Apparent treatment-resistant hypertension among ambulatory hypertensive patients: a cross-sectional study from 13 general hospitals

Background/Aims@#To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. @*Methods@#We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. @*Results@#Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. @*Conclusions@#Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.

Apparent treatment-resistant hypertension among ambulatory hypertensive patients: a cross-sectional study from 13 general hospitals

Background/Aims@#To examine the prevalence and clinical characteristics of apparent treatment-resistant hypertension among ambulatory hypertensive patients. @*Methods@#We enrolled adult ambulatory hypertensive patients at 13 well-qualified general hospitals in Korea from January to June 2012. Apparent resistant hypertension was defined as an elevated blood pressure > 140/90 mmHg with the use of three antihypertensive agents, including diuretics, or ≥ 4 antihypertensives, regardless of the blood pressure. Controlled hypertension was defined as a blood pressure within the target using three antihypertensives, including diuretics. @*Results@#Among 16,915 hypertensive patients, 1,172 (6.9%) had controlled hypertension, and 1,514 (8.9%) had apparent treatment-resistant hypertension. Patients with apparent treatment-resistant hypertension had an earlier onset of hypertension (56.8 years vs. 58.8 years, p = 0.007) and higher body mass index (26.3 kg/m2 vs. 24.9 kg/m2, p < 0.001) than those with controlled hypertension. Drug compliance did not differ between groups. In the multivariable analysis, earlier onset of hypertension (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97 to 0.99; p < 0.001) and the presence of comorbidities (OR, 2.06; 95% CI, 1.27 to 3.35; p < 0.001), such as diabetes mellitus, ischemic heart disease, heart failure, and chronic kidney disease, were independent predictors. Among the patients with apparent treatment-resistant hypertension, only 5.2% were receiving ≥ 2 antihypertensives at maximally tolerated doses. @*Conclusions@#Apparent treatment-resistant hypertension prevalence is 8.9% among ambulatory hypertensive patients in Korea. An earlier onset of hypertension and the presence of comorbidities are independent predictors. Optimization of medical treatment may reduce the rate of apparent treatment-resistant hypertension.

Effectiveness and Safety of Zotarolimus-Eluting Stent (Resolute™ Integrity) in Patients with Diffuse Long Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. METHODS: From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. RESULTS: Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. CONCLUSIONS: Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.

Effectiveness and Safety of Zotarolimus-Eluting Stent (Resoluteâ„¢ Integrity) in Patients with Diffuse Long Coronary Artery Disease

BACKGROUND AND OBJECTIVES@#Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD.@*METHODS@#From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months.@*RESULTS@#Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE.@*CONCLUSIONS@#Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.

Comparison of the Signal-averaged ECG after Primary Percutaneous Coronary Intervention according to Thrombus Aspiration in ST Elevation Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Percutaneous coronary intervention (PCI) is the standard method of treating ST-segment elevation myocardial infarction (STEMI). There is continuing uncertainty as to whether reducing the thrombus burden through catheter aspiration improves the arrhythmogenic structure of the myocardium in STEMI. We compared the changes in electrical instability after thrombus aspiration-assisted primary PCI using conventional primary PCI. METHODS: The study population included 170 consecutive patients with STEMI who underwent primary PCI. The patients were divided into 80 patients who underwent primary PCI only and 90 patients who underwent thrombus aspiration before PCI. The signal-averaged ECG (SAECG) was obtained 5 +/- 2 days after the intervention. RESULTS: There were no significant differences between the groups in terms of sex, age, cardiovascular risk factors, or time from the onset of symptoms to treatment. The duration of the low amplitude signals less than 40 microV (LAS40), duration of the QRS complex (QRSD), and root mean square voltage of the terminal 40 ms of the QRS complex (RMS40) did not differ between the thrombus aspiration and no thrombus aspiration groups. The incidences of QRSD > 114 ms and RMS40 38 ms was significantly higher in the non-thrombus aspiration group (18 vs. 8, p = 0.018). CONCLUSIONS: Among random patients with STEMI, thrombus aspiration improved all of the parameters of SAECG, which is related to ventricular arrhythmogenesis, although the long-term clinical outcomes need to be assessed.

Acute decompensated heart failure and acute kidney injury due to bilateral renal artery stenosis / 영남의대학술지

Atherosclerotic renal artery stenosis (RAS) may result in hypertension, azotemia, and acute pulmonary edema. We report on a renal angioplasty with stent placement for bilateral RAS in a patient with acute decompensated heart failure and acute kidney injury. A 67-year-old female patient was admitted to our hospital with acute shortness of breath and generalized edema. Echocardiography showed left ventricular wall motion abnormality and the follow up electrocardiography showed T wave inversion in the precordial leads. We performed a coronary angiography to differentiate ischemic heart disease from non-cardiac origin for the cause of the heart failure. The coronary angiography showed no significant luminal narrowing, but bilateral RAS was confirmed on the renal artery angiography, therefore, we performed renal artery revascularization. After the procedure, the pulmonary edema was improved and the serum creatinine was decreased. Two weeks later, an echocardiography showed improvement of the left ventricular systolic function.

Efficacy and safety of antiplatelet-combination therapy after drug-eluting stent implantation

BACKGROUND/AIMS: Combination single-pill therapy can improve cost-effectiveness in a typical medical therapy. However, there is a little evidence about the efficacy and tolerability of combination single-pill antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). METHODS: From June to November 2012, in total, 142 patients who met the following criteria were enrolled: at least 18 years old; successful PCI with DES at least 3 months earlier; and regular medication of aspirin and clopidogrel with no side effects. After VerifyNow P2Y12 and aspirin assays, the combination single pill of aspirin and clopidogrel was given and laboratory tests were repeated 6 weeks later. RESULTS: At baseline, the incidence of aspirin resistance, defined as aspirin reaction unit (ARU) > or = 550, was 9.2%, that of clopidogrel resistance, defined as P2Y12 reaction unit (PRU) > or = 230, was 46.5%, and that of percent inhibition of PRU < 20% was 32.4%. At follow-up, the incidence of resistance by ARU value was 7.0%, 50.0% by PRU value, and 35.9% by percentage inhibition of PRU, respectively. The mean values of ARU (431.5 +/- 63.6 vs. 439.8 +/- 55.2; p = 0.216) and PRU (227.5 +/- 71.4 vs. 223.3 +/- 76.0; p = 0.350) were not significantly different before versus after antiplatelet-combination single-pill therapy. Five adverse events (3.5%) were observed during the study period. CONCLUSIONS: Combination single-pill antiplatelet therapy, which may reduce daily pill burden for patients after PCI with DES, demonstrated similar efficacy to separate dual-pill antiplatelet therapy.

A Case of Diffuse Alveolar Hemorrhage Following Abciximab Therapy / 대한내과학회지

Platelets play an important role in the development of acute coronary syndrome. Platelet-inhibiting drugs, such as glycoprotein IIb/IIIa inhibitors, can be beneficial when they are administered at the time of primary percutaneous coronary intervention for acute coronary syndrome. Although an increased risk for bleeding complications is well recognized, the risk associated with diffuse alveolar hemorrhage is much less reported. We report a case of diffuse alveolar hemorrhage after using abciximab.

Relationship between Antiphospholipid Antibodies and Major Adverse Cardiovascular Events after Drug-Eluting Stent Implantation in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Several studies have reported an association between antiphospholipid antibodies (APA) and major adverse cardiovascular events (MACE) following acute myocardial infarction (AMI). However, the relationship between APA and the prognosis after drug-eluting stent (DES) implantation in patients with AMI is not known. METHODS: Thus, we investigated the relationship between the incidence of MACE and APA levels in patients with AMI who underwent successful DES implantation. RESULTS: Of 182 patients, 78 (42.9%) tested positive for APA. Lupus anticoagulant was positive in 37.6% (68 of 181) patients, anticardiolipin antibody IgM was positive in 8.3% (15 of 180), and anticardiolipin antibody IgG was positive in 1.7% (3 of 180) patients. At follow up, a MACE had occurred in 11 (14.1%) patients in the APA-positive group and in seven (6.7%) patients in the APA-negative group (p = 0.099). CONCLUSIONS: No significant association was found between the incidence of MACE and the presence of APA in patients with AMI who underwent successful DES implantation.

Asymptomatic Isolate Tricuspid Regurgitation with Chordae Tendineae Rupture Caused by Blunt Chest Injury / 영남의대학술지

The incidence and importance of tricuspid valve regurgitation after a blunt chest injury has risen with the increase in the number of automobile accidents and steering wheel traumas. This kind of injury has been reported more frequently in the last decade because of the better diagnostic procedures and understanding of the pathology. However, tricuspid valve regurgitation following a blunt chest injury can still be easily missed because most patients do not show symptoms at the time of the trauma. A 55-year-old male patient presented himself at our facility after suffering a chest injury from an automobile accident. His transthoracic echocardiography (TTE) revealed severe tricuspid valve regurgitation due to the prolapse of his anterior valve leaflet. We report a case of asymptomatic tricuspid regurgitation that developed after a blunt chest injury.

Effect of Valsartan on N-Terminal Pro-Brain Natriuretic Peptide in Patient With Stable Chronic Heart Failure: Comparison With Enalapril

BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.

Effect of Valsartan on N-Terminal Pro-Brain Natriuretic Peptide in Patient With Stable Chronic Heart Failure: Comparison With Enalapril

BACKGROUND AND OBJECTIVES: The plasma concentration of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a st-rong prognostic indicator for patients with heart failure (HF) across all stages of the condition. Several clinical trials have de-monstrated convincingly that neurohormonal modulation on the renin angiotensin system (RAS) decreases plasma NT-pro-BNP level and results in favorable outcomes. But there are still limited comparative data on the neuro-hormonal modulatory effects of two RAS inhibitors: angiotensin converting enzyme inhibitor and angiotensin receptor blocker. SUBJECTS AND METHODS: This study was a prospective, multi-center, randomized, open-label, controlled, and non-inferiority study involving 445 patients with left ventricular ejection fraction (LVEF) less than 45%. Patients were assigned to receive either valsartan (target dose of 160 mg bid) or enalapril (target dose of 10 mg bid) for 12 months. We compared plasma NT-pro-BNP, high sensitive C-reactive protein (hs-CRP) level and echocardiographic parameters before and after treatment with valsartan or enalapril. RESULTS: The NT-pro-BNP and hs-CRP levels were significantly decreased after 12 months of treatment with valsartan and enalapril. The percentage change was similar between both groups. LVEF improved and left ventricular internal dimensions were decreased in both groups, and there were no significant differences between two groups. CONCLUSION: Valsartan is as effective on improving plasma NT-pro-BNP level as enalapril in patients with stable chronic HF.

Improvement in Left Ventricular Systolic Dyssynchrony in Hypertensive Patients After Treatment of Hypertension

BACKGROUND AND OBJECTIVES: Left ventricular (LV) dyssynchrony has been commonly detected among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The purpose of our study was to assess the changes in LV systolic dyssynchrony (SDSLV) among hypertensive patients after antihypertensive treatment, and to determine the relationship between SDSLV and other conventional echocardiographic parameters. SUBJECTS AND METHODS: Forty one hypertensive patients with normal LV ejection fraction were enrolled. By performing a conventional echocardiographic study, the SDSLV was measured as the time difference between the shortest and longest time of the peak myocardial systolic velocities among 12 segments of the basal and mid-levels of the 3 apical views, and radial dyssynchrony of the basal (RDSbase) and mid-levels (RDSmid) measured as the time difference between the earliest and latest peak values on the radial strain curves of each level of the parasternal short-axis views. RESULTS: Compared to baseline after six months of antihypertensive treatment, the SDSLV improved significantly (48.7+/-37.9 ms vs. 29.5+/-34.1 ms, p=0.020). Also the RDSbase and RDSmid improved significantly in respect to the baseline values (129.9+/-136.3 ms vs. 38.8+/-45.4 ms, p=0.002 and 75.2+/-63.8 ms vs. 28.2+/-37.7 ms, respectively, p<0.001). CONCLUSION: The severity of SDSLV improved with antihypertensive treatment, and was associated with the regression of LV mass. Furthermore, it might precede improvement in the mitral inflow pattern, as assessed by conventional echocardiography, so that early detection of the benefit of antihypertensive treatment may be possible.

Isolated Double-Chambered Right Ventricle in a Young Adult

Double-chambered right ventricle (DCRV) is a rare congenital heart disorder in which the right ventricle is divided by an anomalous muscle bundle into a high pressure inlet portion and a low pressure outlet portion. We report a case of isolated DCRV without symptoms in adulthood, diagnosed through echocardiography, cardiac catheterization and cardiac magnetic resonance imaging.

A Case of Uremic Pericarditis and Cardiac Tamponade That Developed after Ethylene Glycol Poisoning: A Case Report / 대한구급학회지

Ethylene glycol is commonly incorporated into automotive antifreeze agents and a variety of other commercial products. Ethylene glycol poisoning can cause life-threatening metabolic acidosis, cardiopulmonary failure, and renal failure that may be fatal. We present an unusual case of a patient who ingested a large amount of ethylene glycol for the purpose of suicide and developed multiorgan damage, including acute renal failure followed by uremic pericarditis and cardiac tamponade. This unusual complication was effectively managed with echocardiography-guided percutaneous pericardiocentesis and continuous catheter drainage for 3 days. After intensive hemodialysis and supportive care, the patient made a good recovery with near normal cardiac and renal function. Physicians should be aware of the possibility of acute pericarditis and cardiac tamponade in cases of acute renal failure caused by ethylene glycol poisoning.

Left Ventricular Dyssynchrony in Patients Showing Diastolic Dysfunction without Overt Symptoms of Heart Failure

BACKGROUND/AIMS: Few studies have assessed left ventricular (LV) dyssynchrony in cases of diastolic dysfunction that do not include overt symptoms of heart failure. We hypothesized that systolic or diastolic dyssynchrony involves unique features with respect to the degree of diastolic impairment in isolated diastolic dysfunction. METHODS: We examined 105 subjects with no history of overt symptoms of heart failure and a left ventricular ejection fraction > 50% for mechanical dyssynchrony using tissue Doppler imaging. RESULTS: In terms of longitudinal dyssynchrony, four cases showed (6.3%) LV intraventricular systolic dyssynchrony (SDS(LV)), whereas none had LV intraventricular diastolic dyssynchrony (DDS(LV)) or co-existing systolic dyssynchrony. Radial dyssynchrony (RD) was found in six cases (9.4%). After adjusting for age, SDS(LV) and DDS(LV) were found to be significantly related to increases in the E/E' ratio (r = 0.405 and p < 0.001 vs. r = 0.216 and p = 0.045, respectively). RD at the base and apex was also significantly related to increases in E/E' (r = 0.298 and p = 0.002 vs. r = 0.196 and p = 0.045, respectively). CONCLUSIONS: Systolic and diastolic dyssynchrony in subjects with isolated diastolic dysfunction but without overt symptoms of heart failure was not as common as in patients with diastolic heart failure; however, the systolic and diastolic intraventricular time delay increased with increases in the E/E' ratio, an indicator of diastolic dysfunction.

Clinical experience with primary cardiac tumors / 대한내과학회지

BACKGROUND/AIMS: In Korea, few studies have examined primary cardiac tumors, which have a reported incidence of 0.0017~0.19% in autopsy series. This study surveyed the status of primary cardiac tumors over the past 7 years in one region. METHODS: A retrospective review examined all patients with primary cardiac tumors, except for confirmed thrombus, using hospital medical records from 2000 to 2006 at six community hospitals. Identified cases undergoing biopsy and surgery were selected for the study. RESULTS: The operative mortality was 7.7%. Of the 71 patients (26 males) with identified primary cardiac tumors, 65 (91.5%) tumors were benign and 6 (8.5%) were malignant. The benign tumors were myxoma (78.9%), rhabdomyoma (4.2%), fibroelastoma (2.8%), fibroma (1.4%), and leiomyoma (1.4%). Two of the myxomas were present at multiple locations. The malignant tumors included sarcomas (67%) and lymphomas (33%). Most of the tumors were located in the left atrium (76%). The majority of patients presented with chest pain and dyspnea. During follow-up for an average of 26.8+/-21.3 months, all but one patient with benign tumors was alive; one myxoma patient died perioperatively (1.5%). Four of the patients with malignant tumors (67%) died. CONCLUSIONS: Cardiac myxomas and sarcomas were the most common primary benign and malignant tumors, respectively. Benign tumors had excellent postoperative survival rates, while malignant tumors had high mortality.

The Relationship Between Chronic Atrial Fibrillation and Reduced Pulmonary Function in Cases of Preserved Left Ventricular Systolic Function

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the relationship between chronic atrial fibrillation (AF) and reduced pulmonary function. SUBJECTS AND METHODS: Eighty-six chronic AF patients who were enrolled from annual health examination programs were studied using echocardiography and pulmonary function tests (PFT). Echocardiography and PFT matched for age, gender, and year performed were selected by the control group who had normal sinus rhythms. Patients with ejection fractions <50%, valvular heart disease, or ischemic heart disease were excluded. RESULTS: In the chronic AF patients, the forced expiratory volume at one second (FEV1), FEV1%, and FEV1/forced vital capacity (FVC) were significantly reduced, and the right ventricular systolic pressure was significantly increased. Episodes of heart failure were more frequently associated with the chronic AF patients than the controls. In particular, the FEV1% had the most meaningful relationship to chronic AF after an adjustment for cardiovascular risk factors {p=0.003, Exp (B)=0.978, 95% confidence interval (CI):0.963-0.993}. CONCLUSION: Reduced FEV1%, which represents the severity of airway obstruction, was associated with chronic AF, and the greater the pulmonary function impairment, the greater the co-existence with AF and congestive heart failure in those with preserved left ventricular systolic function.

Relationship Between Left Atrial Size and Stroke in Patients With Sinus Rhythm and Preserved Systolic Function

BACKGROUND/AIMS: Increased left atrial (LA) size has been proposed as a predictor of poor cardiovascular outcome in the elderly. In the present study, we evaluated the relationship between LA size and stroke in subjects of all ages who presented with preserved left ventricular systolic function (LVSF) and sinus rhythm (SR), and investigated the relationships between LA size and other echocardiographic parameters of diastolic function. METHODS: A total of 472 subjects were enrolled in the study (161 men, 311 women) and divided into the stroke group (n=75) and control group (n=397). A conventional echocardiographic study was then performed. Subjects with valvular heart disease, atrial fibrillation, or coronary heart disease were excluded. RESULTS: The mean subject age was 65.2+/-5.1 years in the stroke group and 65.6+/-5.9 years in the control group. Mitral inflow pattern and E & A velocity showed no significant relationship with stroke (p=NS, p=NS, respectively). Left ventricular mass index and LA dimension were significantly related to stroke (p=0.003, p=0.023, respectively), and hypertension showed a marginal relationship with stroke (p=0.050). Age was not related to stroke in the present study (p=NS). CONCLUSIONS: The LA dimension is significantly related to the incidence of stroke. Therefore, strategies for prevention of stroke in patients with preserved LVSF and SR should be considered in cases of LA enlargement.

Characteristics of Myocardial Deformation and Rotation in Subjects With Diastolic Dysfunction Without Diastolic Heart Failure

BACKGROUND AND OBJECTIVES: There have been very few pathophysiologic studies on isolated diastolic dysfunction. We hypothesized that the characteristics of isolated diastolic dysfunction would be located, on the clinical continuum, between those of a normal heart and diastolic heart failure. SUBJECTS AND METHODS: We enrolled 102 subjects who had no history of overt symptoms of heart failure and who had a left ventricular ejection fraction of more than 50%. They were examined for myocardial deformation and rotation using the two-dimensional speckle tracking image (2D-STI) technique. RESULTS: The circumferential strains and radial strain at the apical level (RS(apex)) were related to the ratio of the transmitral early peak velocity over the early diastolic mitral annulus velocity (E/E'). After adjustment for age, the RS(apex) showed a positive relationship with the E/E' ratio; whereas, the circumferential strains did not. Instead, the circumferential strains demonstrated a significant correlation with age. Basal rotation and left ventricular (LV) torsion were also related to age, but had no relationship with the E/E' ratio. However, as the E/E' ratio value increased, systolic mitral annular velocity decreased. CONCLUSION: Except for the RS(apex), LV myocardial deformation and rotation did not vary with the degree of E/E' ratio elevation when there was no associated diastolic heart failure. Additionally, in clinical situations such as isolated diastolic dysfunction, the advancement of age has a relatively greater influence on characteristics of LV myocardial deformation and rotation rather than on the E/E' ratio.