BACKGROUND: Heart rate variability(HRV) represents one of the methods of examining the function of autonomic nervous system. Many patients with acute myocardial infarction show evidence of autonomic disturbance during the acute phase of the attack and reduced heart rate variability is a significant predictor of mortality in patients after acute myocardial infarction. METHOD: The study groups included 25 patients admitted to our hospital with acute myocardial infarction and 23 age matched control group. Heart rate variability(time domain measures : mean NN, SDNN, SDANN, SD, rMSSD, pNN50 and frequency domain measures : TF, LF, HF) was measured from 24 hour Holter recording and wall motion score index(WMSI)was calculated from echocardiography in both groups. Jeopardy score(JS) and ejection fraction(EF) were calculated from coronary angiogram and left ventricular cineangiogram. In patients, HRV, echocardiography and coronary angiography were taken at a mean of 9+/-4, 4.3+/-2.9, and 13+/-6 days after admission. Results: 1) HRV(time domain measures : SDNN, SDANN, SD, rMSSD, pNN50 and frequency domain measures : TF, LF, HF) except mean heart rate was significantly decreased in patients with acute myocardial infarction(AMI)(p<0.001). 2) The angiographic EF and echocardiographic WMSI showed significant negative correlation in patients with AMI(r=-0.49, p<0.05). 3) The EF was significantly related with mean heart rate(r=0.52, p<0.05), SD(r=0.45, p<0.05), TF(r=0.46, p<0.05) and LF(r=0.50, p<0.05) in patients with AMI. 4) There was no correlation among the JS, WMSI, and HRV in patients with AMI. CONCLUSIONS: These findings support that the autonomic control of the heart was pathologically changed in patients with AMI and among the HRV measurements, mean NN, SD, TF and LF were closely related with left ventricular function.
Autonomic Nervous System ; Coronary Angiography ; Echocardiography ; Heart Rate* ; Heart* ; Humans ; Mortality ; Myocardial Infarction* ; Ventricular Function, Left

BACKGROUND: Insulin resistance syndrome has been proposed as a major promotor of atherosclerotic disease and earlier studies have implied the hyperinsulinemia itself may enhance coronary vasomotor tone. In patients with vasospastic angina, previous studies have been inconclusive whether to basal coronary artery tone is elevated at the spasm related and nonspasm related artery. This study was performed to investigate whether basal coronary artery tone is elevated ans insulin resistance syndrome correlates to vasospastic angina. If insulin resistance syndrome correlates to vasospastic angina, we also investigated whether insulin resistance syndrome correlates to basal coronary artery tone. METHODS: The study comprised 27 patients with vasospastic angina(M/F ; 19/8, mean age ; 52+/-2 year) and 21 control subjects with atypical chest pain(M/F ; 9/8, mean age ; 47+/-3 year). We assessed basal coronary artery tone by obtaining the percent increase in coronary artery diameter induced by nitroglycerin and also examined glucose and insulin response to an oral glucose load of 75g. RESULTS: 1) There were no significant differences in body surface area, abdominal hip ratio, body mass index, incidence of hypertension, lipid profile, von-Willebrand factor, fibrinogen, and microalbumin except smorking incidence [vasospastic angia ; 16(50%) vs control ; 5(24%), p<0.05)] between vasospastic angina group and control. 2) Basal coronary artery tone was greater at the nonspastic site of the spasm-related artery(28.1+/-2.2% vs 13.1+/-0.9%, p<0.0001) and non-spasm related artery(23.7+/-1.6% vs 13.1+/-0.9, p<0.0001) in the patients with vasospstic angina than in control subjects. In the patients with vasospastic angina, high activity group had a greater basal coronary artery tone than low activity group at the nonspastic site of the spasm-related artery(31.7+/-2.6 vs 20.4+/-2.7%, p<0.001) and non-spasm related artery(26.8+/-2.0 vs 19.4+/-5.8%, p<0.001). 3) Plasma glucose and serum insulin response to an oral glucose load were similar between vasospastic angina group and control subjects, and glucose area, insulin area, and insulinogenic index(delta sigma Glucose / delta sigma Insulin)(330+/-12 vs 328+/-20 mg/dl *hour, 107+/-14 vs 96+/-17uU/ml*hour, and 2.18+/-0.33 vs 2.63+/-0.46, respectively, p=NS) also did not between both groups. 4) Two group did not differ siginificantly in the prportion of glucose intolerance but glucose area and insulin area were significantly high in vasospastic angina patients with glucose intolerance than in control subjects with normal glucose tolerance(366+/-22 vs 257+/-17mg /dl*hour, 127+/-19 vs 52+/-15uU*hour, respectively, p<0.05), but basal coronary artery tone did not differ significantly between vasospastic angina patients with glucose intolerance and control subjects with normal glucose tolerance. CONCLUSION: 1) These results revealed that basal coronary artery tone is elevated at the nonspastic site of the spasm related artery and non-spastic vessel, and the disease activity associated with elevated basal coronary artery tone in vasospastic angina. 2) But these results did not reveal the correlation of hyperinsulinemia with vasospastic angina, and so we did not determine the role of hyperinsulinemia as a pathogenesis of coronary spasm and the relation between hyperinsulinemia and basal coronary artery tone.
Arteries ; Blood Glucose ; Body Mass Index ; Body Surface Area ; Coronary Vessels* ; Fibrinogen ; Glucose ; Glucose Intolerance ; Hip ; Humans ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Nitroglycerin ; Spasm ; Thorax

BACKGROUND AND OBJECTIVES: Several echocardiographic methods, such as ejection fraction, fractional shortening, and Doppler tissue imaging (DTI), have been developed to quantify systolic function but all had several important limitations. The purpose of this study was to quantify the regional wall motion abnormality, using strain, in an acute myocardial infarction, compared with a visual estimation. SUBJECTS AND MEHTODS: Forty-five patients, with acute anterior (n=28) and inferior myocardial (n=17) infarctions, who underwent color DTI, were examined using longitudinal strain and standard echocardiography, and the results were compared with 54 normal controls. A total of 594 segments [3 segments (apical, mid and basal portion) of septum and inferior wallx99 patients] were evaluated. RESULTS: In the normal control group, the strain was uniformly distributed in all segments (-20%~-23%). In the infarction groups, the strain was negatively related with the wall motion score. The strain of the apical segments and mid-septum was decreased in the anterior wall infarctions, and the strain of basal septum and mid to basal inferior wall was decreased in the inferior wall infarctions. The dyskinetic segments showed positive strain. CONCLUSION: This study validates strain as a superior method for the quantification of the regional wall motion abnormality in an acute myocardial infarction than visual estimation.
Echocardiography ; Humans ; Infarction ; Myocardial Infarction*

BACKGROUND AND OBJECTIVES: Electrical dyssynchronicity (Dsyn) appears to be prognostic of survival in congestive heart failure (CHF). Recent study has shown some discrepancy between the electrical Dsyn and the Doppler tissue image (DTI) assessed mechanical Dsyn. The aim of our study was to evaluate the relationship between the QRS duration and DTI assessed Dsyn. SUBJCETS AND METHODS: One hundred and forty patients, with CHF and left ventricular ejection fractions < or =40%, were enrolled. DTI was performed on 5-basal and 5-mid segments to assess the time from the R-wave to the peak systolic velocity (RS time). A QRS duration >130 msec, standard deviation (SD) of the RS time >40 msec, or a difference in the maximal and minimal RS times (RS time-diff) >100 msec were indicators of'Dsyn'. RESULTS: The prevalence of myocardial Dsyn, by QRS duration, SD of the RS time and the RS time-diff were 19, 43 and 47%, respectively. The SD of the RS time (49.8+/-23.6 vs. 36.6+/-20.7, p<0.01) and the RS time-diff (139.2+/-63.2 vs. 98.0+/-54.3, p<0.01) were prolonged in the wide (>130 msec) compared with the narrow QRS group. There was also a weak positive correlation between the QRS duration and the SD of the RS time (R=0.34, p<0.001) and the RS time-diff (R=0.38, p<0.001). However, from a cross-tabulation analysis, more than one third of patients had a discrepancy between QRS duration and DTI assessed mechanical Dsyn. From a multivariate analysis, a major determinant of the SD of the RS time was the QRS duration. CONCLUSION: Although a major determinant of the DTI assessed Dsyn was the QRS duration, more than one-third of patients had a discrepancy between electrical and mechanical Dsyn. Therefore, not only the QRS duration, but the DTI assessed Dsyn, should be measured when considering cardiac resynchronization therapy.
Cardiac Resynchronization Therapy ; Diagnosis* ; Electrocardiography* ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Multivariate Analysis ; Prevalence ; Stroke Volume

BACKGROUND AND OBJECTIVES: Electrical dyssynchronicity (Dsyn) appears to be prognostic of survival in congestive heart failure (CHF). Recent study has shown some discrepancy between the electrical Dsyn and the Doppler tissue image (DTI) assessed mechanical Dsyn. The aim of our study was to evaluate the relationship between the QRS duration and DTI assessed Dsyn. SUBJCETS AND METHODS: One hundred and forty patients, with CHF and left ventricular ejection fractions < or =40%, were enrolled. DTI was performed on 5-basal and 5-mid segments to assess the time from the R-wave to the peak systolic velocity (RS time). A QRS duration >130 msec, standard deviation (SD) of the RS time >40 msec, or a difference in the maximal and minimal RS times (RS time-diff) >100 msec were indicators of'Dsyn'. RESULTS: The prevalence of myocardial Dsyn, by QRS duration, SD of the RS time and the RS time-diff were 19, 43 and 47%, respectively. The SD of the RS time (49.8+/-23.6 vs. 36.6+/-20.7, p<0.01) and the RS time-diff (139.2+/-63.2 vs. 98.0+/-54.3, p<0.01) were prolonged in the wide (>130 msec) compared with the narrow QRS group. There was also a weak positive correlation between the QRS duration and the SD of the RS time (R=0.34, p<0.001) and the RS time-diff (R=0.38, p<0.001). However, from a cross-tabulation analysis, more than one third of patients had a discrepancy between QRS duration and DTI assessed mechanical Dsyn. From a multivariate analysis, a major determinant of the SD of the RS time was the QRS duration. CONCLUSION: Although a major determinant of the DTI assessed Dsyn was the QRS duration, more than one-third of patients had a discrepancy between electrical and mechanical Dsyn. Therefore, not only the QRS duration, but the DTI assessed Dsyn, should be measured when considering cardiac resynchronization therapy.
Cardiac Resynchronization Therapy ; Diagnosis* ; Electrocardiography* ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Multivariate Analysis ; Prevalence ; Stroke Volume

BACKGROUND AND OBJECTIVES: The recovery of the left ventricular ejection fraction (LVEF) appeared to be prognostic of survival in congestive heart failure (CHF). The aim of our study was to evaluate the parameters that appear to predict the LVEF recovery in CHF. SUBJECTS AND METHODS: Forty-nine patients, with CHF and a LVEF< 35%, were enrolled. Doppler myocardial imaging was performed on 5-basal and 5-mid segments in order to assess the systolic duration, the time from the R-wave to the peak systolic velocity (RS time) and the time from the R-wave to the peak early diastolic velocity (RE time). The standard deviation (SD) of the RS time was an indicator of the 'systolic synchronicity'. After at least 3 months of full medical therapy, a follow-up echocardiography was performed. According to the changes in the LVEF, the patients were divided into groups I (< 5%, n=29) and II (> or =5%, n=20). RESULTS: The baseline clinical and echocardiographic parameters were similar in both groups. In group II, the LV end-systolic and end-diastolic volumes were decreased, but the LVEF was increased by up to 44% at the follow-up. The right ventricular annulus velocity (group I: 6.7+/-2.1 vs. group II: 8.0+/-2.0 cm/sec, p< 0.05), the use of beta-blocker (69 vs. 100%, p< 0.05) and the SD of the RS time (46+/-21 vs. 21+/-12, p< 0.01) were significantly different between the two groups. However, the systolic duration and the SD of the RE time were similar in the two groups. From a multivariate analysis, only the SD of the RS time was an independent predictor of the LVEF recovery. CONCLUSION: Myocardial systolic synchronicity is an important predictor of the LVEF recovery.
Echocardiography ; Estrogens, Conjugated (USP)* ; Follow-Up Studies ; Heart Failure* ; Heart Ventricles* ; Humans ; Multivariate Analysis ; Recovery of Function* ; Stroke Volume

BACKGROUND AND OBJECTIVES: The purpose of this study is to examine clinical characteristics and outcome in patients with cardiogenic shock or ongoing cardiogenic shock by acute coronary syndrome who underwent intraaortic balloon pump(IABP) support, and to identify factors predictive of in-hospital mortality. MATERIALS AND METHODS: Thirty-two consecutive patients with IABP support from 1994 to 1997 were analyzed retrospectively. RESULTS: The causes for insertion of IABP are cardiogenic shock(31%), unstable hemodynamics during angiography or angioplasty(31%), ventricular tachycardia(15%), mechanical complications(15%), and ongoing chest pain(6%). The overall survival rate was 47%. Revascularization procedures were done in 23 cases(72%) in whom inhospital survival rate was 52%. The mortality rate was significantly higher in patients with cardiogenic shock(80%) and mechanical complications(100%) including ventricular septal defect and acute mitral regurgitation, but lower with intractable ventricular tachycardia. Differences between survivors and nonsurvivors were not significant in regard to clinical characteristics, extent of coronary artery disease, time to IABP, time to coronary artery bypass graft, and clamping time, but only duration of IABP is longer in nonsurvivors. CONCLUSIONS: Emergent uses of IABP in patients with intractable ventricular tachycardia may be effective in maintaining hemodynamics before revascularization procedures, but patients with pump failure by cardiogenic shock or mechanical complications have higher mortality rates.
Acute Coronary Syndrome ; Angiography ; Constriction ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Septal Defects, Ventricular ; Heart* ; Hemodynamics ; Hospital Mortality ; Humans ; Mitral Valve Insufficiency ; Mortality ; Retrospective Studies ; Shock, Cardiogenic ; Survival Rate ; Survivors ; Tachycardia, Ventricular ; Thorax ; Transplants

Infective endocarditis is still one of the important fatal diseases, especially with systemic embolic manifestations. Infective endocarditis is often misdiagnosed because of variability of systemic embolic manifestations. We have experienced 3 cases of infective endocarditis with systemic embolic manifestations who were initially misdiagnosed as other infectious diseases. Case 1 is a 66 year-old man, who was admitted to our hospital with dyspnea , fever and petechia. His chest X-ray showed rapid decrease of cardiomegaly and pulmonary congestion in two days. At 1 week after discharge he was readmitted for recurrent fever. On the follow-up echocardiography, mitral regurgitation was newly detected. Case 2 is a 75 year-old man, who was admitted to neurology department with sudden left hemiplegia and headache, in whom it was initially difficult to differentiate from ischemic brain infarction. Case 3 is a 29 year-old man, who was admitted to neurosurgery department with fever and back pain, in whom it was initially difficult to diffrentiate from tuberculous spondylitis in early radiologic study. All 3 cases were treated effectively with appropriate antibiotic therapy and discharged with improvement of symptoms. We report 3 cases of systemic embolic manifestations complicated by infective endocarditis with a brief review of literatures.
Adult ; Aged ; Back Pain ; Brain Infarction ; Cardiomegaly ; Communicable Diseases ; Dyspnea ; Echocardiography ; Embolism ; Endocarditis* ; Estrogens, Conjugated (USP) ; Fever ; Follow-Up Studies ; Headache ; Hemiplegia ; Humans ; Mitral Valve Insufficiency ; Neurology ; Neurosurgery ; Spondylitis ; Thorax

BACKGROUNG AND OBJECTIVES: There were numerous reports for clinical characteristics and prognosis of patients with variant angina (VA) but little information is available for patients with VA who presented as acute myocardial infarction (AMI). The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI. MATERIALS AND METHODS: The study group comprised 166 patients with VA:forty one (25%) of whom presented as AMI (Group A;Male 32, mean age 50 years) and 125 presented as typical VA or unstable angina (Group B;Male 73, mean age 54 years). The diagnosis of VA was made by spontaneous spasm and ergonovine or acetylcholine (only Group B) provocation. RESULTS: 1)Male gender (78% vs. 58%, p<0.05), smoking (74% vs. 53%, p<0.05), and disease duration (18+/-5 vs. 7+/-1 month, p<0.0001), and ST-segment elevation during chest pain (71% vs. 23%, p<0.05) were significantly higher in group A than in Group B. 2)Prevalence of fixed stenosis of 50% or greater was higher in Group A than in group B (12% vs. 2%, p<0.05) and the percent stenosis after nitroglycerin injection was also greater in group A than in group B (43+/-5% vs. 28+/-2, p<0.01), but the disease activity such as frequency of resting angina, spontaneous spasm, and multivessel spasm were not different between two groups. 3)During clinical follow-up at a mean duration of 2.7 years, three patient (2%) in group B died of a cardiac cause. Non-fatal MI occurred 1 (2%) and 3 patients (2%) in group A and B, respectively. CONCLUSIONS: Our data show that male gender, smoking, duration of disease, ST-segment elevation during chest pain, and a fixed stenosis of 50% or greater are predictors for initial development of AMI in patients with VA. The prognosis in group A is excellent and this may be associated with less severe atherosclerotic disease and a high rate of medication with calcium channel blocker or nitrate compared with those in previous studies.
Acetylcholine ; Angina, Unstable ; Calcium Channels ; Chest Pain ; Constriction, Pathologic ; Diagnosis ; Ergonovine ; Follow-Up Studies* ; Humans ; Male ; Myocardial Infarction* ; Nitroglycerin ; Prognosis ; Smoke ; Smoking ; Spasm

BACKGROUND AND OBJECTIVES: This study was performed to determine the predictive factors for edge dissection (ED) and clinical significance of ED after coronary stenting. MATERIALS AND METHODS: The study group comprised 215 patients (243 lesions, mean age 59 years, 157 male) in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor (a very focal segment <5mm from the stent margin), major (>5mm with prominent adventitial staining and >50% of lumen compromize), and acute closure. RESULTS: 1.ED occurred in 30 (12.3%, minor 15, major 12) out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2.Development of ED after stenting significantly correlated with severity of stenosis at the stent margin (> or =30%, 19/30 vs. 33/213, p=0.0001), degree of angulation (>45 0 , 16/30 vs. 48/213, p=0.0001), and calcification in the lesion (2/30 vs. 4/213, p=0.02). 3.There was no significant difference in clinical success rate between two groups (27/30 vs. 175/185, NS). 4.CRR in major and acute closure EDs (n=12) were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents (5/6 vs. 1/8, p=0.02). CONCLUSIONS: EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis (> or =30%) at the stent margin, angulation (>45 0 ), and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.
Angiography ; Angioplasty ; Constriction, Pathologic ; Follow-Up Studies* ; Humans ; Stents*