RESUMO
Introduction: MR may be caused by either primary valvular or secondary to mitral annular dilatation. Global myocardial performance index [Tei-index] which is defined as the sum of isovolumic contraction and relaxation time divided by the ejection time, was reported to be simple, reproducible and independent of heart rate and blood Pressure. The Tei-Index has already been applied clinically in patients with different cardiac diseases. Aim of the study is to evaluate the value of Tei-Index in evaluation of patients with significant MR
Patients and Method: The study included 60 patients [35 male and 25 female, mean age 40 +/- 10 years] with symptomatic significant MR. There were 30 patients with PMR [group I], due to rheumatic degeneration, n =22: valve prolapse, n =6 and rupture of chordae tendenae, n=2.There were 26 female and 4 male. The other 30 patients [group II], were SMR due to ischemic cardiomyopathy, 25 male and 5 female. All subjects underwent full Echocardiographic examination including Doppler recording of mitral and aortic flow and calculation of Tei-Index [The sum of isovolumic contraction and relaxation time [a] divided by ejection time[b], [a - b]/b]
Results: Tei-Index showed no significant correlation to heart rate or blood pressure. Tei-Index showed significant correlation to LVEDD [r=0. 74, P<0.05], LVESD [r=0.80, P<0.05]. Tei-Index was significantly higher in patients with SMR in comparison to PMR and control group [p<0.05]. On the other hand, in patients with PMR, Tei-Index did not differ significantly from control group [p>0.05]. Cut point of >49% for Tel-Index was able to separate SMR from PMR, with sensitivity of 90% and specificity of 81%
Conclusion: Tei-Index is simple, feasible, non-invasive, easily obtained and independent of heart rate and blood Pressure The index is normal in patients with PMR with preserved systolic function and it is increase in patients with SMR, which makes this index of value in differentiation between patients with PMR and SMR
RESUMO
Background: although both Thallium scintigraphy and dobutamine echocardiography have been used to assess left ventricular dysfunction in patients with coronary heart disease, the mechanisms by which these two methods identify viable myocardium are different
Aim of the Study: investigate the value and limitation of low dose dobutamine during stress echocardiography and Thallium scintigraphy and the cost benefit of each of the two-non invasive tests
Patients and Methods: forty patients of CAD [31 males and 9 females] with their mean age of 49 +/- 14 years were included in the study. All of them had clinical and angiographic proof of coronary artery disease. Patients underwent clinical examination, coronary angiography, resting and dobutamine echocardiography at rate of 5 and 10 ug/kg/min, and single photon emission computed tomographic Thallium scintigraphy, stress, redistribution, reinjection images were recorded then after 24 hours low dose dobutamine [5ug/kg/min] followed by reingection image was done. The LV was divided into 20 segments for analysis of echocardiographic and Thallium images
Results: out of 800 myocardial studied segments of the 40 patients, there were 320 abnormal segments during resting echocardiography. Whereas 178 [55.6%] segments were detected to be viable by LDD echocardiography versus 154 [48.1 %] segments which were detected to be viable by Thallium imaging. On the other hand, the two methods were in agreements in detection of 125 viable segments [39.1 %] and 113 nonviable segments [35.3%] i.e. 238/320 [74.4%] segments show agreements by the two methods [P <0.05]. On adding LDD to Thallium study, the number of viable segments which could be detected by Thallium imaging increased to be 197 [61.6%] versus 178 [55.6%] segments which could be detected to be viable by LDD echocardiography i.e. Thallium become more sensitive in detection of viable myocardium than before. Furthermore the two methods were in detection of 168 viable segments [52.2%] and 113 non-viable segments [35.3%] i.e. 281/320 [87.8%] segments show agreement by the two methods [P<0.001]
Conclusion: although both Thallium scintigraphy and dobutamine echocardiography have nearly the same cost, the proportion of segments with preserved Thallium uptake [with low dose dobutamine] is greater than those showing a positive response to dobutamine Echocardiography and despite the difference is statistically insignificant, yet its is physically significant