To assess the effects of regional wall motion abnormalities on left ventricular function, mitral annulus(MA) motion and left ventricular posteior wall(LVPW) motion were studied by M-mode and Doppler echocardiography in 13 normal subjects and 40 mitral valve replaced(MVR) patients. In MVR patients, mitral annulus motion showed significantly delayed contraction(DC) after A2 by 3.7+/-3.0mm in amplitude and 80+/-35 msec in time(normal control; 0.1+/-0.3mm, 35+/-15msec, p<0.01 for both) and reduction in systolic % thickening of LVPW(39.7+/-23.6 VS 63.2+/-18.4%, p<0.01). MVR patients were devied into 2 group according to the amplitude of MA motion, 4mm Group I(n=13, DC> or =4mm) showed increase epicardial excursion of LVPW compared with Group II(n=27, DC<4mm)(Group I vs Group II, 11+/-3.7 vs 8.6+/-2.6 mm, p<0.05). In mechanical prosthetic valve replaced patients(n=22), time relationship between valve opening, mitral flow, peak thining rate of LVPW and valve peak excursion were studied also and the phase difference that are observed in normal subjects, were lost. We interpreted these delayed contraction of mitral annulus motion and epicardial motion increment as muscle fiber architectural abnormalities which might effect on MVR patients as a factor of left ventricular systolic and diastolic dysfunction.
Echocardiography, Doppler ; Humans ; Mitral Valve* ; Ventricular Function, Left

The pressure gradient across the mitral valve and atrioventricular pressure half time were measured by Doppler echocardiography during cardiac catheterization in 15 patients with mitral stenosis. Among these 15 patients with mitral stenosis, 6 patients were combined with aortic insufficiency and 4 patients with mitral insufficiency. Mitral valve area(MVAe) was measured by Doppler echocardiographic pressure half time and mitral valve area(MVAc) was measured by cardiac catheterization data(modified Gorlin's formula). Mean diastolic pressure gradient(MDPG) and peak diastolic pressure gradient(MDPG) measured by Doppler echocaridgraphy were compared with pulmonary wedge pressure. Obtained results were as follows; 1) Thewe was significant correlation between MVAe and MVAc regardless of mitral regurgitation or aortic regurgitation(r=0.09). 2) There was significant correlation between mean diastolic pressure geadient(MDPG) and mean pulmonary wedge pressure(r=0.69). But MDPG were lower than mean pulmonary wedge pressure in patients with mitral regurgitation or aortic regurgitation, which may be due to left ventricular volume overload. 3) The correction coefficiency between peak diastolic pressure gradient(PDPG) measured by Doppler echocardiography and mean pulmonary wedge pressure(r=0.59) was slightly lower than the correlation coefficiency between mean diastolic pressure gradient(MDPG) and mean pulmonary wedge pressure(r=0.69).
Aortic Valve Insufficiency ; Blood Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Pulmonary Wedge Pressure

Authors analysed systolic pressure-volume-stress relations by combined echo-pressure-cineangiographic measurement in 10 normal subjects(Group I) and 37 patients with chronic valvular heart diseases. Patients with chronic valvular heart diseases were divided into 3 groups : Group II ; mitral stenosis(n=9), Group III ; mitral stenosis with aortic regurgitation(n=19). The aims of this study are to find useful left ventricular(LV) contractility indices and evaluate left ventricular contractility at various volume loading states. Studied LV contractility indices were maximal elastance of isovolumic contraction(Eiso), endsystolic pressure-volume ratio(Ees) and slope of regression line in late systolic stress-volume loop(A). Eiso was estimated using an isovolumic contraction model of Sunagawa and A was analysed in a single ejecting beat. Endsystolic volume index(ESVI), end diastolic volume index(EDVI), stress at peak pressure(Speak), cardiac index, Vmax, mean Vcf and ejection fraction were determined also. The obtained results were as follows. 1) Significant correlations were found in whole group(n=47) between Eiso and Ees(r=0.88, P<0.005), Elso and cardiac index(r=0.83, P<0.005), Ees and CI(r=<0.76, p<0.005). Further, these correlation coefficiencies were not different between any two groups of Group I, Group II, Group III, Grouop IV and whole group (p<0.05); that is Eiso or Ees had a constant significance at various loading state. 2) Significant correlation between A and cardiac index was noted in Group I+II+III(n=28, r=0.48, p<0.01), but this correlation coefficiency was significantly different from that of Group IV(n=19, r=0.08); p<0.05. 3) In Group II(patients with mitral stenosis), cardiac index* and EDVI* and stress at peak pressure** were decreased significantly(*:p<0.05, **:p<0.005). But Eiso, Ees, A and all the other idices were not decreased. These findings suggested that left ventricular contractility is not reduced in mitral stenosis. 4) In Group IV(patients with amitral regurgitation with or without aortic regurgitation), **EDVI and ESVI** were increased while Eiso**, Ees, Vmax*, mean Vcf* and cardiac index** were decreased significantly. But ejection fraction and A were not decrease. These findings suggested that ejection fraction and A may not be decreased at volume overload, despite of impaired left ventricular contractility. In summary; Eiso or Ees was evaluated as an useful contractility index which appeared not to be influenced by various volume loading state, while eiection fraction and A to be influenced. Patients with mitral stenosis as a group have reduced cardiac performance which is not due to impairment of left ventricular contractility(muscle function) but to reduced preload.
Constriction, Pathologic ; Heart Valve Diseases* ; Humans ; Mitral Valve Stenosis

BACKGROUND: Form the 1970's calcium channel blockers have been used as one of the most effective drugs for antihypertensive therapy. Nilvadipine(Nivadil(R)) is a new vessel-selective calcium channel blocker with a markedly high oral bioaviliability and a long elimination half-life time. To evaluate the efficacy and side effects of nilvadipine, daily monotherapy was done in 22 patients with essential hypertension. METHOD: After more than 2 weeks of previous drug wash-out periods, Nilvadipine 8-12mg was administered daily in 2 or 3 divided dosage for 8 weeks in patients with mild to severe essential hypertension. The sitting blood pressure(BP) and heart rate were measured before and 2, 4, 8 weeks after medication. RESULT: Systolic and diastolic BP were significantly reduced at 2 weeks after medication and no further significant BP reduction were noted throughout the remainer of the trial(4 to 8 weeks). Normotension(diastolic BP < or =90mmHg) was achieved in 14 cases(67%) after 8 weeks therapy and in 7 cases(33%) BP reduced effectively. The side effect noted were headache and facial flushing in 2 cases and in one of them the medication were discontinued. And fatigue, dizziness were complaint in 1 case respectively. There were no significant laboratory changes before and after nilvadipine therapy. CONCLUSION: It can be concluded that nilvadipine(Nivadil(R)) monotherapy is effective in many patients with essential hypertension and a clinical study of combined therapy with other antihypertensive agents in larger numbers of patients will be needed.
Antihypertensive Agents ; Calcium Channel Blockers ; Calcium Channels ; Dizziness ; Fatigue ; Flushing ; Half-Life ; Headache ; Heart Rate ; Humans ; Hypertension*

Early diastolic left ventricular relaxation was determined in 20 patients by combined echopressure measurement. 7 normal control cases and 13 cases with valvular regurgitation were studied with reference to incremental delta elastance. The hemodynamic and echocardiographic data were analysed during the phase of decreasing left ventricular elastance (that is, when pressure is decreasing while volume is increasing). Starting from a fixed level of wall stress (40 kdyne/cm2), we determined Incremental Delta Elastance(ratio big up tri, Delta p/big up tri, Delta V) by a constant increase in LV volume(eg. 10 ml/M2 or 20 ml/M2). We named Incremental Delta Elastance at 10 ml/M2 and 20 ml/M2 of LV volume increase as d-E 10 and d-E 20 respectively. In valvular regurgitation, incremental delta elastances were statistically different from those of normal subjects(p<0.01). d-E10 was -1.67+/-0.69(versus -3.38+/-1.75 in normal subjects) mmHgm2/ml and d-E20 was -0.98+/-0.39(versus -1.69+/-0.84 in normal subjects) mmHgm2/ml. d-E 10 and d-E20 were compared with ejection phase indices(ejection fraction, meanVcf) in whole group(n=20). There was significant correlation between d-E and ejection fraction(d-E10 : r=-0.47, d-E20:r=-0.50) p<0.05. There was significant correlation between d-E and meanVcf(d-E10: r=0.53, d-E20: r=-0.57) p<0.05. d-E10 and d-E20 were compared with volume indices(end-diastolic volume index and end-systolic volume index) but no significant correlation was found. Because we evaluated that inotropic state or afterload would influence incremental delta elastance, further study, especially with reference to endsystolic volume index may be needed. The absolute values between d-E10 and d-E20 were different but they were simliar in property. We concluded that incremental delta elastance(d-E10 or d-E20) could be used as a useful index of early diastolic relaxation in chronic valvular regurgitation.
Echocardiography ; Hemodynamics ; Humans ; Relaxation*

No abstract available.
Blood Pressure*

To stydy the parameters of preload, afterload, and contractility of the heart, we evaluated 10 mitral stenosis, 5 mitral stenoinsufficiency, and 5 mitral stenosis with aortic insufficiency by measuring the external energy potential, external mechaical work, and external energy potential to PVa(Pressure-volume Area) ratio with non-invasive method, echocardiography and carotid pulse tracting. The results are summarized as follows; 1) External energy potential of mitral stenosis was significantly higher than that of MSI or MS with AI. 2) External mechanical work of MSI or MS with AI was significantly higher than that of Ms. 3) External energy potential to PVA ratio was signifiantly higher in the MS, but there was no significantly difference between the MSI and MS with AI. According to the above results, external energy potential to PVA ratio with echocardiogram and carotid pulse tracting was good parameters of preload, afterload, and contractility. And this method may used bed-side monitoring in the clinical area.
Echocardiography ; Heart ; Heart Valve Diseases* ; Mitral Valve Stenosis

Resistant hypertension is defined as when the blood pressure cannot be reduced to below 140/90 mmHg in patients who are adhering to an adequate and appropriate triple drug regimen that includes a diuretic, in near full doses. Before changing or increasing the antihypertensive medication, several factors should be checked. A careful evaluation of the patient's adherence to therapy and adequate measurement of blood pressure are needed to exclude pseudoresistance secondary to poor medical adherence or white coat hypertension. Patients should be asked regularly about medications or substances that could interfere with blood pressure control. Successful treatment requires the identification of causes and a reversal of life style factors contributing to treatment resistance. Diabetes, chronic kidney disease, nonsteroidal anti-inflammatory drugs, high salt intake, obesity, and alcohol abuse are frequent causes of uncontrolled hypertension in Korea. The diagnosis and appropriate treatment of secondary hypertension is also needed. When multiple medications are used, vasodilators are the most commonly used antihypertensive drugs that cause subsequent fluid retention or sympathetic tone elevation. Adequate, effective, and sufficient diuresis and catecholamine suppression are needed for patients who do not respond to several vasodilators.
Alcoholism ; Antihypertensive Agents ; Blood Pressure ; Diuresis ; Humans ; Hypertension ; Korea ; Life Style ; Obesity ; Renal Insufficiency, Chronic ; Retention (Psychology) ; Vasodilator Agents ; White Coat Hypertension

BACKGROUND: It is known that left ventricular(LV) wall motion is not uniform even in normal heart, and the restoring forces make phase differences between LV wall motion and mitral flow velocity during rapid filling period. METHOD: To investigate the regional nonuniformity and restoring forces in 46 patients with hypertension(HT)(group:normal wall thickiness.n=12,II:LVH with fractional shortening(FS)>25%. n=22. III:FS<25%.n=12). We measured the time intervals from A2 to peak thinning rate point of LV posterior wall(A2-(-)dpw/dt).to mitral flow starting point (IRT).and to peak mitral flow velocity(A2-E) by M-mode and Doppler echocardiography. RESULTS: The noniformity((-)dpW/dt-dL/dt)and phase differance((-)dpw/dt-E) were increased in HT(control:HT.22+/-7.8 vs. 49+/-5.2msec, 63+/-4.5 vs, 86+/-6.2msec, p<0.05 respectively).In group comparison, nonuniformity increased in group II and III(group I: group II, III, 35+/-5.1 vs. 50+/-7.1,70+/-14msec, p<0.05 respectively). but phase difference increased only in group II(groupII: group I, III, 93+/-6.0 vs. 75+/-5.2, 80+/-20msec, p<0.05, respectively). CONCLUSION: We interpreted these data that in HT with hypertrophy or not, the nonuniformity of LV wall motion working on the restoring forces which can be expressed as phase difference between LV wall motion and mitral flow. But in HT with hypertensive heart failure group, no significant changes of phase difference and it's suggest that other mechanism could be also working on early diastolic filling.
Echocardiography* ; Echocardiography, Doppler ; Heart ; Heart Failure ; Humans ; Hypertension* ; Hypertrophy

BACKGROUND: A regional wall motion nonuniformity and a phase difference between LV posterior wall motion and transmitral flow are present during normal rapid filling period and are thought to be an evidence for involvement of ventricular restoring forces. To assess the role of nonuniformity on diastolic funtional impairment of asymmetric septal hypertrophy(ASH), the time relations between left ventricular regional wall motions and filling velocity were studied. METHOD: We measured the time intervals from A2 to peak rate of LV posterior wall(short axis) thinning(A2-(-)dpw/dt), peak rate of medial mitral annulus (long axis dimension) lengthening(A2-dL/dt) and peak mitral flow(A2-E) by M-mode and Doppler echocardiography. Result: In ASH patients, A2-(-)dpw/dt(106+/-6msec, mean SE) and the regional wall motion nonuniformity((-)dpw/dt-dL/dt, 89+/-11msec, mean SE) were increased significantly when compared with normal control values(88+/-4, 28+/-5msec, mean SE, p<0.01,respectively).In normal controls, peak mitral flow velocity lagged peak rate of regional wall motion, so the phase differences were present((-)dpw/dt-E :71+/-8msec, dL/dt-E:44+/-6msec). In ASH patients, (-)dpw/dt-E was present(90+/-16msec) but dL/dt-E was not present or reversed(-21+/-18 msec). So these chacteristic phase differences were disturbed. CONCLUSION: These data suggested that the relaxation nonuniformity of regional wall motion in ASH may act as an energy dissipating factor of restoring forces during rapid filling period.
Axis, Cervical Vertebra ; Cardiomyopathy, Hypertrophic* ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Relaxation