Enoximone therapy as pharmacological bridging to cardiac transplantation

Keeping pre-transplant patients alive while waiting for a suitable donor is still a major challenge. New pharmacological agents which can provide improved hemodynamics are urgently needed in patients with severe heart failure who are on the waiting list for cardiac transplantation. Intravenous enoximone therapy (an initial 0.5 mg/kg bolus, then 1.25-5.0 mcg/kg/min infusion) was administered to 35 transplant candidates with progressive heart failure despite optimal drug regimen including digoxin, diuretics, and ACE-inhibitors. In 18 out of 35 patients complete hemodynamic, echocardiographic, neurohumoral, and Holter-ECG studies were performed before and 24 hours after intravenous enoximone infusion. Patients were then continued on chronic oral therapy of 100 mg twice a day. Enoximone infusion increased the cardiac index (CI) (1.78 +/- 0.45 l/min/m2 vs 3.04 +/- 0.83 l/min/m2; p< 0.001) and stroke volume index (SVI)(22.33 +/- 9.45 ml/m2 vs 32.28 +/- 7.29 ml/m2; p< 0.05) and decreased wedge pressure (PCP)(24.1 +/- 11.98 mmHg vs 17.78 +/- 8.76 mmHg; p< 0.05) while mean arterial pressure (MAP) was unchanged. Left ventricular ejection time (LVET)(225.1 +/- 26.9 ms vs 242.2 +/- 25.8 ms; p< 0.05) was increased whereas other echocardiographic parameters were unchanged (Left ventricular end-diastolic dimension LVEDD, left ventricular end-systolic dimension LVESD, fractional shortening FS, early diastolic relaxation parameter Te). Plasma neurohumoral parameters did not change (Aldosterone, epinephrine, renin, atrial natriuretic factor) except for a significant drop in norepinephrine (936.7 +/- 443.2 pg/ml vs 522.4 +/- 287.6 pg/ml; p< 0.05). Holter-ECG parameters (ventricular premature beats VPB, couplets, ventricular tachycardia VT) were not influenced by enoximone infusion.

The Effect of Aging on the Left Ventricular Mass

The fundamental alterations in the cardiovascular system that occur consequent to aging are of great pratical importnace to clinicians. Senescent cardic muscle has many features of prolonged tension development, impaired relaxation and diminished response to receptor-mediated inotropic interactions. We estimated left ventricular mass by 2-D echo area-length method using a high quality planimeter. Age-related increments in left ventricular mass demostrated, but left ventricular enddiastolic cavity volumes were unaffected by age. The increase in left ventricular mass observed with aging is typical of pressuer-overload hypertrophy and its stimulus may be increased afterload from senescent changes.

The Effect of Left Ventricualr Mass on the Transmitral Blood Flow

Measurements of mitral flow velocity by pulsed Doppler echocardiography are very useful in evaluating left ventricular diastolic filling properties. In hypertensive patients, abnormalities of diastolic function may precede systolic abnormalities and may serve as a more sensitive marker of end organ damage. We estimated left ventricular nass by 2-D echo short axis area-length method and compared with peak mitral flow velocity in early diastole(PFVE)and during atrial systolic(PFVA). There was a significant increase of LV mass and LV mass indices in the hypertensive patients and PFVE/PFVA ratio was decreased in them. Aithough there was no relationship between blood pressure and PFVE/PFVA ratio, a significant relationship was demonstrated between LV mass index and PFVE/PFVA ratio in the hypertensive patients.

Significance of QRS Scoring System in the Acute Myocardial Infarction

Early and longterm prognosis depended on the extents of acute myocardial infarction and residual myocardial function. Many clinical methods have been evaluated to determine their ability to estimate the size of myocardial infarcts. But because of many disadvantages simplified QRS scoring system, used with standard 12-lead EKG, was developed, which is noninvasive, inexpensive and easily releatible. Therefore, the correlation between QRS and peak CK,killip classification were evaluated in 55 patients with initial acute myocardial infarction at the Chung-Ang University, Yong-San and Pil-Dong Hospital during the period from January 1983 to December, 1986. The results were as follows : 1) The average QRS score of the anterior wall infarction is 7.1 and that of the inferior wall infarction is 4.5 and there is a statistical significance(p<0.01). 2) In the acute myocardial infarction, the correlation coefficeient between the QRS score and the killip classification is 0.66(p<0.05). 3) In the acute myocardial infarction, the average QRS score is 6.3 and the correlation coefficient between the leak CK and the QRS score is 0.52(p<0.05). 4) In the anterior wall infarction, the average QRS score is 7.1 and the correlation coefficient between the peak Ck and QRS score is 0.48(p<0.05). 5) In the inferior wall infarction, the average QRS score is a 4.5 and the correlation coefficient between the leak CK and QRS score is 0.79(p<0.05).

A Clinical Observation on the Antihypertensive Effects of Trimazosin Hydrochloride in patients with Mild to Moderate Hypertension

Trimazosin Hydrochloride is a new orally active antihypertensive agent derived from the Quinazoline family, related chemically and pharamacologically to parazosin, but unlike its precedecessor, no first-dose syncope has been note, and no tolerance in the management of long term hypertensive patients. The antihypertensive effect of Trimazosin was observed from Oct. 1984 to Mar, 1985 at hospital of Chung-Ang Univesity as outpatient base involving a total 25 patients(Male;16, Female;9)with mild to moderate Hypertension(Diastolic B, P> or =90mmHG but< or =110mmHg). And the average age was 51.5 year(39-66yrs.) Our data demonstrate that 1) Trimazosin is an effective antihypertensive agent for controlling both systolic(166mmHg to 135.7mmHg)and diastolic(102.8mmHg to 85.3mmHg)pressure, and the mean arterial pressure was decreased from 123.8mmHg to 102.1mmHg(P%0.001). 2) We achieved significant sustained reduction in blood pressure with Trimazosin alone in 10 patients, Trimazosin plus Thoazide diuretics in 4 patients, Trimazosin plus-Beta-blocker in 5 patients, and with above triple regimensin 5 patients. 3) Side effects observed during Trimazosin theraphy(mean 3.8 months)appear to be minor and are reflection of its hemodynamic effects, (fatigability 2, dizziness 3, nausea 3 and headache 3) except one had to stop due to severe pounding headache.

Clinical Study on Cerebral Blood Flow in Korean Adult

Although measurement of cerebral blood flow by radioactive - isotope method became popular, there is still no report of study on the cerebral blood flow in Korea. Auther studied the regional cerebral blood flow in 28 normal Korean adults and and 76 patients including 14 cases of essential hypertension, 11 cases of heart diseases (coronary artery disease, valvular diseases and A-V block), 14 cases of brain diseases(cerebral thrombosis and cerebral insufficiency), 22 cases of head trauma and 15 cases of miscellaneous medical diseases. The regional cerebral blood flow was measured by intravenous in jection of (99m)Tc-DTPA 15-20Ci and by taking serial cerebral angiograms with CGR Gamma Tome 7000 and was analized by computer Imac 7310. The results were as follows: 1) The average regional cerebral blood flow of normal Korean adult was 50.0+/-5.89mg/100g /min. with range of 41-60ml/100g/min. 2) In most cases of essential hypertension the regional cerebral blood flow was within normal limit except rare case which was considered to have impaired autoregulation of cerebral blood flow. 3) In patients with myocardial infarction, valvular heart diseases with congestive heart failure and complete A-V block, there was markedly reduced cerebral blood flow. The reduced cerebral blood flow increased after the improvement of congestive heart failure and after the implantation of pacemaker. 4) In patients with cerebral thrombosis with infarction and cerebral insufficiency with symptoms of dizziness, headache or blurred vision, the cerebral blood flow was considerably reduced. However in acute encephalits the cerebral blood flow was increased. The measurement of cerebral blood flow by radioactiveisotope method is considered to be accurate, easy and useful clinical test to evaluate brain diseases and function.

Clinical Study of Atrial Fibrillation

Clinical study was done on 119 patients with atrial fibrillation in the aspect of underlying diseases, particulary. The results were as follow : 1) In the underlying diseases of atrial finbrillation, rheumatic heart disease, hepertension and ischemic heart disease were common, which occupied 27.8%, 22.7% and and 15.1%, respectly. No apparent underlying disease was found in 21.0%, but in the transient atrial fibrillation, no apparent underlying disease in 42.9%. 2) There were no significant correlations between the ventricular rate, amplitude of f wave and underlying diseases of atrial fibrillation. 3) Complications were found in 29.4% of all cases, such as congestive heart failure(22.7%), embolism(6.7%). Otherwise, atrial fibrillation without underying cardiovascular diseases, congestive heart failure was found only(7.7%).

Epidemiological Study of Heart Disease in Korea: 5 Year Interval Change

In order to investigate the trend of prevalence of heart disease in Korea, statistical observation was made on 19,239 cases of medical in-patients who were treated in 3 general hospitals, Korea University Hospital, Seoul Red Cross Hospital and Seoul Adeventist Hospital, on 73,484 cases of medical out-patients who were seen at Korea University Hospital and Seoul Adventist Hospital during the period of 5 years, from 1972 through 1976, on 7,746 cases of medical in-patients during the period of 10 years (1967 through 1976), and on 50,083 cases of medical out-patients during the period of 15 years (1962 through 1976) who were treated in Korea University Hospital. The results obtained were as follows. 1. Heart disease was 5.5% (male 5.4%, female 5.7%) of medical out-patients and 16.1% (male 16.7%, female 15.5%) of medical in-patients. 2. The incidence of heart disease was increased with the increase of age in both out-patients and in-patients. The incidences of heart disease in out-patients by age group to the total out-patients of each age group were 1.8% in 15~40 year group, 10.2% in 41~60 year group and 18.4% in over 61 year group, and those in in-patients were 5.0% in 15~40 year group, 24.4% in 41~60 year group and 30.8% in over 61 year group. 3. The incidences of individual heart disease to 4,074 cases with heart disease (male 1,986, female 2,088) of out-patients were as follows. Rheumatic myocarditis was 0.5% (male 0.6%, female 0.5%), mitral valvular disease 8.3% (male 5.8%, female 10.6%), aortic valvular disease 3.1% (male 3.9%, female 2.2%), mitral and aortic valvular disease 0.7% (male 1.3%, female 0.7%), hyper tension 72.0% (male 72.8%, female 71.0%), myocardial infarction 0.7% (male 1.2%, female 0.2%), angina pectoris 2.2% (male 3.1%, female 1.4%), atherosclerotic heart failure 4.5% (male 4.8%, female 4.1%), pericarditis 0.4% (male 0.6%, female 0.3%), idiopathic myocardiopathy 0.5% (male 0.5%, female 0.6%), postpartum myocardiopathy 0.3% in female, cor pulmonale 0.3%(male 0.2%, female 0.4%) and congenital heart disease 1.4% (male 1.8%, female 1.1%). 4. Incidences of individual heart disease to total 3,091 cases with heart disease (male 1,573, female, 1,518) of in-patients were as follows. Rheumatic myocarditis was 0.4% (male 0.5%, female 0.3%), mitral valvular disease 8.1% (male 5.1%, female 11.2%), aortic valvular disease 1.1% (male 1.3%, female 0.8%), mitral and arotic valvular disease 0.3% (male 0.3% female 0.4%), hypertension 69.6% (male 71.3%, female 68.5%), myocardial infarction 2.8% (male 4.3%, female 1.4%), angina pectoris 1.7% (male 2.0%, female 1.3%), atherosclerotic heart failure 7.5%(male 7.7%, female 6.8%), pericarditis 0.8% (male 0.9%, female 0.8%), idiopathic myocardiopathy 1.3% (male 1.3%, female 1.3%), postpartum myocardiopathy 0.7% in female, cor pulmonale 1.5% (male 1.5%, female 1.6%) and congenital heart disease 0.5% (male 0.4%, female 0.5%). 5. There was no significant seasonal variation of the incidences of individual heart diseases. 6. The incidences of rheumatic valvular heart disease, coronary heart disease and congenital heart disease of medical out-putients of Korea University hospital by 5-year-period for 3 consecutive periods (1962 through 1976) were increased and those of hypertension and cor pulmonale were decreased. 7. The incidneces of coronary heart disease and idiopathic myocardiopathy of medical in-patients of Korea University Hospital by 5-year-period for 2 consecutive periods (1967 through 1976) were increased and those of rheumatic myocarditis, hypertension and postpartum myocardiopathy were decreased. There was no change in incidence of rheumatic heart disease including rheumatic myocarditis, and congenital heart disease. 8. The trend of increasing prevalence of coronary heart disease, especially angina pectoris, was noted. Although hypertension was decreased in relative incidence, the total number of patients with hypertension was increased. This seems to suggest that hypertension tends to increase.