Acute regional myocarditis with normal ventricular wall motion diagnosed by two-dimensional speckle tracking imaging

No abstract available.

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 ( or = 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.

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 ( or = 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.

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 60degrees C 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+/-0.4degrees C vs. 37.0+/-0.9degrees C, p=0.017) was increased by 1.0degrees C 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.

The Difference of Left Ventricular Hypertrophy and the Diastolic Function between Prehypertensives and Normotensives

BACKGROUND AND OBJECTIVES: We investigated whether prehypertensives (PHs) exhibit more prevalent electrocardiographic and echocardiographic left ventricular hypertrophy (ECG LVH) and if they are are more associated with impaired left ventricular (LV) diastolic function than are normotensives (NTs). SUBJECTS AND METHODS: A total of 608 subjects> or = 40 years of age with normal BP (SBP<120 mmHg and DBP<80 mmHg, n=335) and PH (n=273) and who were without a history of hypertension, diabetes and any other known cardiovascular diseases underwent blood sampling for obtaining the lipid profile, and they also underwent 12-lead electrocardiography and echocardiography. RESULTS: Compared with the NTs, the PHs had significantly higher Sokolow-Lyon and Cornell voltage for ECG LVH, and they ahd a higher prevalence of ECG LVH (men: 16.9% vs 5.9%, women: 2.0% vs 1.0%, respectively). The PHs had a more increased left ventricular mass index (LVMI, Men: 118.1+/-24.4 g/m2 vs 102.0+/-19.1 g/m2, p=0.02; Women: 117.5+/-26.4 g/m2 vs 101.9+/-30.7 g/m2, p=0.02) and a more decreased LV diastolic function (E/A, Men: 1.14+/-0.6 vs 1.30+/-0.4, p=0.03; Wemen: 1.11+/-0.6 vs 1.25+/-0.5, p=0.03) on echocardiography than the NTs. CONCLUSION: The PHs were associated with a higher prevalence of ECG LVH and a more increased LVMI on echocardiography than that of the NTs. Therefore, we should pay earlier attention to diagnose and screen the pre-hypertensive group.

Tissue Doppler Image-Derived Myocardial Performance(Tei Index) as a Simple Assessment of Global Cardiac Function in Adults

BACKGROUND AND OBJECTIVES: A new Doppler time index of myocardial performance (the Tei index) has been studied as a useful predictor of global cardiac function. It is defined as (a-b)/b, where a is the interval between the end and onset of the mitral inflow, and b is the ejection time of the left ventricular outflow. However, the Doppler time intervals are not measured on the same cardiac cycle. SUBJECTS AND METHODS: We compared the tissue Doppler imaging (TDI)-derived Tei index, which can be measured on the same cardiac cycle, with the conventional Tei index as measured by pulsed wave Doppler method, in healthy persons (n=44), in patients having diastolic dysfunction with an E/E' ratio >10 (DD, n=56), and in patients having systolic dysfunction with an ejection fraction<50% (SD, n=10). At the septal and lateral mitral annulus from the apical 4-chamber view, the time interval between the end and onset of the mitral annular velocities during diastole (a') minus the duration of the systolic wave (b') divided by b', which is (a'-b')/b', is defined as the TDI-tei index. RESULTS: The TDI-Tei index and the conventional Tei index were significantly higher in the SD group than in the DD group, and they were also higher in the DD group than in the healthy controls. The TDI-Tei index at the septal and lateral annulus correlated well with the Tei index (r=0.71, r=0.65, respectively, p<0.001) and this showed a good correlation with other echocardiographic parameters of diastolic function. CONCLUSION: We demonstrated that the TDI-Tei index correlates well with the conventional Tei index along with having the advantage of simultaneous recording of the systolic and diastolic velocities in adults.

The Relation of Circadian Blood Pressure Variation to Left Ventricular Mass, Diastolic Function, and Dynamic QT Dispersion

BACKGROUND AND OBJECTIVES: A non-dipping pattern in hypertensive patients has been shown to be associated with a greater left ventricular (LV) hypertrophy, LV diastolic impairments and prolonged ventricular repolarization. The dynamic parameters of the QT dispersion (QTd) have been highlighted as markers of ventricular repolarization heterogeneity. The aim of this study was to demonstrate if the extent of nocturnal blood pressure (BP) fall was related to the LV mass, LV diastolic function and dynamic parameters of the QTd. SUBJECTS AND METHODS: 122 subjects, receiving electrocardiography, 24-hour ambulatory BP monitoring, 12 lead-24hr Holter monitoring and 2-dimensional Doppler echocardiography examinations, were enrolled. The subjects were classified as normotensive, dipper and non-dipper. The LV mass (LVM) and LV diastolic indices were measured. Using the QT Guard software, with 12 lead-24hr Holter monitoring, the QTd, mean QTd, QTd variation (the difference between the maximum minus the minimum QTd value observed over the recording time), QTd maximum (the maximum difference of QTd between consecutive beats) and QTd variability (QTd standard deviation) were analyzed. RESULTS: Of the 122 patients, 39 and 40 were placed in the dipper and non-dipper groups, respectively. The non-dipper group had a greater LVM index (LVMI) than the dipper group (p<0.01). The non-dipper group had greater increases in their A velocity (p<0.01), and more prolonged deceleration (p<0.01) and isovolumic relaxation (p<0.01) times than the dipper group. There were no significant differences in the QT and QTc interval between the 3 groups, but the QTd was much more increased in the non-dipper than the dipper and normotensive groups (p<0.01). For the dynamic parameters of the QTd, the QTd variation, QTd maximum and QTd variability were significantly increased in the non-dipper compared to the dipper and normotensive groups (p<0.05). Comparing the dipper and normotensive groups, there were no significant differences in the LVMI, LV diastolic indices, QTd and dynamic parameters of the QTd. CONCLUSION: The non-dipper group of hypertensive patients had a greater LVMI, more impaired LV diastolic function and greater increases in their QTd and dynamic parameters of the QTd compared to the dipper and normotensive groups, suggesting the possibility of a much greater chance of cardiovascular events, and their complications, in the non-dipper compared to the dipper group.

Lesion Characteristics of Mitral Valve Prolapse due to Myxomatous Degeneration in Korea: A Prospective Multicenter Study Using Echocardiography

BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.

Exercise Stress Echocardiography

No abstract available.

History of Echocardiography in Korea

No abstract available.

Abnormal Mitral Regurgitation Flow Velocity Spectra by Continuous Wave Doppler in Flail Mitral Valve

No abstract available.

Clinical Study on the Effect of Carteolol in Patients with Cardiac Neurosis

Fiftyeight patients with cardiac neurosis were studied to evaluate the effects of Carteolol 10mg/day. Systolic blood pressure was declined to 122.7+/-17.2mmHg from 137.1+/-23.2mmHg, diastolic blood pressure was declined to 79.6+/-11.1mmHg from 88.2+/-17.5mmHg. Pulse rate was decreased from 83.0+/-10.2 to 73.9+/-6.8per minute. The most frequent subjective symptom was palpitation (74.1%) and effectiveness of therapy for subjective symptom was 91.4%, for usefulness was 93.1%. There was no significant serious side reaction observed. We concluded that Carteolol therapy for the patients with cardiac neurosis could be useful and safe with a small dosage.

Comparison of Two-Dimensional Doppler Echocardiography and Fick Method with Cardiac Catheterization of Qp, Qs and Qp/Qs Ratio in Ventricular Septal Defect in Children

This study was performed to compare the amount of blood flow from left and right side heart using Doppler echocardiography and Fick method. The pulmonary blood flow (Qp), aortic blood flow (Qs) and Qp/Qs ratio were noninvasively evaluated by two dimensional Doppler echocardiography in 10 patients with ventricular septal defect in children, aged 2 years to 15 years (mean+/-SD=7.1+/-4.9 years). Cardiac catheterization was performed within 2 days after examination of Doppler echocardiography in all patients. Systemic and pulmonary blood flow was calculated by using Fick principle, based on measured oxygen consumption and measured blood oxygen saturation. The Doppler frequency shift was analyzed by computer system combined with Meridian Echocardiography System. Comparison of Qp, Qs and Qp/Qs ratio obtained by invasive methods and by two-dimensional pulsed wave Doppler echocardiography showed a correlation of 0.679 in Qp, 0.710 in Qs and 0.639 in Qp/Qs ratio (p<0.05).

Systolic Pressure Gradients in Aortic Valve Stenosis by Continuous Wave Doppler Echocardiography

No abstract available.

Clinical Study on Congestive Heart Failure

An analytical observation was carried out on clinical symptoms, physical findings, etiology, precipitating factors, pulse rate, and blood pressure manifested by 115 patients admitted to the Kyung hee university Hospital under the diagnosis of congestive heart failure for a period of October 1971 to September 1974. The results were as follows: 1. The disease affected female 1.4 times more frequently than male and occured most frequently in the 6th decade (26.1%), and its incidence decreased in the 7th decade (22.6%). 2. The important causes of congestive heart failure were hypertensive heart disease (39.7%), rheumatic heart disease (26.1%), cor pulmonale (13.9%), atherosclerotic heart disease (6.1%), postpartum heart failure (6.1%) and pericardial disease (3.5%). The unknown etiology was 3.5% of all cases. 3. The most common precipitatiog factors of the 106 patients of congestive heart failure were infections (59.5%), especially in the upper respiratory tract infection (37.8%). The physical exertion, pregnancy and labor, psychic stress, angina, myocardial infarction, and discontinuation of Tapazol and digitalis were followed. 4. The most common symptoms and signs were the dyspnea (93%), and the next common were pulmonary rales (65.2%), hepatomegaly (59.1%), distention of cervical vein (55.7%), pitting edema (44.3%) and cardiac murmur (38.3%) on admission. 5. The increased pulse rate over 101/min. was about 38.3%, but less than 60/min. was found in 4.3% only. 6. The electrocardiographic findings were abnormal except one case out of 107 cases. The left ventricular hypertrophy (48.1%), atrial fibrillation (24.5%), and bundle branch block (21.7%) were frequently observed. 7. The range of systolic blood pressure measured in 43 patients who had been suffered from hypertensive heart disease were disclosed that 221-240 mmHg (23.3%), 161-180mmHg (20.9%), and 181-200mmHg (20.9%) in order.

Clinical Study on Congestive Heart Failure

An analytical observation was carried out on clinical symptoms, physical findings, etiology, precipitating factors, pulse rate, and blood pressure manifested by 115 patients admitted to the Kyung hee university Hospital under the diagnosis of congestive heart failure for a period of October 1971 to September 1974. The results were as follows: 1. The disease affected female 1.4 times more frequently than male and occured most frequently in the 6th decade (26.1%), and its incidence decreased in the 7th decade (22.6%). 2. The important causes of congestive heart failure were hypertensive heart disease (39.7%), rheumatic heart disease (26.1%), cor pulmonale (13.9%), atherosclerotic heart disease (6.1%), postpartum heart failure (6.1%) and pericardial disease (3.5%). The unknown etiology was 3.5% of all cases. 3. The most common precipitatiog factors of the 106 patients of congestive heart failure were infections (59.5%), especially in the upper respiratory tract infection (37.8%). The physical exertion, pregnancy and labor, psychic stress, angina, myocardial infarction, and discontinuation of Tapazol and digitalis were followed. 4. The most common symptoms and signs were the dyspnea (93%), and the next common were pulmonary rales (65.2%), hepatomegaly (59.1%), distention of cervical vein (55.7%), pitting edema (44.3%) and cardiac murmur (38.3%) on admission. 5. The increased pulse rate over 101/min. was about 38.3%, but less than 60/min. was found in 4.3% only. 6. The electrocardiographic findings were abnormal except one case out of 107 cases. The left ventricular hypertrophy (48.1%), atrial fibrillation (24.5%), and bundle branch block (21.7%) were frequently observed. 7. The range of systolic blood pressure measured in 43 patients who had been suffered from hypertensive heart disease were disclosed that 221-240 mmHg (23.3%), 161-180mmHg (20.9%), and 181-200mmHg (20.9%) in order.

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: 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. 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. 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. 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.

Studies on the lung fluke, 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: 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. 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. 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.

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.