1.Study of left and right ventricular diastolic dysfunction in the hypertensive patients by pulsed doppler echocardiography.
Korean Journal of Medicine 1993;45(3):291-298
No abstract available.
Echocardiography, Doppler, Pulsed*
;
Humans
2.Study for Mitral B-Bump and Its Relation to Left Ventricular Dysfunction by M-Mode Echocardiography.
Korean Circulation Journal 1991;21(1):100-106
Normally the AC segment of mitral valve echogram consists of a rapid slope, from A peak to C point(complete closure). The initial portion is usually less steep than its final portion ; the latter represents abrupt mitral valve closure secondary to the rapid rise in left ventricular(LV) pressure at the onset of LV systole. The point on the mitral echogram at which closure aburptly accelerates in the B point. In order to see wither or not the echocardiographically recorded mitral valve could reflect alterations in left ventricular pressure, mitral valve echograms and left ventricular pressure were obtained on 30 patients undergoing diagnostic cardiac catheterization. The results were as follow : 1) Of 23 patients with LV ejection fraction>55%(71.2%+/-7.9%), 2 had B-bump ; of 7 patients with LV ejection fraction<55%(47.0%+/-4.9%), 5 had B-bump. The difference in frequency of B-bump between the normal LV ejection fraction and the low LV ejection fraction groups was statistically significant(p<0.001). 2) Of 6 patients with LVEDP>5mmHg (17.7mmHg+/-3.6mmHg), 5 had B-bump ; of 24 patients with LVEDP<15mmHg (8.5mmHg+/-2.6mmHg), 2 had B-bump. The difference in frequency of B-bump between the normal LVEDP and the elevated LVEDP groups was statistically significant(p<0.001). 3) Of 22 patients with LV ejection fraction>55%(71.2%+/-7.9%), as well as LVDEP<15mmHg(8.5mmHg+/-2.6mmHg), 1 had B-bump ; Of 5 patients with LV ejection fraction<55%(47.0+/-4.9%), as well as LVEDP>15mmHg(17.8mmHg+/-3.6mmHg), 4 had B-bump. The difference in frequency of B-bump between in normal LV ejection fraction, as well as normal LVEDP and the low LV ejection fraction, as well as elevated LVEDP groups was statistically significant(p<0.001). Thus, the mitral B-bump correlated primarily with LV dysfunction. When properly recorded, the presence of a B-bump is a useful sign of significantl LV dysfunction.
Cardiac Catheterization
;
Cardiac Catheters
;
Echocardiography*
;
Humans
;
Mitral Valve
;
Systole
;
Ventricular Dysfunction, Left*
;
Ventricular Pressure
3.Lipoprotein(a) as a Risk Factor for Coronary Heart Disease : Whether Related with NIDDM or Not.
Korean Circulation Journal 1996;26(2):507-513
BACKGROUND: It is now well established that hypercholesterolemia is an important cause of coronary heart disease, and clinical intervention studies have demonstrated the therapeutic value of correcting hypercholesterolemia. One of lipoprotein, lipoprotein(a) [LP(a)] contains one(or two) molecule of apo(a) linked to apo B100 by a disulphied bridge, is associated with an increased risk of coronary heart disease. NIDDM patients have a two-to fourfold increased risk of coronary heart disease relative to nondiabetic subjects. This excess risk is explained only partially by increased levels of standard risk factors. This study was conducted to assess the relatioship between serum Lp(a) levels and coronary heart disease. Furthermore, whether the Lp(a) level was related with NIDDM or not. METHODS: Total 83 subjects undergoing coronary angiography were evaluated on clinical risk factors and lipid profies with Lp(a). Among them, 24 subjects had normal coronary artery, while the others revealed significant stenosis of coronary arteries more than 50%. RESULTS: The serum Lp(a) levels of the CHD group were significantly higher than control group(37.4 +/- 31.8mg/dl vs 22.6 +/- 12.9mg/dl). Other lipids profile were not significantly dfferent between two groups. Serum Lp(a) levels had no relations to fasting blood sugar level. Multivariate logistic regression analysis of lipid parameters revealed that cholesterol, LDL-cholesterol, and Lp(a) were best discriminator among risk factors for coronary heart disease. But in our study, the serum cholesterol and LDL-cholesterol levels were within normal range. CONCLUSION: This study suggested that Lp(a) level was a significant independent risk factor for coronary heart disease whether there was fasting hyperglycemia or not.
Blood Glucose
;
Cholesterol
;
Constriction, Pathologic
;
Coronary Angiography
;
Coronary Disease*
;
Coronary Vessels
;
Diabetes Mellitus, Type 2*
;
Fasting
;
Humans
;
Hypercholesterolemia
;
Hyperglycemia
;
Clinical Trial
;
Lipoprotein(a)*
;
Lipoproteins
;
Logistic Models
;
Reference Values
;
Risk Factors*
4.Percutaneous Transradial Approach for Coronary Angiography.
Si Hoon PARK ; Gil Ja SHIN ; Woo Hyung LEE
Korean Circulation Journal 1995;25(4):803-810
BACKGROUND: Recently the percutaneous transradial approach for coronary angiography, transluminal coronary angioplasty or coronary stention were reported but there was no report in Korea. So we tested the safety and efficacy of the transradial appreach for coronary angiography in Korean. METHODS: Eleven patients(male 9, female 2, mean age 59.3 yeal old)with chest pain underwent percutaneous transradial coronary angiography with 5 french multipurpose catheter. We evaluated clinical efficacy and observed complication of percutaneous transradial coronary angiography by physical examination and DOpple ultrasonography of puncture site of radial artery. RESULTS: Right coronary angiography and left ventriculography were performed successfully in all cases, but left coronary angiogrphy was failed in three cases. In another three cases, the patient complained of arm pain which was aggravated during manipulation of the catheter. After the procedure, it took 10.3 minutes to stop the bleeding at the puncture site, Clinically significant complications were not observed after the procedure. The patients were not restricted to bed at all since the completion of the procedure. CONCLUSION: In our limited dexperience, percutaneous transradial coronary angiography could be performend on the outpatient basis without significant complications.
Angioplasty
;
Arm
;
Catheters
;
Chest Pain
;
Coronary Angiography*
;
Female
;
Hemorrhage
;
Humans
;
Korea
;
Outpatients
;
Physical Examination
;
Punctures
;
Radial Artery
;
Ultrasonography
5.A Study for Diastolic Functions in Patients with Early Acute Myocardial Infarction.
Seung Jung KIM ; Gil Ja SHIN ; Si Hoon PARK
Korean Circulation Journal 1997;27(8):862-869
BACKGROUND: Doppler echocardiography is a non-invasive technique that has been used to evaluate LV diastolic dysfunction. Impaired left ventricular diastolic filling is known to occur in patients with coronary artery disease. Compared with those in normal subjects, Doppler-derived transmitral blood flow velocities have been reported to be reduced during early diastolic filling and to be compensatory elevated subsequent to atrial systole in patinets with coronary artery disease. But stiffness of myocardium normalize the E/A ratio, and normal E/A ratio may reveal increased ventricular filling pressure. We tried to investigate left ventricular filling parameters by Doppler echocardiography in patients with early myocardial infarction, and to compare left ventricular diastolic function regarding infarct location on EKG, one or multivessel disease on coronary angiography, and treatment modality. METHODS: From September 1993 to August 1995, Pulsed wave Doppler echocardiography was performed in patients with early acute myocardial infarction(N=95) and control group(N=20) within 5 days after admission, and parameters of diastolic function was evaluated. RESULTS: Echocardiographic data showed significant differences in mean ejection fraction, mean left ventricular mass, and mean left ventricular mass index between two groups. There was no significant difference in E/A ratio, deceleration time, and isovolumetric relaxation time between two groups. Neither, there was significant difference in each diastolic parameter for infarct related wall on EKG. And there was no significant difference in deceleration time for one or multi vessel disease on coronary angiography, treatment modality(conservative treatment, thrombolytic therapy, or primary PTCA). CONCLUSION: In patients with early acute myocardial infarction, left ventricular diastolic dysfunction was absent. And there was no significant correlation between the presence of diastolic dysfunction and the location of infarct related wall on EKG, or one or multi vessel disease, or treatment modality.
Blood Flow Velocity
;
Coronary Angiography
;
Coronary Artery Disease
;
Deceleration
;
Echocardiography
;
Echocardiography, Doppler
;
Electrocardiography
;
Humans
;
Myocardial Infarction*
;
Myocardium
;
Relaxation
;
Systole
;
Thrombolytic Therapy
6.Angiographic Differences Analysis of Coronary Artery Lesions in Patients with Stable and Unstable Angina Pectoris.
Chung Hyun CHUN ; Ick Mo CHUNG ; Gil Ja SHIN
Korean Circulation Journal 2000;30(9):1099-1106
BACKGROUND AND OBJECTIVES: As previously reported, unstable angina is usually related to characteristic coronary artery lesion's morphology analyzed by coronary angiogram. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. Although most studies were done for lesions with high degree stenosis(>50%), recent studies emphasized the role of vulnerability of plaque in acute coronary syndrome and even mild degree stenotic lesions may progress rapidly to evoke acute coronary syndrome. Therefore in this study, we analyzed the morphological characteristics of coronary artery lesions with mild degree stenosis as well as severe stenosis. MATERIALS AND METHODS: We conducted a retrospective study of 96 patients with angina pectoris (42 of stable patients and 54 of unstable patients) who underwent coronary angiography. Each lesions with 25% or greater diameter stenosis were categorized into simple and complex lesion(convex intraluminal obstruction with a narrow neck or irregular borders, diffuse irregularities, ulceration, thrombus). Calcification of coronary artery, extents of lesions were analyzed and stenosis grade and location were categorized by AHA classification. RESULTS: There were no significant differences between the stable angina and unstable angina in risk factors and vessel involvement, numbers of lesions, calcification and total obstruction. In morphologic analysis, complex lesions were more frequent in unstable angina than stable angina (49% vs 33%, p<0.05). The mean of percent diameter stenosis was not signigicantly different between two groups, but severe stenotic lesions with 90% or more stenosis were more frequent in unstable angina (34% vs 22%, p<0.05). Locations of involved vessels were similar between the angina groups. Complex lesions were distributed more frequent in RCA and simple lesions were more in LAD and LCX (p<0.05). CONCLUSIONS: The lesions with both complex morphology and severe degree stenosis are closely implicated in unstable angina.
Acute Coronary Syndrome
;
Angina Pectoris
;
Angina, Stable
;
Angina, Unstable*
;
Classification
;
Constriction, Pathologic
;
Coronary Angiography
;
Coronary Vessels*
;
Humans
;
Neck
;
Pectinidae
;
Retrospective Studies
;
Risk Factors
;
Ulcer
7.The Cprrelation between LVH, LV Function and 24-hour Ambulatory Blood Pressure Monitoring in Patients with Newly Diagnosed Hypertension.
Keehyun LEE ; Gil Ja SHIN ; Hong Keun CHO
Korean Circulation Journal 1997;27(7):712-720
BACKGROUND: Left ventricular hypertrophy is one of the major cardiovascular risk factors. So it is generally thought to be a predictor of complication and prognosis of hypertension. The 24-hour noninvasive ambulatory blood pressure monitoring (ABP) has been shown to be superior to office BP inpredicting target organ involvement in patients with hypertension and assessing antihypertensivve therapy. To determine the correlation between blood pressure and left ventricular hypertrophy in patients with newly diaggnosed systemic hypertension, we evaluate blood pressure by 24-hour ABP, office BP and echocardiiographic parameters of left ventricular hypertrophy. METHODS: From january 1995 to September 1995, in 22 patients with untreated essential hypertension who were diagnosed recently (within 1 month). They were studied by 24-hour noninvasive ambulatory blood pressure monitoring and cross sectional, M-mode and pulsed Doppler echocardiography for examining the relation between ABP and echocardiographic parameters. In the present study, we divided the oatuebts by two groups; white-coat hypertensive group and sustained hypertensive group. RESULTS: 1) Among the 22 patients who were diagnosed by office blood pressure, the white-coat hypertension was in 7 cases (31.8%) and sustained hypertension was 15 cases (68.2%). 2) In sustained hypertensive group, LV mass, LV mass index and relative posterior septal wall thickness were significantly increased compared with white-cost hypertensive group. 3) 24-hour ABP and systolic BP and loading % were significantly correlated with relative posterior septal wall thickness (p<0.05). CONCLUSION: In patients with newly diagnosed hypertension (especially with sustained hypertension), there was left ventricular hypertrophy expressed by increasing of LV mass, LV mass index, and relative posterior septal wall thickness. And, there were close correlation between 24-hour ABP monitoring-especially systolic BP and loading % of systolic BP and LVH.
Blood Pressure
;
Blood Pressure Monitoring, Ambulatory*
;
Echocardiography
;
Echocardiography, Doppler, Pulsed
;
Humans
;
Hypertension*
;
Hypertrophy, Left Ventricular
;
Prognosis
;
Risk Factors
8.Circadian Variation of Ventricular Premature Complex in Hypertension and Ischemic Heart Disease Patients.
Seung Jung KIM ; Si Hoon PARK ; Gil Ja SHIN ; Woo Hyung LEE
Korean Circulation Journal 1995;25(3):581-588
BACKGROUND: Circadian rhythms have been described for acute myocardial infarction, sudden cardiac death, cerebrovascular disease, ischemic heart disease, and ventricular arrhythmia. Most of studies reported that the frequency of ventricular permature contractions(VPC's) shows a peak in day time. We tried to see that the circadian rhythm of VPC's in hypertension and ischemic heart disease(IHD) patients. And we will also studied the relationship between heart rate and frequencey of VPC's. METHOD: Twenty four hour holter monitoring was performed in hypertensive patients (N=23), ischemic heart disease patients(N=25), and normal control group(N=30). We tested the circadian pattern of VPC's and heart rates and the relationships of the frequency of VPC's and heart rates. RESULT: In hypertension group, a peak incidence of heart rate is between 5 and 8 P.M., in ischemic heart disease group, between 3 and 6 P.M.. In control group, the heart rate shows a peak beteen 1 and 3 P.M.. The frequency of VPC's in hypertension group shows the first peak between 4 and 10 P.M., and the second peak beteen 7 and 10 A.M.. In ischemic heart disease group, they show a peak between 2 and 8 P.M..In control group, there was no circadian variation for the frequency of VPC;s. Both in hypertension and IHD patients group, there was significant correlation between the frequency of VPC's and the heart rates. CONCLUSION: It seemed that VPC' were more frequently occurred in relation to the increase of heart rate in the afternoon, in hypertensive and ischemic heart disease patients.
Arrhythmias, Cardiac
;
Circadian Rhythm
;
Death, Sudden, Cardiac
;
Electrocardiography, Ambulatory
;
Heart
;
Heart Rate
;
Humans
;
Hypertension*
;
Incidence
;
Myocardial Infarction
;
Myocardial Ischemia*
;
Ventricular Premature Complexes*
9.The Role of Insulin Resistance as a Risk Factor of Coronary Artery Disease.
Sung Ae JUNG ; Si Hoon PARK ; Gil Ja SHIN ; Woo Hyung LEE
Korean Circulation Journal 1996;26(1):35-43
BACKGROUND: Established risk factors for coronary artery disease include smoking, hypertension, diabetes mellitus and hypercholesterolemia. However, these account for less than 50% of the actual incidence of coronary artery disease and the importance of other risk factors is being increasingly realized. It has been known that insulin resistance associated with hyperinsulinemia is a pivotal link to several risk factors of coronary artery disease, including hypertension, glucose intolerance, dyslipidemia and obesity. Recently both experimental and clinical studies have produced evidence suggesting that high plasma insulin level may promote the development of atherosclerotic vascular diseasa. Several prospective studies showed independently that high plasma insulin is associated with an increased risk of major coronary artery disease. In our study, plasma glucose, insulin and C-peptide level were determined with oral glucose tolerance test to assess the insulin resistance or hyperinsulinemia as a risk factory of coronary artery disease. METHOD: From September 1993 to April 1995, after excluding patients with hypertension, diabetes mellitus, hypercholesterolemia and obesity, 17 patients with significant coronary artery stenosis and 10 control subjects with normal coronary finding were selected among the 226 patients who undertook coronary angiography. In the 17 cases(M:F=15:2) of coronary artery disease group, the mean age was 54+/-10 years, and in the 10 cases(M:F=8:2) of control group, 51+/-9 years. All were matched for age, gender and body mass index. Blood pressure, lipid and lipoprotein were measured and smoking history was assessed. Glucose, insulin and C-peptide responses to oral glucose tolerance test were also determined. RESULT: 1) There was no significant difference in systolic and diastolic and diastolic blood pressure, total-cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ApoA and smoking history except ApoB between the subjects with coronary artery disease and normal control subjects. 2) In oral glucose tolerance test, the plasma glucose levels were not significantly different in the two groups. plasma insulin and C-peptide levels at 60 and 120 minutes were higher in the patient group than control, but the results lack statistical significance. The area under the insulin curve and C-peptide curve were larger in patient group than control, but the result lack statistical significance also. CONCLUSION: Although our study dose not prove the hypothesis that insulin resistance or hyperinsulinemia is statistically an independent risk factor for coronary artery disease, this study showed the tendency of insulinresistance to be correlated with development of coronary artery disease. As this study has limitations due to small sample size, further study is required to confirm the role of hyperinsulinemia using a larger sample size.
Apolipoproteins A
;
Apolipoproteins B
;
Blood Glucose
;
Blood Pressure
;
Body Mass Index
;
C-Peptide
;
Coronary Angiography
;
Coronary Artery Disease*
;
Coronary Stenosis
;
Coronary Vessels*
;
Diabetes Mellitus
;
Dyslipidemias
;
Glucose
;
Glucose Intolerance
;
Glucose Tolerance Test
;
Humans
;
Hypercholesterolemia
;
Hyperinsulinism
;
Hypertension
;
Incidence
;
Insulin Resistance*
;
Insulin*
;
Lipoproteins
;
Obesity
;
Plasma
;
Prospective Studies
;
Risk Factors*
;
Sample Size
;
Smoke
;
Smoking
;
Triglycerides
10.Coronary Fistula Anastomosing between Right Coronary Artery and Left Bronchial Artery Accompanied with Cystic Lung Disease.
Tae Hee KIM ; Ick Mo CHUNG ; Gil Ja SHIN ; Kyu Ok CHOE
Korean Circulation Journal 1999;29(4):419-423
We report a case of 86-year-old woman with coronary artery fistula connecting the right coronary artery and left bronchial artery accompanied with cystic lung disease presenting with dyspnea and chest pain. Coronary angiography revealed that right coronary artery was anastomosed with the collaterals of left bronchial artery at the right hilum and tortuously ascended along the aortic arch and descended connecting with left pulmonary lobar artery at a certain site which is faintly opcified showing to and pro phasic movement. Chest CT scan shows the multicystic changes of the left lower lobe of the lung and hypertrophied bronchial artery of left lobar bronchus. Under the diagnosis of coronary artery fistula, hypertensive heart disease and multicystic lung disease, patient's symptoms and signs were improved by conservative treatment without surgical intervention.
Aged, 80 and over
;
Aorta, Thoracic
;
Arteries
;
Bronchi
;
Bronchial Arteries*
;
Chest Pain
;
Coronary Angiography
;
Coronary Vessels*
;
Diagnosis
;
Dyspnea
;
Female
;
Fistula*
;
Heart Diseases
;
Humans
;
Lung Diseases*
;
Lung*
;
Tomography, X-Ray Computed