BACKGROUND AND OBJECTS: Mitral annulus velocity by Pulsed Wave Doppler has been used as method of evaluation of left ventricular diastolic function. However, it is unknown how this is altered in the patients with left ventricular hypertrophy (LVH). this study was aimed to compare a group of healthy subjects with a group of patients with LVH. METHODS: Subjects were 80 patients with LVH (left ventricular mass index125 g/m2) and 163 controls with normal left ventricular mass index (<125 g/m2). For measuring the mitral annulus velocities by doppler tissue imaging (=DTI), we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjects. in LVH group, mitral annulus E've#locity was significantly lower than controls (5.2+/-1.3 cm/sec vs 6.2+/-1.7 cm/sec, p(<0.001) and mitral annulus A' velocity was also significantly higher than controls (8.5+/-1.3 cm/sec vs 8.0+/-1.1 cm/sec, p<0.02). annular displacement measured by DTI-TVI (time velocity integral), also In LVH group, mitral annulus E'-TVI was significantly lower than controls (5.7+/-1.8 mm vs 6.8+/-2.2 mm, p<0.001). CONCLUSION: Mitral annulus velocity determined by DTI could be used as one of the parameters in evaluating diastolic function in patient with LVH.
Diastole ; Humans ; Hypertrophy, Left Ventricular*

BACKGROUNS AND OBJECTIVES: Mitral annulus velocity measured by Pulsed Wave Doppler Tissue Imaging has been used as method of evaluation of left ventricular diastolic function. However, there are few reports of mitral annulus velocity measured by doppler tissue imaging in healthy normal people. the puopose of this study is to know normal values of mitral annulus velocity in healthy korean people. SUBJECTIVES AND METHODS: Subjectives were 100 healthy normal korean (men : 58 and women : 42 average : 51+/-7, range : 41-67) without hyper-tension and heart disease. subjectives were divided three groups according to age, group I which are forties (n=42), group II which are fifties (n=46), and group III which are sixties (n = 14). For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjectives. mitral annulus E'velocities were significantly decrease with aging (group I * 7.5+/-l.3 cm/sec, group II 5.7+/-1.3 cm/sec, group III 5.1+/-1.3 cm/sec. *p <0.001 in group I vs group lI and group I vs group III ) and also E'/A' ratios were significantly decrease with aging (group I * 1.0+/-0.2, group #II 0.8+/-0.2, group III 0.6+/-0.2. *p<0.001 in group I vs group ll and group I vs group III). mitral annulus A' velocities were increase with aging but has no statistical significance (group I 7.8+/-1.0 cm/sec, group II 7.9+/-1.2 cm/sec, group III 8.3+/-0.8 cm/sec. p=NS). mitral annulus E'velocities were correlated with age (r=-0.686, p <0.01) CONCLUSION: This results shows that mitral annulus E'velocities and E'/A' ratios were significantly decrease with aging and mitral annulus A' velocities were increase with aging, also there are good correlation between mitral annulus E' velocities and aging.
Aging ; Diastole ; Female ; Heart Diseases ; Humans ; Reference Values

One of the most important therapeutic targets of current cardiology practice is to determine optimal strategies for the minimization of myocardial necrosis and optimization of cardiac repair following an acute myocardial infarction. Myocardial necrosis after acute myocardial infarction induces complement activation and free radical generation, triggering a cytokine cascade initiated by tumor necrosis factor-alpha (TNF-alpha) release. When reperfusion of the infarcted area is initiated, intense inflammation follows. Chemokines, cytokines and the complement system play an important role in recruiting neutrophils in the ischemic and reperfused myocardium. Cytokines promote adhesive interactions between leukocytes and endothelial cells, resulting in transmigration of inflammatory cells into the site of injury. The recruited neutrophils have potent cytotoxic effects through the release of proteolytic enzymes, and they interact with adhesion molecules on cardiomyocytes. In spite of the potential injury, reperfusion enhances cardiac repair; this may be related to the inflammatory response. Monocyte chemoattractant protein (MCP)-1 is upregulated in reperfused myocardium and can induce monocyte recruitment in the infarcted area. Monocyte subsets play a role in phagocytosis of dead cardiomyocytes and in granulation tissue formation. In addition, the transforming growth factor (TGF)-beta plays a crucial role in cardiac repair by suppressing inflammation. Resolution of inflammatory infiltration, containment of inflammation and the reparative response affecting the infarcted area are essential for optimal infarct healing. Here, we review the current literature on the inflammatory response and cardiac repair after myocardial infarction.
Adhesives ; Cardiology ; Chemokines ; Complement Activation ; Complement System Proteins ; Containment of Biohazards ; Cytokines ; Endothelial Cells ; Granulation Tissue ; Inflammation ; Leukocytes ; Monocytes ; Myocardial Infarction ; Myocardium ; Myocytes, Cardiac ; Necrosis ; Neutrophils ; Peptide Hydrolases ; Phagocytosis ; Reperfusion ; Reperfusion Injury ; Transforming Growth Factors ; Tumor Necrosis Factor-alpha ; Ventricular Remodeling

BACKGROUND AND OBJECTIVE: Mitral annulus velocity measured by doppler tissue imaging (DTI) has been used as a method of evaluation of the left ventricular diastolic function. This study was aimed to evaluate the left ventricular diastolic function using the mitral annulus velocity measured by DTI in the patients with hypertension. METHODS AND SUBJECTS: One hundered twenty nine patients with blood pressure above 140/90mmHg and age sex matched 123 normotensive subjects were studied. For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical four chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocities were easily obtained from all subjects. In the hypertension group, mitral annulus E'velocity was significantly lower than normotensive controls (5.4 1.3 cm/sec vs 6.5 1.8 cm/sec, p<0.001) and mitral annulus A' velocity was significantly higher than normotensive controls (8.6 1.4 cm/sec vs 7.9 1.1 cm/sec, p<0.001). In comparison with patients with normal LVML(IV mass index in hypertension group and subjects with normal LVMI in normotensive controls, mitral annulus E'velocity was reduced in patients with normal LVMI in hypertension group compared with subjects with normal LVMI in normotensive controls (5.6 1.4 cm/sec vs 6.7 1.8 cm/sec, p<0.001). CONCLUSION: Mitral annulus velocity measured by DTI could be used as one of the parameters in evaluating the early changes of left ventricular diastolic function in the patient with hypertension.
Blood Pressure ; Humans ; Hypertension*

Peripheral arterial disease represents a significant problem, particularly among the elderly population. There has been great progress made in the treatment of peripheral arterial disease in recent years. Percutaneous transluminal angioplasty (PTA) has been employed as a method of treatment for patients with a variety of peripheral arterial disease. We report our experience with PTA of contralateral common iliac and superficial femoral arteries via graft vessel in a patient with femorofemoral bypass due to ipsilateral iliac artery occlusion.
Aged ; Angioplasty ; Femoral Artery ; Glycosaminoglycans ; Humans ; Iliac Artery ; Peripheral Arterial Disease ; Transplants

Spontaneous pneumothorax is a rare manifestation of metastatic lung cancers and described in advanced diseases or during cytotoxic chemotherapy which is manifested by sudden onset of dyspnea. The cause or mechanism of spontaneous pneumothorax has been unknown, as well as the association with site of metastases or type of cancers or side effect of chemotherapeutic drugs has been reported rarely. A 68-yr-old man underwent excision of angiosarcoma of the scalp. Chest radiography did not show any evidence of possible metastatic lung lesion at that time. Therefore, systemic doxorubicin and dacarbazine were given. After nineteen days of chemotherapy, he developed a bilateral spontaneous pneumothorax and palpable cervical lymph nodes. Both parietal and visceral pleura were intact and showed no evidence of metastatic and pathologic lesions on thoracoscopic evaluation. The patient managed with bilateral tube thoracostomy and both lungs were expanded. Lymph nodes became unpalpable during three cycles of the paclitaxel and doxorubicin, however, bilateral lung metastases were developed and progressed despite chemotherapy. The patient died due to respiratory failure after five months. This report underlines that spontaneous pneumothorax can occur as the first manifestation of metastatic angiosarcoma even if imaging studies do not show of a metastatic lesion.
Aged ; Antigens, CD31/metabolism ; Antineoplastic Combined Chemotherapy Protocols ; Fatal Outcome ; Hemangiosarcoma/complications* ; Hemangiosarcoma/pathology ; Human ; Lung Neoplasms/complications* ; Lung Neoplasms/secondary ; Male ; Pneumothorax/etiology* ; Scalp/pathology* ; Skin Neoplasms/complications* ; Skin Neoplasms/pathology

Acute myocardial infarction (AMI) is rare in patients with idiopathic thrombocytopenic purpura (ITP). We describe a case of an AMI during thrombocytopenia in a patient with chronic ITP. A 47-yr-old woman presented with anterior chest pain and a low platelet count (21,000/microliter) at admission. Urgent coronary angiography revealed total occlusion of proximal right coronary artery and primary percutaneous coronary intervention (PCI) was performed successfully. This case suggests that primary PCI may be a therapeutic option for an AMI in patients with ITP, even though the patient had severe thrombocytopenia.
Purpura, Thrombocytopenic, Idiopathic/*complications/drug therapy ; Myocardial Infarction/*complications/*therapy ; Middle Aged ; Immunoglobulins, Intravenous/administration & dosage/adverse effects ; Humans ; Heparin/administration & dosage/adverse effects ; Female ; Anticoagulants/administration & dosage/adverse effects ; *Angioplasty, Transluminal, Percutaneous Coronary

BACKGROUND AND OBJECTIVES: High aerobic exercise capacity and sport-related physical activity are reported to be inversely associated with arterial stiffness in healthy young adults. However, it is unknown whether increased physical activity and/or high aerobic exercise capacity attenuate arterial stiffness in patients with untreated hypertension. SUBJECTS AND METHODS: We studied subjects with never-treated hypertension {n=84 (55 males); mean age+/-SD, 49+/-7 years; age range, 36-65 years}. We excluded subjects with a history of diabetes, angina, myocardial infarction, major arrhythmia, or cerebrovascular diseases and those who were taking any cardiovascular medications, including lipid-lowering agents. Carotid intima-media thickness (IMT) and heart-femoral pulse wave velocity (hfPWV) were measured before exercise testing was performed. Physical activity was estimated using a modified Baecke questionnaire. Aerobic exercise capacity was measured with maximal cardiopulmonary exercise testing (maximum oxygen uptake, Vo2max). RESULTS: Linear regression analysis showed a significant inverse correlation between sport-index and hfPWV (r=-0.404; p<0.001), which multiple linear regression analysis showed to be independent of the individual variables of age, gender, body mass index, mean arterial pressure, total cholesterol, fasting blood glucose, and heart rate (beta=-0.277; p=0.004). However, the work- and leisure-indices and Vo2max were not associated with hfPWV (p>0.05). Carotid IMT was not associated with physical activity indices or Vo2max. CONCLUSION: In patients with untreated hypertension, increased sport activity was associated with lower aortic stiffness, but high aerobic exercise capacity was not. These results suggest that regular daily exercise, but not exercise capacity, is an important determinant of aortic stiffness in patients with untreated hypertension.
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Glucose ; Body Mass Index ; Carotid Intima-Media Thickness ; Cholesterol ; Exercise ; Exercise Test ; Fasting ; Heart Rate ; Humans ; Hypertension ; Linear Models ; Motor Activity ; Myocardial Infarction ; Oxygen ; Pulse Wave Analysis ; Sports ; Vascular Stiffness ; Young Adult ; Surveys and Questionnaires

BACKGROUND: The adequate intravascular ultrasound (IVUS) criteria for stent optimization have not been determined in long coronary stenting. We evaluated the predictors of angiographic restenosis and compared that according to stent lumen cross-sectional area (CSA) and stent length between short (stent length < 20 mm) and long (> or =20 mm) coronary stenting. METHODS: IVUS-guided coronary stenting was successfully performed in 285 consecutive patients with 304 native coronary lesions. Six-month follow-up angiogram was performed in 236 patients (82.8%) with 246 lesions (80.9%). Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. RESULTS: The overall angiographic restenosis rate was 22.8% (56/246)(short stent 17.6% vs long stent 32.2%, p=0.009). Using multivariate logistic regression analysis, the independent predictors of angiographic restenosis were the IVUS stent lumen CSA (odd ratio=1.51, 95% CI 1.18-1.92, p=0.001) and stent length (odd ratio=0.95, 95% CI 0.91-1.00, p=0.039). The angiographic restenosis rate was 54.8% in stent lumen CSA & 5.0 mm2 (short stent 37.5% vs long stent 73.3%, p=0.049), 27.4% between 5.0 and 7.0 mm2 (short stent 24.1% vs long stent 31.7%, p=0.409), 10.5% between 7.0 and 9.0 mm2 (short stent 10.0% vs long stent 12.5%, p=0.772), and 11.4% in stent lumen CSA > or =9.0 mm2 (short stent 10.4% vs long stent 13.3%, p=0.767)(p=0.001). CONCLUSIONS: Compared with short coronary stenting, long coronary stenting is effective treatment modality to cover long lesions with comparable long-term clinical outcomes in cases of stent lumen CSA > or =7.0 mm2. Regardless of the stent length, the most important factor determining the angiographic restenosis was the IVUS stent lumen CSA in relatively large coronary artery lesions.
Coronary Artery Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Logistic Models ; Stents* ; Ultrasonography*

BACKGROUND: The chronic stent recoil of Palmaz-Schatz stent was minimal. However, the chronic stent recoil of other types of stents has not been determined. We evaluated the chronic stent recoil of different design of stents. METHODS: Serial (after stent implantation and follow-up) intravascular ultrasound images using automatic transducer pullback devices were obtained in 70 native coronary artery lesions: slotted-tube design of Palmaz-Schatz stent 30 and NIR 10, sinusoidal ring design of GFX 20, and coil design of CrossFlex 10. Measurements of stent cross-sectional area (CSA) (4 image slices in Palmaz-Schatz stent and 7 image slices in GFX, NIR and CrossFlex) using computerized planimetry were performed. Stent CSA post-stenting and follow-up was compared to evaluate the chronic stent recoil of different designs of stent. The chronic stent recoil (%) was defined as (post-intervention-follow-up) stent CSAx100/post-intervention stent CSA. RESULTS: The changes of stent CSA between post-intervention and follow-up period were minimal in NIR stent, Palmaz-Schatz and GFX. However, there was significant reduction of stent CSA in CrossFlex stent. Compared with other types of stents, the changes of stent CSA were significantly larger in CrossFlex stent (p=0.001). The chronic stent recoil was significantly larger in CrossFlex stent than in other types of stents (4.0+/-6.0% vs 0.7+/-5.8% in GFX stent, 0.4+/-5.0% in Palmaz-Schatz and 0.3+/-3.0% in NIR, p=0.001, respectively). There were no significant differences of chronic stent recoil among GFX, NIR and Palmaz-Schatz stent. CONCLUSIONS: The chronic stent recoil was minimal in slotted-tube and sinusoidal ring designs of stent. However, there was significant chronic stent recoil in coil design of stent.
Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Stents* ; Transducers ; Ultrasonography*