BACKGROUND: Left ventricular diastolic dysfunction is often observed in hypertensive patients with normal left ventricular systolic function and can cause heart failure symptoms. Doppler echocardiography has become a standard tool for examining left ventricular diastolic function. This study was performed to evaluate the left ventricular diastolic function in hypertensive patients with normal left ventricular systolic function and to determine the changes in left ventricular diastolic function after antihypertensive treatment. METHODS: Mitral inflow and pulmonary venous Row velocities were evaluated by transthoracic pulsed-wave Doppler study in patients with hypertension before antihypertensive treatment(n= 50) and after antihypertensive treatment for 4 months(n=24). The patients were randomly assigned to group I to receive ACE inhibitor or group II to receive other antihypertensive drugs. RESULTS: Before antihypertensive treatment, mitral inflow E/A ratio was 0.94+/-0.27, decele- ration time was 222+/-47 msec, and pulmonary venous flow S/D ratio was 1.62+/-0.42. Follow- up Doppler study was completed in 24 patients after 4 months of antihypertensive treatment. Mitral inflow E/A ratio was significantly increased(0.96+/-0.24 vs. 1.16+/-0.25, p<0.001), but deceleration time showed no significant changes. Pulmonary venous flow S/D ratio was signi- ficantly decreased(1.75+/-0.27 vs. 1.50+/-0.24, p<0.001). There was no significant difference in changes in mitral inflow E/A ratio, deceleration time and pulmonary venous flow S/D ratio between ACE inhibitor group and other antihypertensive group. CONCLUSION: There was some improvement in left ventricular diastolic function in patients with hypertension after 4 months of antihypertensive treatrnent. But, there was no significant difference in changes in diastolic parameters between ACE inhibitor group and other antihy- pertensive group.
Antihypertensive Agents ; Deceleration ; Echocardiography, Doppler ; Heart Failure ; Humans ; Hypertension*

OBJECTIVES: Evaluation of left ventricular function and wall motion analysis is essential in patients with heart disease, especially ischemic heart disease. However, it is frequently limited by many factors ', obesity, chronic obstructive lung disease, etc. We conducted our study to know the feasibility of PMI technique, recently developed method to overcome these lirnitation. METHODS: We recorded echocardiography of consecutively admitted patients by ATL HDI 3000 and conducted LV wall motion analysis according to standardization of ASE and then recorded echocardiography again by PMI technique in 44 patients in which more than on left ventricular segments were poorly visualized. We compared the resolution of echocardiography of PMI technique with traditional echocardiography. We categorized the segments semiquantitatively ; grade A in which endocardium is clearly visualized, grade C in which endocardium is not discernible, grade B in which endocardium is suboptimally visualized. RESULTS: 1) 44 patients(30 males and 14 females) were studied and their rnean age was 63.4+/-10.5 years old. 2) 20 patients had myocardial infarction and 12 patients angina, 6 patients heart failure, 4 patients arrhythmia, and 2 patients other diseases. 3) Among total 704 segments, 462 segments(65.6%) were categorized as grade A, 203 segments(28.8%) as grade B, 39 segments(5.6%) as grade C. In 19 patients, more than one segments were categorized as grade C. In 6 patients, rnore than 3 segments were categorized as grade C. 4) With PMI technique, 557 segrnents(79.1%) were categorized as grade A, 126 segments (17.9%) as grade B, 21 segments(2.9%) as grade C with upgrade from grade C to A in 124 segments(17.6%) and grade C to B or B to A in 17 segments(2.4%). CONCLUSION: Echocardiography by PMI technique is feasible in left ventricular wall motion analysis in patients with poor echocardiographic windows.
Arrhythmias, Cardiac ; Echocardiography ; Endocardium ; Heart Diseases ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Obesity ; Pulmonary Disease, Chronic Obstructive ; Ventricular Function, Left

BACKGROUND: An unusual form of hypertrophic cardiomyopathy localized to the left ventricular apex has racial differences in phenotypic expression between many Japanese reports and most reports from outside Japan. In Japanese patients follow up study of apical hyertrophy has shown benign clinical course without demonstrable genetic transmission, but other ethnic patients with this variant was clinically different from Japanese patients. The purpose of this study was to evaluate the clinical course and the progression of hypertrophy of apical hyper- trophic cardiomyopathy by echocardiography and to define the relationship between the severity of apical hypertrophic cardiomyopathy and the clinical course. METHODS: Between June 1990 and August 1996, 35 out of 53 patients with apical hypertrophic cardiomyopathy diagnosed by echocardiography were studied. In 26 out of 35 patients, two- dimensional echocardiography and EKG were obtained at initial visit and follow up. We analyzed the sum of S wave in lead Vl and R wave in lead VS(mm) and T wave negativity in lead V4 on EKG. Measured echocardiographic parameters were apical thickness and apical cross-sectional area of left ventricle at end-diastole in apical tour chamber view, anteroposterior left atrial dirnension at end systole in parasternal short axis view and pulsed-wave Doppler pattern of transmitral inflow. RESULTS: 1) Mean age at presentation was 57.9+8.3 years(range 37 to 72). Mean follow up duration of echocardiography and EKG were 29.5+/-13.5 months and 27.7+ -1.4 months, respectively. 2) Eleven(31%) out of 35 patients were asymptomatic at initial presentation. In the remaining 24 patients, major symptoms included atypical chest pain(n=7), angina (n=11), dyspnea(n=12), palpitation(n=4) and fatigue(n=l), During follow-up, symptoms aggravated in 5/35(14%), no change in 22/35(63%) and allenated in 8/35(23%). The clinical event during follow up was transient ischemic attack in 1 patient, syncope in 1 patient and death in 1 patient with cerebral infarction and upper gastrointestinal bleeding. 3) Electrocardiography revealed normal sinus rhphm in 24 patients and atrial fibrillation in 2 patients at initial presentation. Paroxysmal atrial fibrillation was observed in 1 patient during follow up period at 24 hours Holter monitoring. Negative T wave amplitude was increased from 11.5+/-5.5 to 13.1+/-6.5mm(p<0.05), however the sum of SV, and RV, did not change significantly. 4) The apical thickness and apical cross-sectional area changed over time, frorn 19.9+/- 3.2 to 21.8+/-4.lmm(p<0.005) with interobservers difference of 2.3+/-1.2mm and from 11.4+/-2.4 to 12.5+/-3.1cm(p<0.05) with interobservers difference of 1.9+/-1.5cm, respectively. Left atrial dimension increased from 43.5+/-6.6 to 46.2+/-6.1mm(p<0.005). Transmitral inflow revealed norrnal E/A ratio and deceleration time of 150~ 40msec in 11 patients with changed to relaxation abnormalities in three and pseudonormalization in ovo and relaxation abnormalities in 14 patients with changed to pseudonormalization in three at follow-up. CONCLUSIONS: Patients with apical hypertrophic cardiomyopathy have relatively favorable prognosis during follow up period without any significant clinical event and symptomatic deterioration. T wave negativity on EKG and left atrial dimension on echocardiographic examination were increased during follow up, but these parameters were not associated with clinical presentation.
Asian Continental Ancestry Group ; Atrial Fibrillation ; Axis, Cervical Vertebra ; Cardiomyopathies ; Cardiomyopathy, Hypertrophic* ; Cerebral Infarction ; Deceleration ; Echocardiography* ; Electrocardiography ; Electrocardiography, Ambulatory ; Follow-Up Studies* ; Heart Ventricles ; Hemorrhage ; Humans ; Hypertrophy ; Ischemic Attack, Transient ; Japan ; Prognosis ; Relaxation ; Syncope ; Systole ; Thorax

BACKGROUND: Mortality and morbidity of the patients with chronic renal failure frequently related to cardiovascular disease, especially to Hypertension. The present study was performed to assess the value of arnbulatory blood pressure(ABP) monitoring in determining the adequacy of blood pressure(BP) control, and its relationship to echocardiographic findings in hemodialysis (HD) patients. SUBJECT AND METHODS: Twenty adult patients who had been on regular hemodialysis treatment for median duration of 23 rnonths were studied. 24 hour ABP monitoring was performed using a non-invasive ABP monitor. All of the study population were non diabetic. Casual BP (CBP) was defined as the average of two measurements obtained at two HD sessions, one preceding and the one following the ABP recordings, and was calculated for both the predialysis and postdialysis phases. Cardiac echocardiography was performed in each patient to determine interventricular septal thickness(IVS), left ventricular posterior wall thickness(LVPW), left ventricular fractional shortening(FS), and left ventricular mass index(LVMI). RESULTS: 1) 17(85%) of patients showed left ventricular hypertrophy in echocardiography. LVMI was positively correlated with systolic BP load(r=0.45, p<0.05). But, the correlation between LVMI and diastolic BP load was not statistically significant. 2) IVS shoved positive correlation to 24hr systolic and diastolic blood pressure load, but LVPW did not show correlation to any subset of 24h-ABP monitoring data except daytime sysrolic BP load. 3) LVMI showed correlation to day-time systolic BP load, but it did not show correlation to night-time BP load. 4) Casual BP did not show correlation to echocardiographic data. CONCLUSIONS: These results suggest that 24hr ABP monitoring is more useful and accurate method than CBP to determine the degree of LVH and control of blood pressure in hemo- dialysis patients with hyertension.
Adult ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Cardiovascular Diseases ; Dialysis ; Echocardiography* ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Mortality ; Renal Dialysis*

BACKGROUND: In end stage renal disease, left ventricular hypertrophy developed frequently due to volume and pressure overload and other unclarified precipitating factors which could not be seen in essential hypertension. It is now well established that left ventricular hypertrophy and patterns of left ventricular geometry can influence the prognosis in essential hypertension. The aim of present study was to investigate the characteristics and prognostic significance of left ventricular hypertrophy and geornetrir patterns in hemodialysis patients and to compare them with essential hypertension group. METHOD: One hundred and forty essential hyertensive patients and forty eight hemodialysis patients were enrolled and their left ventricular geometric patterns(normal, roncentric remodeling, concentric hypertrophy, eccentric hypertrophy) were compared. RESULTS: 1) Mean age was higher in essential hypertension group(57.3+/-13.5 years versus 48.8+/-11,2 years) but the left ventricular mass index was higher in hemodialysis group(126.0+/-35.3g/m versus 142.6+/-44.4g/m, p=0.01). 2) Among left ventricular geometric patterns in hemodiaysis patients, only the prevalence of concentric hypertrophy was higher statistically compared with essential hypertensive patients(p= 0.014). 3) In essential hypertension group, age(B=0.18, p=0.016), systolic blood pressure(B=0.40, p<0.01) and total peripheral resistance(B=- 0.45, p<0.01) were correlated with left ventricular mass index. On the other hand, mean blood pressure(B=0.38, p<0.01), heart rate(B=- 0.39, p=0.012) and total peripheral resistance(B= - 0.70, p<0.01) were correlated with left ventricular mass index in hemodialysis group. 4) The hemodynamic characteristics of left ventricular hypertrophy were similar in both groups. Cardiac index was lowest and total peripheral resistance was highest in concentric remodeling. Left ventricular mass index, left ventricular septal and posterior wall thickness were highest in concentric hypertrophy and left ventricular internal dimension was highest in eccentric hypertrophy. 5) Comparing the difference between pre- and post-dialysis, only norrnal pattern slightly showed decreased left ventricular internal dimension in diastole, increased relative wall thickness and increased fractional shortening. CONCLUSION: It is considered that the characterization of geometric patterns of left ventricular hypertrophy and investigation of its precipitating factors in essential hypertensive patients and hemodialysis patients mll be helpful to improve their mortality and morbidity.
Diastole ; Hand ; Heart ; Hemodynamics ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Mortality ; Precipitating Factors ; Prevalence ; Prognosis ; Renal Dialysis* ; Vascular Resistance

BACKGROUND: False tendons(FT), also referred to as pseudotendons or bands, are fibrous strings that pass from two papillary muscles and insert elsewhere except mitral valve leaflets. They can be classified into six types according to sites of attachment to the left ventricular wall and thickness. FT have been generally considered to be common normal structural variants with no clinical significance. But, these may be misinterpreted echocardiographically as left ventricular endocardium of the ventricular septum or mural thrornbus, since the echo from the tendon might mimic these structures. Moreover they have been reported to be a cause of functional ejection murmur. Some investigators have suggested that FT rnight be an etiologic factor in the genesis of ventricular arrhythmias in the autopsy and the clinical studies. METHODS: We evaluated the prevalence of the false tendons in consecutive 263 patients for 2 month period in routine echocardiographic method. In cases with FT, we examined their attachment and thickness accurately by tilting and rotating the echo probe, and classified them. In possible 9 cases, 24 hour ambulatory ECG monitoring was performed and evaluated the existence of ventricular arrhythmias. RESULTS: FT were found in routine echocardiographic views in 15 patients(male 11, female 4) out of 263 patients(prevalence 5.7%). The pye of FT were longitudinal type 7 cases(thin 3 cases, thick 4 cases) most commonly, diagonal type 3 cases(thin 2 cases, thick 1 cases), transverse thin type 4 cases and apical thin type 1 case. In 24 hour ambulatory ECG monitoring, ventricular premature contractions were detected in all 9 patients. Interestingly in one patient(case 5) visited with dyspnea and repetitive long period of palpitation, suggestive ILVT(idiopathic left ventricular tachycardia) and FT(longitudinal thick type) were coexisted. CONCLUSION: FT are common normal variants, but may be confused with other normal structures. Clinically in apparently healthy subjects with symptomatic idiopathic ventricular arrhythmias(ventricular premature contractions, ILVT and so on), the echocardiography would be performed carefully for the existence of FT and could be helpful for the evaluation of etiologies.
Arrhythmias, Cardiac ; Autopsy ; Dyspnea ; Echocardiography* ; Electrocardiography ; Endocardium ; Female ; Humans ; Mitral Valve ; Papillary Muscles ; Prevalence ; Research Personnel ; Systolic Murmurs ; Tendons* ; Ventricular Septum

OBJECTIVES: To evaluate the serial changes in left atrial function we performed electrical cardioversion of chronic nonvalvular atrial fibrillation under the monitoring of transesophageal echocardiography(TEE) and followed the success cases with TEE. METHODS: All patients were anticoagulated from three weeks prior to and till four weeks after cardioversion. After exclusion of thrombi, direct-current cardioversion was done with the probe in situ. Immediately after comersion, TEE repeated. Follow-up TEE was done in cases whose rhythm were sinus over three months. Spontaneous echo rontrast(SEC): appendage emptying velocity, filling velocity, diameter, area, emptying fraction ', pulmonary vein systolic(S) velocity, diastolic(D) velocity, atrial reversal(AR) velocity, systolic time-velocity-integral(S - TVI), diastolic- TVI(D-TVI), S/D ratio, S-TVI/D-TVI ratio, AR duration : transmitral E velocity, A velocity, E- TVI, A- TVI, E/A ratio, A- TVI/E TVI ratio and deceleration time(DT) were measured. RESULTS: The number of patients was thirty-one(18 males) with the mean age of 58 years (range :39-69). Mean duration of AF was 56 months(range : 5-360). Mean follow-up duration was 8 months(range: 3-13). Hypertension(10), dilated cardiomyopathy(8), ischemic heart disease(2) and chronic lung disease(1) were associated. There were no complications, The SEC increased immediately after conversion and decreased at follow-up. The appendage emptpng velocity decreased after conversion and increased at follow-up significantly. The appendage emptpng fraction showed increasing tendency, but that was not statistically significant. The pulmonary vein S/D ratio and S - TVI/D - TVI ratio were increasing gradually after conversion and follow-up. The AR duration increased at follow-up. The transmitral E velocity was gradually decreasing after conversion and at follow-up. The E/A ratio decreased, the E-TVI decreased and the A-TVI/E-TVI ratio increased. The DT increased after conversion, but not changed significantly at follow-up. CONCLUSIONS: The immediate changes after conversion suggested "atrial stunning" or "electromechanical dissociation". The follow-up TEE suggested that left atrial function was recovering with maintenance of sinus rhythm.
Atrial Fibrillation* ; Atrial Function, Left ; Deceleration ; Echocardiography, Transesophageal* ; Electric Countershock* ; Follow-Up Studies ; Heart ; Humans ; Lung ; Pulmonary Veins

BACKGROUND AND OBJECTIVES: Dilated cardiomyopathy(DCMP) probably is the end result of myocardial damage produced by various causes and shows various clinical manifestations. Some patients with DCMP experience more shortness of breath when change their position especially in left lateral decubitus position. We investigated whether the symptomatic changes according to position in DCMP patients were related to the changes of mitral inflow pattern. MATERIALS AND METHOD: DCMP patients with New York Heart Association functional class III or IV, who felt more shortness of breath when changed their position, were studied. The patients with atrial fibrillation or with moderate and severe valvular heart disease were excluded. Early and late atrial left ventricular filling velocities and time velocity integrals(TVI) and it's ratios of mitral inflow, heart rates, isovolumic relaxation time(IVRT), decelaration time(DT) of early mitral inflow were analysed in each decubitus position. RESULTS: 4 men and 3 women were included and their mean age was 60.3 years. 6 patients had mild mitral regurgitation and 4 patients had mild aortic regurgition. All patients felt more shortness of breath in left lateral decubitus position. Peak velocity and TVI of early mitral inflow were not changed significantly according to position. Peak velocity of late mitral inflow was increased significantly with right lateral decubitus position(Lt; 39.0+/- 14.1cm/sec, Rt; 49. 4+/-23.6cm/sec, p<0.05). TVI of late mitral inflow was increased significantly with right lateral decubitus position(Lt; 2.8+/-1.1cm, Rt; 3.8+/-1.9cm, p<0.05). Ratio of early and late mitral inflow peak velocity was decreased significantly with right lateral decubitus position(Lt; 2.13+ 0.34, Rt: 1.62+/-0.57, p<0.05). Ratio of early and late mitral inflow TVI was decreased significantly with right lateral decubitus position(Lt; 3.13+/-1.49, Rt; 2.13+/-1.32, p<0.01). Heart rate, IVRT, DT were not changed significantly according to position. CONCLUSION: In DCMP patients with symptomatic relief in right lateral position, mitral inflow patterns were changed. And this finding suggests that symptomatic relief may be related to decreased left ventricular filling pressure.
Atrial Fibrillation ; Cardiomyopathy, Dilated* ; Deoxycytidine Monophosphate ; Dyspnea ; Female ; Heart ; Heart Rate ; Heart Valve Diseases ; Humans ; Male ; Mitral Valve Insufficiency ; Relaxation

Left ventricular-right atrial communications, known as Gerbode-type defects, are rare intracardiac defects that can be either congenital or acquired. Acquired forms arises from endocarditis, trauma, mitral or aortic valve replacement and myocardial infarction. In this case, a forty-seven year-old man with resting dyspnea and fever was diagnosed to have infected congenital bicuspid aortic valve resulting in severe acute aortic regurgitation and he also was diagnosed to have a Gerbode-type defect which were demonstrated by the color doppler method and realtime three-dimensional echocardiography. The causasive organism was Streptococcus mitis. After sufficient antibiotics therapy, aortic valve replacement was performed and the atrioventricular portion of the membranous septum was closed directly with mattress suture. We also review the anatomical features and hemodynamic consequences of such a defect.
Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Bicuspid ; Dyspnea ; Echocardiography* ; Echocardiography, Three-Dimensional ; Endocarditis* ; Fever ; Hemodynamics ; Myocardial Infarction ; Streptococcus mitis ; Sutures

BACKGROUND AND PURPOSE: Left ventricular hypertrophy (LVH) and increased common carotid artery intimamedia thickness (IMT) are known target organ damages of hypertension. However, the relation between LVH and carotid artery IMT is not well defined in Korea. Thus, the purpose of this study is to evaluate the association of common carotid artery IMT and luminal diameter (LD) with LVH (LV mass) in patients with hypertension. METHOD: LV mass was measured by echocardiography and IMT and LD of right and left common carotid artery were measured by high resolution ultrasound in non-hypertensive subjects (n=24), patients with known hypertension without LVH (n=22) and hypertension with LVH (n=22). Data obtained were adjusted statistically for age. RESULTS: Mean IMT (in mm) were 0.51+/-0.12 in non-hypertension group, 0.61+/-0.09 in hypertension without LVH group and 0.73+/-0.13 in hypertension with LVH group (age adjusted p<0.0001 by ANCOVA). Mean systolic and diastolic IMT/LD ratios were 0.077+/-0.015 and 0.089+/-0.018 in non-hypertensive group, 0.052+/-0.015 and 0.09+/-0.014 in hypertension without LVH group, and 0.085+/-0.015 and 0.104+/-0.022 in hypertension with LVH group (p=0.063 for systolic ratio and 0.137 for diastolic ratio). CONCLUSION: These findings suggest that there is a significant correlation between carotid artery intima-media thickness and LVH in hypertensio.
Carotid Arteries* ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Echocardiography ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Korea ; Phenobarbital ; Ultrasonography