Left Ventricular Myocardial Performance Index Research Articles

Left Ventricular Adaptations in Herding Dogs

Background: Athlete’s heart syndrome comprises a set of functional and anatomic cardiac changes secondary to intense and prolonged physical exercise in humans and animals. The heart adapts to the type of activity performed, and Doppler echocardiography is the best tool for identifying these changes. Speckle tracking echocardiography (STE) has provided new data on cardiovascular adaptations secondary to physical exercise in humans, information that conventional echocardiography cannot provide. Although physical activity and work in dogs are well documented, there are few studies on cardiovascular adaptations secondary to exercise in dogs, and no studies to date evaluated these adaptations using STE.Materials, Methods &Results:A total of 31 dogs of the Border Collie and OvelheiroGaúchoBrasileiro breeds were divided into two groups: a herding group (HG, n = 15), which performed herding activity five to six times a week for at least 4 months, and a sedentary group (SG, n = 16), with no history of physical activity in the past twelve months. All dogs were previously subjected to electrocardiography and blood pressure measurement. After that, the animals underwent echocardiographic examination at rest at a single time point. The data were analyzed by two-way multivariate analysis of variance (ANOVA) at a level of significance of 5% (P < 0.05) and a trend at 90% (P < 0.1). The dogs of the HG had higher values for left-ventricular end-systolic diameter (LVESD) and systolic volume (SV), and lower values for left-ventricular myocardial performance index (Tei index) and systolic septal movement. STE results indicated that the HG presented lower values for strain and strain rate in some myocardial segments in the radial, circumferential, longitudinal, and transverse directions.Discussion:The increase in LVESD is justified by the increase in preload (volume) required to meet the increased oxygen demand, whereas SV is directly related to the Frank-Starling mechanism. The lower Tei index in the HG indicates better systolic-diastolic performance, explained by a shorter isovolumetric relaxation time and isovolumetric contraction time and by an increase in left ventricular (LV) ejection time. Similar results were not observed in LV systolic wall motion. Therefore, we believe that the most likely explanation is a higher systolic efficiency, associated with lower energy demand at rest. According to STE criteria, the lower strain and strain rate in the HG in some myocardial segments in all directions suggest less need for myocardial deformation and lower deformation velocity in order to maintain systolic function. In conclusion, conventional echocardiography and STE were complementary and fundamental to understand cardiovascular adaptations in herding dogs.

Correlation between fetoplacental Doppler indices and measurements of cardiac function in term fetuses.

Redistribution of cardiac output (CO) is responsible for the brain-sparing effect seen during periods of fetal stress. Our aim was to investigate prospectively the correlation between fetoplacental Doppler indices and measurements of cardiac function in uncomplicated term singleton pregnancy. This was a prospective observational study of normotensive women with appropriately grown, non-anomalous singleton pregnancy. Participants underwent fortnightly ultrasound examinations from 36 weeks' gestation until delivery, and intrapartum and neonatal outcomes were recorded. The correlation between fetoplacental Doppler indices and various measurements of cardiac function was evaluated. The study cohort comprised 273 singleton pregnancies. The cerebroplacental ratio (CPR) was correlated positively with left ventricular CO (LVCO) (P< 0.001, rho = 0.29), left-to-right ventricular CO ratio (LVCO/RVCO; P< 0.001, rho= 0.41), global left ventricular strain (P< 0.01, rho = 0.17) and global right ventricular strain (P< 0.001, rho = 0.22). The CPR was correlated inversely with the left ventricular myocardial performance index (P< 0.01, rho = -0.18) and the RVCO (P< 0.001, rho = -0.28). The LVCO and global left ventricular strain were correlated positively with umbilical venous flow (P= 0.04, rho = 0.18 and P< 0.001, rho = 0.25, respectively). There was minimal or no correlation between either the mean uterine artery pulsatility index (PI) or umbilical artery PI with any cardiac indices. The fetal CPR, middle cerebral artery PI and umbilical venous flow are correlated positively with LVCO, LVCO/RVCO and global left ventricular strain in low-risk term pregnancies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

The Role of Exercise Stress Echocardiography for Determination of Subclinical Cardiac Involvement in β-Thalassemia Major

β-Thalassemia major (β-TM) patients are at increased risk for cardiovascular diseases. Determination of subclinical cardiac involvement is essential for preventive measures. Thus, we aimed to evaluate the role of stress echocardiography for identification of subclinical cardiac dysfunction in β-TM patients. In this prospective study, 45 β-TM patients who were referred for cardiac evaluation, were enrolled. Exclusion criteria included non sinus rhythm and overt cardiac disease. Stress echocardiography levels and cardiac magnetic resonance imaging (MRI) results were obtained from β-TM patients. Patients were divided into two groups of normal vs. iron overload from cardiac T2* greater or less than 20 msec, respectively. Resting and peak exercise right ventricular stroke volume (RVSV) and left ventricular SV (LVSV) were significantly lower in iron overload vs. normal β-TM patients, respectively (p value <0.05). At peak LV global longitudinal strain (GLS) and myocardial performance index (MPI) were significantly decreased and increased compared with resting in iron overload vs. normal β-TM patients, respectively (p value <0.05). There was a significant relationship between inappropriate hemodynamic response to exercise and lower age (p value = 0.032). Resting LVSV and RVSV seemed better prognosticators for iron overload than LV ejection fraction (LVEF). Decreased GLS and increased MPI at peak exercise could also predict the presence of cardiac iron overload. These measurements by stress echocardiography could be evaluated when cardiac T2* could not be determined.

Assessment of relationship between contrast-induced nephropathy and left ventricular myocardial performance index in patients at risk for nephropathy

Aim: Contrast induced nephropathy (CIN) is associated substantially with a risk of morbidity and mortality. The aim of this study was to assess the left ventricular myocardial performance assessed by ‘Tei index’ on the development of contrast induced nephropathy in patients underwent coronary angiography. Material and Methods: Study population consist of patients who underwent coronary angiography and/or percutaneous coronary intervention and baseline creatinine level 1 mg/dl above and/or having diabetes mellitus. 51 patient were included the study. Patients divided into two groups as CIN developed or not. CIN was defined as %25 and/or 0.5 mg/dl increase in basal serum creatinine levels after 48-72 hours exposure to contrast media. Conventional and tissue Doppler echocardiography was performed in all patients prior to angiography. Tei index was calculated from tissue Doppler echocardiography data. Results: Two groups were defined as CIN-developed group (n =13, 62.5 ± 6.8 ) and CIN-undeveloped (n=38, 62.4±9.6 )group. Except gender, there is no difference in demographic characteristics between the study groups. Left ventricular (LV) systolic function such as ejection fraction and tissue Doppler imaging Sm and basic LV diastolic function (E/A, Em/Am, DT) parameters were found to be similar in both groups. Tissue Doppler-derived Tei index values did not differ significantly between the two groups (0.42 ± 0.09 vs 0.46 ± 0.12, p = 0.25). Conclusion: The Tei index is inadequate for predicting the risk of developing nephropathy in patients at risk for contrast induced nephropathy with preserved ejection fraction.

Prognostic Relevance of Left Ventricular Myocardial Performance After Transcatheter Aortic Valve Replacement.

The left-ventricular myocardial performance index Tei is an echocardiographic parameter that incorporates the information of systolic and diastolic time intervals. While the prognostic value of selected systolic and diastolic parameters is well established after transcatheter aortic valve replacement, the role of Tei has not been evaluated in this setting. Between August 2007 and December 2015, consecutive patients with symptomatic, severe aortic stenosis and transthoracic echocardiography pre- and post-transcatheter aortic valve replacement were considered eligible for this analysis. The primary end point was all-cause mortality at 1 year after transcatheter aortic valve replacement. Of 824 patients with echocardiographic images to calculate Tei, pre-Tei was normal (<0.45) in 639 and high (≥0.45) in 185, whereas post-Tei was normal in 602 and high in 120, respectively. After adjustment for confounding factors, high pre-Tei was associated with an increased risk of all-cause mortality at 30 days (adjusted hazard ratio [HRadj] 3.62; 95% CI, 1.89-6.91) and 1 year (HRadj 2.56; 95% CI, 1.78-3.69). Similarly, post-Tei was associated with an increased risk of mortality between 30 days and 1-year follow-up (HRadj 6.70; 95% CI, 4.22-10.63). At multivariable analysis Tei emerged as an independent predictor of early (pre-Tei index per 0.1-HRadj 1.40; 95% CI, 1.23-1.60) and late mortality (post-Tei index per 0.1-HRadj 1.40; 95% CI, 1.31-1.50), respectively. The left-ventricular myocardial performance index Tei is associated with impaired clinical outcomes during short- and longer-term follow-up after transcatheter aortic valve replacement. URL: https://www.clinicaltrials.gov . Unique identifier: NCT01368250.

The effect of cold stress on right ventricular function in patients with systemic sclerosis

Objective: Pulmonary hypertension and right heart failure are poorprognostic factors in systemic sclerosis (SSc). The effect of coldstress on pulmonary vasospasm was evaluated in some trials butthe results were conflicting. The aim of our study was to determinethe effect of cold stress on right ventricular (RV) functions.Materials and Methods: Twenty-four patients with SSc and24 age and sex-matched healthy controls were enrolled in thestudy. Transthoracic echocardiography (TTE) was performed to allpatients at rest and after peripheral cold exposure. Baseline andafter cold stress test TTE were compared between the groups.Results: Cold exposure induced changes in particularly rightventicular functions. Pulmonary acceleration time was significantlyshortened in the SSc group (118.8±11.7ms vs 111.3±13.7ms,P&amp;lt;0.001). Tricuspid annular plane systolic excurison and RVfractional area change were also decreased after cold exposurein the SSc group. (23.3±1.6mm vs 21.9±1.9 mm, P&amp;lt;0.001;46.3±5.8 vs 44.4±5.8,P= 0.007, consecutively). Left ventricular(LV) functions did not change after cold stress (LV myocardialperformance index (0.42± 0.04 vs 0.42± 0.05), P= 0.748).Conclusion: Peripheral cold exposure caused a reductionin right ventricular functions indicating pulmonary Raynaud’sphenomenon as a possible contributing factor.

Is FGF-23 an early indicator of atherosclerosis and cardiac dysfunction in patients with gestational diabetes?

Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone and plays a role in the pathogenesis of myocardial hypertrophy. The aim of this study was to evaluate the association of FGF-23 levels with echocardiographic parameters and insulin resistance (IR) in patients with gestational diabetes. Fifty-four pregnant patients with gestational diabetes mellitus (GDM) (age, 31.12 ± 5.72 years) and 33 healthy pregnant women (age, 29.51 ± 4.92 years) were involved in the study. Fasting insulin, fasting plasma glucose (FPG), lipid profile, oral glucose tolerance test (OGTT), FGF23, echocardiographic parameters, and carotid artery intima-media thickness (CIMT) were evaluated in the two groups. The two groups were not significantly different in age, sex, body mass index, lipid profile, or blood pressure. Insulin, homeostatic model assessment-insulin resistance (HOMA-IR), FGF-23 levels, CIMT, left ventricular (LV) mass, LV mass index and myocardial performance index (MPI) were significantly higher in the GDM group. HOMA-IR was positively correlated with FGF-23, and insulin was positively correlated with FGF-23. Additionally, FGF-23 was positively correlated with CIMT, LV mass index, and MPI. Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with GDM.

Maternal arterial stiffness and fetal cardiovascular physiology in diabetic pregnancy.

In mothers with pregestational or gestational diabetes, abnormal arterial stiffness (stiffer arteries) has been reported. The impact of abnormal maternal arterial stiffness on placental and fetal cardiovascular physiology is unknown. The purpose of this study was to determine the impact of maternal diabetes on maternal arterial stiffness and the association with fetal cardiovascular physiology as measured by fetal echocardiography. Between December 2013 and January 2017 a prospective study was conducted on diabetic (but otherwise healthy) and non-diabetic, healthy pregnant mothers aged 18-40 years at 20-28 weeks' gestation who had a normal fetal cardiac echocardiogram and obstetric ultrasound. Clinical data were collected by means of a patient questionnaire and measurement of blood pressure, height, weight, arterial augmentation index (AIx) and placental and fetal cardiovascular parameters were collected by fetal echocardiography. Descriptive statistics were calculated. Comparisons were made using parametric and non-parametric tests between controls and diabetic mothers. Twenty-three healthy pregnant controls and 43 diabetic pregnant women (22 with pregestational and 21 with gestational diabetes) were included in the study. Maternal AIx was higher in those with diabetes than in healthy controls (12.4 ± 10.6% vs 4.6 ± 7.9%; P = 0.003). Fetal aortic valve (AoV) velocity time integral (VTI) was higher in fetuses whose mothers had diabetes than in those with non-diabetic mothers (7.7 ± 1.9 cm vs 6.3 ± 3.0 cm; P = 0.022). Left ventricular (LV) myocardial performance index (MPI) was lower in diabetic pregnancies than in controls (0.40 ± 0.09 vs 0.46 ± 0.11; P = 0.021). Umbilical artery (UA) resistance index (RI) was lower in diabetic pregnancies with glycated hemoglobin (HbA1c) levels ≥ 6.5% than in those with HbA1c levels < 6.5% (0.69 ± 0.06, n = 15 vs 0.76 ± 0.08, n = 21; P = 0.009) but not at higher HbA1C cut-offs. No correlation between AIx and AoV-VTI, LV-MPI or UA-RI was found. Arterial stiffness is higher in pregnant women with diabetes than in controls. Fetuses of diabetic mothers show altered cardiovascular parameters, with higher AoV-VTI and lower LV-MPI, which are markers of myocardial function. Placental function assessed by UA-RI was normal despite differences between groups. Arterial stiffness did not correlate with placental or fetal cardiovascular variables. Instead, the findings are likely to represent a shared response to the environment of abnormal glucose metabolism. The clinical significance of these findings is yet to be determined. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Effect of well-controlled gestational diabetes on left ventricular diastolic dysfunction in neonates

Background: There are some evidences supporting the relation between gestational diabetes mellitus (GDM) and diastolic dysfunction. The aim of our study was to investigate the effect of well-controlled GDM on morphological and functional myocardium. Materials and methods: We designed a prospective cross-sectional study to evaluate left ventricular (LV) diastolic function of 60 neonates born from mothers with well-controlled GDM (case group) on days of 3–5 after birth. The infants of diabetic mothers (IDM) group were divided into two groups: diabetic mothers treated only with diet (class A) and group of mothers on medical therapy by insulin or metformin (class B). Traditional echocardiography and pulsed-wave Doppler (PWD), tissue Doppler imaging (TDI) were performed for all the neonates. Results: The study group consisted of 60 neonates as males (M) = 32, (0.53%) and females (F) = 28, (0.46%). Using M-mode echocardiography, interventricular septum thickness (IVS), and LV mass were significantly higher in IDM than control group (p = .0001). The PWD showed both a significantly more peak mitral flow at early diastolic wave (E) and an early filling deceleration time (E-DT) (p = .0001). Tissue Doppler echocardiography parameters A′ (cm/s) (p = .0001), E′ (cm/s) (p = .002), and E′/A′ ratio (p = .0001), left ventricular myocardial performance index (LVMPI), and isovolumetric relaxation time (IVRT) were outstandingly different between the two groups (p = .0001, respectively). Evaluating the GDM group mothers of class A and class B, no significant difference was noted in PWD or TDI parameters compared with the healthy ones. Conclusions: It seems that neonates of mothers with well-controlled GDM are still at increased risk of cardiac hypertrophy, subclinical diastolic dysfunction, and impaired left ventricular relaxation. This can be interpreted that focusing only on glycemic control is not enough to prevent cardiac dysfunction.

Echocardiographic parameters to identify sickle cell patients with cardio-pathology.

Sickle cell disease (SCD) affects millions of people and causes chronic hemolytic anemia leading to vasculopathies such as pulmonary hypertension and abnormalities in cardiac function that increase complications and mortality. It is therefore crucial to identify cardiac abnormalities in SCD. We aimed to assess the prevalence of echocardiographic parameters in SCD to help identify cardiopulmonary risk. Ninety-one patients (53% male), median age of 30, body surface area (BSA) of 1.79m2 , hemoglobin of 8.8g/dL, and creatinine of 0.7mg/dL identified. We retrospectively measured laboratory and echocardiographic parameters in patients with SCD : left ventricular (LV) dimensions, LV ejection fraction (LVEF), LV Myocardial Performance Index (MPI), LV Mass Index (MI), Left Atrial Volume Index (LAVI), Tricuspid Regurgitation Velocity (TRV), tricuspid annular plane systolic excursion (TAPSE), right heart dimensions. Prevalence of left heart abnormalities was 32%: increased LV end-diastolic diameter (EDD), 78%: LV MPI, 21%: diastolic dysfunction, 38%: decreased LVEF, 24%: increased LVMI, and 47%: increased LAVI. Right heart abnormalities were 39%: TAPSE, 38%: increased TRV, and 59%: increased pulmonary systolic pressure (PASP). Multivariate logistic regression analysis was significant for increased LVMI and LAVI in those with hemoglobin ≤8g/dL (odds ratio (OR) 7.4, 95% confidence interval (CI) 2.23-24.6, P=.001) and (OR 3.32, 95% CI 1.18-9.33, P=.023). We confirmed increased prevalence of abnormal LVEDD, LVMI, diastolic function, LAVI, and PASP in SCD. In addition, we identified abnormal LV MPI (78%), TAPSE (29%). These parameters may be useful and readily accessible echocardiographic prognostic tools in this population.

Left Ventricular Isovolumetric Relaxation Time Is Prolonged in Fetal Long-QT Syndrome.

Long-QT syndrome (LQTS), an inherited cardiac repolarization disorder, is an important cause of fetal and neonatal mortality. Detecting LQTS prenatally is challenging. A fetal heart rate (FHR) less than third percentile for gestational age is specific for LQTS, but the sensitivity is only ≈50%. Left ventricular isovolumetric relaxation time (LVIRT) was evaluated as a potential diagnostic marker for fetal LQTS. LV isovolumetric contraction time, LV ejection time, LVIRT, cycle length, and FHR were measured using pulsed Doppler waveforms in fetuses. Time intervals were expressed as percentages of cycle length, and the LV myocardial performance index was calculated. Single measurements were stratified by gestational age and compared between LQTS fetuses and controls. Receiver-operator curves were performed for FHR and normalized LVIRT (N-LVIRT). A linear mixed-effect model including multiple measurements was used to analyze trends in FHR, N-LVIRT, and LV myocardial performance index. There were 33 LQTS fetuses and 469 controls included. In LQTS fetuses, the LVIRT was prolonged in all gestational age groups (P<0.001), as was the N-LVIRT. The best cutoff to diagnose LQTS was N-LVIRT ≥11.3 at ≤20 weeks (92% sensitivity, 70% specificity). Simultaneous analysis of N-LVIRT and FHR improved the sensitivity and specificity for LQTS (area under the curve=0.96; 95% confidence interval, 0.82-1.00 at 21-30 weeks). N-LVIRT, LV myocardial performance index, and FHR trends differed significantly between LQTS fetuses and controls through gestation. The LVIRT is prolonged in LQTS fetuses. Findings of a prolonged N-LVIRT and sinus bradycardia can improve the prenatal detection of fetal LQTS.

OP-500 - Relation between Left Ventricular Myocardial Performance Index and Nıhss Score in Patients with Acute Ischemic Stroke

Objective: Myocardial performance index (MPI) is an easily measured index for the assessment of global heart function, combining both systolic and diastolic components. It can be derived from both pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI) and is defined as the sum of the isovolumic contraction time (ICT) and the isovolumic relaxation time (IRT) divided by the ejection time (ET). MPI has been shown to be independent of HR, blood pressure, loading conditions and the geometry of the ventricles. In this study, we aimed to investigate the relation between left ventricular myocardial performance index and National Institutes of Health Stroke Scale (NIHSS) score in acute ischemic stroke patients.

Left ventricular myocardial performance index in prediabetic patients without coronary artery disease.

Prediabetes is a high-risk condition for diabetes mellitus type 2, which is an important public health issue. The myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. We evaluated the MPI and left ventricular (LV) function in prediabetic patients who did not have coronary artery disease. In total, 80 prediabetics (34 females and 46 males) and an equal number of sex-matched healthy volunteers (35 females and 45 males) were enrolled prospectively. All subjects underwent laboratory analyses and echocardiographic examinations, including MPI measurements. There was a moderate increase in MPI between healthy controls and prediabetics (P<.001). Prediabetes was strongly associated with MPI (r=.553, P<.001). We found that MPI was associated with prediabetes on multivariate logistic regression analysis (Odds Ratio (OR)=1.967, 95% confidence interval [CI]=1.574-2.459, P<.001). The results of this study show that systolic functions and LV diastolic parameters were adversely affected in prediabetic patients. Prediabetes is closely associated with subclinical LV systolic and diastolic dysfunction as assessed by MPI.

Assessment of Subclinical Cardiac Alterations and Atrial Electromechanical Delay by Tissue Doppler Echocardiography in Patients with Nonfunctioning Adrenal Incidentaloma.

BackgroundMajority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group.ObjectiveIn this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI.MethodsThirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant.ResultsLeft ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups.ConclusionOur study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.

Assessment of Left Ventricular Diastolic Functions and Myocardial Performance Index in Patients with Prediabetes

Amac: Kalp yetmezligi (KY), fonksiyonel kapasite ve hayat kalitesinin azalmasi, morbidite ve mortalitenin artisi ile karakterize progresif, kronik bir sendromdur. Korunmus ejeksiyon fraksiyonlu (EF) kalp yetmezligi, KY olgularinin yaklasik yarisini temsil eder. Diyabetes mellitus (DM), KY ile yakindan iliskilidir ve DM hastalarinda KY, iki-sekiz kat daha siktir. Prediyabet, diyabetten onceki asama olup, bozulmus glukoz toleransi (BGT), bozulmus aclik glukozu (BAG) veya her ikisinin varligi olarak tanimlanmistir. DM’nin, korunmus EF’li kalp yetmezligi ve diyastolik disfonksiyonla iliskisi ortaya konmussa da, prediyabetik evrenin diyastolik disfonksiyonla iliskisi net degildir. Bu calisma prediyabet ile diyastolik disfonksiyon arasindaki iliskiyi ortaya koymayi amaclamaktadir. Materyal ve Metot: Bu calisma tek merkezli, prospektif, kesitsel bir calismadir. Calismaya, basvuru sirasinda 75 gr glukoz ile yapilan oral glukoz tolerans testi (OGTT) ile normal, yeni diyabet veya prediyabet tanisi konulan 110 hasta alindi. Hastalarin sistolik, diyastolik ve diger kardiyak parametleri konvansiyonel ekokardiyografi ve doku Doppler ekokardiyografi ile degerlendirildi. Kontrol, prediyabet ve diyabet gruplari, mitral kapak akim hizlari ve doku Doppler bulgulari ile diyastolik fonksiyonlar acisindan karsilastirildi. Bulgular: Prediyabetiklerde, Mitral E/A orani (kontrol: 1,10±0,26; prediyabet: 0,90±0,16; diyabet: 0,93±0,24; p=0,001), ortalama doku Doppler Em/Am orani (kontrol: 1,13±0,33; prediyabet: 0,94±0,33; diyabet: 0,92±0,26; p=0,001), diyabetiklerde oldugu gibi azalmis olarak izlendi. Ayri-ca deselerasyon zamani, izovolumik relaksasyon zamani, ve miyokardiyal performans indeksi prediyabetiklerde de diyabetiklerde oldugu gibi yuksek izlendi. Ayrica bu calismada aclik kan sekeri ve OGTT ikinci saat kan sekeri ile mitral akim E/A orani ve Doppler global Em/Am orani arasinda korelasyon saptandi. Sonuc: Diyastolik disfonksiyon indekslerini ve MPI’yi diyabetik hastalarla ve kontrol grubu ile karsilasti-ran bu calismada, prediyabetik hastalarda, diyastolik disfonksiyon oldugu tespit edildi. Bu calis-ma, diyabet komplikasyonlarinin bu glukoz seviyelerinde dahi basladigini ve diyastolik disfonksi-yonun kan seker seviyeleri korele oldugunu ortaya koymustur.

Myocardial performance index as an echocardiographic predictor of early in-hospital heart failure during first acute anterior ST-elevation myocardial infarction.

ObjectivesTo determine the value of Myocardial Performance Index (MPI) as an echocardiographic predictor of early in-hospital heart failure (HF) during first acute anterior ST-Elevation Myocardial Infarction (STEMI).BackgroundMyocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. The ejection fraction (EF) and transmitral flow, the most frequently used methods for evaluation of systolic and diastolic functions respectively, both have considerable limitations. The MPI is a single parameter, capable of estimating combined systolic and diastolic performance and lacks such limitations.MethodsWe enrolled 60 patients presented with a first acute anterior STEMI who have undergone primary PCI. Echocardiography was done within 24 h of chest pain with measurement of MPI. The LV MPI was calculated as (isovolumic contraction time “ICT” + relaxation time “IRT”)/Ejection time “ET”. Besides, clinical and echocardiographic variables were analyzed and CHF was defined as Killip class ≥ II.ResultsEarly in-hospital HF occurred in 23 of patients (38%). Ejection fraction was found to have a highly significant negative correlation with the development of in-hospital HF (p = .0001), while MPI was found to have a highly significant positive correlation (p = .0001). A cut-off point of MPI > 0.73 showed a very high specificity (94.6%) and sensitivity (78.3%) for identifying patients with HF. On the other hand, a cut-off point of EF ≤ 33% has shown 94.6% specificity and 56.5% sensitivity for HF prediction.ConclusionsThe MPI might be a strong predictor of in-hospital HF after first acute anterior STEMI.

Subclinical systolic and diastolic dysfunctions in patients with metabolic syndrome and angiographically normal coronary arteries: An echocardiographic study.

The metabolic syndrome (MetS), as a combination of cardiovascular risk factors, is associated with subclinical cardiovascular diseases. We sought to evaluate the subclinical myocardial dysfunctions using echocardiography in patients with normal coronary arteries. In this cross-sectional study, we assessed 50 consecutive patients with angiographically-proven normal coronary arteries and a left ventricular (LV) ejection fraction (EF) ≥55%. The diagnosis of MetS was based on the National Cholesterol Education Program/Adult Treatment Panel III criteria. All patients were examined using conventional and two-dimensional speckle tracking echocardiography for evaluating the myocardial functions. The patients' mean age was 52.3 ± 8.3 years with 32 females (64%). LV EF, mass index, and full volume were comparable between groups. The LV myocardial performance index (0.40 ± 0.13 vs. 0.32 ± 0.10; P = .027), global longitudinal strain (GLS, -15.8 ± 4.5 vs. -19.7 ± 2.1; P < .001), and global circumferential strain (-17.9 ± 6.1 vs. -21.5 ± 3.3; P = .014) were different between patients with or without MetS, respectively. The GLS discriminated patients with MetS (area under the curve = 0.837, sensitivity 80%, specificity 88%, P < .001). In MetS without coronary artery disease, echocardiography demonstrated subclinical systolic and diastolic dysfunction.

Assessment of left ventricular function using the Myocardial Performance Index in term fetuses that develop intrapartum compromise

Objective: To investigate the relationship between the prelabour left ventricular Myocardial Performance Index (LVMPI) and intrapartum fetal compromise (IFC) in low-risk term pregnancies.Methods: A blinded, prospective observational cohort study at the Mater Mother’s Hospital, Brisbane, Australia. A cohort of 284 women with uncomplicated singleton pregnancies underwent fortnightly ultrasound from 36 weeks until delivery. The LVMPI was assessed by conventional Doppler ultrasound and correlated with intrapartum outcomes. The LVMPI was also correlated with other Doppler indices of fetal wellbeing.Results: Two hundred and seventy-three women were included in the final analysis, the median LVMPI was higher in fetuses that required any emergency operative delivery for IFC (0.56, 0.52–0.60 versus 0.54, 0.50–0.58, p = .007). The left ventricular cardiac output (LVCO) and cerebroplacental ratio (CPR) were lower in fetuses that required any emergency operative delivery for IFC compared to those that did not (164 ± 19 ml/min/kg versus 181 ± 30 ml/min/kg, p < .001) (1.63 + 0.30 versus 1.90 + 0.50, p < .001), respectively. The LVMPI was inversely correlated with the CPR (r = −0.20, p < .01), MCA PI (r = −0.29, p < .01), and LVCO (r = −0.22, p < .01).Conclusions: Higher global LVMPI is associated with a higher risk for IFC and poorer condition of the newborn.

Cardiac changes in moderately malnourished children and their correlations with anthropometric and electrolyte changes.

To evaluate electrocardiographic and echocardiographic changes in moderately malnourished children and to correlate them with both anthropometric and electrolyte changes. Sixty moderately malnourished children were taken as patient group, and 60 healthy children of matched age and sex were taken as control group. Weight, height, body mass index (BMI), serum albumin, and electrolytes were measured for all children. Electrocardiographic evaluation for calculated QT (QTc) and QT dispersion (QTd) was performed. Left ventricular (LV) function was also evaluated using conventional echocardiography, tissue Doppler, and strain methods. Left ventricular mass index (LVMI) was also calculated. Weight, BMI, serum levels of albumin, total calcium, and ionized calcium were significantly lower, while QTc and QTd were significantly prolonged in malnourished children (P=.001 for all). There was significant reduction in LV fraction shortening (FS), LV E'/A', LV strain (S), LV myocardial performance index (MPI), LV global systolic strain (GLSS), and LVMI (P=.001 for all) in malnourished children. There was significant correlation between BMI and all cardiac variables. Moreover, there was significant positive correlation between serum albumin level and LV E'/A' (P=.02), LV GLSS (P=.03), and LVMI (P=.03).Total and ionized calcium level were significantly correlated with QTc, QTd, and LVMI (P<.05 for all). BMI was the most powerful predictor of these electrocardiographic and echocardiographic changes. Cardiac changes were present in moderately malnourished children as documented by electrocardiographic and echocardiographic changes, and these changes are in strong association with BMI and for a lesser extent with electrolyte changes especially serum calcium.

P29.03: Assessment of fetal myocardial performance index in routine follow‐up of twin pregnancy: feasibility study

To demonstrate the feasibility of fetal left-ventricular myocardial performance index (LV-MPI) assessment in routine follow-up of twin pregnancy. Qualitative assessment of LV-MPI measures was performed prospectively by two gynecologist-obstetrician operators on mono and dichorionic twin pregnancies managed between March and July 2016 in a single tertiary referral fetal medicine unit. Each measure was retrospectively scored by 2 pediatric cardiologists using a 10-points scale based on 7 parameters. Only measures with a score ≥8/10 were validated. The LV-MPI value, the time to perform the measure and the nature of technical problems faced during the measure were also reported. Twin–twin transfusion syndrome (TTTS) pregnancies were excluded. Sixty-two measures of LV-MPI were performed on 64 fetuses from 32 consecutive twin pregnancies between 16 and 35 WG. Two (3%) measures could not be performed due to technical difficulties and 2 measures performed at 33 WG on fetuses from the same pregnancy were not validated due to an unsatisfying Doppler profile despite a correct anatomical position. All validated measures were performed in less than 5 minutes with a median LV-MPI value of 0.43 (range 0.23-0.78). The most frequently reported technical problem by operators was to obtain the proper anatomical position. LV-MPI assessment is properly and quickly achieved by trained operators without major technical problems during the follow-up of twin pregnancies. Recently published data suggest that echocardiographic findings including LV-MPI in the recipient fetus may provide substantial predictive information to assess cardiovascular and therefore global morbidity and mortality during TTTS. The present study warrants further routine evaluation of LV-MPI in TTTS severity staging.