고혈압성 심장에서 4 심음과 좌심실 근질량 및 승모판 혈류양상의 관계 = Fourh Heart Sound in Hypertensive Heart ; Relationship to the Left Ventricvlar Mass and Mitral Flow Pattern고혈압성 심장에서 4 심음과 좌심실 근질량 및 승모판 혈류양상의 관계

다국어 초록 (Multilingual Abstract)

To determine the clinical significance of the fourth heart sound (S.) in hypertensive heart, 31 patients with essential hypertension aged between 32 to 77 years old and 15 normal controls were examined by physical examination, phonocardiography and echocardiography, All hypertensive patients had normal sinus rhythm and no history of coronary artery disease nor COPD and most of them had moderate to severe hypertension. Depending upon the presence of audible S4, hypertensive patients were divided into 3 groups; those without audible S, (group I, 15 cases), those with audible S, (group II, 12 cases) and those with questionably audible S, (group III, 4 cases). M-mode echocardiograms of the left ventricle and pulsed wave Doppler echocardiograms of the mitral valve were performed to determine the left ventricular thickness/dimension ratio (T/D), left ventricular mass index (LVMI) and A/E ratio of mitral flow pattern. T/D and LVMI were significantly increased in both hypertensive group I and group 11 (p<0.01) and T/D of hypertensive group II was more increased than that of hypertensive group I (p<0,05), but there was no significant difference between hypertensive group I and group II in LVMI. In contrast, the A/E ratio of mitral Doppler flow pattern was increased only in hypertensive group II compared to normal controls (p<0.01), and there was a significant difference between hypertensive group I and group II (p<0.01). Audible S, was found in hypertensive patients with an A/E ratio greater than 1.10 and in a normal person with an A/E ratio of 1.27, and all 10 hypertensive patients above an A/E ratio of 1.20 except one had an audible fourth heart sound. In conclusion, audible fourth heart sound is a useful bedside parameter for detecting left ventricular diastolic dysfunction in the hypertensive heart.