No abstract available.
Atrial Fibrillation*

To evaluate the efficacy and safety of lovastatin, new hypolipidemic agent of HMG-CoA reductase inhibitor, we administered lovastatin 40mg to 80mg once daily for 12 weeks in 20 patients(7 males, 13 females) with primary hypercholesterolemia, and observed the sequential chamges of the lipid profile every 4 weeks. The results are as follows ; 1) The seurm total cholesterol was reduced significantly by 31% from 321+/-36mg% to 210+/-26mg%(p<0.05). 2) The serum triglycerides was significantly reduced from 321+/-168mg% to 228+/-74mg% by 29%(p<0.05). 3) The low density lipoprotein cholesterol was reduced significantly from 177+/-36mg% to 120+/-22mg% by 32%(p<0.05). 4) The total lipid, high density lipoprotein cholesterol and very low density lipoprotein cholesterol were also reduced significantly. 5) The ratio between total cholesterol and high density lipoprotein cholesterol, low density lipoprotein cholesterol and high density lipoprotein cholesterol did not change after lovastatin therapy. 6) There was no adverse reaction due to lovastatin therapy during 12 weeks of therapy. These results suggested that lovastatin is a effective and safe now hypolipidemic agent and is a convenient HMG-CoA reductase inhibitor for clinical use.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Cholesterol, VLDL ; Humans ; Hypercholesterolemia* ; Lovastatin* ; Male ; Oxidoreductases ; Triglycerides

Atrial fibrillation (F) the most common cardiac arrhythmia that requires treatment, has been the subject of increased interest and intensive clinical research in recent years. Management strategies are heavily influenced by the temporal pattern of the arrhythmia (paroxysmal or chronic) and by the clinical setting. The clinical presentations and associations of AF are very broad, with symptoms that range from unrecognizable to severely disabling. The hemodynamic consequences of AF are due to 1) the loss of atrial systole and 2) a rapid ventricular rate that decreases the diastolic filling period of the left ventricle and the diastolic flow time of the coronary arteries. There is a tendency toward a more aggressive approach to early reversion, because of 1) the demonstrated effects of 'electrical remodeling' of atrial myocytes during AF, which favor persistence of the arrhythmia and resistance to reversion and 2) the increased thromboembolic risk of patients with AF lasting 48 hours or more. If cardioversion is to be attempted in these patients, 3 weeks of anticoagulation should precede the procedure to reduce embolic risk. An attempt to revert to sinus rhythm either pharmacologically or electrically, the latter usually with a concomitant pharmacological agent, may be an appropriate option. Long-term anticoagulant with warfarin is indicated for patients with AF lasting more than 48 hours. The decision to intervene in longer episodes of AF is based on the balance between hemodynamic tolerance and the likelihood of being able to control future episodes.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Coronary Vessels ; Drug Therapy* ; Electric Countershock ; Heart Ventricles ; Hemodynamics ; Humans ; Muscle Cells ; Systole ; Warfarin

Regional left ventricular wall motion was evaluated by two-dimensional echocardiographic technique with floating-axis (internal frame of reference) system in three groups of subject; normal subject (n=12), patients with acute anterior myocardial infraction(n=16), and patients with acute inferior myocardial infraction(n=10). Significant hypokinetic wall motion were detected in apical portion (Mean Percent Shortening; 0.27-5.84% in anterior infraction group and 9.64-13.17% in controls) and apicoanterior portion (MPS; 2.86% in anterior infraction group and 14.13% in controls) in patients with acute anterior myocardial infraction (P<0.01), and inferior portion (MPS; 3.56-6.93% in inferior infraction group and 18.26-19.8% in controls) and apical portion (MPS; 4.04% in inferior infraction group and 9.64% in controls) in patients with acute inferior myocardial infraction (P<0.01) in apical long-axis views. We conclude that echocardiographic wall motion analysis by floating axis system is an accurate non-invasive method for detecting abnormal wall motion in patients with acute anterior and in ferior myocardial infraction.
Axis, Cervical Vertebra ; Echocardiography* ; Humans ; Myocardial Infarction*

To study left ventricular diastolic filling in patient with hypertension in different form of left ventricular hypertrophy(LVH), 105 patients with hypertension and 30 normal persons underwent M-mode echocardiography and pulsed Doppler measurement of the left ventricular inflow. From the M-mode echocardiographic measurement of left ventricular dimension, hypertensive patients were subdivided into three grouops : group I(n=27) ; no LVH, group II(n=36) ; concentric LVH, grooup III(n=42) asymmetric septal hypertrophy. From the digitized trace of the pulsed Doppler at the mitral valve level, Doppler diastolic time intervals, peak velocities at rapid filling (E velocity) and atrial contraction(A velocity) and the triangle area under the A velocity(A area) and triagle area under the E velocity(E area) were measured. The peak A velocity(normal subjects ; 0.51+/-0.08m/sec, group I ; 0.73+/-0.14m/sec, group II ; 0.78+/-0.15m/sec, group III ; 0.8+/-0.23 m/sec) and the A area(noral subjects ; 4.71+/-1.64, group I; 6.24+/-1.78, group II ; 7.75+/-2.93, group III ; 8.05+/-3.11) and the peak A/E velocity ratio and the A/E area ratio were significantly different from the normal controls(P<0.01). The peak E velocity(normal subjects ; 0.76+/-0.13, group I ; 0.7+/-0.12, group II ; 0.63+/-0.12, group III ; 0.59+/-0.15m/sec) and E area (normal subjects ; 9.61+/-2.8, group I ; 8.11+/-2.13, group II ; 7.82+/-2.73, group III ; 7.34+/-3.07) were significantly different between hypertensive groups with LVH and normal controls. Doppler time intervals, total area were not different between groups. This study shows that abnormal pattern of left ventricular diastolic filling occur in patients with hypertension and the peak A velocity and the peak A/E velocity ratio and the peak A/E area ratio are the earliest findings that can detectable by Doppler echocardiography.
Cardiomyopathy, Hypertrophic ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension* ; Mitral Valve

No abstract available.
Coronary Vessels* ; Myocardial Infarction* ; Perfusion*

BACKGROUND: The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interactions between actin and myosin. cTnI is highly sensitive and specific marker for myocardial injury and is useful in diagnosis and detection of reperfusion in acute myocardial infarction (AMI). In this study, we measured the serum concentration of cTnI according to serial time after chest pain in patients with AMI and compared serum concentration of cTnI with CK-MB and echocardiographic data to evaluate the significance of measuring serum concentration of cTnI in AMI. SUBJECTS AND METHODS: The study was carried out on 16 patients with first attack of AMI within 6 hours of chest pain. All patients were performed thrombolytic therapy and reperfusion was confirmed by coronary angiography. Blood samples for measuring of CK-MB and cTnI were collected at 4-h intervals during the first 24 h, 12-h intervals until 48 h, and 24-h intervals until fourth days after hospitalization. Echocardiography were performed before thrombolytic therapy in all patients. RESULTS: 1) The mean age of subjects was 63.6+/-11.5 years (range:44 - 84 years) and 11 patients were men and 5 patients were women. The site of infarction was anterior in 11 patients and inferior in 5 patients. 2) The peak concentrations of CK-MB and cTnI were reached from 4-h to 12-h after admission in all patients (7.3+/-2.6-h, and 9.0+/-3.1-h, respectively), but there was no significant difference in peak time. 3) Serum concentration of CK-MB was normalized at 72-h after admission, but cTnI was remained in increased state until 96-h after admission. The numbers of the patients with above cutoff value of CK-MB and cTnI at different time after admission were significantly different after 72-h (p<0.05). 4) The peak cTnI and sigma cTnI level were significantly correlated with peak CK-MB and sigma CK-MB level, respectively (r 2 =0.7955, p<0.0001 and r 2 =0.6378, p=0.0002, respectively). 5) The ejection fraction was not correlated with peak cTnI concentration (r 2 =0.0948, p=0.2461) and sigma cTnI (r 2 =0.1867, p=0.0946). 6) The wall motion score index was not correlated with peak cTnI concentration (r 2 =0.2135, p=0.0716), but significantly correlated with sigma cTnI (r 2 =0.2540, p=0.0465). CONCLUSION: The serum concentration of cTnI was useful in late diagnosis of AMI and cTnI release in patients with AMI was correlated with myocardial infarct size.
Actins ; Chest Pain ; Coronary Angiography ; Delayed Diagnosis ; Diagnosis ; Echocardiography ; Female ; Hospitalization ; Humans ; Infarction ; Male ; Myocardial Infarction* ; Myosins ; Reperfusion ; Thrombolytic Therapy ; Troponin I* ; Troponin*

BACKGROUND: It is known from the extensive experimental and clinical experiences that dipyridamole infusion can provoke myocardial ischemia in the presence of coronary artery stenosis. Conversely, the decrement of regional contractile function is directly related to the regional subendocardial blood flow with acute progressive stenosis and during stress induced ischemia. METHODS: To assess the clinical usefulness of dipyridamole echocardiography test and 99mTc-methoxy-isobutyl-isonitrile(MIBI) single photon emission computed tomography(SPECT) in detecting coronary artery disease(CAD), 33 patients(21 males, 12 females, mean age : 56 years) RESULTS: Dipyridamole echocardiography and MIBI SPECT identified 15(75%) and 12 (60%) out of the 20 patients with significant CAD(defined as> or =75% diameter stenosis). The sensitivity and specificity for ditecting individual diseased vessels were 67% and 83% for dipyridamole echocardiography and 46% and 91% for MIBI SPECT respectively. Dipyridamole echocardiography test had slightly higher sensitivity than SPECT in detecting isolated left anterior descending coronary stenosis(75% vs 50%, p<0.05). No patients had significant side effects with dipyridamole injection. CONCLUSION: Both dipyridamole echocardiography test and 99mTC-MIBI SPECT may be useful noninvasive methods for the evaluation of suspected coronary artery disease.
Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Dipyridamole* ; Echocardiography* ; Echocardiography, Stress ; Female ; Humans ; Ischemia ; Male ; Myocardial Ischemia ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Atrial fibrillation in mitral stenosis(MS) may be cause of error in calculation of mitral valve area(MVA) by Doppler derived pressure half-time(PHT) method. This is due to changes of peak velocity and diastolic slope in mitral inflow Doppler spectrum in cases of assoociated with atrial fibrillation. However, few data exist regarding the effect of atrial fibrillation on the validity of this method. Two hundreds and three patients with mitral stenosis were studied by Doppler echocardiography and two-dimensional echocardiography(2DE) to assess whether atrial fibrillation affected the calcullation of MVA. Total patients was divided into four groups according to the accompanied mitral or aortic regurgitation. Ninety patients had mitral stenosis only(group 1), 45 patients had mitral stenosis only(group 2), 54 patients were combined with aortic regurgitation(group 3) and 14 patients were combined with both mitral and aortic regurgitation(group 4). And then, each group was divided into sinus rhythm subgroup and atrial fibrillation subgroup respectively. In total patients, Doppler echocardiographic indices(pressure half-time, mean pressure gradient, peak pressure gradient and peak velocity) were correlated significantly with 2DE-MVA in both patients with sinus rhythm and patients, with atrial fibrillation(P<0.005). In group 1 patients, Doppler echocardiographic indices were significantly correlated with 2DE-MVA in both patients with sinus rhythm and patients with atrial fibrillation(P<0.005). In group 2 patients, these Doppler derived indices were significantly correlated with 2DE-MVA in both patients with sinuns rhythm and patients with atrial fibrillation(P<0.005). In group 3 patients, only pressure half-time was significantly correlated with 2DE-MVA in both patients with sinus rhythm and patients with atrial fibrillation(P>0.005). In group 4 patients, pressure half-time was significantly correlated in patients with atrial fibrillation(P<0.005). Therefore, Doppler echocardiography can estimates mitral valve area in patients with mitral stenosis associated with mitral and aortic regurgitation regardless of presence of the atrial fibrillation.
Aortic Valve Insufficiency ; Atrial Fibrillation* ; Echocardiography ; Echocardiography, Doppler* ; Humans ; Mitral Valve ; Mitral Valve Stenosis*

Mitral pressure half-time(PHT) is widely used as an independent measure of mitral valve area(MVA) in patients with mitral stenosis. However, few data exist regarding the effect of mitral regurgitation and aortic regurgitation on the validity of this method. Two hundreds and three patients with mitral stenosis were studied by Doppler echocardiography and 2 dimensional echocardiography(2 DE) to assess whether mitral regurgitation and aortic regurgitation affected the calculation. Ninety patients had mitral stenosis only, 45 patients were combined with mitral regurgtation, 54 patients were combined with aortic regurgitation and 14 patients were combined with both mitral and aortic regurgitation group. Doppler PHT and 2DE estimates of MVA correlated well in total patients(r=0.903) and mitral stenosis only group(r=0.924). Good correlations were maintained in patient subgroups combined with mitral or aortic regurgitation(r=0.867 and 0.911, respectively) and both mitral and aortic regurgitation(r=0.843). Thus, measurement by Doppler PHT may reflect accurately the MVA as determined by 2DE regardless of presence of mitral and/or aortic regurgitation.
Aortic Valve Insufficiency ; Echocardiography, Doppler* ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis*