Gender disparities in prevalence by diagnostic criteria, treatment and mortality of newly diagnosed acute myocardial infarction in Korean adults

Acute myocardial infarction (AMI) is highly prevalent and remains the leading cause of mortality. Particularly in women, under-recognition and management of AMI have been raised. The aim of this study was to investigate the long-term trends of prevalence, treatment methodologies, and mortality of AMI by gender. The subjects of this study were patients hospitalized for AMI according to the Korean National Health Insurance Claims Database from 2002 to 2018. Total 633,097 AMI patients were hospitalized, 40% women. The incidence of AMI has been increasing since 2011, with a lower incidence in women. Overall, 53.1% of patients underwent CAG, with a lower tendency in women than in men (39.8% vs. 62.3%). Furthermore, fewer women underwent PCI than men (77.5% vs. 85.8% in 2018, p < 0.0001). Of the 336,463 AMI patients undergoing CAG, women were undertreated with a lower prescription rate of beta-blockers or statins at discharge. When adjusted for age, women showed higher 7-day mortality but lower 1-year mortality relative to men. According to the Korean National Health Insurance Claims Database, women with AMI have been under-recognized, underdiagnosed, and undertreated in terms of revascularization or medical therapy for years suggesting that efforts to close the gender gap are necessary. © 2023, The Author(s).ope

Prognostic value of preoperative left ventricular global longitudinal strain for predicting postoperative myocardial injury and mortality in patients undergoing major non-cardiac surgery (SOLOMON study)

Background: The usefulness of preoperative measurement of left ventricular global longitudinal strain (LVGLS) for predicting prognosis in patients undergoing non-cardiac surgery has not been evaluated. We analyzed the prognostic value of LVGLS in predicting postoperative 30-day cardiovascular events and myocardial injury after non-cardiac surgery (MINS). Methods: This prospective cohort study was conducted in two referral hospitals and included 871 patients who underwent non-cardiac surgery <1 month after preoperative echocardiography. Those with ejection fraction <40%, valvular heart disease, and regional wall motion abnormality were excluded. The co-primary endpoints were the (1) composite incidence of all-cause death, acute coronary syndrome (ACS), and MINS and (2) com-posite incidence of all-cause death and ACS. Results: Among the 871 participants enrolled (mean age: 72.9 years; female: 60.8%), there were 43 cases of the primary endpoint (4.9%): 10 deaths, 3 ACS, and 37 MINS. Participants with impaired LVGLS (<= 16.6%) had a higher incidence of the co-primary endpoints (log-rank P < 0.001 and 0.015) than those without. The result was similar after adjustment with clinical variables and preoperative troponin T levels (hazard ratio = 1.30, 95% confidence interval [CI] = 1.03-1.65; P = 0.027). In sequential Cox analysis and net reclassification index, LVGLS had an incremental value for predicting the co-primary endpoints after non-cardiac surgery. Among the 538 (61.8%) participants who underwent serial troponin assay, LVGLS predicted MINS independently from the traditional risk factors (odds ratio = 3.54, 95% CI = 1.70-7.36; P = 0.001). Conclusions: Preoperative LVGLS has an independent and incremental prognostic value in predicting early postoperative cardiovascular events and MINS. Clinical Trial Registration: URL: https://trialsearch.who.int/. Unique identifiers: KCT0005147.ope

Artificial Intelligence-Enabled ECG Algorithm for the Prediction of Coronary Artery Calcification

Coronary artery calcium (CAC), which can be measured in various types of computed tomography (CT) examinations, is a hallmark of coronary artery atherosclerosis. However, despite the clinical value of CAC scores in predicting cardiovascular events, routine measurement of CAC scores is limited due to high cost, radiation exposure, and lack of widespread availability. It would be of great clinical significance if CAC could be predicted by electrocardiograms (ECGs), which are cost-effective and routinely performed during various medical checkups. We aimed to develop binary classification artificial intelligence (AI) models that predict CAC using only ECGs as input. Moreover, we aimed to address the generalizability of our model in different environments by externally validating our model on a dataset from a different institution. Among adult patients, standard 12-lead ECGs were extracted if measured within 60 days before or after the CAC scores, and labeled with the corresponding CAC scores. We constructed deep convolutional neural network models based on residual networks using only the raw waveforms of the ECGs as input, predicting CAC at different levels, namely CAC score ≥100, ≥400 and ≥1,000. Our AI models performed well in predicting CAC in the training and internal validation dataset [area under the receiver operating characteristics curve (AUROC) 0.753 ± 0.009, 0.802 ± 0.027, and 0.835 ± 0.024 for the CAC score ≥100, ≥400, and ≥1,000 model, respectively]. Our models also performed well in the external validation dataset (AUROC 0.718, 0.777 and 0.803 for the CAC score ≥100, ≥400, and ≥1,000 model, respectively), indicating that our model can generalize well to different but plausibly related populations. Model performance in terms of AUROC increased in the order of CAC score ≥100, ≥400, and ≥1,000 model, indicating that higher CAC scores might be associated with more prominent structural changes of the heart detected by the model. With our AI models, a substantial proportion of previously unrecognized CAC can be afforded with a risk stratification of CAC, enabling initiation of prophylactic therapy, and reducing the adverse consequences related to ischemic heart disease.ope

Role of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Optimizing Outcomes in Acute Myocardial Infarction

Background The role of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is still unclear in patients with acute myocardial infarction acute myocardial infarction. This study aimed to evaluate the long-term impact of IVUS-guided PCI in patients with acute myocardial infarction. Methods and Results Among a total of 13 104 patients with acute myocardial infarction, enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health, we selected patients who underwent PCI with second-generation drug-eluting stent implantation. The primary outcome was the risk of target lesion failure at 3 years. Among the study population, 1887 patients (21.0%) underwent IVUS-guidance, and 7120 patients (79.0%) underwent angiography-guidance for second-generation drug-eluting stent implantation. IVUS-guided PCI was associated with a significantly lower risk of target lesion failure at 3 years (4.8% versus 8.0%; hazard ratio [HR], 0.59; 95% CI, 0.47 to 0.73; P<0.001) compared with angiography-guided PCI. The difference was driven mainly by a lower risk of cardiac death and target vessel myocardial infarction. The results were consistent after confounder adjustment by multiple sensitivity analyses. Moreover, quartile analysis of volume of IVUS use showed that higher IVUS use was associated with a decreased risk of 3-year target lesion failure (adjusted HR, 0.58; 95% CI, 0.45 to 0.75; P<0.001 for quartile 1 versus 4; P<0.001 for trend comparison across all quartiles). Conclusions In patients with acute myocardial infarction who underwent PCI with second-generation drug-eluting stent implantation, the use of IVUS guidance was associated with a significant reduction in 3-year target lesion failure, mainly driven by hard end points, such as cardiac death and target vessel myocardial infarction.ope

Red cell distribution width as a prognosticator in patients with heart failure

Aims: Increased red cell distribution width (RDW) is a poor prognostic factor in patients with heart failure (HF). However, only a few large-scale studies have identified the clinical utility of RDW after adjusting for covariates affecting RDW. Methods and results: From January 2010 to April 2021, we retrospectively enrolled patients diagnosed with HF from three referral hospitals with available RDW data (taken within 3 months of HF diagnosis) using an integrated clinical data system. Patients with an ejection fraction (EF) < 50% or HFA-PEFF (Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final aetiology) score ≥ 2 without severe valvular heart disease or coronary revascularization were enrolled. The primary endpoint was all-cause mortality, and cardiovascular mortality was also collected. Multivariable Cox regression analysis and stabilized inverse probability of treatment weighting (IPTW) were used to identify any association between RDW and all-cause death by balancing covariates or compounding factors. The global χ2 score was calculated and discrimination analysis was performed to evaluate the incremental value of RDW in predicting prognosis. Among the 6599 participants enrolled in this study, 1256 (19.0%) cases of all-cause death occurred, and the median duration of follow-up was 887 (interquartile range 351-1589) days. Elevated RDW at the initial diagnosis was associated with poor prognosis [cumulative incidence: 819 (30.2%) vs. 437 (11.2%), relative risk 1.58, 95% confidence interval (CI) 1.51-1.67, log-rank P < 0.001]. Multivariable Cox analysis showed that elevated RDW was a poor prognostic factor for the primary endpoint [hazard ratio (HR) 1.11, 95% CI 1.06-1.16, P < 0.001], independent of clinical risk factors, N-terminal pro-brain natriuretic peptide (NT-proBNP), and EF, which was concordant with the stabilized IPTW (HR 1.29, 95% CI 1.10-1.49, P < 0.001). Adding RDW to model composed of traditional risk factors, NT-proBNP, and echocardiographic parameters showed incremental prognostic value for predicting poor prognosis (area under the receiver operating characteristic curve, 0.799-0.826; P < 0.001). Conclusions: Increased RDW at the time of diagnosis is associated with poor prognosis in patients with HF, independent of clinical risk factors, such as NT-proBNP, and echocardiographic parameters. Therefore, RDW may aid in the management of these patients beyond traditional risk factors.ope

A Study on Sonata for Cello and Piano in F Major Op.99 by Johannes Brahms

The purpose of this dissertation is to analyze melodies, forms, and harmonies of Johannes Brahms&amp;apos; Sonata for Cello and Piano in F Major, Op. 99 and look up his biography and philosophy of music for profound interpretation. Brahms used a typical four-movement sonata form in this piece to shows his admiration of classical period. But his progressive characters such as theme and variation techniques, advanced use of harmonic progressions, and chromatic use of melodies and keys influence composers of the next generation. Formal plan of this sonata - 1st movement in sonata allegro form, the second in song-form, the third in scherzo, fourth in Rondo form - is typically used in classical period, and the tonal plan also inherits the true classical spirit. Brahms&amp;apos; progressive character can be found in sustained dominant, and frequent use of secondary dominant 7th and neapolitan 6th, and modulations without cadences. But he kept tonal balance with using triads at the cadence of each section. Progressive and classical aspects and characteristics of Brahms&amp;apos; compositional techniques will be discussed in this dissertation so that those elements can be adopted to performances of this work and other similar pieces of Brahms.;본 논문의 목적은 브람스(Johannes Brahms, 1833~1897)의 Sonata for Cello and Piano in F Major, op.99의 선율, 형식, 리듬, 화성적 특징을 파악하고, 이를 그의 생애나 음악적 철학의 기준으로 조망하여, 이 곡의 연주를 함에 있어서 보다 심도 있는 해석을 할 수 있도록 하는데 있다. 형식상 4악장의 고전적인 소나타형식의 틀을 준수하고 있는 이 곡은 특히나 고전주의를 신봉했던 브람스의 음악적 철학을 대변한다. 하지만 동기의 선택이나 이것을 변주하는 방식, 이전의 낭만시대 음악과 비교하여 훨씬 진보적인 화성진행, 반음계적인 선율 조성의 사용 등은 후대의 음악에 지대하게 큰 영향을 미친 그의 진보주의적 성향을 보여주는 것이기도 하다. 형식상으로 1악장 소나타형식, 2악장 가요형식, 3악장 복합 3부형식의 스케르쪼, 4악장 론도형식으로 진행하는 구조는 고전주의 시대 이후에 정착된 소나타 형식에서 가장 빈번하게 사용되는 구성으로 그 속에 보이는 조성의 채택 또한 큰 틀에서 봤을 때에는 고전주의의 정신을 온전하게 계승하고 있는 것으로 보인다. 화성적으로 딸림화음의 지속적인 유지와, 그 속에서 빈번하게 사용되는 딸림화음의 감7화음 또는 나폴리 6화음의 존재, 장3도 또는 단2도 거리의 조성으로 뚜렷한 종지 없이 전조하는 모습에서 반음계주의적인 진보적인 모습을 보이기도 한다. 하지만 이 속에서 각 부의 종결은 주요화음을 주로 사용하여, 전반적으로 조성적인 균형을 맞추고자하는 그의 의지 또한 엿볼 수 있다. 본 논문을 통해 이 곡만이 아니라 이와 유사한 그의 다른 곡의 연주에도 적용될 수 있도록, 브람스의 작곡기법 상의 고전적인 경향과 진보적인 경향을 동시에 파악하고 그 특징을 정리하고자 한다.I. 서론 1 II. 본론 3 A. 브람스의 생애와 그의 음악 3 1. 브람스의 생애와 음악 활동 3 2. 브람스 음악의 특징 5 B.악곡분석 7 1. 1악장 7 2. 2악장 24 3. 3악장 33 4. 4악장 45 III. 결론 53 참고문헌 54 ABSTRACT 5

The Relationship between Parentification, Parenting Stress and Family Burnout : The Mediating effects of Perfectionism and Suppression of Emotional Expression

본 연구는 부모화 경험과 양육스트레스, 가정소진, 완벽주의 및 정서표현억제 간의 관계를 살펴보고, 성장기 부모화 경험이 성인이 된 후 양육스트레스와 가정소진에 미치는 관계에서 완벽주의와 정서표현억제가 매개효과를 갖는지 확인하고자 하였다. 이를 위해 20세 이하의 자녀를 양육하고 있는 성인 남녀를 대상으로 부모화 척도, 양육스트레스 척도, 가정소진 척도, 다차원적 완벽주의 척도, 정서표현태도 척도를 포함하는 설문조사를 실시하였으며, 수집된 572건의 자료는 SPSS 21.0과 AMOS 21.0 프로그램을 사용하여 분석되었다. 본 연구의 주요 결과는 다음과 같다. 첫째, 부모화, 양육스트레스, 가정소진, 완벽주의, 정서표현억제 간의 관계를 알아보기 위해 상관분석을 실시한 결과 모든 잠재변인들 간 상관관계가 유의미한 정적 상관으로 나타났다. 둘째, 부모화, 양육스트레스, 가정소진, 완벽주의, 정서표현억제의 구조적 관계를 알아보기 위하여 구조방정식 모형 분석을 실시한 결과 부모화는 양육스트레스, 완벽주의, 정서표현억제에 직접적인 영향을 미치는 것으로 나타났으며, 양육스트레스가 가정소진에 미치는 영향도 유의하게 나타났다. 셋째, 부모화와 양육스트레스, 가정소진의 관계에서 완벽주의와 정서표현억제의 매개효과는 어떠한지 Bootstrapping 방법을 사용하여 검증을 실시하였다. 그 결과 양육스트레스는 부모화와 가정소진의 관계를 완전매개 한다는 것을 확인하였다. 또한, 부모화와 양육스트레스의 관계에서는 완벽주의와 정서표현억제의 매개효과도 유의하게 나타났다. 여기서 완벽주의의 경우 양육스트레스, 가정소진으로 가는 각각의 직접 경로가 유의하지 않게 나타났는데, 이로 인해 부모화와 양육스트레스의 관계에서 완벽주의는 정서표현억제를 통해 양육스트레스로 가는 경로만 유의함에 따라 정서표현억제를 통해 다중매개하는 것으로 나타났다. 본 연구에서는 상담현장에서 자주 만날 수 있는 부모화 경험이 있는 성인의 가정생활과 관련한 부적응적인 심리기제를 밝혔다. 부모화 경험은 완벽주의적인 성향과 정서표현을 억제하는데 영향을 미칠 수 있고, 그로 인해 양육스트레스도 높아질 수 있으며 가정생활에서의 소진으로까지 연결될 수 있다는 이러한 심리적 기제는 상담장면에서 활용될 수 있으며, 양육스트레스와 가정소진으로 인해 어려움을 호소하는 내담자의 경우 좀 더 효과적인 개입을 할 수 있을 것으로 기대한다.Maste

Usefulness of Diastolic Function Score as a Predictor of Long-Term Prognosis in Patients With Acute Myocardial Infarction

Background: Left ventricular diastolic function (LVDF) evaluation using a combination of several echocardiographic parameters is an important predictor of adverse events in patients with acute myocardial infarction (AMI). To date, the clinical impact of each individual LVDF marker is well-known, but the clinical significance of the sum of the abnormal diastolic function markers and the long-term clinical outcome are not well-known. This study aimed to investigate the usefulness of LVDF score in predicting clinical outcomes of patients with AMI. Methods: LVDF scores were measured in a 2,030 patients with AMI who underwent successful percutaneous coronary intervention from 2012 to 2015. Four LVDF parameters (septal e' ≥ 7 cm/s, septal E/e' ≤ 15, TR velocity ≤ 2.8 m/s, and LAVI ≤ 34 ml/m2) were used for LVDF scoring. The presence of each abnormal LVDF parameter was scored as 1, and the total LVDF score ranged from 0 to 4. Mortality and hospitalization due to heart failure (HHF) in relation to LVDF score were evaluated. To compare the predictive ability of LVDF scores and left ventricular ejection fraction (LVEF) for mortality and HHF, receiver operating characteristic (ROC) curve and landmark analyses were performed. Results: Over the 3-year clinical follow-up, all-cause mortality occurred in 278 patients (13.7%), while 91 patients (4.5%) developed HHF. All-cause mortality and HHF significantly increased as LVDF scores increased (all-cause mortality-LVDF score 0: 2.3%, score 1: 8.8%, score 2: 16.7%, score 3: 31.8%, and score 4: 44.5%, p < 0.001; HHF-LVDF score 0: 0.6%, score 1: 1.8%, score 2: 6.3%, score 3: 10.3%, and score 4: 18.2%, p < 0.001). In multivariate analysis, a higher LVDF score was associated with significantly higher adjusted hazard ratios for all-cause mortality and HHF. In landmark analysis, LVDF score was a better predictor of long-term mortality than LVEF (area under the ROC curve: 0.739 vs. 0.640, p < 0.001). Conclusion: The present study demonstrated that LVDF score was a significant predictor of mortality and HHF in patients with AMI. LVDF scores are useful for risk stratification of patients with AMI; therefore, careful monitoring and management should be performed for patients with AMI with higher LVDF scores.ope

Relationships Between Pre-service Teacher's Meta-cognition and Social Problem-Solving Skills

본 연구는 예비교사가 인지하는 메타인지와 사회적 문제해결기술과의 관계를 알아보기 위해 서울시의 예비중 등교사 114명을 대상으로 실시되었다. 검사도구로는 Schraw와 Dennison(1994)가 제작한 Meta-cognitive Skill 측정도구와 D'zurilla 와 Nezu(1990)가 제작한 사회적 문제해결능력 척도(SPSI: Social Problem-Solving Inventory) 중에서 본 연구과 직접 관련되는 문항만을 취하여 여려 차례 전문가의 검토를 거쳐 수정・보완된 것이 사용되었다. 연구결과, 메타인지가 높은 집단은 메타인지가 낮은 집단에 비해 사회적 문제해결기술이 더 높은 것으로 나타났다. 메타인지의 하위요소 중에서 평가하기, 정보관리하기, 모니터링하기가 사회적 문제해결 기술을 유의하게 예측하는 요소인 것으로 나타났는데, 그 중에서도 평가하기가 가장 유의한 핵심요소로 분석되 었다. 또한, 메타인지의 하위요소가 사회적 문제해결기술의 하위요소인 문제규정, 대안산출, 의사결정, 해결실행 을 예측하는 설명력을 알아본 결과, 사회적 문제해결기술의 하위요소 중 문제규정과 대안산출에서는 정보관리하 기가 핵심요소로, 의사결정에서는 모니터링하기가 핵심요소인 것으로 나타났다. 이러한 연구결과를 바탕으로, 본 연구는 교사양성 교육과정에서 예비중등교사들이 다양한 문제해결과제를 통해 메타인지를 적용하는 능력을 키워나갈 수 있도록 하고, 문제해결 과정에서 스스로 정보를 관리하고, 모니터링하고, 평가할 수 있는 환경을 조성해 주어야 할 필요가 있음을 제안한다. This study aims at investigating the relationships between pre-service teacher's meta-cognition and social problem-solving skills. A total of 114 student-teachers entering a university in Seoul were chosen to conduct a survey, The pre-service teachers' meta-cognition was measured by Meta-cognitive Awareness Inventory developed by Schraw and Dennison (1994) and their social problem-solving skills were measured by Problem-Solving Inventory developed by D'zurilla and Nezu(1990) after several expert reviews and revisions to meet the needs of current study. According to the research results, comparing to a low level of meta-cognition group, a high level of meta-cognition group showed higher level of social problem-solving skills. Some subordinate factors of meta-cognition(evaluating, information controlling, and monitoring) significantly predict one's social problem-solving skills and evaluating was the most significant predictor. In addition, based on the analysis of subordinate factors of both meta-cognition and social problem-solving skills, information management and monitoring were the significant factor for problem identification, alternative generation, and decision making respectively. Based on these findings, it is considered that curriculum of pre-service teachers creates opportunities for pre-service teachers to develop meta-cognition through diverse problem-solving projects through which they could efficiently manage information, monitor and evaluate their performance by themselves

Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction

Background: A limitation of the current guidelines regarding the timing of invasive coronary angiography for patients with non-ST-segment elevation acute coronary syndrome is the randomization time. To date, no study has reported the clinical outcomes of invasive strategy timing on the basis of the time of symptom onset. Objectives: The aim of this study was to investigate the effect of invasive strategy timing from the time of symptom onset on the 3-year clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: Among 13,104 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health, 5,856 patients with NSTE myocardial infarction were evaluated. The patients were categorized according to symptom-to-catheter (StC) time (<48 or ≥48 hours). The primary outcome was 3-year all-cause mortality. Results: Overall, 3,919 patients (66.9%) were classified into the StC time <48 hours group. This group had lower all-cause mortality than the group with StC time ≥48 hours (7.3% vs 13.4%; P < 0.001). The lower risk for all-cause mortality in the group with StC time <48 hours group was consistent in all subgroups. Notably, emergency medical service use (HR: 0.31; 95% CI: 0.19-0.52) showed a lower risk for all-cause mortality than no emergency medical service use (HR: 0.54; 95% CI: 0.46-0.65; P value for interaction = 0.008). Conclusions: An early invasive strategy on the basis of StC time was associated with a decreased risk for all-cause mortality in patients with NSTEMI. Because the study was based on a prospective registry, the results should be considered hypothesis generating, highlighting the need for further research. (iCReaT Study No. C110016).restrictio