Early cardiac valvular changes in ankylosing spondylitis: a transesophageal echocardiography study.

BACKGROUND: This study was conducted to determine the early cardiac valvular changes in young male ankylosing spondylitis (AS) patients. METHODS: A total of 70 AS patients on treatment without clinical cardiac symptoms were divided into group I (< 10 years, n = 50) and group II (≥ 10 years, n = 20) depending on their disease duration after first diagnosis. Twenty-five healthy volunteers were selected as control subjects. All the subjects underwent transthoracic and transesophageal echocardiography, electrocardiography, and rheumatologic evaluation for AS patients. RESULTS: The thickness of both the aortic and mitral valve was more increased in AS patients than in controls. Aortic valve thickness over 1.3 mm could predict AS with a sensitivity of 73% and specificity of 76%. The prevalence of aortic valve thickening was higher in the AS group compared to the controls. The prevalence of aortic and mitral regurgitation was very low and there was no difference between the controls and the patients. The aortic valve thickening was related to longer disease duration, high blood pressure, disease activity and inflammatory markers. CONCLUSION: Thickening of the aortic and mitral valve was observed without regurgitation in male AS patients early in the course of their disease without clinical cardiac manifestations. This subclinical change of aorto-mitral valve in early AS should be considered and followed up to determine its prognostic implication and evolution.

Treadmill exercise stress echocardiography in patients with no history of coronary artery disease: a single-center experience in korean population.

BACKGROUND AND OBJECTIVES: Treadmill exercise stress echocardiography (TSE) has superior diagnostic accuracy than exercise electrocardiography (ECG). The objectives of the study are 1) to define the diagnostic accuracy and safety of TSE in patients without a history of coronary artery disease (CAD), 2) to identify the clinical characteristics that predict positive TSE results and 3) to assess the differential predictive value between TSE and concomitant exercise ECG in a Korean population. SUBJECTS AND METHODS: A total of 1,287 patients among 1,500 consecutive patients with no prior history of CAD and who were referred for TSE during a 4-year 3-month period were enrolled. RESULTS: Of the 1,287 patients, 95 (7.4%) showed positive TSE results (newly developed regional wall motion abnormality). Among the 154 patients with coronary angiography, 94 patients (61%) showed significant CAD (30 of 77 patients with negative TSE results and 64 of 77 patients with positive TSE results). The TSE positive population had more cardiovascular risk factors and showed a higher Duke treadmill score and wall motion score index than the TSE negative group. TSE showed relatively good sensitivity (68%), specificity (78%) and positive and negative predictive values (83% and 61%, respectively), and TSE also had higher diagnostic accuracy than concomitant exercise ECG (72% vs. 64%, respectively). CONCLUSION: TSE is safe and offers greater diagnostic power for CAD than exercise ECG in Korean population without a history of CAD. Its prognostic value in this population needs to be confirmed in a larger prospective study.

Prognostic value of serial global longitudinal strain measured by two-dimensional speckle tracking echocardiography in patients with ST-segment elevation myocardial infarction.

The aim of this study was to determine whether assessment of global longitudinal strain (GLS) before revascularization could predict adverse cardiac events after ST-segment elevation myocardial infarction (STEMI). In addition, the relation between GLS and cardiac biomarkers was investigated. From July 2006 through December 2009, 98 patients with first STEMI underwent conventional and speckle tracking echocardiography at initial presentation and 3 days after primary coronary intervention. Patients were divided into 3 groups according to percent changes of GLS compared to baseline GLS values: group 1, improved GLS >10%; group 2, unchanged GLS from -10% to 10%; and group 3, decreased GLS <-10%. Subsequent complications including all-cause mortality and readmission because of congestive heart failure during a 6-month period of follow-up were prospectively evaluated. After coronary intervention, GLS was improved in 29 patients (30%, group 1), unchanged in 55 patients (56%, group 2), and worsened in 14 patients (14%, group 3). Complications developed in 7 patients (group 1, n = 0, 0%; group 2, n = 2, 28%; group 3, n = 5, 72%, p <0.01). Multivariate Cox analysis showed an independent association of GLS before and after coronary intervention with subsequent complications. Significant correlations were observed between GLS and cardiac biomarkers. In conclusion, GLS assessment before coronary intervention was a good predictor of complications in patients with STEMI comparable to predictions using GLS after intervention at 6-month follow-up.

Serial assessment of left ventricular remodeling by measurement of left ventricular torsion using speckle tracking echocardiography in patients with acute myocardial infarction.

The relation between remodeling and left ventricular (LV) torsion has not yet been fully investigated. The aim of this study was to determine whether LV torsion assessed by speckle tracking imaging can predict progressive LV dilation after acute myocardial infarction (AMI). From January 2006 through June 2008, 91 patients with AMI who were successfully treated with primary coronary intervention underwent conventional and speckle tracking echocardiographies at initial presentation and 3 days and 6 months after first AMI. Patients were divided into 2 groups based on presence of LV remodeling (increase of LV end-diastolic volume >20%) at 6-month follow-up. LV remodeling developed in 23 patients. At initial presentation, LV end-diastolic volume was not significantly different between the no-remodeling and remodeling groups (91.27 ± 35.68 vs 85.74 ± 28.89 ml, p = 0.51), but LV torsion (2.23 ± 0.67 vs 1.70 ± 0.58°/cm, p <0.05) was significantly decreased in the remodeling group. At 6-month follow-up speckle tracking echocardiography, apical rotation and global torsion in patients with remodeling were 6.7 ± 2.6 (p <0.05) and 1.7 ± 0.7°/cm (p = 0.76 from baseline), respectively, and in patients without remodeling, 8.8 ± 3.4 (p <0.01) and 2.5 ± 0.7°/cm (p <0.01 from baseline), respectively. According to receiver operating characteristic analysis, LV torsion of 1.9°/cm (area under curve 0.79, sensitivity 75%, specificity 78%) at initial presentation was selected as a significant predictor of remodeling. In conclusion, decreased LV torsion assessed by speckle tracking echocardiography may predict late LV remodeling after reperfusion therapy after AMI.

Preliminary clinical experience with waon therapy in Korea: safety and effect.

BACKGROUND: Waon therapy has beneficial effects on chronic heart failure (CHF), peripheral arterial disease, and other various diseases. This was to assess the safety and effect of Waon therapy by echocardiography for the first time in Korea. METHODS: Ten patients with CHF were enrolled. The patients with a light gown were placed in a sitting-position in an evenly maintained 60 dry sauna system for 15 minutes, and then after leaving the sauna, they underwent bed rest with a blanket to keep them warm for an additional 30 minutes. Waon therapy was performed once a day, 5 days a week. RESULTS: Four of the 5 patients who had been treated for more than 2 weeks as protocol noted improvement of heart failure (HF) symptoms and decrease in left ventricular (LV) volume. There were trends in improvement of LV ejection fraction and parameters of diastolic function after the therapy although statistical significance was lack. No one complained of worsening of HF symptoms. In each session, body weight (61.8+/-10.2 kg vs. 61.6+/-10.3 kg, p=0.008) and blood pressure (systolic, 119+/-28 vs. 111+/-27 mmHg, p=0.005; diastolic, 69+/-12 mmHg vs. 63+/-10 mmHg, p=0.005) were significantly decreased, oral temperature (35.9+/-0.4 vs. 37.0+/-0.9, p=0.017) was increased by 1.0 at the end of sauna bathing, but the heart rate (71+/-10/min vs. 72+/-8/min, p=0.8) was not changed. CONCLUSION: We have experienced Waon therapy which was safe and well tolerated and some beneficial effects for patients with CHF. Large scale randomized study is needed to apply Waon therapy as a promising therapy in Korean HF patients.

A case of systemic amyloidosis following ankylosing spondylitis associated with congestive heart failure.

Secondary (amyloid A [AA]) amyloidosis is a systemic disease characterized by amyloid deposition in many organs, leading to impaired function. Although cardiac involvement may occur with AA amyloidosis, significant deposition of amyloid in the heart is considered an infrequent observation and is rarely the cause of death. It occurs in 5% of patients with poorly controlled chronic inflammatory disease, mainly rheumatoid arthritis, ankylosing spondylitis, and familial Mediterranean fever. The authors report a case of AA amyloidosis diagnosed by rectal and skin biopsies, with cardiac involvement demonstrated by typical echocardiographic features in the presence of low voltage on electrocardiography.

A case of concentric left ventricular hypertrophy with falsely normal blood pressure in patient with Takayasu's arteritis.

This is a case of full-blown Takayasu's arteritis in a young woman complicated with recurrent strokes, which was diagnosed late, after echocardiographic examination identifying concentric left ventricular hypertrophy of unknown cause and falsely normal blood pressure due to arterial stenoses in all four limbs. Herein we describe this interesting and instructive case with a short review of literature.

Bloodletting-induced cardiomyopathy: reversible cardiac hypertrophy in severe chronic anaemia from long-term bloodletting with cupping.

Cardiac hypertrophy in a patient with severe iron deficiency anaemia associated with long-term bloodletting using cupping, called 'puhang' in oriental medicine, is discussed using chest electrocardiographic and radiographic images. With iron supply, the patient showed remarkable improvement of cardiomegaly, which is a unique feature of chronic severe iron deficiency anaemia.

[Studies On The Lungfluke, Paragonimus Iloktsuenensis: VI. Effect Of Prednisolone Injection On The Immune Responses Of Albino Rats]

In order to understand the effect of prednisolone injection on the immune responses of albino rat against Paragonimus iloktsuenensis infection, the differential leucocyte counts, appearance of immunoblast (large pyroninophilic cell, LPC) in the spleen and lungs in various experimental groups were observed in relation with the growth, maturation and migration sites of this rodent lungfluke. Rats of 3 experimental groups (A series), each group consisted of 5 rats, were infected with 20 metacercariae of P. iloktsuenensis, and they were kept for 3 days(Group I), 3 weeks(Group II), and 4 weeks (Group III) of infection period. The same number of experimental groups, each group of rats received 10 mg/kg dose of prednisolone injection every other day, were also kept and examined in comparison with the former groups. Preparation of peripheral blood smear and collection of worms were completed immediately after the end of infection period, and they were stained with Giemsa or Semichon's acetocarmine. Paraffin sections of the spleen and the lung tissues were stained with hematoxylin-eosin and methyl green pyronin (MGP). Those materials from A and B series of experimental groups were examined under the light microscope, and the results obtained were as follows: 1. On observing differential leucocyte counts of peripheral blood smear, lymphocyte counts were consistently higher than those of uninfected controls in A series of infected groups, while those of B series were consistently low. On the other hand, neutrophil counts of A series showed lower counts than those of B series. In general, fluctuation patterns of both A and B series of experimental groups were almost the same, although lymphocyte and neutrophil counts showed reciprocal relation. The eosinophil counts of both series were negligible, especially in the groups of B series. 2. The counts of LPC in the periarterial lymphatic sheath of the spleen were rapidly increased in the groups of A series, while those of B series were much less than those of A series, and the appearance of considerable LPC in the spleen was also delayed in B series. Furthermore, LPC of peribronchial lymphatic tissue in A series started to increase after the invasion of lungflukes into the lungs, while those of B series were much less due to the inhibited migration of lymphocytes into the lesions. 3. Number, size and maturity of collected worms showed no significant differences between the groups of A and B series, but migration speed of the lungflukes was somewhat accelerated in B series than in A series. In this connection, it was considered that the immune responses of albino rats did not contribute for the complete protection against P. iloktsuenensis, but inhibited the migration of this lungfluke to some extent.

[Studies on the lungfluke, Paragonimus iloktsuenensis: V. Host tissue reactions in albino rats]

In order to understand the tissue responses of albino rat host against Paragonimus iloktsuenensis infection, the histopathological changes of the spleen and the lungs in 6 experimental groups of rats were observed in relation with the growth, maturation and migration of this lung fluke. Rats of the experimental groups, each group consisted of 5 rats, were infected with the metacercariae of P. iloktsuenensis which were isolated from brackish water crab, Sesarma dehaani, and were kept for 3 days, 3 weeks, 4 weeks, 7 weeks, 10 weeks and 14 weeks of infection period. Peripheral blood smear slides for the differential leukocyte count were prepared and also worm collection was completed immediately after the infection period. Paraffin sections of the spleen and the lung tissue were stained with hematoxylin-eosin and methyl-green-pyronin (MGP) stain. Those materials from the experimental groups were examined in comparison with the materials obtained from control group, with special reference to immunologic aspects of host response. The results obtained were as follows: 1. The counts of large pyroninophilic cell (LPC) in the periarterial sheath of spleen were rapidly increased in earlier period of infection, and those of peribronchial lymphatic tissue started to increase after the penetration of lungfluke into the lungs. 2. The LPC counts of both the spleen and the lungs were on the decrease in conjunction with the necrosis of the lung fluke in 14th week of infection. 3. On observing differential leukocyte count of peripheral blood smear, the fluctuation of lymphocyte count was proportional to that of LPC count, and the lymphocyte count was consistently higher than that of normal rats. On the other hand, neutrophil count of experimental group showed reciprocal relation to the LPC counts. 4. The nature and characteristics of pulmonary lesion produced by the P. iloktsuenensis were just the same as those produced by P. westermani. The lesions were represented by thick and fibrosclerotic cavern, granuloma due to eggs, pneumonic process and cellular infiltrations.

Some Aspects Of Human Sparganosis In Korea.

Human sparganosis in Korea was discussed on the bases of five human cases experienced by the present authors and 58 case records already reported by many previous authors, in aspects of epidemiology and clinical features. Sparganosis is not infrequent tissue helminthiasis now in Korea and the incidence has been evidently increased during past 10 years. It might be interpreted that improved medical delivery system and health care exposed the hidden but prevalent disease. The distribution of sparganosis in Korea is apparently subdivided into three major endemic areas; Kyunggi Do, Kyungsang Do and Hamkyung Nam Do. Although scanty in other areas of Korea, the distribution of this disease is presumably throughout the whole peninsula of Korea except Cheju Do. The majority of human cases of sparganosis in Korea has revealed raw consuming of snakes for treatment of tuberculosis, syphilis and joint pain, for tonics and for the belief of special nutrition among very limited group of Korean population. Because of this kinds of mode of infection, comprising four fifths of all cases, the majority of cases detected were male adult consisting of about 70% of total cases. And drinking of untreated water in rural area where no protective, sanitary measures for water sources were provided in the past, seems another important causes of infection especially in women and children in Korea. Thus it may be concluded that sparganosis in Korea is concluded by eating of infective stages per os voluntarily or involuntarily, but not through the direct invasion. Clinically, subcutaneous mass or lump was the most frequent problem in those patients and those masses were associated with inflammatory signs. By the anatomical location of the lesion, some peculiar manifestations could be developed as in orbital, abdominal, urethral, ureteral and vertebral cases. And the lesions could be complicated by haemorrhage or abscess formations. The larval worms hitherto collected in Korea has been identified tentatively as Sparganum mansoni because neither branched larvae nor Sparganum proliferum were ever reported.