Development and a Psychometric Evaluation of Cardiovascular Disease-Specific Quality of Life Scale for Koreans / 간호학회지

PURPOSE: Health-related quality of life (HRQOL) in patients with cardiovascular disease in Korea has rarely been studied, mostly due to the lack of a psychometrically validated disease-specific instrument. The purpose of this study was to develop and validate a cardiovascular specific-HRQOL questionnaire (CD-QOL). METHOD: The CD-QOL was developed and validated as follows; item generation, pilot study, and psychometric tests. Patients were recruited from three-university hospitals. The patients were asked to complete the preliminary questionnaire comprising the content-validated items, SF-36, and CES-D. The NYHA and KASI classifications were used to classify the functional performance of the patients. The data was analyzed using correlation, factor analysis, multidimensional scaling, multitrait/multi-item matrix, ANOVA, and Cronbach's alpha. RESULT: Preliminarily, thirty-nine items were generated. Factor analysisextracted a five-factor solution with a total of twenty-two items. One item was deleted based upon the MDS. The remaining items were moderately correlated with the subscales of the SF-36 and associated with depression measured with the CES-D. The mean scores of patients in NYHA and KASI class I were significantly higher than those in NYHA and KASI class II or/and III, which suggested patients with better functional performance were likely to have a better HRQOL. Cronbach's alphas of the total and subscales were all greater than 0.70. CONCLUSION: The CD-QOL is a easily applicable instrument with excellent psychometric properties of content, criterion, factorial, convergent, and known-groups validity, and internal consistency reliability in Korean patients with cardiovascular disease.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia in a Patient with Dextrocardia Associated with Atrial Septal Defect

It is known that tachyarrhythmias in patients with congenital heart defects have a potentially high impact on quality of life, morbidity and mortality. Conventional treatment with antiarrhythmic drugs may have untoward results including recurrence of tachyarrhythmia and its adverse effects. Therefore, radiofrequency catheter ablation is increasingly used for the treatment of supraventricular tachycardias in patients with congenital heart diseases, although abnormal anatomy and atypical conduction systems have the potential to complicate catheter ablation procedures. This report describes our experience with the successful radiofrequency catheter ablation of atrio-ventricular nodal reentrant tachycardia (AVNRT) in a patient with dextrocardia with situs solitus (isolated dextrocardia).

Usefulness and Limitation of 24 Hour Reinjection Images to Assess Myocardial Viability in Patients with Acute Myocardial Infarction

OBJECTIVE: The study was performed to evaluate whether thallium reinjection (RI) distinguishes viable from nonviable myocardium among myocardial segments which showed persistent perfusion defect (PD) in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: We studied 22 patients underwent PTCA after AMI. SPECT was performed in all patients using dipyridamole stress- 4 hour redistribution (RD) followed by 24 hour RI protocols. Dysfunctional segs were classified into 5 groups: 1) normal, 2) reversible, 3) mild to moderate PD, 4) severe PD and 5) reverse redistribution (RR). All patients underwent follow up echocardiography after 4 months to assess regional wall motion (WM) improvement such as a criteria of viable myocardium. RESULTS: A total of 127 segs with abnormal WM was analyzed. Of 74 segs with PD, 17 (23%) showed enhanced uptake after 24 hour RI. Five of 17 segs (29%) with PD that responded to RI with enhanced thallium uptake showed WM improvement. WM improvement were seen in the 24 of 57 segs (42%) not responding to RI. All four segs (100%) with RR that responded to RI showed improvement. WM improvement were not seen in the 5 of 8 segs (71%) with RR not responding to thallium RI. Eleven (73%) of 15 segs with mild-moderate PD after RI showed improvement, but 33% of segs with severe PD after RI did not showed improvement. Segs with mild-moderate PD after RI and fill in after RI showed improvement in comparison to segs with severe PD after RI(p<0.05). CONCLUSIONS: These data indicate that because only small proportion of PD showed further perfusion improvement after RI and predictive value by the uptake after RI was low, there was limited role of RI after myocardial infarction. Usefulness of RI could be found in segs showing RR responding to RI in AMI reflects viable myocardium.

A Case of SVC Obstruction in Behcet's Syndrome

The clinical triad of relapsing iritis, ulcers of the mouth and genitalia was first described in 1939 by Hulusi Behcet. This entity, originally confined to the above triad of symptoms appears to be systemic disease manifested by skin lesion, thrombophlebitis, neurologic, cardiovascular or visceral symptoms. The vascular involvement in Behcet's syndrome has been reported since Mischima first described a case in 1961, four types of vascular lesion are freuqnetly observed most commonly on the inferior or superior vena cava. Treatments consist of anticoagulation and administering oral steroids. We report a case of SVC obstruction in 36 years old female patient with Behcet's syndrome.