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

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 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

No abstract available.
Atrial Fibrillation*

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

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Dobutamine* ; Echocardiography, Stress*

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*

BACKGROUND: The electrocardiogram may provide valuable information regarding the identity of the culprit coronary artery and the location of obstructing lesion within the artery, which may be of guidance in selecting the therapeutic modality. Previous studies have concluded that changes in lateral leads (I, aVL, V5, V6) are predictive of left circumflex coronary artery obstruction in inferior wall acute myocardial infarction. Elect-rocardiographic criteria for determining the location of the obstructing lesion, however, have not been well established. The purpose of this study is to investigate the patterns of ST segment depression in lateral leads in inferior wall acute myocardial infarction and the obstruction site of culprit artery according to ST segment depression in lateral leads. METHODS: We examined 78 patients with inferior wall acute myocardial infarction analizing their electrocardiogram and coronary angiography which performed during acute hospitalization. RESULTS: Of the fifty-five patients in which the culprit artery could be determined, 1)in 41 the culprit artery was the right coronary artery (19 proximal to the right ventricular branch and 22 distal), and in 14 the left circumflex coronary artery (7 proximal to the first obtuse marginal branch or involving a high first obtuse marginal branch, and 7 with distal obstruction). 2)Significant ST depression (ST< or =1 mm) in leads I and aVL was more common in right coronary artery obstruction (p<0.05 and p=0.01 respectively) than left circumflex artery. 3)It was difficult to define the location of obstruction with ST segment change of lateral precordial leads (V5, V6). CONCLUSIONS: In acute inferior wall myocardial infarction, ST segment depression in lateral limb leads (I, aVL) can be indicative of the right coronary artery obstruction and the ST segment depression pattern in lateral precordial leads was not indicative of the site of obstruction.
Arteries ; Coronary Angiography ; Coronary Vessels ; Depression* ; Electrocardiography ; Extremities ; Hospitalization ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction*

Abnormal left ventricular diastolic properties have been reported in dilated cardiomyopathy (DC). Characteristics of transmitral flow were analysed in 37 patients with DC and 29 age matched normal subjects by pulsed Doppler echocardiography. Peak flow velocity of early diastole(PFVE, E), atrial systole (PFVA, A), E/A and deceleration rate of early diastolic flow (DEF) were measured from mitral Doppler spectrum. The extent of mitral regurgitation (MR) was determined by mapping method in the left atrium. Significant mitral regurgitation was founded in 27 out of 37 patients. Three distinct transmitral flow velocity patterns were demonstrated. Ten Patients without significant MR(27%, group 1), PFVE(58+/-17 cm/s), PFVA(73+/-17 cm/s) and E/A (0.94+/-0.4) were significant different from normal subjects (73+/-11 cm/s, 61+/-11 cm/s, 1.22+/-0.26, P<0.025, P<0.005, P<0.05, respectively). In contrast 17 patients with significant MR(46%, group 2) showed higher E (89+/-24 cm/s), lower A(52+/-19 cm/s), higher E/A (1.83+/-0.6) and DEF (596+/-149 cm/s2) than group 1 patients. Remained 10 cases (27%, group 3) had higher single peak flow (104+/-25 cm/s) with higher DEF and significant MR. In conclusion, abnormalities of left ventricular filling are detected in dilated cardiomyopathy without MR but not in DC with MR by Doppler echocardiography. The presence of MR, which augments early diastolic filling, may mask abnormal diastolic filling properties of DC.
Cardiomyopathy, Dilated* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed ; Heart Atria ; Humans ; Masks ; Mitral Valve Insufficiency ; Systole