The Significance of the Precordial ST: segment Depression in Acute (V1- V3) Inferior Myocardial Infarction / 대한내과학회지

BACKGROUND: Reciprocal ST-segment depression in precordial leads is a common finding in acute inferior myocardial infarction. The responsible mechanism and the significance of this finding, however, are still controversial. METHODS: From January 1991 to December 1994, 38 patients with acute inferior myocardial infarction were treated at the Department of Internal Medicine in Kyung Hee University Hospital. Clinical characteristics, serial electrocardiograms, and angiographic findings of coronary artery and left ventriculography, echocardiography were reviewed. Reciprocal ST-segment depression was defined as ST-segment depression>or=1.0mm in two or more adjacent precordial leads(V1-V3) in patients with acute inferior myocardial infarction showing ST-segment elevation in II, III, aVF. Coronary angiography and echocardiography were performed within 24 hours from admission. In this study, angiographic distribution score was used to define the perfusion territory causing inferior ischemia. RESULTS: 1) The summation of ST-segment elevation in II, III, aVF leads was significantly more higher in group H than group A (P0.05). 3) There were no evidence of anterior wall motion abnormality in two groups. CONCLUSIONS: Our results suggest that the S'I'- segment depression on the precordial leads in acute myocardial infarction can be explained mainly by benign reciprocal electrical change.

A Case of Multifocal Cerebral Infarction Associated with Idiopathic Hypereosinophilic Syndrome / 대한내과학회지

The idiopathic hypereosinophilic syndrome represent a heterogenous group of disorders with common features of prolonged eosinophilia of an undetectable cause and organ system dysfunction. Recently, we experienced a case of idiopathic hypereosinophilic syndrome with multifocal cerebral infarction. The patient was 33-year-old male and visited our hospital with right upper extremity weakness and headache. The blood eosinophil counts were 8,316/mma and the marrow showed eosinophils were predominant and in mature forms The two-dimensional echocardiogram showed hyperechoic density at left ventricular apical wall without thrombus formation. Multifocal infarctions were seen at left cerebellar hemisphere, left thalamus, right frontal lobe and left periventricular white matter on brain MRI scan. No cause for hypereosinophilia was found. He was treated with prednisone and hydroxyurea.

Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients without Structural Heart Disease

BACKGROUND: Radiofrequency catheter ablation therapy of idiopathic ventricular tachycardia in patients without obvious structural heart disease has been assessed in a few studies, but the clinical feasibility and efficacy are not certain. This study reports our results of catheter ablation with radiofrequency energy in thirteen patients. METHODS: Thirteen consecutive patients with idiopathic ventricular tachycardia underwent electrophysiologic study, pharmacological interventions and radiofrequency catheter ablation therapy. RESULTS: There were 7 men and 6 women with a mean age of 34+/-11years(13-55 years). The QRS configuration during tachycardia were left bundle branch block and inferior axis in 5 patients, right axis in 1 patient and right bundle branch block configuration with superior axis in 4 patients, right axis in 2 patients, left axis in 1 patients. Mean tachycardia cycle length was 361 +/-20 milliseconds. The focus of ventricular tachycardia were located in the right ventricular outflow tract(six patients) and the left ventricular inferior wall(four patients), posterobasal wall(one patients), anterolateral wall(one patients). Ventricular tachycardias were electrically induced in 9/13 patients. Mapping and radiofrequent catheter ablation was done with standard technique and ventricular tachycardia or VPCs were successfully eliminated in nine patients(69.2%). One patients complicated with transient pleural effusion. During mean follow-up period of 12+/-3months, one patients had a recurrence of symptomatic ventricular tachycardia. CONCLUSION: Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease is effective and safe and may be considered as primary choice of therapy in the patients.

Antihypertensive Effects and Safety of Barnidipine in Patients with Essential Hypertension

BACKGROUND: The goal of antihypertensive therapy will be to extended the life expectancy of hypertensive patients to that of subjects without high blood pressure. Hypertension treatment in the 1990s will focus on the mechanisms by which blood pressure is lowered by various antihypertensive agents, as will as individualization of drug therapy. In recognition of their lack of adverse lipid effects and their tolerability, first line therapy with alpha blocker, angiotensin converting enzyme inhibitors and calcium antagonists will become increasingly commom. We studied a new dihydropyridine calcium antagonist barnidipine to evaluate the efficacy and safety in patients with essential hypertension. METHODS: The rabit aortic rings were cut and mounted on the force transducer to record an isometric tension on polygraph. To elucidate the mechanism of saponin effect on vascular smooth muscle, the contractility of the vascular smooth muscle were measured under vatying experimental condition. RESULTS: 1) The baseline sitting systolic and diastolic blood pressure after 4 weeks washout period were 154.+/-15.9mmHg and 1.0+/-8.2mmHg. At the end of 8 weeks of therapy sitting systolic and diastolic blood pressure were 126+/-9.5mmHg and 84.5+/-4.6mmHg which declined statistically significant(p<0.05). 2) The pulse rates did not change significantly during treatment period(70.0+/-6.6 beats / min at baseline, 70.9+/-7.2 beats / min at 2 weeks, 71.2+/-5.0 beats / min at 4 weeks, 72.8+/-8.5 beats / min at 6 weeks, and 71.9+/-6.8 beats / min). 3) The adverse reactions due to branidipine were reported in 2 patients(6.5%) with headache, 2 patients(6.5%) with facial flushing, 1 patient(3.4%) with dizziness and 1 patients(3.4%) with nausea and vomiting). 4) The abnormal laboratory findings due to barnidipine were reported in 1 patient with increased total bilirubin and GPT, 1 patient with increased transaminase and 1 patient with CK but another findings were normal. CONCLUSION: These results indicate that barnidipine is effective and safe antihypertensive agent in the treatment of essential hypertension.

Usefulness of Dobutamine Stress Echocardiography for Assessment of cardiac Risk before Noncardiac Surgery

BACKGROUND: Two-dimensional echocardiography performed during incremental infusion of dobutamine has been shown to be a safe and accurate method for detection of coronary artery disease in patients who are unable to undergo conventional exercise testing. A significant proportion of these patients are referred for evaluation before undergoing noncardiac surgery. METHOD: To assess the value of dobutamine stress echocardiography(DSE), for assessment of preoperative cardiac risk, 88 patients (male : 32, female : 56, mean age : 60 years) were evaluated. patients records were reviewed to determine the short-term outcome of surgery. significant cardiac events were defined as unstable angina, myocardial infarction and sudden cardiac death occurred before discharge. Intravenous dobutamine was infused in a graded fashion (10 to 45µg/kg/min in 3 minutes stages), with two-dimensional echocardiographic monitoring of segmental wall motion of left ventricle. RESULTS: 1) The major reasons underwent dobutamine stress echocardiography were abnormalities of ECG such as ST-T changes, abnormal Q wave(65% : 64 of 98 patients) and history of coronary artery disease(29% : 28 of 98 patients). 2) Of the 88 patients who underwent noncardiac surgery, 85(97%) patients were negative response in dobutamine stress echocardiography, and no patients had cardiac events, also 3(3%) patients who had positve response did not occur cardiac events. 3) No major adverse effects occurred with stress test in any patient. CONCLUSION: These results suggest that DSE is useful preoperative diagnostic method for predicting short-term surgical outcome in patients with suspicous coronary artery disease undergoing noncardiac surgery.

Diagnosis of Latent Hypertrophic Obstructive Cardiomyopathy with Dobutamine Stress Echocardiography

BACKGROUND: In latent type of hypertrophic obstructive cardiomyopathy, there is no pressure gradient at rest in left ventricular outflow tract(LVOT), but it develops with provocation. Dobutamine increase myocardial contractility and may inducce outflow tract obstruction. To evaluate the usefulness of dobutamine induced outflow tract obstruction as a provocation test, nine patients with latent obstructive cardiomyopathy were studied. METHOD: 680 cases of dobutamine stress echocardiography were reviewed. Nine patients developed late peaking outflow velocity pattern in response to dobutamine infusion(inducible group). Ten patients developed early peaking velocity pattern were included as control group. Left ventricular dimension, outflow tract diameter were measured, and pattern of septal hypertrophy was classified. Changes of peak velocity and acceleration time/ejection time ratio (AT/ET) were measured at rest and peak dose dobutamine. RESULTS: The peak outflow velocity at rest was not different in both groups(1.49±0.45, 1.18±0.11m/sec). Peak velocity and AT/ET ratio were significantly increased in inducible group(4.2±0.9m/sec, 0.66±0.17), but no significant changes were noted in control group. Patients with inducible group had greater septal thickness, smaller outflow tract diameter and greater prevalence of septal bulge morphology. CONCLUSION: These results suggest that dobutamine stress Doppler echocardiography could be a useful provocation test to diagnosis of latent obstructive cardiogyopathy.

A Comparative Study of the echocardiographic Methods Assessing Severity of Stenosis in Pateints with mitral Stenosis

BACKGROUND: Determination of mitral valve area (MVA) in patients with mitral stenosis is very important in clinical practice. Therefore, the ability to assess accurately MVA by noninvasive technique is of great meaning to the management of patients with mitral stenosis. Echo-Doppler(ED) method was derived from the study of fluid dynamics that the flow volume is proportional to orifice area, velocity of flow which shows period requird by the flow. It has been proposed recently that measuring the flow convergence region proximal to an orifice by Doppler flow mapping can be used to derive cardiac output or flow rate proximal to stenotic orifices and therefore to calculate their areas by the continuity equation (area=flow rate/velocity). Applying these methods in mitral stenosis would provide a unique way of validating the underlying concept because the predicted areas could be compared with those measured directly by planimetry and pressure half-time method. Valve resistance has been proposed as an alternative hemodynamic indicator, but initially this index was not used because it was unlikely to remain constant at different flow rates. Recently valve resistance provided a better indices of hemodynamic obstruction than mitral valve area, and these indices usually estimated by invasive method, but it is able to calculate from Doppler echocardiography and compared to the results of invasive method. METHODS: The mitral inflow volume can be obtained by estimating the stroke volume (SV) by Teichholz's method from M-mode echocardiogram of the left ventricle, and the mean diastolic velocity(MDV) and diastolic filling period (DFP) by mitral inflow continuous-wave Dopler echocardiogram. Therefore, Echo-Doppler method is MVA=SV/MDV×DFP. Doppler color flow recordings of mitral inflow were obtained from the apex, and the radius of the proximal flow convergence region was measured at its peak diastolic value from the calculated assuming uniform radial flow convergence toward the orifice, modified by a factor that accounted for the inflow funnel angle formed by the mitral leaflets. Mitral valve area was then calculated as peak flow rate divided by peak velocity by continuous-wave Doppler. To Compare the stenotic indices from noninvasive method and invasive method, cardiac catheterization was performed. RESULTS: 1) ED-MVA of these 28 patients with mitral stenosis correlated well at a coeffitient of 0.867 than PHT-MVA(r=0.513) or 2DE(r=0.513) in comparison with Cath-MVA. 2) Excluding 4 patients with mitral regurgitation, the ED-MVA of 24 patients with isolated mitral stenosis showed a better correlation with r=0.944 than with PHT-MVA(r=0.642) or 2DE-MVA(r=0.647) in comparison with Cath-MVA. 3) MVA determined by PISA method were correlated with planimetry method on 2DE(r=0.51, p < 0.001). 4) MVA determined by PISA method were correlated with PTH method(r=0.44, p=0.002). 5) Agreement with planimetrymethod was similar for 26 patients with mitral regurgitation and 24 without it, as well as for 34 in atrial fibrillation. 6) The correlation coefficient of mitral valve area and mitral valve resistance between echocardiography(r=0.87) and cardiac catheterization(r=0.82) showed positive correlation(p < 0.001). 7) Linear regression analysis showed a negative correlation of mitral valve resistance and Gorlin mitral valve area between echocardiography (r=−0.84) and cardiac catheterization(r=−0.84). CONCLUSION: Echocardiographic evaluation of mitral valve stenosis by planimetry, pressur half-time method, Echo-Doppler method, PISA method, and mitral valve resistance were useful noninvasive methods in assessing the severity of mitral stenosis. In mitral stenosis patients with mitral regurgitation and/or aortic regurgitation, PISA and mitral valve resistance methods were also reliable. In conclusion, these results suggested that the echocardiographic methods could be sufficient for assessing the severity of mitral stenosis without the necessity of invasive technique.

Echocardiographic Evaluation of Left Ventricle before and after Maximum Exercise in Track Athletes

BACKGROUND: Long term athletic training is associated with an increase in left ventricular diastolic cavity dimension, wall thickness, and mass. These changes in left ventricular morphology represent an adaptation to increased ventricular load and are generally described as the “athlete's heart”. In the present study, we used echocardiography to evaluate the left ventricular structure and function in track athletes. METHODS: We studies 48 males(average age 22 years)by Doppler and echocardiography, which consisted of 12 normal controls, 36 track athletes(12 long distance track, 12 sprint, 12 jump). These athletes were trained regularly for 3-19 years(average 9±4 years). RESULTS: 1) At rest, left ventricular diastolic and systolic diameter, systolic interventricular septal wall thickness, diastolic and systolic posterior wall thickness, and left ventricular end diastolic and systolic dimension were larger in long distance track athletes than in the controls. 2) Left ventricular mass was larger in long distance track athltes and sprinter than controls. 3) After maximum exercise, left ventricular diastolic and systolic diameter, systolic interventricular septal wall thickness, diastolic and systolic posterior wall thickness, and left ventricular end diastolic and systolic dimension increased more significantly in long distance track athletes than in the controls. But, in sprinters, the left end systolic diameter, diastolic and systolic interventricular septal thickness, and left end diastolic and systolic dimensions were increased. 4) At rest, the E/A and Ei/Ai of the mitral flow in long distance track athletes increased more than in the controls. But there were no differences of parameters of mitral and aortic flow between long distance track athletes and controls after maximum exercise. CONCLUSIONS: The left ventricular mass of long distance and sprint track athletes were lager Than controls. In the long distance track athletes, the left ventricular structural and functional changes before and after maximum exercise were prominent. In the sprinters, after maximum exercise, the left ventricular structural and functional changes were prominent.

The Prognostic Significance of Maximal Precordial ST-Segment Depression in Patients with Acute Inferior Myocardial Infarction

BACKGROUND: Inferior myocardial infarctions account for 40-50% of all acute myocardial infarctions and are generally viewed as having a more favorable prognosis than anterior wall infarctions. However, nearly 50% of patients suffering inferior infarction will have complications such as heart block, concomitant precordial ST-segment depression and right ventricular infarction or distinguishing features associated with an increased mortality that will substantially alter an otherwise favorable prognosis. METHODS: Clinical characteristics, electrocardiograms, and angiographic findings of coronary artery were viewed in 47 patients with inferior myocardial infarction. Significant ST-segment change was defined as > or =0.1mV horizontal or down sloping depression in acute inferior myocardial infarction patients with ST-segment elevation on leads II, III, aVF measured with reference to the TP segment, 80ms after J point. A group=no precordial ST-segment depression. B group=sum of ST-segment depression in leads V1 to V3 equal to or more than the sum of ST-segment depression in leads V4 to V6. C group=maximal precordial ST-segment depression in leads V4 to V6. RESULTS: 1) Incidence of multi-vessel disease in group A and in group B were 23% and 22%, respectively, compared with 60% for those of group C(p0.05). CONCLUSION: The patients with acute inferior myocardial infarction with the maximal ST-segment depression in leads V4 to V6 would be at high risk for congestive heart failure and multi-vessel disease.

Patterns of Pulmonary Venous Flow in the Patients with Mitral Stenosis using Transesophageal Echocardiography

OBJECTIVES: In mitral stenosis, there is an alteration of normal left atrial hemodynamics because the narrowed mitral valve prolongs the decay in diastolic pressure, and atrial function may be impaired secondary to atrial fibrillation. In this study, we purposed to evaluation of the pulmonary venous flow patterns in the patients with mitral stenosis using transesophageal echocardiography. METHODS: The study was performed on 35 patients(13 men and 22 women, mean age 51±13.1 years) with mitral stenosis. We measured the left ventricular end-diastolic and end-systolic dimension, left atrial dimension, mitral valve area by planimetry method and the mean pressure gradient by transthoracic echocardiography. Systolic and diastolic peak velocities, atrial reversal and diastolic pressure half time of pulmonary venous flow by transesophageal echocardiography were evaluated. RESULTS: 1) The pulmonary venous peak systolic and diastolic flow velocities were 27.5±7.0cm/sec, 28.2±9.3cm/sec in patients with sinus rhythm, and 23.9±7.6cm/sec, 27.1±8.3cm/sec in patients with artial fibrillation. But there was no difference between patients with sinus rhythm and with atrial fibrillation. 2) The lesser mitral valve area, the more decreased peak systolic velocity and systolic to diastolic flow ratio. Especially, the systolic to diastolic flow ratio was significantly decreased(1.16±0.26, 0.95±0.23, 0.68±0.20, p < 0.05). But there was no difference at the peak diastolic velocity. 3) The thrombus or spontaneous echo contrast in the left atrium was not influence on the pulmonary venous flow pattern. CONCLUSION: In mitral stenosis, systolic flow and systolic to diastolic flow ratio decrease with the decrease of mitral valve area and diastolic flow becomes predominant, which may be useful in assessing the hemodynamics of mitral stenosis.

Assessment of Mitral Valve Area in Patients with Mitral Stenosis Using Color Doppler Proximal Isovelocity Surface Area Method

BACKGROUND: It has been proposed recently that measuring the flow convergence region proximal to an orifice by Doppler flow mapping can provide a means of calculating regurgitant flow rate. And this method also can be used to derive cardiac output or flow rate proximal to stenotic orifices and therefore to calculate their areas by the continuity equation(area=flow rate/velocity). Applying this method in mitral stenosis would provide a unique way of validating the underlying concept because the predicted areas could be compared with those measured directly by planimetry and pressur half-time method. METHOD: We studied 50 patients with mitral stenosis using imaging and Doppler echocardiography. Doppler color flow recordings of mitral inflow were obtained from the apex, and the radius of the proximal flow convergence region was measured at its peak diastolic valve from the orifice to the first color alias along the axis of flow. Flow rate was calculated assuming uniform radial flow convergence toward the orifice, modified by a factor that accounted for the inflow funnel angle formed by the mitral leaflets. Mitral valve area was then calculated as peak flow rate divided by peak velocity by continuous-wave Doppler. RESULTS: The calculated areas agreed well with those from comparative techniques. 1) Cross-sectional area by planimetry(y=0.38×+0.81, r=0.51, p < 0.001). 2) Area derived from the Doppler pressure half-time(y=0.35+0.55, r=0.44, p=0.002). 3) Agreement with planimetry was similar for 26 patients with mitral regurgitation and 24 without it, as well as for 34 in atrial fibrillation. CONCLUSION: These results suggested that the proximal flow convergence concept in the clinical setting demonstrate calculating method of mietral valve area in patients with mitral stenosis.

Antihypertensive Effects and Safety of Manidipine in Patients with Essential Hypertension

BACKGROUND: Calcium antagonists are highly effective agents for lowering high blood pressure and play a very important role in the treatment of Patient with ischemic heart disease and various other cardiovascular disorder. Manidipine, a dihydropyridine-type ccalcium channel blocker, is a potent relaxant of the arteriolar smooth muscle. We studied ths new calcium channel blocker to evaluated the efficacy and safety in patients with essectial hypertension. METHODS: Twenty patients(ten women and ten men;range of age, 30-66 years old)with mild-to-moderate essential hypertension were enrolled in this study. After a placebo run-in phase of two weeks duration, 5mg-20mg manidipine once daily orally was administered for eight weeks. RESULTS: 1) At the end of 8 weeks of manidipine therapy, systolic and diastolic blood pressure were significantly reduced from 160.1+/-11.8/105.5+/-5.1mmHG in sitting, 160.1+/-12.1/104.5+/-5.4mmHG in supine, 157.1+/-17.0/104.1+/-5.3mmHg in standing to 128.4+/-10.1/85.2+/-5.7mmHg in sitting, 129.1+/-10.2/84.2+/-5.9mmHg in supine, 128.1+/-12.8/86.7+/-5.9mmHg in standing(p<0.01). 2) The pulse rate did dnot change significantly. 3) The reduction of mean systolic and diastolic blood pressur at the end of 8 weeks were 31.5+/-14.5/20.3+/-7.4mmHg in sitting. 4) There was no serious side effect except mild symptom, mild headache(6 casem 30%) and facial flushing(1 case, 5%). CONCLUSION: These results indicate that manidipine is an effective and safe antihypertensive agent in the treatment of mild and moderate essential hypertension.

An Adult Case of Congenitally Corrected Transposition of the Great Arteries Associated with Paroxysmal Atrial Fibrillation and Heart Failure

Congenitally corrected transposition of the great arteries is a rate congenital heart disease. In this discase, there is discordance between both the atria and ventricles and the ventricles and great vessels. The anatomic left ventricle lies on the rightside and is connected to the pulmonic trunk, whereas the anatomic right ventricles lies on the left side and functions as the systemic ventricle. Most patients have associated another cardiac anomalies and conduction disturbance.Less commonly, ventricular extrasystoles, paroxismal supraventricular tachycardia, WPW preexitaion and atrial fibrillation may be obserced. We report an adult case of congenitally corrected transposition of great arteries associated with paroxysmal atrial fibrillation and heart failure.

Four Cases of Cystic Nature Adjacent to Right Atrial Wall by Two-Dimensional Echocardiography

Two-dimensional echocardiography is a simple, noninvasive method of evaluating cardiac strucures and pericardiac structures. The diagnosis of pericarial cyst is strongly suggested by the prominent roentgenographic appearance of a round, sharply demarcated mass along the right cardiac silhouette in an asymptomatic patient. Two-dimensional echocardiography is also useful method for diagnosing pericardial cyst, but differential diagnosis is difficult when other mass revealed echo-lucent cystic nature is located adjacent to the right atrial wall. We report the similar two-dimensional echcardiography findings located adjacent to the right atrial wall which are diagnosed different disease entity each oter. We suggest that two-dimensional echocardiography helps diagnosis of mass adjacent to the right atrial wall and may need more extensive investigation for accurate differential diagnosis.

Quantitative Evaluation of Regurgitant Volume in the Patients with Mitral Regurgitation Using Color Doppler Proximal Isovelocity Surface Area Method

BACKGROUND: The Evaluation of valvular regurgitation is a long standing clinical problem. While many ways to evaluate the severity of valvular insufficiency have been tried, none allows precise quantification of regurgitation volume. Invasive angiographic grading of mitral regurgitation is semiquantitative and subjective. Recent studies have shown that using color Doppler flow mapping can identify a blue-red aliasing radius, corresponding to a proximal isovelocity surface area(PISA), proximal to a regurgitant orifice. Thus regurgitant volume across the mitral orifice can be calculated. METHODS: The clinical applicability of the PISA method was evaluated prospectively in 23 patients with mitral regurgitation and also the regurgitant volume calculated by using the time-velocity integral(TVI) method. The regurgitant jet area were compared to regurgitant volume calculated from the PISA method. RESULTS: 1) Regurgitant volume calculated by using the PISA method correlated well with the regurgitant volume calculated by using the TVI method(r=0.73, P=0.0001). 2) Regurgitant volume calculated by using the PISA method did not correlate with the regurgitant jet to left atrial ratio(r=-0.02, P=0.94). 3) Eccentricity of regurgitant flow did not influence the result of PISA method. CONCLUSIONS: It is concluded that PISA method by color Doppler flow imaging is simple and useful noninvasive method for the quantitative evaluation of mitral regurgitant volume.

Doppler Echocardiography in the Diagnosis and the Estimation of the Severity of the Infundibular Pulmonic Stenosis

BACKGROUND: The diagnosis and estimation of severity of infundibular pulmonic stenosis (PS) is difficult by two-dimensional or M-mode echocardiography. In continuous wave(CW) Doppler signal valvular PS is seen as a parabolic velocity profile but infundibular PS is seen as a velocity signal with its peak in late systole. The purpose of this study is that Doppler echocardiography can discriminate valvular PS from infundibular PS and assess the severity of infundibular obstruction. METHOD: Six patients with valvular and infundibular PS by Doppler echocardiography and cardiac catheterization were studied. All had been undergone surgery. We compared their Doppler echocardiographic and cardiac catheterization finding with surgical finding. RESULT: 1) CW Doppler signal of infundibular PS had lesser peak velocity(2.84m/sec vs 4.33m/sec, p < 0.05) and later systolic peak in velocity(AT/ET ratio : 0.73 vs 0.51, p < 0.05) than that of valvular PS. 2) Pressure gradient across the infundibular obstruction measured by Doppler echocardiography correlated well with that by cardiac catheterization(r=0.89, p < 0.05). 3) Operation finding showed infundibular PS in 5 case but not one and coexisting other anomaly such as ASD in 4 case, TOF in 1 case, PAPVR in 1 case. CONCLUSION: Doppler echocardiography is a useful noninvasive method for the diagnosis and the estimation of severity of infundibular obstruction in patient with PS.

Assenssment of Left Ventricular Mass and Diastilic Function in Patients with Essential Hypertension after One Year Antihypertensive Therapy

BACKGROUND: Left ventriculuar hypertrophy(LVH) detected by echocadiography has long been recognized as a consequence of hypertension as well as independent predictor of subsequent cardiovascular morbidity and mortality. Numerous studies have shown left ventricular hypertrophy regression in response to antihypertensive drug therapy. The advent of echocardiography has made possible the noninvasive estimation of left ventricular mass. In this study, we analyesd hypertensive patients with LVH and without LVH by echocardiography to assees the changes of the left ventricular mass(LVM) and diastolic function after one year antihypertensive therapy. METHODS: Twenty patients with established hypertension were studied. No patients had a previos history of antihypertensive therapy. Patients were divided two group ; patients with LVH(Group I), patients without LVH(Group II). We obtained the basal echocardiography at the diagnosis and follow-up echocardiography after 6months and 12months antihypertensive therapy with angiotensin converting enzyme inhibitor. RESULTS: 1) Group I ; Baseline blood pressure was 155/104mmHg and fell to 129/86mmHg (p < 0.05) after 12 months antihypertensive therapy. There was no significant reduction in heart rate. Group II ; Baseline blood pressure was 149/102mmHg and fell to 123/83mmHg (p < 0.05) after 12 months antihypertensive therapy. There was no significant reduction in heart rate. 2) Group I ; LVM was reduced significantly from 160g/m2 to 132g/m2 after 12 months antihypertensive therapy. Group II ; LVM was not significantly reduced after 12 months antihypertensive therapy. 3) Group I ; Time velocity intergral dimension E(Ei) was increased from 9.1cm to 12.5cm significantly(p < 0.05), and Ei/Ai was significantly increased from 1.7 to 2.1 (p < 0.05) after 12 months antihypertensive therapy. Group II ; There were no significantly interval changes in time velocity intergral dimension E(Ei), time velocity intergral dimension A (Ai) and Ei/Ai after 12 months antihypertensive therapy. CONCLUSIONS: We concluded that antihypertensive therapy with ACE inhibitor reduced significantly the lefe ventricular mass and increased left ventricular diastolic function in hypertensive patients with LVH. We demonstrate the useful role that echocardiographic evaluation of left ventricular structure and function may play in hypertension research.

Usefulness of dobutamine stress echocardiography in the diagnosis of coronary artery disease

No abstract available.

Usefulness of exercise stress echocardiography and 99Tc-MIBI heart SPECT for the detection of coronary artery disease

No abstract available.

Early stress echocardiogram and 99Tc-MIBI heart spect findings after coronary atrery revascularization

No abstract available.