Poor R-Wave Progression(PRWP) of precordial leads is frequently encountered electrocardiographic findings of uncertain significance and has simply been deemed as suggestion of anterior myocardial infarction without concrete ground. 217 cases with poor R-Wave Progression have been analyzed on clinical records and results are as follows. 1) PRWP was most frequently found in fifties and sixities, comprising 63.9% of the subjects. 2) Co-existent disease entities with PRWP were classified into three categories, cardiovascular diseases, chronic lung diseases and normal variants. 3) The cardiovascular diseases related with PRWP were mainly hypertensive diseases, comprising 59.8% of cardiovascular diseases, followed by ischemic heart disease, valvular heart disease and cardiomyopathies. 4) PRWP may be an early sign of acute myocardial infarction in a certain part of cases, which was endorsed by typical clinical symptoms and enzyme studies. 5) As the criterion of PRWP, V3R equal to or less than 3 mm was thought more adequate for higher specificity rather than 4 mm.
Cardiomyopathies ; Cardiovascular Diseases ; Electrocardiography ; Heart Valve Diseases ; Lung Diseases ; Myocardial Infarction ; Myocardial Ischemia ; Sensitivity and Specificity

Pentoxifylline (Trental(R)) is a drug which blocks pathophysiologic process of cerebrovascular disease by inhibiting platelet aggregation, improving cerebral microcirculation preventing development of cerebral edema. In an attempt to evaluate the effect of pentoxifylline for the treatment of 25 patients (male 17 cases, female 8 cases) with cerebrovasculaar disease, we administered pentoxifylline 600mg daily in devided dosage for 1 to 7 months. Most of them were patients with cerebral thrombosis (52%), cerebral embolism (24%), cerebral hemorrhage (12%) and transient ischemic attack (12%). Clinical effects were evaluated at least 1 month later by the criteria using scoring method of serverity of symptoms. In summary, definite effect was found in 15 cases (60%), mild effect in 6 cases (24%) and no efect or aggravation in 4 cases (16%), especially in patients with cerebral hemorrhage. During treatment there was no significant side effect except mild elevation of serum creatinine in one case who was associated with chronic renal failure.
Brain Edema ; Cerebral Hemorrhage ; Creatinine ; Female ; Humans ; Intracranial Embolism ; Intracranial Thrombosis ; Ischemic Attack, Transient ; Kidney Failure, Chronic ; Microcirculation ; Pentoxifylline* ; Platelet Aggregation ; Research Design

No abstract available.
HLA-DR Antigens* ; Thyroid Gland* ; Thyroid Neoplasms*

Seventeen cases of apical hypertrophic cardiomyopthy were reviewed to clarify whether there is any racial difference in phenotypic expression of apical hypertrophic cardiomopathy and to study whether there is any clinical or morphological difference between apical hypertrophic cardiomyopathy of Japanese type (J-APH) and apical hypertrophic cardiomyophthy of non-Japanese type (NJ-APH). The diagnosis was made by cardiac catheterization, left ventriculography and echocardiography. Seventeen patients were divided into 9 (53%) patients with J-APH and 8 (47%) patients with NJ-APH. Mean ages of patients with J-APH and NJ-APH were 55 years and 57 years, respectively. The most common clinical symptoms were chest pain(100%), dyspnea(59%) and palpitation(35%). Mean values of S1+R5 and T wave depth were 58+/-16mm and 16+/-6mm in J-APH and 42+/-11mm and 7+/-3mm in NJ-APH(p<0.05, respectively). Seven patients experienced transient or permanent atrial fibrillation without significant symptoms. Seven patients showed progression or regression of T wave depth greater than 5mm during the period of follow-ups. On echocardiography IVS/LVPW thickness(mm) at the base were 11+/-2/10+/-2 in J-APH and 17+/-7/11+/-2 in NJ-APH, and IVS/LVPW thickness(mm) at the apex were 25+/-7/24+/-5 in J-APH and 26+/-3/26+/-2 in NJ-APH. Three patients with NJ-APH showed asymmetrical septal hypertrophy, cardiac catheterization disclosed elevated left ventricular end diastolic pressure in 11 out of 19 patients. Dye entrapment at the apex during systole was noted in 5 out of 18 patients. In conclusion, our study showed high prevalence rate expression of J-APH in contrast to the Western countries, there may be racial difference in phenotype of apical hypertrophic cardiomyopathy. Considering progression or regression of T-wave depth, NJ-APH may be a forme fruste or regressed form of J-APH.
Asian Continental Ancestry Group ; Atrial Fibrillation ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic ; Classification* ; Diagnosis ; Echocardiography ; Echocardiography, Doppler* ; Follow-Up Studies ; Heart Septal Defects, Ventricular* ; Humans ; Hypertrophy ; Phenotype ; Prevalence ; Systole ; Thorax

BACKGROUND: Since reperfusion early after acute myocardial infarction has been demonstrated to reduce the infarct size and mortality, many drugs and interventions to reduce the reperfusion injury have been tried with limited success. Adenosine, a potent coronary vasodilator, has been reported to counteract a few mechanisms implicated with reperfusion injury, however, its effects and exact mechanisms to reduce the reperfusion injury have not been clearly elucidated. METHODS AND RESULTS: Effects of adenosine upon infarct size reduction and upon postulated mechanisms involved in the reperfusion injury such as no reflow phenomenon and neutrophil infiltration were evaluated in anesthetized open chest dog model where acute myocardial infarction was induced by 90 minute left anterior descending coronary artery occlusion followed by 240 minute reperfusion. Adenosine(3.75 mg/min) was administered intravenously for total 90 minutes from 30 minutes before reperfusion. Compared to control group(n=6), infarct area/risk area ratio was significantly lower in adenosine group(n=6)(34+12% vs. 22+/-11, p=0.04), although risk area/total left ventricular area ratio were similar in both groups. Myocardial blood flows(MBF), measured by radiolabelled microspheres, of the infarcted regions during coronary occlusion were similar in both groups, however, both subepicardial MBF(0.63+/-0.15ml/min/g vs. 0.95+/-0.31, p=0.02) and subendocardial MBF(0.45+/-0.08 ml/min/g vs. 0.69+/-0.27, p=0.02) were higher in daenosine group. Neutrophil infiltration, semiquantitatively measured under light microscope, were less severe in daenosine group,compared to control group. CONCLUSION: Intravenous adenosine administered before coronary reperfusion appears to reduce infarct size by limiting reperfusion injury through improving no reflow phenomenon and preventing neutrophil infiltration to the ischemic myocardium during reperfusion.
Adenosine* ; Animals ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Microspheres ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Myocardium ; Neutrophil Infiltration ; No-Reflow Phenomenon ; Reperfusion Injury* ; Reperfusion* ; Thorax*

To evaluate the usefulness of continuous wave Doppler echocardiography in the quantitative assessment of aortic regurgitation, the aortic regurgitant flow velocity curves taken by continuous wave Doppler echocardiography were analyzed to develop indexes such as the peak velocity(PV), the deceleration slope(SLOPE) and the pressure half time(PHT) in 66 patients with aortic regurgitation. The Doppler indexes were compared with the aortic regurgitation fraction(RF) obtained from gated radionuclide ventriculography in 33 patients without other valvular regurgitation, and were also compared with angiographic grading of aortic regurgitation in 47 patients who under went aortic angiography. The results were as follows : 1) The deceleration slope and the pressure half time were correlated well with the regurgitation fraction measured by gated radionuclide ventriculography (r=0.68, -0.78). 2) The deceleration slope increased significantly with increasing angiographic grading (rade 1+vs.2+ ; 1.89+/-0.61m/sec vs.2.64+/-0.39, P<0.05, Grade 2+ vs.3+ ;2.64+/-0.39 vs. 4.37+/-1.35, P<0.01, but statistical singnificance was not found between Grade 3+ and 4+(4.73+/-1.35vs. 5.00+/-0.39, P<0.05). 3) The pressure half time decreased significantly with increasing angiographic grading (Grade 1+vs.2+ ; 0.61+/-0.16 sec vs. 0.49+/-0.08, p<0.05, Grade 2+ vs.3+ ; 0.49+/-0.08vs. 0.29+/-0.07, p<0.01), but statistical significance was not found between Grade 3+ and 4+ (0.29+/-0.07vs. 0.26+/-0.08, p>0.05), either. 4) The pressure half time was independent of aortic or mitral stenosis associated with aortic regurgitation. 5) The peak velocity had no significant relationshop with the regurgitation fraction by gated radionuclide ventriculography or angiographic grading by aortic angiography. 6) A PHT threshold of 400 msec separated mild (Grade 1+ and 2+)and severe (grade 3+ and 4+) aortic regurgitation with sensitivity of 88%, specificity of 96% and predictive value of 95%. Therefore continuous wave Doppler echocardiographic method of anlyzing aoritc regurgitant flow velocity curve seemed to be useful for the noninvasive assessment of the severity of aortic regurgitation.
Angiography ; Aortic Valve Insufficiency* ; Deceleration ; Echocardiography ; Echocardiography, Doppler* ; Gated Blood-Pool Imaging ; Humans ; Mitral Valve Stenosis ; Sensitivity and Specificity

To validate ventricular diastolic phase parameters of reconstructed transmitral flow rate curve by M-mode, 2-dimensional and pulsed Doppler Echocardiography, these parameters were compared with same parameters by left ventriculography. The study population was 22 patients who received both coronary arteriography and echocardiographic examination. Transmitral flow rate curve and left ventricular filling volume curve were reconstructed from transmitral flow velocity curve by pulsed Doppler, mitral annulus diameter by two diameter by two dimensional and diastolic motion of both mitral leafltes by M-mode echocardiography. From left ventriculography, left ventricular filling volume curve and transmitral flow rate curve were made using area-length method by Sandler and Dodge. From trasmitral flow fraction, 1/2 diastolic time filling fraction, normalized peak filling volume, 1/3 diastolic time filling fraction, 1/2 diastolic time fraction, normalized peak early filling rate and ratio of early to late peak filling rate were measured. Correlation between same parameters derived from echocardiography and left ventriculography were observed. 1) Total diastolic filling volume:correlation coefficient r=0.47, P<0.05. 2) 1/3 diastolic time filling fraction:correlation coefficient r=0.90, P<0.001. 3) 1/2 diastolic time filling fraction:correlation coefficient r=0.80, P<0.001. 4) Normalized peak early filling rate:correlation coefficient r=0.57, P<0.01. 5) Ratio of early to late peak filling rate:correlation coefficient r=0.85, P<0.001. Therefore, left ventricular diastolic phase parameters of reconstructed transmitral flow rate curve using, M-mode, 2-dimensional and pulsed Doppler echocardiography seems to be useful for the noninvasive evaluation of the left ventricular diastolic function.
Angiography ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Humans

Maze operation could alter P wave morphology in electrocardiogram (ECG), which might prevent exact diagnosis of the cardiac rhythm of patients. However, characteristics of P wave in patients with sinus rhythm after the operation have not been elucidated systematically. Consecutive patients who underwent the modified Cox Maze operation from January to December 2007 were enrolled. The standard 12-lead ECG and echocardiography were evaluated in patients who had sinus rhythm at 6 months after the operation. The average axis of P wave was 65+/-30 degrees. The average amplitude of P wave was less than 0.1 mV in all 12-leads, with highest amplitude in V1. The most common morphology of P wave was monophasic with positive polarity (49%), except aVR lead, which was different from those in patients with enlarged left atrium, characterized by large P-terminal force in the lead V1. There were no significant differences in P-wave characteristics and echocardiographic parameters between patients with LA activity (30.6%) versus without LA activity (69.4%) at 6 months after the operation. In conclusion, the morphology of P wave in patients after Maze operation shows loss of typical ECG pattern of P mitrale: P wave morphology is small in amplitude, monophasic and with positive polarity.
Atrial Fibrillation/*physiopathology/*surgery ; Cardiovascular Surgical Procedures/*methods ; Electrocardiography/*methods ; Female ; Heart Conduction System/*physiopathology/*surgery ; *Heart Rate ; Humans ; Male ; Middle Aged ; Treatment Outcome

No abstract available.
Purpura* ; Thrombocytopenia*

OBJECTIVE: We observed the nature of ipsilateral weakness, not hemiplegic side after stroke. And we studied correlation between ipsilateral weakness and neurologic recovery of hemiplegia. METHOD: This study was prospective, follow-up clinical trial. Ipsilateral motor power was checked serially in 20 subjects using Nicholas Manual Muscle Tester (NMMT) (shoulder abduction, wrist extension, hip flexion, ankle dorsiflexion). The subjects are first attacked hemiplegic stroke patients. Other outcome measures are Mini-mental Status Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS). We studied correlations between motor power recovery in ipsilateral limbs and recovery of neurologic impairment in hemiplegic limbs of stroke patients through SPSS 7.0 program. RESULTS: Ipsilateral motor power in early stage stroke patients is significantly low compared with that of normal subject except ankle dorsiflexion (p<0.05). Comparing ipsilateral proximal with distal limbs power in pre and post multidisciplinary rehabilitation program, upper proximal part recovered faster than the distal part, but which was not statistically significant. Recovery of ipsilateral upper proximal and distal limb weakness is associated with neurologic recovery in hemiplegic side. CONCLUSION: After the stroke, ipsilateral upper limb motor weakness does occur and which follows similar neurologic recovery pattern to the hemiplegic side. Ipsilateral cortical and subcortical tracts take effect on the neurologic recovery of contalateral side.
Ankle ; Extremities ; Follow-Up Studies ; Hemiplegia* ; Hip ; Humans ; National Institutes of Health (U.S.) ; Outcome Assessment (Health Care) ; Prospective Studies ; Rehabilitation ; Stroke* ; Upper Extremity ; Wrist