Earticle

본 연구는 무증상 한국 여성의 인체측정지표(체표면적, 체질량지수)와 심장이완기능지표와의 관계를 통해 생애주기에 따른 심혈관질환 위험이 증가할 수 있는 시기를 파악하고자 하였다. 실험대상은 좌심실박출률이 50% 이상인 860명의 한국 성인여성으로 생애주기에 따라 4개의 그룹으로 구분하여 양적연구를 실시하였다. 인체측정지 표를 심장이완기능지표들과 피어슨 상관분석으로 관련성을 확인하였고 생애주기 구분에 따라 인체측정지표가 이완 기능지표에 영향을 미치는지 선형회귀분석을 실시하였다. 그 결과 이완기능지표의 비정상적인 수치가 중년기부터 증가하고, 만성 이완기능장애지표의 좌심방 용적지수는 50세 이후인 장년기부터 노년기까지 체질량지수와 유의한 상관관계가 나타났다. 따라서 위험성 예측의 간단한 방법인 체질량지수를 이용하여 장년기에 만성 이완기능장애를 간접적으로 평가함으로써 심혈관질환의 예방과 건강관리 예측인자로서 진단에 도움이 될 것으로 사료된다.

This study sought to determine the relationship between anthropometric indices(Body surface area, Body mass index) and cardiac diastolic function indices in asymptomatic Korean women to identify changes in the heart according to the life cycle and when risk may increase. The subjects were 860 Korean adult women with a left ventricular ejection fraction of 50% or more. They were divided into four groups according to their life cycle and a quantitative study was conducted. The relationship between anthropometric indices and cardiac diastolic function indices was confirmed through Pearson correlation analysis, and a linear regression analysis was performed to determine whether anthropometric index affect diastolic function index according to life cycle categories. As a result, abnormal values of diastolic function index increased from middle aged group, and the left atrial volume index of chronic diastolic dysfunction index showed a significant correlation with body mass index from late middle-aged to older aged group, after the age of 50. Therefore, it is believed that indirectly assessing chronic diastolic dysfunction in late middle-aged using body mass index, a simple method of risk prediction, will be helpful in diagnosis as a predictor of cardiovascular disease prevention and health management.

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’) ≥ 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.

BACKGROUND: Diastolic function has been reported to be impaired in many patients with coronary slow flow phenomenon (CSFP). CSFP has broad spectrum of clinical presentations, including non-ST elevation myocardial infarction (NSTEMI). We sought to study the short-term evolution of diastolic function in CSFP patients presenting with NSTEMI. METHODS: This study included 92 patients with CSFP and acute NSTEMI. Conventional echocardiography Doppler imaging and tissue Doppler echocardiography imaging were used to evaluate diastolic function during index NSTEMI and after 3 months. RESULTS: Mean age of study patients was 45.7 ± 6.8 years. The prevalence of diastolic dysfunction (DD) at baseline was 69 patients (75%) and 28 patients (30.4%) at 3 months, p < 0.001. Various diastolic function indices showed significant improvement from baseline to 3 months follow-up. E/Em was 17.32 ± 3.41 at baseline compared to 12.41 ± 5.58 at 3 months, p = 0.039. Septal e′ velocity was 5.67 ± 4.56 cm/s at baseline compared to 7.78 ± 3.22 cm/s at 3 months, p = 0.023. Medications used were not significantly different between those with improved versus unimproved DD. CONCLUSIONS: Diastolic function seems to improve over short-term follow-up in patients with CSFP presenting with NSTEMI. This could reflect a transient worsening during acute NSTEMI.

Background and Purpose Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated. Methods In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e’) was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e’ as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year. Results Among included patients, E/e’ was 10.6±6.4: E/e’ <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e’ ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction. Conclusions LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.

Diastolic dysfunction, which is increasingly viewed as being influential in precipitating heart failure and determining prognosis, is often unrecognized and has therapeutic implications distinct from those that occur with systolic dysfunction. In this review, several therapeutic modalities including pharmacologic, nonpharmacologic, and surgical approaches for primary diastolic dysfunction and heart failure will be discussed.

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Background/Aims: Few studies have assessed left ventricular (LV) dyssynchrony in cases of diastolic dysfunction that do not include overt symptoms of heart failure. We hypothesized that systolic or diastolic dyssynchrony involves unique features with respect to the degree of diastolic impairment in isolated diastolic dysfunction. Methods: We examined 105 subjects with no history of overt symptoms of heart failure and a left ventricular ejection fraction > 50% for mechanical dyssynchrony using tissue Doppler imaging. Results: In terms of longitudinal dyssynchrony, four cases showed (6.3%) LV intraventricular systolic dyssynchrony (SDSLV), whereas none had LV intraventricular diastolic dyssynchrony (DDSLV) or co-existing systolic dyssynchrony. Radial dyssynchrony (RD) was found in six cases (9.4%). After adjusting for age, SDSLV and DDSLV were found to be significantly related to increases in the E/E′ ratio (r = 0.405 and p < 0.001 vs. r = 0.216 and p = 0.045, respectively). RD at the base and apex was also significantly related to increases in E/E′ (r = 0.298 and p = 0.002 vs. r = 0.196 and p = 0.045, respectively). Conclusions: Systolic and diastolic dyssynchrony in subjects with isolated diastolic dysfunction but without overt symptoms of heart failure was not as common as in patients with diastolic heart failure; however, the systolic and diastolic intraventricular time delay increased with increases in the E/E′ ratio, an indicator of diastolic dysfunction. (Korean J Intern Med 2010;25:246-252)

BACKGROUND: The function of left atrium (LA) is difficult to assess because of its ventricle-dependent, dynamic movement. The aim of this study was to assess LA function using velocity vector imaging (VVI) and compare LA function in patients with hypertrophic cardiomyopathy (HCMP) and left ventricular hypertrophy (LVH) with normal controls. METHODS: Fourteen patients with HCMP (72% male, mean age of 52.6 ± 9.8), 15 hypertensive patients with LVH (88% male, mean age of 54.0 ± 15.3), and 10 age-matched controls (83% male, mean age of 50.0 ± 4.6) were prospectively studied. Echocardiographic images of the LA were analyzed with VVI, and strain rate (SR) was compared among the 3 groups. RESULTS: The e′ velocity (7.7 ± 1.1; 5.1 ± 0.8; 4.5 ± 1.3 cm/sec, p = 0.013), E/e′ (6.8 ± 1.6; 12.4 ± 3.3; 14.7 ± 4.2, p = 0.035), and late diastolic SR at mid LA (?1.65 ± 0.51; ?0.97 ± 0.55; ?0.82 ± 0.32, p = 0.002) were significantly different among the groups (normal; LVH; HCMP, respectively). The e′ velocity, E/e′, and late diastolic SR at mid LA were significantly different between normal and LVH (p = 0.001; 0.022; 0.018), whereas LA size was similar between normal and LVH (p = 0.592). The mean late diastolic peak SR of mid LA was significantly correlated with indices of diastolic function (E/e′, e′, and LA size). CONCLUSIONS: The SR is a useful tool for detailed evaluation of LA function, especially early dysfunction of LA in groups with normal LA size.

BACKGROUND: Hypertensive patients are at increased risk of diastolic dysfunction. The hypothesis of this study was that addition of amlodipine would be superior to valsartan in improving diastolic dysfunction associated with hypertension. METHODS: In this randomized trial, we randomly assigned 104 controlled, hypertensive patients with diastolic dysfunction to receive either amlodipine 2.5 mg or valsartan 40 mg, in addition to antihypertensive therapy. The primary end point was the change in the ratio of early mitral inflow velocity to early mitral annular relaxation velocity (E/E′) from baseline to the 6-month follow-up. Secondary end points included changes in systolic blood pressure (SBP), left ventricular (LV) mass index, and left atrial volume index. RESULTS: SBP decreased significantly from baseline in both treatment groups (p < 0.001). E/E′ decreased significantly from 13.0 ± 2.2 to 12.0 ± 2.7 in the amlodipine arm and from 14.4 ± 4.3 to 12.7 ± 3.7 in the valsartan arm (p < 0.01 in both groups). The change of E/E′ was not significantly different between treatment groups (p = 0.25). There were also no significant between-group differences regarding the changes in SBP, LV mass index, and left atrial volume index. Two patients (3.8%) in the amlodipine group and 1 (16%) in the valsartan group had serious adverse event. CONCLUSIONS: In this randomized trial involving controlled hypertensive patients, addition of amlodipine or valsartan was associated with an improvement of diastolic dysfunction, but the effects on diastolic dysfunction did not differ significantly between the treatment groups.

Background: The level of Galectin-3 (Gal-3) protein purportedly reflects an ongoing cardiac fibrotic process and has been associated with ventricular remodeling, which is instrumental in the development of heart failure with preserved ejection fraction (HFpEF) syndrome. The aim of this study was to investigate the potential use of Gal-3 in improved characterization of the grades of diastolic dysfunction as defined by echocardiography. Methods: Seventy HFpEF patients undergoing routine echocardiography were prospectively enrolled in the present monocentric study. Blood samples for measurements of Gal-3 and amino-terminal pro-brain natriuretic peptide (NT-proBNP) were collected within 24 hours pre- or post-echocardiographic examination. The classification of patients into subgroups based on diastolic dysfunction grade permitted detailed statistical analyses of the derived data. Results: The Gal-3 serum levels of all patients corresponded to echocardiographic indices, suggesting HFpEF (E/A, P =0.03 and E/E’, P =0.02). Gal-3 was also associated with progressive diastolic dysfunction, and increased levels corresponded to the course of disease (P =0.012). Detailed analyses of ROC curves suggested that Gal-3 levels could discriminate patients with grade III diastolic dysfunction (area under the curve [AUC]=0.770, P =0.005). Conclusions: Gal-3 demonstrates remarkable effectiveness in the diagnosis of patients suffering from severe grade diastolic dysfunction. Increasing levels of Gal-3 possibly reflect the progressive course of HFpEF, as classified by the echocardiographic grades of diastolic dysfunction.

Background: To point out a possible correlation between left atrial volume index (LAVI) and left ventricular (LV) diastolic time interval to better define LV diastolic dysfunction, this study was performed. Methods: In 62 hypertensive-hypertrophic patients without LV systolic dysfunction, LV volumes, myocardial mass index,ejection fraction% (EF%) and LAVI were measured by two-dimensional echocardiography. Instead, tissue Doppler echocardiography (TDE) was used to measure myocardial performance index (MPI) and its systo-diastolic time intervals, such as:iso-volumetric contraction time (IVCT); iso-volumetric relaxation time (IVRT); ejection time. LAVI, TDE-MPI and time intervals where also measured in 15 healthy controls, to obtain the reference values. Results: Results shown a significant increase of LV volumes in hypertensives in comparison to the control group (p < 0.05). LV mass index also augmented (p < 0.001). Instead, EF% not significantly changed in hypertrophic patients in comparison with healthy controls. LAVI raised in hypertensives wih left ventricular hypertrophy, whereas IVCT resulted within the normal limits. On the contrary, IVRT significantly raised. Accordingly, MPI resulted higher in controls. Conclusion: LAVI, MPI and its time intervals appear as reliable tools to non-invasively individualize LV diastolic dysfunction in systemic hypertension, in absence of mitral valve disease.

BACKGROUND: Assessment of diastolic dysfunction (DD) and left ventricular filling pressures (LVFP) by echocardiography is complex in patients with preserved ejection fraction (EF). The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) jointly published recommendations in 2016 to simplify the diagnosis and classification of DD and the assessment of LVFP. We aimed to study the impact of the updated 2016 ASE/EACVI guidelines vis-a-vis the 2009 ASE recommendations on prevalence of DD and LVFP in patients with preserved EF. METHODS: Five hundred patients referred to the echocardiography laboratory from March 2020 to May 2020 were analyzed. Patients with left ventricular ejection fraction (LVEF) < 50% were excluded. All patients underwent comprehensive transthoracic echocardiography. DD and LVFP were assessed by the 2016 ASE/EACVI and 2009 ASE recommendations. The concordance between the guidelines was analyzed by kappa coefficient and overall proportion of agreement. RESULTS: Mean age was 53 ± 13 years and 63.4% were men. Prevalence of DD and abnormal LVFP were significantly lower with the 2016 recommendations than with the 2009 recommendations (9.4% vs. 16.8%, p < 0.001 and 8.4% vs. 12.8%, p < 0.05). Patients with Grade 1 DD (100%) and Grade 2 DD (46.4%) were reclassified by the 2016 recommendations. Indeterminate diastolic function (9.8%) was strikingly high according to the 2016 recommendations. The concordance between the two recommendations was moderate (kappa = 0.569). The overall proportion of agreement was 85.4%. CONCLUSIONS: Prevalence of DD and abnormal LV filling pressures were lower with application of the 2016 ASE/EACVI recommendations in patients with preserved EF. There was moderate agreement between the 2009 and 2016 recommendations.

Background We aimed to find predictors of ejection fraction (EF) deterioration in heart failure with preserved EF (HFpEF) patients to prevent their further deterioration. Methods We studied 215 patients (mean age, 73 ± 8 years; 63% women) with HFpEF and with records of Charlson Comorbidity Index, glomerular filtration rate. Myocardial work, global longitudinal, radial, circumferential, and area strain. The global work index, global constructive work (GCW), wasted work, global work efficiency was obtained by echocardiography. Patients were followed up for 3 years. Results Five patients developed myocardial infarction and were excluded from the study. Baseline EF was higher in female patients (61.2% ± 3.1% vs. 56.4% ± 2.7%, P < 0.002), in patients aged > 70 years (62.4% ± 2.1% vs. 57.1% ± 2.3%, P < 0.005), and in patients with end-diastolic volume index < 60 mL/m2 (56.1% ± 3.2% vs. 63.4% ± 2.3%, P < 0.001). EF decline compared to baseline was ?7.3% ± 1.6% (P < 0.01). EF decline was significantly more in patients aged > 70 years, in patients with coronary artery disease and did not relate to sex, left ventricle size, cardiac index, and glomerular filtration rate. During follow-up 58 patients (27%) had EF < 50%, worsening in area strain (?27.9% ± 8.5% vs. ?24.7% ± 5.3%, P < 0.003), global longitudinal strain (?19.7% ± 2.4% vs. ?17.1% ± 1.6%, P < 0.005), and GCW (2,378% ± 117% vs. 2,102% ± 10%, P < 0.002). Patients with EF < 50% at the end of the study had less area strain and GCW baseline values compared with patients with EF > 50% (22.4% ± 7.2% vs. ?27.6% ± 8.1%, P < 0.002; 2,081 ± 92 vs. 2,489 ± 127, P < 0.001). GCW was the predictor of EF deterioration (area under curve, 0.8853). Conclusions GCW predicts EF

Purpose: The fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is oftenfound during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clini-cal implications of premature E-A fusion of uncertain cause in the absence of tachycardia. Materials and Methods: We identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between Janu-ary 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates lessthan 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) werecompared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion. Results: The premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV di-astolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msecvs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%,p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred atlower heart rate, the |LV GLS| was also lower (p for trend=0.002). Conclusion: Premature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based in-dices and LV GLS are helpful for evaluating this easily overlooked population.

Evaluation of left ventricular diastolic function is essential, especially in patients with heart failure with preserved ejection fraction. The American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines were released in 2016. Four principal parameters were used to assess left ventricular diastolic function. However, there are grey areas; the situation is complex. Recently, various other indicators have been employed to explore left ventricular diastolic function.

좌심실 이완기능 장애는 심근허혈이나 좌심실비대 등과 같은 심근질환이 잇는 환자에서 대부분 관찰되지만 심장질환이 없는 건강한 사람에서도 흔하게 관찰된다. 정상 심박출(수축기능)상태에서 좌심실의 이완기 장애 평가는 심부전의 진행과 예후에 영향을 줄 수 있다. 심장외막지방조직은 생리활성분자를 생성하는 대사활동기관으로 심혈관질환에 직접적으로 연관성이 있으며 이는 심근에 직접적으로 영향을 미쳐 이후 심장의 기능장애를 초래한다. 본 연구목적은 심장외막지방의 두께를 측정하여 정상의 수축기 기능인 상태에서 확장기(이완기) 기능장애의 평가와의 연관성을 연구하고자하였다. 연구결과 심장외막지방두께와 이완기 장애 유무가 통계적으로 유의한 수준에서 높은 연관성이 있는 것으로 분석되었다. 특히 심장외막지방두께 측정단면 EAT2에서 측정된 값과 이완기 장애평가방법 E'는 높은 상관관계가 있는 것으로 나타났다. 따라서 심장외막지방두께변화는 좌심실의 이완기능장애를 평가할 수 있는 예측인자로 사용될 수 있을 것으로 사료된다.

Left ventricular diastolic dysfunction is mostly observed in patients with cardiac disease, such as myocardial ischemia or LVH, but linking is usually observed in healthy people without heart disease. Evaluation of left ventricular diastolic failure in normal cardiac output(systolic function) conditions can affect the progress and prognosis of heart failure. The direct relevance to the epicardial adipose tissue metabolism in cardiovascular engine for generating a bioactive moleculer, which leads to dysfunction of the later had a direct effect on myocardial heart. The purpose of this study is to measure the thickness of the epicardial adipose tissue was to study the relevance of the assessment of diastolic dysfunction in systolic function in normal conditions. Results epicardial adipose tissue thickness and diastolic dysfunction was analyzed to have a high correlation in a statistically significant level. In particular, the epicardial adipose tissue thickness measured at the measuring section EAT2 and diastolic function evaluation E' was found to have a high correlation. Thus epicardial adipose tissue thickness variation is believed can be used as a predictor to evaluate the left ventricular diastolic dysfunction.

목적: 만성 실질환 환자에서 허혈성 심질환은 주된 사망원인으로, 이와 연관된 위험인자를 파악하고 관리하는 것은 중요하다. 허혈성 심질환과 관련된 심장의 구조적인 변화 중 특히 좌심실 이완기능 장애는 최근 발생률이 증가하고 있으며, 예후 또한 불량한 것으로 보고되고 있다. 따라서 본 연구는 만성 실질환 환자를 대상으로 심초음파를 이용하여 좌심실 이완기능 장애를 진단하고, 좌심실 이완기능 장애가 사망률 및 허혈성 심질환의 발생률에 미치는 영향에 대하여 알아보고자 하였다. 방법: 2005년 1월부터 2010년 5월까지 본원에서 심초음파를 시행한 만성 실질환 환자 중, 좌심실 구혈률이 55% 미만, 중등도 이상의 판막질환이 있는 환자와 관찰기간이 6개월 미만인 환자를 제외한 71명의 환자를 대상으로 하였다. 임상적 지표들은 의무기록 조사를 통해 수집하였고, 심초음파 검사, 혈액검사를 후향적으로 분석하였다. 결과: ROC curve를 이용한 허혈성 심질환과 연관된 좌심실 이완기능 장애의 진단 기준값은 E/E’ = 15.55 (sensitivity: 100%, specificity: 64.7%, p = 0.005), E/A = 0.79 (sensitivity: 84.6%, specificity: 55.9%, p = 0.006)였다. 이 값을 기준으로 E/E` > 15.55, E/A > 0.79인 19명을 좌심실 이완기능 장애가 있는 환자군, Group I으로 지정하였고, 그 외 나머지 환자 52명을 Group II로 나누었다. 심초음파에서 Group I의 E/A, DT, E/E’ 값은 각각 1.27, 184.21, 19.08이었고 Group II에서는 0.73, 225.19, 13.58이었다(E/A, p < 0.001; DT, p = 0.017; E/E’, p < 0.001). 좌심실 이완기능 장애에 영향을 미치는 인자를 분석하였고 연령, 허혈성 심질환의 병력, 낮은 혈색소 수치, 높은 저밀도 지단백 수치가 관련이 되었다. 또한 허혈성 심질환을 야기시키는 위험인자를 분석하였을 때는 좌심실 이완기능 장애, 흡연, 높은 저밀도 지단백 수치, 높은 부갑상선 호르몬 수치가 상관관계가 있었다. 좌심실 이완기능 장애와 사망률 사이의 연관성을 살펴보면, 전체 사망률은 Group I, II에서 유의한 차이를 보이지 않았지만(p = 0.177), 허혈성 심질환을 나타내는 disease free survival로 비교하면 Group I이 Group II보다 의미있게 생존율이 감소하였다(p = 0.001). 결론: 만성 신질환 환자에서 좌심실 수축기능이 정상이라도 E/E’ > 15.55, E/A > 0.79인 중등도 좌심실 이완기능 장애를 가진 환자는 허혈성 심질환의 발생률이 높았다.

Background/Aims:Cardiovascular complications are commonly seen in patients with chronic kidney disease (CKD). Recently, the prevalence of left ventricular diastolic dysfunction (LVDD) has increased, and the importance of LVDD has emerged in patients with CKD. The objectives of this study were to identify diagnostic criteria for LVDD related to ischemic heart disease (IHD) and evaluate the prognostic impact of diastolic dysfunction in patients with CKD. Methods:A total of 71 patients with CKD who were evaluated between January 2005 and May 2010 were included in this study. These patients were evaluated by conventional echocardiography and tissue Doppler imaging (TDI) for diastolic dysfunction. Results:Diagnostic cutoff values for LVDD related to IHD were E/E’ = 15.55 (sensitivity: 100%, specificity: 64.7%, p = 0.005) and E/A = 0.79 (sensitivity: 84.6%, specificity: 55.9%, p = 0.006). Group I consisted of 19 patients with an E/E’ > 15.55 and E/A > 0.79. Group II consisted of the remaining patients. Factors contributing to LVDD were age, history of ischemic heart disease, anemia, and high low-density lipoprotein (LDL) level. Factors contributing to IHD were LVDD, smoking, high LDL level, and high parathyroid hormone (PTH) level. The disease-free survival for IHD was significantly lower in group I compared to group II (p = 0.001). However, there was no significant difference in overall survival between groups I and II (p = 0.177). Conclusions:Our study showed that moderate LVDD (E/E’ > 15.55 and E/A > 0.79) in patients with CKD is positively associated with IHD. (Korean J Med 2012;83:328-336)

본 연구는 심장내과에서 심장 초음파를 받은 529명의 환자를 대상으로 진행되었다. 연구방법은 좌심실 박출률이 정상인 대상자를 대상으로 심장초음파 지수를 사용하여 좌심실이완기능장애를 평가하였다. 이완기능장애로 진단된 대상자를 중심으로 대사증후군 위험요인과 심장초음파 지수의 상관관계를 분석하였다. 연구결과, 108명(20.4%)의 연구대상자에서 이완기능장애가 있는 것으로 진단되었다. 대사증후군 분석에서 좌심실이완기능장애가 있는 연구대상자에서 101명(93.5%)이 대사증후군이 동반되었다. 위험요인 중에는 중성지방이 X² = 22.925로 가장 높은 연관성을 보였다. 상관관계 분석에서는 중성지방, HDL 콜레스테롤, 고혈압의 순으로 상관관계가 있는 것으로 확인되었다.

This study was conducted on 529 patients who underwent cardiac ultrasound in the Department of Cardiology. The research method was to evaluate left ventricular diastolic dysfunction using cardiac ultrasound indices in subjects with normal left ventricular ejection fraction. The correlation between metabolic syndrome factors and cardiac ultrasound indices in subjects diagnosed with diastolic dysfunction was analyzed. As a result of the study, diastolic dysfunction was confirmed in 108 patients (20.4%). In the analysis of metabolic syndrome 101 patients (93.5%) with left ventricular diastolic dysfunction had metabolic syndrome. Among risk factors, neutral fat had the highest correlation at X² = 22.925. Correlation analysis confirmed that the correlation was in the order of triglyceride, HDL cholesterol, and hypertension.