma exacerbation was established using intranasal challenge with ovalbumin (OVA) plus dsRNA for 4 weeks in mice sensitized with OVA plus dsRNA. Lung infiltration of inflammatory cells, especially neutrophils, was increased by repeated challenge with OVA plus dsRNA, as compared to OVA alone. The neutrophilic inflammation enhanced by dsRNA was partly abolished in the absence of IFN-gamma or IL-17 gene expression, whereas unaffected in the absence of IL-13. In terms of the roles of NOSs, dsRNA-enhanced neutrophilic inflammation was significantly decreased in inducible NOS (iNOS)-deficient mice compared to wild type controls; in addition, this phenotype was inhibited by treatment with a non-specific NOS inhibitor (L-NAME) or an specific inhibitor (1400 W), but not with a specific endothelial NOS inhibitor (AP-CAV peptide). Taken together, these findings suggest that iNOS pathway is important in the development of virus-associated exacerbation of neutrophilic inflammation, which is dependent on both Th1 and Th17 cell responses.
Animals ; Asthma/*immunology/virology ; Imines/pharmacology ; Mice ; Mice, Inbred BALB C ; NG-Nitroarginine Methyl Ester/pharmacology ; Nitric Oxide Synthase Type II/antagonists & inhibitors/*metabolism ; RNA, Double-Stranded/metabolism ; Th1 Cells/*immunology ; Th17 Cells/*immunology

PURPOSE: We wanted to assess the usefulness of MRCP after intravenous morphine administration in the evaluation of the hepatopancreatic pancreatico-biliary ductal system. MATERIALS AND METHODS: We studied 15 patients who were suspected of having disease of hepatopancreatic ductal system and they did not have any obstructive lesion on ultrasonography and/or CT. MRCP was acquired before and after morphine administration (0.04 mg/kg, intravenously). Three radiologists scored the quality of the images of the anatomic structures in the hepatopancreatic ductal system. We directly compared the quality of the images obtained with using the two methods and the improvement of the artifacts by pulsatile vascular compression. RESULTS: The MRCP images obtained after intravenous morphine administration were better than those obtained before morphine administration for visualizing the hepatopancreatic ductal system. On direct comparison, the MRCP images obtained after morphine administration were better in 12 cases, equivocal in two cases, and the images before morphine administration were better in only one case. In three patients, MRCP before morphine injection showed signal loss at the duct across the pulsatile hepatic artery. In two of three patients, MRCP after morphine injection showed no signal loss in this ductal area. CONCLUSION: MRCP after intravenous morphine administration enables physicians to see the hepatopancreatic ductal system significantly better and the artifacts caused by pulsation of the hepatic artery can be avoided.
Artifacts ; Hepatic Artery ; Humans ; Morphine* ; Ultrasonography

BACKGROUND: Vancomycin-resistant enterococci (VRE) infection is an emerging nosocomial problem. VRE usually multidrug-resistant, poses therapeutic dilemmas. The gene that encodes the resistance against vancomycin may spread the resistance to Staphylococcus aureus. However, there are no well-organized studies on the clinical manifestations and the factors that contribute to mortality in Korea. Herein, this study was focused on the clinical manifestations and mortality risks of patients with VRE infection during 8 years (1994-2001) in a university hospital. Understanding of the epidemiology and clinical manifestations of VRE would help develop control strategy of VRE outbreak in a hospital. METHOD: Sixty seven cases that had the VRE infection in Korea University Guro Hospital from January 1, 1994to December 12, 2001, were reviewed. We analyzed the risk factors of VRE infection and death by using univariable and multivariable statistic analyses. RESULTS: VRE infections have recently been increasing. Most of VRE infections were caused by Enterococcus faecium (85.1%) and Enterococcus faecalis (10.4%). Among 67 cases, 40 cases (59.7%) expressed VanA phenotype, 23 cases (34.3%) expressed VanB phenotype, and 3 cases expressed VanC phenotype (6%). The risk factors for death were renal dysfunction, central venous catheter insertion, and tracheostomy by using univariable analysis. The risk factor for death was renal dysfunction by using multivariable analysis. CONCLUSION: VRE has been increasing during the late 1990s in Korea. The VRE infection occurs especially in the patients who have renal dysfunction, long-term hospitalization, and ICU care. The implementation of careful isolation, infection control measures, prudent use of antibiotics, especially vancomycin, and periodic screening of patients populations are required to control VRE infection.
Anti-Bacterial Agents ; Central Venous Catheters ; Enterococcus faecalis ; Enterococcus faecium ; Epidemiology ; Hospitalization ; Humans ; Infection Control ; Korea ; Mass Screening ; Mortality ; Phenotype ; Risk Factors* ; Staphylococcus aureus ; Tracheostomy ; Vancomycin

BACKGROUND: Vancomycin-resistant enterococci (VRE) infection is an emerging nosocomial problem. VRE usually multidrug-resistant, poses therapeutic dilemmas. The gene that encodes the resistance against vancomycin may spread the resistance to Staphylococcus aureus. However, there are no well-organized studies on the clinical manifestations and the factors that contribute to mortality in Korea. Herein, this study was focused on the clinical manifestations and mortality risks of patients with VRE infection during 8 years (1994-2001) in a university hospital. Understanding of the epidemiology and clinical manifestations of VRE would help develop control strategy of VRE outbreak in a hospital. METHOD: Sixty seven cases that had the VRE infection in Korea University Guro Hospital from January 1, 1994to December 12, 2001, were reviewed. We analyzed the risk factors of VRE infection and death by using univariable and multivariable statistic analyses. RESULTS: VRE infections have recently been increasing. Most of VRE infections were caused by Enterococcus faecium (85.1%) and Enterococcus faecalis (10.4%). Among 67 cases, 40 cases (59.7%) expressed VanA phenotype, 23 cases (34.3%) expressed VanB phenotype, and 3 cases expressed VanC phenotype (6%). The risk factors for death were renal dysfunction, central venous catheter insertion, and tracheostomy by using univariable analysis. The risk factor for death was renal dysfunction by using multivariable analysis. CONCLUSION: VRE has been increasing during the late 1990s in Korea. The VRE infection occurs especially in the patients who have renal dysfunction, long-term hospitalization, and ICU care. The implementation of careful isolation, infection control measures, prudent use of antibiotics, especially vancomycin, and periodic screening of patients populations are required to control VRE infection.
Anti-Bacterial Agents ; Central Venous Catheters ; Enterococcus faecalis ; Enterococcus faecium ; Epidemiology ; Hospitalization ; Humans ; Infection Control ; Korea ; Mass Screening ; Mortality ; Phenotype ; Risk Factors* ; Staphylococcus aureus ; Tracheostomy ; Vancomycin

Ankylosis ; Arthroplasty ; Burns ; Classification ; Congenital Abnormalities ; Facial Asymmetry ; Jaw ; Malocclusion ; Mandible ; Mouth ; Temporomandibular Joint