BACKGROUND AND OBJECTIVES: The structural significance of the inappropriateness of left ventricular mass (iLVM) is known to be an important prognostic factor for cardiovascular events; however, the functional changes associated with iLVM have not been established. This study was performed to determine if diastolic dysfunction is associated with iLVM using a tissue Doppler technique. SUBJECTS AND METHODS: Three hundred sixty consecutive subjects, including 221 hypertension patients from the echocardiography database, were analyzed. Regarding the appropriateness of left ventricular (LV) mass, an observed/predicted ratio of LV mass (OPR) >130% was defined as inappropriate. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), isovolumetric relaxation time (IVRT), and E/early mitral annulus velocity (E'), were compared between the appropriate LV mass (aLVM) group and the iLVM group. RESULTS: Among transmitral flow parameters, only the E velocity was negatively correlated with the OPR when adjusted for age (adjusted r=-0.107, p=0.04). Based on multiple regression analysis, the OPR (beta=0.163, p=0.003), as well as age (beta=0.286, p=0.0001), systolic blood pressure (beta=0.120, p=0.019), fasting blood glucose (beta=0.098, p=0.042), and male gender (beta=0.157, p=0.002) were independent factors determining E/E'. The cholesterol level was not an independent factor (beta=-0.059, p=0.355). In the iLVM group (n=105), the adjusted E/E' was higher than in the aLVM group (n=255; 11.7+/-3.4 vs. 10.8+/-3.1, p=0.02), while the peak E flow velocity was significantly lower than in the aLVM group (70.9+/-15.1 vs. 75.5+/-17.6, p=0.03). CONCLUSION: Inappropriateness of LV mass is independently associated with increased E/E'. Thus, E/E' may be a useful parameter for the evaluation of diastolic dysfunction.
Blood Glucose ; Blood Pressure ; Cholesterol ; Deceleration ; Echocardiography ; Fasting ; Heart Ventricles ; Humans ; Hypertension ; Hypertrophy ; Male ; Relaxation

The coronary artery-left ventricular microfistula is an extremely rare congenital anomaly. Little is known about their epidemiologic and clinical features. Moreover, to our knowledge, only two cases of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography have been reported in the literature. Recently we experienced a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography, who was a 63 year old woman and visited for evaluation of chest pain. Herein, along with a review of the pertinent literature regarding this disorder, we report a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography.
Chest Pain ; Echocardiography, Doppler* ; Female ; Humans ; Middle Aged

BACKGROUND AND OBJECTIVES: Aging is a major factor related to a relaxation abnormality of the left ventricle. Increased arterial stiffness and central distribution of body fat are common physiologic changes observed in the elderly. To further elucidate the relationship between aging and a relaxation abnormality of the left ventricle, we investigate the relationship between the pulse wave velocity, abdominal obesity and diastolic function parameters of the left ventricle. SUBJECTS AND METHODS: In 490 subjects (153 normotensive, 128 prehypertensive, 120 untreated hypertensive and 89 hypertensive on anti-hypertensive drugs, aged 59.8+/-12.6 (21-88) years), the brachial-ankle pulse wave velocity (baPWV) and echocardiographic indices for a relaxation abnormality, i.e. transmitral E, A, E/A, DT, IVRT, were measured. A relaxation abnormality was defined by an E/A <1 or a DT >240 ms in the young (<55 years), an E/A <0.8 and a DT >240 ms in the old (<55 years). Subjects with normal relaxation of the left ventricle (group I, n=252) were compared to the subjects with abnormal relaxation of the LV (group II, n=238), with respect to the baPWV and abdominal circumference. RESULTS: In a multiple linear regression analysis, the mean baPWV (cm/sec) was independently correlated with pulse pressure, age, blood pressure, abdominal circumference (AC), body mass index (BMI) and heart rate (R2=0.492, SEE=261.898). However, neither gender nor the left ventricular mass index (g/m2.7) was associated with the mean baPWV. A logistical regression analysis showed abdominal obesity (AC> or =90 cm in male, > or =80 cm in female, OR: 2.34), a high baPWV (> or =1,600 cm/sec, OR: 3.96) and a high BMI (> or =25 kg/m2, OR: 0.60) to be independent deter-minants of a relaxation abnormality. The age adjusted mean baPWV (1526.9+/-119.4 vs. 1577.1+/-106.9 cm/sec, p< 0.0001) and AC (86.2+/-9.8 vs. 88.5+/-7.7 cm, p=0.005) were higher in group II than group I. CONCLUSION: Arterial stiffness is the major determinant of a relaxation abnormality of the left ventricle. Abdominal obesity and a high BMI were found to be independent of each other, and an inverse relationship was found with respect to a relaxation abnormality of the left ventricle in a rural Korean population, including hypertensive patients.
Adipose Tissue ; Aged ; Aging ; Antihypertensive Agents ; Blood Pressure ; Body Mass Index ; Echocardiography ; Female ; Heart Rate ; Heart Ventricles* ; Humans* ; Hypertension* ; Linear Models ; Male ; Obesity ; Obesity, Abdominal* ; Pulse Wave Analysis ; Relaxation* ; Vascular Stiffness ; Ventricular Function, Left

Despite the major advances in diagnostic technology and improvements in antimicrobial selection and monitoring accompanied by parallel advances in surgical techniques, the morbidity and mortality of infective endocarditis(IE) still remain high. Because of this high mortality rate, it is worthy of investigating the clinical features of IE and it's complications thoroughly. The main causes of mortality in IE are congestive heart failure and septic embolization. In 9% of active IE, acute myocardial infarction(AMI) developed. AMI caused by coronary artery obliteration by occlusion or embolization is a rare but recognized complication of aortic valve endocarditis with annular abscess. We reported a case of aortic valve endocarditis with aortic root abscess which was complicated by AMI and death.
Abscess* ; Aortic Valve ; Coronary Vessels ; Endocarditis ; Heart Failure ; Mortality ; Myocardial Infarction*

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate endothelium dependent vasodilation in the diabetic patients suffering with coronary artery disease (CAD). SUBJECTS AND METHODS: 43 patients who presented with typical chest pain and who underwent coronary angiography were enrolled in this study. They were classified into diabetic patients with CAD (n=13), non-diabetic patients with CAD (n=13), diabetic patients without CAD (n=7), and non-diabetic patients without CAD (n=10), according to the presence of CAD and diabetes mellitus. Endothelium-dependent vasodilation of the brachial artery was measured in all the subjects by performing 7.5 MHz high-resolution ultrasound sonography. RESULTS: The endothelium-dependent vasodilation in the diabetic patients with CAD was 1.30+/-2.13% and it was 5.72+/-3.70% in the non-diabetic patients with CAD. There was a significant difference between the two groups (p=0.001). The endothelium-dependent vasodilation in diabetic patients without CAD was 2.28+/-1.88% and it was 10.70+/-10.19% in the non-diabetic patients without CAD. There was a significant difference between the two groups (p=0.029). The endothelium-dependent vasodilations in the diabetic group was 2.28+/-1.88% and it was 10.70+/-10.19% in the non-diabetic group for all the patients. There was a significant difference between the two groups (p=0.029). There was correlation between the endothelium-dependent vasodilation and the fasting blood sugar. There was negative correlation between the endothelium-dependent vasodilation and the fasting blood sugar (FBS) in the patients with CAD (r=-0.59, p=0.002). However, there was no correlation between the endothelium-dependent vasodilation and the FBS in the patients without CAD (r=-0.327, p=0.201). There was negative correlation between the endothelium-dependent vasodilation and the FBS in all subjects (r=-0.352, p=0.021). CONCLUSION: The endothelium-dependent vasodilation was decreased in the diabetic patients with CAD as compared to the non-diabetic patients with CAD. There was also was negative correlation between the endothelium-dependent vasodilation and the FBS in the patients with CAD.
Blood Glucose ; Brachial Artery ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Endothelium ; Fasting ; Humans ; Ultrasonography ; Vasodilation*

PURPOSE: To date, it has been impossible to relate the occurrence of ventricular arrhythmia to survival in hyperkalemia. QT dispersion is thought to reflect the inhomogeneity of ventricular repolarization and to be related to ventricular-arrhythmia-induced sudden cardiac death in various medical conditions. Therefore, the purpose of this study was to investigate to use QT dispersion as a prognostic marker in hyperkalemia and to suggest treatment guidelines for hyperkalemia by analyzing the correlations between the QT dispersion on the initial ECG and the treatment outcomes. METHODS: This study's population was comprised of 104 patients with serum potassium concentrations > or =5.5 mEq/L, who were divided into 2 groups; group 1 was the survival group (n=81), group 2 was the death group (n=23). We reviewed retrospectively the underlying diseases, electrolytes, treatment outcomes and the clinical and ECG findings during the initial and the recovery states. The QT interval for each lead was measured manually on an enlarged (X1.5) ECG. The QT interval was measured from the first deflection of the QRS complex to the point of the T wave offset, and the corrected QT interval was obtained by using B a z e t t's formula. The QT dispersion and the corrected QT dispersion were defined as the differences between the minimal and the maximal QT values and between the corresponding corrected QT values for each of the 12 leads, respectively. RESULTS: The treatment outcomes were not related to the initial serum potassium and the hourly serum potassium change rates. For hyperkalemia > or =7.0 mEq/L, the death group had significantly larger QT dispersion than the survival group (death group = 95.6+/-15.4 msec, survival group = 51.8+/-17.5 msec, p<0.01). However, the QT dispersions of the two groups were not different for serum potassium levels <7.0 mEq/L. For hyperkalemia > or =7.0mEq/L, QT dispersion above 65 msec had a 93.8% sensitivity, a 79.4% specificity, and a 68.2% positive predictive value for death. CONCLUSION: For hyperkalemia > or =7.0 mEq/L, QT dispersion above 65 msec should be considered to be a prognostic marker for prediction of the treatment outcome.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac ; Electrocardiography ; Electrolytes ; Humans ; Hyperkalemia* ; Potassium ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Treatment Outcome

OBJECTIVE: Although hemodialysis using heparin bound Hemophan (HBH-HD) has been reported to be a possible modality in patients at risk of bleeding, the efficiency and safety of HBH-HD is not certain. Therefore, we prospectively compared the safety and efficiency of HBH-HD with those of saline flushing HD (SF-HD) and HD using low dose heparin (LDH-HD) in 13 HD patients at risk of bleeding in a cross-over design. METHODS: The safety and efficiency were evaluated by measuring activated partial prothrombin time (aPTT) before and during HD, hemostasis time after needle removal, total blood compartment volume (TBCV) loss of dialyzer, urea clearance (K) and Kt/V. RESULTS: There was no difference in compression time needed to achieve hemostasis at puncture site after needle removal between HBH-HD, SF-HD and LDH-HD. During HBH-HD, there was a slight increase in aPTT at 15 min (50.6+/-4.5 sec), compared to predialysis levels (40.9+/-4.7 sec). In this cross- over study, aPTT during dialysis session was markedly higher in LDH-HD than those in HBH-HD or SF-HD (p<0.05). The loss of TBCV of the dialyzer was greater in SF-HD than HBH-HD or LDH-HD (17.4+/-1.9% vs. 12.4+/-1.4% vs. 10.1+/-1.8%). However, there was no difference in K (212.0+/-30.7 vs. 217.2+/-36.9 vs. 221.6+/- 29.5 mL/min) and Kt/V (1.22+/-0.12 vs. 1.24+/-0.16 vs. 1.26+/-0.18). CONCLUSION: We concluded that the safety and efficiency of HBH-HD are not different compared to SF-HD or LDH-HD and HBH-HD could an alternative hemodialysis method in patients at risk of bleeding.
Anticoagulants ; Cross-Over Studies ; Dialysis ; Flushing* ; Hemorrhage* ; Hemostasis ; Heparin* ; Humans ; Needles ; Prospective Studies ; Prothrombin Time ; Punctures ; Renal Dialysis* ; Urea

BACKGROUND AND OBJECTIVES: The left ventricular mass is known to be influenced by both hemodynamic and non-hemodynamic factors. Body size and gender are the most representative non-hemodynamic factors. This study was performed to establish the influences of these variables on the variation of the left ventricular mass in healthy Korean adults. SUBJECTS AND METHODS: 368 subjects (male=184, female=184), with a normal body mass index and blood pressure, were included in the echocardiographic analysis from the echocardiography database of the Hanyang University Hospital and of the Yangpyung Epidemiologic Survey 2004. The left ventricular mass was calculated using the equation: 1.04x(IVSd+LVDd+PWTd)3-LDVs3)x0.8+0.6. The stroke volume was calculated (mL/beat) using Teichholz's formula. The stroke work (SW in gram-meters/beat [g-m/beat]) was computed as the cuff systolic BPxstroke volumex0.0144. RESULTS: The stroke work (SW) was the most important factor associated with the LV mass (adjusted R2=0.501, p<0.001), and body weight, age and gender were independent factors (adjusted R2=0.642). In a regression model, including stroke work, gender and height2.7, the LV mass was predicted by the equation: 54.9+7.62xheight (m2.7)+0.67xSW (g-m/beat)-13.2xgender (male=1, female=2)(constant=54.9+/-14.7 g, adjusted R2=0.576, SEE=21.67, p=0.001). CONCLUSION: As with the studies in the western countries, the stroke work, gender and height2.7 were important determinants of the left ventricular mass in Korean adults with a normal weight and normal blood pressure.
Adult* ; Blood Pressure* ; Body Mass Index ; Body Size* ; Body Weight ; Echocardiography ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Ideal Body Weight* ; Stroke ; Stroke Volume

BACKGROUND AND OBJECTIVES: Arterial compliance is a well-known factor affecting the left ventricular structure and function. Pulse wave velocity (PWV) is a reliable indicator of arterial compliance. To elucidate the role of arterial stiffness on the geometric adaptation of LV, the relationship between the pulse wave velocity and geometric patterns of the LV were investigated in subject living in a rural area of Korea. SUBJECTS AND METHODS: The brachial-ankle pulse wave velocity (baPWV) and echocardiographic indices, i.e. left ventricular mass index (LVMI), relative wall thickness (RWT), were measured in 217 (59 hypertensive, 158 normotensive, and age of 57.7+/-12.8 (21-86)) subjects. The relationship between the baPWV and RWT was analyzed according to the presence of LVH, which was defined by >52.0 g/m2.7. Group I was defined as having a RWT< or =0.35 and group II as a RWT>0.35. RESULTS: In a multiple regression model for the relative wall thickness, the stroke volume (beta=-0.261), PWVright (beta=0.177), total peripheral resistance (beta=0.227), abdominal circumference (beta=0.317) and body mass index (beta=-0.214) were found to be independent determinants (R2=0.265, SEE=0.043, constant=0.258+/-0.043, p=0.0001). In subjects without LVH, those in group II (n=42) were older (59.3+/-13.4 vs. 52.0+/-13.0, p=0.005) and had a higher meanPWV (1590.7+/-407.3 vs. 1711.3+/-407.3 cm/sec, p=0.02) than those in group I (n=65). In subjects with LVH, those in group II (n=66) were older (62.5+/-10.9 vs. 57.5+/-11.4, p=0.03) and had a higher meanPWV (1623.7+/-385.3 vs. 1488.5+/-266.3 cm/sec, p=0.03) than those in group I (n=44). In group II, the total peripheral resistance was higher (1858.7+/-447.7 vs. 1608.0+/-347.4 dynes-sec-cm-5, p=0.0001) and the stroke volume lower (67.0+/-14.2 vs. 79.4+/-15.7 ml, p=0.0001) than in group I. CONCLUSION: Pulse wave velocity is independently associated with the concentric geometry of the left ventricle in the rural Korean population used in this study.
Body Mass Index ; Compliance ; Cross-Sectional Studies* ; Echocardiography ; Heart Ventricles ; Hypertension ; Hypertrophy, Left Ventricular ; Korea ; Pulse Wave Analysis ; Stroke Volume ; Vascular Resistance ; Vascular Stiffness

BACKGROUND: Plasma clearance of iohexol (Omnipaque(r)) which used widely in radiologic procedure is considered as useful method for estimation of GFR because iohexol is neither reabsorbed nor secreted from tubule after filtered as inulin and its extrarenal clearance is negligible. Plasma clearance of iohexol can be calculated from two compartment model or one compartment model with Brochner-Mortensen (B-M) modification which convenient and reliable. But there were controversies about sufficient sampling numbers and times for B-M modification of iohexol clearance. METHODS: Nineteen healthy Korean without renal disease underwent measurement of iohexol clearance. Iohexol was given as a single iv dose, and 14 blood sample were drawn up to 300 min. A reference GFR was iohexol clearance calculated from two-compartment model using 14 samples (CL-T). From 8, 3 and 2 samples clearances were calculated by B-M modification (CL-M8, 3 and 2 respectively). The accuracy of estimates was evaluated as percent of estimates falling within 10% above or below the reference GFR. Accuracy of CCr and equations for GFR estimation were also compared. RESULTS: CL-T, CL-M8, CL-M3 and CL-M2 were not different (101.9+/-24.0, 101.9+/-18.7, 101.7+/-18.6, 101.9+/-19.5 mL/min/1.73 m2 respectively). Accuracy of CL-M8, 3 and 2 were not different (74%, 84% and 79% respectively, p>0.05). MDRD equation had higher accuracy (47%) compared with other equations. CONCIUSION: These results indicate that sampling number for measuring iohexol plasma clearance using simplified method might be reduced to only two without accuracy loss in Korean without renal disease.
Inulin ; Iohexol* ; Plasma*