Myocardial Performance Research Articles

Myocardial performance index improves prediction of major adverse cardiovascular events and heart failure in type 1 and type 2 diabetes without known heart disease: Thousand&1 and Thousand&2 study

Abstract Background Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in type 1 (T1D) and type 2 diabetes (T2D). Despite myocardial involvement in diabetes, current risk prediction models do not include parameters of the myocardial function. Myocardial performance index (MPI) reflects left ventricular systolic and diastolic function. The prognostic value of MPI has not been evaluated in larger-scale diabetes populations. Purpose To assess the prognostic value of MPI in a larger-scale diabetes population. Methods We evaluated two prospective cohort studies: The Thousand&1 Study (1093 individuals with T1D) and The Thousand&2 Study (1030 individuals with T2D). Clinical data, including echocardiography, were collected at baseline. We excluded 480 individuals with heart disease. We collected follow-up data from national registries. We defined major adverse cardiovascular events (MACE) as the first incident of all-cause death, hospital admission for acute coronary syndrome, heart failure, or stroke. Results For included individuals (56% male, 54±15 years, MPI 0.51±0.1, 63% T1D), follow-up was 100% after a median of 5.3 years (interquartile range: 4.8 to 6.3). MPI was significantly associated with MACE (Hazard ratio 1.2, 95% confidence interval 1.0-1.3, p=0.012, per 0.10-unit increase) and heart failure (Hazard ratio 1.3, 95% confidence interval 1.1-1.6, p=0.005, per 0.10-unit increase) after adjusting for clinical and echocardiographic variables. MPI predicted MACE better in T1D than in T2D (p=0.031 for interaction). MPI added discriminatory power to the Steno T1D Risk Engine (1,2) in predicting heart failure, but not MACE. Conclusions MPI is an independent predictor of MACE and heart failure in T1D and T2D, with the strongest prediction in T1D. Echocardiographic assessment in diabetes may enhance risk prediction.

Association between cardiac time intervals and incident heart failure after acute coronary syndrome

Abstract Background Cardiac time intervals are sensitive markers of myocardial dysfunction that predisposes to heart failure (HF). Color tissue Doppler imaging (TDI) curved M-mode is a reliable method for measuring cardiac time intervals. Purpose We aimed to investigate the association between cardiac time intervals and HF in patients with acute coronary syndrome (ACS). Methods This was a retrospective cohort study of 580 ACS patients treated with percutaneous coronary intervention (PCI). Patients underwent an echocardiography examination performed a median of two days after PCI. By echocardiography cardiac time intervals including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) were obtained by TDI curved M-mode and used to derive the myocardial performance index (MPI). The outcome was incident HF. Patients with prevalent at baseline HF were excluded from the analysis. Results The final study sample consisted of 387 patients, 73% were male, the mean age was 64 years, 76% of the ACS events were STEMI and LVEF and GLS were 42% and -13.1%, respectively. During follow-up (median 4.3, IQR:1.0-6.7 years), 140 (36%) developed HF. In unadjusted analyses, longer combined indexes were associated with a higher risk of HF (IVRT/ET: HR 1.24 (1.07-1.43), P = 0.003, per 0.1 increase) and (IVCT/ET: HR 1.44 (1.10-1.91), P = 0.010, per 0.1 increase), and so was higher MPI (HR 1.20 (1.08-1.34),P = 0.001, per 0.1 increase). In addition, shorter ET was also associated with higher HF risk (HR 1.13 (1.07-1.18), P<0.001 per 10ms decrease). MPI and IVCT/ET showed a curvilinear association with the outcome, whereas a linear association was observed for ET and IVRT/ET to the outcome (figure 1). After multivariable adjustment for cardiovascular risk factors, only MPI (HR 1.13 (1.01-1.27), P = 0.034), ET (HR 1.09 (1.01-1.17), P = 0.025), and IVCT/ET (HR1.37 (1.04-1.81), P = 0.023) remained significantly associated with HF. Of note, left ventricular ejection fraction (LVEF) significantly modified the association between ET and HF (p for interaction = 0.002), such that ET was associated with HF even in those with preserved LVEF (>40%) (HR 1.13 (1.02-1.24, P = 0.017, per 10ms decrease), but not in those with reduced LVEF (HR 1.02 (0.96-1.08), P = 0.56, per 10ms decrease). These findings also persisted after adjustment for cardiovascular risk factors. Conclusion Shortened ET, prolongation of combined indexes, and higher MPI were associated with an increased risk of incident HF. In addition, shortening of the ET was associated with an increased risk of HF in patients with preserved systolic function by LVEF.

Speckle tracking echocardiography detects subtle right ventricular systolic dysfunction in post Covid syndrome after mild severity Covid-19

Abstract Introduction Now that the global COVID-19 pandemic has come to an end, many patients seek medical help for its aftermath giving rise to post COVID syndrome. Post COVID syndrome describes individuals with a history of probable or confirmed COVID-19 infection, usually 3 months from the onset of infection with symptoms that last for at least 2 months and no alternative diagnosis can be explained. The affection of the right ventricular (RV) systolic function is a cornerstone in the pathogenesis underlying Post COVID syndrome. Many modalities were used to assess the RV with a widespread debate as to the most accurate one. However, echocardiography remains the modality of choice for the evaluation of RV systolic function, especially when using its novel features as myocardial deformation imaging by speckle tracking echocardiography (STE) to surpass the RV’s peculiar anatomy, retrosternal position and complex architecture. Purpose The aim was to assess RV systolic function by STE 3-6 months after recovery from mild severity COVID-19 disease and correlate these findings with Post COVID syndrome. Methods This study included 96 adults (above 18 years of age) who were classified into three equal groups; the first group recruited 32 subjects 3-6 months after recovery from mild severity COVID-19 disease without post COVID syndrome, the second group included 32 subjects 3-6 months after recovery from mild severity COVID-19 disease with post COVID syndrome and the third group recruited 32 gender-matched healthy subjects of similar ages without previous COVID-19 disease (control group). Each subject underwent a detailed transthoracic echocardiography including RV function assessment using 2D RV STE imaging. Results RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) were significantly lower in patients after recovery from mild severity COVID-19 disease with post COVID syndrome (P-value= 0.010) in comparison to the other groups. There was a statistically significant negative correlation found between RV 2D STE parameters and RV end-diastolic dimension, systolic pulmonary artery pressure and RV myocardial performance index. Also, there was a statistically significant positive correlation found between RV 2D STE parameters and RV fractional area change, tricuspid annular plane systolic excursion and RV S'. The cardiac symptomatology in patients with post COVID syndrome was analyzed showing that the most common three symptoms were fatigue, palpitations and chest pain with a prevalence of 65.6%, 40.6% and 31% respectively. These three symptoms showed a significant negative relation with RV-GLS and RV-FWLS. Conclusion RV function assessed using STE occupied the lower normal ranges in patients recovering from mild severity COVID-19 disease, particularly those with post COVID syndrome. 2D STE may be used for the detection and follow-up of possible subtle long term RV dysfunction after mild severity COVID-19 disease.RV-GLS and RV-FWLS in the studied groupsRV-GLS and RV-FWLS using 2D STE

Efficacy of Empagliflozin in the Treatment of Experimental Myocardial Infarction

Introduction. With the emergence of empagliflozin in the pharmaceutical market, there has been an increase in publications on the primary and secondary pharmacodynamics of the drug, and the list of potential indications for the use of this sodium-glucose co-transporter inhibitor is increasing. Hypotheses about pharmacological effects and mechanisms of their implementation are tested both in large-scale clinical studies and in animal experiments.Aim. The purpose of this work was to study the effectiveness of empagliflozin by echocardiographic, histological and molecular biological analyses at the three most significant points of the dynamic transition from acute myocardial infarction to post-infarction chronic heart failure in laboratory male rats.Materials and methods. The experiment was performed on 60 male outbred rats. Myocardial infarction was modeled in narcotic animals by permanent ligation of the left coronary artery. Based on echocardiographic (EchoCG) study data, animals were randomized to two groups: control infarction: untreated pathology group treated with placebo and pathology group treated with empagliflozin 1 mg/kg per os intragastric daily from the first day of the experiment. At 10, 20 and 30 days after the operation, the animals were also subjected to EchoCG testing, and a group of 10 animals from each group were euthanized for histological examination and molecular analysis.Results and discussion. Empagliflozin use in animals after myocardial infarction modeling contributed to a significant increase in myocardial performance on days 10, 20 and 30, reaching a maximum on day 20 (47.58 ± 1.87 %). The drug promotes long-term preservation of the area of damage to the heart muscle with early formation of mature connective tissue, and also increases myocardial resistance to hypoxia by increasing the amount of HIF-1.Conclusion. Based on the studies carried out, it can be concluded that it is possible to use the sodium-glucose cotransporter type 2 empagliflozin in the formation of post-infarction chronic heart failure in the conditions of normoglycemia.

Determinants of right ventricular systolic dysfunction among patients with left heart failure in a Ghanaian hospital.

The presence of right ventricular dysfunction affects outcomes in patients with left heart failure. We assessed the determinants of right ventricular systolic dysfunction (RVSD) among patients with left heart failure presenting to the Korle Bu Teaching Hospital of Ghana. Consecutive patients with left heart failure who were 18 years and above were prospectively enrolled and assessed for evidence of RVSD by measuring the tricuspid annular plane systolic excursion, the peak velocity of the tricuspid annulus in systole (RV S'), the two-dimensional right ventricular fractional area change (RV FAC) and the right ventricular myocardial performance index (RV MPI). Two hundred and seventy participants were enrolled, of whom 75.2% had at least one abnormal index of right ventricular systolic function. The prevalence of RVSD was significantly higher among those with non-hypertensive heart failure (85.3 vs 66.0%, p < 0.001). The left ventricular outflow tract velocity-time integral (LVOT VTI) was strongly correlated with the RV FAC and an LVOT VTI < 9.8 cm predicted the presence of an RV FAC < 35% with a sensitivity of 81.5% and specificity of 81.9% [area under the curve 0.882; 95% confidence interval (CI): 0.838-0.926, p < 0.001]. Independent predictors of the presence of RVSD included a transmitral E/A > 2 [odds ratio (OR) = 4.684, 95% CI: 1.521-14.428, p = 0.007), left ventricular ejection fraction < 40% (OR = 4.205, 95% CI: 1.643-10.760, p = 0.003), pulmonary artery systolic pressure (PASP) ≥ 35 mmHg (OR = 2.434, 95% CI: 1.012-5.852, p = 0.047) and systemic systolic blood pressure (SBP) < 140 mmHg (OR = 2.631, 95% CI: 1.152-6.011, p = 0.022). RVSD was common in these Ghanaian patients with left heart failure. Left ventricular function, SBP and PASP were independent predictors of the presence of RVSD. Pending further validation, the LVOT VTI may serve as a useful surrogate or screening tool for RVSD in these patients.

Abstract 12735: Investigating Cardiac Function After Anthracycline Exposure in Childhood Cancer Survivors With Modifiable Cardiovascular Risk Factors

Introduction: Anthracycline exposure can lead to cardiac dysfunction, which may possibly be worsened by secondary cardiovascular risk factors (CVRFs), such as hypertension, hyperlipidemia, obesity and diabetes. The prognostic impact of CVRFs in childhood cancer survivors is largely unknown. Now with advanced cardiac imaging, it is now possible to identify how CVRFs might influence subclinical cardiac function. Hypothesis: Anthracycline-exposed childhood cancer survivors with CVRFs will demonstrate echocardiogram-based subclinical cardiac dysfunction more frequently than those without. Methods: This is a single-center, retrospective study. Inclusion criteria are: &lt; 18 years old, history of anthracycline-containing chemotherapy and 2 echocardiograms performed. Exclusion criteria are: congenital cardiac disease, subsequent cancer relapse and inadequate imaging quality. Echocardiographic images were analyzed for longitudinal left ventricular strain, left ventricular ejection fraction (LVEF) and myocardial performance index (MPI). Wilcoxon rank-sum test was used to compare measures of cardiac function between patients with at least one CVRF (at time of cancer diagnosis) and patients without. Results: There were 111 patients identified with 49.5% having dysfunction at some point in time. CVRFs were identified in 19 patients with the majority of those being obese (52.6%). At baseline, there was a statistically significant difference in mean strain between those with CVRFs vs those without (-19.4% vs -21.3%). At 1-6 months after chemotherapy completion, LVEF was significantly reduced in those with CVRFs vs those without (48.7% vs 59.7%) as well as mean strain (-15.8% vs -20.0%). At &gt;5 years after chemotherapy, there was a decrease in strain magnitude in those with CVRFs vs those without (-17.7% vs -20.5%) along with abnormal mean MPI (0.57 vs 0.44). Conclusions: Anthracycline-exposed pediatric cancer survivors with CVRFs demonstrate reduced cardiac function at baseline and both at near-and long-term follow-up. Further investigation is warranted to investigate the significance of these reduced echocardiographic measures and CVRFs among childhood cancer survivors to mitigate cardiac morbidity as they age into adulthood.

Myocardial Performance Index in Cardiological Evaluation in Kidney Transplant Recipients

Myocardial Performance Index in Cardiological Evaluation in Kidney Transplant Recipients

DNA Methylation and Telomeres-Their Impact on the Occurrence of Atrial Fibrillation during Cardiac Aging.

Atrial fibrillation (AF) is the most common arrhythmia in humans. AF is characterized by irregular and increased atrial muscle activation. This high-frequency activation obliterates the synchronous work of the atria and ventricles, reducing myocardial performance, which can lead to severe heart failure or stroke. The risk of developing atrial fibrillation depends largely on the patient's history. Cardiovascular diseases are considered aging-related pathologies; therefore, deciphering the role of telomeres and DNA methylation (mDNA), two hallmarks of aging, is likely to contribute to a better understanding and prophylaxis of AF. In honor of Prof. Elizabeth Blackburn's 75th birthday, we dedicate this review to the discovery of telomeres and her contribution to research on aging.

A Comparative Assessment of Myocardial Work Performance during Spontaneous Rhythm, His Bundle Pacing, and Left Bundle Branch Area Pacing: Insights from the EMPATHY Study.

Physiological pacing has gained significant interest due to its potential to achieve optimal hemodynamic response. This study aimed to assess left ventricular performance in terms of electrical parameters, specifically QRS duration and mechanical performance, evaluated as myocardial work. We compared His Bundle Pacing (HBP) and Left Bundle Branch Area Pacing (LBBAP) to evaluate their effects. Twenty-four patients with class I or IIa indications for pacing were enrolled in this study, with twelve patients undergoing HBP implantation and another twelve undergoing LBBAP implantation. A comprehensive analysis of myocardial work was conducted. Our findings indicate that there were no major differences in terms of spontaneous and HBP activation in myocardial work, except for global wasted work (217 mmHg% vs. 283 mmHg%; p 0.016) and global work efficiency (87 mmHg% vs. 82 mmHg%; p 0.049). No significant differences were observed in myocardial work between spontaneous activation and LBBAP. Similarly, no significant differences in myocardial work were found between HBP and LBBAP. Both pacing modalities provide physiological ventricular activation without significant differences when compared to each other. Moreover, there were no significant differences in QRS duration between HBP and LBBAP. However, LBBAP demonstrated advantages in terms of feasibility, as it achieved better lead electrical parameters compared to HBP (threshold@0.4 ms 0.6 V vs. 1 V; p = 0.045-sensing 9.4 mV vs. 2.4 mV; p < 0.001). Additionally, LBBAP required less fluoroscopy time (6 min vs. 13 min; p = 0.010) and procedural time (81 min vs. 125 min; p = 0.004) compared to HBP.

Assessment of fetal myocardial performance index in pregnant women with SARS-CoV-2 infection: A prospective cohort study.

Our aim was to investigate the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on fetal myocardial performance in women who had it during their pregnancy. In our prospective cohort study including healthy pregnant women and pregnant with SARS-CoV-2 infection, we collected patients' data between June 2021 and April 2022. Maternal characteristics, gestational age at SARS-CoV-2 infection and ultrasound examination, and body mass index were noted. Fetal biometry, fetal anatomy scanning, placenta, amniotic fluid index (AFI), and Doppler parameters were routinely examined in all patients. Left ventricular myocardial performance index (MPI) was measured during fetal echocardiography examination. Doppler parameters, AFI, and MPI values were compared between two groups. Compared with the control group (n = 80), MPI values were found within normal limits in fetuses of pregnant women with SARS-CoV-2 infection (n = 80) (MPI: 0.38 ± 0.06 in the control groups vs. 0.39 ± 0.05 in the SARS-COV-2 positive group, p = 0.79). There was no relationship between SARS-CoV-2 infection and changes in AFI and umbilical artery pulsatility index (PI) values. Uterine artery PI values were significantly higher in pregnant women with (SARS-CoV-2) infection (0.81 in the control group vs. 0.97 in the SARS-CoV-2 group, p < 0.05). Fetal cardiac functions were not affected in pregnant women with previous (SARS-CoV-2) infection. Further metaanalyses are warranted to confirm the results.

The evaluation of fetal interventricular septum with M-mode and spectral tissue Doppler imaging in gestational diabetes mellitus: a case-control study.

To demonstrate possible functional changes in the frequently affected fetal interventricular septum (IVS) with spectral tissue Doppler imaging (TDI) and M-mode imaging to compare gestational diabetes mellitus (GDM) and control groups. A total of 63 pregnant women with GDM, 30 on diet (A1 GDM) and 33 on treated with insulin (A2 GDM), and 63 healthy pregnant women randomly selected and matched to the case group in the control group were included. The GDM fetuses had significantly thickened IVS, increased early diastole (E'), atrial contraction (A'), systole (S'), higher myocardial performance index (MPI'), prolonged isovolumetric relaxation time (IVRT'), shortened ejection time (ET'), and decreased septal annular plane systolic excursion (SAPSE) than the controls. The A2 GDM group fetuses had significantly thickened IVS, increased S' and shortened ET' than the A1 GDM group. In the GDM group, we found a significantly positive low correlation between glycated hemoglobin levels and maternal serum fasting glucose and one-hour postprandial glucose with fetal IVS thickness. We demonstrated a significantly negative low correlation between maternal serum one-hour postprandial glucose, glycated hemoglobin levels, and gestational weight gain with fetal IVS ET'. Fetal IVS diastolic and systolic functions were altered in the GDM group compared to controls, and systolic functions were altered in A2 GDM compared to A1 GDM. This may alert clinicians to possible cardiovascular diseases in the postnatal life, and early preventive strategies and long-term lifestyle changes may provide protection in fetuses with GDM.

Non-invasive technologies for heart failure, systolic and diastolic dysfunction modeling: a scoping review.

The growing global prevalence of heart failure (HF) necessitates innovative methods for early diagnosis and classification of myocardial dysfunction. In recent decades, non-invasive sensor-based technologies have significantly advanced cardiac care. These technologies ease research, aid in early detection, confirm hemodynamic parameters, and support clinical decision-making for assessing myocardial performance. This discussion explores validated enhancements, challenges, and future trends in heart failure and dysfunction modeling, all grounded in the use of non-invasive sensing technologies. This synthesis of methodologies addresses real-world complexities and predicts transformative shifts in cardiac assessment. A comprehensive search was performed across five databases, including PubMed, Web of Science, Scopus, IEEE Xplore, and Google Scholar, to find articles published between 2009 and March 2023. The aim was to identify research projects displaying excellence in quality assessment of their proposed methodologies, achieved through a comparative criteria-based rating approach. The intention was to pinpoint distinctive features that differentiate these projects from others with comparable objectives. The techniques identified for the diagnosis, classification, and characterization of heart failure, systolic and diastolic dysfunction encompass two primary categories. The first involves indirect interaction with the patient, such as ballistocardiogram (BCG), impedance cardiography (ICG), photoplethysmography (PPG), and electrocardiogram (ECG). These methods translate or convey the effects of myocardial activity. The second category comprises non-contact sensing setups like cardiac simulators based on imaging tools, where the manifestations of myocardial performance propagate through a medium. Contemporary non-invasive sensor-based methodologies are primarily tailored for home, remote, and continuous monitoring of myocardial performance. These techniques leverage machine learning approaches, proving encouraging outcomes. Evaluation of algorithms is centered on how clinical endpoints are selected, showing promising progress in assessing these approaches' efficacy.

The influence of maternal inflammatory bowel diseases on fetal cardiac functions: A case-control study

BackgroundThe altered maternal inflammatory milieu and changes in maternal vascular structure (arterial stiffness) and function may affect the fetal heart in pregnant women diagnosed with inflammatory bowel disease (IBD). AimsTo investigate fetal cardiac functions in IBD pregnancies and to reveal the relationship between IBD duration and fetal cardiac functions. Study designProspective case-control study. SubjectsThe case group included 19 pregnant women with ulcerative colitis and seven with Crohn's disease who were in remission at the time of the study. The control group consisted of 52 healthy pregnant women matched for gestational age in the third trimester of pregnancy (at 32 to 33 weeks). Outcome measuresFetal cardiac functions. The assessment was blinded as to whether the patients were cases or controls. ResultsThe right ventricular E', E'/A', S′, and tricuspid annular plane systolic excursion (TAPSE) were significantly lower, and E/E', myocardial performance index (MPI’), and isovolumetric relaxation time (IVRT’) were significantly higher in fetuses of IBD pregnancies. Diastolic functions (E/E', E', E'/A', and IVRT’), systolic functions (S′ and TAPSE), and global function (MPI’) were changed in the case group. A significantly strong correlation was between maternal disease duration and fetal right ventricle diastolic function parameters (E/E', E, E', E'/A') in the case group (r2 = 0.780; p ≤0.001, r2 = 0.570; p ≤0.001, r2 = 0.604; p ≤0.001, r2 = 0.638; p ≤0.001, respectively). ConclusionDiastolic and systolic fetal cardiac functions changed in IBD pregnancies. As the disease duration increases, especially fetal cardiac diastolic functions may be affected.

The Role of Myocardial Performance Index in Evaluating Effect of Hypothyroidism on Systolic and Diastolic Functions of Heart

The Role of Myocardial Performance Index in Evaluating Effect of Hypothyroidism on Systolic and Diastolic Functions of Heart

Echocardiographic and Angiographic Assessment of Right Ventricular Function and Right Coronary Artery Stenosis in Acute Inferior Wall Myocardial Infarction.

Cardiovascular diseases (CVDs) are a global concern. CVD remains a primary cause of death despite reduced coronary heart disease death rates. Acute coronary syndrome (ACS) involves myocardial infarction (MI) and unstable angina, sharing mechanisms such as plaque instability. Our study assesses the right ventricular (RV) function's predictive value in acute inferior wall MI (IWMI) to identify high-risk patients with an elevated likelihood of experiencing severe cardiac complications, hemodynamic instability, or a higher mortality risk following an acute IWMI. The research was conductedin the Department of Cardiology at theRajendra Institute of Medical Sciences (RIMS), Ranchi, from July 2021 to June 2022, following the necessary ethical approval. A cohort of 140 patients with IWMI, carefully chosen according to rigorous criteria, clearly understood the study's objectives before providing informed consent. The evaluations were conducted in the following order: clinical assessments, followed by blood testing, then echocardiography, and finally, coronary angiography. Furthermore, the study examined risk factors and utilized statistical methods to elucidate the associations between qualities and results. The study included 140 participants, with 61% being male and 39% female. Among the participants, 14% were aged 30-45, 50% were aged 46-60, and 30% were over 60. Age shows significant proportions in different categories. Diabetes, dyslipidemia, hypertension, and smoking/tobacco addiction did not differ among stenosis groups. Proximal right coronary artery (RCA) stenosis patients had elevated jugular venous pressure (JVP). The echocardiograms were performed within 48 hours of post-percutaneous coronary intervention, and significant differences between groups were observed. Participants with proximal stenosis had lower tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC), which showedcompromised RV systolic function. Proximal stenosis patients had reduced systolic motion velocity (Sm), indicating impaired myocardial contraction. Echocardiographic parameters such as early diastolic velocity (Em), atrial contraction velocity (Am), Em/Am ratio (a marker of diastolic function), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) between groups were different, indicating distinct cardiac functions. Proximal stenosis increased the myocardial performance index (MPI), indicating cardiac impairment. The left ventricular ejection fraction (LVEF) was comparable in the two stenosis groups, indicating similar left ventricular performance. Echocardiography showed significant RV function differences in acute inferior wall ST-segment elevation myocardial infarction (STEMI) patients with proximal and distal RCA lesions. RV dysfunction is linked to right ventricle myocardial infarction (RVMI), and echocardiographic markers can provide valuable insights. Results emphasizethat acute inferior wall STEMI is diagnosed by electrocardiogram (ECG) criteria, particularly ST-segment elevation. However, these markers emphasize the importance of RV assessment in RCA involvement assessment. These findings suggest that RV function can help diagnose acute inferior wall STEMI RCA involvement. In acute inferior STEMIs, RV function echocardiography is essential for RCA lesion location.

Feasibility study on evaluating right ventricular diastolic function by new Tei’-Index

ObjectiveDoppler-derived myocardial performance index (Tei) has been used in the evaluation of right ventricular (RV) function. However, the usage in isolated diastolic dysfunction is limited.We sought to find a new Tei’-index that is more appropriate for evaluating isolated diastolic dysfunction (IDD) based on the symmetry of cardiac structure and function. Methods21 patients with impaired RV relaxation were compared to 44 control subjects. Tei and Tei’ including their components, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), the ejection time (ET), and RV rapid filling time (RFT) were measured from RV outflow and tricuspid inflow Doppler velocity profiles. ResultsTei-index have no change between IDD group and control subjects (0.21 ± 0.08 vs 0.23 ± 0.07 PNS). The Tei’-index was significantly shortened in IDD group(0.24 ± 0.09 vs 0.32 ± 0.12,p＜0.05).The decrease in Tei’-index was due to the prolongation of both IRT and RFT, and in the abbreviation of ICT. Tei’-index cutoff value of ≥0.31 identified impaired RV relaxation with a sensitivity of 50 % and specificity of 86 %.We also find that the Tei’-index correlated well with doppler measures of diastolic parameters like E/A, E/e’, DT, which suggests its potential use as a noninvasive indicator of the right ventricular (RV) relaxation in patients with heart failure of different causes. ConclusionNew Tei's index is highly effective and specific in the evaluation of early diastolic dysfunction of right ventricle, and can be used as an indicator for the detection of IDD in clinic.

EP01.03: Assessment of the fetal right myocardial performance index in diabetic pregnancy in the third trimester

EP01.03: Assessment of the fetal right myocardial performance index in diabetic pregnancy in the third trimester

EP13.14: The role of fetal right heart modified myocardial performance index in prediction of adverse perinatal outcomes in fetal growth restriction

EP13.14: The role of fetal right heart modified myocardial performance index in prediction of adverse perinatal outcomes in fetal growth restriction

Assessment of Prevalence, Clinical Characteristics, and Risk Factors Associated With “Low Flow State” Using Cardiac Magnetic Resonance

ObjectiveTo assess prevalence, clinical characteristics, and risk factors associated with low flow state (LFS) in a multiethnic population with normal left ventricular ejection fraction (LVEF). Patients and MethodsThe study included 4398 asymptomatic participants undergoing cardiac magnetic resonance from July 17, 2000, to August 29, 2002. Left ventricular (LV) mass, volume, and myocardial contraction fraction were assessed. Low flow state was defined as stroke volume index (SVi of <35 mL/m2). Clinical characteristics, cardiac risk factors, and cardiac magnetic resonance findings were compared between LFS and normal flow state (NFS) groups (NFS: SVi of ≥35 mL/m2). ResultsThere were significant differences in the prevalence of LFS in different ethnic groups. Individuals with LFS were older (66±9.6 vs 61±10 years; P<.0001). The prevalence of LFS was 19% in the group aged older than 70 years. The logistic multivariable regression analysis found that age was independently associated with LFS. The LFS group had significantly higher prevalence of diabetes (30% vs 24%; P=.001), LV mass-volume ratio (1.13±0.22 vs 0.91±0.15; P<.0001), inflammatory markers, a lower LV mass index (59±10 vs 65±11 kg/m2; P<.001), lower myocardial contraction fraction (58.1±10.6% vs 75.7±13%; P<.001), and a lower left atrial size index (32.2±4.6 vs 36.7±5.9 mm/m2; P<.0001) than NFS. ConclusionLow flow state may be considered an under-recognized clinical entity associated with increasing age, multiple risk factors, increased inflammatory markers, a lower LV mass index, and suboptimal myocardial performance despite the presence of normal LVEF and absence of valvular disease.

The Importance of Tissue Doppler Imaging and M-Mode Ultrasonography in Fetuses With Preterm Premature Rupture of Membranes: A Case-Control Study.

To compare the cardiac functions of fetuses with preterm premature rupture of membranes (PPROM) between their control groups and investigate its relationship with perinatal outcomes. This prospective study was conducted with 102 pregnant women. Pregnant women with PPROM were divided into two subgroups Group A, between 26 and 30 weeks, and Group B, between 30 and 34 weeks. A control group was formed by randomly including one healthy pregnant woman for each study patient. Sociodemographic, obstetric data, tissue Doppler imaging, and M-mode imaging results were compared. The relationship between echocardiographic parameters and perinatal outcomes was also investigated. Tricuspid annular plane systolic excursion (TAPSE), S', and ET' of systolic cardiac parameters were shortened in both groups compared with their controls. Diastolic function indicator E'/A', and global function indicator myocardial performance index' increased in both groups. Isovolumetric contraction time' did not change between groups. A correlation was found between myocardial performance index', and the length of neonatal intensive care unit stay in Group A and TAPSE and duration of respiratory support and length of neonatal intensive care unit stay in Group B. The fetal cardiac function seems to be affected by PPROM, and these changes are associated with neonatal outcomes. Therefore, administering fetal cardiac function evaluation in pregnancies complicated by PPROM may help physicians establish more appropriate clinical management protocols in this special population.