Relationship between presystolic wave and subclinical left ventricular dysfunction as assessed by myocardial performance index in patients with metabolic syndrome

The myocardial performance index (MPI) is an index that shows both systolic and diastolic functions of the ventricle. Presystolic wave (PSW) is a late diastolic wave encountered in the left ventricular outflow tract (LVOT) and is associated with increased left ventricular stiffness and decreased left ventricular compliance. In our study, MPI was compared between patients with metabolic syndrome and normal patients, and we also investigated whether PSW could predict subclinical left ventricular dysfunction (SCLVD) in patients with metabolic syndrome. A total of 119 patients, 59 with metabolic syndrome and 60 healthy volunteers, were included in our study. Our study is a two-center prospective study. The patient groups were compared in terms of demographic, laboratory and echocardiographic parameters. Univariate and multivariate regression analyzes were performed to detect predictors of SCLVD. Higher MPI and PSW were found in patients with metabolic syndrome compared to the normal population (0.56 ± 0.11 vs. 0.46 ± 0.07, p < 0.001, 34 (57.6%) vs. 19 (31.7%), p = 0.004, respectively). MPI was found to be higher in patients with metabolic syndrome with PSW ( +) (0.59 ± 0.13 vs. 0.52 ± 0.05, p = 0.005). Smoking and PSW were found as Independent Predictors of Subclinical Left Ventricular Dysfunction in the Multivariate Logistic Regression Analysis Model (OR 0.146, 95%CI 0.028-0.767, p = 0.023 and OR 10.689, 95%CI 2.176-52.515, p = 0.004, respectively). Higher MPI and SCLVD were detected in patients with metabolic syndrome compared to the normal population. In addition, PSW positivity was associated with SCLVD in this patient group.

Evaluate the elasticity of carotid artery in the type 2 diabetes mellitus patients with nonalcoholic fatty liver disease by two-dimensional strain imaging

To evaluate carotid elasticity by using two-dimensional strain imaging (2DSI) in type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD). 98 patients with T2DM diagnosed in our hospital were selected. All the patients were without carotid plaque, which were proved by carotid ultrasonography. According to the fatty liver classification standard, patients were divided into three groups. There were 35 cases without NAFLD in group A, 33 cases with mild NAFLD in group B and 30 cases with moderate to severe NAFLD in group C. By using two-dimensional and M-mode ultrasound to measure the left carotid intima-media thickness (IMT), common carotid arterial systolic diameter (Ds) and diastolic diameter (Dd). The systolic peak velocity was measured by spectral Doppler ultrasound. The systolic global peak circumferential strain (CS), early and late systolic global circumferential strain rate (CSr) were measured by 2DSI. The stiffness parameters β1 and β2 were calculated by M-mode ultrasound and 2DSI separately. Among three groups, the Ds, Dd and systolic peak velocity showed no significant difference (all P > .05). In group C, IMT and β1 were obviously increased than those of groups A and B (all P < .05). Compared groups A and B, there were no significant difference in IMT and β1 (all P > .05). β2 was higher in groups B and C than those in group A, CS, CSr were lower in groups B and C than those in group A (both P > .05). The carotid elasticity of T2DM patients with NAFLD can be evaluated by 2DSI.

Prevalence of the presystolic wave in echocardiography and its association with the extent of coronary artery disease in patients with chronic stable angina

INTRODUCTION

Since mortality and morbidity of coronary artery disease are high, there is a need for non-invasive diagnostic methods for early diagnosis and prediction of ischemic heart disease (IHD) outcome. This study aimed to assess the relationship between angiographic findings, the Presystolic wave (PSW) and some of the ischemic related parameters in echocardiography of the patients with chronic stable angina.

MATERIALS AND METHODS

This cross-sectional study was conducted on the patients with chronic angina pectoris who referred to a tertiary hospital for coronary angiography in Mashhad, Iran. Demographic and medical history of the patients, as well as echocardiography findings, including ejection fraction (EF), regional wall motion abnormalities (RWMA), PSW and diastolic function were recorded. Angiographic findings, including SYNTAX score were also assessed.

RESULTS

A total of 220 patients (132 males and 88 females) with the mean age of 62.43 ± 11.40 years old participated in this study. The prevalence of PSW was 49.1%. The absence of the PSW was related to more RWMA (P =.002), and higher stages of left ventricular diastolic dysfunction (LVDD) (P =.029) and higher SYNTAX score (P =.001). There was a significant association between the absence of the PSW and EF categories, especially in severe LV systolic dysfunction (LVEF < 30%) (P =.001).

CONCLUSIONS

The findings of this study revealed that PSW is strongly associated with the SYNTAX score. The absence of the PSW may indicate patients at high-risk clinical status (higher SYNTAX score, severe systolic dysfunction, more RWMA, and higher stages of LVDD).

Relation of p - wave dispersion with presystolic a - wave and aortic valve sclerosis in asymptomatic subjects

BACKGROUND

P-wave duration and P-wave dispersion (PWD) are thought to be the surrogate marker of devoloping atrial fibrillation (AF). The main purpose of present study was to investigate the association between presystolic wave (PSW), aortic valve sclerosis, and PWD.

PATIENTS AND METHODS

Patients with sinus rhythm admitted to the cardiology outpatient clinic were consecutively enrolled. Maximum (Pmax) and minimum (Pmin) P-wave duration and PWD were measured. Echocardiography was used to assess the aortic valve morphology and presence of PSW. The patients were divided into two groups according to presence or absence of AVSc and PSW.

RESULTS

A total of 100 patients were enrolled consecutively. Patients with both PSW and AVSc had higher PWD values compared with those without PSW (42 ± 15 vs 65 ± 20) and AVSc (52 ± 21 vs 69 ± 19). The patients were categorized on the basis of median PWD values. According to univariate analysis, there was significant association between PWD and presence of PSW (P: .004), presence of AVS (P: .011), hypertension (P: .01) interventricular septal thickness (IVST) (P: .026), and posterior wall thickness (PWT) (P: .022). Multivariate logistic regression analyses demonstrated presence of PSW (95% confidence interval (1.058-6.505, P: .037) as an independent determinant of PWD.

CONCLUSION

Assessment of presystolic A-wave on echocardiography examination may provide important information regarding the atrial conduction velocities that is a electrophysiological cause of AF. While there was a significant association between AVSc and PWD in univariate analysis, this significance disappeared in multivariate analysis.