서론 재료및방법 대상환자 201

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1 Original Articles Korean Circulation J 2001;312: 심근증환자에서좌심실수축기능의정상화와관련된 임상및심초음파인자 신준한 최소연 윤명호 안성균 신승수 김한수 탁승제 최병일 Echocardiographic and Clinical Factors Affecting Normalization of LV Systolic Function in Patients with Cardiomyopathy Joon-Han Shin, MD, So-Yeon Choi, MD, Myung-Ho Yoon, MD, Sung-Gyun Ahn, MD, Seung-Soo Shin, MD, Han-Soo Kim, MD, Seung-Jea Tahk, MD and Byung-Il W. Choi, MD Deparment of Cardiology, Ajou University School of Medicine, Suwon, Korea ABSTRACT BackgroundDuring clinical practice we found that left ventricular systolic function LVSF has been normalized in some patients with cardiomyopathy. We investigated the echocardiographic and clinical factors affecting normalization of LVSF in these patients. MethodThe patients with LV systolic dysfunction EF40% were evaluated with echocardiography, coronary angiography and/or 201-Thallium SPECT and follow-up echocardiography FUE one year later. They had no coronary, valvular, congenital heart diseases. Consecutive 50 patients with improved LVSF EF55% in FUE were defined to Group 1 mean age 5716, male 21, female 29, mean follow-up 186 month and another consecutive 50 patients with sustained decreased LVSF EF 40% and no increment of EF over 10% in FUE were defined to Group 2 mean age 5614, male 32, female 18, mean follow-up 206 month. ResultsBy univariate analysis, significant factors affecting normalization of LVSF were female sex, non-smoker, first experience of dyspnea, absence of bundle branch block in ECG, end-diastolic dimension of LV LVEDD, end-diastolic volume of LV LVEDV, LA size, less sphericity, presence of pericardial effusion, peak and end systolic wall stress. By multivariate analysis, LVEDD Group 1617, Group 2717 mm, p0.001, LVEDV Group , Group ml, p0.01, absence of bundle branch block in ECG and 1 st attack of symptom were significant. By Receiver operating characteristics curve analysis, area under curve of LVEDD and LVEDV were %CI and %CI , respectively. LVEDD64 mm predicted normalization of LVSF with a sensitivity 76% and a specificity 86%. ConclusionDetermination of cardiac dimension and volume by echocardiography is very important to predicting normalization of LV systolic function in primary myocardial disease. And this results suggest that myocardial structural integrity may be important for recovery of LV function in clinical setting. Korean Circulation J 2001;312: KEY WORDSLeft ventricular systolic function Cardiomyopathy. 200

2 서론 재료및방법 대상환자 201

3 심초음파검사 202 통계 Table 1. Several equations LVEDD Sphericity Apex to middle MV plane in A4C view PSWS SBPLVEDD PWTd1 PWTs LVESD dynes/cm2 ESWS SBPLVEDD PWTd1 PWTs LVESD 2103 dynes/cm2 ) LV mass1.04[lveddpwtdivsd 3 LVEDD 3 ] g LVEDDLV end-diastolic dimension, MVmitral valve, A4Capical 4 chamber, PSWSpeak systolic wall stress, ESWSend-systolic wall stress, SBPsystolic blood pressure, LVESDLV end-systolic dimension, PWTsposterior wall thickness at systole, PWTdposterior wall thickness at diastole, IVSdinterventricular septal thickness at diastole Korean Circulation J 2001;312:

4 결과 대상환자의임상적특징 심초음파결과 Table 2. Clinical characteristics Variables Group I n50 Group II n50 p value Age yrs old Sex female* Follow-up period month NYHA class Viral prodrome st attack of Sx* Hypertension Diabetes Heavy alcoholics Smoking* Hyperlipidemia Systolic BP mmhg* Diastolic BP mmhg* BSA m Atrial fibrillation Bundle branch block* Serum Na meq/l Serum K meq/l *p0.05, NYHANewYork Heart Association, Sxsymptoms, BPblood pressure, BSAbody surface area 203

5 Table 3. Echocardiographic characteristics Variables Group I n50 Group II n50 p value LVEDD mm* LVESD mm* LVEDV ml* LVESV ml* LVEDD index mm/m 2 * LVESD index mm/m 2 * LVEDV index ml/m 2 * LVESV index ml/m 2 * Sphericity* Ejection fraction % Septum mm Posterior wall mm LV mass g* LV mass index g/m 2 * E velocity m/sec A velocity m/sec E/A ratio Deceleration time msec Mitral regurgitation None-G2/ G3/4-G4/ LA size mm* Pericardial effusion* PSWS 10 3 dyne/cm 3 * ESWS 10 3 dyne/cm 3 * LVEDDLV end-diastolic dimension, LVESDLV end-systolic dimension, LVEDVLV end-diastolic volume, LVESV LV end-systolic volume, PSWSpeak systolic wall stress, ESWSend systolic wall stress 204 Korean Circulation J 2001;312:

6 Table 4. Results of multivariate analysis by stepwise logistic regression Variables Risk ratio 5% CI p value LV end-diastolic dimension LV end-diastolic volume Bundle branch block st attack of symptoms 좌심실수축기능정상화의예측인자 Fig. 1. LV end-diastolic dimension in two groups. Fig. 2. LV end-diastolic volume in two groups. 205

7 Fig. 5. Changes of end-diastolic and end-systolic dimension in both groups. Fig. 3. ROC curve analysis of LV end-diastolic dimension. Fig. 4. ROC curve analysis of LV end-diastolic volume. 고찰 206 Korean Circulation J 2001;312:

8 Fig. 6. Correlation between changes of EF and cardiac dimension. 207

9 제한점 요약 연구목적 : 방법 : 208 결과 : 결론 : 중심단어 REFERENCES 1) Prazak P, Pfisterer M, Osswald S, Buser P, Burkart F. Differences of disease progression in congestive heart failure due to alcoholic as compared to idiopathic dilated cardiomyopathy. Eur Heart J ) Fruhwald FM, Dusleag J, Eber B, Fruhwald S, Zweiker R, Klein W. Long-term outcome and prognostic factors in dilated cardiomyopathy. Angiology ) Wynne J, Braunwald E. The cardiomyopathies and myocarditides. In Braunwald E, editor. Heart disease. 5th ed. Philadelphia W.B. Saunders company1997. p ) Anguta M, Arizon JM, Bueno G, Latre JM, Sancho M, Korean Circulation J 2001;312:

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$(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])$ Cardiovascular Disease in Metabolic Syndrome 김상현 보라매병원내과 서울대학교의과대학내과학교실 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management