Prognostic Value of Normal Exercise Echocardiography in Postmenopausal Women

BACKGROUND AND OBJECTIVES: Coronary artery disease (CAD) is the leading cause of death in postmenopausal women, and exercise echocardiography was reported to be a useful noninvasive test for diagnosis of CAD and risk-stratification in the era of fundamental echocardiographic imaging. This study was performed to determine whether normal findings on exercise echocardiography using advanced imaging equipments such as harmonic imaging provide useful data on prognosis in postmenopausal women with chest pain. METHOD: The study population consisted of 102 patients with postmenopausal women who were proven to be normal on exercise echocardiography from August 1997 to January 1999. Patients were followed up for a mean duration of 3.5 years. These patients were classified into 3 groups on existence of risk factors; low-risk, moderate-risk, high-risk. End points during follow-up were all-cause mortality and cardiac events (cardiac death, nonfatal myocardial infarction and coronary revascularization). We studied the prognostic value of exercise echocardiography in 102 patients of postmenopausal women with chest pain (mean age 59+/-6 years). RESULT: Of these 102 patients, 1 patient (0.1%) among the high-risk group underwent coronary revascularization and 2 patients (1.9%) among low- and moderate-risk group died of non-cardiac reasons. No cardiac deaths or nonfatal myocardial infarction were reported. According to risk group classification, there was no difference in major adverse cardiac events between each risk groups. ST segment change on exercise electro-cardiography was observed in 7 patients (7%). CONCLUSION: Normal results on exercise echocardiography using harmonic imaging in postmenopausal women with chest pain is a good method of predicting long-term prognosis.

Factors Influencing the Improvement of Left Ventricular Systolic Function in Patients with Idiopathic Dilated Cardiomyopathy

BACKGROUND AND OBJECTIVES: Idiopathic dilated cardiomyopathy (IDC) is a disease entity with no known specific curative measures. However, significant improvement in the left ventricular (LV) systolic function, during the management course for IDC, is frequently observed. In this study we tried to ascertain associated factors for the improvement of the LV function in patients with IDC. SUBJECTS AND METHODS: Thirty-three patients, newly diagnosed as IDC between Jan. 1999 and Jan. 2001, on whom a 6-month follow-up echocardiography was performed, were included in the study. Improvement in the LV systolic function was defined as an increase in the LV ejection fraction greater than 10% from the baseline. The subjects were divided into two groups; the improved group (IG) and the unimproved group (UG). The clinical characteristics and management methods were evaluated, and compared between the two groups. RESULTS: Seventeen patients (M/F:15/2) were included in the IG, and 16 (M/F:7/9) were included in the UG. There were no significant differences in the baseline LV systolic function (IG:23.4+/-1.5% vs. UG:28.9+/-2.3%), age, NYHA functional class or resting heart rate on admission between the two groups. b-blocker therapy (p=0.002), the absence of diabetes mellitus (p=0.046) and male sex (p=0.007), were all significantly associated with an improvement in the LV systolic function from the univariate analyses. With the multivariate analyses, only b-blocker therapy was significantly associated with an improvement in the LV systolic function. The 6-month event-free survival rate was significantly better in the IG compared with UG (94+/-5% vs. 63+/-13%, p=0.031). CONCLUSION: b-blocker therapy exerts a considerable effecs on the improvement in the LV systolic function of patients with IDC.

Analysis of P Wave Signal-Averaged Electrocardiogram in Patients with Paroxysmal Atrial Fibrillation

BACKGROUND AND OBJECTIVES: The diagnosis of paroxysmal atrial fibrillation (PAF) and the prediction of its recurrence are sometimes difficult. There have been several recent studies attempting to detect patients at risk for PAF while in sinus rhythm by using the P wave signal-averaged ECG. We undertook to define an appropriate technique of P wave signal-averaged ECG and to estimate the reproducibility of the test. Additionally, we estimated the usefulness of P wave signal-averaged ECG in patients at risk for PAF. SUBJECTS AND METHODS: Forty-five patients with PAF were included in the study undertaken between March 1997 and June 1998. Twelve-lead surface ECG and P wave signal-averaged ECG were performed in the patients. The total P wave duration was measured by the P wave signal-averaged ECG using P wave template and least-square fit filter. The same process was followed in forty sex- and age-matched controls. RESULTS: The measurement of P wave duration with P wave signal-averaged ECG was highly reproducible. The measured P wave duration showed significant prolongation in the patient group at cutoff frequencies of 20 Hz and 30 Hz (123.6+/-15.3 vs. 114.8+/-14.5 msec, p=0.009 at 20 Hz, 120.1+/-17.8 vs. 107.5+/-18.8 msec, p=0.002 at 30 Hz). An abnormal P wave duration defined as over 120 msec in duration by P wave signal-averaged ECG was able to detect PAF with a sensitivity of 60%, specificity of 73%, positive predictive value of 71%, and a negative predictive value of 62%. CONCLUSION: A prolonged P wave duration as measured by P wave signal-averaging technique may be a simple noninvasive marker of risk for the development of atrial fibrillation.

Changes of Heart Rate Variability in Patients with Postmenopausal Syndrome after Hormonal Replacement Treatment

BACKGROUND AND OBJECTIVES: Climacteric women often suffer from vasomotor symptoms. These symptoms are thought to be related to an imbalance of autonomic control of the cardiovascular system and are effectively controlled with hormonal replacement therapy. Heart rate variability (HRV) reflects the autonomic integration of the cardiovascular system. In this study, we attempted to compare the HRV indices of postmenopausal women before and after hormonal replacement therapy. SUBJECTS AND METHODS: Eighteen patients with postmenopausal syndrome (mean age:53+/-4 years) received estrogen and/or progesterone replacement therapy. They underwent 24-hour ambulatory electrocardiographic monitoring at baseline and after the early period of therapy (mean:112+/-19 days) and eleven patients underwent the examination after the later period of therapy (mean 213+/-23 days). HRV was analyzed over a full 24-hour period, using time and frequency domain parameters. RESULTS: No statistically significant HRV change was observed during the early period of therapy. However, during the later therpy period , HRV indices such as rMSSD[from 27.6 to 31.3 (msec)], HF[from 4.8 to 5.05 ln (ms2)], LF/HF ratio (from 1.17 to 1.12) were significantly changed (p value<0.05). CONCLUSION: HRV was significantly changed in postmenopausal women during the later period of hormonal replacement therapy.

Heart Rate Variability in Stable Angina Patients without History of Myocardial Infarction

BACKGROUND AND OBJECTIVES: Heart rate variability(HRV) reflects the autonomic integration of heart. There were many reports that HRV in patients with myocardial infarction or heart failure is an independent prognostic factor to predict fatal arrhythmia and sudden cardiac death. But, the role of HRV is still controversial in stable angina patients without history of myocardial infarction. In this study, we tried to compare HRV indices between stable angina patients and normal subjects. MATERIALS AND METHODS: Twenty-one stable anginal patients without history of myocardial infarction (mean age : 57 +/- 2 years) and twenty-one relatively healthy persons without history of coronary heart disease (mean age : 53 +/- 2 years) were included in the study and underwent 24-hour ambulatory ECG monitoring. In patients group, all underwent coronary angiography after 24-hour ambulatory ECG monitoring. HRV was analyzed over the whole 24 hours, using time and frequency domain parameters, according to time phases and coronary angiographic severity. RESULTS: There were no significant differences in age, sex and cardiovascular risk factors, except hypertension (p=.001) between two groups. HRV indices such as rMSSD, pNN50, LF, HF, LFnorm and HFnorm were significantly decreased (p<0.05) in patients group. But the angiographic severity of coronary arteries did not show any significant effect on the HRV indices in patients group. CONCLUSIONS: We observed significantly reduced HRV indices in patients with stable angina without history of myocardial infarction.

Head-up Tilt Test in Subjects with No History of Syncope or Presyncope

BACKGROUND AND OBJECTIVES: Head-up tilt test is increasingly being used to diagnosis neurocardiogenic syncope. But the protocol of head-up tilt test has not been settled. The purpose of this study was to evaluate the effect of isoproterenol provocation during head-up tilt test in normal volunteers with no prior history of syncope or presyncope. METHOD: Head-up tilt test was performed with 53 volunteers (age 309, male 27, female 26) in the fasting state. After supine heart rate and blood pressure were obtained, each volunteer was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1g/min and then increased by 1g/min every three minutes to a maximum of 5g/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance to isoproterenol, heart rate >150beat/min and completion of the protocol. When an end point was reached, the volunteer was rapidly returned to the supine position. RESULTS: Positive response to head-up tilt test was noted in 14 cases (26%). The pattern of positive response was vasodepressive in all cases. There was no significant side effect of isoproterenol. There was no significant difference between positive and negative response group in terms of age, sex, peak infusion rate of isoproterenol and hemodynamic response. The positive response rate at 2 g/min , 3 g/min, 4 g/min and 5 g/min of isoproterenol infusion was 1.9%, 9.7%, 23.7% and 32.5%, respectively. CONCLUSION: Head-up tilt test at 70 degree angle with isoproterenol infusion provided an adequate specificity.

Dose-dependent Effect of Benidipine in Patients with mild moderate Hypertension

BACKGROUND AND OBJECTIVES: This study was designed to evaluate the appropriate dose and dose-dependent effect of benidipine hydrochloride, a Ca+ +/- channel blocker, in patients with mild-moderate essential hypertension. Material and MethodsBenidipine was administered in 2 mg, 4 mg and 8 mg once daily with 1 month interval in 41 hypertensive patients with diastolic blood pressure over 90 mmHg and systolic blood pressure from 140 to 210 mmHg. Blood pressure, heart rate, subjective symptoms and adverse effects were checked every 4 weeks after benidipine administration. Laboratory examinations were performed before and after benidipine administration. RESULTS: The dose-dependent, antihypertensive effect of benidipine was evaluated in 41 patients. The blood pressure significantly reduced from 166+/-15 mmHg/103+/-7 mmHg to 13815 mmHg/88+/-11 mmHg at 12 weeks administration of benidipine and overall effective rate was 95%. The systolic and diastolic blood pressure was reduced significantly in proportion to dose of benidipine (p<0.0001). Antihypertensive effect was prominent at 4mg of benidipine. The heart rate was not affected by benidipine. No significant laboratory changes were observed. CONCLUSION: Benidipine has a dose-dependent effect in the treatment of mild-moderate hypertension, and the dosage to be needed may be 4mg or more for sufficient antihypertensive effect.

Heart Rate Variability in Patients with Neurocardiogenic Syncope or Presyncope

BACKGROUND AND OBJECTIVES: Neurocardiogenic syncope is believed to be caused by a transient imbalance of autonomic nervous system. Actually, there were significant differences in heart rate variability (HRV) indices during head-up tilt test between patients with neurocardiogenic syncope and normal controls. But there was no definite evidence for it during daily activity. So, we tried to evaluate HRV during daily activity with 24-hour ambulatory electrocardiography monitoring. MATERIALS AND METHODS: 27 patients with neurocardiogenic syncope or presyncope (mean age 45+/-3) and 25 normal volunteers (mean age 47+/-2) comparable for age and sex underwent 24-hour ambulatory electrocardiography. Head-up tilt test was used to diagnose neurocardiogenic syncope or presyncope in patients group. HRV was analysed over the whole 24 hours, using time and frequency domain parameters. Student's t-test was applied. ResultsThere were no significant differences in HRV measures between two groups, over 24-hour period and day-time and night-time period. But the hourly HRV measures showed a transient decrease of LF, LFnorm and LF/HF ratio in patients group compared to normal control group. CONCLUSIONS: These results indicate that patients with neurocardiogenic syncope or presyncope suffer from temporarily decreased sympathetic tone with normal parasympathetic tone. So, transient additive change of autonomic nervous tone may cause syncope or presyncope in these patients. (Korean Circulation J 2000;30 (6):716-723)

Herpes Simplex Virus Pneumonia in Immunocopmromised Host / 결핵

No abstract available.

The Effects of Arthroscopic Lavage Combined with Percutaneous multiple Drilling in Patients with Degenerative arthritis of knee

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.