Carotid ultrasound is an imaging modality that allows non-invasive assessment of vascular anatomy and function. Carotid intima-media thickness (IMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. However, in 2013, American College of Cardiology/American Heart Association guidelines designated that the carotid IMT as class III evidence level was not recommended for use in clinical practice as a routine measurement of risk assessment for a first atherosclerotic CV event. Following the announcement of this guideline, combined common carotid IMT and plaque, including plaque tissue characterization and plaque burden, using 3D ultrasound was reported to be better than either measurement alone in a variety of studies. Moreover, changes in the intima thickness were related to aging and early atherosclerosis, and remodeling of the media thickness was associated with hypertension. Separate measurement is useful for evaluating the effects of different atherosclerotic risk factors on the arterial wall; however, a more detailed and elaborate technique needs to be developed. If so, separate measurement will play an important role in the assessment of atherosclerosis and arterial wall change according to a variety of risk factors, such as metabolic syndrome. In addition, although carotid blood flow velocity is a useful tool for risk classification and prediction in clinical practice, further clinical research is needed. The value of carotid IMT by ultrasound examination for risk stratification remains controversial, and groups developing future guidelines should consider the roles of plaque presence and burden and hemodynamic parameters in additional risk stratification beyond carotid IMT in clinical practice.
Aging ; Atherosclerosis* ; Blood Flow Velocity ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Carotid Stenosis ; Classification ; Heart ; Hemodynamics ; Hypertension ; Methods* ; Risk Assessment ; Risk Factors ; Ultrasonography*

PURPOSE: The effect of radiofrequency catheter ablation (RFCA) on left atrial (LA) volume and function in patients with paroxysmal atrial fibrillation (PAF) has not been extensively studied. The aim of this study was to evaluate the long-term impact of RFCA on LA volume and function in patients with PAF. MATERIALS AND METHODS: A total of 90 patients with drug-refractory PAF who had sinus rhythm on the initial echocardiogram were examined at baseline, 3 months and 1 year after ablation. We measured LA volume index, LA ejection fraction (LAEF; maximal-minimal LA volume/maximal LA volume), and LA active emptying fraction (LAAEF; mid-diastolic-minimal LA volume/mid-diastolic LA volume). RESULTS: After 12+/-1 months, 78 patients returned, and 61 patients (78%) had sinus rhythm. After 3 months, the LA maximal volume indices decreased (from 33+/-13 to 28+/-12 mL/m2; p<0.001). But, LAEF and LAAEF also decreased (from 48+/-13 to 39+/-12; p<0.001, from 27+/-13 to 19+/-11; p<0.001). After 1 year, LA volumes, LAEF, and LAAEF remained similar at 3 months. In patients without atrial fibrillation (AF) recurrence, LAEF and LAAEF decreased after 3 months (from 50+/-12 to 40+/-11; p<0.001, from 29+/-13 to 22+/-11; p<0.001) and did not change after 1 year. However, in patients with AF recurrence, those who did not have decreased levels after 3 months had significantly decreased after 1 year (from 43+/-14 to 34+/-11; p=0.026, from 22+/-12 to 15+/-10; p=0.012). CONCLUSION: Successful RFCA of PAF decreased LA volume and function at 3 months. At one year, LA volume and function was remained unchanged in successfully ablated patients whereas LA function in patients with AF recurrence worsened.
Adult ; Aged ; Atrial Fibrillation/*therapy ; Atrial Function, Left/*physiology ; *Catheter Ablation ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

PURPOSE: The effect of radiofrequency catheter ablation (RFCA) on left atrial (LA) volume and function in patients with paroxysmal atrial fibrillation (PAF) has not been extensively studied. The aim of this study was to evaluate the long-term impact of RFCA on LA volume and function in patients with PAF. MATERIALS AND METHODS: A total of 90 patients with drug-refractory PAF who had sinus rhythm on the initial echocardiogram were examined at baseline, 3 months and 1 year after ablation. We measured LA volume index, LA ejection fraction (LAEF; maximal-minimal LA volume/maximal LA volume), and LA active emptying fraction (LAAEF; mid-diastolic-minimal LA volume/mid-diastolic LA volume). RESULTS: After 12+/-1 months, 78 patients returned, and 61 patients (78%) had sinus rhythm. After 3 months, the LA maximal volume indices decreased (from 33+/-13 to 28+/-12 mL/m2; p<0.001). But, LAEF and LAAEF also decreased (from 48+/-13 to 39+/-12; p<0.001, from 27+/-13 to 19+/-11; p<0.001). After 1 year, LA volumes, LAEF, and LAAEF remained similar at 3 months. In patients without atrial fibrillation (AF) recurrence, LAEF and LAAEF decreased after 3 months (from 50+/-12 to 40+/-11; p<0.001, from 29+/-13 to 22+/-11; p<0.001) and did not change after 1 year. However, in patients with AF recurrence, those who did not have decreased levels after 3 months had significantly decreased after 1 year (from 43+/-14 to 34+/-11; p=0.026, from 22+/-12 to 15+/-10; p=0.012). CONCLUSION: Successful RFCA of PAF decreased LA volume and function at 3 months. At one year, LA volume and function was remained unchanged in successfully ablated patients whereas LA function in patients with AF recurrence worsened.
Adult ; Aged ; Atrial Fibrillation/*therapy ; Atrial Function, Left/*physiology ; *Catheter Ablation ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies

No abstract available.
Pregnancy*

No abstract available.

No abstract available.
Animal Experimentation* ; Animals* ; Echocardiography*

Stroke, a sudden development of a focal neurologic deficit, remains as a frequent leading cause of death even in Korea. Five to 13% of strokes occur in patients with younger than 45 years of age; up to 40% of strokes occur in patients without occlusive cerebrovascular disease; and it is estimated that the source is cardiac origin in 15 to 20%. Another 30n to 40% are in the category of stroke of undetermined cause, also known as cryptogenic stroke. An increasing number of echocardiographic findings have been found in this group of cryptogenic stroke patients and in patients with embolic stroke. Cardiac tumors can be a source of emboli, but the most commonly implicated sources are thrombi from the left atrial appeadage or left ventricle, left atrial spontaneous contrast, atrial septal aneurysm associated with a patent foramen ovale (PFO), thrombi traversing a PFO, valve vegetations, protruding aortic atheroma of aortic arch, and emboli associated with mitral and aortic prostheses. Echocardiography is most helpful in defining the cause of cerebrovascular ischemia in patients without occlusive cerebrovascular disease. For complete evaluation of potential source of cardiac embolic sources, transesophageal echocardiography (TEE) is required because many of the entities such as left atrial appendage thrombus can be detected only with this technique.
Aneurysm ; Aorta, Thoracic ; Atrial Appendage ; Cause of Death ; Echocardiography* ; Echocardiography, Transesophageal ; Foramen Ovale, Patent ; Heart Neoplasms ; Heart Ventricles ; Humans ; Ischemia ; Korea ; Neurologic Manifestations ; Plaque, Atherosclerotic ; Prostheses and Implants ; Stroke* ; Thrombosis

PURPOSE: The aim of this study was to evaluate the utility of contrast-enhanced MRI with first-pass and delayed images in prediction of myocardial viability after acute myocardial infarction. MATERIALS AND METHODS: Ten patients (M:F=:4, mean age =6 5 years) with acute myocardial infarction underwent first-pass image after bolus injection of gadolinium (one image/sec for 120sec)and delayed image (7 2 minutes later). According to 60 segments on midventricular level, the assessment of MRI were concerned about location of lesion, depth of lesion, enhancement on first-pass image and enhancement pattern on delayed image. MRI findings were compared with wall motion on resting echocardiography and stress or follow-up echocardiography. RESULTS: 1) MRI findings were classified into 4 types: normal enhancement on first-pass and delayed images (type 1), normal enhancement on first-pass image and nontransmural hyperenhancement on delayed image (type 2), non-transmural enhancing defect on first-pass image and transmural enhancement with endocardial non-enhancing defect on delayed image (type 3), and transmural enhancing defect on first-pass image and transmural hyperenhancement on delayed image (type 4).2) Type 2 suggested viable myocardium and type 3 had high porbability of viability. Type was compatible with non-viable myocardium. CONCLUSION: Enhancing defect on first-pass image and involving thickness on both the first-pass image and delayed image in contrast enhanced MRI may predict myocardial viability.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction* ; Myocardium

No abstract available.
Neurofibromatoses* ; Neurofibromatosis 1* ; Neurofibromin 1 ; Vitiligo*

The cardiomyopathies constitute a group of diseases in which the dominant feature is direct involvement of the heart muscle itself. They are distinctive because they are not the result of pericardial, hypertensive, congenital, valvular, or ischemic diseases. Although the diagnosis of cardiomyopathy requires the exclusion of these etiological factors, the features of cardiomyopathy are often sufficiently distinctive-both clinically and hemodynamically-to allow a definitive diagnosis to be made. With increasing awareness of this condition, along with improvements in diagnostic techniques, cardiomyopathy is being recognized as a significant cause of morbidity and mortality. Whether the result of improved recognition or of other factors, the incidence and prevalence of cardiomyopathy appear to be increasing. A variety of schemes have been proposed for classifying the cardiomyopathies. The most widely recognized classification is that promulgated jointly by the World Health Organization (WHO) and the International Society and Federation of Cardiology (ISFC). In the WHO/ISFC classification, the cardiomyopathies are classified based on their predominant pathophysiological features; other diseases that affect the myocardium that are associated with a specific cardiac disorder or are part of a generalized systemic disorder are termed specific cardiomyopathies. Three basic types of functional impairment have been described: 1) dilated (DCM, formerly called congestive), the most common form, accounting for 60 percent of all cardiomyopathies and characterized by ventricular dilatation, contractile dysfunction, and often symptoms of congestive heart failure; 2) hypertrophic (HCM), recognized by inappropriate left ventricular hypertrophy, often with asymmetrical involvement of the interventricular septum, with preserved or enhanced contractile function until late in the course; and 3) restrictive (RCM), the least common form in western countries, marked by impaired diastolic filling and in some cases with endocardial scarring of the ventricle. Two other forms of cardiomyopathy are recognized: arrhythmogenic right ventricular cardiomyopathy and unclassified; the latter includes fibroelastosis, systolic dysfunction with minimal dilatation, and mitochondrial involvement. The distinction between the three major functional categories is not absolute, and often there is overlap; in particular, patients with HCM also have increased wall stiffness as a consequence of the myocardial hypertrophy and thus present some of the features of an RCM. Late in their course, ventricular dilation and systolic heart failure, bearing some resemblance to DCM, may occur. The aim of this review is to introduce the unusual forms of cardiomyopathy with the current literatures in this field.
Arrhythmogenic Right Ventricular Dysplasia ; Cardiology ; Cardiomyopathies* ; Cicatrix ; Classification ; Diagnosis ; Dilatation ; Heart Failure ; Heart Failure, Systolic ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Incidence ; Mortality ; Myocardium ; Prevalence ; World Health Organization