ABSTRACT
Background: MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet detected by TTE. Obstructive CAD was defined as either 50% reduction of the internal diameter of the left main coronary artery or 70% reduction of the internal diameter of the left anterior descending, right coronary, or left circumflex artery distribution. Objective: The aim of the study was to evaluate the role of echocardiographically detected MAC as a predictor of coronary artery disease (CAD).Material & Methods:In this prospective, observational, case-control study, coronary angiography was done in 50 patients with MAC and equal number of patients without MAC, detected with transthoracic echocardiography. Analysis was done to observe the association and correlation of MAC with angiographic findings.Results:Mean age of the case control was 55.16 � 10.73 years and control was 49.80 � 8.84 years. In this study 34% of patients with MAC and 32% patients without MAC had single vessel disease, 16% of patients with MAC and 24% patients without MAC had double vessel disease, 42% of patients with MAC and 22% patients without MAC had triple vessel disease (TVD), 16% of patients with MAC and 4% patients without MAC had Left main coronary artery disease and 8% of patients with MAC and 22% patients without MAC had no significant CAD.Multivariate analysis shows MAC (p=0.049) as an independent predictor for coronary artery disease (CAD).Conclusions:Transthoracic echocardiographically detected MAC is an independent predictor of coronary artery disease. The low cost, portable and radiation free nature of the ultrasound approach make MAC an attractive parameter in the ongoing search for the ideal marker of coronary artery disease (CAD).
ABSTRACT
Background: Cardiac resynchronization therapy (CRT) had shown great promise in improving hospitalization and mortality of the patients suffering from refractory heart failure (HF) inspite of optimal medical management. The goal of CRT is to reduce cardiac mechanical dyssynchrony, thereby enabling the heart to contract more efficiently. Mechanical ventricular dyssynchrony as estimated by electrical dyssynchrony, is assessed with the QRS duration. But electrical and mechanical dyssynchrony are not well correlated in all HF patients. The dyssynchrony might have been related to the underlying etiology of HF. Objective: To compare the concordance of mechanical and electrical dyssynchrony in both ischemic and nonischemic cardiomyopathy patients. Methods: Doppler echocardiography and strain echocardiography was performed in 76 patients presenting with heart failure due to ischemic cardiomyopathy (n=40) or nonischemic cardiomyopathy (n=36) with left ventricular ejection fraction<35% & New York Heart Association class III–IV, regardless of their QRS duration. Interventricular dyssynchrony was assessed by the time interval between preaortic and prepulmonary ejection times. Intra-ventricular dyssynchrony was assessed by using conventional Doppler and strain echocardiograpy. Obtained from the three standard apical view (TMinMax) and (2) the standard deviation of the averaged time-to-peak strain (TPS-SD, ms) and (3) time to peak myocardial systolic velocity (Ts-SD) of same segments. Result: The correlation coefficient between QRS duration and mechanical interventricular dyssynchrony was significant (r=0.57, P=0.001) in patients with non-ischemic cardiomyopathy and insignificant (r=0.175, p=0.281) in patients with ischemic cardiomyoparhy. The correlation coefficient between QRS duration and mechanical intraventricular dyssynchrony was significant in patients with nonischemic cardiomyopathy (r= 0.69, P = 0.001 for TMin Max; r=0.57, P= 0.001 for TPS-SD; r=0.48, p=0.003 for TS-SD) and insignificant in patients with ischemic cardiomyopathy (r=0.153; p=0.345 for TMin Max; r=0.178; p=0.273 for TPS-SD r=0.139; p=0.392 for TS-SD). Conclusion: This study showed that the relationship between electrical and mechanical dyssynchrony is dependent on the underlying etiology of heart failure.