Stress echocardiography in the identification of left anterior descending coronary artery disease in patients with inferior myocardial infarction and a positive exercise electrocardiography result

INTRODUCTION AND OBJECTIVES: In patients with an inferior myocardial infarction (IMI), ST-segment depression in left precordial leads during exercise electrocardiography (ExECG) has been associated with left anterior descending coronary artery (LADCA) disease. The aim of this study was to assess the value of stress echocardiography in identifying LADCA disease in patients with IMI and a highly abnormal ExECG result. METHODS: The study included patients with an IMI and an abnormal ExECG result whose coronary angiography findings were available. A highly abnormal ExECG result was defined as ST-segment depression in three or more leads, including V5. The wall motion score index was calculated and each patient was evaluated echocardiographically for ischemia in LADCA territory. RESULTS: Of 241 patients who underwent stress ECG, 100 (mean age 57 [11] years) met inclusion criteria. Some 38 had significant LADCA stenosis and, in 75, ExECG gave a highly abnormal result. The sensitivity, specificity and accuracy of a highly abnormal ExECG result for detecting LADCA disease were 74% (60%-88%), 26% (15%-37%), and 44% (34%-54%), respectively. Echocardiographic detection of ischemia had similar sensitivity, at 74%, but higher specificity, at 92% (P< .001), and accuracy, at 85% (P< .001). Multivariate analysis of clinical, exercise test, and stress echocardiography variables revealed that the only independent predictors of LADCA disease were age (OR=1.070), recent IMI (OR=0.136), and ischemia in LADCA territory (OR=19.9). CONCLUSIONS: Stress echocardiography is a good noninvasive technique for detecting LADCA disease in patients with an IMI. The diagnostic accuracy of a highly abnormal ExECG result is not sufficient for its use in this clinical setting.     

Clinical predictors of left main coronary artery disease in high-risk patients with a first episode of non-ST-segment elevation acute coronary syndrome

INTRODUCTION AND OBJECTIVES: Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Our objective was to identify clinical variables that predict significant stenosis (i.e., >50%) of the left main coronary artery in high-risk patients who have had a first episode of non-ST-elevation acute coronary syndrome but who do not have a history of coronary artery disease. METHODS: The study included 102 high-risk patients with no history of coronary artery disease who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into two groups: those with significant left main coronary artery stenosis (n=14) and those without (n=88). RESULTS: Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age >65 years (57.1% vs 15.9%, P=.002), diabetes mellitus (71.4% vs 33.0%, P=.006), chronic renal failure (28.6% vs 5.7%, P=.019), left heart failure (71.4% vs 6.8%, P< .0001), cardiogenic shock (21.4% vs 1.1%, P=.008), and a low left ventricular ejection fraction at admission (49.9% [14.7%] vs 58.8% [9.9%], P=.044). In the multivariate analysis, the only significant independent predictor of left main coronary artery disease was left heart failure. CONCLUSIONS: The presence of left heart failure at initial assessment of high-risk patients with non-ST-elevation acute coronary syndrome but without a history of coronary artery disease could be a useful predictor of significant left main coronary artery disease.     

Initial experience with the Impella left ventricular assist device for postcardiotomy cardiogenic shock and unprotected left coronary artery angioplasty in patients with a low left ventricular ejection fraction

Low-output syndrome is one of the leading causes of death following open-heart surgery or high-risk angioplasty. Ventricular assist devices have been used to treat patients who suffer from postoperative cardiogenic shock despite use of an intraaortic balloon pump and maximum inotropic support. The Impella pump (Impella Cardiosystems AG, Aachen, Germany) is a newly introduced left ventricular assist device that has been shown to reduce infarct size and to accelerate recovery of stunned myocardium. We report our initial experience using the Impella device for the treatment of cardiogenic shock following cardiopulmonary bypass and for maintaining hemodynamic stability in high-surgical-risk patients undergoing unprotected left coronary artery angioplasty.     

Takotsubo cardiomyopathy manifesting as no reflow pattern in coronary flow by transthoracic Doppler echocardiography and prolonged recovery of regional left ventricular wall motion abnormality: a case report

A 80-year-old woman was admitted to our hospital because of chest pain. Electrocardiography revealed ST segment elevation in the I, aVL, and V1-V5 leads. Echocardiography revealed left ventricular apical aneurysmal change with ejection fraction of 31%. Coronary angiography showed no abnormalities. Creatine kinase was not elevated in her clinical course. The diagnosis was takotsubo cardiomyopathy. Transthoracic Doppler echocardiography was performed on the 2nd hospital day. Coronary flow velocity pattern in the left anterior descending artery revealed shortened diastolic deceleration time (108 msec) and systolic retrograde flow. Asynergy of the left ventricle gradually improved, but still persisted slightly at 6 months after discharge. Most patients with takotsubo cardiomyopathy have normal coronary flow velocity pattern in the acute phase. In this case, no reflow pattern of coronary flow was observed during prolonged recovery from left ventricular regional wall motion abnormality.     

Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction

OBJECTIVES

The purpose of this study was to examine the relationship between the pattern of coronary blood flow velocity immediately after successful primary stenting and the recovery of left ventricular (LV) wall motion in patients with acute myocardial infarction (AMI).

BACKGROUND

It is difficult to predict the recovery of LV wall motion immediately after direct angioplasty in AMI. Recent reports indicate that dysfunctional coronary microcirculation is an important determinant of prognosis for AMI patients after successful reperfusion.

METHODS

We measured left anterior descending coronary flow velocity variables using a Doppler guide wire immediately after successful primary stenting in 31 patients with their first anterior AMI. The patients were divided into two groups: those with and those without early systolic reverse flow (ESRF). Changes in LV regional wall motion (RWM) and ejection fraction (EF) at admission and at discharge were compared between the two groups. Coronary flow velocity variables immediately after primary stenting were compared with changes in left ventriculographic indexes.

RESULTS

The change in RWM was significantly greater in the non-ESRF group than it was in the ESRF group (0.9 ± 0.7 vs. −0.1 ± 0.3 standard deviation/chord, respectively, p < 0.001). The change in EF was also significantly greater in the non-ESRF group than it was in the ESRF group (10 ± 10 vs. 1 ± 6%, respectively, p < 0.05). In the non-ESRF group (diastolic to systolic velocity ratio [DSVR] <3.0), the DSVR correlated positively with the change in RWM (r = 0.60, p < 0.005, n = 24) and the change in EF (r = 0.52, p < 0.01).

CONCLUSIONS

The coronary flow velocity pattern measured immediately after successful primary stenting is predictive of the recovery of regional and global LV function in patients with AMI.     

PTCA前后应用多普勒导丝测定冠状动脉血流速度及储备功能的意义

目的:评价经皮腔内冠状动脉成形术(PTCA)前后应用多普勒导丝测定冠状动脉血流速度及冠状动脉血流储备的变化意义.方法:对25例冠心病患者的31支冠状动脉行PTCA.于PTCA前后用多普勒导丝分别记录狭窄近端和远端的平均峰值血流速度(APV),狭窄近、远端血流速度比(P/DVR)及冠状动脉血流速度储备(CFR).结果:PTCA前31支冠状动脉的直径狭窄率为(84.88±12.25)%.PTCA后残余狭窄为27.65%(P＜0.05),术后病变冠状动脉近端APV较PTCA前有所增加,但差别未达统计学意义[(23.74±15.98)cm/s∶(27.36±18.32cm/s,P=0.06].狭窄远端基础APV、充血相APV及CFR均较术前明显增加[(15.07±11.63)cm/s∶(23.09±10.33)cm/s,(20.53±10.69)cm/s∶(41.67±17.43)cm/s,1.20±0.40∶1.81±0.66,均P＜0.05],P/DVR则明显降低(1.84±1.06∶1.45±0.74,P＜0.05).但残余狭窄的多少与PTCA后基础及充血相APV、CFR、P/DVR改善的程度之间并无明显的相关关系.结论:多普勒导丝测量技术可以更细致的评价PTCA前后冠状动脉血流模式的变化及PTCA术后的急性期疗效,是一种值得在临床上使用并进一步深入研究的新方法.     

TIMI frame count immediately after primary coronary angioplasty as a predictor of functional recovery in patients with TIMI 3 reperfused acute myocardial infarction

OBJECTIVES: The purpose of this study was to evaluate whether higher coronary blood flow, estimated by the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (CTFC), is related to better functional and clinical outcome after successful percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI). BACKGROUND: Experimental studies have found that functional recovery of the infarcted myocardium was associated with increased blood flow (reactive hyperemia) to the infarcted bed shortly after reperfusion. METHODS: We measured CTFC immediately after successful (TIMI 3) primary PTCA in 104 consecutive patients with their first AMI. Wall motion score index (WMSI) and the presence of pericardial effusion were assessed by two-dimensional echocardiography before and one month after PTCA. RESULTS: The patients were divided into two groups according to mean CTFC for corresponding coronary artery of the control group: TIMI 3 slow group (45 patients, 40 > CTFC > or = 23) and TIMI 3 fast group (59 patients, CTFC < 23). There were no significant differences in the baseline characteristics and WMSI before reperfusion between the two groups. Improvement of WMSI in the TIMI 3 fast group was significantly greater than that of the TIMI 3 slow group (1.33 +/- 0.52 vs. 0.60 +/- 0.34, p < 0.001). Pericardial effusion and intractable heart failure were observed more frequently in the TIMI 3 slow group than in the TIMI 3 fast group (27 vs. 10%; p < 0.05, 36 vs. 17%; p < 0.05). Corrected TIMI frame count, assessed as a continuous variable, had a significant correlation with the change in WMSI (r = 0.60, p < 0.001) after adjusting for age, gender, history of hypertension, history of diabetes, elapsed time to PTCA, collateral grade, presence of antegrade flow before PTCA and number of diseased vessels. CONCLUSIONS: Lower CTFC of the infarct-related artery immediately after PTCA was associated with greater functional recovery; and hence, CTFC can predict clinical and functional outcome in patients with successful PTCA.     

Flow velocity and predictors of a suboptimal coronary flow velocity reserve after coronary balloon angioplasty.

AIMS: This study was conducted to analyse flow velocity parameters and predictors of a suboptimal coronary flow reserve (<2.5) following balloon angioplasty. METHODS: Two hundred and twenty-five patients underwent sequential intracoronary Doppler as part of the DEBATE I study. Of these, 183, with complete angiography and Doppler at the 6-month follow-up, were included. Univariate and multivariate logistic analysis was performed to identify independent predictors of post-procedural suboptimal coronary flow reserve, defined as coronary flow reserve <2.5. RESULTS: Forty-eight per cent (n=88) of the patients achieved a suboptimal coronary flow reserve. These patients had higher baseline velocities (cm.s(-1)) before balloon angioplasty (18+/-9 vs 14+/-6, P=0.004), after balloon angioplasty (22+/-11 vs 14+/-5, P<0.001) and at follow-up (19+/-9 vs 16+/-6, P=0.011) than the optimal coronary flow reserve group. Although the suboptimal group had lower hyperaemic velocities (cm.s(-1)) after balloon angioplasty than the optimal group (42+/-17 vs 49+/-16, P=0.008), these velocities became similar at follow-up. Increasing age (odds ratio, OR 1.071, P=0.0002), female gender (OR 2.52, P=0.014) and increasing pre-procedural baseline average peak velocities (OR 1.056, P<0.001) were found to be independent predictors of a suboptimal coronary flow reserve following balloon angioplasty. CONCLUSION: A suboptimal coronary flow reserve was associated with (1) a chronically elevated baseline average peak velocity (2) a transient deficit in the hyperaemic average peak velocity (3) the elderly, and female gender.     

Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty.

AIM: To investigate the effect of abciximab on microvascular integrity and left ventricular (LV) functional recovery in patients with acute myocardial infarction (MI) treated by primary coronary angioplasty (PTCA). METHODS AND RESULTS: Thirty-one patients (27 males; age 39-76 years) with first, acute MI (<6 h after onset) were randomized to receive either abciximab+primary PTCA (n=17) or primary PTCA alone (n=14). Baseline characteristics of the two groups were similar. Myocardial reperfusion was studied shortly after PTCA by corrected TIMI frame count (cTFC) and intracoronary myocardial contrast echocardiography (MCE), after 48 h by intravenous MCE using intermittent, harmonic power Doppler, and after 1 month by intravenous MCE and 99 mTc-tetrofosmin SPECT. The patients treated with abciximab showed a shorter cTFC (23+/-4 vs 30+/-9 frames; P<0.05), a more preserved microvascular integrity shortly after PTCA (77% vs 55%; P<0.01), after 48 h (86% vs 50%; P<0.005) and at 1-month follow-up (86% vs 54% by MCE, P<0.001, and 68% vs 60% by SPECT, P<0.005) than patients treated with PTCA alone. Abciximab patients also showed a better recovery of LV function, as demonstrated by greater reduction in wall motion score index (1.4+/-0.3 vs 1.5+/-0.2; P<0.05) and increase in LV ejection fraction (53+/-7% vs 48+/-5%; P<0.001). CONCLUSIONS: Abciximab improves microvascular perfusion and LV functional recovery in primary PTCA.     

Mitral flow derived Doppler indices of left ventricular diastolic function in a general population; the Tromso study.

AIMS: Left ventricular diastolic dysfunction has been proposed as the basis of heart failure in patients with normal left ventricular systolic function. Doppler indices of mitral inflow have been widely used to diagnose this condition and have been shown to correlate well with increased left atrial pressure in patients with cardiovascular disease. We wanted to establish age-specific criteria for normality of these indices in a large population and to determine the association of abnormal values to age and cardiovascular disease. METHODS AND RESULTS: In our sample of subjects aged 25-85 years, 3022 had pulsed Doppler measurements of mitral inflow velocities and early inflow deceleration time. The association of these indices to age and gender were established in a 'healthy' reference subsample of 949 subjects. Age-specific percentiles showed a significant decline with increasing age for peak early mitral inflow velocity and the ratio of peak early and atrial inflow velocities (E/A ratio), whereas early inflow deceleration time and peak atrial inflow velocity showed a significant increase with increasing age. According to current criteria for diastolic dysfunction, the prevalence of dysfunction decreases with increasing age in the general population, as well as in the subgroup with cardiovascular disease. Only 7% of the variance in deceleration time was explained by cardiovascular disease or risk factors. For the E/A ratio, however, 41 and 48% of the variance were explained for men and women, respectively. CONCLUSION: Age- and gender-specific criteria for normality are provided. Our data confirm the existence of a significant effect of age and gender on mitral Doppler indices of diastolic dysfunction. However, Doppler criteria for diastolic dysfunction based on these measurements need revision.     

Renal insufficiency and vascular complications after primary angioplasty via femoral route. Impact of vascular closure devices use

Introduction and objectives

We sought to determine the incidence of vascular complications in patients with chronic kidney disease undergoing primary angioplasty via the femoral route; we also evaluated the safety and efficacy of the use of vascular closure devices in this setting.

Methods

Registry of 527 patients undergoing primary angioplasty via the femoral route from January 2003 to December 2008. Chronic kidney disease was defined as creatinine clearance less than 60 mL/min. The primary endpoint was the presence of major vascular complications.

Results

Baseline chronic kidney disease was observed in 166 (31.5%) patients. Patients with chronic kidney disease experienced higher rates of major vascular complications compared to those without worsening of renal function (8.4% vs 4.2%; P=.045), especially those requiring transfusion (6.6% vs 1.9%; P=.006). Among patients with chronic kidney disease, 129 (77.7%) received a vascular closure device and manual compression was used in 37 patients (22.3%). The risk of major vascular complications was significantly lower with vascular closure device use compared to manual compression (4.7% vs 21.6%; P=.003). Multivariable logistic regression analysis showed that the use of a vascular closure device was independently associated with a decreased risk of major vascular complications in patients with chronic kidney disease undergoing primary angioplasty (odds ratio=0.11; 95% confidence interval, 0.03-0.41; P=.001).

Conclusions

Patients with chronic kidney disease undergoing primary angioplasty via the femoral route experience higher rates of major vascular complications. The use of vascular closure devices in this group of patients is safe and is associated with lower rates of major vascular complications compared to manual compression.Full English text available from:www.revespcardiol.org     

Speckle tracking imaging as a predictor of left ventricular remodeling 6 months after first anterior ST elevation myocardial infarction in patients managed by primary percutaneous coronary intervention

Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. LV remodeling is an important factor in the pathophysiology of advancing heart failure (HF).

The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study. Doppler Endpoints Balloon Angioplasty Trial Europe.

BACKGROUND: There are limited data regarding the immediate and long-term effect of balloon angioplasty on the coronary flow reserve evaluated in a multicentre setting. METHODS AND RESULTS: A total of 86 patients with one-vessel disease and normal left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis <35%) and at 6-month follow-up. Coronary flow reserve was assessed with a Doppler guide wire. A low coronary flow reserve (2.5 (46% vs 23% and 36% vs 16%, respectively; P<0.05) due to a trend towards restenosis (29% vs 16%; P=0.15) or a low coronary flow reserve at follow-up due to persistent elevated baseline blood flow velocity. Patients without restenosis showed a decrease or increase of coronary flow reserve during follow-up, determined by alterations of hyperaemic blood flow velocity. CONCLUSIONS: Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve >2.5. This patient group consists of patients prone to develop restenosis, while other patients are characterized by a persistently low coronary flow reserve, probably secondary to disturbed autoregulation and/or diffuse mild coronary atherosclerosis. Coronary flow reserve alterations in patients without restenosis were related to changes in hyperaemic blood flow velocity, suggesting that this phenomenon relates to epicardial remodelling.     

A comparison of two methods to measure coronary flow reserve in the setting of coronary angioplasty: intracoronary blood flow velocity measurements with a Doppler catheter, and digital subtraction cineangiography

Intracoronary blood flow velocity measurements with a Dopplerballoon catheter and the radiographic assessment of myocardialperfusion with contrast media, before and after the intracoronaryadministration of papaverine, have previously been used to investigateregional coronary flow reserve. In the present study we appliedboth techniques in 21 patients to measure coronary flow reservein the setting of coronary angioplasty. Pre-angioplasty (N=14)and post-angioplasty (N=19) measurements of coronary flow reservewere obtained by digital subtraction cineangiography in themyocardial region supplied by the dilated coronary artery, andwith the Doppler probe in the proximal part of the dilated vessel.The reactive hyperaemia following the final balloon inflationwas recorded with the Doppler balloon catheter still positionedacross the stenotic lesion. Coronary stenosis geometry was quantifiedwith the Cardiovascular Angiography Analysis System. When theepicardial stenosis was the only factor causing a reductionin coronary flow reserve, flow reserve measured with both digitalsubtraction cineangiography and with the Doppler probe correlatedwell with the cross-sectional area at the site of obstruction,r = 0·88, SEE =0·36 and r = 0·77, SEE =0·45respectively. In contrast, when other factors decreasing coronaryflow reserve were present (intimal dissection, left ventricularhypertrophy, previous myocardial infarction, collaterals) measurementsobtained with both techniques correlated poorly with cross-sectionalarea (r = 0·55, SEE =0·57, and r = 0·59,SEE =0·50). Flow reserve measurements obtained with digitalsubtraction cineangiography correlated well with the measurementsobtained with the Doppler probe (r = 0·85, SEE=0·38,and r = 0·87, SEE =0·34), although the two approacheshave methodologically nothing in common and their respectiveregions of interest (myocardium for the radiographic techniqueand intracoronary lumen for the Doppler technique) are basicallydifferent. Furthermore, the reactive hyperaemia following thefinal balloon inflation was related to the flow reserve measuredwith both the angiographic technique (r = 0·85, SEE =0·34)and the Doppler technique (r = 0·83, SEE=0132) usingpharmacologically induced coronary vasodilatiori with intracoronarypapaverine. This suggests that the same quantity of coronaryflow reserve that can be recruited pharmacologically can berecruited by ischaemia following a transluminal occlusion.     

冠心病左心功能不全时肺静脉血流频谱的研究

目的 :通过对冠心病 (CHD)左心功能不全患者的肺静脉血流频谱的研究探索肺静脉血流频谱在CHD左心功能评定中的意义。方法 :应用脉冲多普勒技术对 132例左心功能Ⅰ～Ⅳ级的CHD患者及 90例健康人 (正常对照组 )进行了肺静脉血流频谱各项参数的测定并进行对照研究。结果 :与正常对照组相比CHD患者的肺静脉血流频谱D波的最大流速 (Dp)、S波最大流速 (Sp) /Dp及二尖瓣血流频谱的E峰的最大流速 (E)、A峰的最大流速 (A)在Ⅰ、Ⅱ、Ⅲ级心功能出现异常 (P <0 .0 5～ 0 .0 1) ,肺静脉血流频谱S波持续时间 (ST)及二尖瓣血流E/A在Ⅰ、Ⅱ、Ⅲ、Ⅳ级心功能均出现异常 (P <0 .0 5～ 0 .0 0 1) ,S波的速度和时间积分 (Si)、A波的速度和时间积分 (Ai)在Ⅲ、Ⅳ级心功能时出现异常 ,A波持续时间 (AT)在Ⅲ级心功能时出现异常 (P <0 .0 5 )。Sp、肺静脉的收缩期积分 (SF)在Ⅳ级心功能时才出现异常 (P <0 .0 1)。结论 :CHD患者舒张功能受损早于收缩功能 ,一旦出现收缩性心功能不全 ,临床上均为混合型左心功能不全。如果已经存在严重左心收缩功能不全的CHD患者肺静脉血流频谱Dp、D波的速度和时间积分 (Di)、AT及二尖瓣血流频谱E/A正常化说明是左心舒张功能严重受损的一种假性正常化。肺静脉血流频谱Dp、ST、Sp/Dp为CHD患者早期     

Improvement in diastolic left ventricular function after coronary artery bypass grafting as assessed by recordings of mitral annular velocity using Doppler tissue imaging.

AIMS: The aim of the study was to evaluate the changes in diastolic function after coronary artery bypass grafting (CABG), using pulsed-wave Doppler tissue imaging (DTI). METHODS: Fifty-three patients with coronary artery disease were studied before and 3 and 12 months after CABG. Using pulsed-wave DTI, the mitral annular velocities were determined at 4 sites in the left ventricle (LV). Patients were also examined with dobutamine stress echocardiography and myocardial scintigraphy before and 3 months after CABG. RESULTS: The conventional transmitral velocity profiles were unchanged after CABG. DTI showed a marked improvement in diastolic LV function after CABG (early diastolic velocity: 7.5+/-1.9, 8.2+/-1.7 and 9.3+/-2.7 cm/s before and 3 and 12 months after CABG, respectively, P < 0.01). The improvement in early diastolic velocity was more pronounced in patients showing no sign of residual ischemia in comparison to those with residual ischemia determined by myocardial scintigraphy (7.41+/-2.04 vs. 9.25+/-2.61 cm/s, P < 0.01 in the nonischemic group; 7.29+/-2.16 vs. 8.41+/-2.55 cm/s, n.s., in the ischemic group). Before CABG, a significant increase in the systolic velocity (6.4+/-1.3 vs. 8.7+/-2.5 cm/s, P < 0.001), but not the early diastolic velocity (7.6+/-1.9 vs. 8.0+/-2.2 cm/s), was noted during stress echocardiography. Three months after CABG, both the systolic (6.5+/-1.3 vs. 9.3+/-2.8 cm/s, P < 0.001) and the early diastolic velocities (8.1+/-1.8 vs. 10.3+/-2.2 cm/s, P < 0.001) improved during stress echocardiography. CONCLUSION: The results of the present study show that diastolic function improves at rest and under stress in patients after CABG. The improvement was seen only in patients without postoperative signs of reversible ischemia.     

Tissue Doppler imaging and conventional echocardiography after anthracycline treatment in adults: early and late alterations of left ventricular function during a prospective study.

AIM OF THE STUDY: To evaluate the short and long-term effects of anthracycline chemotherapy in adults using conventional echocardiography and pulsed tissue Doppler imaging (TDI). METHODS AND RESULTS: Twenty patients were included of which 16 had a complete follow up. They underwent an echocardiography before chemotherapy, 1-3 months and 3.5+/-0.6 years after the treatment. We recorded pulsed TDI at the mitral annulus, the basal segments of the left ventricular (LV) lateral and posterior walls; peak velocities in systole (Sm), early (Em) and late diastole and the isovolumic relaxation time (IVRT) were measured. The cumulative dose of doxorubicin was 211+/-82 g/m2. Early after anthracycline therapy, we observed changes in the diastolic LV function with a decrease of the mitral E peak velocity and TDI Em. At the late control, diastolic changes were more pronounced and associated with an alteration of the systolic function (LV ejection fraction and Sm). Four patients had a LV ejection fraction <50%; in these patients we observed a mitral annulus IVRT <80 ms at the early control; this could be of interest to predict later impairment of the LV ejection fraction. CONCLUSION: We found early changes in LV diastolic function and observed that late impairment of the LV ejection fraction occurred frequently after anthracycline therapy, despite normal systolic LV function during the first months of follow-up.