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Arasaratnam P, Lee E. Prognostic value of the E/e′ ratio among octogenarians in Singapore. HEART ASIA 2013; 5:176-80. [DOI: 10.1136/heartasia-2013-010361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/11/2013] [Accepted: 07/21/2013] [Indexed: 11/03/2022]
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Dogan C, Ozdemir N, Hatipoglu S, Bakal RB, Omaygenc MO, Dindar B, Candan O, Emiroglu MY, Kaymaz C. Relation of left atrial peak systolic strain with left ventricular diastolic dysfunction and brain natriuretic peptide level in patients presenting with ST-elevation myocardial infarction. Cardiovasc Ultrasound 2013; 11:24. [PMID: 23829445 PMCID: PMC3708795 DOI: 10.1186/1476-7120-11-24] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 06/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In patients presenting with ST-elevation myocardial infarction (STEMI), we investigated the relation of left atrial (LA) deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and B-type natriuretic peptide (BNP) level. METHODS Ninety STEMI patients who were treated with primary percutaneous coronary intervention (PCI) and 22 healthy control subjects were enrolled. STEMI patients had echocardiographic examination 48 hours after the PCI procedure and venous blood samples were drawn simultaneously. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient. Average peak LA strain values during left ventricular (LV) systole (LAs-strain) were measured. RESULTS BNP values were higher in MI patients compared to controls. Mean LAs-strain in control group was higher than MI group (30.6 ± 5.6% vs. 21.6 ± 6.6%; p = 0.001). LAs-strain had significant correlation with LVEF (r = 0.51, p = 0.001), also significant inverse correlations between LAs-strain and BNP level (r = -0.41, p = 0.001), E/Em (r = -0.30, p = 0.001), LA maximal volume (r = -0.41, p = 0.001), LA minimal volume (r = -0.50, p = 0.001) and LV end systolic volume (r = -0.37, p = 0.001) were detected. The cut off value of LAs-strain to predict BNP > 100 pg/ml was determined as 19.9% with 55.3% sensitivity and 77.2% specificity (p < 0.05 AUC:0.7). CONCLUSION Our study showed that LAs-strain values decreased consistently with deteriorating systolic and diastolic function in STEMI patients treated with primary PCI. LA-s strain measurements may be helpful as a complimentary method to evaluate diastolic function in this patient population.
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Iwahashi N, Kimura K, Kosuge M, Tsukahara K, Hibi K, Ebina T, Saito M, Umemura S. E/e′ Two Weeks after Onset Is a Powerful Predictor of Cardiac Death and Heart Failure in Patients with a First-Time ST Elevation Acute Myocardial Infarction. J Am Soc Echocardiogr 2012. [DOI: 10.1016/j.echo.2012.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Oraby MA, Ibrahim MF, Nasr GM, El Hawary AA. Relationship between restrictive Doppler mitral inflow pattern and myocardial viability after a first acute myocardial infarction. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Perlini S, Chung ES, Aurigemma GP, Meyer TE. Alterations in Early Filling Dynamics Predict the Progression of Compensated Pressure Overload Hypertrophy to Heart Failure Better than Abnormalities in Midwall Systolic Shortening. Clin Exp Hypertens 2012; 35:401-11. [DOI: 10.3109/10641963.2012.739235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bajraktari G, Miccoli M, Buralli S, Fontanive P, Elezi S, Metelli MR, Baggiani A, Dini FL. Plasma metalloproteinase-9 and restrictive filling pattern as major predictors of outcome in patients with ischemic cardiomyopathy. Eur J Intern Med 2012; 23:616-20. [PMID: 22939806 DOI: 10.1016/j.ejim.2012.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Assessment of plasma matrix metalloproteinase-9 (MMP-9) and Doppler markers of increased left ventricular (LV) filling pressure may be added to risk stratify patients with ischemic cardiomyopathy (IC). Therefore, we aimed at investigating the value of plasma MMP-9 and restrictive filling pattern (RFP) in IC patients. METHODS Eighty-eight consecutive patients hospitalized for heart failure (LV ejection fraction ≤ 40%) due to IC were enrolled. A complete M-mode and two-dimensional echo-Doppler examination were performed. Patients were defined as having RFP if they had a mitral E wave deceleration time<150 ms. Plasma MMP-9 and N-terminal protype-B natriuretic peptide levels were assessed at the time of the index echocardiogram. The end point was all-cause mortality or hospitalization for worsening HF. Follow-up period was 25 ± 17 months. RESULTS Median value of MMP-9 was 714 ng/ml. On univariate analysis, a number of measurements predicted the composite end point: NYHA class>2, RFP, MMP-9>60.5 ng/ml, LV ejection fraction<27%, anemia, pulmonary pressure ≥ 35 mm Hg, N-terminal protype-B natriuretic peptide>1742 pg/ml, and glomerular filtration rate<60 ml/min/1.73 m(2). Independent variables of outcome were anemia (HR=1.9, p=0.031), and the combination of plasma MMP-9 and RFP (HR=3.2, p=0.004). On Kaplan-Meier survival curves, patients with elevated MMP-9 levels and RFP had the lowest event-free survival rate (log-rank: 29.0, p<0.0001). The net reclassification improvement showed a significant increase in the prediction model when elevated MMP-9 and RFP were added to the base model that included clinical, biochemical and echocardiographic parameters (p<0.0001). CONCLUSION MMP-9 levels and RFP have an incremental predictive value to risk classify IC patients.
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Affiliation(s)
- Gani Bajraktari
- Service of Cardiology, Internal Medicine Clinic, University Clinical Centre of Kosova, Prishtina, Kosovo
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Hsiao SH, Lin KL, Chiou KR. Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol 2012; 109:748-55. [PMID: 22152972 DOI: 10.1016/j.amjcard.2011.10.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/25/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
Abstract
Because of diastolic coupling between the left atrium and left ventricle, we hypothesized that left atrial (LA) function mirrors the diastolic function of left ventricle. The aims of this study were to assess whether LA volume parameters can be good indexes of left ventricular diastolic dysfunction. Six hundred fifty-nine patients underwent cardiac catheterization and measurements of left ventricular filling pressure (LVFP). Echocardiographic examinations including tissue Doppler and LA volumes were also assessed. Ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity and LVFP tended to increase after progression of diastolic dysfunction. The inverse phenomenon existed in LA ejection and LA distensibility. LA distensibility was superior to LA ejection fraction and early diastolic mitral inflow velocity/early diastolic mitral annular velocity for identifying LVFP >15 mm Hg (areas under receiver operating characteristic curve 0.868, 0.834, and 0.759, respectively) and for differentiating pseudonormal from normal diastolic filling (areas under receiver operating characteristic curve 0.962, 0.907, and 0.741, respectively). Multivariate logistic regression showed that LA ejection fraction and LA distensibility were associated significantly with the presence of pseudonormal/restrictive ventricular filling. In conclusion, LA volume parameters can identify LVFP >15 mm Hg and differentiate among patterns of ventricular diastolic dysfunction. For assessing diastolic function LA parameters offer better performance than even tissue Doppler.
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Sawaya H, Plana JC, Scherrer-Crosbie M. Newest echocardiographic techniques for the detection of cardiotoxicity and heart failure during chemotherapy. Heart Fail Clin 2011; 7:313-21. [PMID: 21749883 DOI: 10.1016/j.hfc.2011.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced cardiotoxicity has become a significant public health issue. Left ventricular ejection fraction is routinely used to monitor cardiotoxicity but fails to detect subtle alterations in cardiac function. Improvements in the measurement of left ventricular ejection fraction, physical or pharmacologic stressors, and novel cardiac functional indices may be useful in the detection of cardiotoxicity. The improvements in the detection and therapy of cancer have led to the emergence of chemotherapy-induced cardiotoxicity. New echocardiographic techniques may be useful in the detection of patients undergoing chemotherapy treatments who could benefit from alternative cancer treatments, therefore decreasing the incidence of cardiotoxicity.
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Affiliation(s)
- Heloisa Sawaya
- Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Aronson D, Mutlak D, Bahouth F, Bishara R, Hammerman H, Lessick J, Carasso S, Dabbah S, Reisner S, Agmon Y. Restrictive left ventricular filling pattern and risk of new-onset atrial fibrillation after acute myocardial infarction. Am J Cardiol 2011; 107:1738-43. [PMID: 21497781 DOI: 10.1016/j.amjcard.2011.02.334] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/06/2011] [Accepted: 02/06/2011] [Indexed: 11/16/2022]
Abstract
Mechanisms for atrial arrhythmias that occur in the context of acute myocardial infarction (AMI) have not been well characterized. AMI often leads to alterations in left ventricular (LV) filling dynamics, which may result in advanced diastolic dysfunction. Diastolic dysfunction may produce increased left atrial (LA) pressure and initiate LA remodeling, promoting the progression to atrial fibrillation (AF). We studied 1,169 patients admitted with AMI. Advanced diastolic dysfunction was defined as a restrictive filling pattern (RFP), defined as ratio of early to late transmitral velocity of mitral inflow >1.5 or deceleration time <130 ms. The relation between RFP and the primary end point of new-onset AF occurring within 6 months was analyzed using multivariable Cox models. Of 1,169 patients (70% men, mean ± SD 64 ± 10 years of age), 110 (9.4%) developed new-onset AF (19.6% and 7.5% in patients with and without RFP, respectively, p <0.0001). RFP was associated with a hazard ratio of 2.72 for AF (95% confidence interval 1.83 to 4.05, p <0.0001). After multivariable adjustments for clinical variables, LV ejection fraction (EF) and LA size, RFP remained an independent predictor of AF (hazard ratio 2.17, 95% confidence interval 1.42 to 3.32, p <0.0001). Risk of AF was higher in patients with RFP for preserved (≥45%, hazard ratio 2.14, 95% confidence interval 1.09 to 4.20, p = 0.03) or decreased (hazard ratio 2.80, 95% confidence interval 1.63 to 4.82, p <0.0001) LVEF. In contrast, decreased LVEF in the absence of RFP was similar to that of patients with preserved LVEF and without RFP. In conclusion, in patients with AMI, presence of advanced diastolic dysfunction was independently associated with new-onset AF, suggesting that increased filling pressures may contribute to the development of AF after AMI.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, and Rappaport Faculty of Medicine and Research Institute, Technion, Israel Institute of Technology, Haifa, Israel.
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Souza LP, Campos O, Peres CA, Machado CV, Carvalho AC. Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function? Cardiovasc Ultrasound 2011; 9:17. [PMID: 21639899 PMCID: PMC3120745 DOI: 10.1186/1476-7120-9-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 06/03/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) has been considered a major determinant of early outcome in acute myocardial infarction (AMI). Myocardial performance index (MPI) has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) specifically in patients with a first isolated ST-elevation AMI. METHODS Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF. RESULTS Early in-hospital CHF occurred in 29 (31%) of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients. CONCLUSION For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.
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Affiliation(s)
- Lilian P Souza
- Cardiology Department, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, Brazil
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61
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Sakaguchi E, Yamada A, Sugimoto K, Ito Y, Shiino K, Takada K, Iwase M, Ozaki Y. Prognostic value of left atrial volume index in patents with first acute myocardial infarction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:440-4. [DOI: 10.1093/ejechocard/jer058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Plana JC. La quimioterapia y el corazón. Rev Esp Cardiol 2011; 64:409-15. [DOI: 10.1016/j.recesp.2010.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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Tamura H, Watanabe T, Nishiyama S, Sasaki S, Arimoto T, Takahashi H, Shishido T, Miyashita T, Miyamoto T, Nitobe J. Increased Left Atrial Volume Index Predicts a Poor Prognosis in Patients With Heart Failure. J Card Fail 2011; 17:210-6. [DOI: 10.1016/j.cardfail.2010.10.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 10/07/2010] [Accepted: 10/20/2010] [Indexed: 11/28/2022]
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Nguyen PK, Schnittger I, Heidenreich PA. A comparison of echocardiographic measures of diastolic function for predicting all-cause mortality in a predominantly male population. Am Heart J 2011; 161:530-7. [PMID: 21392608 DOI: 10.1016/j.ahj.2010.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 12/04/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prior studies demonstrating the prognostic value of echocardiographic measures of diastolic function have been limited by sample size, have included only select clinical populations, and have not incorporated newer measures of diastolic function nor determined their independent prognostic value. The objective of this study is to determine the independent prognostic value of established and new echocardiographic parameters of diastolic function. METHODS We included 3,604 consecutive patients referred to 1 of 3 echocardiography laboratories over a 2-year period. We obtained measurements of mitral inflow velocities, pulmonary vein filling pattern, mitral annulus motion (e'), and propagation velocity (V(p)). The primary end point was 1-year all-cause mortality. RESULTS The mean age of the patients was 68 years, and 95% were male. There were 277 deaths during a mean follow-up of 248 ± 221 days. For patients with reduced left ventricular ejection fraction (LVEF), all measured parameters except for e' were associated with mortality (P < .05) on univariate analysis. For patients with preserved LVEF, the E-wave velocity was significantly associated with mortality (P < .05) on univariate analysis. The deceleration time/E-wave velocity ratio, V(p), and pulmonary vein filling pattern were borderline significant (P < .10). With multivariate analysis, only V(p) was associated with survival for both reduced (P = .02) and preserved LVEF groups (P = .01). CONCLUSION In a large, clinically diverse population, most measures of diastolic function were predictive of all-cause mortality without adjustment for patient characteristics. On multivariate analysis, only V(p) was independently associated with total mortality. This association with mortality may be related to factors other than diastolic function and warrants further investigation.
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Affiliation(s)
- Patricia K Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA.
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Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 10:165-93. [PMID: 19270053 DOI: 10.1093/ejechocard/jep007] [Citation(s) in RCA: 1489] [Impact Index Per Article: 106.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Okuyan E, Okcun B, Dinçkal MH, Mutlu H. Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies. Thromb J 2010; 8:15. [PMID: 20849660 PMCID: PMC2949716 DOI: 10.1186/1477-9560-8-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 09/19/2010] [Indexed: 11/26/2022] Open
Abstract
Background Left ventricular thrombus(LVT] formation is a frequent complication in patients with acute anterior myocardial infarction(MI). LVT is associated with increased risk of embolism and higher mortality rates after acute MI. Anticardiolipin antibodies (ACA) are immunoglobulins that react with phospholipid-binding proteins interfering with the prothrombin activator complex. The effects of phospholipids on pathophysiology of cardiovascular thrombotic events are well known. In this study, we aimed to evaluate the importance of clinical and biochemical parameters including anticardiolipin antibodies on left ventricular thrombus formation after acute anterior MI. Methods and Results Seventy patients with a first anterior AMI were prospectively and consecutively enrolled. Patients with previous MI, autoimmune disease, collagen vascular disease and arterial or venous thrombosis history were excluded from this study. At the time of hospitalization, key demographic and clinical characteristics were collected including age, gender, ethanol intake and presence of traditional risk factors for atherosclerosis (hypertension, diabetes, smoking, hyperlipidemia, positive family history). Patients were evaluated for echocardiographic data, blood chemistry and ACA. Two-dimensional and Doppler echocardiographic examinations were performed in all patients within the first week and at 14 days after MI. LV thrombus was detected in 30 (42.8%) patients. ACA IgM levels were significantly higher in the patient group with LV thrombus than in the group without thrombus (12.44 ±4.12 vs. 7.69 ± 4.25 mpl, p = 0,01). ACA IgG levels were also found higher in the group with LV thrombus (24.2 ± 7.5 vs.17.98 ± 6.45 gpl, p = 0.02). Multivariate analyses revealed diabetes mellitus, higher WMSI, lower MDT and higher ACA IgM and higher ACA IgG levels as independent predictors of left ventricular thrombus formation. Conclusions Our data demonstrate that beside the low ejection fraction, lower MDT and higher wall motion score index, modestly elevated ACA IgM and ACA IgG levels are associated with LV thrombus formation in patients with anterior MI.
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Affiliation(s)
- Ertuğrul Okuyan
- Istanbul University, Institute of Cardiology, Istanbul, Turkey.
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Flachskampf FA. Elevación de las presiones diastólicas como factor predictivo temprano del remodelado ventricular izquierdo tras el infarto: ¿evaluación con ecocardiografía o con péptidos natriuréticos? Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70220-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Flachskampf FA. Raised diastolic pressure as an early predictor of left ventricular remodeling after infarction: should echocardiography or natriuretic peptides be used for assessment? Rev Esp Cardiol 2010; 63:1009-1012. [PMID: 20804694 DOI: 10.1016/s1885-5857(10)70202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part III: functional biomarkers influenced by smoking. Biomark Med 2010; 3:807-23. [PMID: 20477716 DOI: 10.2217/bmm.09.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Smoking cigarettes induces rapidly occurring and reversible functional changes in the cardiovascular system, which precede morphologic changes. These functional changes are also related to atherosclerotic disease development and thus may qualify as prognostic parameters in chronic smokers. As opposed to smoking-induced morphologic changes functional alterations occur and revert within minutes, thus, allowing for the detection of smoking-induced effects on the cardiovascular system within minutes following exposure to mainstream smoke. Some alterations represent 'direct' changes (e.g., endothelial function), others reflect changes in a different organ system (e.g., the autonomous nervous system influencing heart rate variability), while some represent the sum of alterations in many organs and systems (e.g., exercise performance influenced by the autonomous nervous and by endothelial and cardiac function). Since a specific functional parameter usually changes with at least one or several others, caution should be exercised when trying to establish a direct cause relationship between the alteration of a single parameter and a clinical outcome.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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[Are de novo acute heart failure and acutely worsened chronic heart failure two subgroups of the same syndrome?]. SRP ARK CELOK LEK 2010; 138:162-9. [PMID: 20499495 DOI: 10.2298/sarh1004162b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term mortality. OBJECTIVE To investigate clinical presentation of patients with de novo AHF and acute worsening of chronic heart failure (CHF) and to identify differences in blood levels of biomarkers and echocardiography findings. METHODS This prospective study comprised 64 consecutive patients being grouped according to the onset of the disease into patients with the de novo AHF (45.3%), and patients with acute worsening of CHF (54.7%). RESULTS Acute congestion (60%) was the most common manifestation of de novo AHF, whereas pulmonary oedema (43.1%) was the most common manifestation of acutely decompensated CHF. Patients with acutely decompensated CHF had significantly higher blood values of creatinine (147.10 vs 113.16 micromol/l; p < 0.05), urea (12.63 vs. 7.82 mmol/l; p < 0.05), BNP (1440.11 vs. 712.24 pg/ml; p < 001) and NTproBNP (9097.00 vs. 2827.70 pg/ml; p < 0.01) on admission, and lower values of M-mode left ventricular ejection fraction (LVEF) during hospitalization (49.44% vs. 42.94%; p < 0.05). The follow-up after one year revealed still significantly higher BNP (365.49 vs. 164.02 pg/ml; p < 0.05) and lower average values of both LVEF in patients with acutely worsened CHF (46.62% vs. 54.41% and 39.52% vs. 47.88%; p < 0.05). CONCLUSION Considering differences in clinical severity on admission, echocardiography and natriuretic peptide values during hospitalization and after one year follow-up, de novo AHF and acutely worsened CHF are two different subgroups of the same syndrome.
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Jons C, Moerch Joergensen R, Hassager C, Gang UJ, Dixen U, Johannesen A, Olsen NT, Hansen TF, Messier M, Huikuri HV, Bloch Thomsen PE. Diastolic dysfunction predicts new-onset atrial fibrillation and cardiovascular events in patients with acute myocardial infarction and depressed left ventricular systolic function: a CARISMA substudy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:602-7. [DOI: 10.1093/ejechocard/jeq024] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Shanks M, Ng ACT, van de Veire NRL, Antoni ML, Bertini M, Delgado V, Nucifora G, Holman ER, Choy JB, Leung DY, Schalij MJ, Bax JJ. Incremental prognostic value of novel left ventricular diastolic indexes for prediction of clinical outcome in patients with ST-elevation myocardial infarction. Am J Cardiol 2010; 105:592-7. [PMID: 20185002 DOI: 10.1016/j.amjcard.2009.10.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 10/23/2009] [Accepted: 10/28/2009] [Indexed: 12/17/2022]
Abstract
This study examined the prognostic value of novel diastolic indexes in ST-elevation acute myocardial infarction (AMI), derived from strain and strain rate analysis using 2-dimensional speckle tracking imaging. Echocardiograms were obtained within 48 hours of admission in 371 consecutive patients with first ST-elevation AMI (59.7 +/- 11.6 years old). Indexes of diastolic function including mean strain rate during isovolumic relaxation (SR(IVR)), mean early diastolic strain rate (SR(E)) and mean diastolic strain at peak transmitral E wave (E) were obtained from 3 apical views. Mean early diastolic velocity from 4 basal segments by color-coded tissue Doppler imaging was measured. Indexes of diastolic filling including E/SR(IVR), E/SR(E), E/diastolic strain at E, and E/early diastolic velocity were calculated. The primary end point (composite of death, hospitalization for heart failure, repeat MI, and repeat revascularization) occurred in 84 patients (22.6%) during a mean follow-up of 17.3 +/- 12.2 months. Mean SR(IVR) (p <0.001), multivessel disease (p <0.001), Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention (p = 0.004), and left ventricular ejection fraction (p = 0.008) were independent predictors of the combined end point on Cox regression analysis. Mean SR(IVR) showed incremental prognostic value over baseline clinical and echocardiographic variables (global chi-square increase from 41.0 to 51.6, p <0.001). After dividing patient population based on median SR(IVR), patients with SR(IVR) < or =0.24/second had significantly higher event rates than others (hazard ratio 2.74, 95% confidence interval 1.61 to 4.67, p <0.001). In conclusion, SR(IVR) was incremental to left ventricular ejection fraction, Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention, and multivessel disease and superior to other diastolic indexes in predicting future cardiovascular events after AMI. SR(IVR) may be useful in identifying high-risk patients soon after AMI.
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Affiliation(s)
- Miriam Shanks
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation(s)
- Queenie Lo
- Liverpool HospitalDepartment of CardiologySydneyNew South Wales2170Australia
| | - Liza Thomas
- Liverpool HospitalDepartment of CardiologySydneyNew South Wales2170Australia
- The University of New South WalesSydneyNew South Wales2052Australia
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Aronson D, Musallam A, Lessick J, Dabbah S, Carasso S, Hammerman H, Reisner S, Agmon Y, Mutlak D. Impact of diastolic dysfunction on the development of heart failure in diabetic patients after acute myocardial infarction. Circ Heart Fail 2009; 3:125-31. [PMID: 19910536 DOI: 10.1161/circheartfailure.109.877340] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes is often associated with an abnormal diastolic function. However, there are no data regarding the contribution of diastolic dysfunction to the development of heart failure (HF) in diabetic patients after acute myocardial infarction. METHODS AND RESULTS A total of 1513 patients with acute myocardial infarction (417 diabetic) underwent echocardiographic examination during the index hospitalization. Severe diastolic dysfunction was defined as a restrictive filling pattern (RFP) based on E/A ratio >1.5 or deceleration time <130 ms. The primary end points of the study were readmission for HF and all-cause mortality. The frequency of RFP was higher in patients with diabetes (20 versus 14%; P=0.005). During a median follow-up of 17 months (range, 8 to 39 months), 52 (12.5%) and 62 (5.7%) HF events occurred in patients with and without diabetes, respectively (P<0.001). There was a significant interaction between diabetes and RFP (P=0.04) such that HF events among diabetic patients occurred mainly in those with RFP. The adjusted hazard ratio for HF was 2.77 (95%, CI 1.41 to 5.46) in diabetic patients with RFP and 1.21 (95% CI, 0.75 to 1.55) in diabetic patients without RFP. A borderline interaction (P=0.059) was present with regard to mortality (adjusted hazard ratio, 3.39 [95% CI, 1.57 to 7.34] versus 1.61 [95% CI, 1.04 to 2.51] in diabetic patients with and without RFP, respectively). CONCLUSIONS Severe diastolic dysfunction is more common among diabetic patients after acute myocardial infarction and portends adverse outcome. HF and mortality in diabetic patients occur predominantly in those with concomitant RFP.
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Affiliation(s)
- Doron Aronson
- Department of Cardiology, Rambam Medical Center, Haifa, Israel.
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76
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Nicolosi GL, Golcea S, Ceconi C, Parrinello G, Decarli A, Chiariello M, Remme WJ, Tavazzi L, Ferrari R. Effects of perindopril on cardiac remodelling and prognostic value of pre-discharge quantitative echocardiographic parameters in elderly patients after acute myocardial infarction: the PREAMI echo sub-study. Eur Heart J 2009; 30:1656-65. [PMID: 19406871 DOI: 10.1093/eurheartj/ehp139] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To determine (i) the effect of perindopril on several geometric and functional parameters of the left and right ventricles assessed by echocardiography in the unique Perindopril and Remodelling in Elderly with Acute Myocardial Infarction (PREAMI) population of post-acute myocardial infarction (AMI) elderly patients with preserved left ventricular (LV) function; and (ii) the prognostic predictors at pre-discharge derived from echo-Doppler measurements in the same population. METHODS AND RESULTS PREAMI included 1252 post-AMI patients (age 73 +/- 6 years, LV ejection fraction 59.1 +/- 7.7%) receiving optimal therapy after AMI, randomized to perindopril 8 mg/day (n = 631) or placebo (n = 621); n = 896 had complete echo-Doppler data. Outcome measures were clinical [death, heart failure (HF)] and standard echo-Doppler parameters. Pre-discharge LV end-diastolic volume (LVEDV) was similar: 81.1 +/- 23.1 (perindopril) and 79.6 +/- 22.7 mL (placebo). At 6 months and 1 year, LVEDV remained unchanged with perindopril (81.2 +/- 24.4 and 81.8 +/- 26.8 mL, respectively), but increased with placebo (83.0 +/- 25.3 and 83.6 +/- 25.7 mL, respectively, both P < 0.001 vs. baseline). Perindopril reduced cardiac sphericity vs. placebo (P = 0.015 at 6 months; P = 0.020 at 1 year). Classification regression tree analysis showed treatment as the most important predictor of remodelling. Multiple pre-discharge echocardiographic variables predicted the death/HF endpoint, independently of treatment (P < or = 0.05). CONCLUSION Remodelling occurs in post-AMI in elderly patients with normal LV function. Echo-Doppler variables at baseline have prognostic implications. Treatment with perindopril reduces progressive LV remodelling that can occur even in the case of small infarct size.
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77
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Santos AA, Helber I, Flumignan RL, Antonio EL, Carvalho AC, Paola ÂA, Tucci PJ, Moises VA. Doppler Echocardiographic Predictors of Mortality in Female Rats After Myocardial Infarction. J Card Fail 2009; 15:163-8. [DOI: 10.1016/j.cardfail.2008.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 09/17/2008] [Accepted: 10/03/2008] [Indexed: 10/21/2022]
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78
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Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. J Am Soc Echocardiogr 2009; 22:107-33. [PMID: 19187853 DOI: 10.1016/j.echo.2008.11.023] [Citation(s) in RCA: 2282] [Impact Index Per Article: 152.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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79
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Kamp O, Visser CA. Echocardiography for Assessing Acute Myocardial Infarction. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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80
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Khumri TM, Walker BL, Magalski A, Morris BA, Coggins TR, Kusnetzky LL, House JA, Main ML. Combined Assessment of Myocardial Perfusion and Diastolic Function Enhances Risk Stratification in Patients with Anterior Wall Myocardial Infarction. Echocardiography 2009; 26:61-5. [DOI: 10.1111/j.1540-8175.2008.00750.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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81
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Okura H, Kubo T, Asawa K, Toda I, Yoshiyama M, Yoshikawa J, Yoshida K. Elevated E/E' Predicts Prognosis in Congestive Heart Failure Patients With Preserved Systolic Function. Circ J 2009; 73:86-91. [PMID: 19015586 DOI: 10.1253/circj.cj-08-0457] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Iku Toda
- Division of Cardiology, Bell Land General Hospital
| | - Minoru Yoshiyama
- Department of Internal Medicine and Cardiology, Osaka City University School of Medicine
| | - Junichi Yoshikawa
- Department of Internal Medicine and Cardiology, Osaka Ekisaikai Hospital
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Roongsritong C, Sadhu A, Pierce M, Raj R, Simoni J. Plasma Carboxy-Terminal Peptide of Procollagen Type I Is an Independent Predictor of Diastolic Function in Patients With Advanced Systolic Heart Failure. ACTA ACUST UNITED AC 2008; 14:302-6. [DOI: 10.1111/j.1751-7133.2008.00014.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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83
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Møller JE, Whalley GA, Dini FL, Doughty RN, Gamble GD, Klein AL, Quintana M, Yu CM. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation 2008; 117:2591-8. [PMID: 18474816 DOI: 10.1161/circulationaha.107.738625] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restrictive mitral filling pattern (RFP), the most severe form of diastolic dysfunction, is a predictor of outcome after acute myocardial infarction (AMI). Low power has precluded a definite conclusion on the independent importance of RFP, especially when overall systolic function is preserved. We undertook an individual patient meta-analysis to determine whether RFP is predictive of mortality independently of LV ejection fraction (LVEF), end-systolic volume index, and Killip class in patients after AMI. METHODS AND RESULTS Twelve prospective studies (3396 patients) assessing the relationship between prognosis and Doppler echocardiographic LV filling pattern in patients after AMI were included. Individual patient data from each study were extracted and collated into a single database for analysis. RFP was associated with higher all-cause mortality (hazard ratio, 2.67; 95% CI, 2.23 to 3.20; P<0.001) and remained an independent predictor in multivariate analysis with age, gender, and LVEF. The overall prevalence of RFP was 20% but was highest (36%) in the quartile of patients with lowest LVEF (<39%) and lowest (9%) in patients with the highest LVEF (>53%; P<0.0001). RFP remained significant within each quartile of LVEF, and no interaction was found for RFP and LVEF (P=0.42). RFP also predicted mortality in patients with above- and below-median end-systolic volume index (1575 patients) and in different Killip classes (1746 patients). Importantly, when diabetes, current medication, and prior AMI were included in the model, RFP remained an independent predictor of outcome. CONCLUSIONS Restrictive filling is an important independent predictor of mortality after AMI regardless of LVEF, end-systolic volume index, and Killip class.
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84
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Yang NI, Hung MJ, Cherng WJ, Wang CH, Cheng CW, Kuo LT. Analysis of left ventricular changes after acute myocardial infarction using transthoracic real-time three-dimensional echocardiography. Angiology 2008; 59:688-94. [PMID: 18445615 DOI: 10.1177/0003319708316006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little information is available regarding the relationship between three-dimensional (3-D) echocardiographic parameters in acute stage of acute myocardial infarction (AMI) and subsequent left ventricular (LV) remodeling after AMI. METHODS Consecutive patients with AMI were analyzed for echocardiographic predictors of subsequent LV remodeling after AMI using two-dimensional (2-D) echocardiography and real-time 3-D echocardiography at baseline and month 3 of follow-up. LV adverse and favorable remodeling were defined as a >10% and <or=10% increase in 3-D derived LV end diastolic volume index (LVEDVI) at 3 months' follow-up compared with baseline, respectively. RESULTS 19 AMI patients underwent real-time 3-D echocardiography at baseline and at 3 months after AMI. In patients with favorable remodeling (n = 12), baseline, LVEDVI, LV end-systolic volume index (LVESVI) and LV stroke volume index (LVSVI) were significantly increased compared with patients with adverse remodeling. At 3 months of follow-up, patients with favorable remodeling had significant 3-D LVEDVI, LVESVI, and systolic sphericity index reductions compared to patients with adverse remodeling in which these variables were increased. Baseline clinical and echocardiographic variables were analyzed for the identification of favorable LV remodeling. Of these, LVESVI was the most predictive variable with sensitivity, specificity, and positive and negative predictive values for a cutoff value of >42 mL/m(2) of 75%, 71%, 75%, and 71%, respectively. CONCLUSIONS LVESVI assessed by 3-D echocardiography was the most predictive parameter indicating favorable LV remodeling after AMI. LV shape on contraction changed from elliptical shape to more globular in the adverse remodeling process after AMI.
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Affiliation(s)
- Ning-I Yang
- Department of Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Keelung, Taiwan
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85
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Okura H, Takada Y, Kubo T, Asawa K, Taguchi H, Toda I, Yoshiyama M, Yoshikawa J, Yoshida K. Functional Mitral Regurgitation Predicts Prognosis Independent of Left Ventricular Systolic and Diastolic Indices in Patients with Ischemic Heart Disease. J Am Soc Echocardiogr 2008; 21:355-60. [PMID: 17658723 DOI: 10.1016/j.echo.2007.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the prognostic impact of functional mitral regurgitation (FMR) and tissue Doppler-derived index of left ventricular filling pressure, E/E', on long-term clinical outcome in a broad spectrum of ischemic heart disease. BACKGROUND FMR has been shown to predict prognosis in patients with myocardial infarction. METHODS A total of 524 patients with ischemic heart disease were enrolled. Patients were categorized according to the presence (n = 58) or absence (n = 466) of severe FMR. RESULTS Patients with severe FMR were significantly older. By echocardiography, ejection fraction was significantly lower (43.0% +/- 14.6% vs. 56.4% +/- 12.8%, P < .01) and E/E' was significantly higher (21.3 +/- 9.0 vs. 14.6 +/- 6.4, P < .01) in patients with FMR than without FMR. Event-free (death and congestive heart failure) survival was significantly lower in patients with FMR than in those without (log-rank P < .0001). By multivariate logistic regression analysis, E/E' greater than 15 (relative risk [RR] 3.49; 95% confidence interval [CI] 2.08-5.88, P < .0001), ejection fraction less than 50% (RR 3.33; 95% CI 1.96-5.64, P < .0001), and severe FMR (RR 2.34; 95% CI 1.22-2.48, P = .01) were independent echocardiographic predictors of cardiac events. In further analysis of 116 patients matched by a propensity score, severe FMR remained associated with reduced event-free survival (log-rank P = .004). CONCLUSION FMR is a strong predictor of cardiac events independently of left ventricular systolic and diastolic indices in patients with ischemic heart disease.
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Affiliation(s)
- Hiroyuki Okura
- Division of Cardiology, Bell Land General Hospital, Sakai, Japan.
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Barbosa MM, Nunes MDCP, Castro LRDA, Nominato LFRDS, Alencar MCN, Ribeiro AL. Correlation between NT-pro BNP Levels and Early Mitral Annulus Velocity (E′) in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome. Echocardiography 2008; 25:353-9. [DOI: 10.1111/j.1540-8175.2007.00618.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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88
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Whalley GA, Gamble GD, Dini FL, Klein AL, Møller JE, Quintana M, Yu CM, Doughty RN. Individual patient meta-analyses of restrictive diastolic filling pattern and mortality in patients post acute myocardial infarction and in patients with chronic heart failure. Int J Cardiol 2007; 122:207-15. [PMID: 17321616 DOI: 10.1016/j.ijcard.2006.11.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 11/05/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Doppler echocardiographic assessment of diastolic filling provides a non-invasive estimate of left ventricular (LV) filling pressure and the most advanced diastolic filling grade, the restrictive filling pattern (RFP), has been linked to prognosis in patients post acute myocardial infarction (AMI) and with heart failure (HF). There remains some uncertainty about the prognostic role of RFP in patients with varied levels of systolic function. The objective of this collaboration is to determine whether the presence of RFP offers additional prognostic information over LV systolic function, symptoms or other clinical factors in patients post AMI or with HF. METHODS The Meta-analysis Research Group in Echocardiography (MeRGE) has been established in order to test this through two individual patient meta-analyses. Prospective studies that enrolled patients with either established HF or post AMI and included Doppler-echocardiography and outcome data will be merged into two large datasets (3739 AMI patients and 3540 HF patients) in order to evaluate the independent effects of RFP upon total and cardiovascular mortality using Kaplan-Meier survival analysis methods and Cox proportional hazards model for multi-variate analysis. Survival will be examined within different bands of LV systolic function based upon ejection fraction (EF). IMPLICATIONS This unique dataset will provide a very large cohort of patients, which will be adequately powered to provide new and prognostically important information to further aid risk stratification in these two high-risk patient groups.
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89
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Somaratne JB, Whalley GA, Gamble GD, Doughty RN. Restrictive Filling Pattern is a Powerful Predictor of Heart Failure Events Postacute Myocardial Infarction and in Established Heart Failure: A Literature-Based Meta-Analysis. J Card Fail 2007; 13:346-52. [PMID: 17602980 DOI: 10.1016/j.cardfail.2007.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 01/23/2007] [Accepted: 01/25/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Two recent literature-based meta-analyses revealed that restrictive filling pattern (RFP) was associated with a 4-fold increase in the risk of death in patients with heart failure (HF) and postacute myocardial infarction (AMI). This similar but unique analysis evaluated the link between RFP and morbidity. METHODS AND RESULTS Prospective echocardiographic studies of patients post-AMI and with HF that reported HF morbidity were identified. Events (post-AMI: development of HF; HF: HF readmission) were compared between patients with and without RFP in both patient groups. Review Manager version 4.2.7 software was used for the analysis. Twelve post-AMI studies (1286 patients, 271 events) and 5 HF studies (647 patients, 176 events) were identified. RFP was associated with HF readmission in the HF patients (OR 2.96 [2.02-4.33] and development of HF post-AMI (OR 10.10 [7.02-14.51]). The event rate in the RFP group was the same regardless of disease category (49% post-AMI, 42% HF); however, RFP was less prevalent in the post-AMI group (22% versus 39%). CONCLUSIONS This literature-based meta-analysis confirms that RFP is a powerful predictor of HF hospitalization in patients with HF and especially the development of HF post-AMI. This is an important prognostic sign and should be incorporated into routine clinical practice.
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Affiliation(s)
- Jithendra B Somaratne
- Department of Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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90
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Jarnert C, Edner M, Persson HE. Prognosis in myocardial infarction patients with heart failure and normal or mildly impaired systolic function. Int J Cardiol 2007; 117:184-90. [PMID: 16860417 DOI: 10.1016/j.ijcard.2006.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 05/23/2006] [Accepted: 06/02/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess factors of importance for long term prognosis in patients with acute myocardial infarction (AMI) and heart failure and normal or mildly reduced left ventricular systolic function. SUBJECTS AND METHODS Seventy-one consecutive AMI-survivors with clinical or radiological signs of heart failure and an echocardiographically determined wall motion score >1.2 (EF >35-40%) were followed during 11 years for mortality, heart failure readmissions and new ischemic events. RESULTS Seventeen patients died (24%) while the combined endpoint of death or a new ischemic event (MI or hospitalisation for angina pectoris) occurred in 40 (56%) and fatal or non-fatal heart failure in 20 (28%) patients, respectively. A pre-discharge echocardiographic assessment of diastolic function was obtained in 67 patients out of whom 56 (84%) had diastolic dysfunction, most frequently relaxation abnormalities (43%). Wall motion score did not differ between survivors and non-survivors (1.48+/-0.20 vs. 1.44+/-0.18; p=0.46). Adjusting for age, sex and wall motion score N-terminal pro-ANP, prolongation of the isovolumic relaxation time and exercise induced ST-depressions at discharge (global chi2=26.2; p<0.0001) remained as independent mortality predictors while re-admission for heart failure was predicted by wall motion score, N-terminal pro-ANP and previous heart failure (global chi2=23.7; p<0.001). Death or new ischemic events were associated with low Doppler A-wave flow velocity and male sex (global chi2=14.0; p<0.01). CONCLUSIONS Evaluation of diastolic function and a natriuretic peptide adds prognostically important information in AMI-patients with clinical heart failure and normal or mildly reduced left ventricular systolic function. Isovolumic relaxation time is an independent predictor of long term mortality and N-terminal pro-ANP of mortality and heart failure.
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Affiliation(s)
- Christina Jarnert
- Department of Cardiology, Karolinska University Hospital, 176 71, Stockholm, Sweden.
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91
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Radauceanu A, Moulin F, Djaballah W, Marie PY, Alla F, Dousset B, Virion JM, Capiaumont J, Karcher G, Aliot E, Zannad F. Residual stress ischaemia is associated with blood markers of myocardial structural remodelling. Eur J Heart Fail 2007; 9:370-6. [PMID: 17140850 DOI: 10.1016/j.ejheart.2006.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 06/08/2006] [Accepted: 09/25/2006] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Long-term prognosis of coronary artery disease (CAD) patients is worsened when stress ischemia persists on treatment, but the relationship with adverse cardiac remodelling had never been investigated. AIM To analyze changes in blood markers of fibrosis in patients with chronic CAD exhibiting exercise ischaemia. METHODS Circulating markers of collagen: (i) turnover (amino-terminal propeptide of collagen-III [PIIINP]) and (ii) degradation (matrix metalloproteinase 1 [MMP-1]), were obtained in 139 CAD patients referred for exercise 201Tl-SPECT. RESULTS In the 57 patients who had SPECT-ischaemia, PIIINP was higher (4.3+/-2.9 microg L-1 vs. 3.1+/-1.5 microg L-1, p=0.002) and MMP-1 lower (3.8+/-2.1 microg L-1 vs. 4.7+/-2.8 microg L-1, p=0.04) than in the 82 patients without SPECT-ischaemia. PIIINP was independently related to LV volume, SPECT-ischaemia and age, whereas MMP-1 was related to current treatment with ACEI and beta-blockers (p<0.05). In the 104 patients with a normal LV ejection fraction, only PIIINP was related to SPECT-ischaemia (4.1+/-2.2 microg L-1 vs. 3.1+/-1.5 microg L-1, p=0.01). CONCLUSION In patients with chronic CAD, exercise ischaemia is associated with increased collagen-III turnover, independently of concomitant medications and even when LV ejection fraction is normal. Long-term, this increase might relate to adverse cardiac remodelling even when cardiac function is not clearly affected at baseline.
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Affiliation(s)
- Anca Radauceanu
- Centre d'Investigation Clinique (CIC) CHU-INSERM, Nancy, France
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Sinagra G, Bussani R, Abbate A, Piro M, Biondi-Zoccai GGL, Kontos MC, Sabbadini G, Barresi E, Crea F, Biasucci LM, Aleksova A, Pinamonti B, Silvestri F, Vetrovec GW, Baldi A. Left ventricular diastolic filling pattern at Doppler echocardiography and apoptotic rate in fatal acute myocardial infarction. Am J Cardiol 2007; 99:307-9. [PMID: 17261387 DOI: 10.1016/j.amjcard.2006.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 08/08/2006] [Accepted: 08/08/2006] [Indexed: 02/05/2023]
Abstract
Heart failure is a complex syndrome characterized by impaired emptying and/or impaired filling of the heart chambers. The use of parameters of diastolic function has provided novel tools for risk stratification and management of patients with heart failure. This study evaluated the potential correlation between apoptosis at time of death and left ventricular (LV) diastolic function after acute myocardial infarction. We selected, at routine postmortem examination, 14 subjects who died 10 to 62 days after an acute myocardial infarction and had an available echocardiographic report from the most recent hospital admission. The apoptotic rate was calculated at the region bordering the infarct, using co-localization of in situ end-labeling for deoxyribonucleic acid fragmentation and immunohistochemistry for caspase-3. Transthoracic echocardiographic studies were retrospectively reevaluated and pulse-wave Doppler spectra of mitral inflow were analyzed. LV diastolic function was assessed by measuring the ratio of E peak velocity to A peak velocity and E-wave deceleration time; a ratio of E peak velocity to A peak velocity >or=2 and deceleration time <115 ms were considered a restrictive filling pattern. A restrictive pattern was found in 4 cases (29%). All subjects with a restrictive pattern were symptomatic for New York Heart Association class IV heart failure (100% vs 20%, p = 0.015) and had larger transverse heart diameters at pathology (p = 0.014). The apoptotic rate in the peri-infarct region was significantly higher in patients with a restrictive versus nonrestrictive diastolic pattern (13%, 10 to 14, vs 3%, 1 to 6, p = 0.014). At multivariable analysis that included the restrictive pattern, class IV heart failure, and cardiac diameters, the restrictive pattern remained an independent predictor of increased apoptosis (p = 0.030). In conclusion, patients with severe postinfarction LV diastolic dysfunction had significantly higher rates of cardiomyocyte loss by apoptosis, which may partly explain their unfavorable outcome.
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Affiliation(s)
- Gianfranco Sinagra
- Institutes of Cardiology, Anatomic Pathology, and Internal Medicine, University of Trieste, Trieste, Italy
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93
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Szymański P, Rezler J, Stec S, Budaj A. Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction. Clin Cardiol 2006; 25:378-83. [PMID: 12173905 PMCID: PMC6653832 DOI: 10.1002/clc.4950250807] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Tei index of myocardial performance (IMP), which combines parameters of both systolic and diastolic ventricular function, is a useful prognostic factor in many clinical settings. HYPOTHESIS This study assessed the long-term prognostic value of IMP in patients discharged from hospital after acute myocardial infarction (AMI). METHODS Doppler/echocardiographic studies were recorded in 90 consecutive patients on Day 14 +/- 2 following an AMI. The IMP was calculated from the Doppler recordings, as a sum of isovolumetric contraction time and isovolumetric relaxation time, divided by the ejection time. RESULTS The patients were followed for an average (SD) of 57.8 (16.1) months. During this period there were 22 (24%) cardiac events, defined as cardiac deaths (10) or nonfatal recurrent myocardial infarctions (12). After multivariate Cox analysis, Tei index > 0.55 (relative risk [RR] 4.45; 95% confidence interval [CI] 1.28-15.45; p = 0.019), LV end-systolic volume > 65 ml (RR 3.23; 95% CI 1.34-7.79; p = 0.009), and mitral E wave deceleration time < or = 0.145 s (RR 2.94; 95% CI 1.24-6.92; p = 0.014) were the only independent predictors of cardiac events during the follow-up period. In a subgroup of patients with preserved LV systolic function (ejection fraction > 0.40), IMP was the only predictor of cardiac events (RR 6.37; 95% CI 1.32-30.77, p = 0.02). CONCLUSIONS The Tei index of myocardial performance, which is simple and easy to calculate, is a useful tool for risk assessment in patients following myocardial infarction, and in a subgroup of patients with normal or only mildly impaired systolic function.
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Affiliation(s)
- Piotr Szymański
- Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
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94
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Ogunyankin KO, Burggraf GW, Abiose AK, Malik PG. Validity of Revised Doppler Echocardiographic Algorithms and Composite Clinical and Angiographic Data in Diagnosis of Diastolic Dysfunction. Echocardiography 2006; 23:817-28. [PMID: 17069599 DOI: 10.1111/j.1540-8175.2006.00329.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization. METHOD Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications. RESULT The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg. CONCLUSION Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods.
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Affiliation(s)
- Kofo O Ogunyankin
- Division of Cardiology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada.
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95
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Møller JE, Pellikka PA, Hillis GS, Oh JK. Prognostic importance of diastolic function and filling pressure in patients with acute myocardial infarction. Circulation 2006; 114:438-44. [PMID: 16880341 DOI: 10.1161/circulationaha.105.601005] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jacob E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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96
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Whalley GA, Gamble GD, Doughty RN. Restrictive diastolic filling predicts death after acute myocardial infarction: systematic review and meta-analysis of prospective studies. Heart 2006; 92:1588-94. [PMID: 16740920 PMCID: PMC1861228 DOI: 10.1136/hrt.2005.083055] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine, through a systematic review and meta-analysis, the magnitude of the survival deficit associated with a restrictive filling pattern after acute myocardial infarction (AMI). METHODS Online databases were searched for prospective echocardiography outcome studies of patients after AMI. All authors were contacted to seek confirmation of their data. Restrictive filling was compared with all non-restrictive filling patterns. Review Manager Version 4.2.7 software was used for analysis. RESULTS 3855 patients in 16 studies were identified. Follow up varied from two weeks to five years (> 1 year, 10 studies; and > 4 years, four studies). 776 (20%) of patients had a restrictive filling pattern at baseline. 580 patients died (247 in the restrictive group), and the overall odds ratio for death (restrictive filling worse) was 4.10 (95% confidence interval 3.38 to 4.99). CONCLUSIONS Mortality is about four times higher in patients with a restrictive filling pattern than in those with non-restrictive filling patterns after AMI. Echocardiographic assessment of diastolic filling pattern is an important part of the echocardiographic assessment of patients after myocardial infarction and provides important prognostic information about such patients.
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Affiliation(s)
- G A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
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97
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Hillis GS, Ujino K, Mulvagh SL, Hagen ME, Oh JK. Echocardiographic Indices of Increased Left Ventricular Filling Pressure and Dilation After Acute Myocardial Infarction. J Am Soc Echocardiogr 2006; 19:450-6. [PMID: 16581486 DOI: 10.1016/j.echo.2005.11.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Indexed: 11/21/2022]
Abstract
The relationship between echocardiographic indicators of acute and chronic left ventricular (LV) filling pressure and LV dilation after acute myocardial infarction was assessed in 47 patients. The ratio of early transmitral flow velocity to early mitral annulus velocity (E/e') reflects acute LV filling pressure and the indexed volume of the left atrium is an indicator of chronic LV filling pressure. E/e' was higher (19 vs 10, P = .001) among patients who experienced a greater than 15% increase in indexed LV end-diastolic volume (remodeling group, n = 10). Receiver operating characteristic curve analysis confirmed that E/e' was a predictor of remodeling (area under the curve 0.83, P = .002). Patients with E/e' greater than 15 had a mean increase in indexed LV end-diastolic volume of 9.3 versus 1.7 mL/m2 in patients with E/e' 15 or less (P = .01). Multivariable regression analyses confirmed that E/e' was the strongest independent predictor of remodeling in this cohort (odds ratio 1.39, P = .01). There was no relationship between indexed volume of the left atrium and LV dilation. These data suggest that the E/e' ratio may be a useful predictor of LV dilation after acute myocardial infarction. In particular, an E/e' ratio greater than 15 identifies patients at increased risk.
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Affiliation(s)
- Graham S Hillis
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.
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98
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Reynolds HR, Anand SK, Fox JM, Harkness S, Dzavik V, White HD, Webb JG, Gin K, Hochman JS, Picard MH. Restrictive physiology in cardiogenic shock: observations from echocardiography. Am Heart J 2006; 151:890.e9-15. [PMID: 16569556 DOI: 10.1016/j.ahj.2005.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 08/27/2005] [Indexed: 01/23/2023]
Abstract
BACKGROUND Left ventricular diastolic abnormalities are associated with adverse outcome in myocardial infarction. Intra-aortic balloon pump (IABP) support is associated with improved diastolic filling. In the SHOCK trial and registry, average left ventricular ejection fraction (LVEF) was approximately 30%, higher than expected based on the classic paradigm. We hypothesized that restrictive physiology plays a role in cardiogenic shock (CS). METHODS Echocardiograms obtained during the SHOCK trial within 24 hours of randomization were centrally interpreted. Patients with quantifiable mitral E-wave deceleration time were included (n = 64). The restrictive filling pattern was defined as deceleration time < 140 milliseconds. RESULTS The restrictive pattern was seen in 60.9% of patients studied. Patients with this pattern had lower LVEF (31.1% vs 39.0%, P = .02) and higher wall motion score index (2.1 vs 1.8, P = .05). Patients with restriction were more likely to have IABP support during echocardiography (73.7% vs 43.5%, P = .03). There was no difference with and without restriction in demographic and hemodynamic variables or in mitral regurgitation degree or extent of coronary disease. The restrictive pattern had positive predictive value of 80% for pulmonary capillary wedge pressure > or = 20 mm Hg. Thirty-day survival was 53.9% with restriction versus 68.0% without restriction, P = .31. There was no difference in New York Heart Association class at 1 year between groups. CONCLUSIONS The restrictive filling pattern is common in patients with CS, which may suggest that diastolic dysfunction contributes to CS pathogenesis. Patients with the restrictive pattern had lower LVEF despite IABP support. An association between the restrictive pattern and mortality was not demonstrated; power was limited by sample size.
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Affiliation(s)
- Harmony R Reynolds
- Department of Medicine, New York University School of Medicine, New York, NY, USA.
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99
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Neilan TG, Yoerger DM, Douglas PS, Marshall JE, Halpern EF, Lawlor D, Picard MH, Wood MJ. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 2006; 27:1079-84. [PMID: 16554314 DOI: 10.1093/eurheartj/ehi813] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Transient systolic and diastolic abnormalities in ventricular function have previously been documented during endurance sports. However, these described alterations may be limited by the techniques applied. We sought, using less load-dependent methods, to characterize both the extent and the chronology of the cardiac changes associated with endurance events. METHODS AND RESULTS Transthoracic echocardiography (TTE) was performed prior to, immediately after, and approximately 1 month after completion of the 2003 Boston Marathon in 20 amateur athletes. TTE included two-dimensional, spectral and tissue Doppler (TD) and flow propagation velocity (V(p)). After completion of the marathon, global measures of left ventricular (LV) systolic function were unchanged (EF 59 +/- 6 vs. 61 +/- 4% post, P = 0.14), whereas TD-derived measures of LV systolic function [septal strain -23 +/- 5 vs. -17 +/- 4%, P = 0.007; septal strain rate (SR) -1.5 +/- 0.3 vs. -1.1+/- 0.2 s(-1), P = 0.007] and right ventricular (RV) systolic function (RV apical strain -33 +/- 4 vs. -27 +/- 5%, P = 0.001; RV apical SR -2.4 +/- 0.7 vs. -1.8 +/- 0.5, P = 0.002) were reduced. Significant changes in transmitral velocity (E/A ratio 2.0 +/- 0.5 vs.1.3 +/- 0.3, P = 0.005) and TD indices of LV and RV diastolic function (E(a) septal 9.5 +/- 1.8 vs. 8.1 +/- 1.2 cm/s post-marathon, P = 0.01) were also observed, indicating an inherent alteration in LV relaxation. Although all indices of LV and RV systolic function had returned to normal on follow-up, there were persistent diastolic abnormalities (RV E(a), 11.5 +/- 1.5 cm/s pre-marathon vs. 10.0 +/- 1.6 cm/s follow-up, P = 0.01). CONCLUSION Marathon running leads to transient systolic and more persistent diastolic dysfunction of both the LV and the RV.
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Affiliation(s)
- Tomas G Neilan
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, 02114-2696, USA
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100
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Okura H, Takada Y, Kubo T, Iwata K, Mizoguchi S, Taguchi H, Toda I, Yoshikawa J, Yoshida K. Tissue Doppler-derived index of left ventricular filling pressure, E/E', predicts survival of patients with non-valvular atrial fibrillation. Heart 2006; 92:1248-52. [PMID: 16449507 PMCID: PMC1861171 DOI: 10.1136/hrt.2005.082594] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate whether the ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (E') predict prognosis in patients with non-valvular atrial fibrillation. METHODS 230 patients with non-valvular atrial fibrillation were enrolled and studied. According to E/E' value, patients were divided into groups with lower (group A with E/E' <or= 15) and higher (group B with E/E' > 15) E/E'. RESULTS During follow up (average 245 days), 21 (9.1%) deaths were documented. All cause death (15/90 (16.7%) v 6/140 (4.3%)), cardiac death (10 (11.1%) v 2 (1.4%)) and congestive heart failure (16 (17.8%) v 8 (5.7%)) were more common in group B than in group A (all p < 0.01). A Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in group B than in group A (log rank p = 0.0013). By multivariate logistic regression analysis, E/E' (chi(2) = 4.47, odds ratio (OR) 1.05, 95% confidence interval (CI) 1.01 to 1.11, p = 0.03) and age (chi(2) = 6.45, OR 1.06, 95% CI 1.01 to 1.11, p = 0.02) were independent predictors of mortality. CONCLUSION The Doppler-derived index of left ventricular filling pressure, E/E', is a powerful predictor of the clinical outcome of patients with non-valvular atrial fibrillation.
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Affiliation(s)
- H Okura
- Division of Cardiology, Bell Land General Hospital, Sakai, Japan.
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