Original Articles Korean Circulation J 2001;312:200-209 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 113959, Group 219051 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 0.859 95%CI0.7750.920 and 0.805 95%CI0.6810.896, 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;312:200-209 KEY WORDSLeft ventricular systolic function Cardiomyopathy. 200
서론 재료및방법 대상환자 201
심초음파검사 202 통계 Table 1. Several equations LVEDD Sphericity Apex to middle MV plane in A4C view PSWS0.86 0.334SBPLVEDD PWTd1 PWTs LVESD 27103 dynes/cm2 ESWS0.98 0.334SBPLVEDD PWTd1 PWTs LVESD 2103 dynes/cm2 ) LV mass1.04[lveddpwtdivsd 3 LVEDD 3 ] 0.80.6 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;312:200-209
결과 대상환자의임상적특징 심초음파결과 Table 2. Clinical characteristics Variables Group I n50 Group II n50 p value Age yrs old 5716 5614 0.661 Sex female* 29 18 0.045 Follow-up period month 18 6 20 6 0.307 NYHA class 0.070 2 6 6 3 25 35 4 19 9 Viral prodrome 16 13 0.659 1st attack of Sx* 42 22 0.001 Hypertension 10 11 1.000 Diabetes 9 8 1.000 Heavy alcoholics 5 5 1.000 Smoking* 15 26 0.042 Hyperlipidemia 6 4 0.739 Systolic BP mmhg* 12518 11621 0.023 Diastolic BP mmhg* 8211 7313 0.001 BSA m 2 1.590.15 1.650.25 0.286 Atrial fibrillation 18 12 0.064 Bundle branch block* 3 19 0.001 Serum Na meq/l 1384 1393 0.241 Serum K meq/l 4.30.5 4.10.6 0.155 *p0.05, NYHANewYork Heart Association, Sxsymptoms, BPblood pressure, BSAbody surface area 203
Table 3. Echocardiographic characteristics Variables Group I n50 Group II n50 p value LVEDD mm* 61 7 71 7 0.001 LVESD mm* 51 8 61 7 0.001 LVEDV ml* 139 59 188 51 0.001 LVESV ml* 100 49 139 40 0.001 LVEDD index mm/m 2 * 38 7 44 6 0.001 LVESD index mm/m 2 * 32 7 38 76 0.001 LVEDV index ml/m 2 * 89 43 115 30 0.007 LVESV index ml/m 2 * 64 36 83 24 0.008 Sphericity* 0.78.09 0.86 0.09 0.001 Ejection fraction % 29 7 28 5 0.208 Septum mm 10 2 10 2 Posterior wall mm 10 2 10 1 0.459 LV mass g* 320 96 394 91 0.001 LV mass index g/m 2 * 205 61 235 47 E velocity m/sec 0.9 0.3 1.1 0.9 0.307 A velocity m/sec 0.6 0.3 0.5 0.2 0.127 E/A ratio 1.63 1.25 2.53 1.67 0.051 Deceleration time msec 162 47 157 67 0.725 Mitral regurgitation 0.287 None-G2/4 44 39 G3/4-G4/4 6 11 LA size mm* 46 7 49 8 0.033 Pericardial effusion* 13 3 0.014 PSWS 10 3 dyne/cm 3 * 159 44 179 40 0.034 ESWS 10 3 dyne/cm 3 * 130 37 157 45 0.003 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;312:200-209
Table 4. Results of multivariate analysis by stepwise logistic regression Variables Risk ratio 5% CI p value LV end-diastolic dimension 0.5471 0.3704 0.8080 0.0001 LV end-diastolic volume 1.0594 1.0139 1.1070 0.0009 Bundle branch block 0.0235 0.0017 0.3303 0.0005 1st attack of symptoms 10.9756 1.891363.6756 0.0032 좌심실수축기능정상화의예측인자 Fig. 1. LV end-diastolic dimension in two groups. Fig. 2. LV end-diastolic volume in two groups. 205
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;312:200-209
Fig. 6. Correlation between changes of EF and cardiac dimension. 207
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