• The Korean Journal of Medicine
• /
• 제93권6호
• /
• pp.538-547
• /
• 2018

목적: 급성 심근경색증 환자에서 좌심실 이완 기능과 좌심실 충만압은 환자의 예후와 관련되어 있다고 알려져 있다. 이 연구의 목적은 젊은 급성 심근경색증 환자에서 좌심실 이완 기능 저하 및 충만압 상승에 따른 임상 경과의 차이를 파악하고자 하였다. 방법: 2011년 1월부터 2015년 8월까지 Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH)에 등록된 환자 중 젊은 급성 심근경색증(남 < 45세, 여 < 55세)으로 전남대학교병원에 입원한 환자 240명중에서 관상동맥중재술을 시술받고 2년 동안 임상 추적 관찰이 되어 분석 가능한 환자 200명(남 : 여 = 160명 : 40명)을 대상으로 하였다. 200명의 환자를 좌심실 이완 기능이 정상인 군(46명, $39.5{\pm}5.3$세)과 비정상군(154명, $43.5{\pm}5.1$세)으로 나누었다. 좌심실 충만압을 측정하였으며, 좌심실 충만압 상승을 E/e' ratio 15 이상으로 정의하였다. 좌심실 이완 기능 정상군과 비정상군으로 나누었고 정상 좌심실 충만압군과 좌심실 충만압 상승군으로 나누어 각각 주요 심장 사건을 분석하였다. 주요 심장 사건은 사망, 심근경색증의 재발 및 재관류술로 정의하였다. 결과: 연구 대상자를 평균 $40.9{\pm}11.6$개월 동안 임상적으로 추적 관찰한 결과, 이 중 26명(13%)에서 사망, 심근경색증재발 및 재관류등의 주요 심장 사건이 발생하였고, 좌심실이완 기능 정상군과 비정상군 간의 유의한 차이는 없었다(p = 0.810). 또한 좌심실 이완 기능을 정상군과 1도 이완기기능 장애군과 2도 이완기 기능 장애군으로 나누어서 추가 분석하였다. 2도 이완기 기능 장애군에서 심근경색증 재발은 유의한 차이를 보였지만(p = 0.006), 주요 심장 사건과 유의한 차이는 없었다(p = 0.081). 그러나 좌심실 충만압 상승군에서 정상 좌심실 충만압을 가진 환자군에 비하여 주요 심장 사건의 발생률은 유의한 차이가 있었다(p < 0.001). 다변량 분석 결과 주요 심장 사건 발생의 독립적인 인자는 E/e' ratio 15 이상 환자로 파악되었다(p = 0.019). Kaplan-Meier 생존 곡선을 이용한 사망률을 추적한 결과 좌심실 수축 기능 40% 미만인 환자(p < 0.001)와 E/e' ratio 15 이상 환자(p = 0.004)에서 유의하게 생존율이 낮았다. 결론: 높은 좌심실 충만압은 젊은 급성 심근경색증 환자의 예후에 대한 독립적 예측 인자였으며, 좌심실 충만압의 측정은 젊은 급성 심근경색증 환자에서 심근경색증 후 고위험 환자군 분류에 유용할 것으로 기대된다.

• Clinical and Experimental Pediatrics
• /
• 제59권4호
• /
• pp.190-195
• /
• 2016

Purpose: Severe aplastic anemia (SAA), a fatal disease, requires multiple transfusion, immunosuppressive therapy, and finally, hematopoietic stem cell transplantation (HSCT) as the definitive treatment. We hypothesized that iron overloading associated with multiple transfusions and HSCT-related complications may adversely affect cardiac function. Left ventricular (LV) function was assessed in children after HSCT for SAA. Methods: Forty-six consecutive patients with a median age of 9.8 years (range, 1.5-18 years), who received HSCT for SAA and who underwent comprehensive echocardiography before and after HSCT, were included in this study. The data of LV functional parameters obtained using conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were collected from pre- and post-HSCT echocardiography. These data were compared to those of 40 age-matched normal controls. Results: In patients, the LV ejection fraction, shortening fraction, end-diastolic dimension, mitral early diastolic E velocity, TDI mitral septal E' velocity, and STE LV longitudinal systolic strain rate (SSR) decreased significantly after HSCT. Compared to normal controls, patients had significantly lower post-HSCT early diastolic E velocity and E/A ratio. On STE, patients had significantly decreased LV deformational parameters including LV longitudinal systolic strain (SS), SSR, and diastolic SR (DSR), and circumferential SS and DSR. Serum ferritin levels showed weak but significant correlations (P<0.05) with LV longitudinal SS and SSR and circumferential SS and DSR. Conclusion: Subclinical LV dysfunction is evident in patients after HSCT for SAA, and was associated with increased iron load. Serial monitoring of cardiac function is mandatory in this population.

• Journal of Yeungnam Medical Science
• /
• 제16권2호
• /
• pp.309-317
• /
• 1999

만성 신부전증은 지속적인 혈액투석을 하고 있음에도 다양한 형태의 좌심실 기능부전을 보이며, 특히 좌심실 수축기능이 정상이면서 이완기능 장애만으로 임상적인 심부전증 증상인 폐부종 등이 나타나기도 한다. 또한 혈액투석 후 급격한 혈액량의 변화가 생기므로 적정 심박출을 유지하기 위하여 좌심실 이완기능이 중요한 역할을 하는 것으로 알려져 있다. 저자들은 혈액투석이 좌심실의 수축 및 이완기능에 미치는 영향을 알아보기 위해 Doppler 심초음파도 지표들을 이용해 투석 전후에 좌심실 수축 및 이완기능의 변화를 비교분석 하였다. 심초음파 검사상 좌심실 수축기능 부전이 없고(fractional shortening>30%), 심장 판막질환이나 심근 국소벽 운동장애가 없으며 정상 심율동을 가진 만성 신부전증 환자 30명(남자 15명, 연령$45{\pm}10$세)을 대상으로 이면성 심초음파도 검사를 시행하고, 혈액투석 전후의 좌심실 용적, 좌심실 수축기능 및 Doppler 심초음파도를 이용한 좌심실 이완기능 지표들의 변화를 관찰하여 분석하였다. 혈액투석 후 맥박은 약간 증가하는 소견을 보였으나 통계적 유의성은 없었고, 혈압은 수축기 혈압 및 이완기 혈압의 감소가 있었다. 혈액투석 후 좌심방 및 좌심실 확장기 내경의 크기가 감소했으나 좌심실 수축기 내경의 크기는 변화가 없었고, 심실중격 및 좌심실 후벽의 두께는 변화가 없었다. 좌심실 수축기능 지표인 Fractional shortening, 좌심실 구혈율, 좌심실 박출지수, mean VCF은 투석 전후에 유의한 변화를 보이지 않아 혈액투석으로 인한 좌심실 수축지표의 변화는 관찰되지 않았다. 혈액투석 후 좌심실 이완기능지표의 변화로서 peak E velocity는 현저히 감소하였고, peak A velocity의 변화는 통계적 유의성이 없었다. E/A ratio가 감소하였고, IVRT(Isovolumic Relaxation Time)의 증가가 있었으나, DT(Deceleration time)의 변화는 없었다. 수축기 및 이완기 기능 지표로 사용되는 IMP(Index of Myocardial Performance)는 좌심실 구혈율의 증가와 함께 현저히 증가되었다. 이상의 결과로 혈액투석 후 전부하의 감소에 따른 좌심실 이완기능 지표의 변화로서 E파속 및 E/A비의 감소, IVRT 증가가 나타나고 수축기 기능 및 이완기 기능의 지표로 이용되는 IMP의 증가가 발생하므로, 혈액투석 후 흔히 좌심실 이완기능 장애의 악화가 발생하는 것으로 추정된다.

• 대한자기공명의과학회:학술대회논문집
• /
• 대한자기공명의과학회.한국자기공명학회 2005년도 공동학술대회
• /
• pp.34-34
• /
• 2005

• 여성건강간호학회지
• /
• 제6권4호
• /
• pp.594-605
• /
• 2000

The purpose of this study is to collect fundamental data for adult female health improvement based on urban adult female obesity and cardiopulmonary function. Surveyed were 859 adult females who visited a health improvement center in D district in Seoul between April, 1999, and December, 1999, and the resulting data are as follows: 1. The adult female mean BMI was $23.97{\pm}3.11kgm^2$, which comes within the range of overweight. Among them, BMI of the females aged 41-60, and over 60, were significantly higher. Mean percentage of body fat was $32.07{\pm}4.63$, and it significantly increased in accordance with age, recording the highest among those aged over 60. 2. The systolic blood pressure significantly increased in accordance with age, recording highest among those aged over 60. Those aged 41-60 and over 60 showed significantly higher diastolic blood pressure than those in their 20s and 30s; however, they had a significantly lower heart rate. Vital capacity and maximum oxygen intake significantly decreased in accordance with age, and those aged over 60 were lowest. 3. As to health perception, 20.6% of the subjects perceived themselves as healthy, and those who perceived themselves as unhealthy showed significantly higher BMI than those who perceived themselves to be of moderate health. 4. There were no significant differences in blood pressure, heart rate and maximum oxygen intake in accordance with health perception, but those who perceived themselves as healthy showed significantly higher vital capacity than those who didn't. 5. As to cardiopulmonary function in accordance with obesity, the obese group showed significantly higher systolic blood pressure than those whose weight was normal to overweight. The diastolic blood pressure of the normal weight group was the lowest, while the obese group showed significantly lower vital capacity and maximum oxygen intake. These findings indicate that the womens' health promotion program must include an effective strategy for preventing obesity, and strengthening cardiopulmonary function.

• 대한간학회지
• /
• 제24권4호
• /
• pp.409-416
• /
• 2018

Background/Aims: Left ventricular diastolic dysfunction (LVDD) is an early manifestation of cardiac dysfunction in patients with liver cirrhosis (LC). However, the effect of LVDD on survival has not been clarified, especially in decompensated LC. Methods: We prospectively enrolled 70 patients with decompensated LC, including ascites or variceal bleeding, at Daejeon St. Mary's Hospital from April 2013 to April 2015. The cardiac function of these patients was evaluated using 2D echocardiography with tissue Doppler imaging. The diagnosis of LVDD was based on the American Society of Echocardiography guidelines. The primary endpoint was overall survival. Results: Forty-four patients (62.9%) had LVDD. During follow-up (22.3 months), 18 patients died (16 with LVDD and 2 without LVDD). The survival rate was significantly lower in patients with LVDD than in those without LVDD (31.1 months vs. 42.6 months, P=0.01). In a multivariate analysis, the Child-Pugh score and LVDD were independent predictors of survival. Moreover, patients with a ratio of early filling velocity to early diastolic mitral annular velocity (E/e') ${\geq}10$ (LVDD grade 2) had lower survival than patients with E/e' ratio < 10. Conclusions: The presence of LVDD is associated with poor survival in patients with decompensated LC. Therefore, it may be important to monitor and closely follow LVDD patients.

• 한국방사선학회논문지
• /
• 제17권5호
• /
• pp.761-766
• /
• 2023

본 논문에는 경도의 좌심실 이완 기능 장애 유무를 분류하기 위해 TI을 측정하였다. 분류에 사용된 기계 학습 모델은 SVM과 KNN을 이용하였다. 총 306개의 데이터 중에서 206개는 트레이닝 데이터, 100개는 테스트 데이터로 사용하였다. 그 결과, SVM이 KNN에 비하여 비교적 높은 정확도를 보여 좌심실 이완 기능 장애 유무 진단에 더 유용함을 확인했다. 향후 연구에서 TI 뿐만 아니라 심장의 기능을 평가하는 다양한 지표들을 추가하고 더 많은 데이터를 확보한다면 분류 성능을 더 높일 수 있을 것으로 기대된다. 나아가, 타 질환의 예측 및 분류, 증가하는 검사 건수에 비해 부족한 의료 인력 문제를 해결하는데 기초 자료로 활용될 것으로 기대된다.

• International journal of advanced smart convergence
• /
• 제8권2호
• /
• pp.227-236
• /
• 2019

In this study, we develop a Korotkoff sound based automatic blood pressure measurement device including sensor, hardware, and analysis algorithm. PVDF-based sensor pattern was developed to function as a vibration sensor to detect of Korotkoff sounds, and the film's output was connected to an impedance-matching circuit. An algorithm for determining starting and ending points of the Korotkoff sounds was established, and clinical data from subjects were acquired and analyzed to find the relationship between the values obtained by the auscultatory method and from the developed device. The results from 86 out of 90 systolic measurements and 84 out of 90 diastolic measurements indicate that the developed device pass the validation criteria of the international protocol. Correlation coefficients for the values obtained by the auscultatory method and from the developed device were 0.982 and 0.980 for systolic and diastolic blood pressure, respectively. Blood pressure measurements based on Korotkoff sound signals obtained by using the developed PVDF film-based sensor module are accurate and highly correlated with measurements obtained by the traditional auscultatory method.

• 대한간호학회지
• /
• 제26권2호
• /
• pp.372-386
• /
• 1996

Recently, the ratio of elderly in the population are fast growing due to socio-economical development and the better medical service. Proportionally, the health problems in elderly are increasing, too. Medical professionals must try so that the elderly have the better life through health promotion and disease prevention as well as disease treatment. This study evaluated the effect of walking exercise program on the cardiorespiratory function and the flexibility in the elderly women. The design of research was one group pretest-posttest design. The subjects were eleven elderly women over sixty years old to live in K-city, Kyonggi-do. The type of exercise was walking, which was the most popular exercise in questionnaire. The exercise intensity was 40％∼60％ of the target heart-rate by Karvonen's method and maintained by the heart-rate monitor. The exercise period was five weeks and the exercise frequency was three times per week. The exercise duration was forty minutes at first and gradually increased up to an hour. In order to evaluate the effect of walking exercise, we measured VO/sub₂ max, resting heart -rate, systolic/diastolic blood pressure, FVC, FEV/sub₁, the flexibility before and after the five week's exercise program. The data are analyzed by the paired t-test and Wilcoxon signed rank test using SAS package. The results are as follows : 1) The hypothesis that cardiorespiratory function will be improved was partly supported. In VO/sub₂ max（p＝0.0001）, resting heart-rate（p＝0.0030）, systolic/diastolic blood-pressure（p＝0.0387／ p＝0.0024）, there was significant difference. FVC and FEV/sub₁ were increased after the exercise, but there were no significant difference. 2) The hypothesis that the flexibility will be improved was supported. There was significant difference in the flexibility（p＝0.0140）. As the further study, it is necessary to reevaluate the effect with more refined design. We also need to try meta-analysis about the results of previous studies obtained in the experimental setting and compare our result obtained in the field setting with them.

• 대한간호학회지
• /
• 제29권1호
• /
• pp.97-106
• /
• 1999

This study was designed to investigate the effect of a hand massage program on anxiety and immune function in patients during cataract surgery. The hand massage program, in this study, consisted of hand massage and hand-holding. The subjects were sixty-three patients, thirty for the experimental and thirty-three for the control group, who were admitted at Kang Nam St. Mary's Hospital for cataract surgery. This study was carried out from December 10, 1997 to February 26, 1998. The level of anxiety as measured by the Visual Analogue Scale, systolic blood pressure, diastolic blood pressure, and pulse rate were measured before, after hand massage, and after hand-holding. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, lymphocyte, and natural killer cell percentages also were measured before hand massage and five minutes before the end of the operation. Data were analyzed by t-tests, ANCOVA, repeated measures ANOVA, and Bonferroni multiple comparisons. The results were as follows : 1) After hand massage, psychological anxiety levels decreased significantly compared with before hand massage in the experimental group, not in the control group. After hand holding, there were significant decrease in both groups. 2) There were not significant differences on systolic blood pressure, diastolic blood pressure, and pulse rates in both groups. 3) The hand massage program decreased epinephrine, norepinephrine, and cortisol significantly in the experimental group, and increased epinephrine, norepinephrine, and cortisol in the control group. 4) There were no differences in blood sugar levels, neutrophil and lymphocyte percentages in white blood cells after the hand massage program. However, natural killer cells in lymphocytes were significantly increased in the experimental group. These findings indicate that a hand massage program could be a effective nursing intervention in decreasing the psychological and physiological anxiety levels and improving immune function in clients having cataract surgery under local anesthesia.