Korean Circulation Journal 대한심장학회지 순환기 Kim SH, et al. Korean Circ J. 2021 Jan;51(1):58-64. https://doi.org/10.4070/kcj.2020.0174

Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to improve cardiovascular outcomes and reduce the incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). We investigated the clinical outcomes with and without the use of SGLT2is in patients with T2DM and concomitant AF. Methods and results: We derived patient data from a clinical data warehouse constructed from the electronic medical records of seven medical centres. Data for 11 012 patients diagnosed with both AF and T2DM were analysed. New SGLT2i users were classified into the SGLT2i group and those who were not prescribed SGLT2is were classified into the control group. We performed a 1:2 propensity score (PS)-matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure (HF) events in 3 years. The PS-matched population consisted of 1115 patients in the SGLT2i group and 2050 patients in the control group. Incidence of the primary endpoint was significantly lower in the SGLT2i group [8.4 vs. 14.6%, hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.55–0.87]. Sodium-glucose cotransporter-2 inhibitors use was associated with significantly lower all-cause mortality (HR 0.43, 95% CI 0.29–0.67) and HF hospitalization (HR 0.77, 95% CI 0.59–0.99). Adverse renal events, defined as >50% increase in serum creatinine level or initiation of dialysis, occurred less often in the SGLT2i group (HR 0.50, 95% CI 0.38–0.66, P < 0.001). Conclusion: Use of SGLT2is in patients with T2DM and concomitant AF was associated with reduced mortality or HF hospitalization events.

Objective: Complete atrioventricular block (CAVB) in acute inferior ST-segment elevation myocardial infarction (STEMI) is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI) in patients with CAVB complicating acute inferior STEMI, at a single center. Methods: We enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB. Results: Baseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB) (P=0.702). Conclusion: We conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction.

Continuous cardiopulmonary monitoring is essential for improving treatment outcomes because it enables early detection of associated disease and the monitoring of disease status, while allowing medical personnel to intervene quickly and appropriately. However, conventional cardiopulmonary monitoring systems have unresolved problems, such as bulky and cumbersome monitoring devices with numerous cables and a lack of integrity between multiple stand-alone monitoring devices. These limitations increase the complexity of the clinical environment and lead to medical staff fatigue, which in turn affects the safety and quality of patient care. Here, we propose a modular-hybrid electronic system that integrates all wireless communication and biosignal sensing functions into a single device. The importance of the proposed system is also evident in the fabrication and integration of the proposed multimodal, flexible, and disposable sensor, which consists of a laser-induced graphene-based respiratory sensor, flexible Cu electrocardiogram electrodes, and a dual-wavelength photoplethysmography sensor. Several experiments were conducted to ensure the quality of the proposed system. The respiratory sensor fabricated by laser irradiation showed excellent sensitivity (1.59 kΩ·kPa ^-1 ) in the ultralow-pressure range, and the results of the laboratory experiment showed a high correlation between the electrocardiogram signal of the proposed system and that of the reference device (R=0.99). Moreover, in our pilot study conducted in an intensive care unit, the proposed system effectively detected cardiac arrhythmias, and the system was also used for postoperative follow-up monitoring. The proposed system is a promising candidate for accurate and unobstructed critical care and post-discharge monitoring.

Remote monitoring (RM) of cardiac devices has been widely used for over 10 years, even before telehealth became well-known.^1–6 Despite evidence of its efficacy and safety in other countries, the introduction of RM in Korea was delayed due to the conflict of opinions among experts from various fields and the unique National Health Insurance system. This study presents the outcome of the first RM experience in Korea.

Jung M, et al. Yonsei Med J. 2022 Oct;63(10):892-901. https://doi.org/10.3349/ymj.2022.0157