1
|
Oksen D, Aslan M. Impact of oxidative stress on myocardial performance in patients with diabetes: a focus on subclinical left ventricular dysfunction. BMJ Open Diabetes Res Care 2024; 12:e004153. [PMID: 38886070 PMCID: PMC11184181 DOI: 10.1136/bmjdrc-2024-004153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Oxidative stress is known to affect left ventricular functions negatively. There is a strong bidirectional connection between diabetes mellitus (DM) and oxidative stress. In parallel, left ventricular dysfunction is observed more frequently, even in patients with DM without other risk factors. In this context, the objective of this study is to comparatively investigate the potential relationship between oxidative stress and subclinical left ventricular dysfunction (SCLVD) assessed by Myocardial Performance Index (MPI) in patients with and without DM. RESEARCH DESIGN AND METHODS The sample of this observational cross-sectional single-center study consisted of 151 patients who were evaluated for oxidative stress and SCLVD by tissue Doppler echocardiography. Patients' total oxidant status (TOS), total antioxidant status (TAS), and Oxidative Stress Index (OSI) values were calculated. The effects of oxidative stress and DM on MPI were analyzed. RESULTS There were 81 patients with DM (mean age: 46.17±10.33 years) and 70 healthy individuals (mean age: 45.72±9.04 years). Mean TOS and OSI values of the DM group were higher than healthy individuals (5.72±0.55 vs 5.31±0.50, p = <0.001; and 4.92±1.93 vs 1.79±0.39, p = <0.001; respectively). The mean TAS value of the DM group was significantly lower than the healthy group (1.21±0.40 vs 3.23±0.51, p = <0.001). There was a significant correlation between OSI and MPI mitral in the DM group (R 0.554, p = <0.001) but not in the healthy group (R -0.069, p=0.249). CONCLUSIONS Both oxidative stress and myocardial dysfunction were found to be more common in patients with DM. The study's findings indicated the negative effect of oxidative stress on myocardial functions. Accordingly, increased oxidative stress caused more significant deterioration in MPI in patients with DM compared with healthy individuals.
Collapse
Affiliation(s)
- Dogac Oksen
- Cardiology Department, Altinbas Universitesi, Istanbul, Turkey
| | - Muzaffer Aslan
- Cardiology Department, Siirt University, Siirt, Siirt, Turkey
| |
Collapse
|
2
|
Askin L, Yuce Eİ, Tanriverdi O. Myocardial performance index and cardiovascular diseases. Echocardiography 2023. [PMID: 37248742 DOI: 10.1111/echo.15628] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
The Myocardial Performance Index (MPI), also known as the Tei Index, is a measure of the overall performance of the heart that takes into account both systolic and diastolic function. It is a non-invasive echocardiographic index that provides information about the efficiency of the heart's pumping action. The MPI is a useful tool for evaluating cardiac function in various clinical conditions, such as heart failure, myocardial infarction, and cardiomyopathy. A higher MPI value indicates poorer cardiac function, while a lower MPI value indicates better cardiac function. This review will give a summary of the relevant MPI literature, provide a methodology and technical aspects, and make research recommendations.
Collapse
Affiliation(s)
- Lutfu Askin
- Department of Cardiology, Gaziantep Ersin Arslan Education and Research Hospital, Adiyaman, Turkey
| | - Elif İlkay Yuce
- Department of Cardiology, Gaziantep Ersin Arslan Education and Research Hospital, Adiyaman, Turkey
| | - Okan Tanriverdi
- Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
| |
Collapse
|
3
|
Kidney function and the prognostic value of myocardial performance index. Int J Cardiovasc Imaging 2021; 37:1637-1647. [PMID: 33475871 DOI: 10.1007/s10554-020-02149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A decreased glomerular filtration rate (GFR) is a risk factor for cardiovascular disease even after adjustment for conventional risk factors. The myocardial performance index (MPI) is defined as (isovolumetric relaxation time (IVRT) + isovolumetric contraction time (IVCT))/ejection time (ET). It has been shown to be an independent predictor of cardiovascular events. We hypothesized the MPI could prove valuable for assessing cardiac risk in subjects of the general population with decreased estimated GFR (eGFR). MPI was measured in 1915 subjects from a large general population prospective cohort study using color tissue Doppler imaging (TDI) M-mode through the mitral valve. We compared the prognostic capabilities of the MPI between subjects with eGFR ≥ 75 mL/min/1.73 m2 and subjects with eGFR < 75 mL/min/1.73 m2 using multivariable adjusted Cox regression models. The composite endpoint was heart failure, myocardial infarction or cardiovascular death. Mean age was 58 years (SD 16.2), 58% were women, 42% had hypertension and 8.3% diabetes. During a median follow-up time of 12.4 years [IQR 10.6-12.7 years] 269 participants reached the combined endpoint. eGFR modified the prognostic capability of MPI (p-value for interaction < 0.001): After multivariable adjustment, MPI remained an independent predictor of the composite endpoint only in participants with eGFR < 75 mL/min/1.73 m2: HR 1.18 (95% CI 1.02-1.38), p = 0.03, vs. in subjects with eGFR ≥ 75 mL/min/1.73 m2: HR 1.14 (95% CI 0.94-1.39), p = 0.17. These results suggest the MPI could be particularly valuable for identifying elevated cardiac risk in individuals from the general population with decreased eGFR.
Collapse
|
4
|
Abuomara HZA, Hassan OM, Rashid T, Baraka M. Myocardial performance index as an echocardiographic predictor of early in-hospital heart failure during first acute anterior ST-elevation myocardial infarction. Egypt Heart J 2018; 70:71-75. [PMID: 30166885 PMCID: PMC6112368 DOI: 10.1016/j.ehj.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine the value of Myocardial Performance Index (MPI) as an echocardiographic predictor of early in-hospital heart failure (HF) during first acute anterior ST-Elevation Myocardial Infarction (STEMI). Background Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. The ejection fraction (EF) and transmitral flow, the most frequently used methods for evaluation of systolic and diastolic functions respectively, both have considerable limitations. The MPI is a single parameter, capable of estimating combined systolic and diastolic performance and lacks such limitations. Methods We enrolled 60 patients presented with a first acute anterior STEMI who have undergone primary PCI. Echocardiography was done within 24 h of chest pain with measurement of MPI. The LV MPI was calculated as (isovolumic contraction time “ICT” + relaxation time “IRT”)/Ejection time “ET”. Besides, clinical and echocardiographic variables were analyzed and CHF was defined as Killip class ≥ II. Results Early in-hospital HF occurred in 23 of patients (38%). Ejection fraction was found to have a highly significant negative correlation with the development of in-hospital HF (p = .0001), while MPI was found to have a highly significant positive correlation (p = .0001). A cut-off point of MPI > 0.73 showed a very high specificity (94.6%) and sensitivity (78.3%) for identifying patients with HF. On the other hand, a cut-off point of EF ≤ 33% has shown 94.6% specificity and 56.5% sensitivity for HF prediction. Conclusions The MPI might be a strong predictor of in-hospital HF after first acute anterior STEMI.
Collapse
Affiliation(s)
| | | | - Tarek Rashid
- Cardiology Department, Ain Shams University Hospitals, Cairo, Egypt
| | - Mahmoud Baraka
- Cardiology Department, Ain Shams University Hospitals, Cairo, Egypt
| |
Collapse
|
5
|
Gupta-Malhotra M, Hamzeh RK, Poffenbarger T, McNiece-Redwine K, Hashmi SS. Myocardial Performance Index in Childhood Onset Essential Hypertension and White Coat Hypertension. Am J Hypertens 2016; 29:379-87. [PMID: 26271107 DOI: 10.1093/ajh/hpv123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/03/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND As a global measure of ventricular systolic and diastolic function, the myocardial performance index (MPI) can be an early indicator of hypertensive cardiomyopathy in children with essential hypertension (EH). METHODS Children with untreated newly diagnosed EH and white coat hypertension (WCH) by a 24-hour ambulatory blood pressure monitoring (ABPM), both groups without any identifiable etiology for the hypertension, were enrolled for the study. Echocardiograms and vascular ultrasounds for carotid artery intimal medial thickness were performed on all children prior to therapy. Diastolic function (peak E and A velocities, E/A ratio, isovolumic relaxation time, and deceleration times) and MPI were evaluated by simultaneous transmitral and transaortic spectral Doppler flow velocities. Systolic function was evaluated by shortening fraction and ejection fraction. RESULTS A cohort of 66 children (24 with EH, 42 with WCH, males 61%, median age of 13 years, range 10-17 years) were enrolled in the study. The demographic, anthropometric, laboratory tests, vascular ultrasound, and conventional echocardiographic parameters were similar between the 2 groups. There was a very small difference in MPI between the EH and WCH children (0.28 SD: 0.07 vs. 0.31 SD: 0.08, P = 0.045). However, in EH children, MPI increased by 0.14 units for every 10 unit increase in mean ABPM systolic BP (95% confidence interval: 0.03-0.25). CONCLUSIONS We found the increasing MPI was associated with increasing 24-hour mean systolic BP in children with EH. Therefore, MPI may have utility as a single, quick, noninvasive method of detection and tracking of subclinical hypertensive heart disease.
Collapse
Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA; Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA;
| | - Rabih K Hamzeh
- Division of Pediatric Cardiology, Texas Tech University, El Paso, Texas, USA
| | - Tim Poffenbarger
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA
| | - Karen McNiece-Redwine
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Arkansas, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Syed Shahrukh Hashmi
- Pediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, Texas, USA
| |
Collapse
|
6
|
Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 2015; 21:77-94. [DOI: 10.1007/s10741-015-9521-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Pesce P, Cecchetto L, Brocco S, Bolognesi M, Sodhi K, Abraham NG, Sacerdoti D. Characterization of a murine model of cardiorenal syndrome type 1 by high-resolution Doppler sonography. J Ultrasound 2015; 18:229-35. [PMID: 26261465 PMCID: PMC4529411 DOI: 10.1007/s40477-014-0129-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/14/2014] [Indexed: 12/25/2022] Open
Abstract
ABSTRACT Cardiorenal syndrome type 1 (CRS-1) is the acute kidney disfunction caused by an acute worsening of cardiac function. CRS-1 is the consequence of renal vasoconstriction secondary to renin-angiotensin system (RAS) activation. No animal models of CRS-1 are described in literature. PURPOSE To characterize a murine model of CRS-1 by using a high-resolution ultrasound echo-color Doppler system (VEVO2100). MATERIALS Post-ischemic heart failure was induced by coronary artery ligation (LAD) in seven CD1 mice. Fifteen and thirty days after surgery, mice underwent cardiac and renal echo-color Doppler. Serum creatinine and plasma renin activity were measured after killing. Animals were compared to seven CD1 control mice. RESULTS Heart failure with left ventricle dilatation (end diastolic area, p < 0.05 vs. controls) and significantly reduced ejection fraction (EF; p < 0.01 vs. controls) was evident 15 days after LAD. We measured a significant renal vasoconstriction in infarcted mice characterized by increased renal pulsatility index (PI; p < 0.05 vs. controls) associated to increased creatinine and renin levels (p < 0.05 vs. controls). CONCLUSIONS The mice model of LAD is a good model of CRS-1 evaluable by Doppler sonography and characterized by renal vasoconstriction due to the activation of the renin-angiotensin system secondary to heart failure.
Collapse
Affiliation(s)
- P. Pesce
- />Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - L. Cecchetto
- />Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - S. Brocco
- />Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - M. Bolognesi
- />Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - K. Sodhi
- />Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755 USA
| | - N. G. Abraham
- />Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755 USA
| | - D. Sacerdoti
- />Department of Medicine (DIMED), University of Padova, Padua, Italy
| |
Collapse
|
8
|
Gerede DM, Turhan S, Kaya CT, Ozcan OU, Goksuluk H, Vurgun VK, Dincer I, Kutlay S, Erturk S, Erol C. Effects of Hemodialysis on Tei Index: Comparison between Flow Doppler and Tissue Doppler Imaging. Echocardiography 2015; 32:1520-6. [DOI: 10.1111/echo.12895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Sibel Turhan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Ozgur Ulas Ozcan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Huseyin Goksuluk
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Veysel Kutay Vurgun
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Irem Dincer
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Sim Kutlay
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Sehsuvar Erturk
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Cetin Erol
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| |
Collapse
|
9
|
Ozdemir D, Kalkan GY, Bayram NA, Onal ED, Ersoy R, Bozkurt E, Cakir B. Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism. Endocrine 2014; 47:609-17. [PMID: 24676760 DOI: 10.1007/s12020-014-0245-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.
Collapse
Affiliation(s)
- Didem Ozdemir
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey,
| | | | | | | | | | | | | |
Collapse
|
10
|
Kaya MG, Simsek Z, Sarli B, Buyukoglan H. Myocardial performance index for detection of subclinical abnormalities in patients with sarcoidosis. J Thorac Dis 2014; 6:429-37. [PMID: 24822099 DOI: 10.3978/j.issn.2072-1439.2014.03.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/10/2014] [Indexed: 01/12/2023]
Abstract
AIM The aim of this study was to evaluate ventricular functions in patients with sarcoidosis without an obvious heart disease by using tissue Doppler-derived left and right ventricular myocardial performance index (MPI). METHODS The study population included 45 patient with sarcoidosis (29 men, 16 women; mean age, 44±10 years, mean disease duration, 4.2±2.7 years) and 45 healthy control subjects (31 men, 14 women; mean age, 41±8 years). Cardiac functions were determined using echocardiography, consisting of standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Myocardial tissue Doppler velocities [peak systolic (Sa), early diastolic (Ea), and late diastolic velocities (Aa)] were recorded using spectral pulsed Doppler from the LV free wall, septum, and RV free wall from the apical four chamber view. MPI was also calculated by TDI. RESULTS The conventional echocardiographic parameters and tissue Doppler measurements were similar between the patients and controls. Left ventricular MPI (0.490±0.092 vs. 0.396±0.088, P=0.010) and right ventricular MPI (0.482±0.132 vs. 0.368±0.090, P=0.006) were significantly higher in patients with sarcoidosis than the control subjects. There was a correlation between the disease duration and right and left ventricular MPI (r=0.418, P=0.005; r=0.366, P=0.013, respectively). There was also a correlation between the systolic pulmonary arterial pressure and right ventricular MPI but not left ventricular MPI (r=0.370, P=0.012; r=0.248, P=0.109, respectively). In receiver operating characteristics curve analysis, the cutoff value of left ventricular MPI >0.46 had 92% sensitivity and 64% specificity in predicting left ventricular diastolic dysfunction. CONCLUSIONS We have demonstrated that tissue Doppler-derived myocardial left and right ventricular MPI were impaired in sarcoidosis patients, although systolic function parameters were comparable in the patients and controls, showed a subclinic impaired ventricular functions in patients with sarcoidosis.
Collapse
Affiliation(s)
- Mehmet Gungor Kaya
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| | - Zuhal Simsek
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| | - Bahadir Sarli
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hakan Buyukoglan
- 1 Department of Cardiology, 2 Department of Respiratory Disease, Erciyes University School of Medicine, Kayseri, Turkey
| |
Collapse
|
11
|
QT and JT dispersion and cardiac performance in children with neonatal Bartter syndrome: a pilot study. Pediatr Nephrol 2013; 28:1969-74. [PMID: 23760993 DOI: 10.1007/s00467-013-2517-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/03/2013] [Accepted: 05/16/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND QT dispersion and JT dispersion are simple noninvasive arrhythmogenic markers that can be used to assess the homogeneity of cardiac repolarization. The aim of this study was to assess QT and JT dispersion and their relation with left ventricular systolic and diastolic functions in children with Bartter syndrome (BS). METHODS Nine neonatal patients with BS (median age 9.7 years) and 20 controls (median age 8 years) were investigated at rest. Both study and control subjects underwent electrocardiography (ECG) in which the interval between two R waves and QT intervals, corrected QT, QT dispersion, corrected QT dispersion, JT, corrected JT, JT dispersion and corrected JT dispersion were measured with 12-lead ECG. Two-dimensional, Doppler echocardiographic examinations were performed. RESULTS Patients and controls did not differ for gender and for serum levels of potassium, magnesium, and calcium (p > 0.05). Both study and control subjects had normal echocardiographic examination and baseline myocardial performance indexes. The QT dispersion and JT dispersion were significantly prolonged in patients with BS compared to those of the controls {37.5 ms [interquartile range (IQR) 32.5-40] vs. 25.5 ms (IQR 20-30), respectively, p = 0.014 and 37.5 ms (IQR 27.5-40) vs. 22.5 ms (IQR 20-30), respectively, p = 0.003}. CONCLUSIONS Elevated QT and JT dispersion during asymptomatic and normokalemic periods may be risk factors for the development of cardiac complications and arrhythmias in children with BS. In these patients the need for systematic cardiac screening and management protocol is extremely important for effective prevention.
Collapse
|
12
|
Zheng H, Li Y, Xie N, Xu H, Huang J, Luo M. Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia. Clin Exp Hypertens 2013; 36:181-6. [DOI: 10.3109/10641963.2013.804542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Biering-Sørensen T, Mogelvang R, Søgaard P, Pedersen SH, Galatius S, Jørgensen PG, Jensen JS. Prognostic Value of Cardiac Time Intervals by Tissue Doppler Imaging M-Mode in Patients With Acute ST-Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. Circ Cardiovasc Imaging 2013; 6:457-65. [DOI: 10.1161/circimaging.112.000230] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tor Biering-Sørensen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| | - Rasmus Mogelvang
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| | - Peter Søgaard
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| | - Sune H. Pedersen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| | - Søren Galatius
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| | - Peter Godsk Jørgensen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| | - Jan Skov Jensen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S., R.M., P.S., S.H.P., S.G., P.G.J., J.S.J.); and Clinical Institute of Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B.-S., P.G.J., J.S.J.)
| |
Collapse
|
14
|
Bacaksiz A, Kayrak M, Vatankulu MA, Ayhan SS, Sonmez O, Akilli H, Aribas A, Ari H, Ozdemir K. The Effect of Smoking on Myocardial Performance Index in Middle-Aged Males after First Acute Myocardial Infarction. Echocardiography 2012; 30:155-63. [DOI: 10.1111/echo.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ahmet Bacaksiz
- Department of Cardiology; BezmiÂlem Foundation University; Istanbul; Turkey
| | - Mehmet Kayrak
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | | | - Selim S. Ayhan
- Department of Cardiology; Abant Izzet Baysal University; Bolu; Turkey
| | - Osman Sonmez
- Department of Cardiology; BezmiÂlem Foundation University; Istanbul; Turkey
| | - Hakan Akilli
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | - Alpay Aribas
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | - Hatem Ari
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | - Kurtulus Ozdemir
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| |
Collapse
|
15
|
Kim H, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, Kim YN, Kim KB. Usefulness of tissue Doppler imaging-myocardial performance index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011; 34:494-9. [PMID: 21780137 DOI: 10.1002/clc.20932] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/25/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In heart failure with preserved ejection fraction (HFPEF), physiological abnormalities are not solely restricted to diastolic function. Because the tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) offers the advantage of recording systolic and diastolic tissue velocity simultaneously in the same cardiac cycle, this study aimed to determine whether TDI-MPI is an informative index for assessing HFPEF, compared with conventional echo parameters. HYPOTHESIS In patients with HFPEF, TDI-MPI would be an independent predictor for adverse cardiac events. METHODS Among 408 patients who had diastolic dysfunction without heart failure (HF) or HFPEF, cardiac function was evaluated by mitral flow (MF) or TDI-MPI. During the median follow-up of 32 months, clinical outcomes, which were defined as the composite of cardiovascular death and admission for HF, were assessed. RESULTS Mean MF and TDI-MPI were significantly greater in the HFPEF group. TDI-MPI rather than MF had a significant correlation with N-terminal pro-brain natriuretic peptide level. The area under the receiver operating characteristic curve of TDI-MPI for the detection of HFPEF was 0.86. With regard to clinical outcomes, 31 events were identified during follow-up periods. On a multivariate analysis, TDI-MPI >0.66 was the best prognostic predictor of events and provided incremental predictive value. CONCLUSIONS Compared to MF-MPI, TDI-MPI may be a more useful parameter for the evaluation of patients with HFPEF.
Collapse
Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
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.
Collapse
Affiliation(s)
- Lilian P Souza
- Cardiology Department, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, Brazil
| | | | | | | | | |
Collapse
|
17
|
Strobl I, Windbichler G, Strasak A, Weiskopf-Schwendinger V, Schweigmann U, Ramoni A, Scheier M. Left ventricular function many years after recovery from pre-eclampsia. BJOG 2010; 118:76-83. [PMID: 21083867 DOI: 10.1111/j.1471-0528.2010.02780.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Epidemiological observations have shown that women with pre-eclampsia are at increased risk for subsequent development of cardiovascular disease. We evaluated maternal haemodynamics in asymptomatic women many years after pre-eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. DESIGN Case-control study. SETTING University-based department of obstetrics. POPULATION Forty-eight women, 13-18 years after the affected pregnancy: 17 women with a history of HELLP syndrome, 14 women with a history of pre-eclampsia and 17 women following normal pregnancy (control group). METHODS Echocardiographic examination was performed in all groups, recording the isovolumetric contraction time and isovolumetric relaxation time (ICT + IVRT), ejection time (ET), myocardial performance index (MPI), transmitral early to atrial filling velocity ratio (MV-E/MV-A), stroke volume (SV) and cardiac output (CO). MAIN OUTCOME MEASURES Cardiac function. RESULTS Women with previous HELLP syndrome showed a significantly increased MPI (0.34 versus 0.26; P = 0.008) and ICT + IVRT (442.16 versus 415.03; P = 0.01); MV-E/A, SV, ET and CO were not significantly different. Women with a history of pre-eclampsia showed a significantly increased MPI (0.36 versus 0.26; P = 0.006) and decreased ET (317.3 versus 328.93; P = 0.04); ICT + IVRT, MV-E/A, SV and CO were not significantly different. CONCLUSION This study confirms epidemiological observations that women with pre-eclampsia are at increased risk for subsequent development of cardiovascular disease. Many years after HELLP syndrome or pre-eclampsia, asymptomatic women have an increased risk for impaired cardiac function as shown by an increased MPI.
Collapse
Affiliation(s)
- I Strobl
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria.
| | | | | | | | | | | | | |
Collapse
|
18
|
Kirkpantur A, Balci M, Gurbuz OA, Afsar B, Canbakan B, Akdemir R, Ayli MD. Serum fibroblast growth factor-23 (FGF-23) levels are independently associated with left ventricular mass and myocardial performance index in maintenance haemodialysis patients. Nephrol Dial Transplant 2010; 26:1346-54. [PMID: 20813767 DOI: 10.1093/ndt/gfq539] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fibroblast growth factor-23 (FGF-23) is a phosphorus-regulating substance. Circulating FGF-23 levels increase markedly in dialysis patients and are independently associated with increased risk of mortality. Given the fact that cardiovascular disease is the leading cause of death in dialysis patients, the aim of this study was to test if elevated FGF-23 levels might be associated with left ventricular mass index (LVMI) and left ventricular index of myocardial performance (MPI) in maintenance haemodialysis patients. METHODS In this cross-sectional study, plasma FGF-23 concentrations were measured using a C-terminal human enzyme-linked immunosorbent assay kit, and echocardiography was performed in 128 maintenance haemodialysis patients (65 women and 63 men, mean age: 55.5 ± 13 years, mean haemodialysis vintage: 52 ± 10 months, all patients are on haemodialysis thrice a week) and 40 control subjects (21 women and 19 men; mean age: 54 ± 11 years) with normal kidney function (eGFR > 90 mL/min/1.73 m(2)). RESULTS Serum FGF-23 levels were elevated when compared with age- and gender-matched controls with preserved kidney function [(median 958 RU/mL; interquartile range 106-1894 RU/mL) vs (median 27 RU/mL; interquartile range 11-35), P < 0.0001]. Patients with a history of coronary artery disease and aortic valve calcifications had higher levels of log FGF-23 than those without (3.00 ± 0.22 vs 2.82 ± 0.26, P = 0.002; and 3.06 ± 0.19 vs 2.83 ± 0.26, P = 0.0001, respectively). Patients with MPI > 0.47 had higher serum FGF-23 levels than those with MPI < 0.47 [(median 1156 RU/mL; interquartile range 396-1894 RU/mL) vs (median 657 RU/mL; interquartile range 106-1102 RU/mL), P = 0.0001]. Significant correlations were recorded between log FGF-23 levels and LVMI (r = 0.281, P = 0,007) and MPI (r = 0.555, P = 0.0001). Multivariable-adjusted regression analyses revealed that increased log FGF-23 concentrations were independently associated with increased left ventricular mass index (30% increase per 1-SD increase in log FGF-23 concentration, P = 0.002) and increased MPI (28.5% increase per 1-SD increase in log FGF-23 concentration, P = 0.001). CONCLUSIONS Plasma FGF-23 concentration is independently associated with LVMI and MPI in maintenance haemodialysis patients. Further prospective studies are needed to clarify whether increased serum FGF-23 level is a marker or a potential mechanism for left ventricular involvement in patients with end-stage renal disease.
Collapse
Affiliation(s)
- Alper Kirkpantur
- Nephrology, Ministry of Health, Diskapi Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
19
|
Michaux I, Seeberger M, Schuman R, Skarvan K, Filipovic M. Feasibility of Measuring Myocardial Performance Index of the Right Ventricle in Anesthetized Patients. J Cardiothorac Vasc Anesth 2010; 24:270-4. [DOI: 10.1053/j.jvca.2009.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Indexed: 11/11/2022]
|
20
|
Su HM, Lin TH, Lee CS, Lee HC, Chu CY, Hsu PC, Voon WC, Lai WT, Sheu SH. Myocardial performance index derived from brachial-ankle pulse wave velocity: a novel and feasible parameter in evaluation of cardiac performance. Am J Hypertens 2009; 22:871-6. [PMID: 19478795 DOI: 10.1038/ajh.2009.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Right brachial pre-ejection period (rbPEP), brachial-ankle pulse wave velocity (baPWV), and right brachial ejection time (rbET) can be automatically determined from an ABI-form device. The aims of this study are to test the applicability of baPWV-derived myocardial performance index (MPI) (defined as the ratio of rbPEP divided by its own s.d. + baPWV divided by its own s.d. to rbET divided by its own s.d.) as an indicator of combined left ventricular (LV) systolic and diastolic functions. METHODS A sum of 215 patients were consecutively included. The rbPEP, baPWV, and rbET were measured using an ABI-form device and LV function was determined by echocardiography. RESULTS After a multivariate analysis, diastolic blood pressure (beta = 0.220, P < 0.001), LV ejection fraction (LVEF) (beta = -0.291, P < 0.001), transmitral E wave velocity (E) (beta = -0.106, P = 0.032), early diastolic mitral annular velocity (Ea) (beta = -0.142, P = 0.009), and ET obtained by tissue Doppler echocardiography (beta = -0.397, P < 0.001) were the major determinants of baPWV-derived MPI. The area under the curve for rbPEP, baPWV, rbET, rbPEP/rbET, and baPWV-derived MPI in prediction of Ea <8 cm/s, E/Ea >10, or LVEF <50% were 0.69, 0.76, 0.67, 0.73, and 0.83, respectively. CONCLUSIONS BaPWV-derived MPI had a significant correlation with echocardiographic LV diastolic and systolic function. It may be a novel and feasible indicator in assessment of global LV function.
Collapse
|
21
|
Cabrera Schulmeyer MC, Farías J, De la Maza J, Labbé M. [Echocardiography-derived Tei index during surgery, a predictor of postoperative cardiovascular complications]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:355-360. [PMID: 19725343 DOI: 10.1016/s0034-9356(09)70408-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE The Tei index is a Doppler echocardiographic parameter that reflects both systolic and diastolic myocardial function. Our aim was to monitor the Tei index by transesophageal echocardiography during noncardiac surgery to explore the correlation between this parameter and the incidence of postoperative cardiovascular complications. MATERIAL AND METHODS Patients at risk of cardiovascular complications were enrolled. The Tei index was derived from the pattern of pulsed Doppler transmitral filling and aortic outflow, by dividing the sum of isovolumetric contraction and relaxation intervals by ejection time in milliseconds. RESULTS Seventy-three patients (58% men) were enrolled. The mean (SD) age was 68 (12) years. Two groups were identified based on myocardial function. A Tei index over 0.35 defined group 2 (n = 25) and correlated with a larger number of postoperative cardiovascular events. In patients with a normal Tei index less than 0.35 (group 1, n = 48), the incidence of cardiovascular complications was lower. Hypotension occurred in 60% of patients in group 2 and 21% of those in group 1, hypertension in 24% of group 2 and 4.1% of group 1, and pulmonary edema in 8% of group 2 and 2.1% of group 1 (P < .05 for all comparisons). CONCLUSIONS This pilot study found that patients with a high Tei index were more likely to develop postoperative cardiovascular complications. This index may provide a useful indicator to take into consideration in planning hemodynamic management when patients have a history of cardiovascular disease.
Collapse
|
22
|
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]
|
23
|
Murphy GS, Szokol JW, Marymont JH, Avram MJ, Vender JS. Reply. J Cardiothorac Vasc Anesth 2007. [DOI: 10.1053/j.jvca.2006.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
24
|
Murphy GS, Szokol JW, Marymont JH, Avram MJ, Vender JS. Opioids and Cardioprotection: The Impact of Morphine and Fentanyl on Recovery of Ventricular Function After Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2006; 20:493-502. [PMID: 16884978 DOI: 10.1053/j.jvca.2005.07.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Experimental studies have shown that opioids protect the myocardium from ischemic injury and that opioid cardioprotection is enhanced by the coadministration of volatile anesthetics. Previous data suggest that morphine produces a more potent cardioprotective effect than fentanyl. The present study investigated the effect of the choice of intraoperative opioid (morphine or fentanyl) on recovery of myocardial function after coronary artery bypass graft (CABG) surgery. DESIGN Prospective, randomized study. SETTING University hospital. PARTICIPANTS Forty-six patients undergoing CABG surgery. INTERVENTIONS Patients were randomly assigned to receive either morphine (40 mg) or fentanyl (1,000 mug) before cardiopulmonary bypass (CPB). Global cardiac function was assessed intraoperatively using the myocardial performance index (MPI), which combines echocardiographic parameters of both systolic and diastolic function. MEASUREMENTS AND MAIN RESULTS The MPI (median [range]) was increased after CPB in the fentanyl group, indicating a significant worsening of global left ventricular function (0.43 [0.28-0.54] baseline; 0.49 [0.32-0.64] 15 minutes post-CPB; 0.51 [0.36-0.63] end of operation; p < 0.05 post-CPB compared with baseline). The MPI improved in the morphine group after CPB (0.44 [0.32-0.64] baseline; 0.36 [0.24-0.45] 15 minutes post-CPB; 0.34 [0.20-0.46] end of operation; p < 0.05 post-CPB compared with baseline and the fentanyl group). CONCLUSIONS In patients undergoing CPB, global ventricular function is enhanced by the administration of morphine prior to the ischemic insult of cardioplegic arrest.
Collapse
Affiliation(s)
- Glenn S Murphy
- Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL 60201, USA.
| | | | | | | | | |
Collapse
|
25
|
Su HM, Lin TH, Voon WC, Lee KT, Chu CS, Lai WT, Sheu SH. Differentiation of Left Ventricular Diastolic Dysfunction, Identification of Pseudonormal/Restrictive Mitral Inflow Pattern and Determination of Left Ventricular Filling Pressure by Tei Index Obtained from Tissue Doppler Echocardiography. Echocardiography 2006; 23:287-94. [PMID: 16640705 DOI: 10.1111/j.1540-8175.2006.00222.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Tei index obtained from tissue Doppler echocardiography (TDE-Tei index) has an inherent advantage of recording its systolic and diastolic components simultaneously on the same cardiac cycle. The aims of this study are to evaluate whether TDE-Tei index also exerts a correlation with left ventricular (LV) systolic and diastolic function and filling pressure and to see whether it can effectively identify the pseudonormal/restrictive mitral filling pattern. METHODS Echocardiographic examination was performed in 243 consecutive patients. These patients were classified into three groups as normal, abnormal relaxation, and pseudonormal/restrictive groups according to the transmitral E/A-wave velocity (E/A), early diastolic velocity of lateral mitral annulus (Ea) and E/Ea. RESULTS Standard Doppler indices of LV filling such as E, A, E/A, and E-wave deceleration time had a bimodal distribution, but Ea decreased and E/Ea and TDE-Tei index increased progressively with worsening of LV diastolic function. The sensitivity and specificity of TDE-Tei index>0.51 in the discrimination of pseudonormal/restrictive filling pattern were 85% and 96%, respectively. After stepwise multiple linear regression analysis, TDE-Tei index had a significant negative correlation with Ea (beta=-0.296, P<0.001) and ejection fraction (beta=-0.293, P<0.001) and positive correlation with E/Ea (beta=0.235, P=0.001). CONCLUSIONS TDE-Tei index increased with worsening of LV diastolic function and can effectively identify the pseudonormal/restrictive mitral inflow pattern. It also correlated with the echocardiographic parameters of LV systolic and diastolic function and filling pressure. It suggests that TDE-Tei index is a simple and feasible marker in assessing global LV function.
Collapse
Affiliation(s)
- Ho-Ming Su
- Department of Internal Medicine, Division of Cardiology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | |
Collapse
|
26
|
Naqvi TZ, Padmanabhan S, Rafii F, Hyuhn HK, Mirocha J. Comparison of usefulness of left ventricular diastolic versus systolic function as a predictor of outcome following primary percutaneous coronary angioplasty for acute myocardial infarction. Am J Cardiol 2006; 97:160-6. [PMID: 16442355 DOI: 10.1016/j.amjcard.2005.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 08/12/2005] [Accepted: 08/12/2005] [Indexed: 10/25/2022]
Abstract
Left ventricular (LV) diastolic function is an important predictor of morbidity and mortality after acute myocardial infarction (AMI). We evaluated the role of diastolic function in predicting in-hospital events and LV ejection fraction (EF) 6 months after a first AMI that was treated with primary percutaneous coronary intervention (PCI). We prospectively enrolled 59 consecutive patients who were 60 +/- 15 years of age (48 men), presented at our institution with their first AMI, and were treated with primary PCI. Patients underwent 2-dimensional and Doppler echocardiography, including tissue Doppler imaging of 6 basal mitral annular regions within 24 hours after primary PCI and were followed until discharge. Clinical and echocardiographic variables at index AMI were compared with a combined end point of cardiac death, ventricular tachycardia, congestive heart failure, or emergency in-hospital surgical revascularization. Follow-up echocardiographic assessment was performed at 6 months in 24 patients. During hospitalization, 3 patients died, 7 developed congestive heart failure, 4 had ventricular tachycardia, and 1 required emergency surgical revascularization. Stepwise logistic regression analysis showed the ratio of early mitral inflow diastolic filling wave (E) to peak early diastolic velocity of non-infarct-related mitral annulus (p < 0.01) (E') and mitral inflow E-wave deceleration time (p < 0.02) to be independent predictors of in-hospital cardiac events (generalized R2 = 0.66). In a stepwise multiple linear regression model, independent predictors of follow-up LVEF were mitral inflow deceleration time (R2 = 0.39, p = 0.002), baseline LVEF (R2 = 0.54, p < 0.02), and mitral inflow peak early velocity/mitral annular peak early velocity (or E/E') of infarct annulus (R2 = 0.66, p = 0.02). In conclusion, in patients who are treated with primary PCI for a first AMI, E/E' velocity ratio and mitral inflow E-wave deceleration time are strong predictors of in-hospital cardiac events and of LVEF at 6-month follow-up.
Collapse
Affiliation(s)
- Tasneem Z Naqvi
- The Cedars-Sinai Medical Center, University of California Los Angeles School of Medicine, Los Angeles, California, USA.
| | | | | | | | | |
Collapse
|
27
|
Solomon SD, Anavekar N, Skali H, McMurray JJV, Swedberg K, Yusuf S, Granger CB, Michelson EL, Wang D, Pocock S, Pfeffer MA. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 2005; 112:3738-44. [PMID: 16330684 DOI: 10.1161/circulationaha.105.561423] [Citation(s) in RCA: 582] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular function is a principal determinant of cardiovascular risk in patients with heart failure. The growing number of patients with preserved systolic function heart failure underscores the importance of understanding the relationship between ejection fraction and risk. METHODS AND RESULTS We studied 7599 patients with a broad spectrum of symptomatic heart failure enrolled in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program. All patients were randomized to candesartan at a target dose of 32 mg once daily or matching placebo and followed up for a median of 38 months. We related left ventricular ejection fraction (LVEF), measured before randomization at the sites, to cardiovascular outcomes and causes of death. Mean LVEF in patients enrolled in CHARM was 38.8+/-14.9% (median LVEF 36%). Patients with lower LVEF tended to have higher baseline New York Heart Association class. The hazard ratio for all-cause mortality increased by 39% for every 10% reduction in ejection fraction below 45% (hazard ratio 1.39, 95% CI 1.32 to 1.46), with adjustment for baseline covariates. All-cause mortality, cardiovascular death, and all components of cardiovascular death declined with increasing ejection fraction until an ejection fraction of 45%, after which the risk of these outcomes remained relatively stable with increasing LVEF. The absolute change in rate per 100 patient-years for each 10% reduction in LVEF was greatest for sudden death and heart failure-related death. The effect of candesartan in reducing cardiovascular outcomes was consistent across LVEF categories. CONCLUSIONS LVEF is a powerful predictor of cardiovascular outcome in heart failure patients across a broad spectrum of ventricular function. Nevertheless, once elevated to a range above 45%, ejection fraction does not further contribute to assessment of cardiovascular risk in heart failure patients.
Collapse
Affiliation(s)
- Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02445, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Voon WC, Su HM, Yen HW, Lin TH, Lai WT, Sheu SH. Left Ventricular Tei Index: Comparison between Flow and Tissue Doppler Analyses. Echocardiography 2005; 22:730-5. [PMID: 16194166 DOI: 10.1111/j.1540-8175.2005.00126.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is still unknown whether a correlation exists between left ventricular Tei index obtained by tissue Doppler imaging and that determined by flow Doppler waveforms. This study was conducted to evaluate their relationship and to assess the positional effect on them. METHODS Twenty-six healthy subjects and 25 patients with essential hypertension were included. On the tissue Doppler images, the time interval from the end to the onset of the mitral annular velocity pattern during diastole and the duration of the S-wave were used to calculate tissue Doppler Tei index. RESULTS The tissue Doppler Tei index correlated with the flow Doppler Tei index at sitting position (r = 0.406, P = 0.003), but not at left lateral decubitus position. The limits of agreement for the Tei index measured by both methods were -0.26 to 0.62 at left lateral decubitus position and -0.09 to 0.55 at sitting position. Preload reduction associated with sitting position with dangling feet raised the Tei index both in the healthy controls [0.54 (0.14) vs 0.42 (0.12), P < 0.001] and in the hypertensives [0.53 (0.15) vs 0.46 (0.12), P = 0.005]. There was a similar positional effect on the tissue Doppler Tei index in the control subjects [0.75 (0.12) vs 0.53 (0.10), P < 0.001]. CONCLUSIONS Tissue Doppler Tei index does not seem to be a suitable substitute for flow Doppler Tei index. Flow Doppler Tei index is preload dependent and the loading status should be taken into consideration at the application of Tei index to the evaluation of myocardial performance.
Collapse
Affiliation(s)
- Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University, Taiwan, Republic of China.
| | | | | | | | | | | |
Collapse
|
29
|
Cury AF, Bonilha A, Saraiva R, Campos O, Carvalho ACC, De Paola AAV, Fischer C, Tucci PF, Moises VA. Myocardial Performance Index in Female Rats with Myocardial Infarction: Relationship with Ventricular Function Parameters by Doppler Echocardiography. J Am Soc Echocardiogr 2005; 18:454-60. [PMID: 15891755 DOI: 10.1016/j.echo.2005.01.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the study was to analyze the myocardial performance index (MPI), its relationship with the standard variables of systolic and diastolic functions, and the influence of time intervals in an experimental model of female rats with myocardial infarction (MI). METHODS Forty-one Wistar female rats were submitted to surgery to induce MI. Six weeks later, Doppler echocardiography was performed to assess infarct size (IS,%), fractional area change (FAC,%), ejection fraction biplane Simpson (EF), E/A ratio of mitral inflow, MPI and its time intervals: isovolumetric contraction (IVCT, ms) and relaxation (IVRT, ms) times, and ejection time (ET, ms); MPI = IVCT + IVRT/ET. RESULTS EF and FAC were progressively lower in rats with small, medium and large-size MI ( P < .001). E/A ratio was higher only in rats with large-size MI (6.25 +/- 2.69; P < .001). MPI was not different between control rats and small-size MI (0.37 +/- 0.03 vs 0.34 +/- 0.06, P = .87), but different between large and medium-size MI (0.69 +/- 0.08 vs 0.47 +/- 0.07; P < .001) and between these two compared to small-size MI. MPI correlated with IS (r = 0.85; P < .001), EF (r = -0.86; P < .001), FAC (r = -0.77; P < .001) and E/A ratio (r = 0.77; P < .001, non-linear). IVCT was longer in large size MI compared to medium-size MI (31.87 +/- 7.99 vs 15.92 +/- 5.88; P < .001) and correlated with IS (r = 0.85; P < .001) and MPI (r = 0.92; P < .001). ET was shorter only in large-size MI (81.07 +/- 7.23; P < .001), and correlated with IS (r = -0.70; P < .001) and MPI (r = -0.85; P < .001). IVRT was shorter only in large-size compared to medium-size MI (24.40 +/- 5.38 vs 29.69 +/- 5.92; P < .037), had borderline correlation with MPI (r = 0.34; P = .0534) and no correlation with IS (r = 0.26; p = 0.144). CONCLUSIONS The MPI increased with IS, correlated inversely with systolic function parameters and had a non-linear relationship with diastolic function. These changes were due to the increase of IVCT and a decrease of ET, without significant influence of IVRT.
Collapse
Affiliation(s)
- Alexandre Ferreira Cury
- Cardiovascular Laboratory, Department of Cardiology/Medicine of Universidade Federal de São Paulo, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|