Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR.
Cardiovascular Diseases ; Diagnosis* ; Echocardiography ; Echocardiography, Doppler* ; Europe ; Heart Failure ; Mitral Valve Insufficiency* ; Mortality ; North America ; Prevalence

The recently published 2017 American College of Cardiology (ACC)/American Heart Association (AHA)/American Academy of Physician Assistants/Association of Black Cardiologists/American College of Preventive Medicine/American Geriatrics Society/American Pharmacists Association/American Society of Hypertension (ASH)/American Society for Preventive Cardiology/National Medical Association/Preventive Cardiovascular Nurses Association (2017 ACC/AHA/ASH guideline for short) lowered the threshold for diagnosis of hypertension from 140/90 mm Hg to 130/80 mm Hg. Also, the revised guideline recommends pharmacological treatment for all hypertensive patients with either previous cardiovascular disease or 10-year atherosclerotic cardiovascular disease (ASCVD) risk greater than 10%. Since most diabetic hypertensive patients have ASCVD risk greater than 10%, the guideline recommends that all diabetics with blood pressure (BP) above 130/80 mm Hg be treated both pharmacologically and with active lifestyle modification. Although the evidence suggests that intensive lowering of BP may be beneficial in diabetic patients, there is lack of evidence that pharmacologic treatment in subjects with baseline BP below 140 mm Hg is beneficial, with some studies suggesting actual potential for harm. Also, there are data to suggest a potential risk of increased risk of cardiovascular events and mortality in subjects whose diastolic BP (DBP) was lowered to below 60 mm Hg. As such, strict BP lowering may be beneficial if the target BP could be achieved without side effects such as orthostatic hypotension and decreased renal function. Also, lowering of DBP below 60 mm Hg should be avoided. Lastly, treatment should be started in subjects with baseline BP above 140/90 mm Hg until further evidence suggests otherwise.
Blood Pressure* ; Cardiology ; Cardiovascular Diseases ; Diagnosis ; Geriatrics ; Heart ; Humans ; Hypertension ; Hypotension, Orthostatic ; Life Style ; Mortality ; Pharmacists

Hypertension affects the majority of patients with chronic kidney disease (CKD) and increases the risk of cardiovascular disease, end-stage renal disease and mortality. Previously, many hypertension guidelines have suggested blood pressure targets in patients with CKD. Recently, the American College of Cardiology/American Heart Association 2017 Guideline for Hypertension suggests a new definition for hypertension and therapeutic targets, which were equally applicated to patients with CKD. These changes reflect the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, but the renal outcome of intensive blood pressure control was not good. Furthermore, the majority of hypertension guidelines including those of the Korean Society of Hypertension and the European Society of Hypertension have retained the traditional definition. Herein, we intend to analyze in detail the effect of intensive blood pressure control on kidney through the post-hoc analyses of the SPRINT study.
Blood Pressure ; Cardiovascular Diseases ; Diagnosis ; Heart ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Insufficiency, Chronic

diagnosis code, duration of admission, type of test, treatment, and medication. Age-standardized incidence rate by gender, age group, and resident region was calculated from 2007 to 2016. Cumulative case-fatality rate was calculated until 3 years.RESULTS: Age-standardized incidence of hospitalized AMI decreased from 53.6 cases per 100,000 person-years in 2007 to 38.9 cases in 2011. Thereafter, the incidence gradually increased to 43.2 cases in 2016. The trend by gender and age groups was also similar to the total trend. The regional age-standardized incidence was the highest in Daegu (50.3 cases per 100,000 person-years) and the lowest in Sejong (30.2 cases), which were similar to the ischemic heart disease mortality in these regions. The 7-, 30-, and 90-days and 1- and 3-years average case-fatality over 10 years were 3.2%, 6.9%, 9.9%, 14.7%, and 22.4%, respectively.CONCLUSION: Although case-fatality continuously decreased from 2007 to 2016, hospitalized AMI incidence decreased from 2007 to 2011 and gradually increased from 2011 to 2016, with marked disparity between regions. Effective preventive strategies to decrease AMI incidence are required to decrease cardiovascular disease mortality in Korea.]]>
Cardiovascular Diseases ; Cohort Studies ; Daegu ; Diagnosis ; Humans ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Myocardial Ischemia

BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted. RESULTS: The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92). CONCLUSION: We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.
APACHE* ; Cardiovascular Diseases* ; Coronary Care Units* ; Diagnosis ; Humans ; Logistic Models ; Mortality ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Survivors

BACKGROUND AND OBJECTIVES: Risk assessment methods specially designed for coronary care unit (CCU) are lacking. The aims of this study were first to assess the utility of the Acute Physiology and Chronic Health Evaluation III (APACHE III) scoring system for the prediction of mortality in CCU patients and second to derive an equation for estimation of death risk. MATERIALS AND METHOD: 310 patients were retrospectively investigated. The day 1-scores of APACHE III were determinated. An equation for estimation of death risk was derived, using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve for APACHE III score was plotted. RESULTS: The average APACHE III scores of non-survivors were significantly higher than those of survivors (P<0.01). Multivariate logistic regression analysis showed that the APACHE III scores and the diagnoses on admission were two significant predictors of mortality. we formulated an equation which could predict outcomes : Probability of death =eX / 1+X, where X = -8.64 +diagnostic category weight +(0.10xAPACHE III scores). The ROC curve for APACHE III confirmed it as a predictor of mortality, with an area under the curve of 0.933 (standard error(SE)=.016). The sensitivity (95% confidence limit(CL)), specificity (95%CL) for APACHE III scores were, respectively, 0.84 (0.72-0.92), 0.88 (0.83-0.92). CONCLUSION: We conclude that the APACHE III scoring system is a useful tool for the overall assessment and management of cardiovascular disease patients in CCUs.
APACHE* ; Cardiovascular Diseases* ; Coronary Care Units* ; Diagnosis ; Humans ; Logistic Models ; Mortality ; Retrospective Studies ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Survivors

The analysis of heart rate variability (HRV) has recently been established as a non-invasive measurement method for estimation of autonomic nervous system function in the cardiovascular system. HRV reflects the interaction of the sympathetic and parasympathetic nervous systems and the regulation of the cardiovascular system by the autonomic nervous system, and various measures of HRV, such as time-domain, frequency domain, and non-linear measures of HR variability, have been used in risk stratification of cardiovascular disease. Many studies have demonstrated that patients with reduced HRV have an increased risk of mortality after an acute myocardial infarction (AMI) or after a diagnosis of heart failure. HRV performed late after AMI (> 6 wks) better predicts sudden cardiac death and fatal arrhythmia than does HRV at the early phase after AMI, suggesting that impaired recovery of the autonomic nervous system and remodeling of the arrhythmia substrate after AMI may play critical roles in the mechanism of sudden cardiac death. Therefore, early measurement of HRV to identify high risk patients might be repeated later in order to investigate and follow the risk of sudden cardiac death. Future randomized trials using HRV as one of the inclusion criteria should determine whether routine measurement of HR variability can be a useful routine clinical tool for risk stratification in cardiovascular disease.
Arrhythmias, Cardiac ; Autonomic Nervous System ; Cardiovascular Diseases* ; Cardiovascular System ; Death, Sudden, Cardiac ; Diagnosis ; Heart Failure ; Heart Rate* ; Humans ; Mortality ; Myocardial Infarction ; Parasympathetic Nervous System

BACKGROUND: Acute myocardial infarction is one of major cardiovascular disease that increases according to the changes of diet and life style. Early diagnosis and treatment of acute myocardial infarction is critical for better prognosis and for reducing mortality. But early diagnosis of acute myocardial infarction is limited by several factors. Recently it was reported that measurements of several serum cardiac enzymes were useful for early diagnosis of acute mocardial infarction. This study was performed to investigate which method of serum creatine kinase measurement is the faster and accurate and whether serum creatine kinase is an early noninvasive predictor of coronary artery patency following thrombolysis in patients with acute myocardial infarction by means of analysis of serial changes in serum creatine kinase. METHODS: This study included 32 patients who had acute myocardial infarction. Serum CK-MB was measured by electrophoretic method and enzymatic immuoasssay method. and compared with EKG and total CK activity which measured by photoabsorbance method. Also we studied whether CK time-activity could be predictor for reperfusion. RESULTS: Immunoassay method accurately measures the serum CK-MB and correlates well with that of electrophoretic method in patients with acute mocardial infarction. Immunoassay method is more sensitive than EKG and has the similar sensitivity to electrophoretic method in diagnosis of acute myoardial infarction. Reperfusion of an occluded coronary artery results in early elevation of serum creatine kinase and CK-MB reflected by earlier appearance time, peak, and onset of clearance. CONCLUSION: Because immunoassay measurement of serum creatine kinase is faster than electrophoresis and requires less technical expertise, it is possible to make diagnosis in patients with acute myocardial infarction in a more timely and cost effective manner and creatine kinase is good predictor of recanalization of an occluded coronary artery after intravenous thrombolytic therapy.
Cardiovascular Diseases ; Coronary Vessels ; Creatine Kinase* ; Creatine* ; Diagnosis ; Diet ; Early Diagnosis* ; Electrocardiography ; Electrophoresis ; Humans ; Immunoassay ; Infarction ; Life Style ; Mortality ; Myocardial Infarction* ; Professional Competence ; Prognosis ; Reperfusion* ; Thrombolytic Therapy

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.
Aged* ; Cardiovascular Diseases ; Cause of Death ; Crowding ; Diabetes Complications ; Diabetic Foot ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Humans ; Hypoglycemia ; Korea ; Male ; Mortality ; Retrospective Studies

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in end- stage renal disease (ESRD) patients. The early diagnosis and treatment of CVD could improve survival in dialysis patients. The plasma level of B-type Natriuretic Peptide (BNP) correlates with the severity of LV dysfunction and increases following myocardial ischemia. We investigated the ability of BNP as a predictor of CVD in new ESRD patients whose volume overload status were not corrected. METHODS: CVD was defined as an LV ejection fraction <45% or a positive myocardial SPECT. We measured plasma levels of BNP in 79 new ESRD patients requiring hemodialysis (HD) and investigated the relationships between BNP levels and echocardiography and myocardial SPECT. RESULTS: Median concentrations of BNP were higher in 16 patients with heart failure than those in 63 patients without heart failure (1, 748.5 vs. 127.0 pg/mL, p<0.001) and higher in 12 patients with positive myocardial SPECT than those in 67 patients with negative SPECT (1, 160.5 vs. 129.0 pg/mL, p< 0.001). BNP levels were higher in 23 patients with CVD than those in 56 patients without CVD (1, 234.0 vs. 119.0 pg/mL, p<0.001). There was an inverse correlation between BNP and LV ejection fraction (r=-0.65, p<0.001). The present study demonstrated a significant 34.9% increment of cardiac mortality by the every increase of 100 pg/mL of BNP. The negative predictive value of BNP for excluding CVD was 89.3% (cut-off value, 500 pg/mL). CONCLUSION: Our findings suggest that BNP could be an effective screening test for the evaluation of the presence of CVD in ESRD patients starting maintenance HD.
Cardiovascular Diseases* ; Dialysis ; Early Diagnosis ; Echocardiography ; Heart Failure ; Humans ; Kidney Failure, Chronic* ; Mass Screening ; Mortality ; Myocardial Ischemia ; Natriuretic Peptide, Brain* ; Plasma ; Renal Dialysis* ; Tomography, Emission-Computed, Single-Photon