BACKGROUND AND OBJECTIVE: Precise assessment of lesion severity is fundamental for the clinical decision making in the patients with coronary artery disease. Coronary angiography has limitation to projection imaging techniques. Intravascular ultrasound (IVUS) has been known to be a gold standard of morphological severity of coronary stenosis. Fractional flow reserve (FFR) is known to be a lesion specific functional index of epicardial stenosis that can be derived from intracoronary pressure assessed during maximal vasodilation. The objective of this study was to investigate the validity of fractional flow reserve for stenosis severity in comparison with IVUS. METHODS: The study population consisted of 24 patients with angina pectoris (M:F=19:5, age: 58+/-12 yrs). The IVUS and intracoronary pressure wire performed at 26 lesions after diagnostic coronary angiography. We measured angiographical diameter stenosis (DST), minimal luminal diameter (MLD), minimal luminal area (MLA) and reference area stenosis (r-AST). FFR was defined by the ratio of distal mean coronary pressure (Pd) to aortic mean pressure (Pa). RESULTS: FFR showed significant correlation with both r-AST (r=-0.93, p<0.00001) than DST (r=-0.79, p<0.0001). When the lesions with MLD less than 1.1 mm were excluded, considering the limitation of IVUS for the thickness of its catheter, FFR showed excellent correlation with r-AST with higher correlation coefficient (r=-0.96, p<0.00001). FFR showed significant correlation with MLA (r=0.87, p=0.0001) or MLD (r=0.83, p=0.0005). CONCLUSION: FFR with excellent correlation with r-AST measured by IVUS seems to be a useful lesion specific functional index for the assessment of coronary stenosis in angina patients.
Angina Pectoris ; Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Decision Making ; Humans ; Phenobarbital ; Ultrasonography* ; Ultrasonography, Interventional ; Vasodilation

BACKGROUND AND OBJECTIVES: The pathological findings of Non-Q wave myocardial infarction(NQMI) on ECG did not always correspond to subendocardial infarction(SEMI). The purpose of this study was to evaluate the diagnostic validity of ECG for SEMI by myocardial contrast echocardiography (MCE) in the patients with acute myocardial infarction(AMI). MATERIALS AND METHODS: The study population was 84 patients who underwent MCE under the diagnosis of AMI. MCE was performed by intracoronary injection of sonicated Hexabrix into the infarct related artery and SEMI was diagnosed by inspecting endocardial defect with epicardial enhancement on MCE. RESULTS: (1) Among 19 NQMI cases, 7 cases showed SEMI with MCE score 0.5, 11 cases with score 1, and 1 case with score 0. Among 65 Q-wave MI(QMI) cases, only 5 cases showed SEMI. (2) 7 cases who had NQMI with SEMI showed LV wall motion recovery at follow-up echocardiography except 1 case. Whereas, of 5 QMI cases who had SEMI, only 1 case improve LV wall motion. CONCLUSION: NQMI on ECG does not always imply SEMI on MCE, but the absence of pathologic Q wave in the patients with SEMI is thought to be a predictive factor of the recovery of LV wall motion.
Arteries ; Diagnosis ; Echocardiography* ; Electrocardiography* ; Follow-Up Studies ; Humans ; Infarction* ; Ioxaglic Acid

BACKGROUND AND OBJECTIVES: The pathological findings of Non-Q wave myocardial infarction(NQMI) on ECG did not always correspond to subendocardial infarction(SEMI). The purpose of this study was to evaluate the diagnostic validity of ECG for SEMI by myocardial contrast echocardiography (MCE) in the patients with acute myocardial infarction(AMI). MATERIALS AND METHODS: The study population was 84 patients who underwent MCE under the diagnosis of AMI. MCE was performed by intracoronary injection of sonicated Hexabrix into the infarct related artery and SEMI was diagnosed by inspecting endocardial defect with epicardial enhancement on MCE. RESULTS: (1) Among 19 NQMI cases, 7 cases showed SEMI with MCE score 0.5, 11 cases with score 1, and 1 case with score 0. Among 65 Q-wave MI(QMI) cases, only 5 cases showed SEMI. (2) 7 cases who had NQMI with SEMI showed LV wall motion recovery at follow-up echocardiography except 1 case. Whereas, of 5 QMI cases who had SEMI, only 1 case improve LV wall motion. CONCLUSION: NQMI on ECG does not always imply SEMI on MCE, but the absence of pathologic Q wave in the patients with SEMI is thought to be a predictive factor of the recovery of LV wall motion.
Arteries ; Diagnosis ; Echocardiography* ; Electrocardiography* ; Follow-Up Studies ; Humans ; Infarction* ; Ioxaglic Acid

BACKGROUND AND OBJECTIVES: Dilated cardiomyopathy(DCMP) is a primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial contractility. In 1973, Kreulen et al. classified DCMP into two groups-one with generalized hypokinesia and the other with regional asynergy in addition to generalized hypokinesia. Diminished coronary flow reserve has been reported in DCMP with generalized hypokinesia but its mechanism remains obscure. The aim of this study was to investigate the relationship between the degree of microvascular dysfunction and the difference of regional wall motion abnormality in DCMP with regional asynergy. METHODS: The subjects of this study were 11 patients (M:F=:5, mean age:60 15yrs) a diagnosis of DCMP with regional asynergy, normal sinus rhythm without left bundle branch block and normal coronary angiogram who underwent Doppler wire from September 1997 to December 1999. Left ventricle was divided into three territories according to the coronary arterial distribution by echocardiography(A: coronary artery territory showing regional asynergy, I: coronary artery territory showing intermediate wall motion, P: coronary artery territory showing relatively preserved wall motion). Coronary flow reserve(CFR) was measured at the mid portion of left anterior descending artery(LAD), left circumflex artery(LCX) and right coronary artery(RCA) with 0.014 inch Doppler guide wire before and during intracoronary injection of 12-18 of adenosine. Relative coronary flow reserve(rCFR) was obtained by the ratio of the CFR in coronary artery of the territory showing regional asynergy and relatively preserved wall motion to the CFR in coronary artery of the territory showing intermediate wall motion (CFRA/CFRI, CFRP/CFRI). RESULTS: Regional asynergy was observed in LAD territory in 4(36%) patients, LCX territory in 4(36%) patients, RCA territory in 3(28%) patients (p=s). The mean CFR was 2.5 0.6 in LAD, 2.4 0.5 in LCX, 2.4 0.6 in RCA(p=s). The mean CFR and rCFR in coronary arteries showing regional asynergy were significantly lower than those in coronary arteries showing relatively preserved wall motion(2.1 0.5 vs 2.7 0.6, p<0.05, 0.84 0.12 vs 1.11 0.11, p<0.001). CONCLUSION: Degree of regional hypokinesia in DCMP with regional asynergy seems to be associated with that of microvascular dysfunction.
Adenosine ; Bundle-Branch Block ; Cardiomyopathies ; Cardiomyopathy, Dilated* ; Coronary Vessels ; Deoxycytidine Monophosphate ; Diagnosis ; Dilatation ; Heart Ventricles ; Humans ; Hypokinesia*

BACKGROUND AND OBJECTIVES: As lack of myocardial perfusion was demonstrated Microvascular function after reperfusion of infarct related artery (IRA) can be changed in convalescent stage for several possible mechanisms such as hyperemia and microvascular stunning. Therefore, myocardial contrast echocardiography (MCE) performed early stage after reperfusion of IRA may cause over or underestimation of the extent of myocardial necrosis. The aims of the study were to demonstrate the temporal changes of myocardial perfusion after revascularization of IRA and to explore the association of late changes of myocardial capillary flow with contractile recovery. METHODS: MCE was performed 5-7days after the attack of acute myocardial infarction (AMI) in 21 patients (M:F=17:4, age: 58+/-12yrs) who underwent successful reperfusion of IRA. MCE was graded by semiquantitative score (0: no opacification, 0.5: partial opacification, 1: homogenous opacification) by 16 segment model. Every patient underwent 1-2months follow up 2D echocardiography and MCE. Improvement of wall motion score more than 1 at follow up was considered to have contractile recovery. RESULTS: Thirty-one of 71 initially akinetic segments were scored as 1, 30 segments as 0.5 and 10 segments as 0 after attempted reperfusion. Twelve of 30 segments with score of 0.5 and 5 of 10 segments with score of 0 showed late improvement of MCE score to 1 and 0.5. Only 1 of 30 segments with score of 0.5 got worse to score of 0. Every segment with late improvement from 0.5 to 1 showed contractile recovery, whereas none of 5 segments with late improvement from 0 to 0.5 showed contractile recovery. There was no significant difference of predictive value between early and late MCE (p=ns). CONCLUSION: Temporal changes of myocardial perfusion from 1week to 2 months in AMI were mainly progressive improvement caused by recovery of microvascular function from stunning rather than progressive microvascular damage or reactive hyperemia. However, it may not significantly affect the validity of MCE in predicting contractile recovery.
Arteries ; Capillaries* ; Echocardiography ; Follow-Up Studies ; Humans ; Hyperemia ; Myocardial Infarction* ; Necrosis ; Perfusion ; Reperfusion*

BACKGROUND AND OBJECTIVES: As lack of myocardial perfusion was demonstrated Microvascular function after reperfusion of infarct related artery (IRA) can be changed in convalescent stage for several possible mechanisms such as hyperemia and microvascular stunning. Therefore, myocardial contrast echocardiography (MCE) performed early stage after reperfusion of IRA may cause over or underestimation of the extent of myocardial necrosis. The aims of the study were to demonstrate the temporal changes of myocardial perfusion after revascularization of IRA and to explore the association of late changes of myocardial capillary flow with contractile recovery. METHODS: MCE was performed 5-7days after the attack of acute myocardial infarction (AMI) in 21 patients (M:F=17:4, age: 58+/-12yrs) who underwent successful reperfusion of IRA. MCE was graded by semiquantitative score (0: no opacification, 0.5: partial opacification, 1: homogenous opacification) by 16 segment model. Every patient underwent 1-2months follow up 2D echocardiography and MCE. Improvement of wall motion score more than 1 at follow up was considered to have contractile recovery. RESULTS: Thirty-one of 71 initially akinetic segments were scored as 1, 30 segments as 0.5 and 10 segments as 0 after attempted reperfusion. Twelve of 30 segments with score of 0.5 and 5 of 10 segments with score of 0 showed late improvement of MCE score to 1 and 0.5. Only 1 of 30 segments with score of 0.5 got worse to score of 0. Every segment with late improvement from 0.5 to 1 showed contractile recovery, whereas none of 5 segments with late improvement from 0 to 0.5 showed contractile recovery. There was no significant difference of predictive value between early and late MCE (p=ns). CONCLUSION: Temporal changes of myocardial perfusion from 1week to 2 months in AMI were mainly progressive improvement caused by recovery of microvascular function from stunning rather than progressive microvascular damage or reactive hyperemia. However, it may not significantly affect the validity of MCE in predicting contractile recovery.
Arteries ; Capillaries* ; Echocardiography ; Follow-Up Studies ; Humans ; Hyperemia ; Myocardial Infarction* ; Necrosis ; Perfusion ; Reperfusion*

Angiodysplasia is probably responsible for 2.6-6.2% of cases involving of lower gastrointestinal bleeding and 1.2-8.0% of cases involving hemorrhages from the upper GI tract. Small bowel neoplasia is rare, accounting for about 5% of gastrointestinal tumors overall and 2-3% of all malignacies. The third most common malignany of the small bowel is the sarcoma, of which the leiomyosarcoma is the most frequent. A 54-year-old male patient was admitted with the chief complaints of dizziness and headache during 2 months. Laboratory findings revealed iron deficiency anemia. A superior mesenteric arteriography found an intensive vascular stained mass in the hepatic flexure. A celiac artery angiography discovered a irregulary vascular stained lesion in the Ll vertebral level. A colonoscopy located a 10 mm sized angiodysplasia in the right colon. According to these findings, we presumed that these lesions are a colonic angiodysplasia and a suspicious duodenal lesion. The operation was perfomed. The final diagnosis was a colonic angiodysplasia combined with leiomyosarcoma of the duodenum. The rarity of this case is emphasized and the literative reviewed.
Anemia, Iron-Deficiency ; Angiodysplasia ; Angiography ; Celiac Artery ; Colon* ; Colonoscopy ; Diagnosis ; Dizziness ; Duodenum ; Headache ; Hemorrhage ; Humans ; Leiomyosarcoma* ; Male ; Middle Aged ; Sarcoma ; Upper Gastrointestinal Tract

While maternal mortality rates due to obstetric causes have declined in recent years, maternal mortality rates due to non-obstetric causes have relatively increased. Among these, pregnancy related stroke is significant because it has the worst impact on both mother and the fetus. Stroke is the state of necrosis in brain tissues caused by perfusion disorder in the cerebral blood flow and pregnant or puerperal women are reported to have about 13-fold more risk of stroke compared to non-pregnant women. Pregnancy-related stroke must be differentiated from stroke in elderly patients, because it is different in pathophysiological etiologies and recurrence rates and also diagnostic and therapeutic methods may affect the fetal health status. In this article, we experienced one case of hemorrhagic stroke occurred in a normal pregnant woman with gestational age of 40 weeks and the other case with ischemic stroke in 33 gestational weeks, those both without any manifestation of preeclampsia or eclampsia.
Aged ; Brain ; Cerebral Hemorrhage* ; Cerebral Infarction* ; Eclampsia* ; Female ; Fetus ; Gestational Age ; Humans ; Maternal Mortality ; Mothers ; Necrosis ; Perfusion ; Postpartum Period* ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women* ; Recurrence ; Stroke*

BACKGROUND: This study was to determine whether coronary flow reserve (CFR) of infarct related artery is related to the microvascular perfusion status in the infarct zone determined by myocardial contrast echocardiography (MCE) immediately after successful revascularization in patients with acute myocardial infarction and to the presence of non-contractile myocardium at follow-up. METHODS: CFR was measured immediately after successful revascularization in 21 patients 5+/-2 days after acute myocardial infarction. Then, myocardial perfusion status was evaluated by MCE. Myocardial opacification index (MOI) was calculated as the ratio of sum of reperfusion area to total risk area of infarct-related artery. Follow-up transthoracic echocardiography was performed 1 month after infarction. RESULTS: CFR was correlated with myocardial opacification index immediately after successful revascularization (r=0.79, p<0.001). CFR was significantly higher in patients with MOI score of 1 than in patients with MOI score smaller than 1 (2.15+/-0.29 vs 1.52+/-0.27, p<0.05), and higher but insignificantly in patients without non-contractile segments than in patients with (1.83+/-0.46 vs 1.63+/-0.4, p>0.05). CONCLUSION: CFR may be used to determine the microvascular perfusion status of the myocardium in the infarct zone. CFR immediately after successful revascularization seems to be associated more closely with myocardial perfusion status determined by MCE at that time than whether the non-contractile myocardium is presence or not after 1 month.
Arteries* ; Echocardiography ; Follow-Up Studies ; Humans ; Infarction ; Myocardial Infarction* ; Myocardium ; Perfusion* ; Reperfusion*

BACKGROUND: A Stellate ganglion block (SGB) is a sympathetic nerve block method which has been used most frequently in pain clinics due to its wide range of indications. However, SGB leads to regional sympathetic denervation of the heart and to changes in the hemodynamics. The aim of this study was to compare hemodynamic effects as well as echocardiographic changes after a left SGB (LSGB). METHODS: Fourteen healthy male volunteers were studied. The LSGB was performed with 1% mepicacaine 6 ml. Arterial blood pressure, electrocardiographic and echocardiographic variables were measured before the LSGB, 15 and 30 minutes after the LSGB. RESULTS: Arterial blood pressure, ejection fraction and transmitral inflow velocity variables showed no significant changes compared to pre-LSGB values. P-P interval increased significantly 15 minutes after the LSGB, and the Q-T interval increased significantly 30 minutes after the LSGB. The diastolic pulmonary venous flow velocity decreased significantly 15 minutes after the LSGB. CONCLUSIONS: These results showed that a LSGB decreased the heart rate without detrimental changes of left ventricular relaxation in healthy male volunteers.
Arterial Pressure ; Autonomic Nerve Block ; Echocardiography ; Electrocardiography ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Male ; Pain Clinics ; Relaxation ; Stellate Ganglion* ; Sympathectomy ; Ventricular Function, Left* ; Volunteers