Progeostic value of restrictive filling pattern of left ventricle at peak in inferior wall myocardial infarction

The purpose of this research was to study the effect of dobutamine on left ventricular [LV] filling indices in patients suffering their first uncomplicated Acute myocardial infarc-tion restricted to the inferior wall of the LV [AMI-1], and to determine whether restrictive filling pattern [RFP] at peak stress has prognostic value and its utility for evaluation of CAD. METHODS: A total of 40 patients with uncomplicated inferior wall AMI were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E:A ratio > or =1.0, isovolumic relaxation time [IRT] <80 ms, and E-wave deceleration time [Edt] <120 ms. A total of 24 of 40 had RPP at rest, which reverted to non-RFP at stress in 11 [group 2], but persisted in 13 [group 1]; 16 of 40 had non-RFP at rest and peak stress [group 3]. Systolic, diastolic and mean blood pressures were significantly decreased in group [1] compared to group [2] and group [3]. Congested neck veins and lung fields were significantly increased in group [1] compared to group [2] and group [3], and also in group [2] compared to group [3]. LVEDD and LVESD were significantly increased, while LVFS and LVEF were significantly decreased in group [1] compared to group [2] and group [3]. E wave and E/A ratio were significantly increased, while Edt, IRT and Tei index were significantly decreased in group [1] and group [2] compared to group [3], with no significant difference between group [1] and group [2]. CK and CKMB were significantly increased in group [1] compared to group [2] and group [3], and also in group [2] compared to group [3]. In addition, CRP and troponin T were significantly increased in group [1] compared to group [2] and group [3]. Post infarction angina, heart failure and conduction defects were significantly increased in group [1] compared to group [2] and group [3]. Arrhythmia were significantly increased in both group [1] and [2] compared to group [3], with no significant difference between group [1] and group [2].Three vessel disease was statistically more prevalent in group [1] compared to group [2] and group [3]. On the other hand, single vessel disease was statistically more prevalent in group [3] compared to group [1] and group [2]. LAD and LCX lesions were statistically more prevalent in group [1] compared to group [2] and group [3]. In patients suffering inferior infarction, persistence of restrictive filling during stress implies an important marker for increased morbidity and mortality. Stress echocardiography uniquely identifies those high-risk patients

Systolic left ventricular long axis function during stress echo-cardiography in coronary artery disease patients

No study has yet fully compared long axis systolic function [LASF] with wall motion analysis [WMA] of left ventricle [LV] which remains the routine method of patient evaluation despite being semi-subjective and particularly difficult to interpret in the presence of a myocardial infarction [MI] on the base line study. 1- To describe changes in LASF during dobutamine stress echocardiography [DSE] in patients with coronary artery disease [CAD]. 2- To test whether a change in LASF is more accurate than WMA for detection of significant CAD in patients with normal resting wall motion. 3- To see if LASF improves the detection of multi-vessel involvement in patients with a resting wall motion abnormality. A total of 134 subjects divided into 3 main groups; Group I: 68 patients with clinical suspicion of CAD undergoing coronary angiography; Group II: 46 patients had old MI undergoing coronary angiography; Group III: 20 normal subjects of same age and sex as a control group. They were subjected to: Clinical history taking, through physical examination, 12-leads surface ECG, chest X-ray, Echo -Doppler study at rest and during DSE for parameters of LASF of left ventricle, and coronary angiography. The mean ages, sex, heart rate of studied population were comparable with no significant difference among the three studied groups. The mean values of systolic and diastolic blood pressure presence of diabetes mellitus ejection fraction, resting wall motion abnormalities, and coronary angiography patterns were significantlly differe between patient groups and control one. In group I there were 42 [61.8%] patients had single vessel disease while in group II there were 11 [23.9%] patients had single vessel disease. There were 16 [23.5%] and 22 [47.8%] patients had two vessel disease in group I and 11 respectivelly. There were 10 [14.7%] and 13 [28.3%] patients had multi vessel disease in group I and II respectivelly. Patient groups had a highly significant group of LV reduction septal and lateral LASF parameters [amplitude, rate of shortening and Q-onset delay] than control group during DSE group I had a significant reduction of seplul and lateral LASE parameters of LV. Compared with group II during DSE. Patients had two vessel disease and patients had multiple vessel disease had a highly significant reduction in LASF parameters of LV compared with that of single vessel disease. And also, those with multiple vessel disease had a highly significant reduction in LASF parameters of LV compared with that of two vessel disease. Patients having resting wall motion abnormality had a highly significant reduction of septal and lateral walls LASF parameters compared to that patients having normal resting wall motion. 1- The LASF assessment is more reliable and accurate than WMA for the detection of CAD in our patients. 2- LASF parameters measurements were easy, reproducible with less intraobserver variations, specially in patients with poor endocardial delineation. 3- LASF parameters had a higher sensitivity, specificity and predictive values than WMA assessment in diagnosis of CAD. We recommend using of LASF parameters as a technique for detection of ischemia in patients having left bundle branch block by DSE

Differentiation between transmural and non transmural myocardial infarction using tissue doppler imaging

The natural history and outcome of transmural [TM] and nontransmural myocardial infarction [N TM MI] was known to be significantly different many years ago. However, Neither M-mode nor 2-D Echocardiography can provide information regarding TM distribution of contractile performance. Tissue Doppler Echocardiography [TDE] provides new indices of myocardial functions such as myocardial velocity gradient [MVG] which was found to be an accurate method in the experimental assessment of TM. and N. TM. MI. The present work aims to study myocardial velocities in subendocardial and epicardial layers of the infarct segments by pulsed wave [PW] and tissue Doppler echocardiography in order to investigate the value of systolic and diastolic myocardial velocity gradient in distinguishing transmural myocardial infractions from nontransmural one. Forty patients with first attack acute myocardial infarction [MI] and significant single coronary artery disease [> 70% stenosis] were studied with conventional clinical assessment and trans thoracic Echocardiography [TTE] to assess systolic and diastolic left ventricular function, wall motion abnormalities and tissue Doppler imaging [TDI] parameters for assessment of myocardial velocities [including systolic, diastolic and myocardial velocity gradient] in the epicardial and endocardial layers of myocardium. We found a statistically significant difference in the TDI parameters in the endocardial area between the normal and the infarcted segments in patients with transmural and non transmural myocardial infarction. While in the epicardial area there is a statistical significant difference between the infarcted and the normal segments in patients with Q wave myocardial infarction but there is no significant difference in patients with non Q wave myocardial infarction. This means that TDI can detect the non-uniformity of transmural velocity denoting the presence of viable part [epicardial area] in the hypokinetic segments in the nontransmural myocardial infarction. We also found that there is significant difference in TDI parameters in the infarcted segments [either endocardial or epicardial area] between both groups with more depression of the myocardioal velocity in group I [with non Q wave myocardial infarction]. This could be explained by the presence of more viable myocardium in the area with non transmural infarction with less affection of the velocity. We conclude that TDE might be an applicable and noninvasive modality that can detect the non uniformity of transmural velocity differentiating between transmural and nontransmural MI suggesting that aggressive approaches should be taken to salvage myocardium in such patient

Diagnostic value of left ventricular atrioventricular plane displacement in assessment of L.V. systolic function

Several echocardiographic indices applied to evaluate LV function may be not reliable when LV contraction is asymmetrical and require good image quality. Determination of the left ventricular atrioventricular plane displacement [AVPD] has several advantages over traditional methods for the evaluation of left ventricular function. This study aimed to evaluate the left ventricular atrioventricular plane displacement as a new index for assessment of left ventricular systolic function, especially in patients with asymmetrical contraction and to correlate these methods with other echocardiographic-derived LV systolic function indices. This study included 60 patients divided into the following groups: Group A included 20 healthy persons as a control group, 16 males and 4 females with a mean age of 38 +/- 2 9.7 years; group B included 20 patients with ischemic heart disease, 17 males and 3 females with a mean age of 53 +/- 6.9 years and group C included 20 patients with dilated cardiomyopathy, 17 males and 3 females with a mean age of 48 +/- 13-20 years. Multip1e echocardiograms were recorded and selected on the basis of clarity. Measurements included left ventricular AVPD, end diastolic diameter [EDD], end systolic diameter [ESD], FS and EF by Teickholtz and Simpson methods. The study found that systolic atrioventricular plane displacement [AVPD] is an effective index for assessment of both segmental and global left ventricular systolic function and that an AVPD > 10 mm correlates with normal left ventricular systolic function [EF > 50%]. So, the AVPD is a rapid, simple, valuable and noninvasive echocardiographic method for evaluation of left ventricular systolic function

Percutaneous transluminal angioplasty versus cononary artery bypass grafting in patients with depressed left ventricular function

The aim of this study was to compare clinical and functional status after coronary artery bypass grafting or percuraneous coronary angioplxty [PTCA]. The study included 96 patients; 86 patients were males and 10 patients were females with age ranged from 28 years to 66 years [mean of 29]. The patients were divided into two groups, group I undergoing CABG and group II undergoing PTCA. Assessment of global left ventricular function via measuring ejection fraction by modified Simpson's role technique and regional systolic function by dividing the left ventricular into 16 segments as documented by ASE was carried out. LV function indices improved slightly significant or non- significantly in CABG group than PTCA and both groups had the same survival rate. The need for intervention was more in PTCA group. In-hospital mortality was more in CABG group, anginal attacks and need for anti ischemic medications were more prevalent in PTCA group. There was no significant difference between both groups regarding quality of life. The study concluded that CABG does not appear to be associated with unacceptable morbidity. Patients with graftable vessels and reduced EF should not be denied CABG on the basis of their reduced LV function, for many of these patients CABG is probably the most appropriate treatment