Prognostic value of the Tei index combining systolic and diastolic myocardial performance in patients with acute myocardial infarction treated by successful primary angioplasty

Cardiac systolic (left ventricular ejection fraction) and diastolic (mitral inflow velocity pattern and/or mitral deceleration time) function were reported as predictors of clinical outcome or left ventricular remodeling in patients with acute myocardial infarction (AMI). Recently, a new index (Doppler-derived index combining systolic and diastolic myocardial performance; Tei index) for combined systolic and diastolic ventricular function has been reported to be a useful and convenient method for evaluation of global ventricular function. We therefore investigated the usefulness of the Tei index by echocardiography for evaluation of infarct size and clinical outcome in patients with AMI treated by successful primary angioplasty. We analyzed 10 age-matched control subjects and 43 consecutive patients with first AMI treated by successful primary angioplasty. The Tei index of the AMI patients was significantly greater than that of the control subjects (0.630 ± 0.106 vs 0.375 ± 0.036, P 0.0001). Also, the Tei index showed a significant positive correlation with peak creatine kinase values and ^99mTc-tetrofosmin scores. Moreover, multiple logistic regression analysis showed that the Tei index 0.70 (P = 0.0313, odds ratio = 14.14) was the only significant explanatory factor for cardiac death or developed congestive heart failure. The Tei index combining systolic and diastolic myocardial performance reflects infarct size and might be a predictor of clinical outcome in patients with AMI treated by successful primary angioplasty.     

急性心肌梗死患者溶栓后血浆中脑钠素浓度变化的研究

目的研究血中脑钠素(BNP)水平与急性心肌梗死溶栓后左心室射血分数(LVEF)和心肌缺血程度的关系。方法将198例顺序入选的急性心肌梗死行链激酶静脉溶栓治疗的患者分为溶栓成功组(105例)和溶栓未成功组(93例),检测所有患者的血BNP水平及测定LVEF,比较溶栓成功组与溶栓未成功组LVEF>40%和LVEF≤40%的BNP水平。结果溶栓成功组BNP水平明显低于溶栓未成功组的BNP水平(725.4±169.8)ng/L(P<0.05),溶栓成功组和未成功组中LVEF>40%患者的BNP水平[(107.7±46.5)ng/L,(488.5±88.9)ng/L]明显低于LVEF≤40%患者的BNP水平[(515.5±121.2)ng/L,(856.7±129.5)ng/L,P<0.01]。结论急性心肌梗死患者血中BNP水平与LVEF和心肌缺血程度有关。     

Echocardiographic assessment of hypertensive patients with or without hyperhomocysteinemia

The study was designed to assess left ventricular (LV) systolic and diastolic function in hypertensive patients with or without Hhcy. The study participants consisted of 40 hypertensive patients with Hhcy, 40 hypertensive patients without Hhcy and 40 age-matched healthy control participants. Cardiac functions were determined using echocardiography and the Tei index was calculated for analysis. LAVI (left atrial volume index), IVST (interventricular septum thickness in diastole), PVST (posterior ventricular septum thickness in diastole), LVMI (left ventricular mass index), E/A (peak early and late diastolic transmitral filling flow velocities ratio), DT (deceleration time of the E wave), IRT (isovolumic relaxation time), and the Tei index were different in the hypertensive patient groups (hypertension with Hhcy and hypertension without Hhcy) compared with the controls. The Tei index was significantly higher in the hypertensive groups compared with the controls (0.62?±?0.05, 0.51?±?0.04, and 0.40?±?0.04, respectively, p?2), E/A (0.73?±?0.22 versus 0.92?±?0.14), DT (93.1?±?6.9 versus 84.3?±?8.1?ms), IRT (93.1?±?6.9 versus 84.3?±?8.1?ms) and the Tei index. Significant correlations were observed between serum homocysteine levels and LV diastolic function parameters (LAVI: r?=?0.39, E/A: r?=??0.32, DT: r?=?0.47, IRT: r?=?0.51, p?相似文献   

Conventional and segmental myocardial Tei indices measurement in patients with acute ST-segment elevation myocardial infarction: Is there a relation?

Background: Myocardial infarction (MI) results in impairment of left ventricular (LV) systolic and diastolic functions to various degrees. The tissue Doppler image derived Tei index (TDI-Tei index) has recently been used to assess LV function, and like the conventional Tei index, it was also found to be useful for global function. There are a small number of studies which apply TDI-Tei index to assess regional function and whether it varies according to the degree of changes in wall motion in various LV segments.Objectives: This study was conducted to assess the changes of segmental myocardial Tei index by TDI according to the degree of changes of wall motion in the patient with acute ST-segment elevation myocardial infarction (STEMI) and its correlation with Tei index derived by conventional Doppler.Patients and methods: This study was carried out on thirty patients with acute STEMI selected from Coronary Care Unit, Cardiology Department, Mansoura Specialized Hospital, Mansoura University, Egypt. The study group was subjected to clinical assessment, electrocardiography (ECG), routine laboratory profile and Doppler echocardiography (conventional and pulsed wave tissue Doppler imaging “PW-TDI”). Tei index was calculated from the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT), divided by ejection time (ET) which were measured from pulsed wave Doppler imaging of the trans-mitral inflow and LV outflow tracts. Myocardial velocities and TDI-Tei index were measured at basal and mid-segments of LV walts from apical 4, 2 and 5-chamber views using 16-segment model. Average values of myocardial velocities and TDI-Tei indices were obtained from normal, hypokinetic and akinetic segments then compared.Results: The mean values of left ventricular ejection fraction (LVEF), mitral E/A ratio and conventional Tei index were 51.83 ± 5.15%, 1.18 ± 0.15 and 0.63 ± 0.07 ms, respectively. Segmental myocardial TDI-Tei index was correlated positively with conventional Tei index (r = 0.648, P < 0.001). TDI-Tei indices were significantly higher in akinetic and hypokinetic segments than those of normal segments (0.70 ± 0.09, 0.64 ± 0.05 vs 0.63 ± 0.05, P < 0.001).Conclusions: Tei index (either conventional or TDI) is superior to EF in evaluation of LV performance in patients with acute STEMI. Tei index derived by myocardial segments by TDI is correlated with conventional Tei index. Segmental TDI-Tei index values differ according to the grade of dysfunctional wall motion.     

Immediate coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: Left ventricular ejection fraction,hospital mortality and reinfarction

Objectives. The purpose of the present study was to compare intravenous Streptokinase therapy with immediate coronary angioplasty without antecedent thrombolytic therapy with regard to left ventricular function and hospital mortality and reinfarction.Background. Despite the widespread use of intravenous thrombolytic therapy and immediate percutaneous transluminal coronary angioplasty, these two strategies to treat patients with an acute myocardial infarction have only recently been compared in randomized trials. Coronary angioplasty has been shown to result In a higher patency rate of the Infant-related coronary artery, with a less severe residual stenotic lesion, compared with streptokinase therapy, but whether this more favorable coronary anatomy results in clinical benefit remair to be established.Methods. We studied 301 patients with acute myocardial infarction randomly assigned to undergo immediate coronary angioplasty without antecedent thrombolytic therapy or to receive intravenous streptokinase therapy. Before discharge left ventricular ejection fraction was measured by radionuclide scanning.Results. The in-hospital mortality rate in the streptokinase group was 7% (11 of 149 patients) compared with 2% (3 of 152 patients) in the angioplasty group (p = 0.024). In the streptokinase group recurrent myocardial infarction occurred in 15 patients (10%) versus in 2 (1%) in the angioplasty group (p < 0.001). Either death or nonfatal reinfarction occurred in 23 patients (15%) in the streptokinase group and in 5 patients (3%) in the angioplasty group (p = 0.001). Left ventricular ejection fraction was 44 ± 11% (mean ± SD) in the streptokinase group versus 50 ± 11% in the angioplasty group (p < 0.001).Conclusions. These findings indicate that immediate coronary angioplasty without antecedent thrombolytic therapy results in better left ventricular function and lower risk of death and recurrent myocardial infarction than treatment with intravenous streptokinase.     

Importance of left ventricular activation in determining myocardial performance (Tei) index: comparison with total isovolumic time

BACKGROUND: The Tei index is commonly used as a measure of "combined systolic and diastolic function". A sensitive and specific index of intrinsic myocardial contraction and relaxation would be independent of abnormal activation. We aimed to determine whether the Tei index fulfils this criterion in patients with normal activation or left bundle branch block (LBBB), normal or dilated left ventricular (LV) cavities, with or without coronary artery disease (CAD). METHODS: We studied 32 controls and 124 patients; 49 had CAD and normal LV size (11 LBBB), 27 had non-ischaemic dilated cardiomyopathy (DCM, 11 LBBB), and 48 had ischaemic DCM (17 LBBB). Tei index (isovolumic contraction time+isovolumic relaxation time/ejection time) and total isovolumic time (t-IVT: [60-(total ejection time+total filling time]) were measured using Doppler echocardiography. RESULTS: Tei index and t-IVT were prolonged in LBBB (by 0.6 and 9.1 s/min, P<0.001). T-IVT identified LBBB with greater predictive accuracy than Tei index (sensitivity 97% vs. 90%, specificity 93% vs. 91%, P<0.05). Tei index and t-IVT were also prolonged in DCM (by 0.2 and 3.1 s/min, both P<0.001). Although Tei index identified DCM with sensitivity 71%, this fell to 53% when LBBB was excluded (P<0.05). CAD had no effect on Tei index or t-IVT. CONCLUSIONS: The Tei index is not a measure of intrinsic myocardial systolic and diastolic function, since its main determinant is ventricular activation rather than cavity size. T-IVT, however, is more sensitive to activation, is unrelated to cavity size or CAD, and may thus be a more accurate measure of the mechanical consequences of ventricular activation in a variety of cardiac conditions.     

Measurement of myocardial fractional flow reserve during coronary angioplasty in patients with old myocardial infarction

Although myocardial fractional flow reserve (FFRmyo) has been demonstrated to be a useful index for determining functional significance of coronary stenosis, the data in previous studies was derived from a highly selected group of patients. The aim of this study was to investigate the value of FFRmyo in a more clinically relevant group of patients, especially in patients who also had resistance vessel dysfunction. We measured FFRmyo in 20 consecutive patients who had undergone elective coronary angioplasty. FFRmyo was calculated by the ratio of Pc/Pa during intracoronary adenosine 5′-triphosphate (ATP; 50 μg in the left coronary and 20 μg in the right coronary artery) induced maximal hyperemia, where Pa represents mean aortic pressure obtained by the guiding catheter and Pc represents mean distal coronary pressure measured by a 2.1F infusion catheter. In total, 21 vessels were dilated and 14 of them were infarct-related arteries. The percent diameter stenosis significantly decreased from 80 ± 14% to 27 ± 17%, and the FFRmyo increased significantly from 0.46 ± 0.18 to 0.77 ± 0.15 after angioplasty. There was no significant differences in the FFRmyo between vessels with previous myocardial infarction and those without, after angioplasty (0.78 ± 0.18 vs. 0.76 ± 0.08). There was a significant correlation between the percent diameter stenosis and FFRmyo before (r = 0.83, P < 0.001) and after (r = 0.64, P < 0.01) angioplasty. In conclusion, FFRmyo significantly improved immediately after angioplasty in vessels with myocardial infarction as well as those without. These results led us to suggest the usefulness of FFRmyo in patients who had both epicardial stenosis and resistance vessel dysfunction. The significant correlation between FFRmyo and quantitative coronary arterial diameter stenosis would further support the more widespread use of FFRmyo in the clinical setting. Cathet. Cardiovasc. Diagn. 42:19–25, 1997. © 1997 Wiley-Liss, Inc.     

Left atrial functions after myocardial infarction

Acute myocardial infarction results in not only left ventricular but also left atrial dysfunction. Left atrial function is important for optimal filling of the left ventricle. In this study, we aimed at evaluating left atrial functions 6 months after acute myocardial infarction in three different patient groups (thrombolytic therapy, primary percutaneous intervention, or no reperfusion strategies). Between October 2002 and May 2003, 48 patients with ST elevation myocardial infarction who were either administered thrombolytic therapy (group T, n = 16), underwent primary angioplasty (group A, n = 20), or underwent no reperfusion therapy (group C, n = 12) at our unit were enrolled into the study. Echocardiography was performed in these patients 6 months after acute myocardial infarction. Left atrial contractility was assessed by atrial ejection force. Left atrial contribution was assessed by atrial fractional shortening and left atrial volume was calculated. The left atrial volume was significantly higher in group C (P < 0.05), but there was no significant difference between groups A and T (P > 0.05). Patients in group C had significantly lower atrial ejection force values compared with the other groups (P < 0.05). Atrial fractional shortening was not significantly different among the three groups (P > 0.05). Atrial ejection force, which is an indicator of left atrial contractility, is better with either angioplasty or thrombolysis. Left atrial volume is higher in patients who were not treated with reperfusion strategies. Further studies are needed to explain the mechanism involved.     

Influence of obstructive sleep apnea on left ventricular mass and global function: sleep apnea and myocardial performance index

Obstructive sleep apnea (OSA) is associated with cardiovascular mortality and morbidity. It may predispose patients to left ventricular hypertrophy and heart failure. The aim of this study was to determine the left ventricular mass (LVM) and myocardial performance index (MPI) reflecting left ventricular global function in uncomplicated OSA patients. Sixty-four subjects without hypertension, diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into three groups: group 1, control subjects with nonapneic snorers (AHI < 5, n = 18); group 2, patients with mild to moderate OSA (AHI: 5–30, n = 25); and group 3, severe OSA (AHI > 30, n = 21). Basic echocardiographic measurements, LVM, and LVM index were measured. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler echocardiography. There were no significant differences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left atrium, interventricular septum, left ventricular posterior wall, left ventricular end-diastolic and end-systolic diameters, LVM mass, and LVM index were not significantly different among the three groups. Left ventricular MPI was significantly higher in severe OSA patients (0.64 ± 0.18) than in controls (0.49 ± 0.18; P < 0.05). There was no significant difference between controls (0.49 ± 0.18) and mild to moderate OSA (0.61 ± 0.16; P = 0.08) and between mild to moderate OSA (0.61 ± 0.16) and severe OSA (0.64 ± 0.18; P = 0.84). The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.     

Primary angioplasty reduces risk of myocardial rupture compared to thrombolysis for acute myocardial infarction

Although the mechanical complications of acute ventricular septal defect and acute mitral regurgitation are uncommon after acute myocardial infarction, these complications are associated with an extremely high morbidity and mortality. We hypothesized that the administration of thrombolytic drugs may result in hemorrhagic infarction as well as the potential for incomplete revascularization and thus may lead to an increased incidence of mechanical complications compared to primary angioplasty. Accordingly, we reviewed the data of the most contemporary thrombolytic and primary angioplasty trials and compared the incidence of mechanical complications among 36,303 patients treated with thrombolytics reported in the GUSTO trial to the incidence of mechanical complications among 1,295 patients treated with primary angioplasty obtained from the PAMI-1 and PAMI-2 trials. We found that angioplasty resulted in an overall 86% relative risk reduction in mechanical complications (2.20% vs. 0.31%, P < 0.001). In comparison to thrombolytic therapy, angioplasty resulted in an 82% decrease in acute mitral regurgitation (1.73% vs. 0.31%, P < 0.001) and a 100% decrease in acute ventricular septal defect (0.47% vs. 0.00%, P < 0.03). In conclusion, in patients with acute myocardial infarction, reperfusion with primary angioplasty is associated with less myocardial rupture and mechanical complications than thrombolytics. This finding may, in part, explain the improved prognosis observed in myocardial infarction patients treated with primary angioplasty. Cathet. Cardiovasc. Diagn. 42:151–157, 1997. © 1997 Wiley-Liss, Inc.     

TIMI myocardial perfusion frame count: A new method to assess myocardial perfusion and its predictive value for short‐term prognosis

Objectives: We sought to develop a new quantitative method to evaluate the degree of myocardial perfusion. Background: Currently available methods for assessing myocardial perfusion, both TIMI myocardial perfusion grading (TMPG) and myocardial blush grading (MBG), are subjective. Methods: TIMI Myocardial Perfusion Frame Count (TMPFC), an objective method that measures the filling and clearance of contrast in the myocardium using cine‐angiographic frame‐counting, was developed to quantify myocardial perfusion. Myocardial perfusion of 45 normal coronary arteries in 15 patients, and 137 culprit arteries in 137 patients immediately after primary angioplasty, was successfully assessed with TMPFC. Results: The mean TMPFC in the normal arteries was 83.47 ± 17.96 frames (95% CI: 78.07 frames ≤ TMPFC ≤ 88.86 frames). Therefore, TMPFC < 90 frames, a value representing the upper bound of the 95% CI for the TMPFC observed in normal arteries, was defined as normal myocardial perfusion. In 137 culprit arteries, the mean TMPFC values after primary angioplasty for the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) were 141 ± 82.6, 112 ± 80.3, and 102 ± 37.5 frames, respectively. Patients with suboptimal myocardial perfusion (ex: TMPG ≤ 2 or MBG ≤ 2 grade) had higher levels of TMPFC. Furthermore, multivariate analysis shows that the TMPFC was an independent predictor for 30‐day (P = 0.0261) and 6‐month incidence of MACE (P = 0.0207). Conclusions: TMPFC is a quantitative index for the assessment of myocardial perfusion; it allows quantification of TMPG and may serve as a discerning tool to predict prognosis in patients undergoing primary angioplasty. © 2009 Wiley‐Liss, Inc.     

Long-term prognosis of young patients after myocardial infarction in the thrombolytic era

Background: Myocardial infarction (MI) in young adults is a rare event. In the Framingham study, the 10-year incidence rate of MI per 1,000 was 12.9 in men 30–34 years old. Overall, 4–8% of patients with acute MI are ≤ 40 years old. Hypothesis: It was the purpose of this study to assess the in-hospital and long-term morbidity and mortality in patients ≤40 years old with acute myocardial infarction compared with older patients in the thrombolytic era. Methods: A consecutive series of 75 patients aged ≤40 years (mean 35.0 ± 4.8) with acute myocardial infarction was compared with an equally sized group of patients aged >40 years (mean 65.1 ± 9.8). Results: Thrombolysis or direct percutaneous transluminal coronary angioplasty was performed in 52 versus 24% (p = 0.0004) and 5.3 versus 2.7% (p = NS) in younger and older patients, respectively. Significantly fewer young patients had multivessel disease (28 vs. 64%, p < 0.004). No in-hospital mortality was observed in patients with reperfusion therapy irrespective of age. After a mean followup time of 47 ± 35 months, cardiac mortality was 0 and 11% (p < 0.03), respectively, in young and older patients with, and 3 versus 24% (p < 0.02) without reperfusion therapy, respectively. In addition, significantly fewer patients in the younger age group developed recurrent angina pectoris (12 vs. 39%, p = 0.0004) or congestive heart failure (9 vs. 34%, p = 0.0005) irrespective of reperfusion therapy. Conclusion: Our observations demonstrate that long-term prognosis after myocardial infarction in young patients is excellent in the thrombolytic era.     

完全性右束支传导阻滞患者心室机械功能的变化

目的研究完全性右束支传导阻滞(CRBBB)患者心室机械功能的变化。方法选取CRBBB的患者48例为CRBBB组,另选取心电图正常的健康成人42例为正常组。应用脉冲组织多普勒显像技术(PW-TDI)测量CRBBB患者心肌组织的运动速度与时间间期指标以反映其心室机械功能的变化。结果①与正常组比较,CRBBB组右室侧壁基部收缩波峰值速度(Sm)减小、舒张早期波峰值速度(Em)减小、Em/舒张晚期波(A波)峰值速度(Am)减小(13.7±2.53cm/svs17.00±3.10cm/s;12.1±2.06cm/svs21.05±4.23cm/s;0.71±0.38cm/svs1.22±0.65cm/s,P均<0.01),Am无差异(P>0.05);两组间左室基部六个取样点的Sm、Em、Am、Em/Am比较无差异(P均>0.05);②与正常组比较,CRBBB组右室侧壁基部电-机械延迟时间(EMD)和等容舒张时间(IVRT)延长(55±13msvs46±10ms;41±20msvs30±16ms,P<0.05),射血时间(ET)缩短(309±43msvs400±60ms,P<0.05),等容收缩时间(IVRT)与充盈时间(FT)无差异(P均>0.05);两组间左室基部六个取样点的EMD、IVCT、ET、IVRT及FT比较无差异(P均>0.05)。③与正常组比较,CRBBB组右室侧壁基部Tei指数延长(0.56±0.14vs0.43±0.13,P<0.05);两组间左室各取样点的Tei指数无差异(P>0.05)。结论CRBBB患者右室舒缩功能降低,而左室舒缩功能未受影响。     

Predictors of short term clinical and angiographic outcome after coronary angioplasty for acute myocardial infarction

Coronary angioplasty is an effective method to achieve myocardial reperfusion in acute myocardial infarction (AMI). We reviewed our experience in 132 patients (pts) who underwent percutaneous transluminal coronary angioplasty (PTCA) of a totally occluded infarct-related artery (IRA) within 24 h after the onset of symptoms (mean delay 10±7 h), in order to identify the predictors of primary success and of major complications. PTCA was successfully performed in 113 patients (86%). Failure without complications occurred in 12 patients (8.4%); untoward events (death and emergency CABG) occurred in seven patients (5.3%). Pts in the failure group were more likely to have cardiogenic shock (53 vs. 8.8%, P<.0005), longer time to reperfusion (15±6 vs. 9±6 h, P<.0005), lower ejection fraction (EF) (42±16 vs. 54±12%, P<.0005), multivessel disease (74 vs. 43%, P<.03), and a smaller IRA diameter (2.8±0.6 vs. 3.1± 0.6 mm, P<.03). Sex, age, previous bypass surgery, previous thrombolytic treatment, IRA, and infarct location were similar in both groups. Absence of cardiogenic shock (P<.0001), decreasing time to reperfusion (P<.005) and increasing EF (P<.02) were independent predictors of successful PTCA. Presence of cardiogenic shock (P<.0001) and decreasing EF (<.05) were independent predictors of untoward events. Repeat angiography was performed 24 h after the procedure in the success group. Angiographic deterioration (stenosis ? 50% and/or TIMI flow grade ? 1) was present in 18 pts (16%), among whose 5 pts (4.4%) had re-occlusion of the IRA. Pts with early angiographic deterioration were more likely to have a lower IRA diameter (2.8±0.5 vs. 3.1±0.6 mm, P<.02). Conclusion: Emergency PTCA is an effective method for establishing reperfusion in AMI. Pts with high-risk baseline characteristics show the highest rate of untoward events, but are the most likely to benefit from aggressive reperfusion therapy. © 1995 Wiley-Liss, inc.     

Management comparison for acute myocardial infarction: direct angioplasty versus sequential thrombolysis-angioplasty

To compare the results and outcome of different management approaches for acute myocardial infarction, we analyzed our experience with early (i.e., within 6 hours of infarct onset) direct percutaneous transluminal coronary angioplasty (group A) versus initial treatment with thrombolytic therapy (group B) followed by angioplasty. From 1982 to 1989 a total of 214 patients underwent primary angioplasty for acute myocardial infarction. During this time 157 patients underwent initial thrombolytic therapy, 104 with intravenous streptokinase and 53 with intravenous tissue-type plasminogen activator followed by angioplasty. Other than age (group A, 61.7 +/- 11.5 years; group B, 57.3 +/- 11.6 years; p = 0.0002), the clinical characteristics of the groups were similar. In group A, 197 (92.1%) had successful results, and 17 (7.9%) were failures. Of the group treated with thrombolytic therapy, there was an overall 81.5% patency rate for patients treated with streptokinase and tissue-type plasminogen activator with no significant difference between the agents. Angioplasty success after thrombolytic therapy was 94.3%. In-hospital and 1-year survival was significantly better in group B patients (95.5% and 95.5%, respectively) than in group A patients (92.1% and 89.3%, respectively). We conclude that both direct angioplasty and thrombolytic therapy followed by angioplasty provide high recanalization rates but that short- and long-term survival is improved when thrombolytic therapy precedes angioplasty in acute myocardial infarction patients.     

Influence of weight loss on myocardial performance index

Obese patients may have a phase of asymptomatic left ventricular dysfunction. A combined myocardial performance index (MPI) has been demonstrated to be a useful index to estimate left ventricular function and to predict the prognosis of patients with heart failure. The objective of the study was to determine the influence of weight loss on MPI. A total of 18 obese patients (3 men, 15 women, mean age 49.6 ± 5.5 years, body mass index [BMI] >30 kg/m²) were investigated in the study. All patients were treated with a multidisciplinary approach consisting of a hypocaloric diet and orlistat therapy (120 mg three times daily), and all of them underwent two-dimensional and Doppler echocardiographic examination two times before starting the study and after a period of weight loss. Using echo-Doppler methods, ejection fraction, peak velocities of early (E) and late (A) diastolic filling, the E/A ratio, deceleration time (DT), isovolumic contraction time (IVCT), isovolumic relaxation time, ejection time, and MPI were measured. The MPI was obtained by subtraction ejection time from the interval between cessation and onset of the mitral flow. All patients lost at least 10% of their initial body weight, with a mean decrease of 10.8 ± 3.7 kg. This was associated with significant reductions in BMI with a mean decrease 4.5 ± 1.4 kg/m². Compared with baseline, after weight loss the E/A ratio of 1.01 ± 0.22 before treatment increased to 1.17 ± 0.26 (P = 0.012), left ventricular mass index decreased from 88 ± 23 to 82 ± 19 g/m² (P = 0.028), IVCT from 71 ± 20 to 53 ± 30 ms (P = 0.004), DT from 233.65 ± 38.14 to 196.72 ± 47.73 s (P = 0.004), and MPI from 0.63 ± 0.13 to 0.50 ± 0.13 (P = 0.0001). Weight loss ameliorates MPI and seems to be a clinically relevant measurement of left ventricular global function, and may prove to be a valuable tool in assessing the risk of developing heart failure.     

B型脑利钠肽和Tei指数在高血压早期左心室舒张功能不全诊断中的意义

目的探讨B型脑利钠肽(BNP)与Tei指数在评价原发性高血压左心室舒张功能不全中的意义。方法选择高血压患者83例,分为高血压伴左心室舒张功能不全组(DHF组,35例),高血压无心力衰竭组(NHF组,48例),另选健康体检者20例作为对照组。化学发光法检测BNP,超声心动图检测各个参数,并计算左心室Tei值。结果DHF组Tei指数、BNP明显高于NHF组和对照组(P<0.01),NHF组Tei指数、BNP也明显高于对照组(P<0.05,P<0.01)。BNP法诊断敏感性、特异性明显好于Tei指数法,差异有统计学意义(P<0.05)。结论BNP和Tei指数均为诊断高血压早期舒张功能不全的敏感指标,且BNP法较Tei指数法更为高效、准确。     

Retrospective comparative study of primary intracoronary stenting versus balloon angioplasty for acute myocardial infarction

Balloon angioplasty has been shown to be an effective therapy for the treatment of acute myocardial infarction but is associated with a high restenosis rate, substantial early recoil, persistent thrombus and need for intracoronary thrombolysis, and a high rate of reclosure. Because many of the limitations of balloon angioplasty in the noninfarction setting are addressed by intracoronary stenting, we examined the results of primary stenting of 18 consecutive patients treated for acute myocardial infarction, and compared the results to those achieved with primary balloon angioplasty in 18 prior cases. Despite the presence of thrombus prior to angioplasty in 13 of the stented patients, no intracoronary thrombolytic therapy was required. Mean percent stenosis using quantitative coronary angiography was 17.7 ± 10.2% after primary stenting compared with 43.7 ± 20.3% after primary balloon angioplasty (P < .001). One stent patient who had all anticoagulant and antiplatelet therapy withdrawn early suffered subacute thrombosis. Patients were followed up to 3 yr. Complications were similar in the two groups. We conclude that primary stenting for acute myocardial infarction results in superior angiographic appearance as well as resolution of thrombus without the need for routine thrombolysis, and is associated with a low complication rate and excellent short-term clinical patency. Cathet. Cardiovasc. Diagn. 40:235–239, 1997. © 1997 Wiley-Liss, Inc.     

Exaggerated luminal loss a few minutes after successful percutaneous transluminal coronary angioplasty in patients with recent myocardial infarction compared with stable angina: An intracoronary ultrasound study

This study investigates the mechanisms of exaggerated acute luminal loss after successful coronary angioplasty in patients with recent myocardial infarction compared with stable angina by angiography and intracoronary ultrasound (ICUS). We studied 15 consecutive patients (group 1) who, after a successful thrombolysis for myocardial infarction, underwent delayed (8 ± 2 days after the myocardial infarction) successful balloon coronary angioplasty. Group 1 patients were individually matched with 15 stable angina patients (group 2). The percentage of stenosis and acute luminal loss were measured by quantitative coronary analysis. The ultrasound characteristics of lumen pathology were described as soft, hard, calcified, eccentric, concentric, thrombotic, and dissection lesions. Matching by stenosis location, reference diameter, sex, and age resulted in 2 comparable groups of 15 lesions with identical baseline characteristics. Immediately after percutaneous transluminal coronary angioplasty (PTCA), the minimal luminal diameter increased from 0.5 ± 0.3 mm to 2.4 ± 0.3 mm and from 0.5 ± 0.2 mm to 2.4 ± 0.3 mm in groups 1 and 2, respectively. Similar balloon sizes were used in both groups. The acute luminal loss (the difference between the maximal dilated balloon diameter and the minimal luminal diameter) immediately after PTCA was 0.4 ± 0.2 mm and 0.3 ± 0.3 mm (14 ± 8% and 10 ± 11% of balloon size) (P = not significant [NS]) in groups 1 and 2, respectively. After ICUS (mean 24 min after the last balloon deflation), the acute luminal loss was 0.9 ± 0.3 mm and 0.5 ± 0.4 mm (29 ± 11% and 17 ± 8% of balloon size) (P = 0.01) in groups 1 and 2, respectively. There was a significantly higher prevalence of intracoronary thrombus formation as detected by ICUS in group 1 compared with group 2 (80% vs. 20%; P < 0.001). In matched groups of successfully treated coronary angioplasty, patients with recent myocardial infarction had a similar magnitude of acute gained luminal loss immediately after the procedure. However, an exaggerated luminal loss a few minutes after the last balloon deflation in patients with recent myocardial infarction was noted because of mural thrombus formation compared with patients with stable angina. Cathet. Cardiovasc. Diagn. 41:32–39, 1997. © 1997 Wiley-Liss, Inc.     

Impact of Obstructive Sleep Apnea on the Global Myocardial Performance Beyond Obesity

We aimed to assess the impact of obstructive sleep apnea (OSA) on the left ventricular (LV) function independent of obesity using the myocardial performance index (Tei index) and the global longitudinal LV strain (GLS) and its reversibility after surgery. Twenty‐five newly diagnosed OSA patients, normal weight (n = 15) and obese (body mass index [BMI] ≥ 25; n = 20) controls without OSA were enrolled and underwent transthoracic echocardiographic evaluation. The OSA and obese groups had a significantly comparable increased BMI and LV chamber dimension, prolonged isovolumic relaxation time, reduced early mitral filling velocity, and increased late mitral filling velocity and Tei index as compared to the normal weight group. However, GLS was significantly reduced only in the OSA group (–16.5 ± 1.9%) as compared to the normal weight group (–20.6 ± 2.0%, P < 0.001) and obese group (–19.1 ± 2.5%, P < 0.001). As a treatment, 13 of 25 patients underwent surgical modification, and the follow‐up echocardiogram revealed significantly improved Tei index and GLS as compared to baseline (0.37 ± 0.06 and –18.9 ± 3.3% vs. 0.42 ± 0.04 and –16.3 ± 2.4%, P = 0.006 and 0.031, respectively), which was comparable to the obese controls. A reduction in the apnea‐hypopnea index had a significant effect on the improvement in the GLS (r = 0.73, P < 0.001). LV systolic and diastolic function significantly deteriorated in the patients with OSA beyond obesity, and an improvement in the LV function was observed within 6 months after the surgical modification. GLS is considered to be one of the parameters that can be used in the early detection of LV systolic dysfunction in patients with OSA and a normal ejection fraction.