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Objective: This study has evaluated risk factors, especially dyslipidemia, for an acute myocardial infarction (AMI) in postmenopausal women. Materials and Methods: This was a hospital-based, observational, single-center study among 100 postmenopausal women admitted to the medicine ward with AMI. They were categorized based on lipid profile groups, viz., dyslipidemic group and non-dyslipidemic group. All clinical parameters were studied between the groups. Results: Among anthropometric profiles, in the comparison of mean height (cm), weight (kg), body mass index (BMI) (kg/m2 ), and waist circumference (WC) (cm) for the dyslipidemic group and non-dyslipidemic group, only WC was statistically significant (P < 0.001). Most patients were hospitalized between 6 and 12 h after the onset of symptoms. At the time of hospitalization, most patients from both groups were observed to have diabetes and hypertension with poor control of postprandial blood sugar, glycated hemoglobin, and diastolic blood pressure (DBP) (P < 0.05). The dyslipidemic group’s mean C-reactive protein was higher (P < 0.05). The comparison of mean total cholesterol, triglyceride (TG), low density lipoprotein-cholesterol in mg/dL, and TG: high density lipoprotein was significantly increased (P < 0.001), while high density lipoprotein-cholesterol (mg/ dL) was significantly decreased (P < 0.001) in the dyslipidemic group. ST-segment elevation myocardial infarction is standard in both groups. The maximum patient has regional wall motion abnormality in echocardiography after day 3 of admission. Among the dyslipidemic group, ejection fraction was on the lower side, and the predominant complication was in the left ventricular failure (LVF) (P < 0.05). Conclusion: WC has a positive association with patients with AMI who have dyslipidemia and can be used as an indicator of the risk of AMI when BMI is normal. WC is a surrogate marker of abdominal fat mass (subcutaneous and intra-abdominal); increased WC is a significant component marker of metabolic syndrome and insulin resistance related to cardiovascular mortality. There was poor glycemic control and blood pressure (mainly DBP) among the dyslipidemic patients. Hypertriglyceridemia is the most common lipid abnormality, followed by hypercholesterolemia among the dyslipidemic group. LVF is the most common complication in dyslipidemic patients.
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Background: During the cardiac cycle with the effect on cardiac function, Echocardiographic wall motion abnormalities are kinetic alterations in the cardiac wall motion. It can be characterized as per their grades and their distribution pattern like segmental or global. It can be attributed to a coronary territory or follow a non-coronary distribution. Aim of the study: The aim of the study was to evaluate the patterns of echocardiographic wall motion abnormalities among hypertensive patients with electrocardiographic left ventricular hypertrophy.Material & Methods:This was prospective observational study which was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2020 to January 2021. In total 76 hypertensive patients with electrocardiographic left ventricular hypertrophy were included as the study subjects for this study. This study was approved by the ethical committee of the mentioned hospital. A predesigned questioner was used in data collection. All data were collected, processed and analyzed by using MS Office and SPSS version 23 programs as per necessity.Results:In this study, in analyzing the status of wall motion abnormalities (WMA) among the participants we observed that, 22% of the patients were with segmental wall motion abnormalities, 18% were with global dysfunction and 59% were fully free from any type of WMA. Among patients with global dysfunctions, 71% were with mild and 12% were with moderate-to-severe dysfunction whereas this ratio was 47:24 in segmental abnormality patients. On the other hand, in analyzing the severity and location of patients with segmental WMA we observed that 47%, 24%, 53%, 41%, 18%, 24%, 29%, 47%, 35%, 53% and 41% were with mild dysfunction, moderate-to-severe dysfunction, inferior wall dysfunction, antero-septal dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction respectively.Conclusion:In this study, majority of the participants were found free from any type of wall motion abnormality. ‘Mild dysfunction’, inferior wall dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction are found as some more frequent dysfunctions among patients with WMA.
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Background: Left ventricular (LV) dysfunction is the single most accurate predictor of death and one of the most common and lethal consequences after ST segment elevation myocardial infarction (STEMI) that has been substantially decreased by primary percutaneous coronary intervention (PCI). This research investigated the impact of duration of ischemia on the severity and improvement of wall motion abnormalities after revascularization and 40-day follow-up. Methods: This study was performed on 60 STEMI patients, treated with 1ry PCI and distributed in two groups; group1: 37 patients presented early before 12h and group II: 23 patients presented late after 12h. Echocardiogram (ECHO) was done for ejection fraction (EF) and resting segmental wall motion abnormalities (RSWMA) detection after revascularization within 24 h of hospitalization and follow up after 40 days. Results: MI complication showed insignificant difference between both groups. Wall motion score index (WMSI) values in group I were significantly decreased relative to group II during the follow-up period (p=0.001). Major improvement in LV ejection fraction from hospital admission to follow-up (p=0.001) in group I from the beginning of chest pain compared to group II. Correlation between time to wire crossing and WMSI showed significant positive correlation after 40 days in group I (p=0.016) with significant negative correlation with EF after 40 days in group I (p=0.018). Conclusions: Ischemic patients with ? 12 hours symptoms showed a significant degree of recovery from RWMA on follow up after 40 days.
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Objective:To analyze the effects of exercise-based cardiac rehabilitation (ER) on patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), and to identify which type of ACS patients would benefit most in terms of cardiovascular functional capacity after ER. Methods:From December, 2017 to July, 2019, 31 ACS patients who discharged in a stable situation after PCI were studied. All patients were referred to a three-month ER program after discharge. They were divided into normal wall motion group (normal group, n = 14) and abnormal regional wall motion group (abnormal group, n = 17) according to baseline myocardial wall motion reported by echocardiography. The degree of wall motion abnormalities was quantified by the wall motion score index (WMSI). Echocardiography and cardiopulmonary exercise testing (CPET) were performed before and after ER. Results:Eight patients were dropped, and 23 patients completed the trial. WMSI decreased in the abnormal group (Z = -2.852, P = 0.004), and the left ventricular ejection fraction (LVEF) didn't change in both groups (P > 0.05) after ER. CPET showed that the heart rate at rest decreased in the normal group after ER (t = -2.268, P = 0.047); and the peak work rate, peak oxygen uptake, percentage of predicted value of peak oxygen uptake, peak minute ventilation and the third minute heart rate recovery increased in the abnormal group after ER (t > 2.739, P < 0.05). Conclusion:ER during recovery period could help more improve the cardiac function and exercise tolerance of ACS patients with abnormal WMSI after PCI. WMSI is an important indicator of cardiac function in ACS patients with preserved ejection fraction.
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Resumo Fundamento A doença de Chagas (DC) constitui uma causa potencial negligenciada de doença microvascular coronariana (DMC). Objetivos Comparar pacientes com DMC relacionada à DC (DMC-DC) com pacientes com DMC ligada a outras etiologias (DMC-OE). Métodos De 1292 pacientes estáveis, encaminhados para angiografia coronária invasiva para elucidar o padrão hemodinâmico e a causa de angina, 247 apresentaram coronárias subepicárdicas normais, e 101 foram incluídos após aplicação dos critérios de exclusão. Desses, 15 compuseram o grupo de DMC-DC e suas características clínicas, hemodinâmicas, angiográficas, e cintilográficas foram comparadas às do grupo de 86 pacientes com DMC-OE. O nível de significância estatística para todas as comparações adotado foi de 0,05. Resultados Pacientes com suspeita de DMC-DC apresentaram características antropométricas, clínicas e angiográficas, além de alterações hemodinâmicas e de perfusão miocárdica estatisticamente comparáveis às detectadas nos 86 pacientes com DMC-OE. Disfunção ventricular diastólica, expressa por elevada pressão telediastólica do ventrículo esquerdo, foi igualmente encontrada nos dois grupos. Entretanto, em comparação a esse grupo com DMC-OE, o grupo com DMC-DC exibiu fração de ejeção ventricular esquerda mais baixa (61,1 ± 11,9 vs 54,8 ± 15,9; p= 0,049) e mais elevado escore de mobilidade da parede ventricular (1,77 ± 0,35 vs 1,18 ± 0,26; p= 0,02). Conclusão A cardiomiopatia crônica da doença de Chagas esteve associada à etiologia de possível doença microvascular coronariana em 15% de amostra de 101 pacientes estáveis, cujo sintoma principal era angina requerendo elucidação por angiografia invasiva. Embora os grupos DMC-DC e DMC-OE apresentassem características clínicas, hemodinâmicas, e de perfusão miocárdica em comum, a disfunção global e segmentar do ventrículo esquerdo foi mais grave nos pacientes com DMC associada à DC em comparação à DMC por outras etiologias. (Arq Bras Cardiol. 2020; 115(6):1094-1101)
Abstract Background Chagas disease (CD) as neglected secondary form of suspected coronary microvascular dysfunction (CMD). Objectives Comparison of patients with CMD related to CD (CMD-CE) versus patients with CMD caused by other etiologies (CMD-OE). Methods Of 1292 stable patients referred for invasive coronary angiography to elucidate the hemodynamic pattern and the cause of angina as a cardinal symptom in their medical history, 247 presented normal epicardial coronary arteries and 101 were included after strict exclusion criteria. Of those, 15 had suspected CMD-CE, and their clinical, hemodynamic, angiographic and scintigraphic characteristics were compared to those of the other 86 patients with suspected CDM-OE. Level of significance for all comparisons was p < 0.05. Results Patients with suspected CMD-CE showed most anthropometric, clinical, angiographic hemodynamic and myocardial perfusion abnormalities that were statistically similar to those detected in the remaining 86 patients with suspected CMD-OE. LV diastolic dysfunction, expressed by elevated LV end-diastolic pressure was equally found in both groups. However, as compared to the group of CMD-OE the group with CMD-CE exhibited lower left ventricular ejection fraction (54.8 ± 15.9 vs 61.1 ± 11.9, p= 0.049) and a more severely impaired index of regional wall motion abnormalities (1.77 ± 0.35 vs 1.18 ± 0.26, p= 0.02) respectively for the CMD-OE and CMD-CE groups. Conclusion Chronic Chagas cardiomyopathy was a secondary cause of suspected coronary microvascular disease in 15% of 101 stable patients whose cardinal symptom was anginal pain warranting coronary angiography. Although sharing several clinical, hemodynamic, and myocardial perfusion characteristics with patients whose suspected CMD was due to other etiologies, impairment of LV segmental and global systolic function was significantly more severe in the patients with suspected CMD related to Chagas cardiomyopathy. (Arq Bras Cardiol. 2020; 115(6):1094-1101)
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Humans , Coronary Artery Disease/etiology , Coronary Artery Disease/diagnostic imaging , Chagas Cardiomyopathy/diagnosis , Chagas Cardiomyopathy/diagnostic imaging , Stroke Volume , Ventricular Function, Left , Coronary Circulation , MicrocirculationABSTRACT
Aims and Objectives: The aims of the study were to find out the correlation between coronary angiographic findings and hemodynamic parameters derived from impedance cardiography (ICG) and echo-Doppler study. Patients, Materials and Methods: A total of 200 patients of acute myocardial infarction having chest pain, ST elevation in two or more contiguous leads of electrocardiogram (ECG), biomarker positivity, echocardiographic evidence of regional wall motion abnormality (RWMA), and coronary angiographic evidence of coronary lesions were recruited. Subjects unwilling to participate, moribund, critically ill subjects, and patients with concomitant heart failure, arrhythmia, and valvular lesions were excluded from the study. GE™ Vivid 7 Dimension machine was used for ECG-gated echo-Doppler studies. The left ventricular ejection fraction (LVEF), stroke volume (SV), RWMA, diastolic function, etc., were observed. ICG measured LVEDV, LVESV, LVEF, and other parameters particularly amplitudes of the different waves. Coronary angiography (CAG) was done in the Cath Lab having “Siemens™ Axiom Artis Zee (floor)” equipment. Results and Analysis: Results-analysis revealed there is negative correlation (Pearson’s correlation coefficient, r = −0.8) between augmentation pressure and coronary angiographic stenosis percentage and P value is also significant (P = 0.034). Pulse pressure (PP) also is positively correlated (r = −0.78) with coronary angiographic stenosis percentage and P value is also significant (P = 0.027). There is a negative correlation (r = −0.259) between augmentation index (AIx) and coronary angiographic lesions and that is statistically significant (P = 0.03). Conclusion: There is a positive correlation between ICG -derived hemodynamic parameters and the percentage stenosis of coronary arteries. Rise of augmentation pressure and PP in the ICG waveform is associated with coronary artery disease severity. AIx is negatively correlated with severity of coronary arterial stenosis
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Objective@#To explore the clinical value of echocardiography in differential diagnosis of segmental wall motion abnormalities in coronary heart disease(CHD), and to provide help for clinical treatment.@*Methods@#From January 2017 to November 2018, 56 patients with segmental abnormal wall motion of CHD in Yuyao People's Hospital of Zhejiang Province were selected in the study.All patients were diagnosed by echocardiography and coronary angiography.The diagnostic coincidence rate, specificity, sensitivity, false negative rate, false positive rate and accuracy of echocardiography were evaluated.@*Results@#Coronary angiography showed abnormal segmental wall motion in 56 patients, with 100.00% anastomosis rate.Echocardiography revealed abnormal segmental wall motion in 54 patients with CHD, 2 patients showed normal segmental wall motion, anastomosis rate was 96.43%.There was no statistically significant difference between the two diagnostic methods(χ2=0.635, P=0.152), but the specificity of ultrasound diagnosis(80.36%), sensitivity(78.57%) and accuracy(80.36%) were lower than those of coronary angiography(100.00%, 98.21%, 100.00%), there were statistically significant differences (χ2=4.173, P=0.034; χ2=5.154, P=0.024; χ2=4.173, P=0.034).@*Conclusion@#Cardiac echocardiography has a high diagnostic value in differential diagnosis of segmental wall motion abnormalities in CHD.It can guide the clinical treatment of these patients to formulate a reasonable treatment plan.Moreover, it is easy to operate, with low cost and more acceptable to patients.
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Objective To explore the application value of cardiac ultrasound in the diagnosis of segmental ventricular wall motion abnormality of coronary heart disease (CHD),and to continuously improve the diagnosis and treatment quality of CHD.Methods From January 2015 to April 2017,200 CHD patients with segmental ventricular wall motion abnormalities(the echocardiographic diagnosis) in the Fourth People~ Hospital of Datong were selected in the research.Before treatment,the patients received cardiac ultrasound examination,checked out the segmental ventricular wall motion abnormalities,the coronary artery angiography was used for further identification.The cardiac ultrasound detection rate was calculated.The adverse reactions after coronary angiography were recorded.Results Echocardiography showed normal results in 16 cases(8.00％) and 184 cases(92.00％).And 184 cases(92.00％) were diagnosed with segmental wall motion abnormality by coronary angiography,that is,the disease detection rate of cardiac ultrasonic examination was 92.00％.No adverse reactions were found after receiving cardiac ultrasound examination.After coronary angiography examination,there were allergic reactions,nausea and other discomfort reactions,but the difference was not statistically significant(x2 =26.64,P ＞0.05).Conclusion In the diagnosis of segmental ventricular wall motion abnormality of CHD,coronary angiography has high accuracy but it is expensive,and cardiac ultrasound examination is highly accurate and non-invasive,and can be selected by grassroots hospitals without the conditions of coronary angiography.
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Objective To explore the clinical value of echocardiography in differential diagnosis of segmental wall motion abnormalities in coronary heart disease ( CHD), and to provide help for clinical treatment.Methods From January 2017 to November 2018,56 patients with segmental abnormal wall motion of CHD in Yuyao People＇s Hospital of Zhejiang Province were selected in the study.All patients were diagnosed by echocardiography and coronary angiography.The diagnostic coincidence rate ,specificity,sensitivity,false negative rate,false positive rate and accuracy of echocardiography were evaluated.Results Coronary angiography showed abnormal segmental wall motion in 56 patients, with 100.00% anastomosis rate.Echocardiography revealed abnormal segmental wall motion in 54 patients with CHD,2 patients showed normal segmental wall motion ,anastomosis rate was 96.43%.There was no statistically significant difference between the two diagnostic methods (χ2 ＝0.635,P＝0.152),but the specificity of ultrasound diagnosis (80.36%),sensitivity (78.57%) and accuracy (80.36%) were lower than those of coronary angiography(100.00%,98.21%,100.00%),there were statistically significant differences (χ2 ＝4.173,P＝0.034;χ2 ＝5.154,P＝0.024;χ2 ＝4.173,P＝0.034).Conclusion Cardiac echocardiography has a high diagnostic value in differential diagnosis of segmental wall motion abnormalities in CHD.It can guide the clinical treatment of these patients to formulate a reasonable treatment plan.Moreover,it is easy to operate,with low cost and more acceptable to patients.
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Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6–12 weeks. Prognosis is generally good. Recent meta-analysis shows in-hospital mortality of 1–4.5% and recurrence rate of 5–10% during five year follow-up.
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Objective To evaluate the effect of percutaneous coronary intervention (PCI) on chronic total occlusion (OCT) by doubutamine stress echocardiography. Methods Forth-six CTO patients were categorized into the reopening group and failed-reopening group based on the results of PCI. All patients had undergoing low dose doubutamine stress echocardiography before PCI and at 6-month follow-up, measuring rest and stress wall motion score index (WMSI) with semi-quantitative method. Cardiac volumes and ejection fraction were measured with 3D full volume echocardiographic. Results The two groups showed no differences in general clinical data and all baseline echocardiography data before PCI. During follow-up, the reopening group was observed to have improvement in ejection fraction[(60.00±3.22)% vs.(62.65±3.58)%,P=0.017)],and WMSI in stress status[(1.42±0.37)vs.(1.32±0.36),P<0.001], compared with pre-PCI results. The reopening group showed improvement in ejection fraction[(62.65±3.58)% vs.(57.7±5.61)%,P=0.001)]and WMSI in stress status[(1.32±0.36)vs.(1.62±0.47),P<0.001)],when compared with the failed-reopening group. Conclusions Low dose doubutamine stress echocardiography can be nsed for evaluation of the eff ect of revascularization of CTO. The cardiac volumes and contractile function representing by wall motion in stress status were improved after recanalization of CTO.
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AIM To investigate the role of ginkgolide B on the ventricular wall motion and systolic function in acute myocardial infarction (AMI) patients after their revascularization.METHODS A total of 80 cases of AMI patients who underwent revascularization were divided into control group and ginkgolide B treatment group,with 40 patients per group.The two groups of patients both treated basically with routine western medicine were dosed with either placebo or ginkgolide B for 3 months.The cardiac function,normal myocardial percentages,ventricular wall motion,longitudinal peak systolic strain (LPSS) and rate (LPSSR) were evaluated by dobutamine stress echocardiography and these indexes were compared.RESULTS Compared to the control group,left ventricular ejection fraction (LVEF) (66.06 ± 8.39 vs.60.45 ± 13.35,P ＜0.05) and normal myocardial percentages (86.88 ±8.76 vs.79.84 ± 12.25,P ＜0.01) were significantly improved at the 2nd week in ginkgolide B treatment group,but no significant difference on ventricular wall motion was observed'between the two groups (P ＞ 0.05).For the patients with anterior wall AMI,the minus LPSS and LPSSR at basal,middle and apex segment were significantly improved at the 2nd week in ginkgolide B treatment group compared to the control group (P ＜ 0.05,P ＜ 0.01).Moreover,LPSS at apex segment was significantly improved at the 3rd month in ginkgolide B treatment group compared to the control group (P ＜ 0.05).For the patients with inferior wall AMI,minus LPSS at basal and apex segment were significantly improved at the 2nd week and the 3rd month in ginkgolide B treatment group compared to the control group (P ＜ 0.05),whereas minus LPSSR at basal and middle segment at the 2 nd week and basal segment at the 3rd month were significantly improved in ginkgolide B treatment group compared to the control group (P ＜0.05).CONCLUSION Revascularized AMI patients treated with ginkgolide B can expect an improved ventricular wall motion.
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Purpose：A new simple and noninvasive stretch sensor (STR) has been developed to detect chest wall motion for respiratory rehabilitation. The purpose of this study was to investigate the validity of chest wall motion measurements obtained using the new stretch sensor.Methods：Twelve healthy male volunteers wore three different sensors (STR, respiratory inductance plethysmography [RIP], and flowmeter) while they performed the testing protocol, which included natural breathing (120 s), deep breathing (60 s), and polypneic (60 s) and apneic (30 s) conditions in the upright stance. The STR was implemented in two bands for the participant's chest and abdominal measurements. The ability of the three sensors to measure respiration and chest wall motion was analyzed.Results：The output signals from the STR showed significant correlation with the flow and RIP signals (r＝0.5-1.00, p＜0.05). The total number of breaths obtained from the STR signals showed no significant difference from the reference values obtained from the flowmeter signals (p＞0.05). The amplitude of the STR output signals changed significantly according to the respiratory maneuver used. Specifically, it increased from apnea, polypnea, and natural breathing to deep breathing (p＜0.05).Conclusion：The newly developed stretch sensor is capable of measuring chest wall motion in various breathing maneuvers in young men.
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BACKGROUND: Evaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED. METHODS: We prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007. RESULTS: In 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (V(peak)) and strain significantly decreased according to visual regional wall motion abnormality (V(peak), 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, p < 0.01; peak systolic radial strain -31.74 ± 9.15% fornormal, -24.33 ± 6.28% for hypokinesia, -20.30 ± 7.78% for akinesia, p < 0.01). However, the velocity vectors at the time of mitral valve opening (MVO) were directed outward in the visually normal myocardium, inward velocity vectors were revealed in the visually akinetic area (V(MVO), -0.85 ± 1.65 cm/s for normal vs. 0.10 ± 1.46 cm/s for akinesia, p < 0.001). At coronary angiography, V(MVO) clearly increased in the ischemic area (V(MVO), -0.88+1.56 cm/s for normal vs. 0.70 + 2.04 cm/s for ischemic area, p < 0.01). CONCLUSION: Regional wall motion assessment using VVI showed could be used to detect significant ischemia in the patient with acute chest pain at ED.
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Humans , Chest Pain , Coronary Angiography , Emergencies , Emergency Service, Hospital , Hypokinesia , Ischemia , Mitral Valve , Myocardium , Prospective Studies , ThoraxABSTRACT
Objective Using STI and WMSI to evaluate the change of the heart sarcomere local systolic function which suffered from coronary heart disease (CHD), to evaluate the improvement of ischemic heart sarcomere local systolic function after PCI. Methods There are 40 CHD patients after PCI called the treatment group and 40 healthy persons called the control group. Echocardiogram was used to evaluate the change of ventricular wall motion score in the treatment group which was before and 1 week after PCI , compared with the control group. STI is used to get the SLs, GSL and SrLe of the left ventricle six walls in basal segment,middle segmentand apical segment systole. Results The ventricular wall motion index of the left ventricular myocardium obviously rose in CHD patients which was after PCI, compared with the control group (P < 0.05). And it obviously reduced in CHD patients after PCI, compared with CHD patients before PCI(P < 0.05). The results of SLs,GSL and SrLe are reduced in myocardial ischemia segment of CHD patients before PCI,compared with the control group (P < 0.05). But they are significantly improved in the the treatment group 1 week after PCI, compared to which is before PCI(P < 0.05). Conclusion STI and WMS can be used to evaluate the abnormal of regional and global function of myocardium which is caused to coronary artery stenosis the effect of PCI. The left ventricular motion function of CHD is decreased, but the left ventricle regional systolic function of hypokinetic segments in patients with CHD after PCI is significantly increased.
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Objetivos: determinar la utilidad clínica de la detección ecocardiográfica de alteraciones parietales basales de la contractilidad (ABC) reversibles con drogas antiisquémicas en pacientes con cardiopatía isquémica (CI) estable sospechada o conocida. Antecedentes: no hay referencias en la literatura al respecto. Población y método: estudio prospectivo observacional de la práctica clínica corriente en 93 pacientes ambulatorios, consecutivos (52,7% hombres, mediana 69,7 años), con indicación de ecoestrés mostrando ABC no cicatrizales. En su lugar se aplicó un protocolo con nitritos y metoprolol. Se consignaron los cambios del score segmentario (SS), del ángor y del electrocardiograma (ECG). Los pacientes fueron derivados directamente a cateterismo (n=9), internación (n=34) o domicilio (n=50). Se realizó un seguimiento a largo plazo (3,25 años-personas). Resultados: los cambios del SS, ángor y ECG fueron significativos (p < 0,001). La mortalidad global fue 6,34 p-mes-1 x 1000, con tratamiento médico versus invasivo: 8,59 vs 3,8 p-mes-1 x 1000, cateterismo directo vs internados con cateterismo diferido: 3,93 vs 7,22 p-mes-1 x 1000, internados sin cateterismo: 18,62 p-mes-1 x 1000 y domiciliarios con y sin cateterismo: 4,03 vs 4,05 p-mes-1 x 1000, respectivamente. Los pacientes con cateterismo presentaron lesiones severas mayormente de múltiples vasos. Conclusiones: la detección ecocardiográfica de ABC reversibles con drogas antiisquémicas en pacientes con CI evoca la presencia de isquemia miocárdica de reposo en una población de alto riesgo y tiene un importante valor pronóstico.
Objectives: to determine the clinical usefulness in detecting reversible resting echocardiographic segmental wall motion contractile abnormalities (ABC) in patients with stable coronary artery disease (CI). Background: There are no references in the literature. Population and method: This is a current clinical practice prospective observational study on 93 consecutive patients (58% men, median 69,7 years) with stress echocardiograms requested and showing non scarring ABC who were submitted to echocardiograms with nitrates and metoprolol instead. Left ventricular segmental wall motion score index (SS), electrocardiographic abnormalities (ECG) and chest pain changes were determined. Patients were referred either to direct catheterization (n=9), hospitalization (n=34) or to their residences (n=50). A 3,25-years-persons follow-up was performed. Results: SS, ECG abnormalities and chest pain changed significantly (p<0,001). The higher SS, the higher mortality. Global mortality was 6,34 p-mes-1 x 1000; patients with medical vs. invasive treatment: 8,59 vs 3,8 p-mes-1 x 1000, with direct catheterization vs. those hospitalized with deferred catheterization: 3,93 vs 7,22 p-mes-1 x 1000, patients hospitalized without catheterization: 18,62 p-mes-1 x 1000, and domiciliary patients with and without catheterization: 4,03 vs 4,05 p-mes-1 x 1000. Patients with catheterization showed severe multi-vessel disease mainly. Conclusions: Reversible echocardiographic ABC with anti-ischemic drugs evokes resting myocardial ischemia, a high risk CI population and has important prognostic value.
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Objective To evaluate the clinical value of the regional wall motion in patients with suspected coronary artery disease by real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI). Methods A total of 143 hospitaized patients with suspected coronary artery disease and normal wall motion de?tected by two-dimensional echocardiography (2DE) were enrolled and devided into group A (coronary stenosis ≥75%) 73 cases and group B (coronary stenosis<75%) that include 70 cases according to coronary angiography results. Left ventricu?lar segmental ejection fraction (sEF) was measured by RT-3DE and peak systolic longitudial strain (SL) was measured by 2D-STI. ROC curves of the two measurements were generated and compared. Differences in sEF and SL between group A and group B were respectively analyzed. Results (1)Both sEF of RT-3DE and SL of 2D-STI in group A were significantly low?er than those in group B (P<0.05);(2)sEF was positively correlated with SL(r=0.689,P<0.05);(3)Compared with SL, sEF had larger area under ROC curve in some segments of left ventricle where both parameters are abnormal for the diagnosis of the coronary stenosis ≥75% (0.922 vs 0.874). Conclusion Regional wall motion of left ventricular can be measured by both RT-3DE and 2D-STI which can be both used to estimate the extend of stenosis of coronary artery. And RT-3DE is su?perior over 2D-STI.
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Objective To observe the incidence and the rate of embolism in patients undergoing hysteroscopy procedures by using the transesophageal echocardiography (TEE), as well as the changes of respiratoric and haemodynamic variables. Methods Fourty ASA Ⅰ~Ⅱ patients undergoing hysteroscopy procedures under general anesthesia received intraoperative TEE monitoring. The systolic pulmonary artery pressure, the incidence of the venous gas embolism (VGE) and the eegmental wall motion abnormality (SWMAs) were observed. Results In the 40 patients, 38 patients received intravenous anesthesia hysteroscopic surgery, with the intraoperative TEE to monitor the intracardiac VGE. The degree of gas embolism was related with the perfusion and the usage of monopolar or bipolar diathermia (P<0.05). The systolic pulmonary artery pressure promoted and SWMAs were also observed. Conclusions The continue TEE monitor during hysteroscopy could detect the intracardiac gas embolism in time , contributing to early diagnosis and avoiding the occurrence of malignant arrhythmias or myocardial ischemic events.
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Objective To explore the value of real‐time three‐dimensional speckle tracking imaging (RT‐3D‐STI) in the early detection of globle and regional left ventricular myocardial systolic function in patients of coronary stenosis without regional wall motion abnormality. Methods 64 coronary stenosis patients without regional wall motion abnormality were divided into 2 groups according to angiography (CAG):without coronary stenosis group( n = 20) and coronary stenosis group ( n = 44), and all the myocardial segments of the patients were divided into 5 groups:without coronary stenosis group normal myocardial segments ( n = 340 ), coronary stenosis group normal myocardial segments ( n = 235 ), mild coronary stenosis myocardial segments( n = 126), moderate coronary stenosis myocardial segments( n =213) and severe coronary stenosis myocardial segments( n =174). Real‐time three‐dimensional full volume of left ventricle was obtained, left ventricular global area strain (GAS)and regional area strain(AS) of 17 myocardial segments, etc, were measured by RT‐3D‐STI respectively. The parameters between the two groups and among the five sub groups were compared, the correlation between GAS and coronary artery Gensini score was also analyzed. Results GAS in coronary stenosis group significantly reduced compared with without coronary stenosis group( P 0 0.5) S.egmental AS in moderate and severe coronary stenosis myocardial segments significantly reduced ( P < 0.05 ), and that in severe coronary stenosis myocardial segments was lower than that in moderate coronary stenosis myocardial segments, the differences were statistically significant ( P < 0.05 ). In addition, GAS was significantly correlated with coronary artery Gensini score( r =0.828, P <0.01). Conclusions RT‐3D‐STI can quantitatively assess the early changes of left ventricular globle and regional myocardial systolic function in patients with coronary stenosis.
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Objective To study the value of echocardiogram in preoperative examination for the diagnosis of silent myocardial is-chemia in patients before surgery .Methods 172 patients with surgical preoperative suspected diagnosis of coronary heart disease , were divided into heart valve surgery group (72 cases) and non heart valve surgery group (100 cases) .All of the patients had echo-cardiography and coronary angiography before 2 weeks of operation .We drew a series of analysis to assess the sensitivity、specialty and accuracy of diagnosis of silent myocardial ischemia with regional wall motion abnormality (RWMA) and wall motion score in-dex (WMSI) .Results Coronary angiography as the gold standard of coronary heart disease diagnosis .The sensitivity of RWMA for the diagnosis of silent myocardial ischemia in patients undergoing heart valve surgery group and non heart valve surgery group was 85 .7% and 100 .0% ,while the specificity of RWMA was 100 .0% and 80 .0% ,respectively ,the differences between the two groups had no statistical significance (P>0 .05) .We also drew the ROC curve of WMSI for the diagnosis of silent myocardial ische-mia ,maximum area under the ROC curve of WMSI were 2 .20 and 2 .05 .In patients undergoing cardiac surgery and non-cardiac sur-gery ,the curves indicated that the sensitivity were 79 .7% and 75 .9% ,the specificity were 83 .0% and 67 .7% ,respectively .Area under the ROC curve was 0 .832 and 0 .702 ,but the difference was not statistically significant (P>0 .05) .Conclusion Using RW-MA and WMSI as reference indicators ,surgical preoperative echocardiography in the diagnosis of patients with silent myocardial is-chemia has good sensitivity ,specific ,and accurate ,there is no statistically significant difference between heart valve surgery and non heart valve surgery .