Collateral Circulation and 99m Tc - MIBI Heart SPECT in Patients with Totally Coronary Occlusion / 대한내과학회지

OBJECTIVES: The role of coronary collateral circulation in protecting myocardium after the occlusion of a supplying artery has long been debated. Recent date show that the coronary collateral circulation may partially prevent ischemia and preserve myocardial contractile function. The purpose of this study was to evaluate the relation between the grades of collateral circulation and perfusion scores of 99mTc-Heart SPECT in patients with totally coronary occlusion. METHODS: We studied 44 patients with totally coronary occlusion who had been hospitalized at Kyung Hee University hospital between October, 1989 and May, 1994, Patients were classified into two groups; Group 1: patients with angina pectoris (n=21), Group 2: patients with myocardial infarction (n=23). Angiographic collateral circulation was graded from 0 to 3: 0=none, 1=filling of side branch only, 2=partial filling of the epicardial segment, 3=complete filling of epicardial segment. The perfusion score of dipyridamole stress 99mTc-MIBI Heart SPCET was analyzed with angiographic findings. Resting and stress echocardiography were analyzed to identify left ventricular wall motion abnormalities. RESULTS: 1) When LAD was totally occluded, there were hishevcrgree of collateral circulations from RCA in group 1 and group 2. When RCA was totally occluded, there was higherdesree of collateral circulation from LAD in group 1 and group 2. 2) The degree of collateral development was higher in group 1 than in group 2 (2.5+/-0.7 vs. 1.8+/-1.0, p<0.05). 3) In 99mTc-MIBI Heart SPECT, there was no significant difference of perfusion score at stress but perfusion score was significantly higher in group I than in group 2 at rest. 4) In 99mTc-MIBI Heart SPCET, there was no difference of perfusion score between totally coronary occlusion territories in group 1 and more than 50% coronary artery stenotic territories in group 1 and group 2. 5) In stress echocardiography, ten of the 13 patients showed normal LV wall motion at rest, but 9 of these 10 patients showed LV wall motion abnormalities at stress in group l. In group 2, all 10 patients showed LV wall motion abnormalities at rest and 3 of these patients showed more aggravation of LV wall motion abnormalities. CONCLUSION: Collateral circulation in angina patients can prevent myocardial ischemia and preserve myocardial function at rest, but not at exercise. Collateral circulation in patients with myocardial infarction cannot preserve myocardial function at rest. and exercise. Dipyridamole stress 99mTc-MIBI Heart SPECT is one of the indirect quantification methods to evaluate collateral development and coronary flow reserve.

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.

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.