Cardiac Functional Analysis를 위한 ECG-gated MDCT의 유용성과 MRI, SPECT, Echocardiography와의 비교분석

정한별(Han Byul Jeong),김영옥(Young Ok Kim),구본승(Bon Seung Goo),대창민(Chang Min Dae),민관홍(Gwan Hong Min),김성룡(Seong Ryong Kim) 대한전산화단층기술학회 2006 대한CT영상기술학회지 Vol.8 No.1

Purpose In the evaluation of ischemic heart disease, accurate measurement of cardiac function is very important as well as the evaluation of vessel status of coronary artery. therefore we evaluate the accuracy of cardiac functional analysis using ECG-gated MDCT compare with other imaging modality such as MRI, single photon emission computed tomography and echocardiography. Materials and Methods We recruited 21 patients(age range:51~78, mean age:62.8±10.69, sex: male-13 female-8) with ischemic heart disease that underwent 4 exam(CT, MRI, single photon emission computed tomography and Echo) all within 1 month. We used 16 slice MDCT(Mx8000 IDT, Philips Medical Systems, Netherland) and dual injector(Medrad, USA). We measured 4 cardiac functional data(ejection- fraction %, end-diastolic volume, end-systolic volume and mass) of left ventricle. To measure data, we used end-systolic & end-diastolic reconstruction phase during cardiac cycle in ECG-gated cardiac CT. 4 cardiac functional data(EF, EDV, ESV and mass) were measured at short axis view using semiautomated contour technique in Extended Brilliance workstation(Brilliance version 2.0, Philips Medical Systems). This cardiac functional data obtained from CT was compared with MRI, ECG-gated single photon emission computed tomography, echocadiography. MRI is known to reference standard of cardiac function. therefore we analyzed the accuracy of cardiac functional data each modality(CT, single photon emission computed tomography, echocadiography) compared with MRIcardiac functional data as reference of standard. Results We analyze difference MRI with other modality(CT, single photon emission computed tomography, echocardiography). First, mean difference for the measurement of EF(%) is CT ±2.7, SPECT ±6.7, echocardiography: ±7.01. Second, end-diastolic volume(EDV) value(ml), mean of difference is CT: ±18.3, SPECT ±44.1 except echocardiography(because echocardiography is not volume but two dimentional diameter). Third, end-systolic volume(ESV) value(ml), mean of difference is CT: ±8.57, SPECT ±15.9 also except echocardiography. At last, left ventricle mass score is only compare MRI with CT and not include papillary muscle. Mean of difference is CT: ±8.09. Conclusion From thisstudy, we concluded that ECG-gated MDCT is more accurate than SPECT or echocardiography for the assessment of cardiac function. According to MDCT is rapidly developed like as 64 MDCT, improvement of temporal resolution bring to reduce artifact that is influenced heart rate. Therefore MDCT will play an important role in the near future for the evaluation of cardiac functional analysis.

CT를 이용한 심장 기능 검사

이종민 대한영상의학회 2024 대한영상의학회지 Vol.85 No.2

심장 기능의 포괄적인 결과는 심장박출량과 전신 정맥 환류로 표현된다. 심장의 4개의 방실은 각자 고유한 기계적 기능을 가진다. 심장방실과 판막, 폐순환 시스템은 전부하 또는 후부하의 형태로 상호 연관되어 있다. 심장 기능 장애는 전반적인 심장 기능의 실패로 전형적인임상 증상을 나타낸다. 심장 기능 장애의 근본 원인을 조사하려면 심장 내 혈류 유동 경로에대한 단계별 평가가 필요하다. 이러한 맥락에서, 심장의 세부 구조를 볼 수 있는 영상검사의표지자는 심장 기능 평가에 중요한 역할을 한다. 영상기반 평가를 통해 개별 심장 구성 요소의 기능을 단계별로 조사할 수 있다. 심장 기능 평가를 위한 영상검사 중 최근 심장 CT가 포함되고 검증되었다. 본 종설에서는 포괄적 및 단계별 심장 기능 평가를 위한 심장 CT 기반 영상표지자에 대해 논의하겠다. A comprehensive evaluation of cardiac function includes information in relation to cardiac output and systemic venous return. The heart is composed of four chambers: two atria and two ventricles, each with its own unique mechanical function. These four cardiac chambers, their valves, and the pulmonary circulation system are inter-related as they preload or afterload on each other. Cardiac dysfunction is a failure of global cardiac function, resulting in typical clinical manifestations. To investigate the underlying cause of cardiac dysfunction, a step-by-step evaluation of cardiac blood flow tracks is necessary. In this context, imaging markers showing details of the cardiac structures have an important role in assessing cardiac function. An image- based evaluation allows for investigation of function in terms of individual cardiac components. Evaluation of cardiac function using cardiac CT has recently been validated. This review aimed to discuss cardiac CT-based imaging markers for comprehensive and detailed cardiac function assessment.

The Change in Exercise Capacity, Cardiac Structure and Function in Pre-Metabolic Syndrome Adults

Kyung-A Shin,Young-Joo Kim,Sae-Jong Park,Jae-Keun Oh 대한의생명과학회 2011 Biomedical Science Letters Vol.17 No.4

This study divided a group of healthy adults aged 20 or older who had a health examination at J General Hospital in Gyeonggi Province into three groups according to the degrees of metabolic syndrome risk factors. They include the normal group (n=58), the pre-metabolic syndrome group (n=112) and the metabolic syndrome group (n=32). They were compared in exercise capacity and cardiac structure and function and impacts of exercise capacity on the cardiac diastolic function. All the groups took echocardiography to have their cardiac structures and functions examined and an exercise stress test to have their exercise capacity measured. The research findings were as follows: There were differences in exercise capacity, cardiac structure, and diastolic heart function among three groups. Between exercise capacity and diastolic heart function was found to be related. It turned out exercise capacity affected the cardiac diastolic functions. In conclusion, there were significant differences in exercise capacity between the normal group and the metabolic syndrome group and in the cardiac structure and function among the normal, metabolic syndrome, and pre-metabolic syndrome group. In addition, METs (metabolic equivalents) and heart rate recovery of exercise capacity turned out to affect cardiac diastolic functions.

Difference of The Cardiac Structure and Function Depending on Obesity Level of Healthy Adults

Kyung-A Shin(신경아),Seung-Bok Hong 대한의생명과학회 2011 Biomedical Science Letters Vol.17 No.2

The purpose of this study was to find out any difference and correlation between the cardiac structure and its function according to the level of obesity as evaluated by waist measurement and BMI (body mass index) in healthy adults. For research subjects, the study selected a final 519 subjects excluding 198 subjects aged 55 or over out of 717 subjects who received echocardiography through a medical checkup at J General Hospital. For the criteria for obesity, men were defined as being obese in case their waist measurement was over 90 ㎝, whereas women were defined as being obese in case their waist measurement was over 80 ㎝. Also, regarding the BMI criteria, in case a person’s BMI was 30 ㎏/㎡, the subject was classified as belonging to an obese group, and in case a person’s BMI was between 25 ㎏/㎡ and 30 ㎏/㎡, the subject was classified as belonging to an overweight group. Concerning the evaluation of cardiac structure and function, they were evaluated using two-dimensional, M-mode, doppler echocardiography. According to the stage of obesity in accordance with waist measurement and BMI, the cardiac structure showed both eccentric and centripetal changes, and the cardiac function was also discovered to show differences according to the stage of obesity. In addition, also in the overweight group, which is a prior stage to obesity, out of the criteria for obesity classification according to BMI, there were differences in the cardiac structure and function. Also, both the waist measurement and BMI were found to have a correlation with cardiac structure and diastolic function. Consequently, cardiac structure and function are correlated with BMI and waist measurement, which are anthropometrical variables, and obesity is assumed to induce not only structural change but also functional change of the heart.

The changes in cardiac dimensions and function in patients with end stage renal disease undergoing hemodialysis

(Dong Won Lee),(Yong Beom Kim),(Seoung Jae An),(Yoo Suck Jung),(Ihm Soo Kwak),(Yung Woo Shin),(Ha Yeon Rha) 대한내과학회 2002 The Korean Journal of Internal Medicine Vol.17 No.2

N/A Background : It is absolutely necessary to evaluate cardiac function on starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. Methods : Twenty patients with end stage renal disease, who had been in a hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital, were enrolled. They were examined with echocardiography and gated blood pool scintigraphy on starting hemodialysis and after follow-up. The data were analyzed by paired t-test. Results : The patients were 46.2±16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus (n=10), hypertension, glomerulonephritis and others. The duration of symptoms associated with end stage renal disease and underlying diseases was 3.4±2.6 years and the duration of hemodialysis was 13.8±7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p<0.05) with no significant changes for LAD, IVS, PWT and EF (p>0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p<0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p<0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p<0.05) and in four cases associated with cardiac diseases without diabetes there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p<0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p<0.05) as a whole while it increased (5.90%, p<0.05) in the cases associated with diabetes and cardiac diseases. Conclusion : During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore, we can expect that adequate hemodialysis - with dry weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cardiomyopathy.

Cardiac function associated with home ventilator care in Duchenne muscular dystrophy

Lee, Sangheun,Lee, Heeyoung,Eun, Lucy Youngmin,Gang, Seung Woong The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.2

Purpose: Cardiomyopathy is becoming the leading cause of death in patients with Duchenne muscular dystrophy because mechanically assisted lung ventilation and assisted coughing have helped resolve respiratory complications. To clarify cardiopulmonary function, we compared cardiac function between the home ventilator-assisted and non-ventilator-assisted groups. Methods: We retrospectively reviewed patients with Duchenne muscular dystrophy from January 2010 to March 2016 at Gangnam Severance Hospital. Demographic characteristics, pulmonary function, and echocardiography data were investigated. Results: Fifty-four patients with Duchenne muscular dystrophy were divided into 2 groups: home ventilator-assisted and non-ventilator-assisted. The patients in the home ventilator group were older ($16.25{\pm}1.85years$) than those in the nonventilator group ($14.73{\pm}1.36years$) (P=0.001). Height, weight, and body surface area did not differ significantly between groups. The home ventilator group had a lower seated functional vital capacity ($1,038{\pm}620.41mL$) than the nonventilator group ($1,455{\pm}603.2mL$). Mean left ventricular ejection fraction and fractional shortening were greater in the home ventilator group, but the data did not show any statistical difference. The early ventricular filling velocity/late ventricular filling velocity ratio ($1.7{\pm}0.44$) was lower in the home ventilator group than in the nonventilator group ($2.02{\pm}0.62$. The mitral valve annular systolic velocity was higher in the home ventilator group (estimated ${\beta}$, 1.06; standard error, 0.48). Patients with Duchenne muscular dystrophy on a ventilator may have better systolic and diastolic cardiac functions. Conclusion: Noninvasive ventilator assistance can help preserve cardiac function. Therefore, early utilization of noninvasive ventilation or oxygen may positively influence cardiac function in patients with Duchenne muscular dystrophy.

Cardiac function associated with home ventilator care in Duchenne muscular dystrophy

이상흔,이희영,은영민,강성웅 대한소아청소년과학회 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.2

Purpose: Cardiomyopathy is becoming the leading cause of death in patients with Duchenne muscular dystrophy because mechanically assisted lung ventilation and assisted coughing have helped resolve respiratory complications. To clarify cardiopulmonary function, we compared cardiac function between the home ventilator-assisted and non–ventilator-assisted groups. Methods: We retrospectively reviewed patients with Duchenne muscular dystrophy from January 2010 to March 2016 at Gangnam Severance Hospital. Demographic characteristics, pulmonary function, and echocardiography data were investigated. Results: Fifty-four patients with Duchenne muscular dystrophy were divided into 2 groups: home ventilator-assisted and non–ventilator-assisted. The patients in the home ventilator group were older (16.25±1.85 years) than those in the nonventilator group (14.73±1.36 years) (P=0.001). Height, weight, and body surface area did not differ significantly between groups. The home ventilator group had a lower seated functional vital capacity (1,038±620.41 mL) than the nonventilator group (1,455±603.12 mL). Mean left ventricular ejection fraction and fractional shortening were greater in the home ventilator group, but the data did not show any statistical difference. The early ventricular filling velocity/late ventricular filling velocity ratio (1.7±0.44) was lower in the home ventilator group than in the nonventilator group (2.02±0.62). The mitral valve annular systolic velocity was higher in the home ventilator group (estimated β, 1.06; standard error, 0.48). Patients with Duchenne muscular dystrophy on a ventilator may have better systolic and diastolic cardiac functions. Conclusion: Noninvasive ventilator assistance can help preserve cardiac function. Therefore, early utilization of noninvasive ventilation or oxygen may positively influence cardiac function in patients with Duchenne muscular dystrophy.

말기 신질환 환자에서 심기능 지표들의 혈액 투석에 따른 변화

이동원(Dong Won Lee),김용범(Yong Beom Kim),안승재(Seoung Jae An),정유석(Yoo Suck Jung),곽임수(Ihm Soo Kwak),신영우(Yung Woo Shin),나하연(Ha Youn Rha) 대한내과학회 2001 대한내과학회지 Vol.60 No.6

Background : It is absolutely necessary to evaluate cardiac function at starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. Methods : Twenty patients with end stage renal disease were enrolled , who had been in hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital. They were examined with echocardiography and gated blood pool scintigraphy at starting hemodialysis and after follow-up. The data were analyzed by paired T-test. Results : The patients were 46.2±16.8 years old and male to female ratio was 8 : 12. The underlying diseases were diabetes mellitus(n=10), hypertension(7), glomerulonephritis (2) and others(1). The duration of symptoms associated with end stage renal dis- ease and underlying diseases was 3.4±2.6 years, and the duration of hemodialysis was 13.8±7.0 months. The LVEDID, LVESID and RVC decreased significantly (-6.10, -7.80 and -20.00%, respectively, p<0.05) with no significant changes for LAD, IVS, PWT and EF (p>0.05). In ten cases associated with diabetes, LVEDID decreased (-7.90%, p<0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (-8.60 and -10.50%, respectively, p<0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (-5.10%, p<0.05). And in four cases associated with cardiac diseases without diabetes, there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (-10.50%, p<0.05). The EF on gated blood pool scintigraphy decreased (-0.9%, p<0.05) as a whole, while increased (5.90%, p<0.05) in the cases associated with diabetes and cardiac diseases. Conclusion : During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore we can expect that adequate hemodialysis -with dry-weight as low as possible - may prevent progression to eccentric left ventricular hypertrophy and dilated cadiomyopathy. (Korean J Med 60:567-573, 2001)

운동생리학 : 마라톤 달리기가 성인 남성의 심장구조 및 기능에 미치는 영향

김종원(JongWonKim),김태운(TeaUnKim) 한국체육학회 2005 한국체육학회지 Vol.44 No.1

The purpose of this study was to analyze the effects of the marathon running on cardiac structure and function in middle-aged men and to present the basic scientific informations for developing the effective training prescription programs in order to improve the marathon. The subjects recruited for this study were 42 middle-aged men composed with the A group(13 marathon runners), who have regularly participated in marathon running for more than three years, the B group(16 marathon runners), who have regularly participated in marathon running for less than two years, and the C group(13 non-runners), who have exercised irregularly.The measurements were conducted for comparing the differences among the marathon runners for more than three years, the marathon runners for less than two years, and the non-runners on cardiac structure and function.The statistical techniques utilized in this study were; ANOVA and Scheffe test was used in Post-hoc analysis. The findings of this study are as follows;1. Characteristics of Cardiac StructureThe A group was significantly higher than the other two groups in LVIDd, LVPWs and LVPWs/s, and higher than the C group in LVIDd/S, IVSs/S and RVIDd, but no significant differences among three groups in the other factors.2. Characteristics of Cardiac functionThe A group was significantly higher than the other two groups in LVEDV, LVDEV/S, SV and SV/S and higher than C group in LVM/S and LVM/height ratio, and the B group was lower than the C group in CO, and the A group and B group were lower than the C group in HRrest, but no significant differences among three groups in the other factors.In conclusion, these findings of this study indicate that the A group is significantly higher than the other two groups in cardiac structure and function. Therefore, the marathon with long run period have been proved more effective. For the future study, it should be developed the training prescription program to improve these factors in the running career and training intensity.

보행 혈압 측정과 심장 기능의 관계

송영환 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.7

It is well known that hemodynamic load is one of the most important determinants of cardiac structure and function. Circadian variations in blood pressure (BP) are usually accompanied by consensual changes in peripheral resistance and/or cardiac output. In recent years, reduction in circadian variations in BP and, in particular, loss of nocturnal decline of BP were observed in hypertensive patients with left ventricular hypertrophy (LVH). The patients with only a slight or no loss of nocturnal decline of BP were considered "non-dippers". Regression of LVH was observed after prolonged antihypertensive therapy. Restoration of the circadian rhythm of BP was also observed. However, the classification of patients into "dippers" and "non-dippers" is arbitrary and poorly standardized and repeatable, and in the recent studies, most hypertensive patients with LVH were "dippers". Therefore, we should be particularly cautious about the conclusions drawn using this index. On the other hand, reduced activity of low- pressure cardiopulmonary baroreceptors and impaired day-to-night modulation of autonomic nervous system activity were observed in patients with only LVH. Therefore, alterations in cardiac structure may impair BP modulation. On the other hand, the reverse can also be trueprimary alterations in BP modulation, through a persistently elevated afterload, can increase cardiac mass. Thus, the interrelationship between cardiac structure and BP modulation is complex. Hence, new and more specific methods of evaluating circadian changes in BP are needed to better clarify the abovementioned reciprocal influences.