Highlights • Patients with acute heart failure and LVEF ≤ 40% were included. • Echocardiography was performed, and the patients were followed for a mean of 5 years. • Myocardial performance index ...(MPI) had the strongest association with mortality. • MPI ≥ 0.67 meant a 13-fold higher risk of cardiovascular mortality than MPI < 0.67. • MPI might in the future be included in prognostic score models in heart failure.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Coronary microvascular dysfunction (CMVD) is associated with adverse cardiovascular outcome. We aimed to determine the prevalence of CMVD and factors related to index of microcirculatory resistance ...(IMR) in consecutive patients with chronic coronary syndrome (CCS) undergoing elective coronary angiography.
Non-interventional physicians enrolled 274 patients with CCS before angiography, to minimize selection bias by PCI-operators. Fractional flow reserve (FFR) and IMR were measured in the LAD. Subjects with extensively diseased LAD, no measures due to technical reasons or violation of protocol were excluded from the analysis (n = 54). The proportion of patients with IMR corrected for collateral flow (IMRcorr) >25 units was 25% (95% confidence interval CI 19%–31%) in all 220 patients. In subjects with FFR ≤0.80 in the LAD the proportion of IMRcorr > 25 units was 21% (95% CI 13%–30%) as compared to subjects with FFR >0.80, 29% (95% CI 21%–36%), p = .268. Haemoglobin (p < .005; r2 = 0.084), FFR in the LAD (p = .001; r2 = 0.049), creatinine clearance (p = .001; r2 = 0.049; inversely), and NT-proBNP (p = .038; r2 = 0.021) were independently associated with IMRcorr in multivariate linear regression analysis.
We report that IMRcorr is associated with renal dysfunction, NT-proBNP, FFR in the LAD and, for the first time, blood haemoglobin. One in four of patients referred for coronary angiography due to CCS have CMVD defined as IMRcorr > 25 in the LAD.
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•IMR is associated with blood haemoglobin, renal dysfunction, NT-proBNP and FFR.•One in four patients undergoing elective coronary angiography have CMVD.•IMR assessment is associated with use of 19 ml contrast and 2.1 min fluoroscopy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Microvesicles (MVs) released from leukocytes, platelets and endothelial cells are elevated in patients with acute coronary syndrome (ACS). In the present study, we assessed the potential ...pro-aggregatory properties of MVs obtained from ACS patients. Thus, we divided the patients into two groups based on clopidogrel-responsiveness, i.e. high on-treatment platelet reactivity (HPR; n = 16), and low or normal on-treatment platelet reactivity (non-HPR; n = 14), respectively. MVs from patients were obtained by high-speed centrifugation, and the pro-aggregatory effect of MVs added to fresh isolated platelets from healthy subjects were analyzed by 96-well microplate aggregometry. MVs from HPR patients significantly enhanced spontaneous platelet aggregation around two times more than MVs from non-HPR patients. The pro-aggregatory effect of three out of four MV phenotypes correlated to MV-concentrations as determined by flow cytometry. Furthermore, MVs from patients with diabetes mellitus (n = 9) had a stronger pro-aggregatory effect compared to MVs from those without diabetes (n = 21; p = .025 between groups). In conclusion, MVs from ACS patients with clopidogrel non-responsiveness enhance platelet aggregation, as do MVs from ACS patients with diabetes. Thus, MVs from patients with hyperreactive platelets boost platelet aggregation. Blocking MV-formation may reduce platelet hyperreactivity.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim was to study the prognostic value of left ventricular (LV) function using pulse-wave tissue Doppler imaging (TDI) in an ordinary population with heart failure (HF). One hundred fifty-six ...patients hospitalized for HF and LV ejection fraction ≤40% were examined using conventional echocardiography and pulse-wave TDI for the assessment of longitudinal LV function. Mitral annular systolic and early diastolic (e′) velocities were recorded from a mean of 4 annular sites from the apical 2- and 4-chamber views. Noninvasive LV filling pressure was calculated from the ratio between transmitral early inflow velocity (E) and e′. All patients were followed up for 2 years, and data from the National Registry of Deaths were collected. Mean LV ejection fraction was 24.7 ± 7.2%. TDI recordings showed a mean mitral annular systolic velocity of 5.0 ± 1.0 cm/s and e′ velocity of 6.2 ± 1.9 cm/s. E/e′ ratio was 14.1 ± 4.8. Thirty patients (19%) had atrial fibrillation. During follow-up, 27 patients (17%) died of a cardiovascular cause. Multivariate analysis showed that only E/e′ ratio and age were predictors of cardiovascular mortality. A cut-off value for E/e′ ratio >13 had sensitivity of 84% and specificity of 45% to identify patients who died within 2 years of cardiac reasons. In conclusion, in the acute stage of HF, E/e′ ratio is a strong independent predictor of long-term cardiovascular mortality in an ordinary population with HF and systolic dysfunction. Systolic and diastolic velocities had no independent prognostic value.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Assessment of myocardial velocities by Doppler tissue imaging is gaining in importance. However, generally accepted reference values are still missing. In this study we examined 62 consecutive ...healthy subjects (mean age 46, range 22-82 years) by pulsed wave Doppler tissue imaging to characterize the systolic and diastolic velocity profiles of the left and right ventricles. The subjects were divided into 3 different age-groups: group I, younger than 40 years; group II, 40 to 59 years; and group III, 60 years and older. Recordings were made along the long axis in the apical 4- and 2-chamber views by using 4 sites (septal, anterior, lateral, and inferior) at the mitral annulus and 1 site at the tricuspid annulus. Systolic mitral annular velocity (10.3 +/- 1.4 cm/s) correlated strongly with global left ventricular function determined by M-mode echocardiographic mitral annular displacement (r = 0.70, P <.001). The systolic velocity was significantly lower in group III than in group I (9.6 vs 10.8 cm/s, P <.01). A relatively weak, but significant, correlation was found between systolic velocity and the age of the subjects (r = -0.43, P <.001). Mitral annular early diastolic velocity was also lower in group III compared with group I (11.3 vs 17.7 cm/s, P <.001), with a strong correlation with age (r = -0.81, P <.001) and other conventional Doppler diastolic parameters. Both the systolic and early diastolic mitral annular velocities at the septum were lower than at other left ventricular sites. Tricuspid annular systolic velocity (15.2 +/- 1.9 cm/s) was higher than mitral annular systolic velocity (P <.001). Unlike mitral annular velocity, systolic tricuspid annular velocity was not correlated with age. However, the diastolic tricuspid annular velocities correlated well with transtricuspid Doppler diastolic parameters. The method of recording the annular velocities was feasible in all subjects, simple and highly reproducible.
The prognostic value of right ventricular function determined by echocardiographic assessment of tricuspid annular motion in 194 patients after a first myocardial infarction and in 24 age-matched ...healthy persons is discussed. The tricuspid annular motion was reduced in patients with myocardial infarction compared with that in healthy age-matched persons, and was significantly lower in patients with fatal outcome than in survivors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract
OBJECTIVES
Decreased right ventricular (RV) longitudinal function following coronary artery bypass grafting (CABG), as assessed by tricuspid annular systolic excursion (TAPSE) and RV peak ...systolic velocity (RVS′) is a known condition. We aimed to explore the feasibility of the right ventricular index of myocardial performance (RIMP) in the assessment of RV function after CABG at rest and during peak dobutamine stress echocardiography (DSE).
METHODS
Forty-two patients indicated for CABG were included in this study. Coronary angiography, DSE and exercise bicycle test were performed within 6 weeks before and 3 months after CABG. The RIMP, RVS′ and TAPSE at the lateral tricuspid annulus were also assessed. The results were presented as mean ± standard deviation.
RESULTS
The RIMP improved after CABG both at rest (0.45 ± 0.11 before vs 0.38 ± 0.08 after CABG, P = 0.013) and during DSE (0.75 ± 0.23 vs 0.49 ± 0.14, P < 0.001). TAPSE declined significantly when comparing the values from before CABG to after CABG both at rest (23.9 ± 4.46 vs 14.6 ± 3.67, P < 0.001) and during DSE (20.9 ± 4.16 vs 11.9 ± 3.60, P < 0.001). RVS′ also decreased after CABG both at rest (11.9 ± 2.40 vs 8.5 ± 1.93, P < 0.001) and during DSE (15.6 ± 4.30 vs 10.5 ± 3.21, P < 0.001). On the other hand, exercise capacity improved after CABG compared with baseline (128.4 ± 40.12 W vs 142.1 ± 46.73 W, P = 0.014).
CONCLUSIONS
RIMP improved after CABG both at rest and during DSE. The reduction in TAPSE and RVS′ after CABG indicate reduced regional mechanical RV function along the long axis rather than reduced global RV function.
Aims
Myocardial performance index (MPI) is a measure of combined systolic and diastolic myocardial function. In patients with coronary artery disease (CAD) an increase in MPI is consistent with ...myocardial dysfunction. The objectives of this study were to characterize the changes in MPI after coronary artery bypass graft (CABG) at rest and at peak dobutamine stress echocardiography (DSE).
Methods and Results
Thirty‐six patients diagnosed with CAD and accepted for CABG were studied by standard echocardiography and DSE 1 month prior and 3 month after CABG. The MPI was calculated using pulsed‐wave tissue Doppler imaging (PW‐TDI) of the left ventricular (LV) wall‐motion velocity. At baseline, ejection fraction (EF; 42.7 ± 8%) and wall‐motion score index (WMSI; 1.1 ± 0.2) were impaired at rest as well as at peak DSE (EF; 49.2 ± 9 and WMSI 1.4 ± 0.2). MPI was prolonged both at rest (0.61 ± 0.13) and at peak DSE (0.78 ± 0.16). After CABG, EF and WMSI did not improve at rest (43.7 ± 8% and 1.1 ± 0.2, respectively). On the other hand, MPI improved substantially both at rest (0.45 ± 0.08; P < 0.001) and at peak DSE (0.56 ± 0.1; P < 0.001). At peak DSE an improvement of EF (54.2 ± 9; P < 0.05) and WMSI (1.1 ± 0.16; P < 0.001) was seen as well.
ConclusionMyocardial performance index shows significant improvement after CABG in patients with CAD both at rest and peak DSE and appears to be a sensitive measure of myocardial function.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract
Platelet monitoring is presently under evaluation in the clinic as a tool to improve antiplatelet treatment in patients with coronary artery disease (CAD). Measuring platelet function has, ...however, many inherent problems. It is important not only to evaluate the method used, but also to evaluate and standardize sampling and sample handling. As platelet monitoring is often performed in connection to coronary angiography and percutaneous coronary interventions, arterial sampling may be more convenient. However, in the outpatient follow-up setting venous sampling is, for obvious reasons, more practical and convenient. In the present study we compared platelet aggregation in blood collected from the arterial sheath to blood collected from the antecubital vein using multiple electrode aggregometry in whole blood in 28 patients with CAD. We found that sampling from artery and vein give similar data and that an identical number of patients with insufficient antiplatelet responses ('low responders' to aspirin and clopidogrel, respectively, according to predefined criteria) were detected with respect to adenosine diphosphate induced and arachidonic-acid induced aggregation. Thus both arterial and venous blood samples can be used in the monitoring of platelet function when multiple electrode aggregometry is applied to detect 'low responders'.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Right ventricular (RV) involvement in patients with ST elevation myocardial infarction (STEMI) is a clinically important problem. The aim of this study was to evaluate the use of ...tricuspid annular velocity assessed by Doppler tissue imaging (DTI) as a marker of RV involvement in patients with a first STEMI. Methods: Seventy‐one patients with a first STEMI were examined by echocardiography before discharge and after 6 months. The patients were compared to 31 healthy subjects (HS). The diagnosis of RV infarction was based on the presence of ≥ 1 mm ST elevation in the right precordial ECG lead V4R. Tricuspid annular systolic and diastolic velocities using pulsed‐wave DTI were recorded at the RV free wall. Results: At day 1, tricuspid annular velocities were significantly reduced in patients with, compared to those without, ST elevation in V4R (11.1 vs. 13.7 cm/sec, 9.4 vs. 13.1 cm/sec and 14.1 vs. 15.9 cm/sec for systolic, early, and late diastolic velocities, respectively; P < 0.01). With a cutoff value for a tricuspid annular systolic velocity of 13 cm/sec, sensitivity and specificity for identifying patients with ST elevation in V4R were 89% and 71%, respectively. After 6 months, both tricuspid annular systolic and diastolic velocities in patients with RV infarction had increased significantly, but only tricuspid annular systolic velocity was still reduced compared to HS (12.3 vs. 14.7 cm/sec; P < 0.01). Conclusion: Tricuspid annular velocities assessed by DTI may be used as a marker of RV involvement in the acute and the late phase after a first STEMI. (ECHOCARDIOGRAPHY 2010;27:139‐145)
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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