Evaluation of Left Ventricle Diastolic Function by Color M-Mode Doppler Echocardiography in Coronary Artery Disease

PURPOSE: The aims of this study were to evaluate the usefulness of the propagation velocity (Vp) measured by transthoracic color M-mode Doppler in patients with coronary artery disease and compare Vp with conventional diastolic function index using transmitral and pulmonary vein flow. METHODS: Study subjects were classified into two groups according to the presence of coronary artery disease (CAD): 44 subjects (M:F=22:22, mean age 63+/-12 yrs) with CAD (AMI; n=13 , unstable angina; n=5, stable angina; n=26); 31 normal subjects (M:F=13:18, mean age 43+/-15 yrs). Vp of early flow into left ventricular cavity measured by color M-mode Doppler was proposed as an index of left ventricular diastolic function. Vp was compared with conventional diastolic function index. RESULTS: 1. Vp in CAD patients (32.8+/-9.1 cm/sec) was lower than control (63.6+/-14.1 cm/sec)(p>0.01). Among CAD patients, Vp in CAD patients (30.1+/-8.6 cm/sec) with left ventricular hypertrophy (LVH) was lower than Vp in CAD patients without LVH (35.9+/-8.9 cm/sec)(p>0.01). 2. Vp was correlated with left ventricular ejection fraction (r=0.602, p>0.01), with D wave of pulmonary vein flow (r=0.540, p>0.01) and with E/A velocity ratio of mitral inflow (r=0.517, p>0.01) and negatively correlated with left ventricular mass index (r=-0.576, p>0.01). CONCLUSION: The propagation velocity measured by color M-mode Doppler is a useful index for evaluation of diastolic function of left ventricle in the patients with coronary artery disease.

The Usefulness of Echocardiographic Severity Index for Prediction of Severity of Pulmonary Embolism

BACKGROUND: Pulmonary embolism is associated with varying degrees of pulmonary vascular obstruction. This study was undertaken to establish whether the extent of perfusion defect in lung scintigraphy can be predicted from analysis of echocardiographic measurements in patients with pulmonary embolism. METHODS: We retrospectively studied 28 patients who presented with clinical evidence of pulmonary embolism. In order to compare the extent of perfusion defect in lung scintigraphy, we devised a scoring system (echocardiographic severity index, ESI) for various echocardiographic parameters, which include right ventricle size, area, shape, systolic function, and pulmonary artery pressure. [ESI=sum of scores/number of parameters measured]. RESULTS: The mean values (+/-SD) of each parameter were as follow; right ventricular end-diastolic dimension (RVedD), 34.5+/-5.7 mm; LVedD, 40.9+/-5.2 mm; ratio of RVedD to LVedD, 0.87+/-0.2; right ventricular end-diastolic area (RVedA), 24.7+/-9.5 cm2; right ventricular end-systolic area (RVesA), 17.8+/-7.8 cm2; fractional area change, 28.8+/-9.7%; angle between IVS and RV, 96.0+/-14.8degrees; RV hypokinesia, absence or mild in 29%, moderate in 50%, severe in 21%; TR grade, absence or mild in 25%, moderate in 43%, severe in 32%; pulmonary artery systolic pressure, 50 mmHg 11% of patients. The echocardiographic severity index (ESI) in patients with pulmonary embolism was 0.52+/-0.24, and the perfusion defect score was 0.21+/-0.14. There was a close correlation between the ESI and the extent of perfusion defect (r=0.622, p<0.01). CONCLUSION: The echocardiographic severity index may reflect the extent of the perfusion defects in patients with pulmonary embolism, therefore it is potentially applicable in clinical practice for evaluating patients with pulmonary embolism and furthermore in their follow-up over a period of time.

Transthoracic Echocardiographic Assessment of Adriamycin-induced Cardiomyopathy in Rats with a 15 MHz Transducer

BACKGROUND: Adriamycin (doxorubicin) is one of the widely used drugs in the treatment of a variety of solid and hematologic malignancies. However, the adriamycin-induced cardiomyopathy limits the prolonged use of this effective drug. Transthoracic echocardiography is the excellent tool in early detection and follow-up studies of adriamycin-induced cardiomyopathy. The aim of this study was to assess the cardiac function and morphology using a 15 MHz high-frequency imaging in rats. METHODS: Adriamycin was administrated intraperitoneally by six equal injections at a dose of 2.5 mg/kg over a period of 2 weeks for total cumulative dose of 15 mg/kg body weight in 12 male Sprague-Dawley rats (weight 367+/-39 g). Transthoracic echocardiography with a 15 MHz linear-array transducer was performed at baseline and additionally at 3 weeks to measure the left ventricular wall thickness and dimension from the parasternal short axis view with 2D guided M-mode and pulsed Doppler signals of mitral inflow. Within 2 days of echocardiography, the heart was harvested for electron microscopic evaluation after potassium-induced cardiac arrest. RESULTS: 1) The mortality rate during the experimental period was 0%. 2) Transthoracic echocardiography provided adequate 2D guided M-mode images and pulsed Doppler signals of mitral inflow in all rats. 3) In follow-up echocardiography, pericardial effusion was detected in 7out of 12 rats (58%). 4) Compared to baseline, end-diastolic dimensions were increased from 7.01+/-0.69 to 7.74+/-1.25 mm (p<0.001), end-systolic dimensions were increased from 4.13+/-0.69 to 5.22+/-1.12 mm (p<0.05), and interventricular septal and posterior wall thickness at end-systole and end-diastole were significantly decreased (p<0.05, respectively). 5) Fractional shortening was decreased from 43.0+/-6.8 to 32.7+/-8.0%, compared to baseline (p<0.05). 6) E/A ratio of mitral inflow changed significantly from 1.63+/-0.36 to 2.78+/-1.0, compared to baseline (p<0.05). CONCLUSION: Adriamycin administration at total cumulative dose of 15 mg/kg body weight over 2 weeks creates a reliable model of non-ischemic dilated cardiomyopathy in rats with a high success rate. Transthoracic echocardiography using a 15 MHz transducer provides adequate images for assessing the cardiac function and morphology in follow-up studies in adriamycin-induced cardiomyopathy of rats. These results suggest that transthoracic echocardiography using a 15 MHz Transducer is a promising tool for an assessment of adriamycin-induced cardiomyopathy in small animals.

Transesophageal Atrial Pacing in Atrial Flutter

Atrial flutter, a common rhythm disturbance, was first described over 80 years ago. Despite extensive investigations, several important issues remain unresolved concerning its exact mechanism and management. Present therapeutic strategies often appear effective to prevent and terminate atrial flutter. However, controlled trial and definitive studies comparing the various treatment options are surprisingly scarce. Here we report on a study of 9 episodes of spontaneous atrial flutter(AF)(flutter wave cycle length 224+/-39 msec) treatedd by transesophageal atrial pacing(TAP) in 9 patients(7 men and 2 women; mean age 56.9 yrs). TAP was effective in 5 patients : sinus rhythm resumption was immediate in 3 patients and followed a short period of atrial fibrillation in 2 patients. TAP was unsuccessful in 4 patients. All the patients tolerated the procedure well. These data strongly support the immediate first choice use of TAP in AF therapy.

Ventricular Septal Defect after Acute Myocardial Infarction

From May 1989 to March 1994, 6 patients(2 men and 4 women, mean age 63.5 years[range 57 to 69]) with ventricular septal defect after acute myocardial infarction(MI) were seen at Catholic Medical center. The clinical features were as follows : 1) Neck vein engorgement, hepatomegaly and rale on lung auscultation were noted in 5 patients. 2) The acute MI was anterior in 5 patients and posterior in 1 patients. 3) The sites of rupture were apex in 4 patients, among 5 anterior wall MI patients. 4) Pansystolic murmur was heard on left lower precordial area in all patients. 5) Only 1 patient had a history of typical angina. 6) All VSDs occurred during patients's first heart attack. 7) All patients developed VSDs within 7 days after the onset of chest patin. 8)Among 4 patients who underwent coronary angiogram, 3 patients had multivessel coronary artery disease. 9) 2 patients who underwent operation survived but 4 patients who received only medical treatment expired. 10) The time interval from chest pain to death was 14.7 days(range 6 to 27).

Prevalence of Urinary Microalbuminuria in Normal and Hypertensive Koreans and Its Correlation with Blood Pressure Measured by 24 Hours Ambulatory Blood Pressure Monitoring

BACKGROUND & METHODS: Approximately 10% of the essential hypertensive patient have overt proteinuria due to renal target organ damage, which indicates poor prognosis. Recently microalbuminuria has been prove to be a good early predictor for renal damage in patients with diabetes or hypertension. Some authors reported that near 40% of the essential hypertensives have microalbuminuria. To determinate prevalence of microalbuminuria in Korea essential hypertensives, 24-hr ambulatory blood pressure monitoring and radioimmunoassay to detect BP and UAER were performed after 4 weeks wash-out period in 137(78 hypertensive and 54 normotensive) consecutive cases. RESULTS: Among 78 hypertensives, overt proteinuria was seen in 8.97%(7/78). And prevalence of microalbuminuria were 29.4%(23/78) in hypertensives and 16.7%(9/54) in normotensives. Urine microalbumin excretion rate(UAER) was significantly correlated with mean arterial pressure(MAP) in total subjects(r=0.286, p=0.0012), but not in total hypertensives(r=0.135, p=NS) or in hypertensives with UAER(r=-0.098, p=NS).UAER of female hypertensives was increase than that of male hypertensives(13.17+/-16.28microg/min vs 22.87microg/min, p=0.027). CONCLUSION: Prevalence of microalbuminuria in Korean hypertensives was relatively lower then other reports. Overt proteinuria was noted in 8.97% of the hypertensives which is same prevalence as other countries. Moreover MAP was well correlated with UAER in total subjects. Further evaluation should be done to detect exact role of UAER in hypertensives as an early predictor for renal target organ damage.

Prevalence of Urinary Microalbuminuria in Normal and Hypertensive Koreans and Its Correlation with Blood Pressure Measured by 24 Hours Ambulatory Blood Pressure Monitoring

BACKGROUND & METHODS: Approximately 10% of the essential hypertensive patient have overt proteinuria due to renal target organ damage, which indicates poor prognosis. Recently microalbuminuria has been prove to be a good early predictor for renal damage in patients with diabetes or hypertension. Some authors reported that near 40% of the essential hypertensives have microalbuminuria. To determinate prevalence of microalbuminuria in Korea essential hypertensives, 24-hr ambulatory blood pressure monitoring and radioimmunoassay to detect BP and UAER were performed after 4 weeks wash-out period in 137(78 hypertensive and 54 normotensive) consecutive cases. RESULTS: Among 78 hypertensives, overt proteinuria was seen in 8.97%(7/78). And prevalence of microalbuminuria were 29.4%(23/78) in hypertensives and 16.7%(9/54) in normotensives. Urine microalbumin excretion rate(UAER) was significantly correlated with mean arterial pressure(MAP) in total subjects(r=0.286, p=0.0012), but not in total hypertensives(r=0.135, p=NS) or in hypertensives with UAER(r=-0.098, p=NS).UAER of female hypertensives was increase than that of male hypertensives(13.17+/-16.28microg/min vs 22.87microg/min, p=0.027). CONCLUSION: Prevalence of microalbuminuria in Korean hypertensives was relatively lower then other reports. Overt proteinuria was noted in 8.97% of the hypertensives which is same prevalence as other countries. Moreover MAP was well correlated with UAER in total subjects. Further evaluation should be done to detect exact role of UAER in hypertensives as an early predictor for renal target organ damage.

A Case of Interruption of Aorta with Patent Ductus Arteriosus

Interruption of the aortic arch is an uncommon congenital cardiovascular malformation invariably accompanied by other cardiovascular anomalies. This carries a 76% mortality rate in the first month of life. We recently experienced a case of interruption of the aortic arch with patent ductus arteriosus in a 21-year-old man with systolic murmur. he did not showed any other symptoms or signs. Cardiac catheterization with angiography showed interruption of the aortic arch with many systemic arterial collaterals and patent ductus arteriosus.