BACKGROUND: It is now well established that hypercholesterolemia is an important cause of coronary heart disease, and clinical intervention studies have demonstrated the therapeutic value of correcting hypercholesterolemia. One of lipoprotein, lipoprotein(a) [LP(a)] contains one(or two) molecule of apo(a) linked to apo B100 by a disulphied bridge, is associated with an increased risk of coronary heart disease. NIDDM patients have a two-to fourfold increased risk of coronary heart disease relative to nondiabetic subjects. This excess risk is explained only partially by increased levels of standard risk factors. This study was conducted to assess the relatioship between serum Lp(a) levels and coronary heart disease. Furthermore, whether the Lp(a) level was related with NIDDM or not. METHODS: Total 83 subjects undergoing coronary angiography were evaluated on clinical risk factors and lipid profies with Lp(a). Among them, 24 subjects had normal coronary artery, while the others revealed significant stenosis of coronary arteries more than 50%. RESULTS: The serum Lp(a) levels of the CHD group were significantly higher than control group(37.4 +/- 31.8mg/dl vs 22.6 +/- 12.9mg/dl). Other lipids profile were not significantly dfferent between two groups. Serum Lp(a) levels had no relations to fasting blood sugar level. Multivariate logistic regression analysis of lipid parameters revealed that cholesterol, LDL-cholesterol, and Lp(a) were best discriminator among risk factors for coronary heart disease. But in our study, the serum cholesterol and LDL-cholesterol levels were within normal range. CONCLUSION: This study suggested that Lp(a) level was a significant independent risk factor for coronary heart disease whether there was fasting hyperglycemia or not.
Blood Glucose ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Vessels ; Diabetes Mellitus, Type 2* ; Fasting ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Clinical Trial ; Lipoprotein(a)* ; Lipoproteins ; Logistic Models ; Reference Values ; Risk Factors*

Normally the AC segment of mitral valve echogram consists of a rapid slope, from A peak to C point(complete closure). The initial portion is usually less steep than its final portion ; the latter represents abrupt mitral valve closure secondary to the rapid rise in left ventricular(LV) pressure at the onset of LV systole. The point on the mitral echogram at which closure aburptly accelerates in the B point. In order to see wither or not the echocardiographically recorded mitral valve could reflect alterations in left ventricular pressure, mitral valve echograms and left ventricular pressure were obtained on 30 patients undergoing diagnostic cardiac catheterization. The results were as follow : 1) Of 23 patients with LV ejection fraction>55%(71.2%+/-7.9%), 2 had B-bump ; of 7 patients with LV ejection fraction<55%(47.0%+/-4.9%), 5 had B-bump. The difference in frequency of B-bump between the normal LV ejection fraction and the low LV ejection fraction groups was statistically significant(p<0.001). 2) Of 6 patients with LVEDP>5mmHg (17.7mmHg+/-3.6mmHg), 5 had B-bump ; of 24 patients with LVEDP<15mmHg (8.5mmHg+/-2.6mmHg), 2 had B-bump. The difference in frequency of B-bump between the normal LVEDP and the elevated LVEDP groups was statistically significant(p<0.001). 3) Of 22 patients with LV ejection fraction>55%(71.2%+/-7.9%), as well as LVDEP<15mmHg(8.5mmHg+/-2.6mmHg), 1 had B-bump ; Of 5 patients with LV ejection fraction<55%(47.0+/-4.9%), as well as LVEDP>15mmHg(17.8mmHg+/-3.6mmHg), 4 had B-bump. The difference in frequency of B-bump between in normal LV ejection fraction, as well as normal LVEDP and the low LV ejection fraction, as well as elevated LVEDP groups was statistically significant(p<0.001). Thus, the mitral B-bump correlated primarily with LV dysfunction. When properly recorded, the presence of a B-bump is a useful sign of significantl LV dysfunction.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Humans ; Mitral Valve ; Systole ; Ventricular Dysfunction, Left* ; Ventricular Pressure

No abstract available.
Echocardiography, Doppler, Pulsed* ; Humans

BACKGROUND: Left ventricular hypertrophy is one of the major cardiovascular risk factors. So it is generally thought to be a predictor of complication and prognosis of hypertension. The 24-hour noninvasive ambulatory blood pressure monitoring (ABP) has been shown to be superior to office BP inpredicting target organ involvement in patients with hypertension and assessing antihypertensivve therapy. To determine the correlation between blood pressure and left ventricular hypertrophy in patients with newly diaggnosed systemic hypertension, we evaluate blood pressure by 24-hour ABP, office BP and echocardiiographic parameters of left ventricular hypertrophy. METHODS: From january 1995 to September 1995, in 22 patients with untreated essential hypertension who were diagnosed recently (within 1 month). They were studied by 24-hour noninvasive ambulatory blood pressure monitoring and cross sectional, M-mode and pulsed Doppler echocardiography for examining the relation between ABP and echocardiographic parameters. In the present study, we divided the oatuebts by two groups; white-coat hypertensive group and sustained hypertensive group. RESULTS: 1) Among the 22 patients who were diagnosed by office blood pressure, the white-coat hypertension was in 7 cases (31.8%) and sustained hypertension was 15 cases (68.2%). 2) In sustained hypertensive group, LV mass, LV mass index and relative posterior septal wall thickness were significantly increased compared with white-cost hypertensive group. 3) 24-hour ABP and systolic BP and loading % were significantly correlated with relative posterior septal wall thickness (p<0.05). CONCLUSION: In patients with newly diagnosed hypertension (especially with sustained hypertension), there was left ventricular hypertrophy expressed by increasing of LV mass, LV mass index, and relative posterior septal wall thickness. And, there were close correlation between 24-hour ABP monitoring-especially systolic BP and loading % of systolic BP and LVH.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Echocardiography ; Echocardiography, Doppler, Pulsed ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular ; Prognosis ; Risk Factors

BACKGROUND: Recently the percutaneous transradial approach for coronary angiography, transluminal coronary angioplasty or coronary stention were reported but there was no report in Korea. So we tested the safety and efficacy of the transradial appreach for coronary angiography in Korean. METHODS: Eleven patients(male 9, female 2, mean age 59.3 yeal old)with chest pain underwent percutaneous transradial coronary angiography with 5 french multipurpose catheter. We evaluated clinical efficacy and observed complication of percutaneous transradial coronary angiography by physical examination and DOpple ultrasonography of puncture site of radial artery. RESULTS: Right coronary angiography and left ventriculography were performed successfully in all cases, but left coronary angiogrphy was failed in three cases. In another three cases, the patient complained of arm pain which was aggravated during manipulation of the catheter. After the procedure, it took 10.3 minutes to stop the bleeding at the puncture site, Clinically significant complications were not observed after the procedure. The patients were not restricted to bed at all since the completion of the procedure. CONCLUSION: In our limited dexperience, percutaneous transradial coronary angiography could be performend on the outpatient basis without significant complications.
Angioplasty ; Arm ; Catheters ; Chest Pain ; Coronary Angiography* ; Female ; Hemorrhage ; Humans ; Korea ; Outpatients ; Physical Examination ; Punctures ; Radial Artery ; Ultrasonography

BACKGROUND AND OBJECTIVES: As previously reported, unstable angina is usually related to characteristic coronary artery lesion's morphology analyzed by coronary angiogram. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. Although most studies were done for lesions with high degree stenosis(>50%), recent studies emphasized the role of vulnerability of plaque in acute coronary syndrome and even mild degree stenotic lesions may progress rapidly to evoke acute coronary syndrome. Therefore in this study, we analyzed the morphological characteristics of coronary artery lesions with mild degree stenosis as well as severe stenosis. MATERIALS AND METHODS: We conducted a retrospective study of 96 patients with angina pectoris (42 of stable patients and 54 of unstable patients) who underwent coronary angiography. Each lesions with 25% or greater diameter stenosis were categorized into simple and complex lesion(convex intraluminal obstruction with a narrow neck or irregular borders, diffuse irregularities, ulceration, thrombus). Calcification of coronary artery, extents of lesions were analyzed and stenosis grade and location were categorized by AHA classification. RESULTS: There were no significant differences between the stable angina and unstable angina in risk factors and vessel involvement, numbers of lesions, calcification and total obstruction. In morphologic analysis, complex lesions were more frequent in unstable angina than stable angina (49% vs 33%, p<0.05). The mean of percent diameter stenosis was not signigicantly different between two groups, but severe stenotic lesions with 90% or more stenosis were more frequent in unstable angina (34% vs 22%, p<0.05). Locations of involved vessels were similar between the angina groups. Complex lesions were distributed more frequent in RCA and simple lesions were more in LAD and LCX (p<0.05). CONCLUSIONS: The lesions with both complex morphology and severe degree stenosis are closely implicated in unstable angina.
Acute Coronary Syndrome ; Angina Pectoris ; Angina, Stable ; Angina, Unstable* ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Neck ; Pectinidae ; Retrospective Studies ; Risk Factors ; Ulcer

BACKGROUND: Doppler echocardiography is a non-invasive technique that has been used to evaluate LV diastolic dysfunction. Impaired left ventricular diastolic filling is known to occur in patients with coronary artery disease. Compared with those in normal subjects, Doppler-derived transmitral blood flow velocities have been reported to be reduced during early diastolic filling and to be compensatory elevated subsequent to atrial systole in patinets with coronary artery disease. But stiffness of myocardium normalize the E/A ratio, and normal E/A ratio may reveal increased ventricular filling pressure. We tried to investigate left ventricular filling parameters by Doppler echocardiography in patients with early myocardial infarction, and to compare left ventricular diastolic function regarding infarct location on EKG, one or multivessel disease on coronary angiography, and treatment modality. METHODS: From September 1993 to August 1995, Pulsed wave Doppler echocardiography was performed in patients with early acute myocardial infarction(N=95) and control group(N=20) within 5 days after admission, and parameters of diastolic function was evaluated. RESULTS: Echocardiographic data showed significant differences in mean ejection fraction, mean left ventricular mass, and mean left ventricular mass index between two groups. There was no significant difference in E/A ratio, deceleration time, and isovolumetric relaxation time between two groups. Neither, there was significant difference in each diastolic parameter for infarct related wall on EKG. And there was no significant difference in deceleration time for one or multi vessel disease on coronary angiography, treatment modality(conservative treatment, thrombolytic therapy, or primary PTCA). CONCLUSION: In patients with early acute myocardial infarction, left ventricular diastolic dysfunction was absent. And there was no significant correlation between the presence of diastolic dysfunction and the location of infarct related wall on EKG, or one or multi vessel disease, or treatment modality.
Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease ; Deceleration ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Humans ; Myocardial Infarction* ; Myocardium ; Relaxation ; Systole ; Thrombolytic Therapy

OBJECTIVES: The mortality rate due to stroke and myocardial infarction by the complication of the hypertension were the major causes of death among the Korean followed by the cancer. There are many factors to affect the blood pressure variability such as physical activity, sleeping, activation of the autonomic nervous system, climate, cold exposure and seasonal variation. The blood pressure was increased by cold exposure. In general, blood pressure was increased in winter and the cardiovascualr mortality is also increased at winter. In Korea, we have distinct seasonal variation of the climate, we have no clinical data on the seasonal variation of the blood pressure. METHODS: To investigate the seasonal variation of blood pressure of Korean essential hypertensives and make effort to reduce the cardiovascualr mortality, we studied 63 hypertensive men and women hypertensives. RESULTS: 1) The mean age was 60+/-10 years with 19men and 44 women. The mean systolic blood pressure was 146+/-22mmHg, mean diastolic blood pressure was 91+/-11mmHg. 2) The mean systolic and diastolic blood pressure during the 12 months was 137+/-18mmHg, 86+/-10mmHg in men respectively. In women, the mean systolic blood pressure was 137+/-16mmHg and the mean diastolic blood pressure was 86+/-8mmHg. 3) The biochemical findings including hemoglobin, hematocrit and creatinine levels were significantly lower in women(P<0.05). 4) The systolic and diastolic blood pressure were significantly increased during the winter as January and February, 5) There was also significant increase of systolic blood pressure at the transitional zone to the sum- mer to autumn(P=0.0004). CONCLUSION: There was significant increase in systolic and diastolic blood pressure in winter in Korean hypertensives. This phenomenon was also observed the transitional zone to summer to autumn. So, during these period, more strict blood pressure control by frequent measurement and increase the room temperature may be recommended to reduce the cardiovascular mortality during winter.
Autonomic Nervous System ; Blood Pressure* ; Cause of Death ; Climate ; Cold Climate ; Creatinine ; Female ; Hematocrit ; Humans ; Hypertension ; Korea ; Male ; Mortality ; Motor Activity ; Myocardial Infarction ; Seasons* ; Stroke

OBJECTIVES: Hypertension provokes left ventricular diastolic dysfunction due to decreased elasticity of the ventricular myocardium at first. It has been proposed that the Doppler echocardiography might provide information concerning diastole because of its ability to measure the blood flow velocities across the mitral valve noninvasively. But Doppler mitral velocity may be "normalized" in hypertensive patients in different conditions. The purpose of this study is to evaluate diastolic function in hypertensive hearts using Doppler echocardiography of the pulmonary venous flow in conjunction with mitral flow velocity pattern. METHODS: We measured the mitral flow velocity curves and the pulmonary flow velocity curves in fifty hypertensive patients(mean age : 56.3+/-10.0, man : 19, woman : 31) nad forty healthy adults(mean age : 51.6+/-12.5, man : 14, woman : 26) from March 1995 to December 1995 by using the SONO 1000 of Hewlett Packerd. RESULTS: 1) The mitral flow velocity pattern in 50 hypertensive patients was characterized by the decrease in the peak early diastolic filling velocity(E : 0.59+/-0.12m/sec) and the ratio of E to peak filling velocity(A : 1.00+/-0.46m/sec). Isovolumetric relaxation time and deceleration time were 127.2+/-33.3msec, 258.9+/-40.9msec respectively. They were longer than normotensive patients(P < 0.05). 2) The pulmonary venous flow velocity pattern in hypertensive patients was characterized by the decreased peak diastolic forward velocity(D : 33.7+/-9.8cm/sec) and the ratio of peak systolic forward velocity(S) to D(S/D : 1.60+/-0.5)(P < 0.05). 3) There was no relation between the flow velocity integral parameters and the peak flow velocity parameters of pulmonary venous flow pattern in hypertensive patients. 4) The dofference in the pulmonary venous duration and the mitral A wave duration at atrial contraction (DA-DR) was 20.9+/-29.4 msec in hypertensive patients. DA-DR in normatensive patients was 24.3+/-32.9msec. DA-DR was not significant in hypertensive patients compared with that of the healthy subjects (P < 0.05) CONCLUSION: Analysis of pulmonary venous flow velocity pattern in conjunction with mitral flow velocity pattern in hypertensive patients provides more accurate assessment of left ventricular diastolic function.
Blood Flow Velocity ; Deceleration ; Diastole ; Echocardiography, Doppler ; Elasticity ; Female ; Heart* ; Humans ; Hypertension ; Mitral Valve ; Myocardium ; NAD ; Relaxation

We report a case of coronary artery-pulmonary artery fistula in 53-year-old man with review of literature. He complained of anterior chest pain with tightness, but all physical findings were normal. Routine laboratory findings in cluding EKG and chest PA were normal. For evaluation of angina, we performed the coronary arteriogram and established the diagnosis of coronary artery-pulmonary artery fistual incidentally. There was no hemodynamic significance.
Angina Pectoris* ; Arteries* ; Chest Pain ; Diagnosis ; Electrocardiography ; Fistula* ; Hemodynamics ; Humans ; Middle Aged ; Thorax