Dyslipidemia as a risk factor for acute myocardial infarction in postmenopausal women: An observational study

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.

Correlation between Coronary Angiography and Impedance Cardiography

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

Takotsubo syndrome

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.

The value of echocardiogram in preoperative examination for the diagnosis of silent myocardial ischemia in patients before surgery / 重庆医学

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 .

Evaluation of globle and regional left ventricular myocardial systolic function in patients with coronary stenosis by real-time three-dimensional speckle tracking imaging / 中华超声影像学杂志

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.

Evaluation of Regional Wall Motion in Patients with Suspected Coronary Artery Disease by Real-Time Three-Dimensional Echocardiography and Two-Dimensional Speckle Tracking Imaging / 天津医药

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.

Abnormality of Regional Wall Motion of the Left Ventricle in Children with Ventricular Diastolic Overload / 소아과

PURPOSE: To assess the regional wall motion of the left ventricle in patients with diastolic overloaded lesions of congenital heart diseases with centerline analysis and radial method. METHODS: This study included 96 children with congenital heart diseases admitted to Kyungpook National University Hospital from January 1998 to December 2002 who received left ventriculograms. The evaluation of the regional wall motion of the left ventricle was done on review mode of 30-degree elongated right anterior oblique projection of left ventriculogram by using cardiac analysis program of the DXC Hiline Digital System(GER, Paris, France). RESULTS: Compared with the control group, the left ventricular regional wall motions of patients with right ventricular diastolic overload were significantly decreased at the anterolateral portion and increased at the diaphragmatic portion with the centerline analysis method, but no differences were noted with the radial method. CONCLUSION: We confirmed left ventricular regional wall motion abnormalities in patients with right ventricular diastolic overload lesions of congenital heart diseases with the centerline method in spite of normal ejection fraction.

Electrocardiogram as a predictor of functional recovery after recanalization of chronic total coronary occlusions / 中国实用内科杂志

Objective To determine whether the 12-lead-resting electrocardiogram(ECG) is a predictor of left vertricular(LV) recovery after successful recanalization of chronic total coronary occlusions(CTO).Methods The 12-lead-resting ECG was evaluated for Q-wave areas and parameters of QT dispersion.Impairment of regional wall motion was evaluated by real-time three-dimensional echocardiography(RT-3DE) at baseline and at follow-up.Results The wall motion score index(WMSI) was improved from 1.56?0.31 to 1.12?0.21(P0.05).Conclusion In patients with recanalization of CTO,recovery of regional wall motion is reliably predicted by analysis of the12-lead-resting ECG.

The Role of Echocardiography for Evaluation of the Acute Chest Pain Patients with Nonspecific ECG Findings

OBJECTIVE: To evaluate diagnostic role of echocardiography in the patients of acute chest pain with nonspecific ECG findings we have performed prospective study. SUBJECT AND METHOD: 79 out of 101 consecutive patients presenting to the emergency room with symtoms suggestive of acute coronary syndrome (ACS) without diagnostic ECG change were studied. Presence and score of regional wall motion abnormality (RWMA) were assessed according to the American Society of Echocardiography guideline (16 segment model) by two-dimensional echocardiography within 4 hours after arrival. The diagnosis of acute myocardial infarction (AMI) was confirmed by serial myocardial enzyme assay retrospectively. RESULTS: Of the 28 patients with RWMA, 13 (46%) had non-Q AMI, 8 (28%) had unstable angina, 3 (11%) had posterior AMI. Of the 51 patients with normal wall motion, 10 had gastroesophageal disease, 9 had variant angina, 3 had psychologic disease, 1 had aortic dissection and 1 had hypertrophic cardiomyopathy. Thus, Presence of RWMA by echocardiography had a sensitivity of 49% and a specificity of 88% for diagnosis of ACS. In 21 ACS patients with RWMA, regional wall motion score was significantly higher in AMI than in unstable angina (3.1+/-1.8 vs 1.0+/-2.2, p<0.05). As for the significant coronary artery stenosis, there was a higher incidence of multivessel disease in the patients with RWMA (64%). CONCLUSION: RWMA by two-dimensional echocardiography in the emergency room is not a sensitive but a specific technique to diagnose ACS patient with nonspecific ECG change, especially in posterior AMI and non-Q AMI.

Assessment of Regional Wall Motion of the Left Ventricle in Children with Congenital Heart Disease

PURPOSE: To assess wall motion of the left ventricle in the various forms of congenital heart disease and to select appropriate methods by which to gauge left ventricular wall motion. METHODS: We evaluated left ventricular function, including volume, global ejection fraction, and regional wall motion(Centerline method, Local Ejection Fraction, Curved Perimeter method and Radial method). The evaluation was done on review mode of 30-degree elongated right anterior oblique projection of left ventriculogram by using cardiac analysis program of the DXC Hiline Digital System(GER, USA) in 53 pediatric patients undergoing diagnostic(or therapeutic) cardiac catheterization from June 1995 to July 1996 at Kyung-pook National University Hospital. RESULTS: Cardiac indices calculated by Dodge's and Simpson's methods were 5.76+/-2.13 L/min/ m2, 5.86+/-2.31 L/min/m2 respectively with significant correlation to each other(r=0.99, P<0.01). Global ejection fractions using both methods were 69.81+/-8.33%, and 69.69+/-8.20%, respectively (r=0.99, P<0.01). After dividing the left ventricular outline contour into five regions such as posterobasal, diaphragmatic, apical, anterolateral and anterobasal portions, all four models could ascertain regional wall motion abnormalities well(P<0.01). And among them, the Centerline method and the Curved Perimeter method correlated well in assessing wall motion(for each portion r=0.67, 0.84, 0.94, 0.91 and 0.61 respectively, P<0.01). CONCLUSION: In conclusion, we confirmed regional wall motion abnormalities in the various forms of congenital heart disease in spite of normal global ejection fractions, showing that the Centerline and Curved Perimeter methods are preferable methods in the assessment of wall motion in patiens with congenital heart disease.

Alterations in Myocardial Perfusion and Regional Wall Motion in Patients with Permanent Pacemaker

BACKGROUND: The effect of right ventricular pacing on myocardial perfusion and regional wall motion is not well known, although some studies have suggested that it may be adverse. We investigated the effects of right ventricular pacing on myocardial perfusion and regional wall motion in patients with permanent pacemakers. METHOD: Thirty patients receiving permanent pacemakers for complete heart block or sick sinus syndrome were included in this study. All the patients showed normal coronary angiograms. Myocardial scintigraphy and two-dimensional echocardiography were performed to assess myocardial perfusion and to evaluate regional wall motion and global function of the left ventricle (LV). RESULTS: 1) Mean age was 66.2+/-8.2 (41-84) years, and the male-to-female ratio was 1 : 1.7 (11 male, 19 female). Indications for permanent pacemaker implantation were complete atrioventricular (AV) block in 21 patients and sick sinus syndrome in 9. The selected pacing modes were VVI in 14 patients, DDD in 8, VDD in 6, and AAI in 2. LV ejection fraction estimated by 2-dimensional echocardiography was 62.7+/-5.8 (53-86)%. 2) Perfusion defects were noted in 26 (87%) patients including 25 (89%) out of 28 patients with ventricular pacing modes such as VVI, DDD, and VDD, and 1 (50%) out of 2 patients with AAI mode. Locations of perfusion defects were septal in 19 (63%) patients, inferior in 17 (57%), apical in 16 (53%), lateral in 3 (10%), and anterior in 2 (7%). Extent of maximal perfusion defects was 17.0+/-9.5 (0-44)%. 3) Regional wall motion abnormalities were noted mainly over the apical region of the LV in 26 (93%) of 28 patients with ventricular pacing. However, LV ejection fraction did not differ significantly before and early after implantation of the pacemaker (62.7+/-5.8% vs. 61.0+/-5.8%, p-0.313). CONCLUSIONS: Right ventricular apical pacing frequently caused myocardial perfusion defects and regional wall motion abnormalities. These might be due to abnormal ventricular activation and abnormal interventricular septal motion. The long-term effects of these abnormalities remain to be determined, and the pacing technique to minimize these adverse effects should be developed.

Intraoperative Management of Myocardial Ischemia with Transesophageal Echocardiography during Coronary Bypass Surgery / 대한마취과학회지

BACKGROUND; Regional wall motion abnormalities(RWMA) detected by intraoperative transesophageal echocardiography(TEE) are thought to be sensitive indicators of myocardial ischemia. The present study was undertaken to elucidate management of RWMA with an immediate regraft in the area of RWMA or conventional drug therapy. METHOD; Twenty-six patients undergoing coronary artery bypass graft surgery were examined with TEE. After induction of anesthesia, TEE probe was inserted into esophagus and connected to Echo system. LV short axis views at the mid-papillary muscle level were viewed and recorded. TEE showed postbypass RWMA in 6 cases and one patient who did not have the TEE developed postbypass RWMA viewed by the epicardial echocardiography. Regraft was performed at the area of RWMA in 3 patients. The remainder was treated with intraaortic balloon pump(IABP) and/or inotropics. RESULTS; The patients with regraft showed an immediate improvement of the new RWMAs. The patients treated with IABP and/or inotropics had improvement of hemodynamics but did not show any improvement of the RWMAs. All seven patients developed hypotension and ST segment changes. All patients with the conventional treatment and two out of 3 regraft patients developed the postoperative myocardial infarctions. CONCLUSIONS; In conclusion this study demonstrated that patients experiencing persistent RWMA would be more likely to have myocardial infarction than those having only transient changes and that TEE would be an excellent tool for early detection of myocardial ischemia and might improve treatment of ischemic events.

Quantitative Two-Dimensional Echocardiographic Analysis of Left Ventricular Wall Motion in Patients with Acute Myocardial Infarction

Regional left ventricular wall motion was evaluated by two-dimensional echocardiographic technique with floating-axis (internal frame of reference) system in three groups of subject; normal subject (n=12), patients with acute anterior myocardial infraction(n=16), and patients with acute inferior myocardial infraction(n=10). Significant hypokinetic wall motion were detected in apical portion (Mean Percent Shortening; 0.27-5.84% in anterior infraction group and 9.64-13.17% in controls) and apicoanterior portion (MPS; 2.86% in anterior infraction group and 14.13% in controls) in patients with acute anterior myocardial infraction (P<0.01), and inferior portion (MPS; 3.56-6.93% in inferior infraction group and 18.26-19.8% in controls) and apical portion (MPS; 4.04% in inferior infraction group and 9.64% in controls) in patients with acute inferior myocardial infraction (P<0.01) in apical long-axis views. We conclude that echocardiographic wall motion analysis by floating axis system is an accurate non-invasive method for detecting abnormal wall motion in patients with acute anterior and in ferior myocardial infraction.