Effect of Vigorous Preload Reduction on Mitral Annulus Velocity in Chronic Renal Failure

BACKGROUND AND OBJECTIVES: The pulsed wave Doppler echocardiography in the mitral inflow is used widely for the assessment of LV diastolic function. The echocardiographic index of LV diastolic function is known to be affected by several factors, such as the loading condition. In the Doppler tissue image (DTI), the mitral annulus velocity is known to be unaffected by the loading condition. The purpose of this study was to investigate the effect of the preload reduction on the mitral annulus velocity. SUBJECTS AND METHODS: We examined the transmitral and pulmonary venous flows, and the mitral annulus velocity in 30 patients with chronic renal failure, but a normal LV systolic function, by echocardiography, both before and after hemodialysis. The study patients were divided into two groups; Group I (preload reduction 2.0 kg, N=20). RESULTS: In the transmitral flow; the E velocity was changed, both before and after hemodialysis, in Group II. < Group I from 97+/-12 cm/s to 86+/-11 cm/s (NS), Group II from 85+/-5 cm/s to 63+/-5 cm/s (p=0.0001)<. The A velocity was also changed in Group II. In the mitral septal annulus velocity by DTI; The E' velocity was changed in both groups, but the A' velocity was only changed in Group II. In the mitral lateral annulus velocity by DTI; all indices remained unchanged in both groups. CONCLUSION: These results suggested that a vigorous preload reduction might change the echocardiographic indices, and either the transmitral flow pattern or the mitral septal annulus velocity. The mitral lateral annulus velocity indices, which are useful for the evaluation of the LV diastolic function, were unchanged by the preload reduction. The preload condition needs to be accounted for when evaluating the LV diastolic function with a Doppler echocardiography.

Clinical Experiences with the Percusurge(r) for the Coronary Lesions with Intracoronary Thrombus

BACKGROUND AND OBJECTIVES: During coronary angioplasty, a distal embolization of the intracoronary thrombus is associated with an increased risk of myocardial infarction and mortality. Recently, distal protection devices have been tested for distal embolization with varying success. Here we report the experiences with one of the distal protection devices, Percusurge(r). SUBJECTS AND METHODS: From January 2001 to August 2001, 5 cases of a Percusurge(r) being used in patients with intracoronary thrombus were experienced during the angioplasty (male:4, female:1). Both the pre- and post-procedural clinical findings of the patients, the angiographic findings, the number of acute complications, the presence of biochemical marker such as CK-MB, and any in-hospital cardiac events were reviewed. RESULTS: Percusurge(r) was used in the right coronary artery (RCA) in 4 cases and in the saphenous vein graft in 1. The clinical diagnosis included stable angina (2 patients), non-Q wave myocardial infarction (1 patient), and Q-wave myocardial infarction (2 patients). The patients showed a TIMI 0 or 1 flow in 4 patients with a RCA lesion and TIMI 3 flow in 1 patient with a saphenous vein graft lesion. However, the TIMI 3 flow was recovered in all cases after the intervention. The CK-MB level did not show any significant changes between the pre- and post-procedure in 4 cases (11.2 +/- 3.2 U/L vs 10.2 +/- 2.1 U/L). However, one of the distal branchs was totally occluded by the distal embolization of the thrombus, and the CK-MB level increased from 2.1 U/L to 22.7 U/L. Otherwise, no procedure-related complications or major in-hospital cardiac events were observed. CONCLUSION: The use of the distal protection device, Percusurge(r), may reduce both the procedural and clinical complications during a coronary intervention in the thrombus-containing lesion. However, a large prospective study is needed to define the role of the distal protection device.

Clinical Manifestation of Novel Stress-induced Cardiomyopathy Mimicking Acute Myocardial Infarction: Single Center Prospective Registry

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.