Evaluation of regional myocardial systolic function in the early stage of acute myocardial infarction by strain rate imaging

We sought to evaluate the impact of different therapeutic strategies on longitudinal regional myocardial systolic function in the early phase of acute myocardial infarction using strain rate imaging. A total of 38 patients [34 males], with first acute myocardial infarction [AMI] were evaluated. Our patients were divided into 3 groups according to the kind of therapy. The mean age of the patients was 55 +/- 9.4 years [range: 39- 75 years]. Mean left ventricular ejection fraction [LVEF] in the patients was 41 +/- 10.7%. Primary percutaneous coronary intervention [PCI] was performed in 10 patients. Sixteen patients were treated by thrombolytic therapy using streptokinase [SK] and 12 were followed-up conservatively. All patients underwent a comprehensive echocardiography study including SR imaging within 3- 5 days after AMI. The parameters measured included peak systolic strain [peak epsilon] and strain rate [SRs], end-systolic strain [epsilon es], post systolic shortening [PSS], time to peak systolic strain rate [tSRs], time to end of shortening [teSRs], post systolic strain [PS epsilon], post-systolic strain index [PSI], PSS ratio [PSS/ epsilon [Max]] and peak postsystolic strain rate [SRPSS]. There was not any association either between WMSI and ta [P=0.4], or MI location and PSS ratio [P=0.13]. But there was an inverse relationship between WMSI and mean SRS, especially when WMSI was more pronounced. A significant relationship was found between t epsilon epsilon and teSRs with the kind of therapy [shorter in PCI group [P= 0.04]. Using a simple linear regression model, no association was found between PSS ratio and SRs [a=0.056, P =0.70], PSI and teSRs [beta= -0.772, P=0.12]. Simple linear regression model showed a weak but significant relationship between PSI and Median t epsilon [beta = -0.851, P =0.04; r =0.33]. Our study showed that PCI resulted in early recovery of regional systolic function of infarcted myocardium during the early stage of acute myocardial infarction

Non-invasive assessment of left ventricular end-diastolic pressure in patients with chronic aortic regurgitation, comparison of the sensitivity and specificity of CW doppler echocardiography with angiography

Left ventricular end diastolic pressure could be estimated collectively using various measures of mitral valve and pulmonary venous flow velocities. In patients with aortic regurgitation, the AR velocity reflects the diastolic pressure difference between the aorta and the left ventricle. We sought to predict the left ventricular end diastolic pressure by a new Doppler index as aortic regurgitation peak early to late diastolic pressure gradient ratio. Fifty three patients with at least moderate aortic regurgitation were enrolled in this study. Physical examination, electrocardiography and echocardiography were performed one day before cardiac catheterization. The severity of AR was graded according to the recommendations of American society for echocardiography. The pressure half time, aortic regurgitation early diastolic velocity, aortic regurgitation early diastolic pressure gradient, aortic regurgitation end diastolic velocity, aortic regurgitation end diastolic pressure gradient, and early diastolic to end diastolic pressure gradient ratio of averaged three beats were measured and recorded. The results from cardiac catheterization and echocardiography were compared. The early diastolic to end diastolic pressure gradient ratio was very accurate [80%] for determining the left ventricular end diastolic pressure [P =0.01]. An early diastolic to end diastolic pressure gradient ratio of 1.5 has a sensitivity of 96% and a specificity of 32% for left ventricular end diastolic pressure 12 mmHg was higher than 2.0, with a sensitivity of 71% and specificity of 96% We found no significant correlation between the left ventricular end diastolic pressure with either left ventricular ejection fraction or aortic regurgitation severity in cardiac catheterization [P =0.5]. Doppler echocardiography is a viable alternative of cardiac catheterization for determination of the left ventricular end diastolic pressure. The early diastolic to end diastolic pressure gradient ratio is a simple, easy and new method for assessment of the LVEDP in patients with severe chronic aortic regurgitation

Quantification of aortic regurgitation severity by left ventricular to right ventricular stroke volume ratio

Echocardiography is the most common test used for the evaluation of aortic regurgitation [AR]. However, the role of echocardiography as an available and inexpensive method in the quantification of AR by the left ventricle to right ventricle stroke volume ratio [LV/RV SV ratio] has not been completely investigated. Between June 2005 and December 2007, 132 consecutive patients with AR [mean age: 44.7 +/- 14.6 years, 52.3% male] were enrolled in the study. All the patients underwent echocardiography; and aortography, if indicated, was performed as well. Fifty-two percent of the patients had severe AR. There was almost a perfect agreement between echocardiography and cardiac catheterization in determining the severity of AR [Kappa=0.81]. Associated valvular disease was found in 81.8% of the patients, the most common disease being mitral regurgitation [61%]. The results of our bivariate and multivariate analyses showed a significant relation between the LV/RV SV ratio and the AR severity via either echocardiography or cardiac catheterization [both P=0.001]. The receiver operating characteristic [ROC] curve analysis showed that the LV/RV SV ratio was very accurate in the detection of severe AR utilizing cardiac catheterization as the gold standard [AUC=0.71]. The cut point value of the LV/RV SV ratio