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Pericardial Effusion and Pericardiocentesis: Role of Echocardiography
정해억 대한심장학회 2012 Korean Circulation Journal Vol.42 No.11
Pericardial effusion can develop from any pericardial disease, including pericarditis and several systemic disorders, such as malignancies,pulmonary tuberculosis, chronic renal failure, thyroid diseases, and autoimmune diseases. The causes of large pericardial effusion requiring invasive pericardiocentesis may vary according to the time, country, and hospital. Transthoracic echocardiography is the most important tool for diagnosis, grading, the pericardiocentesis procedure, and follow up of pericardial effusion. Cardiac tamponade is a kind of cardiogenic shock and medical emergency. Clinicians should understand the tamponade physiology, especially because it can develop without large pericardial effusion. In addition, clinicians should correlate the echocardiographic findings of tamponade, such as right ventricular collapse, right atrial collapse, and respiratory variation of mitral and tricuspid flow, with clinical signs of clinical tamponade, such as hypotension or pulsus paradoxus. Percutaneous pericardiocentesis has been the most useful procedure in many cases of large pericardial effusion,cardiac tamponade, or pericardial effusion of unknown etiology. The procedure should be performed with the guidance of echocardiography.
Strain 및 Strain Rate 심장초음파를 이용한 수축기 심부전과 이완기 심부전의 감별
정해억,윤호중,신우승,김범준,박철수,조은주,임상현,전희경,백상홍,감동헌,승기배,김재형,홍순조,최규보 대한심장학회 2004 Korean Circulation Journal Vol.34 No.11
Background and Objectives:Diastolic heart failure (DHF) is defined as clinical evidences of heart failure, with a normal ejection fraction (EF) and abnormal diastolic function. However, the distinction between DHF and SHF is often difficult. Strain (S) and strain rate (SR) echocardiography can measure the regional myocardial function as a magnitude and rate of deformation. The hypothesis“myocardial velocity (Vel), S & SR can provide additional information for differentiation DHF from SHF”was assessed. Subjects and Methods:30 patients with symptomatic HF and low EF (SHF group) and 27 with symptomatic HF, and normal EF and diastolic dysfunction (DHF group) were enrolled. 37 age-and sex-matched control subjects were recruited. Conventional echo and regional indices (Vel, S and SR), measured at the mid septum and posterior wall, were obtained. Results:Almost all clinical and echo indices of control were different between the two HF groups. The EF, LV mass, S’ and DT in DHF were greater than those with SHF. The LA size, diastolic dysfunction grades; E, A, E/A, E’, A’ and E/E’, were not different between the two HF groups. In the regional indices, the peak S (long axis: 12.0±5.4 vs. 17.6±5.9%, radial axis: 26.4±12.7 vs. 46.0±16.7%) and systolic Vel (long axis: 2.6±0.8 vs. 3.6±0.9 cm/s, radial axis: 2.1 (1.2 vs. 3.7±1.4 cm/s) with SHF were significantly lower than those with DHF. However, the SR of the two groups was not different. The best cutoff values of peak S were 13.7% (long axis) and 32.9% (radial axis), and the systolic Vel were 3.0 cm/s (long axis) and 2.8 cm/s (radial axis). Conclusion:The peak S and systolic Vel may be useful indices for differentiating DHF from SHF. A similarly decreased SR in the two HF groups suggests that DHF has decreased myocardial contractility, despite the normal EF. 배경 및 목적: 이완기 심부전의 진단기준은 임상적인 심부전 증상과 징후, 정상적 심구혈율 그리고 비정상적인 이완기능을 보일 경우로 정의한다. 그러나 상기한 진단기준만으로 수축기 심부전과 이완기 심부전을 구분짓기 곤란한 경우를 임상에서 관찰할 수 있다. 기존의 조직 도플러 영상에서 파생된 strain 및 strain rate 심장초음파는 국소심근의 변형의 양과 속도를 측정하여 실시간 국소심근의 기능을 평가할 수 있다. 저자들은 심부전증세를 보인 환자에서 국소심근의 심근속도와 strain 및 strain rate가 수축기 심부전과 이완기 심부전을 구분짓는데 도움을 줄 수 있을지 연구해 보았다. 방 법: 심부전증세로 응급실로 내원하여 통상적 심초음파 검사와 더불어 strain 및 strain rate 심장초음파 검사를 시행받은 환자들중 심구혈율이 45%미만인 환자들은 수축기 심부전군(n=30, 평균 48세)으로, 심구혈율이 55% 이상이며 승모판막 유입혈류 도플러 파형분석상 이완기능장애를 보였던 환자들은 이완기 심부전군(n=27, 평균 54세)으로 분류하고 정상군(n=37, 평균 50세)을 대비하여 세군간 심초음파상 여러 지수들과 함께 국소심근 기능지수들(심근속도, strain 및 strain rate)을 비교하였다. 결 과: 정상군은 임상적 특징과 심구혈율등 대부분의 심장초음파상 지표들에 있어 두 심부전군과 의미있는 차이를 보였다. 두 심부전군 사이의 비교에서는 좌심실 직경 (62.8±7.0 vs 53.4±5.8 mm)은 수축기 심부전군이 컸으나, 심구혈율(34.2±6.5 vs 61.9±9.1%), 심실질량(184.9±65.6 vs 226.0±36.6 gram), S’(3.9±0.8 vs 6.9±2.4 cm/s), 감속시간(136.5±56.6 vs 191.9±49.0 msec)은 이완기 심부전군이 컸다. 심방크기, 이완기장애 등급, E, A, E/A, E’, A’, E/E’ 등은 양군간 차이가 없었다. 국소심근기능 지수중 peak strain(장축향 12.0±5.4 vs 17.6±5.9%, 방사향 26.4±12.7 vs 46.0±16.7%)과 수축기 심근속도(장축향 2.6±0.8 vs 3.6±0.9 cm/s, 방사향 2.1±1.2 vs 3.7±1.4cm/s)만이 두 심부전군 사이에 의미있는 차이를 보이며 수축기 심부전군이 적었다. 반면 strain rate는 두군간에 의미있는 차이가 없었다. 이완기 심부전과 수축기 심부전을 감별키 위한 가장 우수한 절단값은 peak strain의 경우 장축향 13.7%, 방사향 32.9%이었고 수축기 심근속도는 장축향 3.0cm/s, 방사향 2.8cm/s이었다. 결 론: Peak strain과 수축기 심근속도가 임상에서 두 심부전을 감별하는데 도움을 줄 수 있을 것으로 사료된다. 두 심부전군의 strain rate가 차이없이 감소되어 있는 것은 이완기 심부전이 심구혈율은 정상이지만 심근수축력이 감소되어 있음을 시사한다.
정해억 ( Hae Ok Jung ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
Pulmonary hypertension is a hemodynamic and pathophysiological condition defined as an increase in mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization. Clinical conditions of pulmonary hypertension are classified into 6 clinical groups with different pathological, pathophysiological, prognostic and therapeutic features. The treatment strategy is remarkably different among 6 clinical groups. Group 1 (pulmonary arterial hypertension) is the only clinical group with specific drug therapy and an evidence-based treatment algorithm is provided. Following descriptions are about the clinical classification of pulmonary hypertension updated at 4th World symposium of pulmonary hypertension held in 2008. (Korean J Med 78:1-4, 2010)
Anatomic Variants Mimicking Pathology on Echocardiography: Differential Diagnosis
김미정,정해억 한국심초음파학회 2013 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.21 No.3
Differentiation of normal from abnormal findings is critical in echocardiography. Anatomic variants occurring in normal cardiac developments often simulate pathologic entities. This review focuses on the differential diagnosis of normal anatomic structures from pathologic ones in echocardiography.