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Coronary Artery Disease: HELP
Articles by Sang Eun Lee
Based on 13 articles published since 2008
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Between 2008 and 2019, Sang-Eun Lee wrote the following 13 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
1 Guideline Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. 2018

Truong, Quynh A / Rinehart, Sarah / Abbara, Suhny / Achenbach, Stephan / Berman, Daniel S / Bullock-Palmer, Renee / Carrascosa, Patricia / Chinnaiyan, Kavitha M / Dey, Damini / Ferencik, Maros / Fuechtner, Gudrun / Hecht, Harvey / Jacobs, Jill E / Lee, Sang-Eun / Leipsic, Jonathan / Lin, Fay / Meave, Aloha / Pugliese, Francesca / Sierra-Galán, Lilia M / Williams, Michelle C / Villines, Todd C / Shaw, Leslee J / Anonymous3891033. ·Weill Cornell Medicine, USA. Electronic address: qat9001@med.cornell.edu. · Piedmont Healthcare, USA. · UT Southwestern Medical Center, USA. · University of Erlangan, Germany. · Cedars-Sinai Medical Center, USA. · Deborah Heart and Lung Center, USA. · Maipu Diagnosis, Argentina. · William Beaumont Hospital, USA. · Oregon Health & Science University, USA. · Medical University of Innsbruck, Austria. · Mount Sinai Health System, USA. · NYU Langone Medical Center, USA. · Severance Hospital, South Korea. · Providence Healthcare, Canada. · Weill Cornell Medicine, USA. · Ignacio Chavez National Institute for Cardiology, Mexico. · William Harvey Research Institute, UK. · American British Cowdray Medical Center, Mexico. · British Heart Foundation, UK. · Uniformed Services University of the Health Sciences F Edward Hebert School of Medicine, USA. ·J Cardiovasc Comput Tomogr · Pubmed #30392926.

ABSTRACT: This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.

2 Clinical Trial Rationale and design of the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry: A comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary computed tomographic angiography study. 2016

Lee, Sang-Eun / Chang, Hyuk-Jae / Rizvi, Asim / Hadamitzky, Martin / Kim, Yong-Jin / Conte, Edoardo / Andreini, Daniele / Pontone, Gianluca / Volpato, Valentina / Budoff, Matthew J / Gottlieb, Ilan / Lee, Byoung Kwon / Chun, Eun Ju / Cademartiri, Filippo / Maffei, Erica / Marques, Hugo / Leipsic, Jonathon A / Shin, Sanghoon / Choi, Jung Hyun / Chung, Namsik / Min, James K. ·Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. · Division of Cardiology, University of Munich, Munich, Germany. · Seoul National University Hospital, South Korea. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Gangnam Severance Hospital, South Korea. · Seoul National University Bundang Hospital, South Korea. · Department of Radiology, Montréal Heart Institute/Université de Montréal, Montréal, Quebec, Canada. · Hospital da Luz, Lisbon, Portugal. · Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, Canada. · National Health Insurance Service Ilsan Hospital, South Korea. · Busan University Hospital, South Korea. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu. ·Am Heart J · Pubmed #27914502.

ABSTRACT: BACKGROUND: The natural history of coronary artery disease (CAD) in patients with low-to-intermediate risk is not well characterized. Although earlier invasive serial studies have documented the progression of atherosclerotic burden, most were focused on high-risk patients only. The PARADIGM registry is a large, prospective, multinational dynamic observational registry of patients undergoing serial coronary computed tomographic angiography (CCTA). The primary aim of PARADIGM is to characterize the natural history of CAD in relation to clinical and laboratory data. DESIGN: The PARADIGM registry (ClinicalTrials.govNCT02803411) comprises ≥2,000 consecutive patients across 9 cluster sites in 7 countries. PARADIGM sites were chosen on the basis of adequate CCTA volume, site CCTA proficiency, local demographic characteristics, and medical facilities to ensure a broad-based sample of patients. Patients referred for clinically indicated CCTA will be followed up and enrolled if they had a second CCTA scan. Patients will also be followed up beyond serial CCTA performance to identify adverse CAD events that include cardiac and noncardiac death, myocardial infarction, unstable angina, target vessel revascularization, and CAD-related hospitalization. SUMMARY: The results derived from the PARADIGM registry are anticipated to add incremental insight into the changes in CCTA findings in accordance with the progression or regression of CAD that confer prognostic value beyond demographic and clinical characteristics.

3 Article Longitudinal assessment of coronary plaque volume change related to glycemic status using serial coronary computed tomography angiography: A PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging) substudy. 2019

Won, Ki-Bum / Lee, Sang-Eun / Lee, Byoung Kwon / Park, Hyung-Bok / Heo, Ran / Rizvi, Asim / Lin, Fay Y / Kumar, Amit / Hadamitzky, Martin / Kim, Yong-Jin / Sung, Ji Min / Conte, Edoardo / Andreini, Daniele / Pontone, Gianluca / Budoff, Matthew J / Gottlieb, Ilan / Chun, Eun Ju / Cademartiri, Filippo / Maffei, Erica / Marques, Hugo / Leipsic, Jonathon A / Shin, Sanghoon / Choi, Jung Hyun / Virmani, Renu / Samady, Habib / Chinnaiyan, Kavitha / Raff, Gilbert L / Stone, Peter H / Berman, Daniel S / Narula, Jagat / Shaw, Leslee J / Bax, Jeroen J / Min, James K / Chang, Hyuk-Jae. ·Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. · Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Department of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, South Korea. · Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA. · Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Seoul National University Hospital, Seoul, South Korea. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Department of Radiology, Seoul National University Bundang Hospital, Sungnam, South Korea. · Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. · Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada. · Department of Cardiology, National Health Insurance Service Ilsan Hospital, South Korea. · Department of Cardiology, Busan University Hospital, Busan, South Korea. · Department of Pathology, CVPath Institute, Gaithersburg, MD, USA. · Department of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA. · Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, And Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA. · Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. · Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. ·J Cardiovasc Comput Tomogr · Pubmed #30580992.

ABSTRACT: BACKGROUND: Data on the impact of glycemic status on coronary plaque progression have been limited. This study evaluated the association between glycemic status and coronary plaque volume change (PVC) using coronary computed tomography angiography (CCTA). METHODS: A total of 1296 subjects (61 ± 9, 56.9% male) who underwent serial CCTA with available glycemic status were enrolled and analyzed from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. The median inter-scan period was 3.2 (2.6-4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were categorized into the following groups according to glycemic status: normal, pre-diabetes (pre-DM), and diabetes mellitus (DM). RESULTS: During the follow-up, significant differences in PVC (normal: 51.3 ± 83.3 mm CONCLUSION: DM had an incremental impact on coronary PP, but pre-DM appeared to have no significant association with an increased risk of coronary PP after adjusting for confounding factors. CLINICAL TRIAL REGISTRATION: ClinicalTrials.govNCT02803411.

4 Article Consistency of quantitative analysis of coronary computed tomography angiography. 2019

Lee, Sang-Eun / Park, Hyung-Bok / Xuan, Dongchun / Lee, Byoung Kwon / Hong, Myeong-Ki / Jang, Yangsoo / Chang, Hyuk-Jae. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea. · Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea; Division of Cardiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea. · Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea. · Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. ·J Cardiovasc Comput Tomogr · Pubmed #30342980.

ABSTRACT: BACKGROUND: The present study aimed to assess the reliability and reproducibility of coronary computed tomography angiography (CCTA) for the serial quantitative assessment of plaque volume. METHODS: Patients who underwent repeated CCTA scans within 90 days were retrospectively screened and enrolled. Clinical data and CCTA imaging data were collected. Paired CCTA scans were analyzed using the quantitative method by separate observers blinded to the other paired CCTA scans. Results were compared between the index CCTA and follow-up CCTA. RESULTS: Paired CT scans of 95 patients (61 ± 13 years; 56.8% men) with same tube voltages (kVp) at both CCTAs and 24 patients (57 ± 19 years; 48.3% men) with different kVp at two CCTAs were analyzed. In patients with same kVp at both CCTAs, there were no difference in PV and PVs of each components in per-segment analysis and per-lesion analysis (all p > 0.05). In per-lesion analysis of CCTAs from patients who used different kVp between two CCTAs, lesion length, area and diameter stenosis, and PVs were not different between index and follow-up CCTAs (all p > 0.05). Segment length and PV were also showed no difference between two serial CCTAs in per-segment analysis. CONCLUSION: We showed the reproducibility and reliability of quantitative analysis of CCTA for assessment of coronary plaques. CCTA can be applied for the serial quantitative assessment of coronary artery disease progression, regardless of differences in the image acquisition protocol.

5 Article Impact of optimal glycemic control on the progression of coronary artery calcification in asymptomatic patients with diabetes. 2018

Won, Ki-Bum / Han, Donghee / Lee, Ji Hyun / Lee, Sang-Eun / Sung, Ji Min / Choi, Su-Yeon / Chun, Eun Ju / Park, Sung Hak / Han, Hae-Won / Sung, Jidong / Jung, Hae Ok / Chang, Hyuk-Jae. ·Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, South Korea. · Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea. · Division of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea. · Division of Radiology, Gangnam Heartscan Clinic, Seoul, South Korea. · Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, South Korea. · Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, South Korea. · Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, South Korea. Electronic address: hjchang@yuhs.ac. ·Int J Cardiol · Pubmed #29887457.

ABSTRACT: BACKGROUND: Data on the impact of optimal glycemic control (OGC) on the progression of coronary artery calcification, an important marker for future adverse cardiovascular events in individuals with diabetes are limited. METHODS: We investigated 1637 asymptomatic adults with diabetes (56 ± 8 years, 88.8% men) and no history of coronary artery disease or stroke, who underwent serial coronary artery calcium (CAC) screening. The median inter-scan period was 3.0 (2.0-4.4) years. The change in CAC was compared base on OGC status. OGC was defined as a follow-up hemoglobin A1C (HbA1C) of <7.0%, and CAC progression was defined by a square root (√) transformed difference between the baseline and follow-up CAC scores (Δ √transformed CAC) of ≥2.5. RESULTS: Despite no significant difference in the baseline CAC scores, the incidence of CAC progression was lower in the OGC group than in the non-OGC group (45.4% vs. 51.7%; p < 0.013). The two groups differed in the Δ √transformed (OGC, 3.8 ± 6.4; non-OGC, 4.7 ± 6.9; p = 0.016) and annualized Δ √transformed CAC (OGC, 1.1 ± 2.4; non-OGC, 1.4 ± 2.6; p = 0.010) scores. Subgroup analysis showed that OGC significantly reduced the risk of CAC progression in patients aged <65 years and in: smokers, and patients with a body mass index of <25 kg/m CONCLUSION: OGC attenuated the progression of coronary artery calcification in asymptomatic patients with diabetes.

6 Article Impact of Non-obstructive left main disease on the progression of coronary artery disease: A PARADIGM substudy. 2018

Weir-McCall, Jonathan R / Blanke, Philipp / Sellers, Stephanie L / Ahmadi, Amir A / Andreini, Daniele / Budoff, Matthew J / Cademartiri, Filippo / Chinnaiyan, Kavitha / Choi, Jung Hyun / Chun, Eun Ju / Conte, Edoardo / Gottlieb, Ilan / Hadamitzky, Martin / Kim, Yong Jin / Lee, Byoung Kwon / Lee, Sang-Eun / Maffei, Erica / Marques, Hugo / Pontone, Gianluca / Raff, Gilbert L / Shin, Sanghoon / Sung, Ji Min / Stone, Peter / Samady, Habib / Virmani, Renu / Narula, Jagat / Berman, Daniel S / Shaw, Leslee J / Bax, Jeroen J / Lin, Fay Y / Min, James K / Chang, Hyuk-Jae / Leipsic, Jonathon A. ·St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada. · St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. · Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. · Cardiovascular Imaging Center, IRCCS SDN Foundation, Naples, Italy. · Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA. · Busan University Hospital, Busan, South Korea. · Seoul National University Bundang Hospital, South Korea. · Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil. · Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. · Seoul National University College of Medicine, Seoul National University Hospital, South Korea. · Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy. · UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal. · National Health Insurance Service Ilsan Hospital, South Korea. · Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. · Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. · Department of Pathology, CVPath Institute, Gaithersburg, Maryland, USA. · Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA. · Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA. · St. Paul's Hospital & University of British Columbia, Department of Radiology, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca. ·J Cardiovasc Comput Tomogr · Pubmed #29802032.

ABSTRACT: BACKGROUND: The aim of the study is examine the impact of non-obstructive (<50%stenosis) left main (LM) disease on the natural history of coronary artery disease using serial coronary computed tomography angiography (CTA). METHODS: CTAs from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) study, a prospective multinational registry of patients who underwent serial CTA at a ≥2 year interval were analyzed. Those without evidence of CAD on their baseline scan were excluded, as were those with obstructive left main disease. Coronary artery vessels and their branches underwent quantification of: plaque volume and composition; diameter stenosis; presence of high-risk plaque. RESULTS: Of 944 (62 ± 9 years, 60% male) who had evidence of CAD at baseline, 444 (47%) had LM disease. Those with LM disease had a higher baseline plaque volume (194.8 ± 221mm3 versus 72.9 ± 84.3mm3, p < 0.001) and a higher prevalence of high-risk plaque (17.5% versus 13%, p < 0.001) than those without LM disease. On multivariable general linear model, patients with LM disease had greater annual rates of progression of total (26.5 ± 31.4mm3/yr versus 14.9 ± 20.1mm3/yr, p < 0.001) and calcified plaque volume (17 ± 24mm3/yr versus 7 ± 11mm3/yr, p < 0.001), with no difference in fibrous, fibrofatty or necrotic core plaque components. CONCLUSION: The presence of non-obstructive LM disease is associated with greater rates of plaque progression and a higher prevalence of high-risk plaque throughout the entire coronary artery tree compared to CAD without LM involvement. Our data suggests that non-obstructive LM disease may be a marker for an aggressive phenotype of CAD that may benefit from more intensive treatment strategies.

7 Article The relationship of insulin resistance estimated by triglyceride glucose index and coronary plaque characteristics. 2018

Won, Ki-Bum / Kim, Yun Seok / Lee, Byoung Kwon / Heo, Ran / Han, Donghee / Lee, Ji Hyun / Lee, Sang-Eun / Sung, Ji Min / Cho, Iksung / Park, Hyung-Bok / Cho, In-Jeong / Chang, Hyuk-Jae. ·Division of Cardiology, Ulsan University Hospital. · Division of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan. · Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine. · Division of Cardiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System. · Division of Cardiology, Chung-Ang University Hospital. · Division of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea. ·Medicine (Baltimore) · Pubmed #29794749.

ABSTRACT: The triglyceride glucose (TyG) index is a useful surrogate marker for insulin resistance, which is an important risk factor for coronary artery disease (CAD). However, data on the relationship of the TyG index and coronary plaque characteristics are limited.This study included 2840 participants with near-normal renal function who underwent coronary computed tomography angiography. CAD was defined as the presence of any plaques, and obstructive CAD was defined as the presence of plaques with ≥50% stenosis. The relationship between the TyG index and noncalcified plaque (NCP), calcified or mixed plaque (CMP), and coronary artery calcium score (CACS) was evaluated.All participants were stratified into 4 groups based on the quartiles of the TyG index. The prevalence of CAD and obstructive CAD significantly increased with increasing quartiles. The risk for NCP and obstructive NCP was not different among all groups. However, compared with group I (lowest quartile), the risk for CMP was higher in groups III (odds ratio [OR]: 1.438) and IV (highest quartile) (OR: 1.895) (P < .05), and that for obstructive CMP was higher in groups II (OR: 1.469), III (OR: 1.595), and IV (OR: 2.168) (P < .05). Multivariate regression analysis showed that the TyG index was associated with an increased risk for CAD (OR: 1.700), obstructive CAD (OR: 1.692), and CACS >400 (OR: 1.448) (P < .05).The TyG index was independently associated with the presence and severity of CAD due to an increased risk for CMP.

8 Article Evaluation of the impact of glycemic status on the progression of coronary artery calcification in asymptomatic individuals. 2018

Won, Ki-Bum / Han, Donghee / Lee, Ji Hyun / Lee, Sang-Eun / Sung, Ji Min / Choi, Su-Yeon / Chun, Eun Ju / Park, Sung Hak / Han, Hae-Won / Sung, Jidong / Jung, Hae Ok / Chang, Hyuk-Jae. ·Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, South Korea. · Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea. · Division of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea. · Division of Radiology, Gangnam Heartscan Clinic, Seoul, South Korea. · Department of Internal Medicine, Gangnam Heartscan Clinic, Seoul, South Korea. · Division of Cardiology, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, South Korea. · Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. · Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, South Korea. hjchang@yuhs.ac. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. hjchang@yuhs.ac. ·Cardiovasc Diabetol · Pubmed #29301531.

ABSTRACT: BACKGROUND: Data on the influence of glycemic status on the progression of coronary calcification, an important marker for future adverse cardiovascular events, are limited. METHODS: Data from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry on 12,441 asymptomatic Korean adults (52 ± 9 years, 84.2% males) without previous history of coronary artery disease and stroke, who underwent serial coronary artery calcification (CAC) screening examinations, were included in this study. The median inter-scan period was 3.0 (2.0-4.8) years. All participants were categorized into three groups based on their glycemic status: normal (n = 6578), pre-diabetes (n = 4146), and diabetes (n = 1717). CAC progression was defined as a difference ≥ 2.5 between the square roots (√) of the baseline and follow-up CAC scores. RESULTS: The incidence of CAC progression was significantly different between the three groups (normal, 26.3%; pre-diabetes, 30.9%; and diabetes, 46.9%; p < 0.001). In the univariate logistic analysis, the risk of CAC progression was higher in the pre-diabetes (odds ratio [OR] 1.253; 95% confidential interval [CI] 1.150-1.366) and diabetes (OR 2.471; 95% CI 2.215-2.758) groups than in the normal group (p < 0.001, both). In the multivariate logistic analysis, the risk of CAC progression was not significantly different between the normal and pre-diabetes groups but was significantly higher in the diabetes group than in the normal group. CONCLUSIONS: In asymptomatic subjects, diabetes had an incremental impact on CAC progression; however, pre-diabetes did not increase the risk of CAC progression after adjusting for confounding factors.

9 Article Rationale and design of the Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization: Relation to Cardiovascular Outcomes, Cost Effectiveness and Quality of Life (CONSERVE) trial. 2017

Lee, Sang-Eun / Lin, Fay Y / Lu, Yao / Chang, Hyuk-Jae / Min, James K. ·Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY. · Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Electronic address: hjchang@yuhs.ac. · Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY. Electronic address: jkm2001@med.cornell.edu. ·Am Heart J · Pubmed #28454832.

ABSTRACT: Although coronary computed tomography angiography (CCTA) has shown promise as a "gatekeeper" to invasive coronary angiography (ICA) in longitudinal cohort studies, it remains unknown whether the strategy of selective ICA by initial performance of CCTA is either safe or effective when compared with a direct ICA strategy in patients with an American Heart Association (AHA)/American College of Cardiology (ACC) guideline-directed indication for ICA. OBJECTIVES: The CONSERVE trial is a prospective randomized multicenter trial to determine the clinical effectiveness of "selective catheterization" vs "direct catheterization" strategies for stable patients with suspected but without known coronary artery disease, who meet AHA/ACC guideline indication for ICA. METHODS: Patients being referred for clinically indicated nonemergent ICA with an AHA/ACC class II guideline indication for ICA will be randomized to either direct catheterization or selective catheterization strategy. Patients in the direct catheterization arm will proceed directly to ICA as planned, whereas patients in the select catheterization arm will undergo initial CCTA, followed by ICA at the discretion of the site physician. All CCTAs and ICAs will be interpreted on site. Follow-up testing and/or therapy after CCTA or ICA will be at the discretion of the site physician. RESULTS: This trial will report a primary clinical end point of noninferiority rates of major adverse cardiac events, as defined by the composite of death, nonfatal myocardial infarction, unstable angina, stroke, urgent or emergent coronary revascularization, or cardiac hospitalization. CONCLUSION: The CONSERVE trial will determine whether selective catheterization strategy, based on initial CCTA in patients being referred to ICA, is safe and effective.

10 Article Chronic Kidney Disease in the Second-Generation Drug-Eluting Stent Era: Pooled Analysis of the Korean Multicenter Drug-Eluting Stent Registry. 2016

Lee, Joo Myung / Kang, Jeehoon / Lee, Euijae / Hwang, Doyeon / Rhee, Tae-Min / Park, Jonghanne / Kim, Hack-Lyoung / Lee, Sang Eun / Han, Jung-Kyu / Yang, Han-Mo / Park, Kyung Woo / Na, Sang-Hoon / Kang, Hyun-Jae / Koo, Bon-Kwon / Kim, Hyo-Soo. ·Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea. · Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul, Korea. · Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. · Department of Medicine, Seoul National University Hospital, Seoul, Korea; Molecular Medicine & Biopharmaceutical Science, Graduate School of Convergence Science & Technology, Seoul National University, Seoul, Korea. Electronic address: hyosoo@snu.ac.kr. ·JACC Cardiovasc Interv · Pubmed #27692820.

ABSTRACT: OBJECTIVES: The purpose of this study was to evaluate the clinical impact of chronic kidney disease (CKD) on clinical outcomes in contemporary practice of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DES). BACKGROUND: Although second-generation DES have improved the safety and efficacy issues in PCI, data regarding the performance of second-generation DES in patients with CKD are still limited. METHODS: We performed a patient-level pooled analysis on 12,426 patients undergoing PCI using second-generation DES from the Korean Multicenter Drug-Eluting Stent Registry. Endpoints were stent-oriented outcomes (target lesion failure [TLF]) and patient-oriented composite outcomes (POCO) during a median follow-up of 35 months. CKD patients were stratified by the estimated glomerular filtration rate (eGFR) from mild CKD to end-stage renal disease patients, and by the coexistence of diabetes mellitus (DM). RESULTS: A total of 2,927 patients had CKD (23.6%), who showed a significantly higher risk of TLF (adjusted hazard ratio [HR CONCLUSIONS: In the era of second-generation DES, CKD patients were at a significantly higher risk of clinical outcomes only in severe CKD and end-stage renal disease patients.

11 Article Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification. 2016

Cho, In-Jeong / Chang, Hyuk-Jae / Cho, Iksung / Heo, Ran / Lee, Sang-Eun / Shim, Chi Young / Hong, Geu-Ru / Chung, Namsik. ·Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. · Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea hjchang@yuhs.ac. ·J Am Heart Assoc · Pubmed #27107130.

ABSTRACT: BACKGROUND: The structure of the aorta is considered to influence exercise systolic blood pressure (SBP) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise SBP with adverse outcomes among elderly individuals. METHODS AND RESULTS: We retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease (CAD; luminal stenosis <50%) who underwent coronary computed tomography (CT) and exercise treadmill testing. ΔSBPstage2 and ΔSBPpeak were defined as the difference in systolic blood pressure (SBP) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score (TACS) and coronary artery calcium score (CACS) were measured using CT scanning procedures. The primary endpoints were defined as all-cause death, admission for heart failure, obstructive CAD requiring coronary intervention, and stroke. In multivariable models, ΔSBPstage2 and ΔSBPpeak were positively related with log(TACS+1), even after adjusting for various clinical variables, baseline SBP, and CACS (P<0.001). During a median follow-up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [HR], 1.12; 95% CI, 1.05-1.19; P<0.001), dyslipidemia (HR, 1.96; 95% CI, 1.14-3.37; P=0.015), and the 4th quartile of TACS (HR, 1.24; 95% CI, 1.03-1.49; P=0.024). Among individual events, the 4th quartile of TACS was the only independent predictor for stroke (HR, 2.15; 95% CI, 1.09-5.13; P=0.044), whereas CACS ≥400 mm(3) was an independent predictor for obstructive CAD requiring intervention (HR, 7.04; 95% CI, 1.58-31.36; P=0.010). CONCLUSIONS: Aortic calcification was related to SBP response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting SBP or CACS.

12 Article Combined ECG, Echocardiographic, and Biomarker Criteria for Diagnosing Acute Myocardial Infarction in Out-of-Hospital Cardiac Arrest Patients. 2015

Lee, Sang-Eun / Uhm, Jae-Sun / Kim, Jong-Youn / Pak, Hui-Nam / Lee, Moon-Hyoung / Joung, Boyoung. ·Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. · Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac. ·Yonsei Med J · Pubmed #26069108.

ABSTRACT: PURPOSE: Acute coronary lesions commonly trigger out-of-hospital cardiac arrest (OHCA). However, the prevalence of coronary artery disease (CAD) in Asian patients with OHCA and whether electrocardiogram (ECG) and other findings might predict acute myocardial infarction (AMI) have not been fully elucidated. MATERIALS AND METHODS: Of 284 consecutive resuscitated OHCA patients seen between January 2006 and July 2013, we enrolled 135 patients who had undergone coronary evaluation. ECGs, echocardiography, and biomarkers were compared between patients with or without CAD. RESULTS: We included 135 consecutive patients aged 54 years (interquartile range 45-65) with sustained return of spontaneous circulation after OHCA between 2006 and 2012. Sixty six (45%) patients had CAD. The initial rhythm was shockable and non-shockable in 110 (81%) and 25 (19%) patients, respectively. ST-segment elevation predicted CAD with 42% sensitivity, 87% specificity, and 65% accuracy. ST elevation and/or regional wall motion abnormality (RWMA) showed 68% sensitivity, 52% specificity, and 70% accuracy in the prediction of CAD. Finally, a combination of ST elevation and/or RWMA and/or troponin T elevation predicted CAD with 94% sensitivity, 17% specificity, and 55% accuracy. CONCLUSION: In patients with OHCA without obvious non-cardiac causes, selection for coronary angiogram based on the combined criterion could detect 94% of CADs. However, compared with ECG only criteria, the combined criterion failed to improve diagnostic accuracy with a lower specificity.

13 Article Paraoxonase 1 gene polymorphism does not affect clopidogrel response variability but is associated with clinical outcome after PCI. 2013

Park, Kyung Woo / Park, Jin Joo / Kang, Jeehoon / Jeon, Ki-Hyun / Kang, Si-Hyuck / Han, Jung-Kyu / Lee, Sang Eun / Yang, Han-Mo / Lee, Hae-Young / Kang, Hyun-Jae / Koo, Bon-Kwon / Oh, Byung-Hee / Park, Young-Bae / Kim, Hyo-Soo. ·Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea. ·PLoS One · Pubmed #23418418.

ABSTRACT: BACKGROUND: Paraoxonase (PON) is a high-density-lipoprotein (HDL) associated enzyme with antioxidative and anti-atherogenic property. Its function is associated with coronary artery disease and its activity genetically controlled. We evaluated whether genetic variation of PON-1 is associated with clinical outcome in a large cohort of Korean patients with drug-eluting stents implantation. METHODS: A total of 1676 patients with drug-eluting stent implantation were enrolled in the prospective CROSS-VERIFY cohort from June 2006 to June 2010. We genotyped the PON1-Q192R gene, measured clopidogrel on-treatment platelet reactivity (OPR), and analyzed lipid profiles. The primary endpoint was the composite of cardiac death, myocardial infarction, and stent thrombosis at 12 months. RESULTS: PON-1 genotyping data were available in 1336 patients. Since the Q-allele is associated with decreased PON-activity, we analyzed the outcome between patients with QQ/QR (815 patients, 61%) and those with RR-genotype (521 patients, 39%). After adjustment for common cardiac risk factors, the QQ/QR-genotype was an independent predictor of the primary thrombotic endpoint with an 11-fold increased risk (HR 11.6, 95% CI: 1.55-87.0), but not repeat revascularization (HR 1.12, 95% CI: 0.78-1.61). The QQ/QR-genotype was not associated with OPR (QQ/QR: 231±86 PRU vs. RR 236±82 PRU, p = 0.342) but higher small-dense LDL levels (1.20±0.12 mg/dL vs. 0.76±0.15 mg/dL, p = 0.027). The increased risk of thrombotic outcomes was more profound in acute coronary syndrome (ACS) patients compared with non-ACS patients. CONCLUSION: PON1 Q-allele is an independent predictor of worse cardiovascular outcome independent of platelet function and is associated with significantly higher levels of small dense LDL-C.