Sung-A Chang

Park I, et al. Korean Circ J. 2027 ;57:e66. https://doi.org/10.4070/kcj.2025.0513

Kim D, et al. Korean Circ J. 2027 ;57:e5. https://doi.org/10.4070/kcj.2025.0440

We report a 62‐year‐old man with myelodysplastic syndrome on immunosuppressive therapy who presented with right lung consolidation and neutropenia. Despite broad antimicrobial therapy for presumed pneumonia, negative microbiologic studies including bronchoalveolar lavage, and a nondiagnostic transbronchial biopsy, serial computed tomography (CT) scans showed progressive right‐sided consolidation, pleural effusion and CT signs of pulmonary hypertension. A routine contrast‐enhanced CT revealed a filling defect in the right pulmonary artery (PA). Dedicated CT pulmonary angiography confirmed persistent unilateral PA obstruction; together with pulmonary hypertension and a lack of improvement despite anticoagulation, this raised concern for chronic thromboembolic disease and PA malignancy. Fluorodeoxyglucose positron emission tomography (FDG PET) CT demonstrated mildly heterogeneous FDG uptake (SUV _max 2.9) favouring thrombus, and endobronchial ultrasound‐guided transbronchial needle aspiration yielded necrotic thrombotic material. Pulmonary endarterectomy, performed after interval clinical worsening, confirmed a chronic organizing septic thrombus. Weeks later, haemorrhagic infarction caused massive haemoptysis requiring wedge resection of the lung. This case highlights a rare septic thrombus in a unilateral PA leading to pulmonary infarction in an immunocompromised host.

Pulmonary hypertension (PH) during pregnancy remains a high-risk clinical condition because normal gestational cardiovascular adaptation may exceed the reserve of the right ventricular (RV)-pulmonary circulation unit. Pregnancy is characterized by progressive increases in plasma volume, heart rate, stroke volume, and cardiac output, together with a reduction in systemic vascular resistance. These changes become particularly hazardous during labor, delivery, and the early postpartum period, when abrupt shifts in preload, venous return, and filling pressures may precipitate RV failure, hypoxemia, arrhythmia, or circulatory collapse. However, pregnancy-related risk in PH is heterogeneous and depends on the underlying PH phenotype, pulmonary vascular disease severity, RV function, oxygenation, and access to expert multidisciplinary care. This review summarizes the hemodynamic challenges of pregnancy in women with PH, phenotype-specific maternal and fetal risks, contemporary outcome data, treatment considerations, delivery planning, and postpartum management. Particular emphasis is placed on the first 24 to 72 h postpartum as a vulnerable period of hemodynamic stress and on the role of imaging, particularly echocardiographic surveillance, in identifying maladaptive RV responses and guiding timely escalation of care.

Purpose: To evaluate the prevalence and cardiac CT features of inferior left atrial diverticula (ILAD) communicating with the right atrium (RA) or inferior vena cava (IVC), a novel type of interatrial communication. Materials and Methods: This retrospective study included 11,512 consecutive patients who underwent cardiac CT. CT features and prevalence of ILAD communicating with the RA or IVC were analyzed. Shunts were defined as anatomical defects between the two structures with or without visible contrast flow. In a subset of the patients we compared interatrial septal aneurysm (n = 20) and ILAD without shunt (n = 66), assessing the involvement of a wedge-like fatty space bordered by both atria, IVC and coronary sinus. Results: There were 33 patients (19 males and 14 females; aged 59.8 ± 11.2 years; age range, 18–87 years) with ILAD with shunts (ILADSs). The prevalence of ILADSs was 4.2% (33/783) among ILAD and 0.3% (33/11,512) among all patients. Maximal dimensions of ILAD were 17.6 ± 9.9 mm (range, 5.3–41.0 mm). Mean ostial diameters of ILAD and mean sizes of shunts were 6.2 ± 5.6 mm and 3.2 ± 2.9 mm, respectively. Shunts were larger than 5 mm in 6 patients (15.2%) and larger than 3 mm in 10 patients (30.3%). In 30 patients who underwent transthoracic echocardiography, ILADSs were not identified at echocardiography. CT showed involvement of the wedge-like fatty space for all ILAD and for no cases with interatrial septal aneurysm. Conclusions: Cardiac CT enables detection of incidental ILADSs unrecognized at echocardiography.

Sooho Yu, M.D., M.S., Min-Seung Park, M.D., Ph.D., Hyun-Young Kim, M.D., Ph.D., Taek Kyu Park, M.D., Ph.D., Sung-A Chang, M.D., Ph.D., Duk Kyung Kim, M.D., Ph.D., and Hee-Jin Kim, M.D., Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2026.0053

BACKGROUND: Moderate aortic stenosis (AS) poses a substantial risk for adverse outcomes, yet its prognostic determinants and cardiac remodeling markers remain underexplored. This study aimed to evaluate prognostic factors, including left atrial strain, and their predictive value for adverse cardiac events in patients with moderate AS. METHODS: A retrospective cohort study included 1125 patients diagnosed with moderate AS between 2008 and 2019. Cardiac remodeling indices, including left atrial reservoir strain (LARS) and left ventricular global longitudinal strain, were assessed using speckle-tracking echocardiography. The primary outcome was cardiac death, while the secondary outcome was a composite of cardiac death or heart failure hospitalization. RESULTS: Among the study population (median age, 74 years; 47.2% women), the Kaplan-Meier–estimated 5-year rates of cardiac mortality and the composite outcome were 16.7% and 33.9%, respectively, during a median follow-up of 42.8 months. Of the cardiac remodeling indices evaluated, LARS emerged as the most sensitive and independent predictor of cardiac death (adjusted hazard ratio, 0.948 per 1% increase; P =0.003) and the composite outcome (adjusted hazard ratio, 0.940 per 1% increase; P P =0.024). Furthermore, among all cardiac remodeling parameters analyzed, LARS showed the highest predictive performance for the composite outcome (C-index, 0.586 [95% CI, 0.541–0.632]) compared with other parameters. CONCLUSIONS: LARS is a sensitive and independent prognostic marker in moderate AS, reflecting cardiac remodeling. Regular assessment of left atrial strain could enhance risk stratification and guide clinical management strategies in patients with moderate AS.

Kwak S, et al. Korean Circ J. 2026 ;56:e67. https://doi.org/10.4070/kcj.2025.0393

Background: Identifying the potential cause of embolic stroke of undetermined source is essential for secondary prevention. We analyzed retrospectively collected real‐world data from the South Korean cohort with embolic stroke of undetermined source to examine trends in baseline characteristics, diagnostic practices, and secondary prevention strategies and to identify cardioembolic factors and supracardiac atherosclerotic lesions associated with stroke recurrence. Methods: We analyzed 5787 patients from the Real‐World Study of Embolic Stroke of Undetermined Source cohort from 19 South Korean stroke centers (2014–2019). Baseline characteristics, diagnostic and secondary prevention trends were evaluated. Factors associated with 1‐year stroke recurrence were identified using multivariable Cox regression analysis in 4036 patients with follow‐up data. Results: Over 6 years, vascular risk factors and cardioembolic evaluations significantly increased. Stroke recurrence was strongly associated with intracranial nonrelevant stenosis involving ≥2 vessels (hazard ratio [HR], 2.756, P P =0.033), atrial septal aneurysm (HR, 4.741, P =0.005), and serum creatinine levels (HR, 1.166, P =0.008). In patients without moderate‐risk cardioembolic sources, a single intracranial nonrelevant stenosis and complex aortic atheroma were also linked to stroke recurrence. Conclusions: Intracranial nonrelevant stenosis and complex aortic atheroma, along with cardioembolic factors like paroxysmal atrial fibrillation and atrial septal aneurysm, are key predictors of stroke recurrence in embolic stroke of undetermined source, especially those without moderate‐risk cardioembolic sources. These findings emphasize the need to consider both supracardiac atherosclerotic and cardioembolic mechanisms in embolic stroke of undetermined source and to develop tailored secondary prevention strategies for atherosclerotic stroke, particularly in cases with supracardiac atherosclerotic lesions to reduce stroke recurrence.

Hyun-Young Kim, M.D., Ph.D., Jae Joon Lee, M.D., Ph.D., Min-Seung Park, M.D., Ph.D., Chang-Hun Park, M.D., Ph.D., Taek Kyu Park, M.D., Ph.D., Sung-A Chang, M.D., Ph.D., and Hee-Jin Kim, M.D., Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2025.0543