OBJECTIVES:Left ventricular hypertrophy(LVH) increases the risk of sudden death in hypertensive patients and this is known due to ventricular arrhythmias. Thus, author studied the relationship between LVH as a hypertensive target organ damage and ventricular arrhythmias. METHODS: 24-hour ambulatory electrocardiographic monitoring, measurement of microalbumin in 24-hour urine and fundoscopic examination were performed on 100 hypertensives (50 patients without LVH and 50 patients with LVH on EKG) who admitted Pusan National University Hospital. RESULTS: In patients with LVH, ventricular extrasystoles occurred more frequently than without LVH(p<0.05) and ventricular couplet and ventricular tachycardia were more common but statistically not different. Microalbuminuria and hypertensive retinopathy were more severe in patients with LVH than without LVH(p<0.05 and p<0.01, respectively). CONCLUSION: Of the ventricular arrhythmias, ventricular extrasystole but not ventricular couplet and ventricular tachycardia occurred more frequently in patients with LVH than without LVH. Thus, prospective study with long-term follow up should be done to establish the relationship between hypertensive LVH and cardiovascular mortality, especially sudden death. And, further study should be done to make the relationship between reduction in LVH with antihypertensive therapy and reduction in LVH-associated ventricular arrhythmias.
Arrhythmias, Cardiac* ; Busan ; Death, Sudden ; Electrocardiography, Ambulatory ; Humans ; Hypertensive Retinopathy ; Hypertrophy, Left Ventricular* ; Mortality ; Tachycardia, Ventricular ; Ventricular Premature Complexes

BACKGROUND: Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. MATERIALS AND METHODS: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was 63.2+/-10 years (30~85 years). RESULTS: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2~167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. CONCLUSION: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.
Aortic Valve ; Aortic Valve Stenosis ; Echocardiography ; Female ; Follow-Up Studies ; Heart Ventricles ; Hospital Mortality ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Retrospective Studies ; Risk Factors ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) is associated with an increased risk of cardiovascular morbidity and mortality. Electrocardiography (ECG) is a widely available, simple and cost-effective screening method for the diagnosis of left ventricular hypertrophy. Since all the ECG criteria for LVH used for Koreans are based on ECG data from Caucasians, i.e., people whose body size is generally bigger than Koreans, its test accuracy may be low. The purpose of this study was to investigate by ECG the best cut-off value for LVH in terms of the left ventricular mass, as determined by echocardiogram. SUBJECTS AND METHODS: We investigated ECG and echocardiograms of 200 consecutive patients who visited the Korean University Anam Hospital. The sensitivity, specificity and diagnostic accuracy of the left ventricular mass for LVH, by the Sokolow-Lyon voltage criteria and Romhilt-Estes point score, were calculated and compared according to the cut-off values of 35, 40 and 45 mm and 3, 4 and 5 points, respectively. RESULTS: The sensitivities of the Sokolow-Lyon voltage criteria at 40 mm were slightly decreased (42.5, 37.5 and 8.8%; > or =35, > or =40, > or =45 mm), but the specificities and diagnostic accuracies were increased (specificities of 84.2, 95.0 and 99.2%, and diagnostic accuracies of 67.5, 72.0 and 63%; > or =35, > or =40, > or =45 mm). The sensitivities of a Romhilt-Estes point score of 4 points were slightly decreased (43.8, 37.5 and 13.8%; > or =3, > or =4, > or =5 points), but the specificities and diagnostic accuracies were increased (specificities 85.8, 94.2 and 98/3%, and diagnostic accuracies 69.0, 71.5 and 64.5%; > or =3, > or =4, > or =5 points). CONCLUSION: The Sokolow-Lyon voltage criteria at 40 mm or more and a Romhilt-Estes point score 4 points or more are appropriate ECG criteria for LVH in Koreans.
Body Size ; Diagnosis* ; Echocardiography* ; Electrocardiography* ; Humans ; Hypertrophy, Left Ventricular* ; Mass Screening ; Mortality ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Stiffening of the aorta is a potential risk factor for increased cardiovascular morbidity and mortality. Increased aortic stiffness can be associated with an increased left ventricular (LV) mass and diastolic dysfunction. The aim of the study was to evaluate the relationship of the aortic stiffness to the LV hypertrophy (LVH) and diastolic dysfunction. SUBJECTS AND METHODS: A total of 188 consecutive patients, without overt cardiovascular disease or symptoms, were included. The LV mass and diastolic filling patterns were assessed. The aortic strain and distensibility were indirectly obtained from the aortic diameters, using echocardiography and blood pressure measurements. RESULTS: Of the 188 patients (92 males, 54+/-14 years old), hypertension was found in 57 and diabetes in 29, with both found in 32 patients. The aortic strain (3.77+/-2.42 vs. 5.13+/-4.27, p<0.001) and distensibility (0.11+/-0.09 vs. 0.22+/-0.21, p<0.001) were significantly lower, but the LV mass index (112.5+/-39.2 vs. 87.8+/-19.0 gm/m2, p<0.001) higher, in the hypertensive compared to normotensive patients. Also, the aortic strain (3.07+/-2.42 vs. 5.18+/-4.01, p<0.001) and distensibility (0.10+/-0.12 vs. 0.21+/-0.20, p<0.001) were lower in patients with LVH. The E/E' ratio was higher in the hypertensive patients (10.9+/-5.0 vs. 8.1+/-3.1, p<0.001) and in those with LVH (10.8+/-5.6 vs. 8.4+/-3.2, p<0.001). In a multivariate analysis, the parameters closely related with aortic strain were age (standardized coefficient beta=-0.240, p=0.001), LV mass index (beta=-0.158, p=0.025) and IVRT (beta=-0.155, p=0.035). The parameters significantly related with aortic distensibility were age (beta=-0.344, p<0.001) and LV mass index (beta=-0.224, p=0.001). CONCLUSION: Increased aortic stiffness is associated with an increased LV mass and diastolic abnormality.
Aorta ; Blood Pressure ; Cardiovascular Diseases ; Echocardiography ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Multivariate Analysis ; Risk Factors ; Vascular Stiffness*

BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplantion recipients. Enhanced cardiac load by the persistence of functioning AVF in posttransplant period is associated with LV hypertrophy and may adversely influence cardiac outcome. METHODS: To investigate the impact of AVF on LV mass and function in kidney transplant recipients, 46 patients with functioning AVF were randomly assigned to surgical closure of AVF (fistular closing group, FC, n=23) or maintenance of fistula (fistular maintenance group, FM, n=23). Serum creatinine of all participants was stable(1.4+/-0.3). Mean age was 46+/-11. Mean posttransplant month was 78+/-53 (12-161). Echocardiography and determination of N-terminal pro-BNP, cTnT and CRP were done at 0, 1 and 6 months in group 1 (FC), and at 0 and 6 months in group 2 (FM). RESULTS: Baseline echocardiographic indices of systolic and diastolic LV function such as EF, E/A, E/E' and Tei index were not significantly different between groups. In patients whose AVF was surgically closed, LV mass (247.7+/-76.8 to 235.2+/-66.5, p=0.015) and LV mass index (144.0+/-10.1 to 137.1+/-8.6, p=0.02) significantly reduced at one month after closure, and no further significant change was observed at 6 months. In two groups no significant change in LV systolic and diastolic performance indices were observed. BNP, cTnT and CRP did not differ between groups in baseline value and did not change after closure. CONCLUSION: We conclude that the persistence of functioning AVF in kidney transplantation recipients is associated with LVH, and which can be reduced by closure of fistula. As LVH is one of major determinants of cardiovascular outcome in transplant patients as well as in general population, it would be prudent to close the fistula in patients with stable graft function.
Arteriovenous Fistula* ; Cardiovascular Diseases ; Creatinine ; Echocardiography ; Fistula ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Kidney Transplantation* ; Kidney* ; Mortality ; Transplantation ; Transplants

BACKGROUND: Left Ventricular hypertrophy(LVH) is welll known independent predictors of cardiovascular morbidity and mortality. Recently echocardiography is popular method to measure Left Ventricular Mass(LVM) and detect LVH. The purpose of this study is to determine the mean values of LVM and criteria for LVH in Korean. METHODS: Two hundered and fifty five subjects who participate in the health clinic were selected and studied(among them, 47 subjects were excluded according to exclusion criteria). History, physical examination, routine laboratories, and echocardiography were performed ot all of the subjects. RESULTS: The mean values of LVM, LVM corrected for body surface area(BSA), and LVM corrected for height are respectively : 199g, 114g/m2, and 119g/m in 119 Korean men, and 168g, 107g/m2, and 108g/m in 89 women, by echocardiography in accordance with the American Society of Echocardiography(ASE) convention. The criteria for LVH, based on mean plus two standard deviation for LVM, LVM/BSA, and LVM/height are, respectively : 301g, 168g/m2, and 181g/m in men, and 262g, 165g/m2, and 168g/m in women. CONCLUSIONS: The prevalence of LV hypertrophy in the evtire study group using LV mass/surface criteria and LV mass/height are respectively 7.6% in men and 10.9% in women and 6.9% in men and 10% in women. There are little difference of the prevalance rate of LV Hypertrophy by whichever criteria were used, either based on LVM/body surface or LVM/height while still correcting for body size.
Body Size ; Echocardiography ; Female ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Methods ; Mortality ; Physical Examination ; Prevalence ; Reference Values

BACKGROUND AND OBJECTIVES: Cardiovascular morbidities and mortalities due to persistent hypertension, left ventricular (LV) dysfunction and increased LV mass have been reported in adolescents and adults with successful coarctoplasty. We evaluated progressive properties by measuring resting blood pressures (BP), LV functions and the masses in young children with successful coarctoplasty in infancy. SUBJECTS AND METHODS: BP in the right arm and the left ankle, LV function and mass, by the use of M-mode and pulsed wave Doppler ultrasound, were measured in 25 patients, with a mean age of 6.4+/-3 years; and a mean age at the time of repair of 0.22+/-0.24 years, and in 22 control subjects, with a mean age of 5.8+/-2.4 years. All subjects were divided into two groups based on age (more than 5 years of age and less than 5 years of age) and were analyzed independently. RESULTS: BP in the right arm and left ankle, LV function and mass showed no consistent differences between the two groups. However, as age increased, there was a tendency of wide pulse pressure (PP) in the right arm of patients contrary to that in the control subjects. The relative increase in the PP was mainly due to a relative decrease in the diastolic BP. There was a significant increase in the LV mass index of patients with increasing age (p<0.01). The LV mass index showed significant positive correlations with the systolic BP (p<0.05) and the pulse pressure (p<0.05) of the right arm of the patients. CONCLUSION: We recommend careful long-term follow-up through out adulthood to reduce morbidity and mortality, even for children who received successful coarctoplasty in early infancy.
Adolescent ; Adult ; Ankle ; Aortic Coarctation ; Arm ; Blood Pressure ; Child* ; Follow-Up Studies ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Mortality ; Ultrasonography ; Ventricular Function ; Ventricular Function, Left*

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

The left ventricular hypertrophy(LVH) in the hypertensive patients is known to be associated with relatively higher risk for cardiovascular morbidity and mortality. In this sense the reversal of LVH with blood pressure control, if attained, could yeild an additional benefit of reducing cardiovascular morbidity and/or mortaility associated with hypertension. However pathogenesis of LVH, the attitude of the LVH to regerss with blood pressure control in a particular patient and whether the regression is really beneficial are not clear. In order to see the effect of angiotensin converting enzyme(ACE) inhibitors on LVH and the age group difference of the LVH regresion, if attainable, 26 hypertensive patients with LVH(LVMI:Left Ventricular Mass Index>125g/m2) were treated with enalapril or captopril for more than 12 weeks and the LVMI followed and the regression rates in younger group "A"(less than 50 years of age) and elder group "B" were compared(LVMI, level of blood pressure, kinds and dosage of enalapril or captopril were not different between the two groups). The LVMI was significantly decreased in both groups, in group A from 191.6+/-74.9g/m2 to 139.7+/-52.0g/m2, and in group B from 185.5+/-58.7g/m2 to 163.9+/-58.7g/m2. In group A the percent decrease of LVMI was significantly higher than that of group B(25.3+/-14.9% versus 10.3+/-8.6%, p<0.005). Above results suggest that enalapril and captopril are equally effective in reducing LVMI in hypertensive patients with LVH and the regression of the LVMI is more marked in the younger age group in this relatively short-term treated small population study.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins* ; Blood Pressure* ; Captopril ; Enalapril ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Mortality ; Peptidyl-Dipeptidase A*

BACKGROUND: Left ventricular hypertrophy is common in chronic renal failure patients and may contribute increased risk of cardiovascular morbidity and mortality. We evaluated the left ventricular morphology and function in renal transplant recipients to find the relationship between hemodynamic changes and morphologic and functional improvement after transplantation. METHODS: Serial echocardiographic evaluations were performed in 27 adults(20 men and 7 women) at the time of transplantaion and posttransplantation 1 month and 4 months. The average duration of hemodialysis was 16+/-24 months(mean+/-S.D.). RESULTS: At the time of transplantation, the hematocrit level was 21+/-6% and posttransplantation 1 month and 4 months, that was increased to 39+/-5% and 42+/-7%, respectively(p<0.001). Left ventricular mass index by echocardiography was decreased significantly from 246+/-87g/m2(pre-KT) to 169+/-38g/m2(post-KT 1 month) and 153+/-40g/m2(post-KT 4 months), respectively (p<0.001). Interventricular septal thickness and left ventricular posterior wall thickness were decreased significantly after 4 months of transplantation. Left ventricular systolic and diastolic dimensions were also decreased significantly after 1 month and 4 months of transplantation. Left ventricular volumes and cardiac output were also decreased significantly. But A/E ratio, ejection fraction and fractional shortening did not change significantly. CONCLUSION: These findings showed that pretransplant high output state was resolved radipidly(within 1 month) but the diastolic function did not improved after transplantation 1 month and 4 months.
Cardiac Output ; Echocardiography* ; Hematocrit ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Renal Dialysis ; Transplantation*