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심근조영초음파 검사를 이용한 측부혈류의 관동맥조영 검사 등급에 따른 심근관류의 평가
권준(Jun Kwan),홍의수(Eui Soo Hong),김대혁(Dae Hyeok Kim),전민재(Min Jae Jeon),서정기(Jeong Kee Seo),박금수(Keurm Soo Park),이우형(Woo Hyung Lee) 대한내과학회 2000 대한내과학회지 Vol.58 No.2
N/A Background : A collateral flow can be assessed and graded by coronary angiography, however, the technique does not provide any information about perfusion. Myocardial contrast echocardiography (MCE) can assess collateral perfusion and has superior spatial resolution in defining its distribution. Objective : To investigate the difference of transmural perfusion according to the angiographical collateral grade in normal myocardium, we performed MCE of collateral artery in 16 patients (m : f = 11 : 5, age: 57±13yrs.) with angina and compared the results with the angiographical grades. Methods : In six patients with preexisting collaterals on baseline angiography, we performed MCE after intracoronary injection of sonicated Hexabrix. For 10 patients without preexisting collaterals on baseline angiography, we performed angiography, MCE for recruited collateral arteries during balloon inflation of stenotic coronary arteries (2 times for 120sec.). For 12 patients who underwent PTCA, we performed pressure wire simultaneously with angiography and MCE for recruited collateral arteries during balloon inflation. Fractional collateral flow(FCF) was defined by the ratio of coronary wedge pressure to proximal pressure(Pw/Pa). Angiographical collaterals were graded according to 'Rentrop' criteria(grade 0-3). Transmural thickness (TMT) and enhanced myocardial thickness (EMT) of an enhanced segment on MCE were measured at diastolic phase. The depth of collateral perfusion was estimated by collateral perfusion index (CPI) that was the ratio of EMT to TMT. Results : There were significant differences of CPI with respect to angiographical grades according to one way ANOVA test (p<0.05). One of five patients who had no recruited collaterals showed partial enhancement confined to the epicardium with CPI of 0.24. There was significant correlation between the angiographical grade and the CPI with Spearman's Rho value of 0.93(p<0.0001). The angiographical grades were significantly correlated with FCF with the Spearman's Rho value of 0.87(p=0.0002). There was also significant correlation between FCF and CPI with Pearson's r=0.81(p=0.0016). Conclusion : The higher the angiographical collateral grade is, the higher the collateral pressure and the deeper the fractional transmural perfusion from epicardium into endocardium gets. (Korean J Med 58:170-179, 2000)
김성은,최원식,이우형,홍의수,현인영,서정기,김대혁,권준,박금수 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.5
Purpose: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. Materials and Methods: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. Results: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). Conclusion: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.
심방세동 환자에서 신동맥 색전증에 의한 급성 신부전 2예
문태훈,김문재,김인한,홍의수 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.3
Renal artery occlusion, whether segmental or total, is accompanied by markedly impaired renal function. Renal artery embolism most frequently occurs in patient with pre-existing cardiac or vascular disease. The clinical picture has been well documented and is fairly characteristic: there is an abrupt onset of severe upper abdominal or flank pain with nausea and vomiting, albuminuria, and often hematuria. We have recently experienced in two cases of renal artery embolism associated with mitral stenosis and atrial fibrillation. The patients suffered from sudden onset of severe intractable abdominal and flank pain. The renal scans showed delayed excretion of the kidney and abdominal CT scans showed low density areas of the affected kidneys. We treated them by anticoagulation therapy and they showed improvement of renal function.
관동맥 환자에서의 PTCA 시행 후 Coronary Flow Reserve 와 Fractional flow Reserve 치의 비교
최문희,이우형,서정기,박금수,홍의수,권준,조성욱 대한내과학회 1999 대한내과학회지 Vol.56 No.1
Objectives : Severity of coronary artery stenosis has been defined in terms of geometric dimensions, pressure gradient-flow relations, resistance to flow and coronary flow reserve(CFR) after maximum arteriolar vasodilation. Myocardial fractional flow reserve(FFR) is a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography. We compared the relationship between FFR and CFR after PTCA and the residual stenosis with FFR and CFR in the patients with acute myocardial infarction (AMI) and angina. Methods : The study population consisted of 25 patients with AMI and 18 patients with angina. All AMI patients had successful restoration of infarc-related artery by thrombolysis or direct PTCA. Doppler index was measured using 0.014 inch Doppler wire 15 minutes after successful restoration of infarc- related artery. Hyperemic index was measured after intracoronary injection of adenosine(16-18ug). Baseline and hyperemic distal coronary artery pressure was measured using 0.014 inch pressure wire with advancing the wire distal to the lesion and simultaneous proximal aortic pressure was measured using guiding catheter. Results : 1) Post-interventional FFR and CFR were 0.91±0.09 and 1.87±0.45 in AMI and 0.93±0.06 and 2.73±0.67 in angina. There was no significant correlation between FFR and CFR in AMI and angina(p=NS). CFR showed the weak correlation with hyperemic distal pressure(hPd) in AMI(p=0.04) and FFR with hDSVR in angina(p=0.04). FFR and CFR were not correlated with mean blood pressure and heart rate(p=NS). 2) FFR and hyperemic pressure gradient had the close correlation with residual stenosis after successful PTCA in AMI and angina(p$lt;0.001). Baseline pressure gradient also showed weak correlation with FFR(p$lt;0.05). 3) CFR was 1.87±0.45 in AMI and 2.73±0.67 in angina with significant difference between two groups (p$lt;0.001) and FFR was 0.91±0.09 in AMI and 0.93±0.06 in angina without difference(p=NS). hPa and hPd showed the significant difference between the two groups(p$lt;0.05). Conclusion : FFR seems to be a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography.