From 1997 July to 2003 April at Hospital 108, the study was carried out on 90 patients suspected of ischemia with chest pain or on ECG. Ultrasound dobutamin stress test was undertaken with infused initial doses of 5mcg/kg/min until reaching an expected heart rate depending on the ages. Results showed that ultrasound dobutamin stresst test is a diagnostic method of 96% of sensitivity, 84% of specificity and 91% of accuracy
Myocardial Ischemia ; ultrasonography ; Heart Diseases

Dobutamin stress test with echocardiography was performed on 90 suspected patients of heart ischemia, aged 59.6  9.5 years old, during 29.1  17.49 months of following from July 1997 to April 2003 at the Hospital N0108. Results showed that, the procedure reach a sensitivity of 96%, specificity of 84% and an accuracy of 91%
Ultrasonography ; Myocardial Ischemia ; Heart Diseases

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*

This study was conducted to evaluate the usefulness of coronary arterial profiles from normal dogs (11 animals) and canines (six dogs) with experimental myocardial infarction (MI) induced by ligation of the left coronary artery (LCA). Blood velocity of the LCA and right coronary artery (RCA) were evaluated following transthoracic pulsed-wave Doppler echocardiography. The LCA was observed as an infundibular shape, located adjacent to the sinus of Valsalva. The RCA appeared as a tubular structure located 12 o'clock relative to the aorta. In normal dogs, the LCA and RCA mean peak diastolic velocities were 20.84 +/- 3.24 and 19.47 +/- 2.67 cm/sec, respectively. The LCA and RCA mean diastolic deceleration times were 0.91 +/- 0.14 sec and 1.13 +/- 0.20 sec, respectively. In dogs with MI, the LCA had significantly (p < 0.01) lower peak velocities (14.82 +/- 1.61 cm/sec) than the RCA (31.61 +/- 2.34 cm/sec). The RCA had a significantly (p < 0.01) rapid diastolic deceleration time (0.71 +/- 0.06 sec) than that found in the LCA (1.02 +/- 0.22 sec) of MI dogs. In conclusion, these profiles may serve as a differential factor for evaluating cardiomyopathy in dogs.
Animals ; Blood Flow Velocity/*veterinary ; Coronary Vessels/surgery/*ultrasonography ; Dog Diseases/*diagnosis ; Dogs/*physiology ; Echocardiography, Doppler, Pulsed/standards/*veterinary ; Female ; Male ; Myocardial Infarction/diagnosis/*veterinary

Atherosclerosis is a generalized disorder that progresses very slowly. Early detection of atherosclerosis is very important to prevent cardiovascular disease such as myocardial infarction, stroke and sudden cardiac death. Various surrogate markers have recently been proposed for the early detection of atherosclerosis in asymptomatic patients who have one or more risk factors. Among them, biomarkers such as CRP, Interleukin, myeloperoxidase, fibrinogen, homocystein and lipoprotein (a) are established as predictors of atherothrobotic events in apparently healthy individuals. Although these novel biomarkers provide important information into the pathophysiology of atherosclerosis, no clear evidence exist that lowering the plasma level of these markers reduces the vascular risk. Imaging markers such as the carotid intima-media thickness and brachial arterial flow mediated vasodilation as assessed by ultrasound, coronary calcification as assessed by CT, and the pulse wave velocity and augmentation index as assessed by tonometry can visualize the arterial wall and directly measure the arterial function. These imaging markers are very useful clinical tools for detecting the early changes of vascular structure and also for predicting cardiovascular events, in addition to being more precise biomarkers in asymptomatic subjects.
Atherosclerosis* ; Biomarkers ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Death, Sudden, Cardiac ; Fibrinogen ; Humans ; Interleukins ; Lipoprotein(a) ; Manometry ; Myocardial Infarction ; Peroxidase ; Plasma ; Pulse Wave Analysis ; Risk Factors ; Stroke ; Ultrasonography ; Vasodilation

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.
Aneurysm ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Chest Pain ; Constriction, Pathologic ; Coronary Vasospasm ; Creatinine ; Dilatation ; Dyspnea ; Follow-Up Studies ; Heart Diseases ; Humans ; Japan ; Myocardial Infarction* ; Myocardial Stunning ; Phosphotransferases ; Prospective Studies* ; Pulmonary Edema ; Shock, Cardiogenic ; Stress, Psychological ; Stroke Volume ; Takotsubo Cardiomyopathy ; Ultrasonography, Interventional

Pheochromocytoma in pregnancy is very rare but it is associated with very high maternal and fetal mortality. Therefore, it is important to include pheochromocytoma in the differential diagnosis of hypertension associated with pregnancy. It is difficult to make a diagnosis of pheochromocytoma in pregnancy before delivery. The characteristic symptoms of pheochromocytoma could be initiated during delivery because the process of delivery, general anesthesia, fetal movement, induce acute surge of catecholamine release, which could also induce cardiomyopathy. Early diagnosis and intensive care can affect the prognosis of cardiomyopathy induced by pheochromocytoma. Proper management with alpha-blockade, beta-blockade and angiotension converting enzyme inhibitor could acutely reverse the course of cardiomyopathy.
Adrenal Gland Neoplasms/surgery ; Adrenal Gland Neoplasms/diagnosis* ; Adrenal Gland Neoplasms/complications ; Adult ; Cardiovascular Agents/therapeutic use ; Disease-Free Survival ; Echocardiography ; Electrocardiography ; Female ; Human ; Myocardial Diseases/ultrasonography ; Myocardial Diseases/etiology* ; Myocardial Diseases/drug therapy ; Pheochromocytoma/surgery ; Pheochromocytoma/diagnosis* ; Pheochromocytoma/complications ; Pregnancy ; Pregnancy Complications, Cardiovascular/etiology* ; Pregnancy Complications, Neoplastic/surgery ; Pregnancy Complications, Neoplastic/diagnosis* ; Pregnancy Outcome* ; Puerperium ; Tomography, X-Ray Computed ; Substances: Cardiovascular Agents

No abstract available.
*Aorta, Thoracic/ultrasonography ; Aortic Diseases/*complications/diagnosis ; Catheterization, Peripheral/*adverse effects ; Cerebral Angiography/*adverse effects ; Electrocardiography ; Fatal Outcome ; *Femoral Artery ; Heart Arrest/diagnosis/etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/*etiology ; Punctures ; *Sinus of Valsalva/ultrasonography ; Thrombosis/diagnosis/*etiology

BACKGROUND: High-resolution carotid ultrasonography is considered a fundamental technique for the investigation of the vascular system. However, it is still very unclear whether ultrasonographic studies of carotid arteries are useful for the prediction of cardiovascular events in patients with coronary heart disease. We have tried to assess the usefulness of carotid ultrasonography to predict the severity of coronary artery stenosis in the patients with ischemic heart disease. METHODS: We studied in 80 patients(53 men, 27 women) with acute chest pain, mean ages 63.1 10.8 yr(35 to 84 yrs), who underwent both coronary angiography and carotid ultrasonography with 10 MHz transducer. The patients who had received revascularization procedure were excluded. We classified the patients into two groups, the control group without significant coronary stenosis(23 patients) and the coronary artery disease(CAD) group(57 patients) with significant stenosis(>50%). The intima-media thickness (IMT) was measured in the far wall of CCA at 10 mm proximal to carotid bulb and the abnormal IMT was defined when the measurement was greater than mean IMT+2 SD of control group(>0.99 mm). Serum total cholesterolQlC), low density lipoprotein(LDL), high density lipoprotein(HDL), triglyceride(TG) and lipoprotein (a) (LP(a)) were measured and history of hypertension, diabetes mellitus, and smoking were investigated. RESULTS: A significant difference in IMT of the CCA was found between control and CAD group(0.75+/-0.12mm vs. 1.02+/-0.34 mm; p<0.001). Also a significant difference in the existence of plaque(control; 26.1% vs. CAD; 73.7%, p<0.00l) and the number of plaque(control; 0.39+/-0.94 vs. CAD; 2.20+/-1.87 p<0.001) was found. The existence and number of carotid plaque were more conelated with coronary artery stenosis severity than carotid IMT. The sensitivity of IMT for prediction of significant CAD was 42.1%, the specificity 95.7%, the positive predictive value 96%, and the negative predictive value 40%. The sensitivity of plaque presence on the carotid artery for prediction of CAD was 73.7%, the specificity 73.9%, the positive predictive value 87.5% and the negative predictive value 53.1%. Among the risk factors, age and LP(a) were correlated with IMT of CCA, and diabetes, hypertension, age were correlated with the presence of plaque. Smoking and hypertension were correlated with coronary artery disease. CONCLUSION: Carotid atherosclerosis was significantly correlated with severity of coronary atherosclerosis. We therefore suggest that carotid ultrasonography is useful to predict the severity of coronary artery stenosis and that the best index of coronary artery stenosis severity may be carotid plaque rather than carotid intima-media thickness.
Carotid Arteries ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Lipoprotein(a) ; Male ; Myocardial Ischemia ; Risk Factors ; Sensitivity and Specificity ; Smoke ; Smoking ; Transducers ; Ultrasonography*

BACKGROUNDS: Ischemic cardiomyopathy in the elderly bears a worse prognosis than non-ischemic cardiomyopathy, and may show an improved outcome after myocardial revascularization. The noninvasive techniques which can reliably distinquish between ischemic and non-ischemic cardiomyopathy have been tested. As ultrasonographically assessed carotid atherosclerosis is being used as a surrogate measure of coronary atherosclerosis, non studies to date have used carotid atherosclerosis to distinguish between ischemic and non-ischemic cardiomyopathy in the elderly. METHODS: One hundred forty eight patients(61 women, 87 male) greater than 65 years of age who have dilated cardiomyopathy with left ventricular enddiastolic inner dimension 55mm and fractional shortening 25% were evaluated by B-mode ultrasound imaging of carotid artery for measurement of atherosclerotic plaque. Also coronary angiography was done, and ischemic cardiomyo- pathy was defined as the presence of any 2 or more epicardial coronary vessels with 75% stenosis. and then the value of carotid athe rosclerosis in the distinction between ischemic and non-ischemic etiology in the elderly with dilated cardiomyopathy was examined. RESULTS: Ischemic etiology of dilated cardiomyopathy in the elderly can be defined as the presence of carotid atherosclerosis with 25% stenosis. Carotid stenosis 25% had sensitivity 82.5%(74% in women, 91% in male), specificity 85.5%(92% in women, 79% in male), positive predictive value 90.5%(93% in women, 88% in male) and negative predictive value 78.5%(73% in women, 84% in male) as whole in the identification of patients with ischemic cardiomyopathy. CONCLUSION: Carotid stenosis by B-mode ultrasonography is noninvasive and useful in the distinction between ischemic and nonischemic etiology in the elderly patients with clinically unexplained cardiomyopathy
Aged ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Myocardial Revascularization ; Plaque, Atherosclerotic ; Prognosis ; Sensitivity and Specificity ; Ultrasonography