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

Glycoprotein III a PI A1/A2 polymorphism in patients with acute coronary syndromes

Recent data suggest that inherited prothrombotic risk factors are associated with acute coronary syndromes. Glycoprotein III a [GP III a] is part of the platelet fibrinogen receptors, the common final pathway of platelet aggregation. PI A1/A2 genetic polymorphism in GP III a, due to a leucine to proline amino-acid substitution at residue 33, has become a fashionable candidate polymorphism in coronary artery disease [CAD]. The aim of the study was to investigate the potential importance of PI A2 [Pro 33] allele as a risk factor for acute coronary syndromes. the study included 90 patients [aged 45 +/- 7 years], with angiographically documented CAD, 39 patients with acute myocardial infarction [MI] 3 with non-Q wave MI, and 48 with unstable angina. Patients underwent complete clinical, ECG, and enzymatic assessment, in addition to coronary angiography. Patients were compared to 48 age- and sex-matched controls. PI Al allele was assessed with the aid of polymerase chain reaction for all patients and controls. The PI A2 allele was present in 24 patients [26.7%] II with acute MI [28.2%] and 13 with unstable angina [27.1%], [P > 0.05]. Yet, it was present in 10 controls [20.8%, P > 0.05]. PI A1/A2 polymorphism has no association to the extent of angiographic findings. This study demonstrated that PI A1/A2 polymorphism might be associated with an increased risk for acute coronary syndromes. Patients who possess PI A2 allele may be at increased risk of coronary thrombotic events. The attractive possibility remains that such polymorphism might identify a subset of individuals who would respond better to a particular therapy

Measurement of left ventricular filling pressures by means of pulsed doppler echocardiography

The left ventricular filling pressure measured non-invasiuely was compared with the pressure values obtained by cardiac catheterization in 28 patients with coronary artery disease. The filling pressure was calculated from the ratio of integrals of late filling wave [Ai] to early filling wave [Ei] by using the previously validated formula LVEDP=1.06+15.15 X Ai/Ei. We found that patients with left ventricular end-diastolic pressure [LVEDP] less 20 mmhg. Measured by inuasive technique was closely correlated to that obtained by the non-inuasive method [group I]. Patients with LVEDP more than 20 mmhg obtained by invasive technique had a significant negative correlation with that obtained by non-invasve technique [group II] r=0.89 [in group I] r=0.62 [group II] P< 0.05. The study showed a significant positive correlation between the invasively measured LVEDP and Ai/Ei ratio [ratio of integrals] in group I patients [r=0.87, P< 0.05] and this correlation was significantly neagative in group II patients [r=0.7, P< 0.5]. These data indicate that transmitral Doppler measurements can predict the elevated LVEDP in patients with CAD. However. The previously used formula can not quantitatively estimate the LVEDP when it is markedly elevated more than 20 mmhg