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BACKGROUND: The commercially available formulation of amlodipine is conjugated with besylate salt to increase water solubility. Recently, a new amlodipine salt formulation has been developed in which the free base of amlodipine is conjugated with a chemically different salt, adipate. OBJECTIVE: The goal of this study was to compare the antihypertensive effect and tolerability of amlodipine adipate with those of amlodipine besylate in patients with mild to moderate hypertension. METHODS: This was a multicenter, randomized, doubleblind, parallel-group study in which patients received 8 weeks of treatment with either amlodipine adipate or amlodipine besylate. The primary efficacy variable was noninferiority of the difference in mean changes from baseline in trough diastolic blood pressure (DBP) after 8 weeks of treatment. Secondary efficacy variables included mean changes in DBP, systolic blood pressure (SBP), and response rate (defined as the proportion of patients whose DBP was <90 mm Hg or whose DBP had decreased from baseline by > or =10 mm Hg). The incidence of adverse events (AEs) was also assessed. RESULTS: Two hundred eleven patients were randomly assigned to receive amlodipine adipate (n = 106) or amlodipine besylate (n = 105). Study patients were primarily female (54.5%), with a mean (SD) age of 52.2 (9.6) years and a mean body weight of 67.1 (10.2) kg; there were no between-group differences in demographic profiles. After 4 weeks of randomized treatment, 58 (27.5%) patients (29 [27.4%] amlodipine adipate, 29 [27.6%] amlodipine besylate) had not achieved a mean DBP <90 mm Hg, and their dose was doubled. Mean DBP changes at 8 weeks were -15.2 (7.3) mm Hg in the amlodipine adipate group and -14.2 (7.4) mm Hg in the amlodipine besylate group (P = NS). Because the 95% CI for the difference in mean DBP changes between groups (-0.53 to 2.55) was within the prespecified lower limit (-4 mm Hg), amlodipine adipate was considered noninferior to amlodipine besylate. Mean SBP changes were -24.9 (12.1) mm Hg in the amlodipine adipate group and -22.0 (14.7) mm Hg in the amlodipine besylate group (P = NS). The response rates were 92.0% for amlodipine adipate and 95.4% for amlodipine besylate (P = NS). The overall incidence of clinical AEs was 20.8% in the amlodipine adipate group and 25.7% in the amlodipine besylate group (P = NS). Drug-related clinical AEs occurred in 5.7% and 12.4% of patients in the respective treatment groups (P = NS). Serum uric acid levels decreased significantly from base-line in both groups (P < 0.001). CONCLUSIONS: Eight weeks of treatment with amlodipine adipate produced significant reductions from baseline in blood pressure in these patients with mild to moderate hypertension. The efficacy of amlodipine adipate was not inferior to that of amlodipine besylate. Tolerability was comparable between the 2 treatment groups.
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Adipatos/química , Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Adulto , Anciano , Amlodipino/efectos adversos , Amlodipino/química , Antihipertensivos/efectos adversos , Antihipertensivos/química , Presión Sanguínea/fisiología , Cápsulas , Método Doble Ciego , Esquema de Medicación , Femenino , Rubor/inducido químicamente , Cefalea/inducido químicamente , Humanos , Corea (Geográfico) , Masculino , Persona de Mediana Edad , Selección de Paciente , Prurito/inducido químicamente , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: A non-dipping pattern in hypertensive patients has been shown to be associated with a greater left ventricular (LV) hypertrophy, LV diastolic impairments and prolonged ventricular repolarization. The dynamic parameters of the QT dispersion (QTd) have been highlighted as markers of ventricular repolarization heterogeneity. The aim of this study was to demonstrate if the extent of nocturnal blood pressure (BP) fall was related to the LV mass, LV diastolic function and dynamic parameters of the QTd. SUBJECTS AND METHODS: 122 subjects, receiving electrocardiography, 24-hour ambulatory BP monitoring, 12 lead-24hr Holter monitoring and 2-dimensional Doppler echocardiography examinations, were enrolled. The subjects were classified as normotensive, dipper and non-dipper. The LV mass (LVM) and LV diastolic indices were measured. Using the QT Guard software, with 12 lead-24hr Holter monitoring, the QTd, mean QTd, QTd variation (the difference between the maximum minus the minimum QTd value observed over the recording time), QTd maximum (the maximum difference of QTd between consecutive beats) and QTd variability (QTd standard deviation) were analyzed. RESULTS: Of the 122 patients, 39 and 40 were placed in the dipper and non-dipper groups, respectively. The non-dipper group had a greater LVM index (LVMI) than the dipper group (p<0.01). The non-dipper group had greater increases in their A velocity (p<0.01), and more prolonged deceleration (p<0.01) and isovolumic relaxation (p<0.01) times than the dipper group. There were no significant differences in the QT and QTc interval between the 3 groups, but the QTd was much more increased in the non-dipper than the dipper and normotensive groups (p<0.01). For the dynamic parameters of the QTd, the QTd variation, QTd maximum and QTd variability were significantly increased in the non-dipper compared to the dipper and normotensive groups (p<0.05). Comparing the dipper and normotensive groups, there were no significant differences in the LVMI, LV diastolic indices, QTd and dynamic parameters of the QTd. CONCLUSION: The non-dipper group of hypertensive patients had a greater LVMI, more impaired LV diastolic function and greater increases in their QTd and dynamic parameters of the QTd compared to the dipper and normotensive groups, suggesting the possibility of a much greater chance of cardiovascular events, and their complications, in the non-dipper compared to the dipper group.
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Humanos , Presión Sanguínea , Desaceleración , Ecocardiografía Doppler , Electrocardiografía , Electrocardiografía Ambulatoria , Hipertensión , Hipertrofia , Hipertrofia Ventricular Izquierda , Características de la Población , RelajaciónRESUMEN
Blunt chest trauma in intoxicated patients is very difficult to evaluate in the emergency medical center. Emergency physicians have difficulty figuring out the nature of the accident because the patients are frequently uncooperative. That is why we should always be cautious when evaluating intoxicated patients. Coronary artery dissection after blunt chest trauma is very rare, but delayed diagnosis can be lethal to the patient. We report a case of a27-year-old intoxicated male patient transferred to our emergency medical center after a motorcycle accident. After the primary survey, there were no severe external wounds, fractures or hemorrhages. We decided to monitor the patient in the observation unit until his mental status fully recovered. About two hours later, he complained of epigastric discomfort and dyspnea. His electrocardiogram showed ST segment elevation in leads I, aVL, V1- V4. Cardiac enzymes were also elevated. The coronary angiogram revealed a total occlusion of the proximal left anterior descending artery (LAD) and a dissecting flap was seen on intravascular ultrasonography. He recovered after successful stent insertion in the LAD lesion.
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Humanos , Masculino , Arterias , Vasos Coronarios , Diagnóstico Tardío , Disnea , Electrocardiografía , Urgencias Médicas , Hemorragia , Motocicletas , Infarto del Miocardio , Stents , Tórax , Ultrasonografía Intervencional , Heridas y LesionesRESUMEN
BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.
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Humanos , Masculino , Ecocardiografía , Ecocardiografía Transesofágica , Hipertensión , Corea (Geográfico) , Insuficiencia de la Válvula Mitral , Prolapso de la Válvula Mitral , Válvula Mitral , Pectinidae , Prevalencia , Prolapso , Estudios Prospectivos , RoturaRESUMEN
BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.
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Adulto , Humanos , Diástole , Ecocardiografía , Ecocardiografía Doppler , Función VentricularRESUMEN
The nonbacterial valvular and mural verrucous endocarditis known as Libman-Sacks endocarditis is found in 40~60% of patients with systemic lupus erythematosus. the Libman-Sacks endocarditis mostly affects the mitral and aortic valves and frequently displays valvular dysfunction. In rare cases, the Libman-Sacks endocarditis can embolize and cause stroke syndrome. We report a case of Libman-Sacks endocarditis confused with infective endocarditis because its clinical manifestations were very similar to those of infective endocarditis. We confirmed systemic lupus erythematosus with Libman-Sacks endocarditis by means of serology and successfully treated patient with steroid.
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Humanos , Válvula Aórtica , Endocarditis , Lupus Eritematoso Sistémico , Accidente CerebrovascularRESUMEN
Isolated tricuspid regurgitation (TR) is rare. Generally, TR is caused by pulmonary hypertension secondary to mitral or aortic valve disease, commonly referred to as "functional" regurgitation. The causes of isolated TR in adults include trauma, endocarditis, carcinoid heart disease, and congenital malformation of the tricuspid valve apparatus. In addition, isolated TR should be distinguished from Ebstein anomaly. In the present case, the patient had no definite causes of TR, and neither mitral nor aortic valve disease. The tricuspid valve of this patient showed no abnormalities other than a severely dilated tricuspid annulus. Isolated TR caused by annular dilatation was diagnosed and then ring annuloplasty was perfomed. The subsequent clinical course was satisfactory.
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Adulto , Humanos , Válvula Aórtica , Cardiopatía Carcinoide , Dilatación , Anomalía de Ebstein , Endocarditis , Hipertensión Pulmonar , Válvula Tricúspide , Insuficiencia de la Válvula TricúspideRESUMEN
Colonic ischemia is the most prevalent form of gastrointestinal ischemia and causes 3~9% of all acute lower intestinal bleeding. Most common cause is known to be cardiac embolus. A 67-year-old female patient presented with rectal bleeding. The patient had cerebral infarction 15 days ago. A colonoscopy showed a large ulcer with hemorrhage in the rectum. Computed tomography showed deep vein thrombosis from the left popliteal vein to infrarenal inferior vena cava. Transthoracic echocardiography was carried out, but no abnormal feature was found. Then, transesophageal echocardiography, with agitated saline contrast to find out a right to left shunt, was performed, patent foramen ovale was found. This patient was treated with anticoagulation and inferior vena cava filtering. We suggest this ischemic colitis may be due to arterial embolization from deep vein thrombosis through PFO.
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Anciano , Femenino , Humanos , Infarto Cerebral , Colitis Isquémica , Colon , Colonoscopía , Dihidroergotamina , Ecocardiografía , Ecocardiografía Transesofágica , Embolia , Foramen Oval Permeable , Hemorragia , Isquemia , Vena Poplítea , Recto , Úlcera , Vena Cava Inferior , Trombosis de la VenaRESUMEN
BACKGROUND AND OBJECTIVES: The second derivative of a photoplethysmogram (SDPTG) is a simple, convenient and non-invasive technique for pulse wave analysis. The SDPTG index correlates with age and other risk factors of atherosclerosis in the Japanese population, but has not yet been described in the Korean population. The purposes of this study were to analyze the age-related changes in the SDPTG of healthy subjects (study 1), and investigate the differences in the SDPTG of patients with hypertension, compared with those of normotensive subjects (study 2). We also compared the differences in the SDPTG between coronary artery disease (CAD) patients and normal subjects (study 3), to test the clinical usefulness of SDPTG in the evaluation of atherosclerosis. SUBJECTS AND METHODS: We consecutively studied 235 healthy adults, 40 with essential hypertension and 42 with CAD. Their SDPTG were recorded in the sitting position using a Fukuda FCP-3166. RESULTS: In study 1, the b/a ratio increased with age, whereas the c/a, d/a and e/a ratios decreased. The SDPTG aging index (AGI)(y) increased with age (x)(r=0.71, p=0.000;y=22.731x+54.571). In study 2, the patients with hypertension showed a lower average d/a ratio (-0.47+/-0.15 vs. -0.38+/-0.15, p=0.02) and higher average SDPTG AGI (-0.09+/-0.34 vs. -0.26+/-0.37, p=0.011) than the normotensive subjects. In study 3, the patients with CAD had higher average b/a ratio (-0.47+/-0.19 vs. -0.59+/-0.17, p=0.001) and SDPTG AGI (-0.01+/-0.41 vs. -0.23+/-0.40, p=0.004) than the normal subjects. In a logistic regression analysis, the SDPTG AGI was a significant determinant of CAD (p=0.046). CONCLUSION: The SDPTG aging index may be useful in the evaluation of vascular aging and damage due to hypertension and atherosclerosis.
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Adulto , Humanos , Envejecimiento , Pueblo Asiatico , Aterosclerosis , Enfermedad de la Arteria Coronaria , Hipertensión , Modelos Logísticos , Fotopletismografía , Análisis de la Onda del Pulso , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVES: Ventricular premature beat (VPB) with a left bundle branch block morphology and an inferior axis usually originates from the right ventricular outflow tract (RVOT) and is a frequent clinical problem. Although some investigators have suggested that RVOT VPBs are associated with RVOT ventricular tachycardia, few data are available on patients with RVOT VPBs. The purpose of this study was to determine the clinical characteristics and prognosis of RVOT VPB. SUBJECTS AND METHODS: The study subjects were 161 consecutive patients with frequent RVOT VPBs on standard electrocardiography. All patients underwent clinical examinations, echocardiography and 24-hour ambulatory electrocardiography. Among these patients, 50 were followed up for a period averaging 28.5+/-18.1 months. RESULTS: No structural cardiac abnormalities were found in 149 (92.5%) of the 161 patients with frequent RVOT VPBs. The prevalence of complex VPBs was relatively high (101 of 161 patients: 62.7%) on initial 24-hour electrocardiography. In the case of the 50 follow-up patients, there was no significant difference in mean frequency of RVOT VPBs between baseline and follow-up study (636+/-482/hour vs. 569+/-502/hour, p=NS). Furthermore, VPBs tended to persist over the follow-up period in the majority (92%) of patients with frequent RVOT VPBs. Five patients (10%) developed nonsustained ventricular tachycardia, 2 (4%) sustained ventricular tachycardia and 1 (2%) died suddenly. Antiarrhythmic drugs are effective in decreasing the frequency of VPBs, and beta-blockers especially seem to be effective in decreasing the severity of VPBs. CONCLUSION: In the patients with frequent RVOT VPBs, sustained ventricular tachycardia or sudden death could develop. Therefore, careful observation is required in patients with frequent RVOT VPBs.
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Humanos , Antiarrítmicos , Vértebra Cervical Axis , Bloqueo de Rama , Complejos Cardíacos Prematuros , Muerte Súbita , Ecocardiografía , Electrocardiografía , Electrocardiografía Ambulatoria , Estudios de Seguimiento , Prevalencia , Pronóstico , Investigadores , Taquicardia Ventricular , Complejos Prematuros VentricularesRESUMEN
BACKGROUND AND OBJECTIVES: Tissue Doppler imaging (TDI)-derived tissue velocity (TV) and strain rate (SR) are new ultrasonic parameters for assessing the regional myocardial function by quantitatively measuring the myocardial velocity. The aim of this study was to investigate the changes of these indices after exercise, in patients with coronary artery disease (CAD), for comparison with the wall motion score index (WMSI). SUBJECTS AND MEHTODS: Twenty-one patients with CAD and 21 normal subjects were studied, before and after an exercise stress test, using the Bruce protocol. TDI data were obtained, and analyzed offline, for peak systolic TV (PSTV) and peak systolic SR (PSSR), using a 16 segment-model. The segmental PSTV and PSSR were compared with the WMSI. RESULTS: The number of segments with a significant increase in the PSTV or PSSR, after exercise (p<0.05), was less in the CAD patients than the normal subjects (9 vs. 14 segments, 7 vs. 10 segments, respectively). The PSTV, after exercise, progressively decreased from the base to the apex in both the normal and CAD groups, but the absolute values were significantly lower in the CAD group (base : 8.44+/-1.28 vs. 6.56+/-1.6, mid : 6.31+/-1.18 vs. 4.26+/-1.25 and apex : 3.48+/-0.83 vs. 1.25+/-1.27 cm/sec, p<0.05, respectively). In the normal subjects, the PSSRs, after exercise, were uniform in all segments, whereas this was not the cases in the CAD group (p<0.05). The PSSR showed a negative correlation with the WMSI (r=-0.45, p<0.05). CONCLUSION: This study has shown that TV and SR can detect the ischemic myocardium with exercise stress, and objectively measure the systolic function in patients with CAD. The quantification of stress echocardiography may overcome the training requirement, and subjective nature, of conventional wall motion scoring.
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Humanos , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Ecocardiografía Doppler , Ecocardiografía de Estrés , Prueba de Esfuerzo , Miocardio , UltrasonidoRESUMEN
Thrombotic thrombocytopenic purpura (TTP) is an unusual syndrome characterized by a clinical picture of micro-angiopathic hemolytic anemia, thrombocytopenic purpura, neurologic symptoms, renal disease and fever. Although widespread vascular thrombosis is common in TTP, the evidence of cardiac involvement is less clear. We report the first Korean case of a 22-year-old woman with TTP associated with acute myocardial infarction. With continued plasmapheresis, the clinical status of TTP improved markedly and was stabilized. Serial echocardiograms showed improvement of the cardiac wall motion.
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Femenino , Humanos , Adulto Joven , Anemia Hemolítica , Fiebre , Infarto del Miocardio , Manifestaciones Neurológicas , Plasmaféresis , Púrpura Trombocitopénica , Púrpura Trombocitopénica Trombótica , TrombosisRESUMEN
BACKGROUND AND OBJECTIVES: It is contradictory that arterial stiffness, especially in a systemic vascular tree, is related to coronary artery disease. This study was performed to establish the relationship between systemic vascular compliance and the severity of coronary artery disease. SUBJECTS AND METHODS: The study population was comprised of 53 chronic stable angina patients and 45 normal healthy controls. Coronary angiography was used to determine the involved vessels. The systemic vascular compliance and other hemodynamic variables were measured by a non-invasive pulse dynamic waveform analysis. RESULTS: In the patient group, 15 (24.5%) had one-vessel disease, 15 (24.5%) a two-vessel disease and the remaining 23 (43%) had a three-vessel disease. In the patients with a three-vessel disease, the systemic vascular compliance was significantly lower than those of the other two groups (p<0.05). The systemic vascular compliance of the patients with multi-vessel diseases (including two-vessel and three-vessel) was also significantly lower than that of the controls or patients with a one-vessel disease (p<0.05). The systemic vascular compliance was found to have a significant negative association with the severity of coronary artery disease (Spearman's rho=-0.296, p<0.05). CONCLUSION: This study has shown that arterial stiffness (or systemic vascular compliance) is significantly associated with the severity coronary artery disease, and the serial non-invasive measurement of the systemic vascular compliance may be useful in the early detection of severe coronary artery disease.
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Humanos , Angina Estable , Adaptabilidad , Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Hemodinámica , Isquemia Miocárdica , Rigidez VascularRESUMEN
BACKGROUND AND OBJECTIVES: This is a comparative, randomized, multi-centered, angiographic trial for the comparison of TNK-tPA with rt-PA, in Korean patients with an acute myocardial infarction (AMI). SUBJECTS AND METHODS: Fifty four patients that were eligible for thrombolysis, diagnosed with an AMI, were randomized into two groups:TNK-tPA (single bolus injection, 25-50 mg weight adjusted;n=25) or rt-PA (accelerated intravenous infusion, up to 100 mg;n=29) at the emergency room. The primary endpoint was the percentage of patients with a TIMI (Thrombolysis In Myocardial Infarction) III flow 90 min following the administration of the study drug. The secondary endpoints were an infarct-related artery patency at 90 min, the percentage of patients with ST segment resolution at 60 and 180 min, and at 30 days mortality. RESULTS: The baseline demographic data, including age, sex and body weight, and a medical history of prior myocardial infarction and risk factors were no different between the TNK-tPA and rt-PA groups. The pain-to-needle and door-to-needle times were also no different. The ST segment resolution was no different between the two groups. A TIMI grade 3, on a coronary angiogram, 90 min following the drug administration, was observed in 19 (76.0%) of the TNK-tPA and 17 (58.6%) of the rt-PA (p=0.24) patients. However, a TIMI grade more than 2 was higher in the TNK-tPA (100%;25/25) than in rt-PA group (72.4%;21/29)(p=0.0052). The in-hospital adverse events, and clinical outcomes at 30 days, were no different between the two groups. CONCLUSION: TNK-tPA is more convenient, and may be a preferred thrombolytic agent, for the revascularization of an AMI.
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Humanos , Arterias , Peso Corporal , Enfermedad Coronaria , Servicio de Urgencia en Hospital , Infusiones Intravenosas , Mortalidad , Infarto del Miocardio , Revascularización Miocárdica , Factores de Riesgo , Terapia TrombolíticaRESUMEN
We report two cases of hepatic metastases from choriocarcinoma in women of childbearing age in whom imaging studies performed at presentation revealed the presence of liver masses, and who had clinically progressive anemia or intraabdominal hemorrhage. CT demonstrated heterogeneously enhanced liver masses. Characteristic angiographic findings included hypervascular hepatic masses with aneurysmal dilatations of the peripheral hepatic arteries at the arterial phase and persistent vascular lakes at the venous phase.
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Adulto , Femenino , Humanos , Angiografía , Coriocarcinoma/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Neoplasias Hepáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND OBJECTIVES: Large volume reduction after hemodialysis in patients with chronic renal failure alters the preload. We investigated the cardiac function by total ejection isovolume (TEI) index- a new simple, readily reproducible Doppler echocardiographic index combining systolic and diastolic function- before and after dialysis. MATERIALS AND METHOD: Thirty-one patients on maintenance hemodialysis including 6 diabetes and 13 hypertensives without known organic heart disease and with normal systolic function were enrolled. They were divided into two groups according to ultrafiltration volume at the study dialysis session, group 1 (2.5kg or less) and group 2 (more than 2.5 kg). They are 46+/-12 years old on average. We examined two-dimensional, M-mode, pulsed wave and tissue Doppler before and after dialysis immediately. TEI index was calculated by dividing the sum of the isovolumic relaxation time (IVRT) and isovolumic contraction time (ICT) by the ejection time. RESULTS: After dialysis, significant decrease of body weight was noted, but baseline heart rate, blood pressure, Left ventricular (LV) ejection fraction and LV mass index were not changed significantly. LV end-diastolic volume was decreased significantly after dialysis in all group, and end-systolic volume was decreased significantly in total and group 2. Peak early E velocity and ratio of E to the peak late (A) velocity (E/A) from mitral inflow signal were decreased significantly after dialysis in all group and deceleration time of early filling phase was prolonged in total and group 1, but A and IVRT did not change significantly. Of the septal mitral annulus motion, Ean velocity and Ean/Aan ratio was decreased, but no significant change was noted in the lateral annulus. The TEI index did not chage significantly after dialysis in all group. CONCLUSION: A new simple echocardiographic TEI index can be used to measure the global myocardial function in patients with chronic renal failure before and after dialysis, relatively independent of preload change.
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Humanos , Presión Sanguínea , Peso Corporal , Desaceleración , Diálisis , Ecocardiografía , Cardiopatías , Frecuencia Cardíaca , Fallo Renal Crónico , Relajación , Diálisis Renal , UltrafiltraciónRESUMEN
BACKGROUND AND OBJECTIVES: Atrial fibrillation(AF) is the most frequently encountered arrhythmia in clinical practice. Pharmacologic therapy has been advocated for both immediate restoration of sinus rhythm and prevention of recurrent AF. Because conventional antiarrhythmic therapy is often ineffective in maintaining sinus rhythm or is associated with adverse side effects in patients with AF, recent interest has focused on the use of class III antiarrhythmic agents. This study investigated the efficacy and safety of sotalol and amiodarone for conversion of chronic AF and prevention of recurrent AF. MATERIALS AND METHOD: Thirty six patients with AF were firstly received sotalol by prospective study protocol. The patients were classified as having paroxysmal AF(PAF, N=2) or chronic AF(CAF, N=4) based on AF pattern. If the patients with CAF did not convert to sinus rhythm or the patients with PAF recurred in AF, the patients were received second agents(amiodarone). Patients were followed up for one year. RESULTS: Among the 12 patients with PAF receiving sotalol, 10(83.3%) patients remained in normal sinus rhythm for average 9.4+/-3.6 months. Sotalol was replaced by amiodarone in the remaing 2 patients with arrhythmia recurrence and 1 of the 2 patients remained in sinus rhythm during the follow-up period. In the case of 24 patients with CAF, conversion to sinus rhythm was achieved in 5(20.8%) patients with sotalol. Among the patients with CAF who were not respond to sotalol, 17 patients received amiodarone subsquently and 3 patients successfully converted to sinus rhythm. There were no proarrhythmic effects related to both agents during the study period. CONCLUSION: Both sotalol and amiodarone appear to be less effective in the termination of CAF, but sequential use of these two agents seem to be very effective for the prevention of recurrence of PAF.
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Humanos , Amiodarona , Arritmias Cardíacas , Fibrilación Atrial , Estudios de Seguimiento , Estudios Prospectivos , Recurrencia , SotalolRESUMEN
No abstract available.
RESUMEN
Trauma and non-traumatic aortic pathologies such as infective endocarditis, syphilis, fenestrated aortic valves, valves with myxomatous transformation, cystic medionecrosis of the aorta, and inherited disorders of connective tissue may occasionally lead to a rupture of the aortic valve. Among the causes of the rupture of the aortic valve, the non-traumatic aortic valve commissural rupture is extremely rare. The aortic valve rupture typically results in a rapidly progressive heart failure and frequently, death. Therefore, early diagnosis is followed by an immediate operation is necessary. The purpose of this article is to report the first successful operation in Korea of a 44-year-old male patient with acute aortic regurgitation due to non-traumatic rupture of the aortic valve commissure.