- Email: [email protected]
P8-01 Influences of left ventricular hypertrophy on transmitral flow pattern and aortic stiffness in hypertension
$62
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S1~75
diabetic mortality. However, ionic mechanisms underlying the diabetic QT prolongailon remained unclear. In hearts inward and outward currents configure the action potential (AP). The rapid delayed rectifier K + current (I~), carried by the a subunlt human ether-gt-go-go related gene (HERG), repolarizes the AP duration (APD) thereby determines the QT interval. Malfuncilon of I~/HERG has been demonstrated to be a cause of inherited or acquired long QT syndrome. Objectives: Investigate the electrical alterations in the type I diabetic rabbit model and elucidate the underlying ionic mechanisms. M e t h o d s a n d Results: In alloxan induced IDDM rabbits, heart rate corrected QT interval in surface ECG is significantly prolonged (13%, p<0.05), rERG protein level, detected by western blot, is not significantly changed. APD at 50% and 90% repolarization recorded using current clamp techniques in isolated ventricular cardiomyocytes from diabetic rabbits are longer than those recorded in healthy cells. IKr current density, measured by whole.ell patch~lamp techniques, is smaller in heart cells isolated from diabetic rabbits. At the potential positive to 0 mV, IK~ densities are 35.~50% (/)<0.05) of that in cells from healthy rabbits. The transient outward K + current (Ito) density is significantly reduced in diabetic cardiomyocytes, to 42,~47% (/)<0.05) of that in healthy cells. The inward rectifier K+current is not remarkable different at the potential positive to 80 m~L Though L type calcium current in myocytes from diabetic rabbit heart is smaller than that in normal cardiomyocytes C~25% less at the plateau phase), there is no significant difference between these two group. C o n c l u s i o n : Impairment of I~/HERG K + function but not expression, and reduced Ito function contribute to the APD/QT prolongation in diabetic hearts.
P7-05 LONG-DISTANCE ELECTROCARDIOGRAPH TRANSMISSION PILOT STUDY A SINGER CENTER EXPERIENCE
Ai Hsien A. Li, Chi Yu Yang, Dong Feng Yeih, Kuo4Ehin Chen, Chao Lun Lal, Yuan Hung Liu, Ho Tsung Hsin, Shu Hsun Chu.
Cardiovascular center, Far Eastern Memorial Hospital, Taipei, Taiwan I n t r o d u c t i o n : More than 80% of the sudden death could be attributed to cardiac origin, especial for the patients with documented ischemic heart disease (IHD), congestive heart failure (CHF), or histo~sJ of lethal an-hytlnnia. On the other hand, for the patients complaining undiagnosed syncope and unexplained palpitation, hardly could resting ECG or con ventional holter system provide a definite diagnosis. As a result, portable electrocardiograph (ECG) Iecorders with a daily data receiving system become a powerful life guard of those patients. So we want to introduce a telemedicine ECG system (i.e. long distance electrocardiograph Wansmis sion) into our center and initiate a pilot for the patients to test the efficacy of such a system. M e t h o d : From September, 22, 2003 to December 2, 2003, we have enrolled totally 19 patients, who carded a snmll, hand held device to keep their ECG's. All their ECG's had been transmitted to our ~ecording centers via cellular (GSM) and analogue telephone lines daily with their subjective symptoms during recording. Of all the patients, 8 have IHD with CHF, and 8 have a~-hythmic history. Besides, 16 of them have frequent palpitation in the previous half year. Results: During the 72 day follow up, totally 805 calls were collected, and 203 (25.2%) presented abnormal ECG findings. Among them, 6 patients had been noted to have lethal an-hytlmtia for their first ffrne (5 patients had have paroxysmal atrial fibrillation and one paroxysnml supraventricular tachycardia). Besides, 121 calls (15.1%) were accompa nied by obvious symptoms as dyspnea, palpitation or angina; and 73 of them yield no accompanied ECG abnomlality. These symptoms, therefore, had been ruled out to have cardiac origin. C o n c l u s i o n : Telemedicine ECG system provides an effective method for the diagnosis and follow up of patients with heart disease. Not only could it detect the lethal arrhytlm~ia, but also clarify the relation of some atypical symptoms to probable underlining cardiac disease.
P7-06 T H E U S E O F H E A R T RATE V A R I A B I L I T Y IN C A R D I O L O G Y
h Majercak, IIIrd Department of Internal Medicine, University Hospital, Kosice, Slovakia Heart rate variability is the marker of the heart's response to the autonomic nervous system activity. The decrease in HRV is a clinical predictive factor of overall cardiac mortality, and especially that of an-hytlnnia complications in the population after infarction. The parameters most significantly used in practice include SDNN and HRV index. %venty four hour measurements are of higher predictive value, and an increase in the positive predictive value can be accomplished by multifactorial stratification. HRV is most frequently combined with ejection fraction and baroreflex sensitivity. The possibilities of HRV assessment are interesting also in coincidence with heart failure, arterial hypertension and atrial fibrillation also after heart Wansplantation. We corelate the HRV parameters with the severity of coronary artery disease. Patients with angiograficaly estimated 3 vessel disease had sig nificantly lover SDNN, which co,elate with 10 year smwival, too.
POSTER SESSION P8
Hypertension P8-01 INFLUENCES OF LEFT VENTRICULAR HYPERTROPHY ON T R A N S M I T R A L F L O W P A T T E R N A N D A O R T I C S T I F F N E S S IN HYPERTENSION
Chih Hsin Hsu, Wei Chuan Tsal, Liang Mfin Tsal, Cheng Han Lee, Wei Ting Lee, Ju Yi Chen, Li4en Lin, Jyh Hong Chen. Department of
Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan I n t r o d u c t i o n : Hypertension causes left ven~cular hypertrophy (LVH). LVH can lead to diastolic dysfunction. However, the effects of LVH on aortic stiffness and its relationship to transffdtral Doppler flow were not fully elucidated. This study was undertaken to investigate the relationship between transffdtral Doppler flow and aortic stiffness in hypertension patients and effect of LVH on this relationship. M e t h o d s : Eighty three patients (mean age 46±8 years, 49 males) with untreated essential hypertension were included in this study. LVH was assessed by M mode echocardio~-aphy and we divided patients into two groups based on the presence of LVH. Transffdtral Doppler flow velocity was measured from the standard four chamber view. Indices of aortic stiffness were measured by M mode echocardio~aphy and were calculated from following formula: Stiffness index (SI) in (systolic blood pressure/diastolic blood pressure)/(changes in aortic diameter/diastolic diameter); Distensibility (DI) 2(changes in aortic diameter)/(diastolic diameter) (pulse pressure). Results: Among all patients, the peak early fiiling velocity (E) was significantly correlated with SI (r 0.227, p 0.039), the peak atrial velocity (A) was significantly correlated with DI (r 0.259, p 0.018), and the early filling to atrial velocity ratio (E/A) was significantly correlated with SI (r 0.233, p 0.034). There were 21 patients (25%) with LVH. Patients with LVH had higher systolic blood pressure, diastolic blood pressure, blood urea nitrogen, SI and lower DI than patients without LVH. Parameters of transmitral Doppler flow pattern were similar in both groups. The correlation between transmBral Doppler flow and indices of aortic stiffness were disappeared in patients with LVH. C o n c l u s i o n : Out data indicated that transmBral Doppler flow pattern were correlated with aortic stiffness. The transmitral Doppler flow pattern was not only influenced by diastolic filling but also increased afterload. However, this phenomenon was blunted by the presence of LVH. When assessing transmitral Doppler flow pattern in hypertension, aortic stiffness should be taken into account and also the influences of LVH.
Abstracts/International Journal of Cardiology 97 SuppL 2 (2004) S1~75
diabetic mortality. However, ionic mechanisms underlying the diabetic QT prolongailon remained unclear. In hearts inward and outward currents configure the action potential (AP). The rapid delayed rectifier K + current (I~), carried by the a subunlt human ether-gt-go-go related gene (HERG), repolarizes the AP duration (APD) thereby determines the QT interval. Malfuncilon of I~/HERG has been demonstrated to be a cause of inherited or acquired long QT syndrome. Objectives: Investigate the electrical alterations in the type I diabetic rabbit model and elucidate the underlying ionic mechanisms. M e t h o d s a n d Results: In alloxan induced IDDM rabbits, heart rate corrected QT interval in surface ECG is significantly prolonged (13%, p<0.05), rERG protein level, detected by western blot, is not significantly changed. APD at 50% and 90% repolarization recorded using current clamp techniques in isolated ventricular cardiomyocytes from diabetic rabbits are longer than those recorded in healthy cells. IKr current density, measured by whole.ell patch~lamp techniques, is smaller in heart cells isolated from diabetic rabbits. At the potential positive to 0 mV, IK~ densities are 35.~50% (/)<0.05) of that in cells from healthy rabbits. The transient outward K + current (Ito) density is significantly reduced in diabetic cardiomyocytes, to 42,~47% (/)<0.05) of that in healthy cells. The inward rectifier K+current is not remarkable different at the potential positive to 80 m~L Though L type calcium current in myocytes from diabetic rabbit heart is smaller than that in normal cardiomyocytes C~25% less at the plateau phase), there is no significant difference between these two group. C o n c l u s i o n : Impairment of I~/HERG K + function but not expression, and reduced Ito function contribute to the APD/QT prolongation in diabetic hearts.
P7-05 LONG-DISTANCE ELECTROCARDIOGRAPH TRANSMISSION PILOT STUDY A SINGER CENTER EXPERIENCE
Ai Hsien A. Li, Chi Yu Yang, Dong Feng Yeih, Kuo4Ehin Chen, Chao Lun Lal, Yuan Hung Liu, Ho Tsung Hsin, Shu Hsun Chu.
Cardiovascular center, Far Eastern Memorial Hospital, Taipei, Taiwan I n t r o d u c t i o n : More than 80% of the sudden death could be attributed to cardiac origin, especial for the patients with documented ischemic heart disease (IHD), congestive heart failure (CHF), or histo~sJ of lethal an-hytlnnia. On the other hand, for the patients complaining undiagnosed syncope and unexplained palpitation, hardly could resting ECG or con ventional holter system provide a definite diagnosis. As a result, portable electrocardiograph (ECG) Iecorders with a daily data receiving system become a powerful life guard of those patients. So we want to introduce a telemedicine ECG system (i.e. long distance electrocardiograph Wansmis sion) into our center and initiate a pilot for the patients to test the efficacy of such a system. M e t h o d : From September, 22, 2003 to December 2, 2003, we have enrolled totally 19 patients, who carded a snmll, hand held device to keep their ECG's. All their ECG's had been transmitted to our ~ecording centers via cellular (GSM) and analogue telephone lines daily with their subjective symptoms during recording. Of all the patients, 8 have IHD with CHF, and 8 have a~-hythmic history. Besides, 16 of them have frequent palpitation in the previous half year. Results: During the 72 day follow up, totally 805 calls were collected, and 203 (25.2%) presented abnormal ECG findings. Among them, 6 patients had been noted to have lethal an-hytlmtia for their first ffrne (5 patients had have paroxysmal atrial fibrillation and one paroxysnml supraventricular tachycardia). Besides, 121 calls (15.1%) were accompa nied by obvious symptoms as dyspnea, palpitation or angina; and 73 of them yield no accompanied ECG abnomlality. These symptoms, therefore, had been ruled out to have cardiac origin. C o n c l u s i o n : Telemedicine ECG system provides an effective method for the diagnosis and follow up of patients with heart disease. Not only could it detect the lethal arrhytlm~ia, but also clarify the relation of some atypical symptoms to probable underlining cardiac disease.
P7-06 T H E U S E O F H E A R T RATE V A R I A B I L I T Y IN C A R D I O L O G Y
h Majercak, IIIrd Department of Internal Medicine, University Hospital, Kosice, Slovakia Heart rate variability is the marker of the heart's response to the autonomic nervous system activity. The decrease in HRV is a clinical predictive factor of overall cardiac mortality, and especially that of an-hytlnnia complications in the population after infarction. The parameters most significantly used in practice include SDNN and HRV index. %venty four hour measurements are of higher predictive value, and an increase in the positive predictive value can be accomplished by multifactorial stratification. HRV is most frequently combined with ejection fraction and baroreflex sensitivity. The possibilities of HRV assessment are interesting also in coincidence with heart failure, arterial hypertension and atrial fibrillation also after heart Wansplantation. We corelate the HRV parameters with the severity of coronary artery disease. Patients with angiograficaly estimated 3 vessel disease had sig nificantly lover SDNN, which co,elate with 10 year smwival, too.
POSTER SESSION P8
Hypertension P8-01 INFLUENCES OF LEFT VENTRICULAR HYPERTROPHY ON T R A N S M I T R A L F L O W P A T T E R N A N D A O R T I C S T I F F N E S S IN HYPERTENSION
Chih Hsin Hsu, Wei Chuan Tsal, Liang Mfin Tsal, Cheng Han Lee, Wei Ting Lee, Ju Yi Chen, Li4en Lin, Jyh Hong Chen. Department of
Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan I n t r o d u c t i o n : Hypertension causes left ven~cular hypertrophy (LVH). LVH can lead to diastolic dysfunction. However, the effects of LVH on aortic stiffness and its relationship to transffdtral Doppler flow were not fully elucidated. This study was undertaken to investigate the relationship between transffdtral Doppler flow and aortic stiffness in hypertension patients and effect of LVH on this relationship. M e t h o d s : Eighty three patients (mean age 46±8 years, 49 males) with untreated essential hypertension were included in this study. LVH was assessed by M mode echocardio~-aphy and we divided patients into two groups based on the presence of LVH. Transffdtral Doppler flow velocity was measured from the standard four chamber view. Indices of aortic stiffness were measured by M mode echocardio~aphy and were calculated from following formula: Stiffness index (SI) in (systolic blood pressure/diastolic blood pressure)/(changes in aortic diameter/diastolic diameter); Distensibility (DI) 2(changes in aortic diameter)/(diastolic diameter) (pulse pressure). Results: Among all patients, the peak early fiiling velocity (E) was significantly correlated with SI (r 0.227, p 0.039), the peak atrial velocity (A) was significantly correlated with DI (r 0.259, p 0.018), and the early filling to atrial velocity ratio (E/A) was significantly correlated with SI (r 0.233, p 0.034). There were 21 patients (25%) with LVH. Patients with LVH had higher systolic blood pressure, diastolic blood pressure, blood urea nitrogen, SI and lower DI than patients without LVH. Parameters of transmitral Doppler flow pattern were similar in both groups. The correlation between transmBral Doppler flow and indices of aortic stiffness were disappeared in patients with LVH. C o n c l u s i o n : Out data indicated that transmBral Doppler flow pattern were correlated with aortic stiffness. The transmitral Doppler flow pattern was not only influenced by diastolic filling but also increased afterload. However, this phenomenon was blunted by the presence of LVH. When assessing transmitral Doppler flow pattern in hypertension, aortic stiffness should be taken into account and also the influences of LVH.