BACKGROUND: Pulsed Doppler measurement of transmitral flow has been widely used to assess the left ventricular relaxation abnormality noninvasively in patients with failing heart. However pulsed Doppler-derived indices are affected by multiple factors, including active relaxation and distensibility of the left ventricle, the pressure gradient between the left ventricle and atrium, and altered loading condition. The purpose of this study is to assess the role of new index, the rate of propagation of left ventricular peak filling flow in early diastole using color M-mode Doppler for the evaluation of left ventricular diastolic function. METHOD: The study group comprised 41 patients(24 males, 17 felames, mean age: 56+/-12). The clinical diagnosis were angina pectoris 32, acute myocardial infarction 3, peripheral arterial obstructive disease 2 and atypical chest pain 4. We measured rate of propagation(ROP) and propagation ratio of peak early filling flow by color M-mode Doppler echocardiography using baseline shifted first aliasing limit technique and compared with pulsed Doppler measurements of transmitral flow. RESULTS: 1) Pulsed Doppler-derived indices of mitral flows were as below. The maximal velocity of E wave was 65.4+/-21.3cm/sec in control group, 54.3+/-7.9cm/sec in group I patients(p<0.05 versus control group) and 70.9+/-15.2cm/sec in group II patients(p<0.01 versus group I). The maximal velocity of A wave was 70.0+/-20.9cm/sec in control group, 78.6+/-3.8cm/sec in group I patients and 60.0+/-14.1cm/sec in group II patients(p<0.01 versus group I). The E/A ratio was 1.01+/-0.42 in control group, 0.69+/-0.10 in group I patients(p<0.05 versus control group) and 1.19+/-0.16 in group II patients(p<0.01 versus group I). The deceleration time was 166.7+/-36.3msec in control group, 202.9+/-17.0msec in group I patients(p<0.01 versus control group) and 160.0+/-10.0msec in group II patients(p<0.01) versus group I). 2) The rate of propagation was 145.0+/-83.4cm/sec in control group, 50.0+/-13.2cm/sec in group I patients(p<0.01 versus control group) and 59.9+/-26.0cm/sec in group II patients(p<0.01 versus control group). 3) The propagation ratio was 2.27+/-1.29cm/sec in control group, 0.93+/-0.25cm/sec in group I patients(p<0.05 versus control group) and 0.86+/-0.36cm/sec in group II patients(p<0.01 versus control group). CONCLUSION: Analysis of filling flow propagation by color M-mode Doppler is an easy and noninvasive method for evaluation of left ventricular diastolic function and may be an additional tool to pulsed Doppler measurement of transmitral flow, especially in differentiation between normal and pseudonormal, but care must be taken in interpretation because of overlapping of values.
Angina Pectoris ; Arterial Occlusive Diseases ; Chest Pain ; Deceleration ; Diagnosis ; Diastole ; Echocardiography, Doppler* ; Heart ; Heart Ventricles ; Humans ; Male ; Myocardial Infarction ; Relaxation

Acute aortic dissection is the most common catastrophic illness of the aorta. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode, but survival may be significantly improved by the timely institution of diagnostic modalities and appropriate medical and surgical therapy. But, approximately 10-20% of patients with acute aortic dissection present with a clinical picture of acute myocardial infarction. This sometimes can not only delay the diagnosis and adequate treatment of acute aortic dissection but also inappropriately treat with thrombolytic agents and anticoagulants which result in rapid deterioration of clinical condition of patient. We report a case of acute aortic dissection with dynamic ST changes in electrocardiogram which resulted in delay of accurate diagnosis and adequate treatment of acute aortic dissection.
Anticoagulants ; Aorta ; Catastrophic Illness ; Diagnosis ; Electrocardiography* ; Fibrinolytic Agents ; Humans ; Myocardial Infarction

BACKGROUND: Several stents are now available for the treatment of failed or suboptimal angioplasty. However, one of the limitations of stents is difficult to deploy especially in tortuous vessels, lesions at a bend, and distal to previously deployed stents. The AVE Micro-II stent has a very low profile(1.65mm), optimum radio-opacity, and highly flexible properties. It is mounted on a semi-compliant balloon with a monorail delivery system. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report clinical outcomes and angiographic follow up results of AVE Micro-II stent. METHODS: Between January 1996 and September 1996, 77 patients were stented with the AVE Micro-II stent. Six-months follow-up angiogram was performed in 57 patients(64 lesions, follow-up rate : 74%). RESULTS: The overall angiographic restenosis rate was 26.6%. By univariable analysis, the rate of restenosis was significantly higher for stents in angulated lesions, in smaller post-stent luminal diameter, in the left anterior descending artery lesion than the right coronary artery, in ostial lesion(p=0.02), in peristent dissecting lesions(p=0.02), in tortuous proximal vessels(p=0.03). Stenting of angulated lesions(p=0.0001, Odds ratio=54.64), small post-stent luminal diameter(p=0.01, Odds ratio=5.46), and the left anterior descending artery than the right coronary artery(p=0.03, Odds ratio=17.2) were the strong independent predictors of restenosis in a multiple logistic regression analysis. Event-free survival(freedom from death, myocardial infarction or revascularization) was 80.7% at 6 months. CONCLUSIONS: 1) The AVE Micro-II stent can be placed safely and efficiently. 2) The angiographic restenosis rate was 26.6%, and 80.7% of patients remained free of cardiovascular events at 6 months. 3) Stenting of angulated lesions, small post-stent luminal diameter, and the left anterior descending artery than the right coronary artery are associated with higher rates of restenosis.
Angioplasty ; Arteries ; Coronary Vessels ; Disease-Free Survival ; Follow-Up Studies* ; Humans ; Logistic Models ; Myocardial Infarction ; Phenobarbital ; Stents*

BACKGROUND: Despite of the first coronary wallstent implantation ushered in the new era in interventional cardiology with the purpose of circumventing the two major limitation of coronary balloon angioplasty, early acute occlusion and late restenosis, however, previous investigators suggested the high rate of subacute occlusion after original wallstent implantation. Recently the low incidence of the subacute closure and restenosis rate with the newely modified less shortening coronary wallstent in native coronary artery and in aortocoronary vein grafts were reported. In this study we report the acute and 6 months follow up results with less shortening coronary wall stent in 32 patients. METHODS: Thirty two patients were enrolled from March 1996 through February 1997 at the Yonsei cardiovascular center of Yonsei University. The specific angiographic criteria for enrollment included at least 70% stenosis and a lesion that was 20mm or more in length and a vessel diameter of at least 2.5mm. Enteric coated aspirin(100mg daily) and ticlopidine(500mg daily) at least 3 days before the procedure and received continuous infusion of 24,000U of heparin for 1day after the procedure. Angiography was performed in two orthogonal views at pre, post procedure and 6months later. Quantitative analysis was performed with the use of the electronic caliper comparing to the empty catheter. All continuous variables were expressed as mean SD and analyzed with the t-test. Differences between groups were analyzed with Chi-square analysis and Fishers Exact test where appropriate. RESULTS: The newly modified Coronary Less Shortening Wallstents were successfully implanted in all the 35 diffuse coronary lesions(more than 20mm in length) of the 32 patients, including 15 pts of acute myocardial infarction, 14 pts of unstable angina, and 3 pts of stable angina. Average 6 months follow up angiography was performed in 26 patients. Immediate angiographic results with Less Shortening Wallstent comparing with 6 months follow up were 3.0+/-0.4mm and 1.7+/-0.9mm in minimal luminal diameter(MLD), 5.1+/-9.1% and 46.8+/-25.8% in diameter stenosis(DS). During the in-hospital phase, no major cardiac event occurred except 2 cases of transmural myocardial infarction, including one of stent thrombosis(3.1%) and one of side branch occlusion, despite of inclusion of 7 cases of threatened occlusion in the long lesion. The restenosis rate at follow up angiography was 30.7%(8/26 pts). The restenosis rate was higher in patients with stent insertion into right coronary artery or adjuvant high pressure oversize ballooning after stent insertion but not statistically significant. CONCLUSIONS: The results of this study suggested that new Less Shortening Wallstent might reduce the requirement of multiple stent in the long lesion and a lower rate of subacute thrombotic occlusion in comparison to the reports with its prototype. Restenosis rate was not significantly different from other types of stents. Althouth the restenosis rate was high in patients with stent insertion, there was no statistical significance probably due to small sample size. But further large scale long term follow-up study is needed to evaluate the role of new Less Shortening Wallstent.
Angina, Stable ; Angina, Unstable ; Angiography ; Angioplasty, Balloon, Coronary ; Cardiology ; Catheters ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies* ; Heparin ; Humans ; Incidence ; Myocardial Infarction ; Phenobarbital ; Research Personnel ; Sample Size ; Stents ; Transplants ; Veins

We describe a case of Takotsubo cardiomyopathy in an elderly woman after status epilepticus. In an emergency echocardiography, not only left ventricular apical ballooning but also right ventricular apical hypokinesia was observed. After a medical management, the patient's condition was improved and a follow-up echocardiography showed substantial recovery of left and right ventricular apical ballooning.
Aged ; Echocardiography ; Emergencies ; Epilepsy* ; Female ; Follow-Up Studies ; Humans ; Hypokinesia ; Status Epilepticus ; Takotsubo Cardiomyopathy*

Myocardial infarction (MI) and stroke often share the same risk factors and pathogenic mechanism. Sometimes they can occur in the same patient proximately, occurring days or weeks apart. However, the simultaneous occurrence of MI and stroke is rare and presents a diagnostic and therapeutic challenge. Specifically, an acute stroke can alter typical features of MI. Thus, recognition of the coexistence of these two events requires a high threshold of suspicion. The authors describe two patients who presented with simultaneous stroke and MI development. The two events developed on the same day in both patients. The second patient did not have chest pain, whereas chest symptoms could not be assessed in the first patient secondary to altered mental status. After the diagnoses were made using clinical and laboratory findings, urgent percutaneous coronary intervention was performed in both patients.
Chest Pain ; Humans ; Infarction ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors ; Stroke ; Thorax

OBJECTIVES: The acute diarrhea is a common complaint among immunocompromised hosts, and may cause life threatening event. The infectious etiologies vary depending on virus, bacteria, and parasites. The most common etiology of acute gastroenteritis is known as enteric virus in Korea. But there are few studies about the infectious etiology of acute gastroenteritis in immunocompromised hosts. The aim of this study was to investigate the infectious etiologies of acute diarrhea in immunocompromised hosts. METHODS: Seventy three patients were enrolled prospectively in a university hospital from January 2013 to July 2014. Immunocompromised hosts included above 65-year-old people, patients with chronic diseases, solid organ or stem cell transplants, solid organ malignancies, hematologic malignancies, immunosuppressive or steroid taking patients. The clinical data were collected and stool samples collected during diarrhea were undergone laboratory analysis for enteric viruses and bacterial enteropathogens including Salmonella spp., Shigella spp., and Clostridium difficile. RESULTS: Fifty five patients were analyzed as follows : above 65 year-old people were 36 cases (66%), previous antibiotic usage was 22 cases (41.5%). 44 cases (81.1%) were admitted to general ward whereas 9 cases to ICU (17%). 41 cases (73.6%) were treated with antibiotics. Positive C. difficile toxin assays were 6 cases (11.9%). Other infectious etiologies were not found. CONCLUSIONS: C. difficile infection was more common infectious etiology while enteric viruses and other bacteria are not associated with acute diarrhea among immunocompromised hosts in this study. So C. difficile infection must be considered preferentially in immunocompromised hosts with acute diarrhea.
Aged ; Anti-Bacterial Agents ; Bacteria ; Chronic Disease ; Clostridium difficile ; Diarrhea* ; Gastroenteritis ; Hematologic Neoplasms ; Humans ; Immunocompromised Host* ; Korea ; Parasites ; Patients' Rooms ; Prospective Studies ; Salmonella ; Shigella ; Stem Cells

BACKGROUND/AIMS: In the bare-metal stent era, routine follow-up coronary angiography (RFU CAG) was used to ensure stent patency. With the advent of drug-eluting stents (DESs) with better safety and efficacy profiles, RFU CAG has been performed less often. There are few data on the clinical impact of RFU CAG after second- or third-generation DES implantation in clinically stable patients with coronary artery disease; the aim of this study was to examine this issue. METHODS: We analyzed clinical outcomes retrospectively of 259 patients who were event-free at 12-month after stent implantation and did not undergo RFU CAG (clinical follow-up group) and 364 patients who were event-free prior to RFU CAG (angiographic follow-up group). Baseline characteristics were compared between the groups. RESULTS: The Kaplan-Meier estimated total survival and major adverse cardiac event (MACE)-free survival did not differ between the groups (p = 0.100 and p = 0.461, respectively). The cumulative MACE rate was also not different between the groups (hazard ratio, 0.85; 95% confidence interval, 0.35 to 2.02). In the angiographic follow-up group, 8.8% revascularization was seen at RFU CAG. CONCLUSIONS: RFU CAG did not affect long-term clinical outcome after second- or third-generation DES implantation in clinically stable patients.
Aged ; *Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease/radiography/*therapy ; Coronary Restenosis/etiology/radiography/surgery ; Coronary Vessels/*radiography ; Disease Progression ; Disease-Free Survival ; *Drug-Eluting Stents ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology/radiography/surgery ; Patient Selection ; Percutaneous Coronary Intervention/adverse effects/*instrumentation ; Predictive Value of Tests ; Proportional Hazards Models ; Prosthesis Design ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND: Coronary stenting is known to reduce the rates of restenosis in focal lesions, but the efficacy of stents for long lesions have not been thoroughly defined. To evaluate the immediate and follow-up results of three different types of stents in lesions longer than 20mm, consecutive series of patients (pts) were reviewed. METHODS: Between February 1996 and January 1997, 123 patients (male 68.3%, mean age 57+/-10 years) with a total of 130 lesions underwent long stent : stenting. Excluding multiple stents and unplanned use for acute closure fifty-three pts (56 lesions) were treated with the Microstent II (M-II):30 pts (31 lesions) received the Less Shortening Wallstent (WA):and 40 pts (43 lesions) were treated by the Gianturco-Roubin II stent (GR-II). RESULTS: With the clinical success defined as <30% residual stenosis without death, CABG, Q-wave MI was achieved in 93% with the M-II, 94% with the WA and 95% with the GR-II. Stent thrombosis occurred 0% in M-II, 1.5% in WA and 2.3% in GR-II. Clinical success and stent thrombosis rates were not different between the three types of stents. Follow-up (FU) quantitative angiography was obtained from 34 pts (64%) in M-II, 25 lesions (83%) in WA and 26 pts (65%) in GR-II after 6 months. Restenosis rate defined as <0A65B>50% diameter stenosis at FU was 26% in M-II, 32% in WA and 38% in GR-II:there was no significant difference between the three stents. Target lesion revascularization (TLR) defined as CABG or target lesion PTCA at FU was 17.6% in M-II, 12% in WA and 23.1% in GR-II. Restenosis rate correlated closely with lesion length (p-value-0.03, Odds ratio-1.096) and small post-stent luminal diameter (p-value-0.002, Odds ratio-0.063) in a mu-ltivariable analysis. CONCLUSION: Coronary stenting for long lesions can be safely performed with acceptable complication rates using any of the three types of stents. Restenosis and late outcome was not related to type of stent.
Angiography ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis

BACKGROUND AND OBJECTIVES: Although cardiac troponin I is widely used as a marker for myocardial infarction (MI), minor elevations of cardiac troponin I are also observed in other clinical situations. The prognostic factors for patients with these clinical features are not well established. The aim of this study was to discover the predictors of mortality for the patients who had minor troponin elevations without acute MI. SUBJECTS AND METHODS: We enrolled consecutive 154 patients from the emergency department or inpatient units who had a peak troponin I level greater than the lower limit of detectability (0.04 ng/mL), and the level was also less than the suggestive value of MI (0.6 ng/mL). They were with chest pain or nonspecific symptoms of circulatory abnormality, but they lacked the traditional features of acute MI. The endpoint was defined as death from all causes. The Cox proportional hazard model was used to test the relationship between the clinical and biochemical variables and the outcomes. RESULTS: During the follow-up period of 7.9+/-7.3 months, mortality occurred in 15 patients. Age, the creatine kinase myocardial isoform (CK-MB) level and the C-reactive protein (CRP) level as continuous variables had significant correlations with the occurrence of death. After adjusting for any possible confounders in the multivariate model, these variables remained as independent predictors of mortality: age (HR 1.07, CI 1.02-1.14, p=0.012), CK-MB level (HR 1.61, CI 1.16-2.24, p=0.005), and CRP level (HR 1.01, CI 1.00-1.01, p=0.025). CONCLUSION: Integration of the CK-MB and CRP levels, as well as age, can be used for risk-stratification in the patients showing minor troponin I elevation for reasons other than acute MI.
C-Reactive Protein ; Chest Pain ; Creatine Kinase ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Inpatients ; Mortality ; Myocardial Infarction* ; Prognosis ; Proportional Hazards Models ; Troponin ; Troponin I*