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￭ Sat-179 ￭
Relation between left ventricular filling pressure and change of left ventricular wall intensity
제주대학교병원 내과학교실
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문성미, 범종욱, 최준혁, 김송이, 김기석, 주승재, 이재근
Background/Aims: The left ventricular (LV) filling pressure has been documented an important factor for expression of LV diastolic dysfunction.
Coronary flow reserve (CFR), which reflects coronary microvascular function, was associated with LV filling pressure. The blood flow of the coronary mi- crovessels was mainly in the diastolic period. The contrast medium will be mainly filled in the diastolic phase in coronary computed tomography angiog- raphy (CCTA). Therefore, the hypothesis of this study is that the change in wall intensity of LV between the diastolic and systolic phases in CCTA (wall in- tensity index, WII) is related to the LV filling pressure and microvascular function. Methods: Transthoracic Doppler echocardiography was performed that included pulsed tissue Doppler of the mitral annulus. The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e’) was used as a surro- gate marker of the LV filling pressure. The average of LV wall intensities were obtained from the diastolic and systolic phase in 17 segments using CCTA.
WII was defined as Hounsfield unit scale of (diastolic phase–systolic phase)/diastolic phase. Patients with aortic valve stenosis, congenital heart disease, hypertrophic cardiomyopathy, dilated cardiomyopathy, permanent pacemaker implantation and previous revascularization due to ischemic heart disease were excluded. Results: Total 50 patients were enrolled and mean age of patients was 59.8 years. WII was significantly low in patients with E/e’ over 14 than those with E/e’ less than 14 (-3.2 ± 9.9 vs. 4.4 ± 4.3; p<0.05). In univariate analysis, age, e’ velocity and E/e’ were significantly associated with WII.
In multivariate analysis, E/e’ was independently associated with WII (β=-0.404, R2=0.146, p=0.004). Conclusions: WII was associated with LV filling pressure and we can suggests that WII can be used to evaluate microvascular function.
￭ Sat-180 ￭
A paraganglioma presented as headache and hypertension
1동국대일산병원 내과, 2동국대일산병원 영상의학과
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김진영
1, 김용석
1, 이용석
2Paragangliomas are rare neuroendocrine tumors that producing catecholamine, arise from the extra-adrenal autonomic paraganglia, small organs consisting mainly of neuroendocrine cells that are derived from the sympathetic or parasympathetic nervous system. We presented a patient of paraganglioma, who had headache, hypertension and eventually recovered from operation. A 36-year old woman was admitted to the cardiovascular department because of the gradual onset of headache. She had weight loss for 5kg for several months. The onset of headache was 2 weeks ago. She visited emergency department for headache and cold sweating. Systolic and diastolic blood pressure was 199/113, heart rate was 91. On physical examination, there was palpable mass at LUQ area. At admission, laboratory results were normal and initial electrocardiogram showed normal sinus rhythm and brain CT showed unremarkable brain parenchyma and CSF space. Chest X-ray showed normal size of heart. Echocardiography showed normal ejection fraction (56%), no regional wall motion abnormality. We suspected secondary hypertension due to renal parenchymal disease, renal artery stenosis, pheochromocytoma, extra-adrenal paraganglioma. Metanephrine and normetanephrine level was high (0.67 nmol/L, 25.04 nmol/L). 24 hr urine VMA, epinephrine, normetanephrine and met- anephrine was also high (35.7mg/day, 35.1 ug/day, 3727.1 ug/day, 511.0 ug/day). CT angiography(figure 1) showed approximately 9 cm well-defined, nod- ular, heterogenous enhancing (solid and cystic) mass in left abdomen that was suspected for primary retroperitoneal tumor(neurogenic tumor such as para- ganglioma, neurilemmoma etc..) and there was no evidence of metastasis. Mass was removed using laparoscopy(figure 2). Histopathologic examination re- vealed synaptophysin and chromogranin positive in tumor cells. After operation, she was recovered from hypertension and headache without medication.
Paraganglioma is a rare and curable cause of hypertension. The presented case shows that secondary hypertension caused by paraganglioma. Prompt recog- nition and early surgical resection is the key in management.
