The Effect of Ultrafiltration and Hemodialysis on Doppler Myocardial Performance Index in Patients with End-stage Renal Disease and Normal Left Ventricular Function

BACKGROUND: Doppler myocardial performance index (DMPI), defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), is an easily measurable index which has been shown to reflect the severity of the disease. It has been known each component of DMPI, as IVCT, IVRT and ET, was affected by the change of preload. Therefore, the objective of this study was to estimate the changes of DMPI during intravascular volume reduction in patients with end-stage renal disease and to determine which components of DMPI contribute to DMPI alteration during intravacular volume reduction. METHODS: We measured blood pressure, heart rate, M-mode echocardiographic and Doppler parameters within 10 minutes before and after hemodialysis and ultrafitration with amount of average 2 L. RESULTS: We studied 40 end-stage renal disease patients (22 men and 18 women, mean age of 52 years) who had left ventricular hypertrophy 39 (97.5%) and normal left ventricular systolic function (diastolic interventricular septal thickness, 13.8+/-2 mm; diastolic left ventricular posterior wall thickness, 12.6+/-2 mm; Ejection fraction, 63.1+/-0.1%). Peak E-wave velocity was significantly decreased after hemodialysis and ultrafiltration (84.85+/-25 cm/s vs 72.89+/-23 cm/s, p<0.05), but other Doppler parameters such as peak A-wave velocity and E deceleration time were not changed. E/A ratio showed decreased tendency which was not significant statistically (p<0.097). DMPI was significantly increased after hemodialysis and ultrafiltration (0.41+/-0.14 vs 0.45+/-0.15, p<0.001). The increase of DMPI was mainly affected by prolongation of IVRT/ET which was due to prolonged IVRT, but IVCT/ET was not changed. The changes of DMPI was little with hemodialysis and ultrafiltration of about 2 L. CONCLUSION: We could prove that DMPI was preload dependent parameter of myocardial function. We suggest the change of preload should be considered as an important factor which may alter the DMPI.

Hemiazygos Continuation of Left Inferior Vena Cava Draining into the Right Atrium via Persistent Left Superior Vena Cava: A Variant of Polysplenia Syndrome Mimicking Aortic Dissection

We report a case of a 58 year-old male with polysplenia and left inferior vena cava draining into the right atrium via hemiazygous vein; the left superior vena cava and the coronary sinus in order. He presented dyspnea on exertion and atrial fibrillation. Originally, through findings of mediastinal widening in chest X-ray and the double lumen of the descending aorta in transesophageal echocardiography, he was erroneously diagnosed with aortic dissection. The anomalous venous connection was discovered via spiral CT and venography. We also found three to five small spleens via CT. We emphasize that normal left superior vena cava mimic aortic dissection on chest X-rays and transesophageal echocardiographys.

Comparison of Mitral Doppler Flow, Flow Propagation Velocity and Peak Filling Rate between Patients with Normal and Systolic LV Dysfunction in Presence of Atrial Fibrillation

BACKGROUND: Methods for evaluating left ventricular diastolic function have been used exclusively in cardiac patients in sinus rhythm and have not been applied to atrial fibrillation because of large cycle variation in flow velocities and absence of atrial contraction. The utility of these rnethods in atrial fibrillation is unknown, especially M-rnode Doppler echocardiography and automatic border detection method. METHODS: Left Ventricular Normal group(LVN group, Ejection fraction> 40%) of 21 patients(mean age 67 years old, 12 men, 9 women) and Left Ventricular Dysfunction group (LVD group, EF ( 40%) of 15 patients(mean age 64 years old, 11 men, 4 women) were studied. We measured parameters in pulsed Doppler recordings of rnitral flow velocity and the flow propagation velocity in color M-mode recording of mitral flow, and peak filling rate from automatic border detection system. Measurements were averaged over 10 cardiac cycles. RESULTS: Mean heart rates were not different in both population(LVN 79+/-18/min, LVD 83+/-16/min). Left ventricular diastolic dimension were more dilated LVD group than LVN group(5.7+/-1.0crn, 4.6+/-0.7cm p < 0.05) but left atrial dimension were similar(4.4+/-0.8cm, 4.3+/-0.7cm). Deceleration time was significantly shortened in LVD group(158.4+/-24.4ms vs. 180.4+37.6ms, p < 0.05) but other parameters of mitral pulsed Doppler recording such as IVRT, acceleration time, acceleration rate and deceleration rate were not different. Flow propagation velocities were significantly decreased in LVD group(41.7+/-14.9cm/s vs. 53.0+/-11. 9cm/s, p < 0.05). Peak filling rates of automatic border detection system were significantly decreased in LVD group(3.4+/-1.2 EDV/s vs 5.4+/-1.1 EDV/s, p< 0.001). CONCLUSION: Echocardiographic measurements of diastolic function via color M-mode Doppler and autornatic border detection may be useful in presence of atrial fibrillation as sinvs rhythm.

A Case of Listeria Monocytogenes Endocarditis in Apparently Healthy Adult

About 50 cases of Listeria monocytogenes endocarditis were reported in worldwide literature in 1950-1995. Though clinical and laboratory data suggest a similarity with other types of bacterial endocarditis, the prognosis is more unfavorable and the mortality rate is higher. However, there has not been a report in Korean literature. We report a case of 55 year-old male with rapidly progressive native aortic endocarditis caused by L. monocytogenes. He had neither history of underlying cardiac disease nor definitive predisposing factor. He presented mild dyspnes, chest pain and febrile sensation for a week. Echocardiography showed large vegetation in aortic valve and severe aortic regurgitation. L. monocytogenes grew on blood culture. We underwent artificial aortic valve replacement due to rapidly progessive heart failure. A thromboembolism occured at right femoral artery on postoperative 2nd day was removed successfully. He discharged without any sequellae.