This study was conducted to determine whether the presence and degree of left ventricular diastolic dysfunction (LVDD) can be predicted by the simple computed tomography -measured left atrial diameter (CTLAD). Methods Among adult patients who underwent both chest CT imaging and echocardiography in the emergency department from January 2020 to December 2021, a retrospective cross-sectional study enrolled patients in whom the time interval between the two tests was <24 hours. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of CTLAD for echocardiographic LVDD. Results In a study involving 373 patients, 192 (51.5%) had LVDD. Among them, 122 (63.5%) had grade 1, 61 (31.8%) had grade 2, and nine (4.7%) had ≥grade 3. Median CTLAD values were 4.1 cm for grade 1, 4.5 cm for grade 2, and 4.9 cm for ≥grade 3. The area under the ROC curve value of CTLAD in distinguishing ≥grade 1, ≥grade 2 (optimal cutoff ≥4.4 cm), and ≥grade 3 (optimal cutoff ≥4.5 cm) were 0.588, 0.657 (sensitivity, 61.4%; specificity, 66.0%, positive predictive value, 29.5%; negative predictive value, 88.1%; odds ratio, 3.1), and 0.834 (sensitivity, 88.9%; specificity, 70.1%; positive predictive value, 6.8%; negative predictive value, 99.6%, odds ratio, 18.7), respectively. Conclusion CTLAD ≥4.4 cm can be used as a rough reference value to distinguish LVDD of ≥grade 2, while CTLAD ≥4.5 cm can reliably distinguish LVDD of ≥grade 3. CTLAD might be a useful parameter for predicting LVDD in situations where echocardiography is not available.

This study was conducted to determine whether the presence and degree of left ventricular diastolic dysfunction (LVDD) can be predicted by the simple computed tomography -measured left atrial diameter (CTLAD). Methods Among adult patients who underwent both chest CT imaging and echocardiography in the emergency department from January 2020 to December 2021, a retrospective cross-sectional study enrolled patients in whom the time interval between the two tests was <24 hours. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of CTLAD for echocardiographic LVDD. Results In a study involving 373 patients, 192 (51.5%) had LVDD. Among them, 122 (63.5%) had grade 1, 61 (31.8%) had grade 2, and nine (4.7%) had ≥grade 3. Median CTLAD values were 4.1 cm for grade 1, 4.5 cm for grade 2, and 4.9 cm for ≥grade 3. The area under the ROC curve value of CTLAD in distinguishing ≥grade 1, ≥grade 2 (optimal cutoff ≥4.4 cm), and ≥grade 3 (optimal cutoff ≥4.5 cm) were 0.588, 0.657 (sensitivity, 61.4%; specificity, 66.0%, positive predictive value, 29.5%; negative predictive value, 88.1%; odds ratio, 3.1), and 0.834 (sensitivity, 88.9%; specificity, 70.1%; positive predictive value, 6.8%; negative predictive value, 99.6%, odds ratio, 18.7), respectively. Conclusion CTLAD ≥4.4 cm can be used as a rough reference value to distinguish LVDD of ≥grade 2, while CTLAD ≥4.5 cm can reliably distinguish LVDD of ≥grade 3. CTLAD might be a useful parameter for predicting LVDD in situations where echocardiography is not available.

This study was conducted to determine whether the presence and degree of left ventricular diastolic dysfunction (LVDD) can be predicted by the simple computed tomography -measured left atrial diameter (CTLAD). Methods Among adult patients who underwent both chest CT imaging and echocardiography in the emergency department from January 2020 to December 2021, a retrospective cross-sectional study enrolled patients in whom the time interval between the two tests was <24 hours. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic power of CTLAD for echocardiographic LVDD. Results In a study involving 373 patients, 192 (51.5%) had LVDD. Among them, 122 (63.5%) had grade 1, 61 (31.8%) had grade 2, and nine (4.7%) had ≥grade 3. Median CTLAD values were 4.1 cm for grade 1, 4.5 cm for grade 2, and 4.9 cm for ≥grade 3. The area under the ROC curve value of CTLAD in distinguishing ≥grade 1, ≥grade 2 (optimal cutoff ≥4.4 cm), and ≥grade 3 (optimal cutoff ≥4.5 cm) were 0.588, 0.657 (sensitivity, 61.4%; specificity, 66.0%, positive predictive value, 29.5%; negative predictive value, 88.1%; odds ratio, 3.1), and 0.834 (sensitivity, 88.9%; specificity, 70.1%; positive predictive value, 6.8%; negative predictive value, 99.6%, odds ratio, 18.7), respectively. Conclusion CTLAD ≥4.4 cm can be used as a rough reference value to distinguish LVDD of ≥grade 2, while CTLAD ≥4.5 cm can reliably distinguish LVDD of ≥grade 3. CTLAD might be a useful parameter for predicting LVDD in situations where echocardiography is not available.

Background/Aims: Cardiorespiratory fitness (CRF), as measured by maximal oxygen consumption (VO2max), is an important independent predictive factor of cardiovascular outcomes in patients with heart failure (HF). However, it is unclear whether conventional equations for estimating CRF are applicable to patients with HF with preserved ejection fraction (HFpEF). Methods: This study included 521 patients with HFpEF (EF ≥ 50%) whose CRF was directly measured by cardiopulmonary exercise test using a treadmill. We developed a new equation (Kor-HFpEF) for half of the patients in the HFpEF cohort (group A, n = 253) and validated it for the remaining half (group B, n = 268). The accuracy of the Kor-HFpEF equation was compared to that of the other equations in the validation group. Results: In the total HFpEF cohort, the directly measured VO2max was significantly overestimated by the FRIEND and ACSM equations (p < 0.001) and underestimated by the FRIEND-HF equation (p <0.001) (direct 21.2 ± 5.9 mL/kg/min; FRIEND 29.1 ± 11.8 mL/kg/min; ACSM 32.5 ± 13.4 mL/kg/min; FRIEND-HF 14.1 ± 4.9 mL/kg/min). However, the VO2max estimated by the Kor-HFpEF equation (21.3 ± 4.6 mL/kg/min) was similar to the directly measured VO2max (21.7 ± 5.9 mL/kg/min, p = 0.124), whereas the VO2max estimated by the other three equations was still significantly different from the directly measured VO2max in group B (all p < 0.001). Conclusions Traditional equations used to estimate VO2max were not applicable to patients with HFpEF. We developed and validated a new Kor-HFpEF equation for these patients, which had a high accuracy.

OBJECTIVE: This study examined whether the depth of chest compression (CC) recommended by current cardiopulmonary resuscitation guidelines is equally appropriate to both men and women. METHODS: Retrospective analysis of the chest computed tomography (CT) findings was performed. The anteroposterior diameter (APD), internal compressible depth (ICD), and anterior chest wall thickness were measured at the midpoint of the lower half of the sternum. The residual diameter (RD) for simulated CC was also obtained. If the RD was less than 20 mm, it was assumed that a potential injury would occur. RESULTS: A total of 319 adults (173 men, 141 women), who underwent chest CT at the emergency room, were enrolled. A statistically significant difference was observed between the mean APD and ICD between men and women. The mean APD and IPD were 8 mm shorter and 9.5 mm shorter, respectively, in women than in men. When adjusted for age, height, weight, and body mass index (BMI), the differences in the value of these parameters increased even more. In simulated CC with a 60 mm depth, the predictors of RD of less than 20 mm were weighed (odds ratio [OR], 0.888; 95% confidence interval [CI], 0.826–0.954; P=0.001) and BMI (OR, 0.706; 95% CI, 0.579–0.862; P=0.001), and all cases with RD of less than 20 mm were women. CONCLUSION: Chest compression of more than 60 mm may increase the potential risk of injury, particularly in women. The maximum allowable chest compression depth of less than 60 mm should be emphasized for women.
Adult ; Body Mass Index ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Female ; Humans ; Male ; Retrospective Studies ; Sternum ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

OBJECTIVE: Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA.METHODS: This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed.RESULTS: In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm³, P=0.020). The best cutoff platelet count was 195,000/mm³, and patients with platelet counts of < 195,000/mm³ had a 5.4- times higher risk of developing sICH than those with platelet counts of ≥195,000/mm³.CONCLUSION: Platelet count was the only independent parameter associated with sICH among the blood test indexes. Mild thrombocytopenia may increase the risk of sICH after intravenous administration of rtPA.
Administration, Intravenous ; Aspartate Aminotransferases ; Brain ; Cerebral Infarction ; Emergency Service, Hospital ; Follow-Up Studies ; Hematologic Tests ; Humans ; Intracranial Hemorrhages ; L-Lactate Dehydrogenase ; Logistic Models ; Observational Study ; Platelet Count ; Retrospective Studies ; Seoul ; Stroke ; Tertiary Care Centers ; Thrombocytopenia ; Thrombolytic Therapy ; Tissue Plasminogen Activator

BACKGROUND:Accurate and timely diagnosis of acute surgical disease in pregnant patient is chal enging. Although magnetic resonance imaging (MRI) is the most accurate modality to diagnose acute appendicitis in pregnant patients, it is often used as a last resort because of high cost and long scan time. We performed this study to analyze differential diagnoses of appendix MRI and to investigate if there are any blood tests that can predict surgical condition in pregnant patients. METHODS:A retrospective, cross-sectional study was conducted on 46 pregnant patients who underwent non-enhanced appendix MRI in suspicion of acute appendicitis from 2010 to 2016. Differential diagnoses of appendix MRI were analyzed and blood tests were compared between those who had surgical and non-surgical disease. RESULTS:Appendix MRI differentiated two surgical disease; acute appendicitis and ovarian torsion; and various non-surgical conditions such as uterine myoma, hydronephrosis, ureterolithiasis and diverticulitis among clinically suspected acute appendicitis in pregnancy. The diagnostic accuracy of MRI for acute appendicitis in this study was 93.5％. Patients who had surgical disease showed significantly higher WBC count (≥11,000/mm3), proportion of neutrophils in the WBC (≥79.9％), neutrophil-to-lymphocyte ratio (NLR≥6.4), levels of C-reactive protein (CRP≥1.82 mg/dL) and bilirubin (≥0.66 mg/dL ) than those who had non-surgical disease. CONCLUSION:MRI can reliably differentiate surgical conditions and several blood tests (WBC, proportion of neutrophils in the WBC, NLR, CRP, bilirubin) can help anticipate acute surgical condition among pregnant patients suspected to have acute appendicitis.

PURPOSE: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. MATERIALS AND METHODS: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 µg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. RESULTS: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. CONCLUSION: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.
Acetylcholine ; Aged ; Angina Pectoris/diagnosis ; Calcium Channel Blockers/therapeutic use ; Cardiovascular Agents/*therapeutic use ; Coronary Angiography/adverse effects ; Coronary Artery Disease/prevention & control ; Coronary Vasospasm/diagnosis/*drug therapy ; Diltiazem/*therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Myocardial Infarction/prevention & control ; Nitrates/*therapeutic use ; Propensity Score ; Time Factors ; Vasodilator Agents/therapeutic use

OBJECTIVE: Cerebrospinal fluid (CSF) examination is mandatory whenever central nervous system (CNS) infection is suspected. However, pleocytosis is not detected in a substantial number of suspected patients who undergo CSF examination. This study aimed to identify parameters that can aid in predicting negative CSF examination results (defined as a white blood cell count of <5 cells/high-power field). METHODS: The study included 101 neurologically intact patients who underwent lumbar puncture because of suspicion of CNS infection. Patients were divided into negative and positive CSF examination groups, and their initial blood tests were comparatively analyzed. RESULTS: The negative group had a significantly higher proportion of neutrophils in white blood cells (81.5% vs. 75.8%, P=0.012), lower proportion of lymphocytes in white blood cells (9.3% vs. 16.7%, P=0.001), a higher neutrophil-to-lymphocyte ratio (9.1 vs. 4.4, P=0.001), a lower lymphocyte-to-monocyte ratio (1.6 vs. 2.4, P=0.008), and a higher C-reactive protein level (21.0 vs. 5.0 mg/L, P<0.001) than the positive group. In the receiver-operating characteristic analysis, neutrophil-to-lymphocyte ratio and C-reactive protein had an area under the curve of >0.7, and the best cutoff values were 6.0 (accuracy 70.3%) and 12.7 mg/L (accuracy 76.2%), respectively. CONCLUSION: The neutrophil-to-lymphocyte ratio ≥6 and C-reactive protein level ≥12.7 mg/L was significantly associated with negative CSF examination result.
C-Reactive Protein ; Central Nervous System Infections* ; Central Nervous System* ; Cerebrospinal Fluid* ; Hematologic Tests ; Humans ; Leukocyte Count ; Leukocytes ; Leukocytosis ; Lymphocytes ; Neutrophils ; Spinal Puncture*

BACKGROUND:Metronome guidance is a feasible and effective feedback technique to improve the quality of cardiopulmonary resuscitation (CPR). The rate of the metronome should be set between 100 to 120 ticks/minute and the speed of ventilation may have crucial effect on the quality of ventilation. We compared three different metronome rates (100, 110, 120 ticks/minute) to investigate its effect on the quality of ventilation during metronome-guided 30:2 CPR. METHODS:This is a prospective, randomized, crossover observational study using a RespiTrainer?r. To simulate 30 chest compressions, one investigator counted from 1 to 30 in cadence with the metronome rate (1 count for every 1 tick), and the participant performed 2 consecutive ventilations immediately following the counting of 30. Thirty physicians performed 5 sets of 2 consecutive (total 10) bag-mask ventilations for each metronome rate. Participants were instructed to squeeze the bag over 2 ticks (1.0 to 1.2 seconds depending on the rate of metronome) and deflate the bag over 2 ticks. The sequence of three different metronome rates was randomized. RESULTS:Mean tidal volume significantly decreased as the metronome rate was increased from 110 ticks/minute to 120 ticks/minute (343±84 mL vs. 294±90 mL, P=0.004). Peak airway pressure significantly increased as metronome rate increased from 100 ticks/minute to 110 ticks/minute (18.7 vs. 21.6 mmHg, P=0.006). CONCLUSION:In metronome-guided 30:2 CPR, a higher metronome rate may adversely affect the quality of bag-mask ventilations. In cases of cardiac arrest where adequate ventilation support is necessary, 100 ticks/minute may be better than 110 or 120 ticks/minute to deliver adequate tidal volume during audio tone guided 30:2 CPR.