좌심실 이완기능의 평가에 있어서 도플러 조직영상으로 평가한 승모판륜 속도의 유용성

홍그루(Gue Ru Hong),전대진(Dae Jin Jun),배준호(Jun Ho Bae),이종석(Jong Suk Lee),김형준(Hyung Jun Kim),박종선(Jong Sun Park),신동구(Dong Gu Shin),김영조(Young Jo Kim),심봉섭(Bong Sup Shim) 대한내과학회 1999 대한내과학회지 Vol.57 No.6

N/A Background : Doppler echocardiography is widely used for the noninvasive evaluation of left ventricular diastolic function. However the mitral flow velocity pattern is affected by several physiologic factors. The mitral annular velocity profile by Doppler tissue imaging may provide more additional information about left ventricular diastolic function. Thus, this study designed to assess the relationship between cardiac catheterization, MUGA scan, mitral flow velocity, and mitral annular velocity data and to assess the clinical availavility of mitral annulus velocity in the evaluation of left ventricular diastolic function. Methods : The study population consisted of 20 patients with dilated cardiomyopathy( 64±7years), 20 patients with normal left ventricular function (61±7years). Left ventricular catheterization was performed with fluid-filled catheter and left ventricular end diastolic pressure, -dP/dtmax were measured. The mitral flow velocity was recorded at mitral valve tip and the mitral annulus velocity during diastole was measured by Doppler tissue imaging(DTI). Simultaneously EF(ejection fraction), PER(Peak filling rate), PFR(Peak filling rate) were measured by MUGA blood pool scan. Results : Mean peak E velocity, mean peak A velocity, E/A ratio, mean peak E' velocity, mean peak A' velocity, E'/A' ratio and -dP/dtmax significantly difference betweeen two group. -dP/dtmax by cardiac catheterization showed significant correlation with mean peak E' velocity (r=0.552, p=0.003), E'/A' ratio(r=0.507, p=0.003), DT of E'(r=-0.556, p=0.001), TVI of E'(r=0.689, p<0.001) and DT of E wave(r=-0.538, p=0.003). PFR by MUGA scan also showed significant correlation with -dP/dtmax(r=0.537, p=0.01). Conclusion : Among mitral annulus velocity index mean peak E' velocity, E'/A' ratio, DT of E',TVI of E' had significant correlation with -dP/dtmax. And DT by mitral flow velocity, PFR by MUGA scan also had significant correlation with -dP/dtmax. Mitral annulus velocity determined by DTI is relatively convenient, safe, and preload-independent variable in evaluating diastole function. Thus mitral annulus velocity by Doppler tissue imaging is may be useful diagnostic modality for evaluating left ventricular diastolic function.(Korean J Med 57:1021-1029, 1999)

스트레스 유발성 심근증 환자들의 원내 사망과 좌심실 기능 회복의 예측인자

김소연 ( So Yeon Kim ),김장영 ( Jang Young Kim ),박용현 ( Yong Hyun Park ),홍경순 ( Kyung Soon Hong ),조경임 ( Kyoung Im Cho ),조현수 ( Hyun Su Jo ),홍그루 ( Gue Ru Hong ),손창우 ( Chang Woo Sohn ),손장원 ( Jang Won Sohn ),윤준철 대한내과학회 2011 대한내과학회지 Vol.81 No.1

Background/Aims: The reported frequency of stress-induced cardiomyopathy (SCMP, Takotsubo cardiomyopathy) is increasing; however, there are no data regarding predictors of in-hospital mortality and the recovery of left ventricular (LV) systolic function in patients with SCMP. Therefore, in this study, we sought to identify clinical predictors of in-hospital mortality and of the recovery of LV dysfunction in Korean patients with SCMP. Methods: From November 2004 to November 2010, 155 patients who fulfilled the clinical diagnostic criteria of the Mayo clinic for SCMP were enrolled retrospectively from eight medical centers in Korea. We checked in-hospital deaths and compared the LVejection fraction (LVEF) and wall-motion score index (WMSI) upon enrollment for each patient with that after 1 week using echocardiograms. A total of 55 continuous variables and 52 nominal variables were analyzed to find variables associated with in-hospital mortality and the recovery of LV dysfunction. All significant variables were entered into a logistic regression analysis. Results: The mean age of the patients was 64±15 years; 118 (76.1%) patients were female. The in-hospital mortality rate was 5.2% (n=8). An elevated initial platelet count was identified as a predictor of in-hospital mortality (odds ratio [95% CI]: 0.99 [0.99-1.00]). There were no predictors of the recovery of LVEF. Predictors of the recovery of WMSI were an absence of arrhythmic events (odds ratio [95% CI]: 22.89 [1.98-265.34]) and an elevated initial LV end-systolic diameter (odds ratio [95% CI]: 0.86 [0.74-1.00]). Conclusions: An initial absence of arrhythmic events and elevated LV end-diastolic pressure in patients with SCMP may be predictors of the timely recovery of LV dysfunction. (Korean J Med 2011;81:64-72)

허혈성 확장형 심근증과 특발성 확장형 심근증환자에서 QT 간격분산의 차이

홍그루,전대진,배준호,석준호,박종선,신동구,김영조,심봉섭 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.4

특발성 발작성 심방세동 환자에서 P파 간격분산의 의의

홍그루,김웅,박종선,신동구,김영조,심봉섭 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.2

P wave dispersion(PWD) is defined as the difference between the maximum and minimal P wave duration in any of the 12 leads of the surface ECG. The prolongation of atrial conduction time and the inhomogeneous propagation of sinus impulse are known electrophysiologic features in patients with paroxysmal atrial fibrillation(PAF). The purpose of this study was to determine the role of P wave dispersion for the prediction of PAF and to evaluate the effectiveness of prophylactic antiarrhythmic therapy. Materials and Methods: The study population included 20 patients with a history of idiopathic PAF and 20 age and sex matched healthy control subjects. We measured the maximum P wave duration(P maximum) and P wave dispersion from 12 lead ECG. Results: P maximum and P dispersion in idiopathic PAF were significantly higher than normal control group(97.2±12, 48.5±9 msec vs, 76.5±11, 21±8 msec, respectively p<0.001, <0.001). After 12-month follow up period P maximum and P dispersion were significantly reduced than those of initial state(77.2±13, 26.4±9 msec vs, 97.2±12, 48.5±9 msec, respectively p<0.001,<0.001). Conclusion: P dispersion and P maximum were significantly different between patients with idiopathic PAF and healthy control group. Those are easily accessible, non-invasive simple electrocadiographic markers that could be used for the prediction and prognostic factors of idiopathic PAF.

고양이를 이용한 허혈성 전조건 모델에서 Heat Shock Protein의 변화에 의한 지연 심근보호효과

박종선,홍그루,신동구,김영조,심봉섭 대한순환기학회 2001 Korean Circulation Journal Vol.31 No.1

P파 신호 가산 평균 심전도법을 이용한 여과 P파 간격 분산 측정의 진단적 유용성

김웅,신동구,홍그루,박종선,김영조,심봉섭 대한순환기학회 2002 Korean Circulation Journal Vol.32 No.4

승모판협착증 환자에서 뇌경색발생의 예측인자

김형준,이종석,홍그루,박종선,신동구,김영조,심봉섭,김웅 영남대학교 의과대학 2000 Yeungnam University Journal of Medicine Vol.17 No.1

저자들은 후향적 연구로, 1995년 1월부터 1999년 3월까지 영남대학교 의과대학 부속병원에 내원하여 경흉부 및 경식도 심초음파를 시행한 승모판 협착증 환자 중 1년 이상 경과 관찰된 127명의 환자를 대상으로 뇌경색의 예측인자를 알아봄으로써 향후 예방 및 치료에 도움을 주고자 본 연구를 시행하였다. 전체 127명의 대상군은 뇌경색이 발생한 군(GroupⅠ : n=26, 나이 : 55±13세)과 뇌경색이 발생하지않은 군(Group Ⅱ : n=101, 나이 : 48.5±13)으로 나누었으며, 두군간에 성별이나 심부전의 정도(NYHA functional class)에는 의미있는 차이가 없었다. 뇌경색군(GroupⅠ)에서 나이가 많았으며(55.0±13 vs 48.5±13 ; p<0.05), 좌심방 크기가 보다 컸으며(5.10±0.48 vs 4.81±0.70 ; p<0.05), 승모판구 면적이 보다 작았고(1.01±0.39 vs 1.21±0.45 ; p<0.05), 심방세동의 유병률이 보다 높았다(22명/26명 vs 57명/101명 ; p<0.05). 좌심방의 자발에코영상은 뇌경색군(22명/26명)에서 비뇌경색군(44명/101명)보다 더 많이 관찰되었다(p<0.001). 상기 의미있는 변수들을 Multivariate logistic regression 분석결과 통계학적으로 유의한 예측인자는 심방세동(R. R=7.69)과 항응고제 치료(R. R=0.23)이었다. 결론적으로, 승모판 협착증 환자에서 뇌경색 발생과 연관된 유의한 예측인자는 심방세동과 항응고제치료이었으며, 나이와 좌심방 크기, 승모판구 면적, 좌심방의 자발에코영상도 밀접한 관계가 있었다. 따라서 심방세동을 동반한 고연령의 중증 승모판 협착증 환자에서는 조기 항응고제 투여가 전신색전증 예방에 중요할것으로 사료된다. Background : Systemic embolism, especially, cerebral infarction is one of the most important complications in patients with mitral stenosis. The authors analyzed the some factors that could predict the development of cerebral infarction in cases of mitral stenosis and propose preventive therapeutic measures. Methods : Retrospective study of 127 patients with rheumatic mitral stenosis was performed by analyzing their medical records for transthoracic(TTE) or transesophageal echocardiography(TEE) over a 12 months period. The patients were divided into two groups according to the presence (Group Ⅰ ; n=26, age ; 55±13 years) or absence (Group Ⅱ ; n=101, age ; 48.5±13 years) of cerebral infarction. No significant difference was observed between the two groups with respect to sex and functional class. Results : Patients in group Ⅰ were older (55.0±13 vs 48.5±13 ; p<0.05), had more dilated left atrial size(5.10±0.48 vs 4.81±0.70 ; p<0.05) and smaller mitral surface area(1.01±0.39 vs 1.21±0.45 ; p<0.05). In Group Ⅰ, the incidence of atrial fibrillation(22 out of 26 vs 57 out of 101 ; p<0.05) and spontaneous left intra-atrial contrast phenomenon(22 out of 26 vs 44 out of 101 ; p<0.05) was more frequently observed. On multivariate analysis, atrial fibrillation and anticoagulant therapy were the independent predictive factors. Conclusion : Age, left atrial dilatation, the severity of mitral stenosis, the presence of spontaneous contrast, and especially the presence of atrial fibrillation are the main predictive factors of the development of cerebral infarction in mitral stenosis. Patients presenting one or several of these factors may benefit from prophylactic anticoagulant treatment.

원발성 심장 림프종 ; 1례 보고

배준호,김형준,김민경,박용호,홍그루,박종선,신동구,김영조,심봉섭,이종석 영남대학교 의과대학 2000 Yeungnam University Journal of Medicine Vol.17 No.1

심장의 원발성 림프종은 아주 드문 질환이며 예후가 나빠 진단후 2-3주내에 사망하는 경우가 대부분이다. 저자등은 흔치 않는 심장의 원발성 림프종을 경험하면서 심장에서 종양이 발견되었을 때 신속한 진단을 위해 노력해야 하며, 또한 치료 시기가 예후에 많은 영향을 미치는 림프종을 염두에 두어야 한다고 생각된다. Primary cardiac lymphoma, defined as involving only the heart and pericardium, is very rare and is diagnosed predominantly late in the course of illness or autopsy. This tumor is commonly fatal and until recently were rarely diagnosed antemortem. Recently, it was reported in patients with acquired immunodeficiency syndrome. We report a case of primary cardiac lymphoma in a 56 year old female who showed progressive exertional dyspnea. On echocardiogram and CT scan, a large ill defined mass was demonstrated in right atrial and ventricular wall. It was diagnosed as B-cell type lymphoma on open cardiac biopsy.

본태성 고혈압에 대한 Imidapril의 강압효과 및 마른기침 발현율에 대한 고찰

신동구,박종선,전대진,배준호,김영조,심봉섭,홍그루 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.1

1993년 일본의 Tanabe제약에서 개발된 염산 Imidapril(Tanatril )은 새로운 작용지속형 ACE inhibitor이며 강압효과와 안정성이 뛰어나고, 마른기침 등의 부작용이 다른 ACE inhibitor 보다는 적은 것으로 보고되고 있다. 1997년 10월 6일부터 1998년 12월까지 영남대학교 의과대학 부속병원 순환기 내과에 내원하여 고혈압이 처음 잔단되었거나 진단받은 후에도 강압제치료를 받지 않았던 환자 중 경증(1기)에서 중증(3기) 본태성 고혈압(JNC V 분류의거)을 보인 30명 중 최종분석이 가능한 21명(부작용으로 투약을 중단한 1명 포함)을 대상으로 하였다. 임상시험 종료 시 측정한 확장기 혈압은 88.7±9㎜Hg로 평균 하강량은 13.8mmHg이었다. 혈압강하효과 판정에서 16명이 혈압 하강군으로 분류되어 혈압강하효과는 76.2%(16/21)였다. Imidapril 단독 투여로 치료 종료시 정상 혈압(140/90㎜Hg 미만)을 보인 경우는 10명(47.6%)이었다. 임상시험 중 나타나는 부작용으로는 마른기침, 두통, 현기증, 오심, 상복부 불쾌감, 졸리움 등이 있었으며 총 7명에서 (33.3%) 부작용이 관찰되었고, 심한 위장관계 불편감을 호소한 한 예를 제외하고는 모두 일상 생활에 불편을 주지는 않는 상태였으며, 시간이 경과할수록 그 정도가 점차로 약해졌다. ACE inhibitor의 가장 흔한 부작용 중의 하나인 마른기침은 모두 2명(9.5%)에서 관찰되었다. 새로운 ACE inhibitor인 Imidapril은 다른 ACE inhibitor와 비슷한 강압효과와 안정성을 보이며 특별히 심각한 부작용을 보이지 않고, 그 중에서도 특히 마른기침 발현 빈도는 9.5%로 다른 제제에 비해 현저히 낮았으며, 그 정도가 미미하여 감량없이 계속투여가 가능했다. Imidapril(Tanatril ), a newly developed ACE inhibitor, has been used to treat hypertension and congestive heart failure. This study was designed to assess the antihypertensive effect and safety of Imidapril(Tanatril ) in patients with essential hypertension. 5-10mg of imidapril(Tanatril ) was administered once a day in 30 patients with essential hypertension and followed up for 8 weeks. We tested the drug's effectiveness, safety, and the incidence of imidapril induced dry coughs. After 8 weeks of treatment with imidapril, 76.2%(16/21) of patients showed lowered blood pressure and 47.6% showed normal blood pressure. The overall incidence of adverse effects was 33.3%(7/21), and among these adverse effects, dry cough was shown in only 9.5%. Thus, we concluded that imidapril(Tanatril ) is as safe and effective as other ACE inhibitors, especially with imidapril showing very little incidence of dry cough compared to other ACE inhibitors.