OBJECTIVE: Although cor pulmonale due to chronic lung disease was not uncommon, there was uncertainty in its diagnosis due to the difficulty in measuring functional and anatomical changes of right heart and pulmonary vascular system. Among various non-invasive diagnostic methods presented so far, no ideal standard diagnostic criterion has been established. The authors attempted to know positive diagnostic ratio of cor pulmonale and to study the presence of the relationship between these diagnostic criteria when electrocardiographic and echocardiographic diagnostic criteria for cor pulmonale were applied to the patients with chronic lung disease. And we investigated the usefulness of echocardiogaphic diagnostic criteria for the diagnosis. METHODS: One electrocardiographic and two echocardiographic diagnostic criteria were applied to 38 patients with chronic lung disease(21 pulmonary emphysema and 17 chronic advanced pulmonary tuberculosis) for the diagnosis of cor pulmonale. Comparison was also made in their relationship. Then pulmonary artery diameter, measurement of pulmonary function test and echocardiographic examination and radio-nuclear right ventricular ejection faction were compared between the groups to ensure each criterion was satisfied. RESULTS: 1) When the three diagnostic criteria for confirming the cor pulmonale, electrocardiographic rriterion(right ventricular hypertrophy), right ventricular dimension criterion(right ventricular end-diastolic dimension>25mm, RVDd>25mm), and right ventricular wall thickness criterion (right ventricular wall thickness>6mm, RVWT>6mm) were applied to the patients, the positive rate were 32%(12/37), 30%(10/33) and 17%(6/36) respectively. A statistically significant correlation between electrocardiographic criterion and right ventricular wall thickness criterion was found to exist. 2) Various parameters of pulmonary function test and echocardiographic examination were compared in the patient groups with and without cor pulmonale when each non-invasive diagnostic criterion was applied to all patients. Followings are the results. (1) In the positive group on electrocardiographic criteria, vital capacity, forced vital capacity, and arterial oxygen tension were significantly smaller than in the negative group on electrocardiographic criterion(p<0.05), and the echocardiographic parameters of right ventricle, ie. end-diastolic area, end-systolic area, end-diastolic dimension, end-systolic dimension, mid-ventricular short axis and maximal short axis in positive group were significantly larger than in the negative group. (2) In the positive group on right ventricular diastolic dimension criterion(RVDd>25mm), percentage forced expiratory volume in 1 second and forced expiratory flow 25-75% were significantly smaller than in the negative group on right ventricular diastolic dimension criterion. (3) In the positive group on right ventricular wall thickness criterion(RVWT>6mm), vital capacity, forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow 25-75% and arterial oxygen tension were significantly smaller than in the negative group on right ventricular wall thickness criterion. CONCLUSION: When several non-invasive diagnostic criteria for cor pulmonale were applied to the patients with chronic lung disease, there were some differences in its positive diagnostic ratio depending on the applied diagnostic criteria. There was also a statistically significant correlation between electrocardiographic criterion and right ventricular wall thickness criterion. When each diagnostic criterion was applied to the patients, significant differences were found in several parameters resulted from pulmonary function test and echocardiographic examination based on presence or nonpresence of cor pulmonale. But no difference in the ejection fraction measured by radio-nuclear method was shown between cor pulmonale group and non cor pulmonale group. Consequently it was suggested that applying echocardiographic criteria in addition to electrocardiographic criterion for the diagnosis of cor pulmonale in the patients with chronic lung disease is clinically useful.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography* ; Electrocardiography ; Forced Expiratory Volume ; Heart ; Heart Ventricles ; Humans ; Lung ; Lung Diseases ; Oxygen ; Pulmonary Artery ; Pulmonary Emphysema ; Pulmonary Heart Disease* ; Respiratory Function Tests ; Uncertainty ; Vital Capacity

BACKGROUND: Hypercholesterolemia is an important risk factor for cardiovascular disease, particulary ischemic heart disease, and it impairs endothelium-dependent vasodilation. Cholesterol-lowering therapy can improve cardiovascular morbidity and mortality in patients with atherosclerosis. Although the mechanism responsible are undear, it has been proposed that enhanced endothelial function might contribute to the improvement in clinical status. The purpose of this study was to examine brachial artery flow-mediated vasodilation(FMD) in patients with hypercholesterolemia and to determine if reduction of serum cholesterol with simvastatin, an inhibitor of HMG-CoA reductase, is associated with an improvement of endothelium-dependent vasodilation. METHODS: Twenty one patients with hypercholesterolemia(mean+/-SD: age 59+/-7 yr) were studied. Endothelium-dependent, flow-mediated vasodilation and endothelium-independent nitroglycerin-mediated vasodilation(NMD) were assessed in the brachial artery using high resolution ultrasound 1) at baseline 2) during 12 weeks of simvastatin(10mg) therapy, and 3) after withdrawal of simvastatin for 4 weeks. RESULTS: Simvastatin significantly decreased total cholesterol from 284+/-31 to 200+/-45mg/ dL, LDL-cholesterol from 178+/-39 to 115+/-44mg/dL, and triglyceride from 263+/-158 to 183+/-102mg/dL in 4 weeks after the drug administration(p=0.0005). At 12 weeks, total cholesterol, LDL-cholesterol and triglyceride fell to 201+/-36mg/dL, 104+/-46mg/dL and 219+/-215mg/dL. Flow mediated vasodilation rose from 6.1+/-4.1% at baseline to 9,7+/-6.4%(p<0.05), 11+/-4.3% and 12+/-3.5%(p=0.002) after 4, 8, 12 weeks therapy. But, after 4 weeks of simvastatin discontinuation(16 week), total cholesterol, LDL-cholesterol rose to 249+/-37mg/ dL, 115+/-44mg/dL(p=0.0002) and FMD fell to 4+/-5.7%(p(0.0002). CONCLUSION: These findings suggest that cholesterol-lowering therapy with simvastatin leads to an improvement of FMD in the brachial artery of patients with hypercholesterolemia.
Atherosclerosis ; Brachial Artery ; Cardiovascular Diseases ; Cholesterol* ; Endothelium ; Humans ; Hypercholesterolemia* ; Mortality ; Myocardial Ischemia ; Oxidoreductases ; Risk Factors ; Simvastatin ; Triglycerides ; Ultrasonography ; Vasodilation*

BACKGROUND: Early prediction of functional recovery could have very important prognostic and therapeutic implication. Modalities evaluating functional recovery of dysynergic segments have included metabolic and perfusion imaging as well as assessment of contractile reserve in response to inotropic agent. Dobutamine stress echocardiography(DSE) assesses contractile reserve whereas rest and 24hr delayed Tl-201 SPECT(T1-201) assesses cell membrane integrity. Does contractile reserve always imply cell membrane integrity? If not, which one could be more useful predictor of contractile recovery of the infarcted segment after restoration of the infarct related artery(IRA) in acute myocardial infarction(AMI)? The aim of this study was to evaluate comparative accuracy of contractile reserve and cell membrane integrity in predicting contractile recovery and their relation. METHODS: We prospectively compared DSE with Tl-201 in 22 of 34 patients with acute myocardial infarction from August 1996 to September 1997. AU patients underwent coronary angiography and got revascularization treatment if they had significant stenosis. DSE and Tl-201 were done within 24hrs after successful restoration without flow limiting residual stenosis. An intravenous infusion of dobutamine(5(mg/kg/min) was started with an infusion pump and continued in 3-minute dose increment up to 20(mg/kg/min under continuous ECG and echocardiographic monitoring. Regional wall motion was assessed according to 16-segment model from American Society of Echocardiography recommendation. Wall motion was scored as 1 (normal), 2(mild to moderate hypokinesia), 3(severe hypokinesia), 4(akinesia), 5(dyskinesia). The improvement of wall motion score(WMS) more than 1 from asynergy during dobutmine infusion was considered to have contractile reserve. SPECT images were obtained at rest and 24hours later. The Tl-201 images were analyzed visually according to 16 segment model, scored by grade 0: normal uptake, 1: mild to moderate decreased, 2: severe decreased, 3: defect. Those segments were considered to have a cellular integrity if the defect at rest improved more than grade 1 on delayed images. All patients underwent 1 month follow up echocardiography after discharge. The improvement of WMS more than score 1 from asynergy at follow up was considered to have contractile recovery. RESULTS: 71 akinetic segments out of total of 352 segments were analyzed. There was no significant difference of sensitivity(88 vs 82%), specificity(82 vs 82%), and accuracy(86 vs 81%) in predicting contractile recovery between DSE and Tl-201. The agreement between contractile reserve and cellular integrity was 73% with kappa value of 0.42(p=0.001). CONCLUSION: Contractile reserve has similar sensitivity, specificity and predictive value with cell membrane integrity in predicting contractile recovery. However contractile reserve immediately after restoration does not necessarily imply cell membrane integrity in acute myocardial inFarction.
Cell Membrane* ; Constriction, Pathologic ; Coronary Angiography ; Dobutamine ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Infusion Pumps ; Infusions, Intravenous ; Myocardial Infarction* ; Perfusion Imaging ; Prospective Studies ; Reperfusion* ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Because of its protean clinical manifestations, diagnosis of acute myocarditis is quite limited unless proved by endomyocardial biospy. However endomyocardial biopsy is not always applicable in these patients. Neither there have been clear clinical criteria for diagnosis nor studies in regard to prognostic factors are available. We retrospectively evaluated clinical features and prognosis of patients with biopsy proven and/or clinically suspected acute myocarditis according to the status of the left ventricular systolic function. METHOD: Thirty six patients of acute myocarditis were enrolled. Eighteen patients were diagnosed by endomyocardial biopsy. We selected clinical diagnostic criteria for this disorder based on the clinicalpaboratory, echocardiographic and ECG findings obtained from this biopsy-proven acute myocarditis. Another 18 patients were selected matching these diagnostic criteria. We divided these thirty-six patients into two groups depending on the left ventricular systolic function : Group 1, EF(3)40(n=20); Group 2, EF<40(n=16). We compared clinical features and prognosis between the two groups. RESULTS: 1) The mean age of Group 1 was 39.7+/-13.6 years(male 12). The mean age of Group 2 was 34.0+/-14.7 years(male 11). Diastolic blood pressure at admission was significantly lower in Group 2 than in Group 1(82+/-10mmHg vs 67+/-15mmHg, p<0.05). 2) In transmitral Doppler findings, Group 1 had 4 patients(25%) with restrictive physiology while Group 2 had 12 patients(75%)(p<0.05). Global LV hypokinesia was more frequent in Group 2 than in Group 1(11/16(69%) vs 3/11(27%), p<(0.05). 3) During the follow up, there was no death in Group 1. But there were 5 deaths in Group 2. Three-year survival rate of Group 1 was better than that of Group 2(100% vs 75%, p<(0.05). In the eleven surviving patients in Group 2, seven patients(64%) showed recovery of the left ventricular systolic function. CONCLUSION: In acute myocarditis, patients who presented with depressed systolic function showed lower diastolic blood pressure at admission, more frequent occurrence of restrictive physiology, more global hypokinesia rather than regional asynergy, and poorer prognosis.
Biopsy ; Blood Pressure ; Diagnosis ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Hypokinesia ; Myocarditis* ; Physiology ; Prognosis* ; Retrospective Studies ; Survival Rate ; Ventricular Function, Left*

BACKGROUND: The known etiologies of atrial fibrillation(AF) were valvular heart disease, coronary artery disease, hypertension(left ventricular hypertrophy), hypertrophic cardiomyopathy, dilated cardiomyopathy, and congenital heart disease and so on. Mitral stenosis, mitral regurgitation, and tricuspid regurgitation account for more than 2/3 of AF related to valvular heart disease. We evaluated the effect of mitral stenosis and mitral regurgitation on development of AF respectively, and the relation between mitral valve disease and that. METHOD: The medical records of patients who was performed transthoracic echocardiography at Dongsan medical center between January 1997 and July 1998 were reviewed retrospectively. Among them, we analyzed the 222 patients who had isolated mitral valve disease without any other cardiac disease. We divided them to 4 group according to left atrial size (group 1: <4.0cm, group 2: >4.0cm and (5.0cm, group 3: (3) 5.0cm and <6.0cm, group 4: (3)6.0cm), then evaluated the effects of disease entity. RESULTS: 1) 94 out of 222(42.3%) patients had atrial fibrillation. The mean age was 51.8+/-15.1 years old. The number of men was 55. 2) The mean left atrial size in the group of AF and sinus rhythm were 5.14+/-0.93cm and 4. 44+/-0.66cm respectively. The mean age in the groups were 57.0+/-11.9 and 48.1+/-16.1 respecitvely. The differences between them were statistically significant(p<0.05). 3) The prevalences of AF in each groups were 12.5%(group 1), 35.6%(group 2), 60.8%(group 3), 86.7%(group 4). More increased the left atrial size, the prevalance of AF was increased significantly(p<0.05). 4) The prevalence of AF was not related to the severity of mitral regurgitation. However, the relation between the severity of mitral stenosis and the prevalence of AF was statistically significally(p<0.01). 5) Increasing the age, the prevalence of AF was increased significantly(p<0.01). 6) The effect of mitral stenosis and regurgitation on the development of AF did not differ significantly in group 1, 2, 3. But in group 4, the AF was present in 100% of patients who had mitral stenosis and 60% of mitral regurgitation. The difference was significant. CONCLUSION: In patients with mitral valve disease, the development of AF was related to age and the size of left atrium. The relation between the severity of mitral regurgiation and the development of AF was not evident, but in mitral stenosis, the relation was significant. If the size of left atrium is similar, the effect of mitral stenosis and regurgitation itself seem to be not related to the development of atrial fibrillation.
Atrial Fibrillation* ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Coronary Artery Disease ; Echocardiography ; Heart Atria ; Heart Defects, Congenital ; Heart Diseases ; Heart Valve Diseases ; Humans ; Male ; Medical Records ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Prevalence ; Retrospective Studies ; Tricuspid Valve Insufficiency

BACKGROUND: With the advance of the techniques of echocardiography and cardiovascular surgery, early detection and successful cardiovascular surgery of congenital heart disease is possible in infant as well as in child. And with the advance of the social insurance, the new case of adult congenital heart disease with mild cardiovascular symptom or frank symptom of the pulmonary hypertension is decreasing. We statistically analyze the new case of adult congenital heart disease. METHOD: 92 patients who were diagnosed to congenital heart disease by echocardiography from January 1993 to June 1998 were studied. 2.25 MHz probe for two-dimensional and Doppler echocardiography and biplane 5 MHz phased-array probe for transesophageal echocardiography(Ultramark-9) were used. RESULT: Among 92 patients, 45 patients(48.9%) were male and 47 patients(51.1%) were female and 6 patients(male : 2, female : 4) had multiple congenital heart disease. 61 patients(66.3%) had no definitive cardiovascular symptom and right bundle branch block was most common electrocardiographic abnormality. 32 cases(32.8%) were atrial septal defect, 21 cases(21.5%) ventricular septal defect, 12 cases(12.3%) patent ductus arteriosus, 8 cases(8.2%) congenial bicuspid aortic valve and so on. Female predominance was noted in ventricular septal defect and endocardial septal defect, while male predominance in bicuspid aortic valve and discrete subaortic stenosis. Atrial septal defect and patent ductus arteriosus were no sex difference. 23 cases(25.0%) were between 20 29, 17 cases(18.5%) between 15-19, and 2 cases(2.2%) over 70 years old. CONCLUSION: Our analysis shows similarity to previous report. With advance of the technique of echocardiography and cardiovascular surgery, a few new case of adult congenital heart disease can be diagnosed hereafter.
Adult* ; Aged ; Aortic Valve ; Bicuspid ; Bundle-Branch Block ; Child ; Discrete Subaortic Stenosis ; Ductus Arteriosus, Patent ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Female ; Heart Defects, Congenital* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Hypertension, Pulmonary ; Infant ; Male ; Sex Characteristics ; Social Security

BACKGROUND: Abnormalities of the left ventricular diastolic function can be classified by pulsed Doppler echocardiography, but sometimes it may be difficult to differentiate normal diastolic function from pseudonormalization. Heart failure caused by increased left ventricular filling pressure is rather associated with pseudonormalization or restrictive pattern than normal pattem or relaxation abnormality. We investigated the usefulness of color M-mode Doppler echocardiographic indexes in differentiating normal relaxation from pseudonormalization after acute myocardial infarction. METHOD: Echocardiographic examination including color M-mode Doppler was performed in 44 patients with acute myocardial infarction between 10 and 14 days after attack. 34 patients without in-hospital congestive heart failure(CHF) were assigned as group I, and 10 patients with in-hospital CHF as group II. Flow propagation slope(FPS), time difference(TD) between the occurrence of peak flow velocity in the apical region and at the mitral tip, and normalized time difference(nTD) by mitral and apical distance were measured with color M-mode Doppler echocardiography. RESULTS: FPS was lower in group II(group I, 42.0+/-20.6cm/sec vs group II, 27.8+/-8.0cm/ sec , p=0.065). Both groups had similar TD and nTD. FPS was compared in patients with E/ A ratio of mitral inflow greater than 1(22 patients of group I and 7 patients of group II). Patients with E/A) 1 in group II had significantly lower FPS(group I, 52.1+/-17.5cm/sec vs group II, 31.0+/-7.4cm/sec ; p(0.01). CONCLUSION: FPS was significantly decreased after acute myocardial infarction in patients with in-hospital CHF compared with patients without in-hospital CHF, even when E/A ratio of mitral inflow was greater than 1. Therefore, FPS was an useful index in differentiating normal relaxation from pseudonormalization.
Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Humans ; Myocardial Infarction* ; Relaxation

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

No abstract available.
Aged* ; Ebstein Anomaly* ; Female* ; Humans

No abstract available.
Diagnosis* ; Echocardiography*