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ABSTRACT: To evaluate whether baseline N-terminal proatrial natriuretic peptide (Nt-proANP) or Doppler echocardiographic parameters could predict two-year left ventricular remodelling after acute myocardial infarction in patients without heart failure.
Seventy-one patients were followed with Doppler echocardiographic examinations at baseline, 3 months, 1 and 2 years, and Nt-proANP was measured at baseline and 3 months. After 2 years there was a significant increase in end-diastolic volume index of 11% ( p=0.006 ) and end-systolic volume index of 14% ( p=0.03 ), and no change in ejection fraction. This remodelling was confined to 12 patients (17%) with a significant increase in end-diastolic volume index above 20 ml/m(2). Baseline Nt-proANP ( p<0.0005 ), 3-month changes in end-diastolic volume index ( p=0.007 ), and 3-month E/A ratio ( p=0.014 ) were independent positive predictors for two-year changes in end-diastolic volume index. Two-year dilatation above 20 ml/m2 was predicted by baseline Nt-proANP (p=0.014) and maximal velocity of systolic pulmonary venous flow ( p=0.034 ).
Seventeen percent of patients with transmural myocardial infarction and no baseline heart failure experienced a significant left ventricular dilatation at 2 years, and this was best predicted by baseline Nt-proANP. Unstructured abstract Seventy-one patients with acute myocardial infarction and no heart failure were followed for two years in an observational Doppler echocardiographic study. There was a significant increase in end-diastolic volume index of 11% ( p=0.006 ) and end-systolic volume index of 14% (p=0.03), but no change in ejection fraction after two years. Nt-proANP was the strongest independent predictor of two-year changes in end-diastolic volume index and of an increase in end-diastolic volume index above 20 ml/m2 after two years.
European Heart Journal 03/2004; 25(5):416-23. · 10.48 Impact Factor
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ABSTRACT: We sought to describe the degree of long-term left ventricular (LV) remodeling after acute transmural myocardial infarction with preserved LV systolic function, and to evaluate whether Doppler echocardiographic parameters in the early phase could predict this process.
A total of 60 patients without heart failure and with LV ejection fraction > or = 0.40 (mean 0.48 +/- 0.054), were followed up with Doppler echocardiographic examinations at baseline, 3 months, and 1 and 2 years.
There was a significant increase in LV end-diastolic volume index of 7% (P =.006) and LV end-systolic volume index of 8% (P =.03), and no change in ejection fraction. This remodeling was confined to 7 patients (12%) with a significant increase in LV end-diastolic volume index above 20 mL/m(2). There was also a significant increase in the deceleration time of both the early mitral filling wave (Delta early mitral filling wave = 58 milliseconds, P <.0005) and the diastolic forward component of pulmonary venous flow (Delta diastolic forward component of pulmonary venous flow = 61 milliseconds, P <.0005), and a shift in filling pattern with increasing prevalence of abnormal relaxation. Changes in end-diastolic volume index were predicted by baseline early mitral filling wave less than 100 milliseconds, but the most powerful predictors of 2-year remodeling were volume changes at 3 months.
Twelve percent of patients with Q-wave infarction and ejection fraction > or = 0.40 experienced significant LV dilatation at 2 years, and this late remodeling was partly related to baseline filling characteristics.
Journal of the American Society of Echocardiography 06/2003; 16(6):630-7. · 3.71 Impact Factor
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ABSTRACT: To evaluate whether changes in myocardial performance index (MPI or Tei index) were related to changes in other Doppler echocardiographic parameters after acute myocardial infarction, or had any independent prognostic impact in a 2-year observational study.
Seventy-one patients with acute myocardial infarction without heart failure were examined at baseline, 3 months, and 2 years. MPI was significantly related to end-diastolic and end-systolic volume indexes, ejection fraction, maximal velocity, and time velocity integral of early mitral filling wave at 3 months and 2 years. MPI did not contribute significantly to the prediction of any changes in the measures of diastolic or systolic function at 3 months or 2 years. Baseline MPI was significantly higher in patients who later developed heart failure(0.55 +/- 0.16)than in other patients(0.43 +/- 0.13, P = 0.006), but had no independent predictive power for the development of heart failure or death relative to end-systolic volume index and deceleration time of early mitral filling wave.
MPI did not accurately reflect changes in Doppler and two-dimensional echocardiographic measures of diastolic or systolic function during a 2-year follow-up after acute myocardial infarction, and did not have any independent prognostic impact.
Echocardiography 02/2003; 20(1):1-7. · 1.24 Impact Factor
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ABSTRACT: The use of a single sample volume in Doppler measurements of the velocity time integral (VTI) in the aortic annulus may introduce errors in calculations of stroke volumes, shunts, regurgitant fractions, and aortic valve area. To study the blood flow velocity distribution and assess this potential error, we used a dynamic 3-dimensional color flow Doppler imaging method.
Seventeen healthy volunteers were studied. The ultrasound data were captured from 10 to 20 heartbeats at a high frame rate (mean 57 frames per second) while freely tilting the transducer in the apical position. A magnetic position-sensor system recorded the spatial position and orientation of the probe. The raw digital ultrasound data were analyzed off-line with no loss of temporal resolution. Blood flow velocities were integrated across a spherical surface that tracked the aortic annulus during systole. The ratios of the systolic maximum to the systolic mean VTI ranged from 1.2 to 1.5 (mean 1.4). At the time of systolic peak flow, the ratios of the maximum to the mean velocity ranged from 1.1 to 2.0 (mean 1.5). The location of the maximum velocities and VTI showed individual variation.
The blood flow velocity profile was nonuniform. By using a single sample volume in Doppler measurements of the VTI in the aortic annulus, errors ranging from 20% to 50% may be introduced in calculations of stroke volumes.
Journal of the American Society of Echocardiography 05/2002; 15(4):328-33. · 3.71 Impact Factor
