Background -Cardiac resynchronization therapy(CRT) is an effective therapy for patients with moderate to severe heart failure and prolonged QRS duration. The purpose of this study was to determine whether reverse left...Background -Cardiac resynchronization therapy(CRT) is an effective therapy for patients with moderate to severe heart failure and prolonged QRS duration. The purpose of this study was to determine whether reverse left ventricular(LV) remodeling and symptomatic benefit from CRT were sustained at 12 months, and if so, in what proportion of patients this occurred. Methods and Results -Serial Doppler echocardiograms were obtained at baseline and 6 and 12 months after CRT in 228 patients enrolled in the Multicenter InSync Randomized Clinical Evaluation(MIRACLE) trial. Measurements were made of LV end-diastolic(EDV) and end-systolic(ESV) volumes, ejection fraction, LV mass, severity of mitral regurgitation(MR), peak transmitral velocities during early(E wave) and late(A wave) diastolic filling, and myocardial performance index. At both 6 and 12 months, respectively, CRT was associated with reduced LV EDV(P< 0.0001 and P=0.007) and LV ESV(P< 0.0001 and P< 0.0001), improved ejection fraction(P< 0.0001 and P< 0.0001), regression of LV mass(P=0.012 and P< 0.0001), and reduced MR(P< 0.0001 and P< 0.0001). LV filling time, transmitral E/A ratio, and myocardial performance index all improved at 12 months compared with baseline(P< 0.001, P=0.031, and P< 0.0001). Reverse LV remodeling with CRT occurred in more patients at 6 than at 12 months(74%versus 60%, respectively; P< 0.05) and was greater in patients with a nonischemic than an ischemic etiology. Conclusions -Reverse LV remodeling and symptom benefit with CRT are sustained at 12 months in patients with New York Heart Association class III/IV heart failure but occur to a lesser degree in patients with an ischemic versus a nonischemic etiology, most likely owing to the inexorable progression of ischemic disease.展开更多
Background Assessment of left ventricular(LV)thrombosis risk after acute myocardial infarction(AMI)is important because of potential embolic sequelae that are reduced by oral anticoagulant agents. The goal of this stu...Background Assessment of left ventricular(LV)thrombosis risk after acute myocardial infarction(AMI)is important because of potential embolic sequelae that are reduced by oral anticoagulant agents. The goal of this study was to investigate whether early assessment of LV systolic and diastolic performance with pulsed wave tissue Doppler ultrasound scanning(PWTD)predicts LV thrombosis after AMI.Methods Two-dimensional and Doppler ultrasound scanning echocardiographic examinations were performed in 92 consecutive patients(age, 58±10 years; 11 women)with first anterior AMI within 24 hours after arrival to the coronary care unit. From the apical 4-chamber view, the mitral annular velocities were recorded at the lateral corner of the mitral annulus with PWTD. The myocardial performance index(MPI), which combines parameters of both systolic and diastolic ventricular function, was calculated from the PWTD recordings. To analyze LV thrombus formation, the 2-dimensional echocardiographic examination was repeated on days 3, 7, 15, and 30. The patients were divided in 2 groups according to LV thrombus formation. Results LV thrombus was found in 32 of 92 patients(35%; group 1)and was not found in 60 patients(65%; group 2). The MPI was significantly higher in group 1 than in group 2(0.73±0.20 vs 0.53±0.14; P <.001). When an MPI >0.6 was used as the cutoff, LV thrombus formation could be predicted with a sensitivity rate of 81%, a specificity rate of 73%, a positive predictive value of 62%, and a negative predictive value of 88%. In multivariate analyses, only MPI and LV wall motion score index were independent predictors of LV thrombus formation(P=.038 and P=.047, respectively). Conclusions The MPI derived with PWTD soon after admission appears to be a useful parameter for assessing the risk of LV thrombosis after AMI. Patientswith an MPI>0.6 after AMI seem to be at a higher risk for thrombus formation.展开更多
Background: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction(MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction(...Background: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction(MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction(LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. Methods: We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients(55%), LVEF was measured a second time at 6 months. Results: Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7%(95%CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery(LAD)related infarcts and to a decrease of 2.4%(95%CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts(P< .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8%(95%CI 4.2-5.3) for LAD and 2.4%(95%CI 1.7-3.1) for non-LAD-related infarcts(P< .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. Conclusion: In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts.展开更多
文摘Background -Cardiac resynchronization therapy(CRT) is an effective therapy for patients with moderate to severe heart failure and prolonged QRS duration. The purpose of this study was to determine whether reverse left ventricular(LV) remodeling and symptomatic benefit from CRT were sustained at 12 months, and if so, in what proportion of patients this occurred. Methods and Results -Serial Doppler echocardiograms were obtained at baseline and 6 and 12 months after CRT in 228 patients enrolled in the Multicenter InSync Randomized Clinical Evaluation(MIRACLE) trial. Measurements were made of LV end-diastolic(EDV) and end-systolic(ESV) volumes, ejection fraction, LV mass, severity of mitral regurgitation(MR), peak transmitral velocities during early(E wave) and late(A wave) diastolic filling, and myocardial performance index. At both 6 and 12 months, respectively, CRT was associated with reduced LV EDV(P< 0.0001 and P=0.007) and LV ESV(P< 0.0001 and P< 0.0001), improved ejection fraction(P< 0.0001 and P< 0.0001), regression of LV mass(P=0.012 and P< 0.0001), and reduced MR(P< 0.0001 and P< 0.0001). LV filling time, transmitral E/A ratio, and myocardial performance index all improved at 12 months compared with baseline(P< 0.001, P=0.031, and P< 0.0001). Reverse LV remodeling with CRT occurred in more patients at 6 than at 12 months(74%versus 60%, respectively; P< 0.05) and was greater in patients with a nonischemic than an ischemic etiology. Conclusions -Reverse LV remodeling and symptom benefit with CRT are sustained at 12 months in patients with New York Heart Association class III/IV heart failure but occur to a lesser degree in patients with an ischemic versus a nonischemic etiology, most likely owing to the inexorable progression of ischemic disease.
文摘Background Assessment of left ventricular(LV)thrombosis risk after acute myocardial infarction(AMI)is important because of potential embolic sequelae that are reduced by oral anticoagulant agents. The goal of this study was to investigate whether early assessment of LV systolic and diastolic performance with pulsed wave tissue Doppler ultrasound scanning(PWTD)predicts LV thrombosis after AMI.Methods Two-dimensional and Doppler ultrasound scanning echocardiographic examinations were performed in 92 consecutive patients(age, 58±10 years; 11 women)with first anterior AMI within 24 hours after arrival to the coronary care unit. From the apical 4-chamber view, the mitral annular velocities were recorded at the lateral corner of the mitral annulus with PWTD. The myocardial performance index(MPI), which combines parameters of both systolic and diastolic ventricular function, was calculated from the PWTD recordings. To analyze LV thrombus formation, the 2-dimensional echocardiographic examination was repeated on days 3, 7, 15, and 30. The patients were divided in 2 groups according to LV thrombus formation. Results LV thrombus was found in 32 of 92 patients(35%; group 1)and was not found in 60 patients(65%; group 2). The MPI was significantly higher in group 1 than in group 2(0.73±0.20 vs 0.53±0.14; P <.001). When an MPI >0.6 was used as the cutoff, LV thrombus formation could be predicted with a sensitivity rate of 81%, a specificity rate of 73%, a positive predictive value of 62%, and a negative predictive value of 88%. In multivariate analyses, only MPI and LV wall motion score index were independent predictors of LV thrombus formation(P=.038 and P=.047, respectively). Conclusions The MPI derived with PWTD soon after admission appears to be a useful parameter for assessing the risk of LV thrombosis after AMI. Patientswith an MPI>0.6 after AMI seem to be at a higher risk for thrombus formation.
文摘Background: Left ventricular function and infarct size are strong predictors for prognosis after acute myocardial infarction(MI). Anterior MI is associated with greater reduction of left ventricular ejection fraction(LVEF) and worse prognosis. Our objective was to study whether the impact of infarct size on global LVEF is dependent of infarct location. Methods: We analyzed 888 patients treated with primary percutaneous coronary intervention for acute MI. Enzymatic infarct size and LVEF within 1 week were measured. In 490 patients(55%), LVEF was measured a second time at 6 months. Results: Every 1000 U/L of cumulative lactate dehydrogense release corresponded to a decrease of 4.7%(95%CI 4.1-5.3) in LVEF measured within 1 week post MI for left anterior descending coronary artery(LAD)related infarcts and to a decrease of 2.4%(95%CI 1.7-3.1) in LVEF measured within 1 week post MI for non-LAD-related infarcts(P< .0001). Left ventricular ejection fraction measured 6 months post MI showed a decrease for every 1000 U/L cumulative lactate dehydrogense release of 4.8%(95%CI 4.2-5.3) for LAD and 2.4%(95%CI 1.7-3.1) for non-LAD-related infarcts(P< .0001). Multivariate correction for relevant clinical and angiographic data did not change these results. Conclusion: In patients with a first acute MI treated with primary percutaneous coronary intervention, LAD-related infarcts show for a similar amount of myocardial necrosis as determined by enzymatic infarct size, a lower residual LVEF when compared with non-LAD-related infarcts.
