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Background and Objectives: Few comparative studies have evaluated wearable single-lead electrocardiogram (ECG) devices and standard multi-lead ECG devices during exercise testing. This study aimed to validate the accuracy of a wearable single-lead ECG monitor for recording heart rate (HR) metrics during graded exercise tests (GXTs). Methods: A cohort of 50 patients at a tertiary hospital underwent GXT while simultaneously being equipped with wearable single- and conventional multi-lead ECGs. The concordance between these modalities was quantified using the intraclass correlation coefficient and Bland–Altman plot analysis. Results: The minimum and average HR readings between the devices were generally consistent. Parameters such as ventricular ectopic beats and supraventricular ectopic beats showed strong agreement. However, the agreement for the Total QRS and Maximum RR was not sufficient. HR measurements across different stages of the exercise test showed sufficient agreement. Although not statistically significant, the standard multi-lead ECG devices exhibited higher noise levels compared to the wearable single-lead ECG devices. Conclusions: Wearable single-lead ECG devices can reliably monitor HR and detect abnormal beats across a spectrum of exercise intensities, offering a viable alternative to traditional multi-lead systems.

Background We investigated the association between individual components of metabolic syndrome (MetS) and left ventricular (LV) geometric changes, including diastolic dysfunction, in a large cohort of healthy individuals. Methods Overall, 148 461 adults who underwent echocardiography during a health‐screening program were enrolled. Geographic characteristics on echocardiography and several markers of LV relaxation function were identified according to individual MetS components. Univariate linear regression analysis and a multivariate regression model adjusted for factors known to influence LV relaxation function were conducted. Results The prevalence of LV diastolic dysfunction (LVDD) was higher in the MetS group than in the non‐MetS group (0.56% vs. 0.27%, p < .001). In univariate and multivariate analyses, E/A ratio, e′ velocity, and left atrial volume index were significantly associated with each component of MetS and covariates (all p ≤ .001). In the age‐ and sex‐adjusted model, MetS was significantly associated with LVDD (odds ratio [95% confidence interval], 1.350 [1.103, 1.652]). However, subjects with more MetS components did not have a significantly higher risk of LVDD. As the analysis was stratified by sex, the multivariate regression model showed that MetS was significantly associated with LVDD only in men (1.3 [1.00, 1.68]) with higher risk in more MetS component (p for trend < .001). In particular, triglyceride (TG) and waist circumference (WC) among MetS components were significantly associated with LVDD in men. Conclusions MetS was associated with the risk of LVDD, especially in men, with a dose‐dependent association between an increasing number of components of MetS and LVDD. TG and WC were independent risk factors for LVDD in men.

Studies comparing efficacy and safety of moderate-intensity statin plus ezetimibe versus high-intensity statin in patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (T2DM) are scarce. In this multicenter non-inferiority randomized trial, 223 ASCVD patients with T2DM were randomly assigned to receive either rosuvastatin 20 mg once daily or single-pill combination of rosuvastatin 10 mg plus ezetimibe 10 mg once daily for 24 weeks. Laboratory parameters and clinical events were evaluated at 12 and 24 weeks. Primary efficacy endpoint was the least square mean percent (LSM %) change of low-density lipoprotein cholesterol (LDL-C) level at 24 weeks from baseline. At 24 weeks, the LDL-C LSM % change from baseline was − 13.5 in the high-intensity rosuvastatin group and − 20.5 in the combination group, with the between-group difference remaining within the predefined non-inferiority margin ( p  = 0.06). Decrease in apolipoprotein B level at 24 weeks from baseline was significantly greater in the combination group than in the high-intensity rosuvastatin group (−15.6% vs. −9.9%, p -value = 0.008). Rates of achieving LDL-C < 55 mg/dL were higher in the combination group than in the high-intensity rosuvastatin group, with a significant difference at 12 weeks ( p  = 0.01), though the difference at 24 weeks was not statistically significant ( p  = 0.09). Incidence of total adverse events was lower in the combination groups than in the high-intensity rosuvastatin group ( p  = 0.048). Single-pill combination of moderate-intensity rosuvastatin plus ezetimibe was non-inferior to high-intensity rosuvastatin in LDL-C lowering efficacy with good safety profile in ASCVD patients with T2DM.

Background Data on whether physical activity (PA) levels are related to nonalcoholic fatty liver disease (NAFLD) when considering body mass index (BMI) are scarce. We assessed whether PA affects the development or resolution of NAFLD in conjunction with BMI changes. Methods Overall, 130,144 participants who underwent health screening during 2011–2016 were enrolled. According to the PA level in the Korean version of the validated International PA Questionnaire Short Form, participants were classified into the inactive, active, and health-enhancing PA (HEPA) groups. Results In participants with increased BMI, the hazard ratio (HR) and 95% confidence interval after multivariable Cox hazard model for incident NAFLD was 0.97 (0.94–1.01) in the active group and 0.94 (0.89–0.99) in the HEPA group, whereas that for NAFLD resolution was 1.03 (0.92–1.16) and 1.04 (0.88–1.23) (reference: inactive group). With increased BMI, high PA affected only new incident NAFLD. PA enhancement or maintenance of sufficient PA prevented new incident NAFLD. In participants with decreased BMI, the HRs were 0.98 (0.90–1.07) and 0.88 (0.78–0.99) for incident NAFLD and 1.07 (0.98–1.17) and 1.33 (1.18–1.49) for NAFLD resolution in the active and HEPA groups, respectively. With decreased BMI, high PA reduced incident NAFLD and increased NAFLD resolution. Maintenance of sufficient PA led to a considerable resolution of NAFLD. Conclusion In this large longitudinal study, PA prevented incident NAFLD regardless of BMI changes. For NAFLD resolution, sufficient PA was essential along with BMI decrease. Maintaining sufficient PA or increasing the PA level is crucial for NAFLD prevention or resolution.

End-stage heart failure patients with implantable cardioverter-defibrillator (ICD) with/without cardiac resynchronization therapy (CRT-D) often require heart transplantation (HTPL) as a last-resort treatment. We aimed to assess the frequency and clinical impact of retained ICD lead materials in HTPL patients. In this retrospective single center study, we examined the clinical records and chest radiographs of patients with ICD and CRT-D who underwent HTPL between January 1992 and July 2014. Of 40 patients with ICD and CRT-D at HTPL, 19 (47.5%) patients had retained ICD lead materials within the central venous system. Retained ICD lead materials following HTPL were more frequently noted in patients with longer implantation durations until HTPL. None of the patients underwent extraction procedures after HTPL. All patients were asymptomatic and did not exhibit significant complications or death related to the retained ICD lead materials. Seven (7/40, 17.5%) patients without any retained ICD lead materials underwent magnetic resonance imaging (MRI) during the follow-up period (median, 29.5 months); none of the patients with retained lead materials were given MRI. Considering the common use of MRI in HTPL patients, further studies on the prophylactic extraction of retained ICD lead materials and safety of MRI in these patients are needed.

Background: The prognostic impact and predictors of NOAF in HF patients are not fully elucidated. This study aims to determine whether new-onset atrial fibrillation (NOAF) affects patient outcome and investigate predictors of atrial fibrillation (AF) in acute heart failure (HF) patients using real-world data. Methods: The factors associated with NOAF in 2894 patients with sinus rhythm (SR) enrolled in the Korean Acute Heart Failure (KorAHF) registry were investigated. Survival was analyzed using AF as a time-dependent covariate. Relevant predictors of NOAF were analyzed using multivariate proportional hazards models. Results: Over 27.4 months, 187 patients developed AF. The median overall survival time was over 48 and 9.9 months for the SR and NOAF groups, respectively. Cox regression analysis with NOAF as a time-dependent covariate showed a higher risk of death among patients with NOAF. Multivariate Cox modeling showed that age, worsening HF, valvular heart disease (VHD), loop diuretics, lower heart rate, larger left atrium (LA) diameter, and elevated creatinine levels were independently associated with NOAF. Risk score indicated the number of independent predictors. The incidence of NOAF was 2.9%, 9.4%, and 21.8% in the low-risk, moderate-risk, and high-risk groups, respectively (p < 0.001). Conditional inference tree analysis identified worsening HF, heart rate, age, LA diameter, and VHD as discriminators. Conclusions: NOAF was associated with decreased survival in acute HF patients with SR. Age, worsening HF, VHD, loop diuretics, lower heart rate, larger LA diameter, and elevated creatinine could independently predict NOAF. This may be useful to risk-stratify HF patients at risk for AF.

Background: Carotid intima-media thickness (IMT) is a noninvasive surrogate marker of subclinical atherosclerosis and cardiovascular disease risk. This study explored IMT distribution across three carotid artery segments in a large cohort of healthy individuals and identified the key factors associated with increased IMT. Methods: This study utilized data from the Kangbuk Samsung Health Study, a cohort of South Korean adults aged ≥ 18 years who underwent comprehensive annual or biennial health examinations. The analysis included 86,351 healthy individuals, excluding those with known carotid disease. IMT was measured using high-resolution B-mode ultrasonography across the three segments: common carotid artery (CCA), carotid bulb, and internal carotid artery (ICA). An increased IMT was defined as a measurement of ≥1.5 mm in any segment. Multivariable linear regression analyses were conducted to identify independent predictors of increased IMT. Results: The study population had a mean age of 46.7 years and was predominantly male (69.7%). The prevalence of thickened IMT was the highest in the carotid bulb, followed by the ICA and CCA. IMT increased progressively with age and was higher in males across all segments, with the disparity becoming more pronounced after 65 years of age. The carotid bulb displayed the largest absolute IMT values, whereas the ICA exhibited a sharper age-related increment. Increased CCA IMT was strongly linked to hypertension (beta, 0.11; p < 0.001) and diabetes mellitus (beta, 0.12; p < 0.001). Both CCA and ICA IMT showed a weak but significant association with dyslipidemia (beta, 0.03; p < 0.001). Conclusions: The IMT distribution and its determinants vary across carotid segments. CCA is a robust marker of systemic vascular health, whereas the carotid bulb is the most sensitive marker for detecting early atherosclerotic changes. This study provides novel insights into segment-specific IMT patterns and their association with cardiovascular risk factors in a large, healthy Asian population.

Objective: The aim of this study was to develop, compare, and validate models for predicting cardiovascular disease (CVD) mortality and hospitalization with hypertension using a conventional statistical model and a deep learning model. Methods: Using the database of Korean National Health Insurance Service, 2,037,027 participants with hypertension were identified. Among them, CVD (myocardial infarction or stroke) death and/or hospitalization that occurred within one year after the last visit were analyzed. Oversampling was performed using the synthetic minority oversampling algorithm to resolve imbalances in the number of samples between case and control groups. The logistic regression method and deep neural network (DNN) method were used to train models for assessing the risk of mortality and hospitalization. Findings: Deep learning-based prediction model showed a higher performance in all datasets than the logistic regression model in predicting CVD hospitalization (accuracy, 0.863 vs. 0.655; F1-score, 0.854 vs. 0.656; AUC, 0.932 vs. 0.655) and CVD death (accuracy, 0.925 vs. 0.780; F1-score, 0.924 vs. 0.783; AUC, 0.979 vs. 0.780). Interpretation: The deep learning model could accurately predict CVD hospitalization and death within a year in patients with hypertension. The findings of this study could allow for prevention and monitoring by allocating resources to high-risk patients.

Cobalt-induced cardiomyopathy is a well-known but uncommon disease, and the physician must maintain a high index of suspicion in order to make a timely diagnosis. We report two patients with cobalt-induced cardiomyopathy. Both patients developed progressively worsening symptoms of cobalt toxicity following revision of a fractured ceramic-on-ceramic total hip replacement to a metal-on-polyethylene bearing. In both patients, echocardiography showed LV hypertrophy, biventricular systolic dysfunction, and a large amount of pericardial effusion. Due to decompensated heart failure, both patients were initially considered candidates for heart transplantation. One patient was diagnosed with cobalt-induced cardiomyopathy before transplantation. He received cobalt chelation therapy and revision surgery, which led to complete recovery of heart function. In the other patient, the diagnosis was not made until the time of heart transplantation. The gross examination of the explanted heart revealed typical features of cobalt cardiotoxicity, which was then diagnosed as cobalt-induced cardiomyopathy. These cases emphasise the importance of early diagnosis and prompt treatment of cobalt intoxication.

Fatty liver (FL), insulin resistance (IR) and obesity often coexist, but data on the independent impacts of these factors on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are scarce. We examined the impact of FL, IR and obesity on NT-proBNP levels using a large set of cross-sectional data. The associations of FL, IR and obesity with NT-proBNP were analyzed in 39,923 healthy adult participants. IR was estimated using a homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. A multivariable regression model was conducted to identify associations between NT-proBNP and FL on abdominal ultrasound. FL, IR and obesity showed independent inverse associations with NT-proBNP after multiple adjustments for baseline characteristics. In a multivariable regression model adjusting for IR and obesity, FL was independently associated with lower levels of NT-proBNP (estimates, Exp(β) 0.864, 0.849–0.880). The combination of FL and IR was a powerful dual indicator, lowering NT-proBNP levels approximately 25% in the generally healthy study population. In conclusion, FL was independently associated with lower NT-proBNP levels. FL and a high HOMA-IR index are a powerful indicator combination for lower NT-proBNP levels. Further research is needed to elucidate the mechanism underlying the association between FL and NT-proBNP.