Kyunghee Lim

Background: Evidence comparing different diuretic doses within fixed-dose combinations (FDCs) remains limited. We evaluated telmisartan/chlorthalidone FDCs according to chlorthalidone dose in patients with blood pressure (BP) inadequately controlled on telmisartan monotherapy. Methods: In this randomized, double-blind trial, 254 patients with uncontrolled BP [sitting systolic blood pressure (SBP) ≥140 and <180 mm Hg; sitting diastolic blood pressure (DBP) <110 mm Hg] after a telmisartan run-in period were randomized (1:1:1) to receive either telmisartan/chlorthalidone FDCs (40/12.5 or 40/6.25 mg), or telmisartan 40 mg for 8 weeks. The primary endpoint was the change in sitting SBP from baseline to Week 8. Results: At Week 8, telmisartan/chlorthalidone FDCs demonstrated greater reductions in sitting SBP compared with telmisartan ­monotherapy: least-squares mean differences were −9.5 mm Hg [95% CI, −13.5 to −5.6] for the 40/12.5 mg and −6.1 mm Hg [95% CI, −10.4 to −1.9] for the 40/6.25 mg. BP control rates (target BP: SBP/DBP <140/90 mm Hg, or <130/80 mm Hg in patients with albuminuric chronic kidney disease or established cardiovascular disease) at Week 8 also favored telmisartan/chlorthalidone FDCs over telmisartan monotherapy (53.2% for the 40/12.5 mg and 43.0% for the 40/6.25 mg vs 32.9% for telmisartan 40 mg). Safety profiles were comparable among treatment groups. Conclusions: In patients inadequately controlled on telmisartan alone, FDCs of telmisartan with 2 different doses of chlorthalidone provided greater BP reduction than telmisartan monotherapy without increased safety risk, supporting its role as an effective and well-tolerated treatment option. Clinical Trial Registration: ClinicalTrials.gov, NCT06291207.

Jong-Sung Park, Ph.D., Kyung Hee Lim, M.D., Dae-Hyun Kim, M.D., Kwang-Min Lee, Ph.D., Kwang-Sook Woo, M.D., and Jin-Yeong Han, Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2025.0144

Background: Diagnosis of epicardial coronary artery spasm, which is considered the cause of vasospastic angina, can be achieved through the coronary angiography (CAG) with a pharmacologic provocation test. However, this procedure is thought to have a potential risk of complications. Although multi-detector computed tomography coronary angiography (MDCTA) is proposed as the alternative test for the diagnosis of spastic coronary artery, myocardial ischaemia does not always coincide with coronary artery stenosis. MDCTA combined with echocardiographic left ventricular global longitudinal strain (LV GLS) is an innovative non-invasive diagnostic method expected to detect multivessel coronary artery spasm in patients with vasospastic angina. Case summary: We report two cases of vasospastic angina caused by multivessel coronary artery spasm, which were confirmed using MDCTA and echocardiographic LV GLS. Discussion: In patients with suspected vasospastic angina, MDCTA and echocardiographic LV GLS during spontaneous attacks could be used to document the coronary artery vasospasm and associated myocardial ischaemia. These non-invasive diagnostic techniques could be considered a new alternative for patients with suspected vasospastic angina who exhibit certain characteristics, such as nitrate-responsive and resting chest pain and no history of significant coronary atherosclerosis. This approach may be particularly useful when these patients present to the emergency department during a spontaneous vasospasm.

Lim KH, et al. Korean Circ J. 2025 May;55:e95. https://doi.org/10.4070/kcj.2025.0124

Atrial fibrillation (AF) is linked to an increased risk of dementia, even in stroke-free patients. The impact of statin therapy on dementia risk is unclear in AF patients receiving oral anticoagulant (OAC) (vitamin K antagonist and direct-acting oral anticoagulant). We sought to investigate the impact of statin therapy on dementia risk in AF patients receiving OAC. Using the Korean National Health Insurance Service database, 91 018 non-valvular AF (NVAF) patients from January 2013 to December 2017 were included in the analysis. Of the total, 17 700 patients (19.4%) were in the statin therapy group, and 73 318 patients (80.6%) were in the non-statin therapy group. The primary endpoint was the occurrence of dementia. The median duration of follow-up was 2.1 years. Statin therapy was associated with a significantly lower dementia risk than non-statin therapy for CHA₂DS₂-VASc scores ≥ 2 (HR = 0.77, 95% CI 0.64–0.90, p = 0.026) in NVAF patients receiving OAC. The statin therapy group had a significantly lower dementia risk in a dose-dependent relationship compared with the non-statin therapy group (p for trend < 0.001). In NVAF patients who received OAC, statin therapy lowered the dementia risk compared with no statin therapy. Furthermore, statin therapy is associated with a dose-dependent reduction in dementia risk.

Background: Vasospastic angina (VSA) is characterized by chest pain at rest with transient ischemic electrocardiographic changes in the ST segment, and a prompt response to nitrates. Vasospastic angina is among the most frequent of the coronary artery diseases in Asia, and coronary computed tomography angiography (CCTA) may become available as a non-invasive diagnosis method. Methods: We prospectively enrolled 100 patients with suspected vasospastic angina at two centers from 2018 to 2020. All patients underwent baseline CCTA without a vasodilator in the early morning followed by catheterized coronary angiography and spasm testing. CCTA with intravenous infusion of nitrate (IV) was repeated within 2 weeks of baseline CCTA. Vasospastic angina as detected by CCTA was defined as significant stenosis (≥50%) with negative remodeling without definite plaques or diffuse small diameter (n = 36; probable positive, n = 18; positive, n = 31). The diagnostic accuracy in terms of CCTA per patient had a sensitivity of 55% (95% CI, 40–69), specificity of 89% (95% CI, 74–97), positive predictive value (PPV) of 87% (95% CI, 72–95), and negative predictive value (NPV) of 59% (95% CI, 51–67). Conclusions: Dual-acquisition CCTA can support the non-invasive detection of vasospastic angina with relatively good specificity and PPV. CCTA was helpful for non-invasive screening of variant angina.

학술논문검색사이트 KISS는 학술논문,연구논문,연구자료,학술지 등 다양한 자료를 서비스하며, 주제별, 등재별, 인용지수, 인기논문, 이슈논문 등 다양한 키워드의 논문을 제공하여 빠른 학술검색 및 인용이 가능하도록 서비스합니다.

Lim KH, et al. J Korean Med Sci. 2022 Oct;37(42):e306. https://doi.org/10.3346/jkms.2022.37.e306

Objectives: The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI).Methods: Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort.Results: In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI.Conclusions: A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.