QT interval prolongation on surface ECG shows significant association with mechanical dyssynchrony and LV dysfunction in HCM. This may add pathophysiological insight into understanding ECG changes in such myocardial disease.
Objectives: Our study aimed to demonstrate the early negative impact of right ventricular apical pacing induced by single (VVI) and dual chamber (DDD) pacemakers on LV functions in patients with preserved EF. And to assess that single brain natriuretic peptide (BNP) after 2 months of implantation is correlated to ventricular dyssynchrony. Methods: 40 patients with implanted VVI and DDD pacemakers were examined before implantation and again after 2 and 6 months of implantation for BNP, left ventricular (LV) systolic and diastolic functions by echocardiography and pulsed tissue Doppler. After 6 months, patients with DDD pacemakers were crossed over to VVI mode of pacing for 2 weeks with lower rate programed to 60 beat per minute then sample for BNP was collected again. Results: There was no statistically significant difference in LV systolic and diastolic functions except for myocardial performance index (MPI) with (P value of 0.03). Mean BNP level in VVI pacing was higher than DDD pacing after two months with P value = 0.001 while comparison after 6 months showed P value = 0.023. There was a statistically significant difference between both groups in results of aortic preejection delay (APED) (P value of <0.05). BNP was correlated to APED (r = 0.651 and P value = 0.001) and pacing percentage (r = 0.687 and P value = 0.00). Conclusion: Loss of atrioventricular synchrony in VVI mode leads to a significant difference in LV dyssynchrony between both groups. BNP level is correlated to LV dyssynchrony and pacing percentage. ª 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Cardiology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
Background: Coronary no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is associated with a poor clinical outcome. Although its pathophysiology is not fully understood, a deregulated systemic inflammatory response plays an important role. We aimed to explore the relationship between platelet\lymphocyte ratio (PLR) and no-reflow in patients with acute STEMI who were treated with a primary percutaneous coronary intervention (PPCI). Methods: A total of 200 patients with STEMI undergoing PPCI were included in the study. Transthoracic echocardiographic examination was performed to assess left ventricular (LV) ejection fraction (EF) and wall motion score index. Blood samples were assayed for platelet and lymphocyte count before PPCI. No-reflow was defined as coronary blood flow thrombolysis in myocardial infarction grade ≤II. Results: No-reflow was observed in 58 (29%) of STEMI patients following PPCI. PLR was significantly higher in hypertensive patients compared to normotensive patients (144.7±91.6 vs. 109.1±47.1, respectively, P <0.001) and in the no-reflow group compared to the normal reflow group (214±93 vs. 101.6±51.3, respectively, P <0.0001). Logistic regression analysis revealed that PLR (β: 0.485, 95% CI: −0.006-0.001, P <0.002) and LV EF (β: 0.272, 95% CI: 0.009-0.034, P <0.001) were independent predictors of no-reflow after PPCI. Conclusion: Pre-procedural increase in PLR is predictive of the no-reflow phenomenon following PPCI in STEMI patients. Relevance for Patients: No reflow phenomenon is an unfavorable complication following PPCI in patients with acute STEMI. High pre-procedural PLR is an independent predictor of reperfusion failure and helps to identify patients who require prophylactic treatment.
BackgroundLeft ventricular (LV) diastolic dysfunction is a prominent feature of hypertrophic cardiomyopathy (HCM). Prediction of LV filling pressure using the ratio between early diastolic transmitral flow and mitral annular velocity (E/e') had proved a good accuracy.Aim of this studyWe investigated the value of E/e' to predict cardiovascular (CV) mortality in patients with HCM.MethodsA total of 243 patients with HCM had E/e' measured in combination with clinical evaluation, conventional echocardiographic measurements, cardiopulmonary exercise evaluation, and Holter monitoring.ResultsDuring a mean follow‐up of (3.2 ± 1.2 years), 17 (7%) patients died. Non survivors had significantly higher SBP, DBP, left ventricular outflow tract obstruction (LVOTO) gradient, mitral E, and E/e', but lower e' of mitral annulus and more prevalent restrictive filling pattern. E/e' was directly correlated with age (r = .24, P < .005), left atrial volume index (r = .44, P < .0001), LVMI (r=0.23,P<.005), LVOT gradient (r = .43, P < .0001), NYHA class (r = .19, P < .006), pulmonary artery pressure (r = .24, P < .005), positive family history of HCM (r = .22, P < .005), and inversely related to peak systolic velocity (S) (r = .44, P < .0001). By multivariate analysis, only LVOTO ([RR] 4.11, 95% CI 1.002 to 1.148, P < .04) and E/e' were independent predictors for overall mortality in HCM (relative risk [RR] 5.27, 95% CI 1.002 to 1.024, P < .02). The risk of dying increased with increasing E/e' ratio, being approximately 4 times higher for patients in the highest quartile (HR 3.8 (CI 1.38‐5.12, log‐rank < 0.002)).ConclusionsIn hypertrophic cardiomyopathy, the E/e' ratio remains a powerful predictor of all‐cause mortality, particularly if it is associated with LVOT obstruction.
Objectives: Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We assessed the global and regional left atrial (LA) function and its relation to left ventricular (LV) mechanics and clinical status in patients with HCM using Vector Velocity Imaging (VVI). Methods: VVI of the LA and LV was acquired from apical four- and two-chamber views of 108 HCM patients (age 40 ± 19years, 56.5% men) and 33 healthy subjects, all had normal LV systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ϵ)/strain rate (SR) measurements. Results: Left atrial reservoir (ϵsys,SRsys) and conduit (early diastolic SRe) function were significantly reduced in HCM compared to controls (P < .0001). Left atrial deformation directly correlated to LVϵsys, SRsys and negatively correlated to age, NYHA class, left ventricular outflow tract (LVOT) gradient, left ventricular mass index (LVMI), LA volume index and severity of mitral regurge (P < 0.001). Receiver operating characterist was constructed to explore the cutoff value of LA deformation in differentiation of LA dysfunction; ϵsys < 40% was 75% sensitive, 50% specific, SRsys < 1.7s− 1 was 70% sensitive, 61% specific, SRe> − 1.8s− 1 was 81% sensitive and 30% specific, SRa> − 1.5s− 1 was 73% sensitive and 40% specific. By multivariate analysis global LVϵsys and LV septal thickness are independent predictors for LAϵsys, while end systolic diameter is the only independent predictor for SRsys, P < .001. Conclusion: Left atrial reservoir and conduit function as measured by VVI were significantly impaired while contractile function was preserved among HCM patients. Left atrial deformation was greatly influenced by LV mechanics and correlated to severity of phenotype.
Background: We examined the impact of left anterior descending (LAD) wrapping on left ventricular (LV) mechanics in patients with normal coronary angiography. Seventy-one patients with evidence of normal coronary angiography (LAD wrapping: n = 52, 73%) and LAD non-wrapping (n = 19, 27%) were included in the study. Using 2D-strain imaging, we measured LV longitudinal and circumferential (circ) strain (ε sys), systolic strain rate (SR sys), early (SR e) and atrial (SR a) diastolic SR, LV electromechanical dyssynchrony (TTP-SD), and LV twist and torsion in study groups. Results: No significant difference in age, gender, body surface area (BSA), or ejection fraction (EF%) between groups. LAD-wrapping group showed higher deceleration time (DT) (P < 0.0001), global longitudinal ε sys % (P < 0.02), circ SR a at the basal segments (P < .02), circ SR sys and SR e, and SR a (P < 0.0001) at the apical segments and apical rotation compared with the non-wrapped group. LV twist was correlated negatively with LV electromechanical dyssynchrony (r = .25, P < 0.03) and positively with longitudinal ε sys (r = .47, P < .0001), circ ε sys% (r = .55, P < .0001), circ SR sys (r = .23, P < .05), and circ SR e (r = .55, P < .0001). Using multivariate regression analysis, DT: OR 0.932, CI 0.877-0.991, and P < 0.02 and circ at atrial diastole (SR a): OR 0.000, CI .000-.271, and P < 0.03 were independent predictors of LAD wrapping around LV apex. Conclusion: Wrapped LAD is associated with better myocardial relaxation and rotational mechanics in patients with normal coronary angiography. This could explain the worse prognosis in such population when LAD occlusion acutely emerges.
Background Aortic root motion was used only as a surrogate parameter of global left ventricular systolic function depending on its direct proportion to cardiac output. We hypothesize that aortic root motion angle and aortic root motion amplitude may overcome many limitations of EF calculation by M mode and two dimensional methods and are easier and reproducible.Objective The aim of this study is to asses systolic aortic root motion measured by M mode and aortic root motion angle as novel indices of global left ventricular systolic function.Patients and methods one hundred patients were enrolled in this study and divided into four groups: according to their age (above and below 60 years) and EF (above and below50%). They were subjected to full history taking, careful clinical examination, and conventional echo-Doppler study .Systolic aortic root motion obtained from long axis parasternal view by M-mode echo guided by 2D echo, and aortic root motion angle was traced off line and mathematically measured. Also global logitudinal strain (GLS) and global longitudinal strain rate (GLSR) from apical 4,3 and 2 chamber views were measured offline.Results Statistical analysis of collected data show that there are significant differences between control groups and patient groups in aortic root motion angle (t= 16.9 and p value <0.001, and in aortic root motion amplitude (t= 20.1 and p value <0.001). Aortic root motion (cm) and aortic root motion angle have significant positive correlation with EF(Mm), EF(2D), Fs, global longitudinal strain(GLS) and global Strain rate . The best cutoff value of aortic root motion angle was 19.5 degree, with sensitivity of 93.9%, specificity of 96.1.Aortic root motion angle >19.5 predicts systolic function >50% and that<19.5 predicts systolic function <50% The best cutoff value of aortic root SAM was 8.5 mm. An aortic root SAM of ˂ 8.5 mm predicts an LVEF of ˂ 50% with sensitivity of 95.9%, specificity of 96.1%.Conclusion The amplitude of systolic aortic root motion (SARM) by (M-mode) and aortic root motion angle are well- correlated with the EF and GLS and could be considered as novel indices of global left ventricular systolic function with high accuracy and reproducibility .
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