How Does Chronic Back Pain Influence Quality of Life in Koreans: A Cross-Sectional Study

STUDY DESIGN: A cross-sectional study. PURPOSE: To explore the impact of chronic low back pain (CLBP) on individuals' quality of life; to understand current treatment practices and level of satisfaction with treatment in patients with CLBP. OVERVIEW OF LITERATURE: Assessing subjective, patient-reported outcomes such as quality of life is essential to health care research. METHODS: Influences of the CLBP were analyzed via a questionnaire, which contained the character of CLBP, effect of pain management, Korean version Oswestry Disability Index (K-ODI) and Korean version of 12-item Short Form Health Survey (SF-12v2). RESULTS: Of 3,121 subjects who responded, 67.3% had moderate to severe pain; 43.5% presented prolonged CLBP of more than two years; and 32.4% had suffered from sleep disturbance due to pain. 22.8% of the patients were not satisfied with current pain management. The mean K-ODI score was 37.63; and it was positively correlated with the mean pain intensity (r=0.6, p<0.001). The SF-12v2 result was negatively correlated with mean pain intensity (PCS: r=-0.5, p<0.001; MCS: r=-0.4, p<0.001) and also negatively correlated with the K-ODI score (PCS: r=-0.75, p<0.001; MCS: r=-0.5, p<0.001). The conformity between patients and doctors in pain assessment was fair (kappa=0.2463). CONCLUSIONS: CLBP negatively affects quality of life. Of total 22.8% of the patients were not satisfied with current pain management. Such needs to be taken more seriously by doctors for improvement of satisfaction and quality of life in patients with CLBP.

Clinical features and prognostic factors in Korean patients hospitalized for coronary artery disease (Catholic Heart Care Network Study) / 대한내과학회지

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.

Transthoracic Echo-Doppler Detection of distal left anterior descending Coronary Artery Flow Initial Experience of Clinical Feasibility

PURPOSE: The aim of this study was to test the feasibility and the clinical usefulness of detection and measurement of distal left anterior descending coronary artery (LAD) flow using transthoracic echocardiography. METHODS: We prospectively examined 200 consecutive subjects(age 56+/-12 yrs, M:F=23:77). Of these subjects, 79 patients underwent coronary angiography. After obtaining the tubular color flow signals of distal LAD using an ultra-band transducer (5-12 MHz) with a special preset program of a low velocity range, the width and length of color Doppler signals, peak diastolic and systolic pulsed Doppler velocity (PDV) and velocity time integral(VTI) were measured. The echocardiographic findings of distal LAD flow were compared with the coronary angiogram. RESULTS: 1. In 142 of 200 subjects (71%), the color and pulsed Doppler signals with clear envelops were identified. 2. Forward biphasic flow in 86(60.6%) subjects and only diastolic flow in 56(39.4%) subjects were detected. 3.The mean length and width of color flow signals were 4.7+/-2.8mm (range 1.1-15.0 mm) and 1.6+/-0.7 mm (range 0.5-4.7 mm), respectively. 4.The mean PDV and VTI were 21.4+/-9.0 cm/sec(range 7.7-58.0 cm/sec) and 8.4+/-4.1 cm(range 2.8-26 cm), respectively. 5. The mean velocity range for obtaining the optimal Doppler signals of distal LAD was 13.0+/-4.2 cm/sec (range 6.4-32 cm/sec). 6. 14 of 22 (63%) subjects who distal LAD color flow signals were not identified showed the total or near total occlusion of LAD on the coronary angiogram. CONCLUSION: Detection and measurement of distal LAD flow are feasible in a high percentage of subjects by use of high frequency transthoracic Doppler echocardiography. The color and pulsed Doppler signals of distal LAD using transthoracic echocardiography at resting state may give the useful clinical information about coronary artery disease.

Comparison between Mitral Flow and Mitral Annulus Velocity by Doppler Tissue Imaging according to Increment of Heart Rate

BACKGROUND AND OBJECTIVES: The utility of Doppler mitral flow pattems for the indirect assessment of left ventricular diastolic function is valid and widely used. One of the most common variables affecting mitral flow is heart rate. The aim of this study was to compare between mitral flow and mitral annulus velocity by Doppler tissue imaging (DTI) according to increment of heart rate. MATERIALS AND METHODS: 17 healthy volunteers (M: F=10: 7, mean age 27+/-2 years) comprised this study. They were free of any acute or chronic illness. The heart rate was elevated by increments of 10 beats (baseline, 80, 90, 100, 110, 120) by transesophageal atrial pacing. We measured mitral flow parameters (E and A velocity, E/A ratio, IVRT, DT of E) and mitral annulus velocity by DTI (e and a velocity, e/a ratio, RIVRT). We gave the score of visual estimation at baseline and each heart rate. The definition of the score was as follows, 1: well visualization of each envelope 2: summation of velocity wave forms 3: no differentiation, completely fused. RESULTS: 1) The E of mitral flow was significantly increased from 100 to 120 BPM and A velocity was significantly increased from 80 to 100 BPM (p<0.05). E/A ratio was significantly decreased from 90 to 100 BPM than baseline (p<0.05). 2) The e and e/a ratio of mitral annulus velocity were significantly increased from above 110, 100 BPM than baseline, respectively (p<0.05). But a velocity was little changed. 3) The score was all significantly higher in mitral annulus velocity pattern by DTI than mitral flow at each heart rate. CONCLUSIONS: The mitral annulus velocity by DTI is less affected by heart rate and visualized better than mitral fiow in increased heart rate. Therefore the assessment of mitral annulus velocity may be helpful for evaluating diastolic function during heart rates of physiologic range.

Persistent Left Superior Vena Cava Diagnosed by Contrast Transthoracic Echocardiography in Patient with Chronic Atrial Fibrillation

Presence of persistent left superior vena cava(PLSVC) is considered to be one of the most frequently encountered anomalies of the systemic venous return. The incidence of PLSVC is reported to be 0.3% to 0.5% in the general population, and in 3% to 10% of patients with congenital heart disease. The presence of PLSVC draining into the coronary sinus is of no hemodynamic significance. However, it is important to recognize this condition, as it can have important clinical implications. The diagnosis can be established by two demensional echocardiography. It should be suspected by the presence of dilated coronary sinus, and confirmed by contrast echocardiography. A 61-year-old man with chronic atrial fibrillation was diagnosed as PLSVC by contrast transthoracic echocardiography(TTE) using agitated saline. Contrast TTE allowed visualization of the time sequence of the echo-contrast within the right atrium first following injection of right antecubital vein. Following injection of left antecubital vein, opacification of the dilated coronary sinus first and then the right atrium was seen.

Correlation of the Time Interval from the Peak of Mitral E Wave to the Peak of Pulmonary Venous D Wave with Mitral Doppler Indexes

BACKGROUND: Pulmonary venous diastolic flow follows the pattern of mitral flow and is dependent on the pressure difference between the pulmonary vein and the left atrium (LA). The magnitude of the decrease in LA pressure in early diastole depends on both the volume of the blood leaving the LA and the stiffness of the left ventricle (LV) and the LA. Relaxation process is known to govern early diastolic compliance. We hypothesized that in patients with decreased early diastolic compliance due to LV relaxation abnormality, there may be rapid rise in LV and LA pressure, resulting in early peak of pulmonary venous D wave as early LV diastolic filling progress. This study was undertaken to define this hypothesis and to examine the relation of the time interval between E wave peak and D wave peak to mitral doppler indexes. METHOD: Patients with significant mitral or aortic valvular disease, or patients with LV ejection fraction below 60%, or patients who have pseudonormal or restrictive LV filling pattern on mitral and pulmonary venous Doppler, were excluded from this study. Mitral Doppler indexes including peak E velocity, peak A velocity, E wave acceleration time (EAT) and deceleration time (EDT) were measured. E/A ratio was calculated. The isovolumic relaxation time from aortic valve closure (Ac) to the onset of E wave , the time interval from Ac to the peak of E wave (AcE), the time interval from Ac to the peak of D wave, and the diastolic time from Ac to R of electrocardiogram (AcR) were measured by the pulsed wave Doppler and phonocardiography. The time interval from the peak of E wave to the peak of D wave (ED) was calculated by the subtraction of AcE from AcD. RESULTS: 1) ED is significantly shorter in patients with E/A or =1 (58.9+/-27.4 msec versus 74.7+/-17.2 msec, p<0.05). 2) ED correlated with IVRT (r=-0.400, p<0.01), AcR (r=0.414, p<0.01), but not with E/A ratio, EDT, or EAT. 3) Multivariate linear regression analysis with all the previously mentioned variables showed that IVRT, AcR, and EAT were independent determinants of the ED. CONCLUSION: This study demonstrates that the ED is shortened in patients who are regarded as having LV relaxation abnormality and that ED is affected by IVRT, AcR, and EAT.

Clinical Experience of Cardiac Myxoma

BACKGROUND AND OBJECTIVES: Cardiac myxoma is histologically benign, but may be lethal because of their strategic position. It may mimic every cardiovascular or systemic disease, and can be missed without a high idex of suspicion. MATERIALS AND METHOD: We reviewed our clinical experience in 25 patients with cardiac myxoma between 1984 and 1999. Special attention was paid to clinical presentation, physical examination, chest X-ray, electrocardiogram, laboratory findings, echocardiographic findings, operative findings and postoperative course. RESULTS: Their age ranged from 23 to 64 (mean 48 years) and there were 6 male (24%) and 19 (76%) female patients. The myxomas were located in the left atrium in 23 (88%), in the right atrium in 2 (12%) cases. The Major presenting symptoms were intracardiac obstruction such as exertional dyspnea in 19 (76%), palpitation in 7 (28%), syncopal episodes in 3 (12%) cases while systemic embolism and constitutional symptoms accounted for 5 (20%) and 10 (40%) cases, respectively. About 70% of patients were present with abnormal, but nonspecific findings in physical examination, chest X-ray, electrocardiogram, and laboratory findings. Echocardiography is the most useful diagnostic screening tool. There was no in-hospital death after operation. But only 1 patient died 5 years after resection from severe pulmonary hypertension and right ventricular failure and 1 patient presented with recurrence at 18 months after primary resection, which was confirmed histologically into chondrosarcoma. CONCLUSION: We conclude that due to nonspecific presentation of cardiac myxoma, a high index of suspicion is needed. If considered as a possible diagnosis, it is easily recognized by echocardiography and usually curative by surgical resection.

Effect of Changes in Pulmonary Venous Flow Pattern by Preload Reduction on Distinguishing Pseudonormal Pattern from Normal

BACKGROUND AND OBJECTIVES: The degree of diastolic dysfunction may explain the difference in clinical symptoms between patients with similar degrees of systolic dysfunction. Pseudonormal mitral filling pattern with increased left ventricular filling pressure is a transitional stage of diastolic dysfunction and is difficult to distinguish from normal. Preload is one of factors affecting the diastolic filling patterns and mitral flow patterns may be influenced by changes in preload in the absence of changes in the left ventricular pressure-volume curve. The changes in the mitral flow velocities caused by preload reduction may be useful in distinguishing patients with a pseudonormal pattern from those with normal. The aim of this study was to establish whether the effect of changes in pulmonary venous flow pattern by preload reduction may be useful in distinguishing pseudonormal pattern from normal. MATERIALS AND METHODS: This study included 40 patients (men 25, female 15, average age 51.0+/-11.2 years) underwent left side cardiac catheterization among patients with normal or pseudonormal patterns. All patients with pseudonormal group had increased LVEDPr (>15 mmHg). The Doppler mitral inflow & pulmonary venous flow parameters at baseline and during reduction of preload using Valsalva maneuver were recorded. RESULTS: 1) There were no difference in sex, diabetes mellitus, hypertension and lipid profiles between both groups. The left ventricular systolic function was better and mean age was younger in normal than pseudonormal group (p 1.0 during Valsalva maneuver in normal group (p<0.05). In pseudonormal group, E velocity was significantly decreased but A velocity was not significantly changed and the E/A ratio was <1.0 during Valsalva (p<0.05). Therefore the change revealed masked LV relaxation abnormality pattern. 3) S and D velocities of pulmonary venous flow were significantly decreased and S/D ratio was significantly increased in both groups (p<0.05). The % changes before and after Valsalva maneuver showed that S velocity was less decreased, D velocity was more decreased and S/D ratio was more significantly increased in pseudonormal than normal group (p<0.05). That revealed masked LV relaxation abnormality pattern. CONCLUSIONS: The Valsalva maneuver for preload reduction is a relatively simple, easily applicable, safe and reproducible method of acutely reducing venous return. The assessment of changes in pulmonary venous flow pattern by preload reduction may be helpful in distinguishing pseudonormal and normal diastolic function in addition to changes in mitral inflow pattern.

Transesophageal echocardiographic detection of thoracic aortic plaque could noninvasively predict significant obstructive coronary artery disease

OBJECTIVE: Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. METHODS: Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54 +/- 12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. RESULTS: Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r = 0.74, P < 0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal, echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. CONCLUSION: This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.