Background: Determining severity of mitral regurgitation (MR) is very important, asit is related with prognosis and management of the disease. Currently, there is no goldstandard exists for quantification of MR severity using echocardiography. AmericanSociety of Echocardiography (ASE) guidelines recommend several parameters basedon integrative criteria using color and spectral Doppler and anatomic measurement.Left Ventricular Early Inflow Outflow Index (LVEIO Index) was proposed as one parameterto assess the severity of MR by omitting geometric error from regurgitantvolume method. Thus, LVEIO index offers a simple, easy and accurate measurementin determining severity of MR.Methods: This study was a diagnostic test research with cross-sectional design. Thesubjects were all patients with organic mitral regurgitation who underwent echocardiographyexamination to measure severity of MR using the LVEIO index as well asother parameters measurements based on parameters of ASE guidelines. Diagnostictest was used to determine the sensitivity, specificity, positive predictive value, negativepredictive value and accuracy of LVEIO index.Results: Of 49 patients in this study, 23 of them have severe MR and 26 are non-severeMR patients. The proportion of gender between two groups almost similar with an agerange from 56 to 61 years and the most common etiology finding was degenerative MR.Echocardiography examination showed the ejection fraction in severe MR was 63±4.2%and 64±3.9% in non-severe MR. The value of LAVI, MPAP, E-wave, VC, EROA andLVEIO index increased parallel with severity of MR (LAVI; 67±18.2 vs. 40±14.2 ml/m2,MPAP; 28±12.8 vs. 20±12.6 mmHg, E-wave 1.5±0.3 vs. 1±0.2 m/s, VC 0.8±0.3 vs.0.5±0.1 cm, EROA 0.4±0.1 vs 0,2±0,1cm2, LVEIO 9±2,4 vs. 5±1,8). The sensitivity,specificity, and accuracy of LVEIO index for diagnosis of severe MR were 86%, 84%,and 89%, respectively.Conclusion: LVEIO can be proposed as a relatively simple, easy and accurate methodin determining severity of MR.
Abstract:The authors presented a letter on the article by Hao et al. published and who refused from PCI were compared. Factors associated with refuse from primary PCI were separated. Besides huge practical importance the study by Hao et al. had methodological dignities. They are dividing prehospital phase (time from symptom onset to admission) into 4 time frames (≤2, 2-6, 6-24, and ≥24 h) and separate analysis of PCI performance in five age subgroups of AMI patients (≤59, 60-69, 70-79, 80-89, and ≥90 years). These features of the study allow comprehensive analysis of medical care process among AMI patients in the MIYAGI-AMI Registry Study.But to our opinion the presented study had several limitations. Firstly, Hao et al. used a restricted set of clinical parameters of AMI patients to reveal predictors of refuse from primary PCI with the help of multivariate logistic regression analysis (age, sex, history of hypertension, diabetes mellitus, dyslipidemia, current smoking, prior myocardial infarction, infarction site, onset at night, ambulance use for admission, elapsed time from symptom onset to admission, and coexisting acute heart failure on admission). Other authors used expanded set of clinical parameters for similar goal that allow detailed analysis of the clinical status of patients with performed PCI and patients refused from intervention [2,3]. Furthermore, there is no clear description of the criteria for inclusion and exclusion of patients from the study by Hao et al. [1]. In this context, we would deeply appreciate if the authors could share some useful data with us. 1) Please, clarify a basis of selection of clinical characteristics for multivariate analysis? 2) What inclusion and exclusion criteria were used in the presented study?Secondly, the absence of separation of patients with STsegment elevation myocardial infarction (STEMI) and non-STEMI patients complicates the interpretation of the study results. It is major limitation of the MIYAGI-AMI Registry Study. It is known that ST-segment elevation on electrocardiogram (ECG) is a main factor associated with PCI performance among patients with acute coronary syndrome [3]. However, in both studies (ref.1 and ref.3) there are some similar results (in particular, the impact of gender and age to PCI perfomance). The other results of these studies complement each other and, of course, are of great scientific and practical interest. Conflict of interest: none declared. Editorial Comments
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