Left ventricular hypertrophy and diastolic function in children and adolescents with essential hypertension

이혜림,공영화,김경희,허준,강이석,송진영 대한고혈압학회 2015 Clinical Hypertension Vol.21 No.20

Introduction: Left ventricular hypertrophy and diastolic dysfunction in children and adolescents with essential hypertension tend to be underdiagnosed. The aims of this study were to investigate left ventricular hypertrophy and diastolic dysfunction in the subjects with essential hypertension defined by ambulatory blood pressure monitoring. Methods: A total of 38 Korean subjects aged 9–19 years without secondary causes of hypertension were reviewed. Ambulatory blood pressure monitoring was done in the 38 subjects to diagnose hypertension and gain the information of blood pressure pattern. The subjects were divided into two groups: a group with elevated blood pressure (BP) index (n = 29) and a group with normal BP index (n = 9). Two-dimensional ultrasound with M-mode imaging and tissue Doppler imaging were performed to measure left ventricular mass index and to assess the left ventricular diastolic dysfunction. Results: Left ventricular mass index(g/m2.7) was significantly higher in the group with elevated BP index than the group with normal BP index, but there were no differences in left ventricular diastolic dysfunction evaluated by E/A ratio and E/E’ ratio. Left ventricular mass index was related only with body mass index, while any of the ambulatory blood pressure monitoring parameters did not predict left ventricular hypertrophy. In terms of diastolic dysfunction in essential hypertension, E/E’ ratio in the subjects with left ventricular hypertrophy was higher than that in the other subjects without left ventricular hypertrophy. Discussion: Left ventricular mass index is significantly correlated with body mass index in children and adolescents with essential hypertension, and the diastolic dysfunction could be in higher risk in subjects with left ventricular hypertrophy.

새로운 Doppler Time Index를 이용한 좌심실 이완기능의 평가

김흥업,이상수,천일석,이상갑,이유판,이종덕,황진용,최동주,서봉관 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.6

좌심실의 이완기장애와 심장외막지방두께와의 연관성 연구

김선화(Sun Hwa Kim),강세식(se sik Kang),김정훈(Jung Hoon Kim) 한국방사선학회 2016 한국방사선학회 논문지 Vol.10 No.7

좌심실 이완기능 장애는 심근허혈이나 좌심실비대 등과 같은 심근질환이 잇는 환자에서 대부분 관찰되지만 심장질환이 없는 건강한 사람에서도 흔하게 관찰된다. 정상 심박출(수축기능)상태에서 좌심실의 이완기 장애 평가는 심부전의 진행과 예후에 영향을 줄 수 있다. 심장외막지방조직은 생리활성분자를 생성하는 대사활동기관으로 심혈관질환에 직접적으로 연관성이 있으며 이는 심근에 직접적으로 영향을 미쳐 이후 심장의 기능장애를 초래한다. 본 연구목적은 심장외막지방의 두께를 측정하여 정상의 수축기 기능인 상태에서 확장기(이완기) 기능장애의 평가와의 연관성을 연구하고자하였다. 연구결과 심장외막지방두께와 이완기 장애 유무가 통계적으로 유의한 수준에서 높은 연관성이 있는 것으로 분석되었다. 특히 심장외막지방두께 측정단면 EAT2에서 측정된 값과 이완기 장애평가방법 E 는 높은 상관관계가 있는 것으로 나타났다. 따라서 심장외막지방두께변화는 좌심실의 이완기능장애를 평가할 수 있는 예측인자로 사용될 수 있을 것으로 사료된다. Left ventricular diastolic dysfunction is mostly observed in patients with cardiac disease, such as myocardial ischemia or LVH, but linking is usually observed in healthy people without heart disease. Evaluation of left ventricular diastolic failure in normal cardiac output(systolic function) conditions can affect the progress and prognosis of heart failure. The direct relevance to the epicardial adipose tissue metabolism in cardiovascular engine for generating a bioactive moleculer, which leads to dysfunction of the later had a direct effect on myocardial heart. The purpose of this study is to measure the thickness of the epicardial adipose tissue was to study the relevance of the assessment of diastolic dysfunction in systolic function in normal conditions. Results epicardial adipose tissue thickness and diastolic dysfunction was analyzed to have a high correlation in a statistically significant level. In particular, the epicardial adipose tissue thickness measured at the measuring section EAT2 and diastolic function evaluation E was found to have a high correlation. Thus epicardial adipose tissue thickness variation is believed can be used as a predictor to evaluate the left ventricular diastolic dysfunction.

Risk Factors Associated with Left Ventricular Diastolic Dysfunction in Type 2 Diabetic Patients without Hypertension

노정현,도준형,이성윤,김태년,이혁,송화영,박정현,고경수,이병두,김동준 대한당뇨병학회 2010 Diabetes and Metabolism Journal Vol.34 No.1

Background: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). Methods: Participants in this study consisted of 65 type 2 diabetes patients (M : F = 45 : 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 ± 2.5 kg/m2) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. Results: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 ± 2.5 vs. 50.5 ± 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 ± 0.7 vs. 24.6 ± 0.3 kg/m2; P < 0.01) and diabetes duration was longer (9.65 ± 1.48 vs. 4.71± 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A1C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex,and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). Conclusion: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.

Original Articles : Risk Factors Associated with Left Ventricular Diastolic Dysfunction in Type 2 Diabetic Patients without Hypertension

( Jung Hyun Noh ),( Joon Hyung Doh ),( Sung Yun Lee ),( Tae Nyun Kim ),( Hyuk Lee ),( Hwa Young Song ),( Jeong Hyung Park ),( Kyung Soo Ko ),( Byoung Doo Rhee ),( Dong Jun Kim ) 대한당뇨병학회 2010 Diabetes and Metabolism Journal Vol.34 No.1

Background: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). Methods: Participants in this study consisted of 65 type 2 diabetes patients (M: F = 45: 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 ± 2.5 kg/m2) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. Results: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 ± 2.5 vs. 50.5 ± 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 ± 0.7 vs. 24.6 ± 0.3 kg/m2; P < 0.01) and diabetes duration was longer (9.65 ± 1.48 vs. 4.71 ± 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A1C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex, and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). Conclusion: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.

Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes

Hong-Kyun Park,김범준,Chang-Hwan Yoon,Mi Hwa Yang,Moon-Ku Han,Hee-Joon Bae 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.2

Background and Purpose Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated. Methods In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e’) was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e’ as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year. Results Among included patients, E/e’ was 10.6±6.4: E/e’ <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e’ ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction. Conclusions LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.

Left Atrial Volume Index as Indicator of Left Ventricular Diastolic Dysfunction: Comparation between Left Atrial Volume Index and Tissue Myocardial Performance Index

Fulvio Cacciapuoti,Anna Scognamiglio,Venere Delli Paoli,Concetta Romano,Federico Cacciapuoti 한국심초음파학회 2012 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.20 No.1

Background: To point out a possible correlation between left atrial volume index (LAVI) and left ventricular (LV) diastolic time interval to better define LV diastolic dysfunction, this study was performed. Methods: In 62 hypertensive-hypertrophic patients without LV systolic dysfunction, LV volumes, myocardial mass index,ejection fraction% (EF%) and LAVI were measured by two-dimensional echocardiography. Instead, tissue Doppler echocardiography (TDE) was used to measure myocardial performance index (MPI) and its systo-diastolic time intervals, such as:iso-volumetric contraction time (IVCT); iso-volumetric relaxation time (IVRT); ejection time. LAVI, TDE-MPI and time intervals where also measured in 15 healthy controls, to obtain the reference values. Results: Results shown a significant increase of LV volumes in hypertensives in comparison to the control group (p < 0.05). LV mass index also augmented (p < 0.001). Instead, EF% not significantly changed in hypertrophic patients in comparison with healthy controls. LAVI raised in hypertensives wih left ventricular hypertrophy, whereas IVCT resulted within the normal limits. On the contrary, IVRT significantly raised. Accordingly, MPI resulted higher in controls. Conclusion: LAVI, MPI and its time intervals appear as reliable tools to non-invasively individualize LV diastolic dysfunction in systemic hypertension, in absence of mitral valve disease.

좌심실 수축 기능부전을 가진 급성 심근경색 환자에서 ST 분절 변화가 미치는 영향

설상훈 ( Sang Hoon Seol ),이은주 ( Eun Ju Lee ),박영진 ( Young Jin Park ),조환진 ( Hwan Jin Cho ),양태현 ( Tae Hyun Yang ),김성만 ( Seong Man Kim ),김대경 ( Dae Kyeong Kim ),김두일 ( Doo Il Kim ),김동수 ( Dong Soo Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

목적: 급성 심근경색 환자에서 ST 분절 상승의 영향에 대해서는 많은 연구가 이루어졌으나 좌심실 수축 기능부전을 동반한 심근경색 환자에서는 연구되지 않았다. 방법: 2004년 1월부터 2006년 6월까지 좌심실 구혈률이 40% 이하의 수축 기능부전을 가진 급성 심근경색 환자 117명을 대상으로 하였다. ST 분절 상승 심근경색 77명과 비 ST 분절 상승 심근경색 환자 40명을 임상적 특징과 관상동맥조영술 결과 및 입원기간 및 1년 주요 심장사건(심장사망, 새로운 비치명적 심근경색, 목표혈관 재관류술, 심부전)을 후향적으로 분석하였다. 결과: ST 분절 상승에 따른 양 군의 기본적인 임상특징의 차이는 없었다. 관상동맥조영술의 TIMI flow 0 grade는 STEMI군에서 많았고(49.4% vs. 15.0%, p<0.01), 다혈관 질환은 NSTEMI군이 많았다(39.0% vs. 65.0%, p=0.01). 하지만 입원 중 심장 사망률과 주요 심장사건은 비슷했다(cardiac death 6.5% vs. 2.5%, p=0.66, MACE 19.5% vs. 22.5%, p=0.81). 1년 심장 사망률과 주요 심장사건에서도 의미있는 차이를 보이지 않았다(cardiac death 14.4% vs. 7.5%, p=0.37, MACE 33.8% vs. 30.0%, p=0.68). 결론: 좌심실 수축기능이 저하된 급성 심근경색 환자에서 ST 분절의 상승은 입원기간과 장기적인 예후에 영향을 미치지 않았다. Background/Aims: Although the impact of ST segment elevation in patients with acute myocardial infarction (MI) has been studied, little information is available on the impact of ST segment elevation in the patients with acute MI and left ventricular systolic dysfunction. Methods: We retrospectively analyzed the baseline clinical and angiographic characteristics and the in-hospital and 1-year clinical outcomes of 117 consecutive patients who were diagnosed with acute MI and who had a left ventricular ejection fraction of less than 40%, and these patients were treated from January 2004 to June 2006 at Busan Paik Hospital. Coronary angiography at the index hospitalization and the major adverse cardiac events (MACEs), including cardiac death, non-fatal reinfarction, target vessel revascularization (TVR), and heart failure, were compared between the 77 patients with ST segment elevation myocardial infarction (STEMI) and the 40 patients with non-ST segment elevation myocardial infarction (NSTEMI). Results: Overall, the baseline clinical characteristics were similar between the two groups. On the coronary angiography, thrombolysis in myocardial infarction 0 flow was more common in the STEMI group as compared to the NSTEMI group (p<0.01) and the NSTEMI group had more frequent multivessel disease compared to the STEMI group (p=0.01). However, the in-hospital cardiac deaths and MACEs were not different on comparison between the two groups (p=0.66, p=0.81, respectively). The one-year cardiac deaths and MACEs were not significantly different on comparison between the two groups (p=0.37, p=0.68, respectively). Conclusions: This study demonstrated that ST segment elevation had no influence on in-hospital and the long term outcomes of patients with acute MI and left ventricular systolic dysfunction.(Korean J Med 74:632-639, 2008)

Tei Index를 이용한 경도의좌심실 이완 기능 장애 분류 모델 평가

김수민,예수영 한국방사선학회 2023 한국방사선학회 논문지 Vol.17 No.5

In this paper, TI was measured to classify the presence or absence of mild left ventricular diastolic dysfunction. Of the total 306 data, 206 were used as training data and 100 were used as test data, and the machine learning models used for classification used SVM and KNN. As a result, it was confirmed that SVM showed relatively higher accuracy than KNN and was more useful in diagnosing the presence of left ventricular diastolic dysfunction. In future research, it is expected that classification performance can be further improved by adding various indicators that evaluate not only TI but also cardiac function and securing more data. Furthermore, it is expected to be used as basic data to predict and classify other diseases and solve the problem of insufficient medical manpower compared to the increasing number of tests.

좌심실 기능부전을 동반한 만성 관상동맥질환에서 Dobutamine 심초음파의 역할

정보영,임세중,최승혁,고충원,하종원,정남식,유경종,강면식 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8