Stress tissue doppler echocardiography, is it has any prognostic implication after acute myocardial infarction?

The index could be a predictor of both systolic and diastolic myocardial performance after acute myocardial infarction [AMI]. Low-dose dobutamine stress echocardiography identifies viability in patients with myocardial dysfunction, and predicts the reversibility of myocardial function after AMI. Pulsed wave -Doppler tissue imaging [DTI] allows measuring regional myocardial velocities, and changes of both systolic and diastolic myocardial function

Aim of the work: This study aimed to assess the prognostic implication of resting and stress tissue Doppler echocardiographic variables in patients with first acute uncomplicated anterior myocardial infarction

Patients and Methods: This study included 159 patients They were divided into two groups; patients group included 129 patients with first acute anterior MI treated with thrombolytic therapy and control group included 30 age- and sex- matched healthy subjects. All patients were subjected to baseline demographic characteristics include age, sex, obesity and clinical data analysis, also coronary risk factors were assessed. Complete resting echocardiographic evaluation and resting Doppler tissue imaging [DTI] study for measuring Tei index and low dose dobutamine stress echocardiography to assess myocardial viability were done in all patients. Pulsed-wave Doppler tissue imaging study before and during low dose dobutamine stress echocardiography and follow-up of major adverse cardiac events by resting conventional echocardiography at one month, was done for every patient

Results: Patients were sub-divided into two groups according to the myocardial functional improvement at follow up; group I: included 68 patients with no improvement of myocardial function, and group II: included 52 patients with improvement on follow up. There was significant correlation between group I and the resting echocardiographic data, and there was significant positive correlation between group II and the viability demonstrated with low dose dobutamine echocardiography [LDDE], DTI, or both techniques together. During follow-up, two patients died from non cardiac cause, the remaining patients had cardiac events, forming the event group [group A], and the non-event group [group B]. Patients in group A were significantly older than patients in group B [P<0.000]. However, there was significant positive correlation between non event group and the myocardial viability. Tei index was the most significant constant independent predictor of early cardiac events

Conclusion: Resting and stress tissue Doppler echocardiographic variables found to have a significant prognostic implication in patients with acute anterior myocardial infarction

Color M-mode for the assessment of left ventricular diastolic function

During the last two decades, Doppler echocardiography has emerged as the principal clinical tool for the assessment of left ventricular [LV] diastolic function. Trans-mitral and pulmonary venous Doppler flow indices have been used to evaluate different parameters of diastolic function, but it is difficult to use these modalities in differentiation between a normal filling pattern and a pseudo-normal filling pattern. Recently, color M-mode [CMM] of LV inflow and tissue Doppler imaging [TDI] of mitral annulus have provided additional insights in the assessment of diastolic function. Aim of the work: was to correlate the new parameter CMM of LV inflow with trans-mitral flow [TMF] in different patterns of diastolic performance to evaluate its clinical utility. 70 patients [46 males, and 24 females] who are having diseases known to affect diastolic function and 10 normal individuals as a control group were included in the study. The 70 patients were divided into 3 groups according to their LV diastolic filling pattern based on the conventional TMF pattern and included, group I [impaired relaxation pattern, IR], group 2 [pseudo-normal pattern, PN] and group 3 [restrictive filling pattern. RFP]. All of them were subjected to trans-thoracic Doppler echocardiography [TTE] with TMF and CMM examinations. In group I [IR], flow propagation velocity [VP] was lower than that in PN and control groups but higher than that in RFP group. Time delay [TD] and E/VP ratio were lower than those in PN and RFP groups but higher than those in control group. In group 2 [PN], VP and TD were higher than those in IR and RFP groups but lower than those in control group. E/VP was higher than that in IR and control groups but lower than that in RFP. In group 3 [REP], VP was lower than that in all other groups. TD and E/VP were higher than those in all other groups. Tei index was significantly higher in group 2 and 3 as compared to the control group but did not show significant change between group 1 and the control group. Also there was statistically significant correlation between E/VP ratio with, E, TD and Tei index. While statistically significant negative correlation was recorded between E/VP ratio with EDT, IVRT and VP. The new modality CMM is helpful in differentiation of PN pattern from normal pattern and can be complementary to TMF to give an idea non-invasively about diastolic parameters