To assess the left ventricular regional relaxation abnormalities in patients with hypertrophic cardiomyopathy (HCM) by quantitative tissue velocity imaging (QTVI), Doppler echocardiography and QTVI were performed in HCM (n=10) and healthy subjects (n=11) at apical long-axis, two-chamber and four-chamber views. Regional early diastolic velocity (rVe) and regional atrial contraction (rVa) were measured at each segment of ventricular middle, basal and annular levels. Mean rVe and mean rVa at three levels as well as mean rVe/rVa ratio were calculated. Our results showed that transmitral inflow peak velocities during early diastole (E) and atrial contraction (A) were also measured and E/A ratio was calculated. The rVe of all left ventricular segments in HCM were lower than those in healthy subjects (P<0.05), but compared with healthy subjects majority of rVa in HCM were not different except inferior wall and anterior wall. E between HCM and healthy subjects was different (P=0.036), while mean rVe between them was significantly different (P<0.0001). Mean rVa and mean rVe/rVa of three levels were lower in HCM than in healthy subjects (P<0.05), but there were no differences in A and E/A between them (P=0.22, P=0.101). Left ventricular regional myocardial relaxation is reduced in HCM. Transmitral inflow E and A are influenced by preload, relaxation of myocardium and atrial contraction, etc., while rVe and rVa reflect myocardial relaxation function independently. QTVI is more sensitive and more accurate than conventional Doppler imaging for characterizingregional diastolic properties in HCM.
Cardiomyopathy, Hypertrophic/*physiopathology ; Cardiomyopathy, Hypertrophic/*ultrasonography ; Diastole ; Echocardiography, Doppler, Color/methods ; Hypertrophy, Left Ventricular/*physiopathology ; Hypertrophy, Left Ventricular/ultrasonography ; Ventricular Function, Left

BACKGROUND: Although left ventricular hypertrophy (LVH) is a compensatory process to pressure overload, there are gender differences in left ventricular function and vascular stiffness in hypertension. We evaluated that inappropriate LVH was related with Framingham risk score (FRS) and vascular stiffness in hypertensive women. METHODS: Total 226 hypertensive women consecutively underwent carotid ultrasound and echocardiography, from which LV mass (LVM), carotid intima-media thickness (IMT) and beta-stiffness were measured. Inappropriate LVH was calculated by the ratio of observed LVM to the value predicted for sex, height and stroke work at rest and defined as > 128% of predicted. FRS was obtained using by National Cholesterol Education Program Adult Treatment Panel III. RESULTS: Of 226 subjects, 59 subjects (26%) had inappropriate LVH. As compared with appropriate LVH, subject with inappropriate LVH showed older age, higher FRS, and IMT. Although LV ejection fraction was not different, diastolic parameters of E/A ratio and left atrial volume were significantly worse in inappropriate LVH group. CONCLUSIONS: The presence of inappropriate LVH in hypertensive women was strongly associated with higher FRS, decreased diastolic function and increased IMT, which might influence future cardiovascular events.
Adult ; Carotid Intima-Media Thickness ; Echocardiography ; Female* ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Ultrasonography ; Vascular Stiffness* ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: Cardiovascular morbidities and mortalities due to persistent hypertension, left ventricular (LV) dysfunction and increased LV mass have been reported in adolescents and adults with successful coarctoplasty. We evaluated progressive properties by measuring resting blood pressures (BP), LV functions and the masses in young children with successful coarctoplasty in infancy. SUBJECTS AND METHODS: BP in the right arm and the left ankle, LV function and mass, by the use of M-mode and pulsed wave Doppler ultrasound, were measured in 25 patients, with a mean age of 6.4+/-3 years; and a mean age at the time of repair of 0.22+/-0.24 years, and in 22 control subjects, with a mean age of 5.8+/-2.4 years. All subjects were divided into two groups based on age (more than 5 years of age and less than 5 years of age) and were analyzed independently. RESULTS: BP in the right arm and left ankle, LV function and mass showed no consistent differences between the two groups. However, as age increased, there was a tendency of wide pulse pressure (PP) in the right arm of patients contrary to that in the control subjects. The relative increase in the PP was mainly due to a relative decrease in the diastolic BP. There was a significant increase in the LV mass index of patients with increasing age (p<0.01). The LV mass index showed significant positive correlations with the systolic BP (p<0.05) and the pulse pressure (p<0.05) of the right arm of the patients. CONCLUSION: We recommend careful long-term follow-up through out adulthood to reduce morbidity and mortality, even for children who received successful coarctoplasty in early infancy.
Adolescent ; Adult ; Ankle ; Aortic Coarctation ; Arm ; Blood Pressure ; Child* ; Follow-Up Studies ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Mortality ; Ultrasonography ; Ventricular Function ; Ventricular Function, Left*

BACKGROUND AND PURPOSE: Left ventricular hypertrophy (LVH) and increased common carotid artery intimamedia thickness (IMT) are known target organ damages of hypertension. However, the relation between LVH and carotid artery IMT is not well defined in Korea. Thus, the purpose of this study is to evaluate the association of common carotid artery IMT and luminal diameter (LD) with LVH (LV mass) in patients with hypertension. METHOD: LV mass was measured by echocardiography and IMT and LD of right and left common carotid artery were measured by high resolution ultrasound in non-hypertensive subjects (n=24), patients with known hypertension without LVH (n=22) and hypertension with LVH (n=22). Data obtained were adjusted statistically for age. RESULTS: Mean IMT (in mm) were 0.51+/-0.12 in non-hypertension group, 0.61+/-0.09 in hypertension without LVH group and 0.73+/-0.13 in hypertension with LVH group (age adjusted p<0.0001 by ANCOVA). Mean systolic and diastolic IMT/LD ratios were 0.077+/-0.015 and 0.089+/-0.018 in non-hypertensive group, 0.052+/-0.015 and 0.09+/-0.014 in hypertension without LVH group, and 0.085+/-0.015 and 0.104+/-0.022 in hypertension with LVH group (p=0.063 for systolic ratio and 0.137 for diastolic ratio). CONCLUSION: These findings suggest that there is a significant correlation between carotid artery intima-media thickness and LVH in hypertensio.
Carotid Arteries* ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Echocardiography ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Korea ; Phenobarbital ; Ultrasonography

OBJECTIVETo assess the left ventricular rotation and twist in patients with hypertrophic cardiomyopathy (HCM) by 2-dimensional ultrasound speckle-tracking imaging (STI).

METHODSTwo-dimensional images of left ventricule (LV) at basal and apical short-axis views were acquired in 20 patients with HCM and 20 healthy subjects to evaluate LV rotation. LV twist were defined as rate of apical LV rotation to the basal. Peak rotation (Prot) and the time to Prot in basal and apical short axis views were measured separately. Peak twist (Ptw), twist at aortic valve closure (AVCtw), twist at mitral valve opening (MVOtw), untwisting rate (Untw R), and half time of untwisting (HTU) were calculated.

RESULTSCompared with the control group, the value of Prot-MV, Prot-AP, Ptw, time to Ptw, AVCtw, MVOtw, and HTU significantly increased (all P < 0.05) and the Untw R significantly decreased (P < 0.05) in the HCM group. In the HCM group, time to Prot in apical view was significantly higher than that in basal view.

CONCLUSIONSTI can noninvasively evaluate the characteristics of LV twist and rotation in patients with HCM.

Cardiomyopathy, Hypertrophic ; complications ; diagnostic imaging ; Humans ; Hypertrophy, Left Ventricular ; diagnostic imaging ; etiology ; Torsion Abnormality ; diagnostic imaging ; etiology ; Ultrasonography

Implanting a valve that will reduce left ventricular mass is critical in aortic stenosis. Regression of left ventricular hypertrophy in 46 aortic valve replacement (AVR) patients receiving a St. Jude Medical (SJM) valve was assessed by serial electrocardiographic and echocardiographic studies during the preoperative, immediate, and late postoperative periods. The patients were divided into three groups according to valve size; 19 mm group (n=9), 21 mm group (n=20), and 23+mm group (n=17). There was no surgical mortality. The NYHA functional class improved from an average of 2.2+/-0.8 preoperatively to 1.3+/-0.5 post-operatively. Left ventricular muscle mass index (LVMI) regression failed to reach statistical significance in the 19 mm group, whereas in the other two groups a steady decrease in the LVMI occurred with follow up. ECG findings were less remarkable showing insignificant differences in voltage among the three groups (p=0.000). In conclusion, the current data suggest that the 19 mm SJM valve may not result in satisfactory left ventricular muscle mass regression despite adequate function, even in small patients. Therefore, additional procedures to accommodate a larger valve may be warranted in the aortic annulus smaller than 21 mm.
Adult ; Aged ; Aortic Valve/ultrasonography ; Aortic Valve Stenosis/surgery* ; Aortic Valve Stenosis/complications ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Valve Prosthesis* ; Human ; Hypertrophy, Left Ventricular/prevention & control* ; Hypertrophy, Left Ventricular/etiology ; Hypertrophy, Left Ventricular/diagnosis ; Male ; Middle Age ; Multivariate Analysis ; Postoperative Period ; Remission Induction ; Risk Factors ; Treatment Outcome

BACKGROUND: Atherosclerosis is a diffuse disease process that produce thickening of the vascular wall because of intimal deposition of lipid, fibrous tissue, and calcific material. Nowadays it is possible to evaluate atherosclerotic changes of carotid arteries accurately by developed noninvasive techniques such as ultrasonography. Left ventricular hypertrophy (LVH) is known to be an important risk factor for cardiovascular events in hypertension. The purpose of this study was to establish whether the carotid intimal - medial thickness (IMT) correlates with the severity of LVH. METHOD: We measured intimal-medial thickness (IMT) for 12 sites in carotid arteries (near and far walls in common carotid, bifurcation, and internal carotid arteries of both sides) by B-mode ultrasonography in both 38 normotensive and 72 hypertensive patients. Left ventricular measurements were made according to the recommendations of the American Society of Echocardiography. Left ventricular mass was derived from the formula described by Devereux et al. and each left ventricular mass value was indexed to body surface area. And then we have investigated whether hypertensive patients have significant changes of carotid IMT and IMT correlates with left ventricular mass index (LVMI). RESULTS: (1) Most hypertensive patients had diffuse thickening of the carotid artery and some had focal or multiple plaques. (2) In general, mean IMT was widest in the carotid bifurcation. (3) The mean IMT of all 12 segments increased about 40% in hypertensive patients compared with normal control group. (4) LVMI significantly correlates with IMT of carotid artery, especially bifurcation site and mean all 12 segments. CONCLUSION: The mean IMT may serve as a useful marker of the severity of atherosclerosis in hypertensive patients. The significant association between carotid IMT and LVMI suggests a simultaneous correlation of carotid atherosclerosis with left ventricular hypertrophy in hypertension.
Atherosclerosis ; Body Surface Area ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Artery, Internal ; Echocardiography ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Risk Factors ; Ultrasonography

OBJECTIVETo investigate the relationship between resting heart rate (RHR)and target organs damage in senile essential hypertension.

METHODSAll 206 elderly essential hypertensive patients (age: 60 - 85 years) were divided into three groups according to the levels of systolic blood pressure (SBP): SBP < 160 mm Hg, 160 mm Hg /= 180 mm Hg. Each of the groups mentioned above were divided into five groups according to the levels of RHR [RHR1 group: RHR < 65 beats/minute(bpm); RHR2: 65 bpm /= 80 bpm]. Electrocardiography, carotid ultrasonography, echocardiography, creatinine clearance rate (CCr) and quantitative test for 24 hours' urinary microalbuminuria (MAU) were performed.

RESULTS(1) Compared with RHR1-RHR4 groups, the RHR5 group showed with lower levels of MAU and left ventricular ejection fraction (LVEF) (P < 0.05 or P < 0.01). Compared with RHR1 and RHR2 groups, RHR5 or RHR4 group showed with higher levels of carotid intima-medial thickness (IMT) and carotid arterial diameter (CAD), lower CCr and MAU (P < 0.05 or P < 0.01). (2) The levels of IMT, CAD, LVMI, MAU were positively correlated to RHR (r = 0.312, 0.289, 0.630, 0.563, 0.576 respectively, all P < 0.01), however, the levels of LVEF, CCr were negatively correlated to RHR (r = -0.563, -0.510. all P < 0.01).

CONCLUSIONSTarget organ damage (TOD) seems not only related with PP, SBP, DBP, but also related with RHR in senile essential hypertension. RHR may be one of the important risk factors in TOD.

Aged ; Aged, 80 and over ; Blood Pressure ; Cardiovascular Diseases ; etiology ; Female ; Heart Rate ; Humans ; Hypertension ; complications ; diagnostic imaging ; physiopathology ; Hypertrophy, Left Ventricular ; Male ; Middle Aged ; Ultrasonography

This study aimed to investigate the relationship between carotid atherosclerosis and left ventricular hypertrophy on electrocardiogram (ECG-LVH) on adults living in the community. A total of 9,266 adults who participated in the Namwon Study were included in this analysis. Carotid atherosclerosis, including intima-media thickness (IMT) and plaques, were assessed using high-resolution B-mode ultrasound. ECG-LVH was determined using the Sokolow-Lyon voltage (SokV) and Cornell voltage (CorV) criteria. The prevalence of ECG-LVH was 12.7% using the SokV criteria and 9.7% using the CorV criteria. After full adjustment, compared to the lowest quartile of common carotid artery IMT (CCA-IMT), the odds ratios and 95% confidence intervals for ECG-LVH of the carotid IMT quartiles 2, 3, and 4 increased linearly as follows: 1.54 (1.24-1.90), 1.62 (1.31-2.02), and 1.91 (1.54-2.38), respectively, for the SokV criteria (p<0.001); and 1.33 (1.05-1.68), 1.41 (1.11-1.78), and 1.48 (1.16-1.88), respectively, for the CorV criteria (p=0.003). Positive associations between the carotid bulb IMT (CB-IMT) quartiles and the ECG-LVH were also observed, although the magnitudes of association between CB-IMT and ECG-LVH were slightly lower than those of CCA-IMT. However, no significant association between carotid plaques and ECG-LVH as defined by the SokV or CorV criteria was found. The present study demonstrated that increased carotid IMT, but not carotid plaques, is significantly associated with LVH defined by various ECG criteria in a large population.
Adult ; Carotid Artery Diseases ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Electrocardiography ; Humans ; Hypertrophy, Left Ventricular ; Jeollabuk-do ; Odds Ratio ; Plaque, Atherosclerotic ; Prevalence ; Ultrasonography

BACKGROUND: The prevalence and clinical significance of white-coat hypertension (WCHT) and masked hypertension (MHT) are unknown in Koreans. Here we measure the frequency of WCHT and MHT in hypertensive subjects and identify the epidemiologic and/or clinical factors that predict it in Korean subjects. METHDOS: This study is a retrospective analysis of a random sample from February 2004 to October 2005. All patients had measurements of blood pressure (BP) in the clinic and 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were classified into four groups on the basis of daytime ambulatory BP and clinic BP level: 1) Normotension (NT), 2) MHT, 3) WCHT, and 4) sustained hypertension (SHT). RESULTS: For all 967 patients, the mean clinic BP was 157.7+/-22.0/ 95.3+/-13.1 mmHg, and the mean daytime ambulatory BP was 136.4+/-15.0/ 86.2+/-10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively. The left ventricular mass index was significantly higher in SHT than in the other groups, and was positively correlated with BP, especially ABPM. Compared with NT, the factors associated with MHT were younger age, male gender, higher BMI, clinic BP > or =130 mmHg, and alcohol consumption. Compared with SHT, the factors associated with WCHT were female gender, lower BMI, and clinic BP < 150 mmHg. CONCLUSIONS: WCHT and MHT were prevalent in the hypertensive population. ABPM was more predictive of target organ damage than clinic BP, and could be useful in identifying subjects at risk for WCHT and MHT.
Blood Pressure Monitoring, Ambulatory ; Female ; Health Status Indicators ; Heart Ventricles/*physiopathology/ultrasonography ; Humans ; Hypertension/*epidemiology/ultrasonography ; Hypertrophy, Left Ventricular/*physiopathology/ultrasonography ; Korea/epidemiology ; Male ; Middle Aged ; Prevalence ; Retrospective Studies ; Risk Factors