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Blood Pressure Variation and Cardiovascular Risks
임세중 대한심장학회 2008 Korean Circulation Journal Vol.38 No.3
There are short-term and long-term variations seen in blood pressure. An abnormal pattern in cyclic variations of blood pressure (diurnal or seasonal) correlates well with an increased cardiovascular risk for hypertension, regardless of the resting blood pressure level. Increased blood pressure reactivity to external stimuli is also associated with a higher cardiovascular risk, and may be a significant determinant of cyclic blood pressure variations. A further understanding of the pathophysiological basis of abnormal blood pressure variations is recommended, and the physiological factors should be considered as new therapeutic targets. (Korean Circ J 2008;38:131-134)
임세중,하종원,최동훈,고충원,이동일,편욱범,전국진,안신기,이문형,장양수,이종두,정남식 한국심초음파학회 2001 Journal of Cardiovascular Ultrasound Vol.9 No.1
Background:Unlike 99mTc-Sestamibi, microbubbles used during myocardial contrast echocardiography (MCE) exist only in the vascular space. Therefore, there may be a difference in the pattern of myocardial perfusion between MCE and 99mTc-Sestamibi Single-Photon Emission Computed Tomography (SPECT) in acute myocardial infarction (AMI). Objectives:The purpose of this study was to assess myocardial perfusion using MCE with intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin microbubbles (IV MCE), and to compare it with SPECT and MCE with intracoronary injection of sonicated Hexabrix (IC MCE). Methods:Seventeen patients with AMI (male 13, age 59.5±8.8 years, anterior MI 10) underwent IV MCE at 8.1±3.7 days after onset. SPECT and IC MCE were also performed at 1.2±1.0 days and 2.0±1.5 days from IV MCE respectively. Any revascularization procedures were not performed between three studies. Perfusion defect by three methods was scored semiquantitativelyas 1:normal perfusion, 0.5:moderate defect, and 0:severe defect at 16 segments of the left ventricle. Results:1) Perfusion defect in infarction territory was detected in 15 patients with SPECT, 12 patients with IV MCE and 11 patients with IC MCE. 2) Concordance of perfusion score at each segment was 93% between IV MCE and IC MCE, 65% between IV MCE and SPECT, and 64% between IC MCE and SPECT. 3) With IV MCE, perfusion defect was observed in all 32 segments which were considered as having defect (score 0 and 0.5) by IC MCE. However, defect by IV MCE was found only in 31 out of 108 segments considered as having defect by SPECT. Conclusion:In the assessment of myocardial perfusion in pts with AMI, IV MCE and IC MCE showed similar results. However, there was some discrepancy in the extent of perfusion defect between MCE studies and SPECT.
경흉부 심초음파를 이용한 관동맥 혈류속도 예비력에 의한 경피적 관동맥 성형술후 재협착의 비침습적인 진단
임세중,고영국,강석민,하종원,최동훈,장양수,정남식 대한심장학회 2008 Korean Circulation Journal Vol.38 No.6
Background and Objectives: Coronary flow reserve (CFR) decreases in the presence of significant coronary stenosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. Subjects and Methods: We studied 99 patients (71 males/28 females, mean age 58±11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0±1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 μg·kg-1·min-1). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. Results: CFRs in 69 patients without restenosis were 2.55±0.99 at 48 hours after PCI and 2.93±1.00 at follow-up (p<0.005). CFRs in 30 patients with restenosis (>50% in diameter stenosis) decreased significantly from 2.70± 1.01 at 48 hours after PCI to 1.98±0.91 at follow-up (p<0.001). There was a significant difference in CFR change (ratio of CFRfollowup/CFRinitial) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR= 0.76, AUC for CFR change=0.82]. Conclusion: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI. Background and Objectives: Coronary flow reserve (CFR) decreases in the presence of significant coronary stenosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. Subjects and Methods: We studied 99 patients (71 males/28 females, mean age 58±11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0±1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 μg·kg-1·min-1). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. Results: CFRs in 69 patients without restenosis were 2.55±0.99 at 48 hours after PCI and 2.93±1.00 at follow-up (p<0.005). CFRs in 30 patients with restenosis (>50% in diameter stenosis) decreased significantly from 2.70± 1.01 at 48 hours after PCI to 1.98±0.91 at follow-up (p<0.001). There was a significant difference in CFR change (ratio of CFRfollowup/CFRinitial) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR= 0.76, AUC for CFR change=0.82]. Conclusion: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.
임세중 ( Se Joong Rim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
Although increased intima-media thickness of common carotid artery independently predicts cardiac outcomes, the clinical significance of carotid intima-media thickness in patients with diagnosed coronary artery disease is still controversial. However, the presence of carotid plaques is clearly associated with an increased risk of cardiovascular events in patients with coronary artery disease, and more aggressive medical treatment is required in this occasion. In addition, carotid disease is commonly associated with coronary artery disease, and the detection of asymptomatic significant carotid stenosis in patients with coronary artery disease may modify treatment strategy and reduce the risk of stroke. Therefore, the screening of carotid atherosclerosis using ultrasound can be helpful in patients with coronary artery disease. (Korean J Med 73:1-3, 2007)