A novel Doppler echocardiographic index integrating left and right ventricular function is superior to conventional indices for predicting adverse outcome of acute myocardial infarction.
ABSTRACT The ratio of peak diastolic early velocity (E) of left ventricular (LV) inflow to peak diastolic longitudinal velocity (e') of the mitral annulus (E/e') is thought to reflect LV filling pressure, and tricuspid annulus velocity at systole (s'-T) is thought to reflect right ventricular function. However, it has not been reported on significance of the combined use of E/e' and (s'-T) to predict outcome of acute myocardial infarction (AMI). Over 21 months, beginning in January 2007, we enrolled 65 AMI patients who were measured hemodynamic and echocardiographic parameters by Swan-Ganz (SG) catheterization just after reperfusion therapy and echocardiography immediately after reperfusion therapy. Cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) via SG catheter were measured, and routine echocardiographic indices, including E, e', E/e', and (s'-T) were determined. In addition, we defined the functional integrated bi-myocardial tissue Doppler (FIT) index as (s'-T)÷E/e'. The relationships between CI, PCWP, and echocardiographic indices were investigated, including FIT index. Moreover, we investigated whether FIT index could predict adverse cardiac events. FIT index was significantly associated with not only CI but also PCWP. In the Cox proportional hazards model, FIT index<1.0 was a significant predictor for adverse outcome of AMI after adjustment for age, Killip class, history of previous coronary revascularization, location of culprit lesion, and LV ejection fraction. The novel index defined as (s'-T)÷E/e' could be quite useful predictor of prognosis in AMI. J. Med. Invest. 60: 97-105, February, 2013.
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ABSTRACT: Carbon monoxide (CO) poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure. Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning. The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function. In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvement.Indian Journal of Critical Care Medicine 03/2013; 17(3):148-153. DOI:10.4103/0972-5229.117044