- Email: [email protected]
Change of the new left ventricular function index (TEI INDEX) in acute myocardial infarction
108
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 2 1998
173 CHANGE OF THE NEW LEFT VENTRICULAR FUNCTION INDEX (TEl INDEX) INACUTE MYOCARDIAL INFARCTION Hidetsuna Kitamura, Akira Takarada, Hiroyuki Kurogane, Teishi Kajiya, Takatoshi Hayashi, Junya Shite, Akihiro Yoshida, Takeshi Itagaki, Masayuki Shouda, Yutaka Yoshida Department of Cardiovasucular center,Himej Indices derived from pulsed-Doppler echocardiography (PDE) has recently been proposed as simple means for the evaluation of both systolic and diastolic left ventdcular (LV) function. These new indices are LV index=(isotonic contraction time OCT) + isotonic relaxation time (IRT))/ejection time (ET), ICT index= ICT / ET and IRT index= IRT / ET, We studied these indices in t7 patients (pts) with acute myocardial infarction (AMI) successfully treated by primary PTCA within 24 hours from the onset. Nine pts sufferd from LAD proximal infarction. We obtained by PDE derived indices and LVEF on day, 0, 6, 21 after on the set. Left ventricular end-diastolic pressu re(LVEDP)and pulmonary wedge pressure (PC) was also obtained by catherization on day, 0, 21. All PDE indices were independent on hemodynamics at each studypoint. Serial change in each index from day 0 to day 21 at follows. LV index: 0.65 ±0.29,0.69 _+0.29 and 0.89_+ 0.23,(p <0.01),tCT index: 0.24_+ 0.12,0.23 _+0.11 and 0.30 _+0.12,(N.S),lRTindex: 0.40 _+0.30,0.45 _+0.25 and 0.60 _+0.18,(p < 0.01). LVEF:41 + 9,44 ± 10,and46 ± ?,(p < 0.01 ),LVEDP:22 _+ 7,18 _+ 6,(N.S),PC:12 ± 5,8 _+ 4,(p=0.02).ln conclusion; LVEF and PC improved ,but LV index and IRT index increased . There was difference between LVEF and LV index. These results indicate that new indices may predict another aspect of left ventiricular function.
175
174 DIASTOLIC RESPONSE DURING LOW DOSE DOBUTAMINE STRESS ECHOCARDIOGRAPHY IS RELATED TO THE OUTCOME OF PATIENTS WITH MILD TO MODERATE CHRONIC HEART FAILURE Kazuya Murata, Kayo Ueda, Takashi Tone, Yasuaki Tomochika, Shire One, Kazumi Morikuni, Masunori Matsuzaki Second Department of Internal Medicine, Yamaguchi University, Ube 755-8505, JAPAN It is well known that restrictive transmitral flow(TMF) pattern is predictive of higher cardiac mortality in patients(pts) with chronic heart failure(CHF). However, prognostic value of non-restrictive TMF pattem(NR) in pts with CHF is still unknown. We evaluated changes in left ventdcular(LV) filling with low dose dobutamine stress echocardiography(DSE) and assessed the prognostic significance of changes of LV filling in pts with CHF showing NR. Low dose (10mcg /kg/min) DSE was performed in 45 pts(36men, age 60+11 years) with CHF(35 pts with prior myocardial infarction, 10 with dilated cardiomyopathy) in NYHA class I1-111with a mean LVEF of 40+13%. Pts were followed over 22+7 months for cardiac events. We measured peak velocities of eady(E) and late(A) diastolic TMF. Isovotumetdc relaxation time(IRT:msec) and deceleration time(DT:msec) of TMF were also measured. We obtained LV outflow time-velocity integrals(OTI) as an index of stroke volume. Then, we evaluated the relations between the changes(A) of these variables during DSE and cardiac events. Pts were subdivided into two groups who had cardiac events(CE:16pts) and had not(NCE:29pts)during followed period. In NCE, percent& IRT shortened significantly during DSE compared to that in CE (NCE:-25% vs CE:-2.4%, p<0.01).ADT,&A/E and AOTI did no~ differ between the two groups. Multivariate analysis showed thatA IRT was the only independent predictor of cardiac events (p<0.01). Conclusions: The shortening of IRT with dobutamine was significantly related to less cardiac event in pts with CHF, suggesting that preserved lusitropy might have favorable effects on the clinical outcome in pts with CHF. Assessment of LV diastolic property with DSE might be useful to predict the outcome in pts with mild to moderate CHF.
176
T I M E R E L A T I O N S H I P B E T W E E N LEFT V E N T R I C U L A R WALL MOTION AND TRANSMITRAL FLOW VELOCITIES DURING EARLY DIASTOLE
EVALUATION OF LEFT VENTRICULAR DIASTOLIC FUNCTION IN MITRAL STENOSIS:ANALYSIS USING NET ATRIOVENTRICULAR COMPLIANCE
Yukiko Onose, Takashi Oki, Yuichiro Mishiro, Hirotsugu Yamada, Miho Abe, Kazuyo Manabe, Yoshimi Kageji, Tomotsugu Tabata, Arata luchi Tokushima University, Tokushima, Japan.
Hiroshi Ikawa, Yutaka Hirano, Yoshinao Ozasa, Satoru Yamada, Hisakazu Uehara, Kinji Ishikawa First Department of Internal Medicine, Kinki University, Osaka 589-8511, Japan
Purpose: To evaluate the time relationship between left ventricular (LV) wall motion and transmitral flow (TMF) velocities during early diastole. Methods: Subjects consisted of 18 patients with hypertrophic cardiomyopathy, 27 with hypertensive heart disease, 12 with dilated cardiomyopathy and 40 normal controls (N: 43_+ 12 yrs). The motion velocity patterns were recorded at the middle site of the LV posterior wall (PW) in the apical long axis view of the LV using pulsed tissue Doppler imaging (TDI). Patients were divided into the two groups: Gr-RF (n=39) with the ratio of peak early to late diastolic TMF velocity (E/A)=<1, and Gr-PN (n=18) with E/A>1. Results: 1) The LV end-diastolic pressure (EDP) was higher, the time constant of LV pressure decay during isovolumic relaxation (Tau) was prolonged, and the peak early diastolic motion velocity (Ew) of the PW was lower in Gr-PN than in Gr-RF. 2) The time to onset of Ew from the second heart sound (IIA-Ew onset) was longer in Gr-PN than in Gr-N, and was longer in Gr-RF than in Gr-N. 3) The isovolumic relaxation time (IRT) was longer in Gr-RF than in Grs-PN and -N, whereas there was no significant difference between Grs-N and -PN. Conclusion: Combined analysis of LV wall motion by TDI and TMF provides important information regarding the LV early diastolic relaxation and filling.
The purpose of this study was to determine whether the left ventdcular diastolic function in mitral stenosis (MS) could be evaluated by Doppler echocardiography. This study population consisted of 55 patients with MS who did not have significant aortic regurgitation, left ventdcular hypertrophy, or ischemic heart disease. They were divided into two groups with respect to age:twenty-five patients who are 65 years of age or older (group E), and thirty patients below 65 years of age (group Y). As an indicator of the left ventricular diastolic function in MS patients, net left atrioventdcular compliance (On) was measured based on Newton's second law of motion: dq/dt=(Pa--Pv-Rc, q2-Rv, q)/M. Where, q:transmitral flow, Pa:left atrial pressure, Pv:left ventricular pressure, M:mitral valve inertance, Rc:convective mitral valve resistance, and Rv:viscous mitral valve resistance. By assuming the value of M and Rv to be zero in MS patients, Cn was calculated as follows: pressure haft-time × functional mitral orifice area / 11.6 × (initial pressure gradient) lf2 (ml/mmHg). The value of Cn was then compared between groups E and Y. Even though there were no significance in the functional mitral orifice area and (in t a pressure gradient) 1~ between the two groups, the pressure half-time was significantly shorter for group E. The average value of Cn for group E and Y was 4.14+0.99 and 5.06-+0.90 ml/mmHg, respectively, so it was significantly lower for E group (p<0.05). We believe that the value of Cn was lower for group E due to the aging process. The results of the present study showed that net atdoventricular compliance measured by Doppler echocardiography would be a useful indicator of the left ventdcular diastolic function in mitral stenosis.
Journal of Cardiac Failure Vol. 4 No. 3 Suppl. 2 1998
173 CHANGE OF THE NEW LEFT VENTRICULAR FUNCTION INDEX (TEl INDEX) INACUTE MYOCARDIAL INFARCTION Hidetsuna Kitamura, Akira Takarada, Hiroyuki Kurogane, Teishi Kajiya, Takatoshi Hayashi, Junya Shite, Akihiro Yoshida, Takeshi Itagaki, Masayuki Shouda, Yutaka Yoshida Department of Cardiovasucular center,Himej Indices derived from pulsed-Doppler echocardiography (PDE) has recently been proposed as simple means for the evaluation of both systolic and diastolic left ventdcular (LV) function. These new indices are LV index=(isotonic contraction time OCT) + isotonic relaxation time (IRT))/ejection time (ET), ICT index= ICT / ET and IRT index= IRT / ET, We studied these indices in t7 patients (pts) with acute myocardial infarction (AMI) successfully treated by primary PTCA within 24 hours from the onset. Nine pts sufferd from LAD proximal infarction. We obtained by PDE derived indices and LVEF on day, 0, 6, 21 after on the set. Left ventricular end-diastolic pressu re(LVEDP)and pulmonary wedge pressure (PC) was also obtained by catherization on day, 0, 21. All PDE indices were independent on hemodynamics at each studypoint. Serial change in each index from day 0 to day 21 at follows. LV index: 0.65 ±0.29,0.69 _+0.29 and 0.89_+ 0.23,(p <0.01),tCT index: 0.24_+ 0.12,0.23 _+0.11 and 0.30 _+0.12,(N.S),lRTindex: 0.40 _+0.30,0.45 _+0.25 and 0.60 _+0.18,(p < 0.01). LVEF:41 + 9,44 ± 10,and46 ± ?,(p < 0.01 ),LVEDP:22 _+ 7,18 _+ 6,(N.S),PC:12 ± 5,8 _+ 4,(p=0.02).ln conclusion; LVEF and PC improved ,but LV index and IRT index increased . There was difference between LVEF and LV index. These results indicate that new indices may predict another aspect of left ventiricular function.
175
174 DIASTOLIC RESPONSE DURING LOW DOSE DOBUTAMINE STRESS ECHOCARDIOGRAPHY IS RELATED TO THE OUTCOME OF PATIENTS WITH MILD TO MODERATE CHRONIC HEART FAILURE Kazuya Murata, Kayo Ueda, Takashi Tone, Yasuaki Tomochika, Shire One, Kazumi Morikuni, Masunori Matsuzaki Second Department of Internal Medicine, Yamaguchi University, Ube 755-8505, JAPAN It is well known that restrictive transmitral flow(TMF) pattern is predictive of higher cardiac mortality in patients(pts) with chronic heart failure(CHF). However, prognostic value of non-restrictive TMF pattem(NR) in pts with CHF is still unknown. We evaluated changes in left ventdcular(LV) filling with low dose dobutamine stress echocardiography(DSE) and assessed the prognostic significance of changes of LV filling in pts with CHF showing NR. Low dose (10mcg /kg/min) DSE was performed in 45 pts(36men, age 60+11 years) with CHF(35 pts with prior myocardial infarction, 10 with dilated cardiomyopathy) in NYHA class I1-111with a mean LVEF of 40+13%. Pts were followed over 22+7 months for cardiac events. We measured peak velocities of eady(E) and late(A) diastolic TMF. Isovotumetdc relaxation time(IRT:msec) and deceleration time(DT:msec) of TMF were also measured. We obtained LV outflow time-velocity integrals(OTI) as an index of stroke volume. Then, we evaluated the relations between the changes(A) of these variables during DSE and cardiac events. Pts were subdivided into two groups who had cardiac events(CE:16pts) and had not(NCE:29pts)during followed period. In NCE, percent& IRT shortened significantly during DSE compared to that in CE (NCE:-25% vs CE:-2.4%, p<0.01).ADT,&A/E and AOTI did no~ differ between the two groups. Multivariate analysis showed thatA IRT was the only independent predictor of cardiac events (p<0.01). Conclusions: The shortening of IRT with dobutamine was significantly related to less cardiac event in pts with CHF, suggesting that preserved lusitropy might have favorable effects on the clinical outcome in pts with CHF. Assessment of LV diastolic property with DSE might be useful to predict the outcome in pts with mild to moderate CHF.
176
T I M E R E L A T I O N S H I P B E T W E E N LEFT V E N T R I C U L A R WALL MOTION AND TRANSMITRAL FLOW VELOCITIES DURING EARLY DIASTOLE
EVALUATION OF LEFT VENTRICULAR DIASTOLIC FUNCTION IN MITRAL STENOSIS:ANALYSIS USING NET ATRIOVENTRICULAR COMPLIANCE
Yukiko Onose, Takashi Oki, Yuichiro Mishiro, Hirotsugu Yamada, Miho Abe, Kazuyo Manabe, Yoshimi Kageji, Tomotsugu Tabata, Arata luchi Tokushima University, Tokushima, Japan.
Hiroshi Ikawa, Yutaka Hirano, Yoshinao Ozasa, Satoru Yamada, Hisakazu Uehara, Kinji Ishikawa First Department of Internal Medicine, Kinki University, Osaka 589-8511, Japan
Purpose: To evaluate the time relationship between left ventricular (LV) wall motion and transmitral flow (TMF) velocities during early diastole. Methods: Subjects consisted of 18 patients with hypertrophic cardiomyopathy, 27 with hypertensive heart disease, 12 with dilated cardiomyopathy and 40 normal controls (N: 43_+ 12 yrs). The motion velocity patterns were recorded at the middle site of the LV posterior wall (PW) in the apical long axis view of the LV using pulsed tissue Doppler imaging (TDI). Patients were divided into the two groups: Gr-RF (n=39) with the ratio of peak early to late diastolic TMF velocity (E/A)=<1, and Gr-PN (n=18) with E/A>1. Results: 1) The LV end-diastolic pressure (EDP) was higher, the time constant of LV pressure decay during isovolumic relaxation (Tau) was prolonged, and the peak early diastolic motion velocity (Ew) of the PW was lower in Gr-PN than in Gr-RF. 2) The time to onset of Ew from the second heart sound (IIA-Ew onset) was longer in Gr-PN than in Gr-N, and was longer in Gr-RF than in Gr-N. 3) The isovolumic relaxation time (IRT) was longer in Gr-RF than in Grs-PN and -N, whereas there was no significant difference between Grs-N and -PN. Conclusion: Combined analysis of LV wall motion by TDI and TMF provides important information regarding the LV early diastolic relaxation and filling.
The purpose of this study was to determine whether the left ventdcular diastolic function in mitral stenosis (MS) could be evaluated by Doppler echocardiography. This study population consisted of 55 patients with MS who did not have significant aortic regurgitation, left ventdcular hypertrophy, or ischemic heart disease. They were divided into two groups with respect to age:twenty-five patients who are 65 years of age or older (group E), and thirty patients below 65 years of age (group Y). As an indicator of the left ventricular diastolic function in MS patients, net left atrioventdcular compliance (On) was measured based on Newton's second law of motion: dq/dt=(Pa--Pv-Rc, q2-Rv, q)/M. Where, q:transmitral flow, Pa:left atrial pressure, Pv:left ventricular pressure, M:mitral valve inertance, Rc:convective mitral valve resistance, and Rv:viscous mitral valve resistance. By assuming the value of M and Rv to be zero in MS patients, Cn was calculated as follows: pressure haft-time × functional mitral orifice area / 11.6 × (initial pressure gradient) lf2 (ml/mmHg). The value of Cn was then compared between groups E and Y. Even though there were no significance in the functional mitral orifice area and (in t a pressure gradient) 1~ between the two groups, the pressure half-time was significantly shorter for group E. The average value of Cn for group E and Y was 4.14+0.99 and 5.06-+0.90 ml/mmHg, respectively, so it was significantly lower for E group (p<0.05). We believe that the value of Cn was lower for group E due to the aging process. The results of the present study showed that net atdoventricular compliance measured by Doppler echocardiography would be a useful indicator of the left ventdcular diastolic function in mitral stenosis.