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.

High Dose Ramipril Inhibits Connective Tissue Growth Factor Expression and Fibrosis in Type 2 Diabetic Rat Heart

BACKGROUND AND OBJECTIVES: Connective tissue growth factor (CTGF) is a profibrotic cytokine, which may play an important role in the development of diabetic cardiovascular complications. ACE inhibition significantly prevents cardiovascular events in diabetics, although the mechanism remains obscure. The purpose of this study was to explore the effect of ACE inhibitors on the expression of CTGF and oxidative stress in the diabetic heart, and determine the effects of long term treatment with ACE inhibitors on diabetic cardiomyopathy. MATERIALS AND METHODS: Thirty OLETF (Otsuka Long Evans Tokushima Fatty) diabetic and thirty LETO (Long Evans Tokushima Otsuka) nondiabetic control rats were randomized into four groups for 24 weeks of treatment with either ramipril (5 mg/kg/day, n=15, each groups) or saline (n=15, each groups). RESULTS: The OLETF diabetic rats had prominent perivascular fibrosis, as shown by picrosirius red stains, compared to the LETO nondiabetic rats. ACE inhibition significantly prevented perivascular fibrosis in OLETF rats (p<0.01). Immunohistochemical stains were used to detect proteins for the receptors of advanced glycation end products (RAGE), CTGF, collagen III and nitrotyrosine. Although there were no significant differences in the myocardiac collagen contents, as found by measuring the hydroxyproline concentration among the four groups, the OLFTF diabetic rats had significantly increased cardiac CTGF and collagen III protein expression compared with the nondiabetic rats. The ACE inhibitor attenuated the increases in RAGE (-50.3%; p<0.01), CTGF (-37.5%; p<0.01) and collagen III (-52.3%; p<0.01) expression in the diabetic heart microvascular area. The OLFTF rats showed marked an increment in cardiac nitrotyrosine, a marker of protein oxidation. Ramipril also inhibited the expression of cardiac nitrotyrosine (-78.3%; p<0.01). CONCLUSION: The present study shows a possible role of RAGE/nitrotyrosine/CTGF in the diabetic cardiomyopathy of OLETF rats. The long term treatment of high dose ACE inhibitors may have beneficial effects on the diabetic heart through both antioxidant and antifibrotic mechanisms.

Analysis of Coronary Artery Flow Patterns in Patients with Chest Pain and Normal Coronary Angiogram: Study Using Transthoracic Doppler Echocardiography

BACKGROUND AND OBJECTIVES: The purpose of this study was to analyze the patterns of coronary artery flow, using transthoracic Doppler echocardiography(TE), in subjects with chest pains and normal coronary angiograms. SUBJECTS AND METHODS: 93 patients(M:F=34:59, mean age:57+/-11 years) ith chest pains and normal coronary angiograms were included in this study. After obtaining baseline clinical data, an exercise treadmill test(TT) as performed, according to the Bruce protocol. The peak diastolic coronary artery flow velocity(DV), at rest, and the coronary flow reserve(FR), in the distal left anterior descending coronary artery(AD), were estimated, using dipyridamole, with TTE. After the administration of angiotensin II receptor(AT II) lockers to 12 patients with a CFR or =2.1. In 7(8.3%) of 12 subjects with a CFR <2.1, their CFR increased, with an improvement of the ETT results, following the administration of the AT II blocker, after an average 19+/-9 months. CONCLUSION: The patients with chest pains and normal coronary angiograms have a heterogeneous clinical spectrum, such as hypertensin, slow flow, reduced CFR, and so on. These subjects need treatment according to the etiology and pathogenesis of their condition, which can be followed up by coronary flow measurements, using TTE.

A Case of Gelatinous Transformation of Marrow in a Patient with Congestive Heart Failure in Malnutrition / 대한혈액학회지

We experienced a case of gelatinous transformation of bone marrow in a patient with congestive heart failure in malnutrition. The biopsy findings of bone marrow were gelatinous transformation, a condition characterized by disruption of marrow architecture, fat atrophy, and deposition of hyaluronic acid. Gelatinous transformation is often mistaken as representing edema, necrosis, or amyloidosis.

Coronary Artery Flow Velocity Pattern Predicting Myocardial Recovery after Acute Anterior Myocardial Infarction

BACKGROUND AND OBJECTIVES: The relationship between the coronary artery flow velocity pattern on the distal left anterior descending coronary artery (LAD), using transthoracic Doppler echocardiography (TTE) and myocardial recovery, following an acute myocardial infarction (MI), has not been studied. SUBJECTS AND METHODS: The coronary flow velocity at the distal LAD was recorded with TTE, immediately, on the 7th day, and at an average, on the 10th month, in 36 patients following an acute anterior MI. The peak diastolic coronary flow velocity (PDV), the initial velocity pattern and alteration in the velocity pattern, during the follow-up period, were analyzed by the changes in the left ventricular systolic function and the anterior apical wall motion. The subjects were divided into two groups: the recovery (R) group:n=24, M:F=14:10, mean age=60+/-9 yrs;and the non-recovery (NR) group:n=12, M:F=11:1, mean age=61+/-11 yrs, according to their myocardial recovery status. RESULTS: The early flow velocity at the distal LAD, using TTE after MI, was divided into 4 patterns;a normal biphasic flow pattern, with a larger diastolic and a smaller systolic component; a pattern, with slow flow and deceleration slope;a pattern, with a retrograde flow; and a pattern, with a rapid diastolic deceleration slope and an early systolic reversal flow. A normal biphasic flow pattern was observed in 16 (66%) of the R-group (n=24), and 1 (8%) of the NR-group (n=12) (p=0.001) patients. A rapid diastolic deceleration slope and an early systolic reversal flow pattern was only observed in 4 of the NR-group (n=12) (p=0.003) patients. CONCLUSION: The patterns, with a rapid diastolic deceleration slope and a systolic retrograde flow, early after MI, and a persistent slow flow velocity during follow up, are related to poor myocardial recovery following an acute anterior MI.

Clinical Characteristics of Patients with Permanent Pacemaker Associated with Lead Thrombi

BACKGROUND AND OBJECTIVES: The formation of thrombi on a permanent pacemaker lead has been reported as a rare complication following the implantation of a permanent pacemaker. However, there is little information about the complications related to modern cardiac pacing. The purpose of this study was to evaluate the factors associated with the formation of a lead thrombosis following the implantation of a permanent pacemaker (P-PM). SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 14 patients (M:F= 6:8, mean age=46+/-11) with P-PM lead thrombus that were detected with a transthoracic echocardiography. The clinical features, type of pacemaker and echocardiographic findings of these patients were analyzed. RESULTS: All thromb us formations had developed in the right atrium (RA), and/or superior vena cava (SVC)(100%, n=14), were mainly in the proximal portion of the RA (71.4%, n=10) and on the ventricular lead (64.3%, n=9). 12 of 14 patients (85.7%), The lead thromboses were atrial fibrillation, with tachy-brady syndrome or sinus pause. Three of the patients had a total SVC obstruction and 1 a thrombus with aspergillosis. The lead thrombus in one patient was completely resolved after thrombolytic treatment. There were no significant differences in the incidences of lead thrombosis in relation to the number of implanted leads, insulation type, echocardiographic parameters. CONCLUSION: Lead thromboses might not be a rare complication following the implantation of a P-PM, and frequently occur in the right atrium of patients with atrial pathology. The necessity for thrombolytic therapy in patients with a lead thrombus should be further investigated.

Effects of Continuous Descending Aortic Balloon Occlusion on Brain Ischemia during Cardiopulmonary Resuscitation in Rabbits

PURPOSE: A recent report introduce a new option for cardiopulmonary resuscitation by using of a continuous descending aortic balloon occlusion. The aim of the present study was to evaluate the effect of balloon occlusion of the descending aorta during cardiopulmonary resuscitation on brain ischemia. METHODS: Twelve rabbits were enrolled in this study. A 4 French Swan-Ganz catheter was advanced through the right femoral artery into the descending aorta. Ventricular fibrillation was induced with an AC current delivered through an electrode catheter advanced into the right ventricle. After 3 minutes of untreated ventricular fibrillation, the rabbits were randomized in two groups: (1) chest compression without balloon occlusion (control group) and (2) chest compression with balloon occlusion of the descending aorta (experimental group). The balloon was inflated for 3 minutes during resuscitation. Defibrillation was attempted at 3 minutes after start of chest compression. At 24 hours after return of spontaneous circulation, brain tissues were fixed in 4% paraformaldehyde and stained with hematoxylin eosin. Then, the ischemic cells in the hippocampal CA1 area were counted. RESULTS: There was significant difference in ischemic neuronal cells between the two groups (control group: 41.8 +/-10.9%, experimental group: 16.8+/-6.8%, p < 0.05). In the experimental group, carotid blood flow was better than it was in the control group during chest compression (control group: 2.4+/-1.0 mL/min, experimental group: 7.6+/-1.9 mL /min, p < 0.05). CONCLUSION: These results suggests that balloon occlusion of the descending aorta during resuscitation decreases brain ischemia in rabbits during cardiac arrest.

In vitro Differentiation of Endothelial Precursor Cells Derived from Umbilical Cord Blood

BACKGROUND AND OBJECTIVES: Ex vivo expansion of endothelial cells is important when applying cell therapy to therapeutic angiogenesis in ischemic tissues. Endothelial precursor cells (EPCs) from the umbilical cord blood are one of adult stem cell. In order to establish the culture system for EPCs, we examined the effects of the media and matrix on the differentiation of a subset of mononuclear cells to endothelial cells, and analyzed their endothelial-lineage phenotype. MATERIALS AND METHODS: Mononuclear cells isolated from human umbilical cord blood were cultured in a chamber slide coated with fibronectin or gelatin in a M199 medium supplemented with 10% fetal bovine serum (FBS) (the normal medium) or with 20% FBS and ECGS (the rich medium). Changes in the morphology and the attainment of DiI-ac-LDL uptake ability were examined during a 7 day period. The attached cells were immunostained for CD31, KDR, and vWF. RESULTS: The fibronectin matrix gave rise to more attached cells than the gelatin matrix (about 1.5 fold). The numbers of attached cells were no different between the normal medium and the rich medium at day 3 and 7, and were about 12% of the seeded mononuclear cells. However, the cell size and the numbers of longer spindle-shaped cells increased with the rich medium. Moreover, there was no increase in cellular population, but a 2-3 fold increase in the cellular size between day 3 and 7. About 20-40% of the attached cells acquired the DiI-ac-LDL uptake ability at day 3, whereas more than 85% of the attached cells could be stained with fluorescent DiI-ac-LDL at day 7 (p<0.001). The attached cells after being cultured for 7 days were stained moderately with the antibodies of CD31, or KDR. However, the cells at day 7 were only weakly immunostained with the vWF antibody, whereas more than 90% of cells were strongly stained at day 14. CONCLUSION: These results suggest that a subset of mononuclear cells derived from cord blood cells can give rise to cells with an endothelial cell-like phenotype, in vitro, at high percentages, which could be applied to in vivo vasculogenesis.

Angiotensin-Converting Enzyme Inhibitor Ramipril Improves Coronary Microvascular Remodeling in Type II Diabetic Rats

BACKGROUND AND OBJECTIVES: Coronary microvascular remodeling is one of the complications associated with diabetic cardiovascular disease. We investigated the effect of long-term treatment with ramipril, an angiotensin converting enzyme inhibitor, on coronary microvascular remodeling on a type II diabetic model, the Otsuka Long-Evans Tokushima Fatty (OLETF) rat. MATERIALS AND METHODS: Twenty OLETF diabetic, and twenty LETO non-diabetic rats at twenty-four weeks old, were randomized into 4 equal groups for treatment with either an aqueous solution of ramipril (5 mg/kg, n=10 for two groups) or saline (n=10 for two groups) for 24 weeks on a daily basis. The blood glucose levels, body weights and blood pressures of the rats were checked on a regular basis. Masson's trichrome and picrosirius red stains were used for the morphometric analysis of the thickening of the coronary arterial wall and the degree of perivascular fibrosis. The myocardial collagen content was determined by measuring the levels of myocardial hydroxyproline. RESULTS: Marked thickening of the coronary microvascular wall and prominent perivascular fibrosis were detected in the hearts of OLETF rats to a greater extent than in the LETO rats (p<0.01). Ramipril significantly prevented coronary microvascular remodeling in OLETF rats (p<0.01), but there was no significant difference in the collagen content/dry heart weight ratio between the groups. CONCLUSION: Long-term treatment with ramipril has an antifibrotic effect, and improves the coronary microvascular remodeling in diabetic OLETF rats.

Cardioprotective Effect of IGF-1 in Mouse with Adriamycin Induced Cardiomyopathy

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the apoptotic pathway, and the effect and mechanism of IGF-1 (insulin like growth factor 1) as a therapeutic agent, in Adriamycin (ADR) induced cardiomyopathy. MATERIALS AND METHODS: We divided 17 mice into ADR (n=6), ADR +IGF-1 (n=6) and saline (n=5) groups. The following were injected into the intraperitoneal cavity for the specified periods: 2.5 mg/kg of ADR every week for 6 weeks, 0.1 mg/kg of IGF-1 in the 5th and 6th weeks and 10 mL/kg of saline every week for 6 weeks. Transthoracic echocardiography, with a 15MHz linear array, was performed before and after injection of the drugs. A TUNEL assay and immunohistochemical staining for Bax, bcl-2, capase-8 and 9, and western blotting for Bax and bcl-2 were performed on the myocardium. RESULTS: The fractional shortening decreased (38.5+/-3.2% before vs. 29.2+/-5.5% after, p<0.05) and the left ventricular end systolic dimension increased (2.5+/-0.3 mm before vs. 3.1+/-0.5 mm after, p<0.05) following the injection of the ADR, but there were no interval changes in the mice treated with saline or ADR+IGF-1. The TUNEL assay showed a higher apoptotic index in the mice treated with ADR than in those treated with saline or ADR+IGF-1 (46+/-8% in ADR, 0.1+/-0.03% in control, 22+/-5% in ADR+IGF-1, p<0.05). The immunohistochemical staining and western blot showed an increase in the expression of Bax, and a decrease in the expression of bcl-2 in the mice treated with ADR than in those treated with ADR+IGF-1 or saline. CONCLUSION: The apoptosis caused by the increased expression of Bax, and the decreased expression of bcl-2, was an important pathogenetic mechanism, and the IGF-1 prevents the progression of cardiomyopathy by attenuating the expressions of Bax and bcl-2 in ADR induced cardiomyopaththy.

Three Cases of Ascending Aortic Aneurysm combined with Bicuspid Aortic Valve

No abstract available.

Clinical Significance of Slow Flow Velocity in the Distal Left Anterior Descending Coronary Artery Detected by Transthoracic Doppler Echocardiography

BACKGROUND AND OBJECTIVES: The aim of this study was to test whether flow velocity in the distal left anterior descending coronary artery (LAD) measured using transthoracic Doppler echocardiography (TTE) can predict pathologic coronary flow dynamics. SUBJECTS AND METHODS: We prospectively examined 222 subjects (mean age 57+/-9 yrs, M:F=132:90) including 55 subjects with myocardial infarction (MI group, mean age=57+/-9, M:F-45:10), 68 with typical angina (Angina group, mean age=62+/-8, M:F=44:24) and 99 with atypical chest pain and normal coronary angiogram (Control group, mean age=54+/-10, M:F=43+/-56). After obtaining tubular color flow signals of the distal LAD using TTE with a special preset program for a low velocity range, the peak (PDV) and mean (MDV) diastolic velocity as well as velocity time integral (VTI) were measured. The echocardiographic parameters of distal LAD flow were compared with the coronary angiographic findings including lesion classification according to ACC/AHA guidelines and the percent diameter stenosis. RESULTS: The average PDV was 20.3+/-9.7 cm/sec in patients with atypical chest pain and normal coronary angiogram, 16.8+/-8.5 cm/sec in patients with typical angina without myocardial infarction and 15.0+/-7.5 cm/sec in those with myocardial infarction (p<0.01 versus the MI group and Angina group, respectively). The PDV was found to be significantly related to the percent diameter stenosis (r=-0.292, p=0.002). The PDV in the group with complex lesion was significantly lower than that of the group with simple lesion. A value of PDV<14 cm/sec had a sensitivity of 76.6% and a specificity of 91.5% for predicting complex lesion of the LAD in groups including myocardial infarction and angina. CONCLUSION: Slow flow velocity in the distal LAD as demonstrated by TTE strongly predicts complex lesions. Baseline coronary flow velocity using TTE provides valuable information about the pathologic condition.

Comparison between Pattern of ST Change during Exercise Treadmill Test and Coronary Flow Reserve in Patients with Chest Pain and Normal Coronary Angiogram

BACKGROUND AND OBJECTIVES: The validity of an exercise test in microvascular angina has not yet been elucidated. Therefore, in order to evaluate the usefulness of the exercise treadmill test in determining the true micorvasculature induced ischemia, we compared patterns of ST depression with coronary flow reserve (CFR) using transthoracic Doppler echocardiography in patients with chest pain and normal coronary angiogram. SUBJECTS AND METHODS: Fifty-nine subjects (M:F=21:38, mean age 55+/-9 yrs) with chest pain and normal coronary angiogram underwent maximal symptom-limited treadmill exercise according to the Bruce protocol. Coronary flow reserve (CFR) was estimated using transthoracic Doppler echocardiography and dipyridamole. Patients with a history of acute myocardial infarction, regional wall motion abnormalities, hypertrophic cardiomyopathy, an ejection fraction of less than 50% or primary valvular heart disease were excluded in this study. The patterns of ST segment depression were compared with CFR. RESULTS: No ST change was observed in 20 of 59 (34%), upslope depression in 20 (34%), flat depression in 13 (22%) and downslope depression in 6 (10%). Eleven of 39 (28%) exercise positive patients demonstrated decreased CFR<2.1. CFR was 3.1+/-0.6 in the group with no ST change, 3.1+/-0.6 in the group with upslope depression, 2.1+/-0.6 in the group with flat depression (p<0.05 versus the group with no change and the upslope depression group, respectively) and 2.0+/-0.4 in the group with downslope depression (p<0.05 versus the group with no change and the upslope depression group , respectively). Flat to downslope depression of ST change during exercise treadmill test had a sensitivity of 58% and a specificity of 95% for predicting CFR<2.1. CONCLUSION: Flat and downslope depression of the ST segment during an exercise stress test may increase the sensitivity and specificity to detect the true microvasculature-induced ischemia that is defined as CFR less than 2.1.

Differences of hemodynamic changes during supraventricular tachycardias: simulation of AVRT and AVNRT in dogs / 대한내과학회지

BACKGROUND: Tachyarrhythmias have various clinical features according to their tachycardia rates, systolic function of the left ventricle, the origin site and the mechanisms. Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) might cause different hemodynamic changes due to their different mechanisms. METHODS: To evaluate the hemodynamic differences of supraventricular tachycardias, atrial tachycardia (atrial pacing with AOO mode, 180/min, group I), AVRT (VA pacing interval 80 msec with DOO mode, 180/min, group II) and AVNRT (VA pacing interval 0 msec, 25 msec with DOO mode, 180/min, group III) were simulated in eleven dogs. Hemodynamic parameters were systemic arterial pressure including systolic, mean and diastolic arterial pressure (SAP, MAP, DAP respectively), mean pulmonary arterial wedge pressure (MPAWP) and cardiac output (CO). RESULTS: The MAP was highest in group I (87.0+/-20.4 mmHg) and decreased with decreasing VA interval of no significance. The SAP was higher in group II (109.8+/-22.6 mmHg) than in group III (95.3+/-27.1 mmHg) (p<0.05). The level of MPAWP had no significant differences among three groups and showed no peculiar pattern with changes of VA interval. The CO was higher in group I (1.18+/-0.32 L/min) than in other two groups with significant difference (p<0.01) and decreased with shortening of VA interval without significance. CONCLUSION: Above results suggested that the AVRT and AVNRT have different effects on hemodynamic changes, those from different timing of atrial contraction, especially on SAP and CO. So hemodynamic compromise during tachycardia could be more severe in AVNRT than in AVRT inspite of their similar QRS morphology and tachycardia rate.

Aspergillus Infection in a Large Thrombus of a Permanent Ventricular Pacing Lead

Pacemaker lead infection is a rare but a dangerous complication. Diagnosis can usually be established by the clinical picture and blood cultures. Transesophageal two dimensional echocardiography might be crucial in the diagnosis by visualizing pacing lead vegetations. Medical treatment alone is rarely successful, and several studies have suggested the infected pacemaker systems should be removed quickly for optimal management. We describe a case of Aspergillus infection in a permanent ventricular pacing lead, which appears to be the first reported case in Korea. A 30-yr-old man was evaluated for the symptoms and signs of congestive heart failure 3 yr after DDD pacemaker implantation. The transthoracic and transesophageal echocardiogram showed a large movable round shaggy mass attached to a ventricular lead in the right atrium. The atrial and ventricular leads were removed during cardiopulmonary bypass, and a new epicardial pacing system was implanted. The functional ventricular pacemaker lead was encased in a large organized thrombus. Histological findings were consistent with Aspergillus infection in a large thrombus attached to a pacemaker lead.

An Individualized Teaching Program for Atherosclerotic Risk Factor Reduction in Patients with Myocardial Infarction

This study was conducted to evaluate the effect of a teaching program on patients with myocardial infarction. Forty-five patients were randomly selected 22 were assigned to a teaching group and 23 to a control group. An individualized teaching program was delivered to the teaching group during the hospitalization period. It covered aspects such as: the characteristics of heart disease, the anatomy and physiology of the heart, risk factors of atherosclerosis, medication and diet and exercise therapy. When these subjects were discharged to their homes, they received regular supportive care via telephone or mail for 12 weeks. Atherosclerotic risk factors, including, smoking, exercise, blood lipid profile and BMI were measured before and after the teaching program. Post-testing revealed that the numbers of those who exercised and the number of non-smokers were significantly higher in the teaching group than in the control group. Increased HDL cholesterol (High-Density Lipoprotein cholesterol) was significantly greater in the teaching group than in the control group. The above findings suggest that this individualized teaching program might be helpful at reducing the risk factors of atherosclerosis in myocardial infarction patients.

A Novel Cardiomyopathy Mimicking Acute Myocardial Infarction

We recently experienced 2 cases of a novel cardiomyopathy following various stressful conditions. Here, we report on this novel cardiomyopathy showing transient left ventricular apical wall motion abnormalities following stress. Our cases exhibited an acute onset, transient left ventricular apical wall motion abnormalities with chest symptoms, electrocardiographic changes and minimal enzyme release, which mimicked acute myocardial infarction without stenosis on the coronary angiograms. The novel cardiomyopathy developed in our patients following aggravation of a systemic disorder (acute pyelonephritis with septicemia) and noncardiac surgery (total hysterectomy). Both our cases exhibited the typical echocardiographic findings of asynergy of the apical region with hypercontraction of the basal segment of the left ventricle, and wall motion abnormalities, which improved rapidly within a few weeks.

Clinical Observation of Peripartum Cardiomyopathy

BACKGROUND AND OBJECTIVES: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure affecting women between the last month of pregnancy and the first five months after delivery. The etiology and prognostic factors of PPCM remains poorly understood, although some risk factors have been described. SUBJECTS AND METHODS: In order to characterize the features of PPCM, clinical and echocardiographic data, obtained from 19 patients who fulfilled diagnostic criteria of PPCM, from January 1996 to march 2001, were retrospectively analyzed. We divided the sample into 2 groups, which were classified according to clinical and echocardiographic improvements. (Group I; patients who improved, Group II; patients who did not improved, or deteriorated). RESULTS: Patients with PPCM (n=19, age: 32+/-5 yrs, NYHA Class: II-IV, LVEF: 34.1+/-8.8%, follow-up period: 14.2+/-16.3 months) had a high frequencies of the following clinical factors: Anaemia (16/19, 84.2%); Pre-eclampsia (11/19, 57.9%); Multiparity (11/19, 57.9%); aged over 30 yrs old at delivery (11/19, 57.9%). During follow up, 10 patients improved to NYHA Class I, 8 patients failed to improve, or deteriorated, and 1 patient died due to ventricular fibrillation. Group II (n=9, age: 31+/-3 yrs, follow up LVEF: 38.8+/-12.9%), as compared to Group I (n=10, age: 33+/-6 yrs, follow up LVEF: 56.4+/-6.4%), had greater left ventricular end-systolic dimension (LVESD, 53.0+/-7.7 mm vs 45.9+/-4.8 mm; p<0.05). CONCLUSION: PPCM has a high rate of progression to dilated cardiomyopathy. Therefore, in pregnant women with common clinical findings of PPCM, including anemia, pre-eclampsia, multiparity and old age at delivery, the initial echocardiographic assessment for cardiac function is essential, and serial follow-up is required.

A Case of Ascending Aortic Aneurysm Associated with Congenital Bicuspid Aortic Valve

Bicuspid aortic valve is the most common form of congenital valvular disease, and its presence may predispose the patients to development of true aortic or dissecting aortic aneurysms. An intrinsic aortic weakness may underlie a bicuspid aortic valve, aortic aneurysm or aortic dissection. We experienced a case of an ascending aortic aneurysm associated with a functionally normal bicuspid aortic valve. A screening echocardiograph was performed due to atypical chest pain, which detected a large ascending aortic aneurysm and a bicuspid aortic valve. The patient underwent an operation for an ascending aortic aneurysm and, is living one year later, and is asymptomatic. To the best of our knowledge, this may be the first case of an ascending aortic aneurysm associated with a bicuspid aortic valve in Korea.

The Relation between Acute Adriamycin induced Cardiomyopathy and Apoptosis in rat : Study using 15 MHz High Frequency Transducer

No abstract available.