급성 심근 경색 환자에서 좌심실 기능 , 좌심방 기능 및 폐정맥 혈류 양상의 변화

김복근(Bok Kun Kim),주승재(Seung Jae Joo),배영환(Young Hwan Bae),박선미(Sun Mi Park),최진(Jin Choi),최휘(Hwi Choi),윤병철(Byung Chul Yoon),오원섭(Won Sub Oh),구양훈(Yang Hwun Koo),홍성준(Sung Jun Hong),김진(Jin Kim),박능화(Neung Hwa 대한내과학회 1997 대한내과학회지 Vol.53 No.6

N/A Objectives: Acute myocardial infarction decreases left ventricular systolic and diastolic function. Left ventricular diastolic function is usually assessed with the left ventricular filling patterns. Abnormal left ventricular tilling patterns after acute myocardial infarction can be classified as relaxation abnormality, pseudonormalization, and restriction, but sometimes the differentiation between pseudonormalization and the normal pattern is difficult. To assess left ventricular systolic and diastolic function, and left atrial function after acute myocardial infarction, M-mode, two-dimensional, pulsed Doppler, and automated border detection echocardiography were performed. To complement the information obtainable from the mitral flow patterns, pulmonary venous flow patterns were also analysed to assess the left ventricular filling patterns. Methods: Twenty six patients (mean age 60 ±10) underwent echocardiographic examination 7 to 14 days after acute myocardial infarction. Twenty healthy persons(mean age 57±12) were served as a control group. Various indexes were obtained with M-mode, two-dimensional, pulsed Doppler, and automated border detection echocardiography Results: 1) Mean age, sex ratio, heart rate, body mass index were not different between patient and control groups. There were five patients with hypertension in patient group. Left ventricular mass index of patient group was greater than that of control group (163±43g/㎡ vs. 109±22g/㎡, P<0.0D1). 2) Patients had decreased cardiac index(2.35±0.53L/min/㎡ vs. 3.02±0.70L/min/㎡, P<0.05) and left ventricular ejection fraction(55±12% vs. 62± 0.4%). There was a negative correlation between left ventricular regional wall motion score and ejection fraction(r=-0.71; P<0.001). 3) In patients, peak mitral flow velocity at atrial contraction(A) was higher(73±11cm/sec vs. 63±13 cm/sec; P<0.01), E/A ratio was lower(0.77±0.28 vs. 1.01±0.25; P<0.01), and left ventricular isovolumic relaxation time was longer(126±34msec vs. 97±21msec; P<0.005). 4) Patients had smaller systolic time-velocity integral(13.0±3.30cm vs. 14.8±2.83cm, P=0.056) and diastolic time--velocity integral(9.18±2.21cm vs. 11.2±2.77cm, P<0.01). 5) Relaxation abnormality of left ventricular filling patterns, which was classified by E/A ratio of less than 1, was more frequently founded in patients than in controls(45%). Four patients had E/A ratio of greater than 1; SV/DV ratio was greater than 1 in two and less than 1 in others. 6) End-diastolic area of left atrium(minimal area) was larger in patients(11±1.9㎠ vs. 9.6+1.4㎠, P<0.01). Therefore, patients showed decreased atrial emptying index and expansion index. Patients had a greater extent of left atrial area decrease resulting from atrial contraction. Conclusion: Patients with acute myocardial infarction showed a decreased left ventricular systolic function and a relaxation abnormality 7 to 14 days after attack, Minimal area of left atrium increased and left atrial function decreased.

심근경색 부위에 따른 좌.우 심실기능의 차이 : 게이트 심장혈액풀스캔에 의한 분석 An ECG-Gated Blood Pool Study

천경아,이재태,안병철,이상우,조용근,채성철,전재은,박의현,이규보 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.6

성인 동맥관 개존증 수술 후 좌심실 기능 저하의 위험 인자 분석

윤태진 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.10

Left ventricular dysfuction is common in immediate postoperative periods after surgical correction of heart diseases with chronic left ventricular volume overload. We speculated postoperative changes of left ventricular volume and unction in patients with patent ductus osus(PDA) who had underwent surgical repair at ages older than 16 years. Factors influencing postoperative left ventricular volume and function were also analyzed. Material and Method: From August 1989 to August 1999 thirty-siz adult patients with PDA 28 females and 8 males. were enrolled in this study. Their age ranged from 16 years to 57 years(mean :32 years). Types of surgical repair were division with primary closure in 22, division with patch closure in 6, internal obliteration using cardiopulmonary bypass in 4 and ligation in 4. Aortic clamping was combined during surgical repair in 22(61%) and cardiopulmonary bypass was used in 8(22%) Two-dimensional echocardiography studies were performed in 34(94%) preoperatively and in 25(66%) immediate postoperatively to assess postoperative changes of left ventricular internal dimensions. left ventricular volume and ejection fraction. Duration of postoperative follow-up ranged from 1 month to 99 months (mean:22 months) and 10 patients underwent 16 echocardiographic evaluation during this period Result : Preoperative and postoperative left ventricular systolic dimensions(LVIDs) were 42$\pm$8.0mm and 42$\pm$8.3mm left ventricular diastolic dimensions(LVIDd) were 64$\pm$10.0mm and 56$\pm$7.4mm left ventricular end systolic volumes(LVESV) were 62$\pm$19cc (z=1.87$\pm$0.06) and 59$\pm$24cc(z=1.78$\pm$0.08) left ventricular end diastolic volumes(LVEDL) were 169$\pm$40cc(z-1.17$\pm$0.1) and 112$\pm$29cc(z=0.85$\pm$0.1) and ejection fractions(EF) were 66$\pm$6.7% and 48$\pm$12.6% respectively. There were statistically significant differences between preoperative and postoperative values in LVDIDd(p=0.001) LVEDV(p=0.001) and EF(p=0.0001) while no significant difference is LVIDs and LVESV. Postoperative depression of ejcection fraction was significantly related with z-score of preoperative LVESV and LVEDV by univariateanalysis while LVEDV only was significant risk factor for postoperative LV dysfunction by multiple regressioin analysis ($\Delta$LVEF=-13.3-4.62$\times$LVEDV(z), p=0.001) During the follow-up periods ejection fractions become normalized in all except one patients. Conclusion ; Left ventricular function is usually deteriorated after the surgical correction of PDA in adult age and preoperative LVEDV is a major determinant of postoperative LV function.

How Does the Left Ventricle Work? Ventricular Rotation as a New Index of Cardiac Performance

송재관 대한심장학회 2009 Korean Circulation Journal Vol.39 No.9

Although simple cylindrical or ellipsoidal left ventricular (LV) geometry with transverse or circumferential muscle contraction has been traditionally used to estimate LV performance, the estimated LV ejection fraction (EF) with muscle fiber shortening up to 20% is less than 50% of maximum, which is lower than the normal EF observed in routine clinical practice. Thus, oblique fiber orientation and LV rotation, in addition to radial thickening and longitudinal shortening, is predicted as an essential component of effective LV pumping. This was confirmed by animal experiments using surgically implanted markers or invasive sonomicrometry. Demonstration of the muscle band extending from the pulmonary artery to the aorta, which connects the ventricular myocardium, both right ventricle and LV as a continuous band (muscle band theory) provides an anatomical backbone of helical configuration of the cardiac muscle band with descending and ascending segments wrapping the LV apex. Moreover, sequential, non-simultaneous, activation and contraction of the helicoids muscle band contributes to LV rotation or twist motion. Recently, magnetic resonance imaging and speckle tracking echocardiography (STE) techniques have provided an excellent noninvasive way to measure LV rotation and twist, which is expected to contribute to a more thorough evaluation of both LV systolic and diastolic function. Initial animal experiments showed that quantification of apical rotation or LV twist using STE is more accurate for estimating LV systolic function than conventional EF under a variety of LV inotropic conditions, irrespective of coronary ligation. As de-rotation or the untwisting rate can also be measured by STE, the role of ventricular untwisting as a temporal link between LV relaxation and suction can be addressed. Further clinical investigations are needed to determine the real clinical impact of these new indices of LV mechanical function. Although simple cylindrical or ellipsoidal left ventricular (LV) geometry with transverse or circumferential muscle contraction has been traditionally used to estimate LV performance, the estimated LV ejection fraction (EF) with muscle fiber shortening up to 20% is less than 50% of maximum, which is lower than the normal EF observed in routine clinical practice. Thus, oblique fiber orientation and LV rotation, in addition to radial thickening and longitudinal shortening, is predicted as an essential component of effective LV pumping. This was confirmed by animal experiments using surgically implanted markers or invasive sonomicrometry. Demonstration of the muscle band extending from the pulmonary artery to the aorta, which connects the ventricular myocardium, both right ventricle and LV as a continuous band (muscle band theory) provides an anatomical backbone of helical configuration of the cardiac muscle band with descending and ascending segments wrapping the LV apex. Moreover, sequential, non-simultaneous, activation and contraction of the helicoids muscle band contributes to LV rotation or twist motion. Recently, magnetic resonance imaging and speckle tracking echocardiography (STE) techniques have provided an excellent noninvasive way to measure LV rotation and twist, which is expected to contribute to a more thorough evaluation of both LV systolic and diastolic function. Initial animal experiments showed that quantification of apical rotation or LV twist using STE is more accurate for estimating LV systolic function than conventional EF under a variety of LV inotropic conditions, irrespective of coronary ligation. As de-rotation or the untwisting rate can also be measured by STE, the role of ventricular untwisting as a temporal link between LV relaxation and suction can be addressed. Further clinical investigations are needed to determine the real clinical impact of these new indices of LV mechanical function.

Left Ventricular Function in Children and Adolescents With Type 1 Diabetes Mellitus

김은하,김여향 대한심장학회 2010 Korean Circulation Journal Vol.40 No.3

Background and Objectives: Adult studies have reported that patients with diabetes mellitus (DM) show ultrastructural and functional myocardial deterioration. The aim of this study was to assess whether cardiac functional deterioration can be detected in pediatric patients with type I DM and whether or not a relatively short duration of DM and hyperglycemia influences cardiac function. Subjects and Methods: Forty-seven children and adolescents with DM and 38 healthy subjects (control group) were enrolled. Glycosylated hemoglobin (HbA1c), DMinduced complications, and left ventricular (LV) function as assessed using conventional and unconventional echocardiography {tissue Doppler imaging (TDI) and vector velocity imaging (VVI)} were evaluated. Results: The conventional echocardiographic parameters, with the exception of early peak mitral inflow velocity, the findings of pulsed wave TDI at the annular level, and regional ventricular function by VVI, were not significantly different between the two groups. Using the conventional and unconventional indices of systolic and diastolic function, no significant relationship was found between the duration of DM and the echocardiographic parameters. The deceleration time (DT) and E’/A’ had an inverse correlation with HbA1c (p=0.042 and p=0.016, respectively). Conclusion: Patients with DM in childhood and early adolescence rarely have insight on the significance of DM,and their diet is difficult to control. An alteration of myocardial function induced by DM may begin earlier than generally thought, and these changes are accelerated when glycemic control is poor. We recommend the early institution of close observation of patients with diabetes for alterations in cardiac function, in addition to other diabetic complications.

Functional Assessment for Congenital Heart Disease

Yiu-Fai Cheung 대한심장학회 2014 Korean Circulation Journal Vol.44 No.2

Significant improvement in survival of children with congenital cardiac malformations has resulted in an increasing population of adolescent and adult patients with congenital heart disease. Of the long-term cardiac problems, ventricular dysfunction remains an important issue of concern. Despite corrective or palliative repair of congenital heart lesions, the right ventricle, which may be the subpulmonary or systemic ventricular chamber, and the functional single ventricle are particularly vulnerable to functional impairment. Regular assessment of cardiac function constitutes an important aspect in the long-term follow up of patients with congenital heart disease. Echocardiography remains the most useful imaging modality for longitudinal monitoring of cardiac function. Conventional echocardiographic assessment has focused primarily on quantification of changes in ventricular size and blood flow velocities during the cardiac cycles. Advances in echocardiographic technologies including tissue Doppler imaging and speckle tracking echocardiography have enabled direct interrogation of myocardial deformation. In this review, the issues of ventricular dysfunction in congenital heart disease, conventional echocardiographic and novel myocardial deformation imaging techniques, and clinical applications of these techniques in the functional assessment of congenital heart disease are discussed.

비만아에서 Tissue Doppler Imaging을 이용한 좌심실 이완 기능에 대한 연구

염혜원,김수정,홍영미 한국소아심장연구회 2003 소아심장 Vol.7 No.2

혈액투석 유지요법 환자에서 투석 전후의 좌심실 Doppler 심초음파를 이용한 기능지표의 변화 : A Doppler Echocardiographic Study

김현서,강동오,김성록,김현수,이두하,박종선 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.2

Background: Left ventricular diastolic filling is an important determinant for maintenance of cardiac output during hemodialysis. Few investigators have studied the influence of hemodialysis on diastolic function. To evaluate the change of left ventricular systolic and diastolic function, we performed M-mode and Doppler echocardiographic studies before and after hemodialysis. Methods: The study population consisted of 30 patients(15 patients were male, mean age 45±10 years) with CRF on maintenance hemodialysis. They have normal left ventricular systolic function(Fractional shortening>30%) and no evidence of valvular heart disease or regional wall motion abnormalities. The ejection fraction(EF) was measured using M-mode echocardiography and Doppler indices such as peak E velocity. peak A velocity, isovolumetric relaxaion time(IVRT), deceleration time(DT), and left ventricular ejection time(LVET) obtained from Doppler echocardiography. The index of myocardial performance (IMP) was calculated from each of the Doppler velocity indices. Results: The weight reduction after hemodialysis was 2.1±1.0kg(p<0.0001). After hemodialysis, there was some decrease in blood pressure(p<0.05), but no significant change in heart rate, EF and fractional shortening, mean VCF. peak A velocity, and DT And significant reduction in peak E velocity, E/A ratio(p<0.0001, p<0.001), and significant increase in IVRT and IMP(p<0.05, p<0.0001) were noted. Conclusion: In conclusion, preload reduction is the main mechanism that accounts for changes in Doppler diastolic indices after hemodialysis. And an increased IMP suggests that diastolic function may be aggravated after hemodialysis, and that implies impaired left ventricular filling and disturbed left ventricular compliance.

^201Thallium SPECT에서 ^201Thallium 제거율과 좌심실 이완 기능과의 관련성

최성일,김정현,신대희,조한표,이숙진,이 상,이재웅,김경수,김순길,임헌길,이방헌,이정균,최윤영 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.1

배경/목적: 관동맥 협착에 의한 관동맥혈류예비능의 감소는 급사의 위험 인자로 잘 알려져 있다. 최근에 정상 관동맥에서도 이완기 장애에 의한 관동맥 혈류 장애의 위험성이 있다는 보고가 있는 후, 좌심실이완 기능 장애의 임상적인 중요성을 찾으려는 노력이 있다. 한편, 201^Thallium 심근 관류 SPECT은 관동맥질환의 진단에 유용하지만, 아직까지 좌심실의 이완 기능을 평가하는 방법은 알려져 있지 않고 있다. 그래서, 201^Thallium 심근 관류 SPECT에서 201^Thallim의 제거율 감소가 이완기 장애 (diastolic dysfunction)를 평가할 수 있는 지표로 사용될 수 있는지 알아보고자 하였다. 방법: 심장초음파 검사에서 구혈률이 정상이고 판막질환과 좌심실비대가 없는 135명의 환자에서 201^Thallium 심근 관류 spect를 시행하였다. 도플러심초음파를 이용한 승모판의 inflow study로 이완 장애군과 정상군으로 구분하였는데, 이완장애군은 E/A비가 1미만이거나, 이완시간이 240ms이상인 경우로 정의하였고, 정상 대조군은 E/A비가 1이상 2미만이고 이완시간이 160ms이상 240ms 미만인 경우로 정의하였다. 결과: 좌심실 이완기 장애시 201^Thallium의 제거율은 38.1%이였고, 정상군에서는 46.6%로 이완 장애군에서 의미있게 낮은 결과를 나타냈다. 결론: 201^Thallium 심근 관류 SPECT에서 201^Thallium의 제거율은 좌심실의 이완기 장애를 나타내는 유용한 지표로 사료된다. Background and Objectives : Reduced coronary flow reserve due to coronary artery stenosis is well known as a risk factor for sudden cardiac death. Recently, as it has been also reported that reduced coronary flow reserve caused by diastolic coronary flow disturbance in normal coronary angiogram is at fisk, much effort is in progression to study clinical significance of left ventricular diastolic dysfunction. By the way, 201^Thallium cardiac perfusion SPECT is useful for the detection of coronary artery disease, but to date, hasn't been yet known for assessment method of left ventricular diastolic dysfunction. Therefore, the aim of this study is to investigate whether the 201^Thallium washout rate in 201^Thallium cardiac perfusion SPECT is considered as a novel marker of evaluation of left ventricular diastolic function. Materials and Method : We selected 135 persons who had heart funcion with normal ejection fraction and normal valvular state and no concentric left ventricular hypertrophy on echocardiography examination, then performed 201^Thallium cardiac perfusion SPECT. They were grouped as normal group and abnormal relaxation group by the definition of echocardiographic mitral valve inflow study, that is, abnormal relaxation is defined as reversed E/A ratio or prolonged deceleration time and normal diastolic function is defined as 1≤E/A ratio〈2 and 160ms≤ deceleration time 〈 240ms. Results : 201^Thallium washout rate of left ventricular diastolic dysfunction group (abnormal relaxation group) in 201^Thallium cardiac SPECT is significantly lower than normal group(38.1%; 46.6%, p〈0.01). Conclusion : 201^Thallium washout rate in 201^Thallium cardiac SPECT is considered as a useful marker of evaluation of left ventricular diastolic function.

도플러 심초음파도를 이용한 요독증 환자의 투석전후 좌심실 이완기능

최춘한,이정규,박영명,김원,최재철,서동룡 대한내과학회 1990 대한내과학회지 Vol.38 No.3

To investigate the acute effects of hemodialysis on the left ventricular function of dialysis patients, M-mode and Doppler echocardiographic studies were performed in 17 patients undergoing maintenance hemodialysis using acetate buffered dialysis solution. The results were as follows: 1) Blood urea nitrogen, creatinine, potassium, body weight, left ventricular end diastolic volume, left ventricular end systolic volume, sroke volume and cardiac index showed significant decreases after hemodialysis. 2) There was no change in sodium, heart rate, ejection fraction and fractional shortening. 3) Peak E velocity and peak A velocity were decreased significantly after hemodialysis and the E/A ratio was increased significantly. In conclusion, hemodialysis improves the left ventricular diastolic function in patients with chronic renal failure, and Doppler echocardiography is one of the useful tools for non-invasive and repeated evaluation of left ventricular diastolic function.