The Prognostic Value of DeltaST/HR Index and Rate-Recovery Loop during Predischarge Exercise Test in Acute Myocardial Infarction

BACKGROUND: The heart rate adjusted ST segment criteria(Delta ST/HR index and rate-recovery loop or R-R loop) compared to standard ST segment criteria may improve the ability of the exercise electrocardiogram for the prediction of severe coronary artery disease and future cardiac events in patients with chronic angina pectoris, but the predictive value of these criteria for predicting these issues has not been studied in patients with acute myocardial infarction. METHODS: 64 patients with first uncomplicated myocardial infarction were studied. All patients performed predischarge(mean 8+/-4 days) symptom-limited exercise test and coronary angiography(mean 11+/-15 days). During the follow-up period(mean 449+/-273 days), the occurrence of the major cardiac events(death, reinfarction, coronary artery bypass surgery) and minor cardiac event(angina, heart failure) were recorded, and then univariate and multivariate analysis of several clinical and exercise variables known to be as prognostic markers were performed. RESULTS: The results are as follows : 1) The sensitivities of Delta ST/HR index and R-R loop(92%, 83% respectively) for predicting multivessel disease showed no significant difference compared to that of standard ST segment criteria(83%). 2) Major cardiac events occurred in 12(20%) of 64 patients and only single independent predictive factor for its prediction was multivessel coronary artery disease(p=0.0001), whereas total cardiac event occurred in 32(50%), multivessel disease(p=0.003), and maximal workload <5mets(p=0.038). 3) For the prediction of total cardiac event, DeltaST/HR index and R-R loop(all 97%) were significantly more sensitive(p<0.05) than standard ST segment criteria(78%), and there was a tendency to increase in specificity in R-R loop(84%) compared to DeltaST/HR index(59%) or standard ST segment criteria(66%). 4) The negative predictive value of all negative test of three ST segment criteria for predicting total cardiac event was 100%. CONCLUSION: Although the heart rate-adjusted ST segment criteria have no advantage over standand ST segment criteria for the prediction of severe coronary artery disease, they can be more useful prognostic markers by enhancing the accuracy of the predischarge exercise electrocardiogram for the prediction of subsequent cardiac events after a first acute myocardial infarction.

The Effect of the Administration of Nitroglycerin and Atropine on the Pattern of Left Ventricular Diastolic Filling as Assessed by Doppler Echocardiography in Normal Human Subjects

BACKGROUND: The diastolic transmitral flow velocity pattern has been commonly used to assess left ventricular(LV) diastolic function. The effects of multiple factors(such as, LV preload, afterload and heart rate, etc.) make difficulties in accurate interpretation. METHODS: In order to investigate the diastolic transmitral filling patterns according to the changes of the proload or heart rate, we studied 27 normal subjects with pulsed Doppler echocardiography after the administration of nitroglycerin(0.6mg/tab.) sublingually or atropine(0.5mg/amp.) intravenously. RESULTS: 1) After nitroglycerin administration, the folowings were obtained. ; The systolic blood pressure and LV diastolic filling time(DFT) decreased by 10.1% and 15.3%, respectively(p<0.001), compared with baseline data. The ratio of peak early to late diastolic transmitral flow velocities (E/A) and time-velocity integrals(TVIE/TVIA) decreased by 10.3% and 14.8%, respectively(p<0.01). The early diastolic filling time(Time E) was unchanged. Therefore, we suggest that time E is helpful, compared with the increments of the preload or the diastolic dysfunction. 2) After atropin administration, the heart rate, peak late diastolic transmitral flow velocity(PA) and percent atrial contribution(%AC) significantly increased by 43.6%, 25.1% and 41.4%, respectively(p<0.001). The E/A, TVIE/TVIA and DFT significantly decreased by 42.9%, 38.9% and 43.0%, respectively(p<0.001) compared to the data before drug administration. 3) The heart rate correlated negatively to the E/A, TVIE/TVIA and DFT. It was correlated positively to %AC(r=+0.63; p<0.001). The normalized E/A ratio by DFT(E/A/DFT) didn't correlate. Therefore, E/A/DFT is helpful on the exclusion of the influences of heart rate by the administration of the atropine. CONCLUSION: The decrement of preload or the increment of heart rate changes the diastolic transmitral flow velocity patterns. Therefore, when the diastolic function is assessed by interpretation of the Doppler transmitral flow velocity pattern with pulsed Doppler echocardiogram, the potential influences of preload and heart rate must be taken into account.

Changes of segmental left ventricular wall motion after coronary artery bypass graft surgery ; two-dimensional echocardiographic study / 대한내과학회지

No abstract available.

Assessment of severity of mitral regurgitation by color doppler echocardiography

No abstract available.

A case of acute monocytic leukemia with multiple lymphadenopathy and multiple leukemic infiltration on the skin / 대한내과학회지

No abstract available.

A Case of Extra-Adrenal Pheochromocytoma with Abdominal Colic and Paroxysmal Hypertension

Pheochromocytomas can arise wherever chromaffin cells are found, and most of them(90%) are in one or both adrenal glands. But they may be located anywhere along the sympathetic chain and rarely in aberrant sites. One of the common extra-adrenal sites from which these tumors can arise is a collection of para-aortic and para-ganglion cells around the origin of the inferior mesenteric artery. We experienced a case of extra-adrenal pheochromocytoma located at the organ of Zukerkandl in a 21-year-old female patient with abdominal colic and paroxysmal hypertension, whose symptoms and blood pressure returned to normal after successful surgical excision of the tumor.

A Case of Refractory Variant Angina Relieved by Clonidine

Coronary spasm may be induced by a variety of physiologic and pharmacologic stimuli but specific receptor blockade has not been consistently shown to prevent the attacks. Most patients with variant angina respond well to treatment with calcium antagonists and nitrates. A small proportion of patients are refractory to this therapy. We report a case of the patient with a 9-year-history of variant angina who has been refractory to high doses of calcium antagonists and nitrates. The repeated addition of clonidine was consistently effective in abolishing both symptoms and objective evidence of myocardial ischemia in this particular patient.

Echocardiographyic assessment of segmental left ventricular wall motion and left ventriclar function after coronary artery bypass graft surgery:early and late follow-up study

No abstract available.