－S 212 －
― F-179 ―
Impact of Mitral Annular Calcification on Left Ventricular Function in Nonagenarian
중앙대학교병원 순환기내과, 심장센터
*서기우, 김은영, 김정은, 조은정, 최여원, 이경헌, 이왕수, 이광제, 김상욱, 김태호, 김치정, 류왕성
Mitral annular calcification(MAC) has been known to associate with degenerative process of cardiac fibrous skeleton and cardiovascular disease mortality. However, MAC have not been evaluated in elderly. Methods: We assessed echocardiographic parameters in 43 nonagenarian and 51 young control group. The comprehensive M-mode and doppler echocardiography was performed including tissue doppler imaging. The presence and severity of MAC was assessed from the leading anterior to the trailing posterior edge at its largest width at least 3 cardiac cycles.
Results: Pt age was 92±2.4 yrs and 25% were male in nonagenarian; pt age was 36±9.7 yrs and 51% were male in control group. Echo showed left atrial diameter was similar(p=0.096), and left ventricular end-diastolic dimension was larger in young controls (p=0.005), however the ejection fraction(EF) was lower in nonagenarian (p<0.0001). The frequency of MAC was more often in nonagenarian (42/43 [97%]) than in controls (9/51 [17%], p<0.0001). Maximal thickness of MAC was larger in nonagenarian (0.51±1.17 mm and 0.052±0.18 mm, p<0.0001).
MAC was correlated with age(r=0.833, p<0.0001), EF(%)(r=0.333, p=0.001), and left ventricular mass index(g/m2)(r=0.28, p=0.015). More importantly, early mitral inflow velocity/early diastolic mitral annulus velocity(E/E') was higher in nonagenarian(p<0.0001). Conclusion: MAC correlate with decreased left ventricular function. These may be associated with increased risk of subsequent events in nonagenarian.
Nonagenarian Controls p-value
Left atrium (mm) 39.02±10.04 36.15±4.91 0.096
Ascending aortic diameter (mm) 33.0±5.03 30.25±2.97 0.003
Left ventricular dimension, systolic (mm) 32.28±7.35 32.90±3.59 0.621 Left ventricular dimension, diastolic (mm) 47.52±6.72 50.94±3.77 0.005 Left ventricular mass index (g/m
2) 105.34±30.75 85.55±17.63 0.001
Ejection fraction (%) 56.71±11.41 63.13±5.25 <0.0001
E/E’ 17.25±3.66 8.77±3.33 <0.0001
― F-180 ―
N-terminal pro-B-type natriuretic peptide in overweight and obese patients with and without diabetes
메리놀병원
*박승제, 조경임, 최성원, 최재원, 김태익, 이현국, 이동원
Background: Recent studies have shown that obesity is an independent predictor of lower N-terminal pro-BNP(NT-proBNP) levels and raised concerns about the validity of this biomarker in obese subjects. BNP has been shown to be increased in patients with DM, even in the absence of structural heart disease, and obesity frequently coexists with diabetes, so it is important to consider the joint influences on natriuretic peptide levels. So we evaluated the influence of diabetes on the correlation BNP and BMI. Method and Results: Simultaneous NT-proBNP and echocardiographic examinations were performed in 933 patients with dyspnea undergoing cardiac catheterization between Feb. 2006-Nov. 2007 in Maryknoll cardiac center who had creatinine of <2.0, no evidence of systolic heart failure. Patients were divided into body mass index(BMI)
>25kg/m2(obese), 23 to 25(overweight), and <23 kg/m2(non obese). NT-proBNP levels, mitral early diastolic/tissue Doppler annular velocity(E/Ea), LV geometry pattern using relative wall thickness and LV mass index and myocardial performance index(Tei index) were compared with groups. In 733 non-diabetic patients, mean NT-proBNP level were significantly lower in obese(n=287, 289.62±164.9 pg/ml) and overweight patients(n=216, 601.69±159.6 pg/ml) compared with nonobese (n=230, 856.39±237.3 pg/ml) patients(p<0001, respectively).
However, in 200 diabetic patients, mean NT-proBNP level were 963.19±223.7 pg/ml, 1450.15±457.3 pg/ml, 658.05±147.1pg/ml, respectively.
so there was no correlation between BMI and pro-BNP(r=-0.91, p=0.19). NT-proBNP did not correlate with mitral E/Ea in obese diabetic patients(r=0.14, p=0.56), whereas NT-proBNP significantly correlated with this variable in the non obese(r=0.24) and non diabetic(r=0.32) groups. However, LV mass index was significantly correlated with NT-pro-BNP all BMI groups(r=0.61, p<0.001), and patients with concentric hypertrophy showed the highest BNP levels. Conclusion: The present study demonstrates that NT-proBNP is not suppressed in obese patients with diabetes and the correlation between plasma BNP and LV mass index was more robust than any other echocardiographic or hemodynamic parameter as well as any patient’s characteristics.
