1,787 research outputs found
Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock. a systematic review and meta-analysis
Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock
Doppler tissue imaging in ST-elevation myocardial infarction
Highly available, noninvasive and cost-effective, echocardiography remains a keystone in
the evaluation of patients with coronary artery disease (CAD). Echocardiographic
assessment of cardiac function at rest and during dobutamine stress has direct clinical
implications. Conventional echocardiographic parameters however, are partly based on
visual interpretation of cardiac motion, thereby subject to interobserver variability,
especially in patients with poor image quality. As a complement, myocardial velocity
imaging techniques such as Doppler tissue imaging (DTI) offer quantitative markers of
cardiac function.
In the present study, we explored the feasibility and diagnostic value of DTI in the
evaluation of left and right ventricular function, the presence of inducible ischemia and
myocardial viability in patients with ST-elevation myocardial infarction (STEMI).
In 90 patients with STEMI (64 men and 26 women aged 65±13 years) echocardiography
was performed at day 1, 5–7 days and 6 months after admission. At day 5–7, dobutamine
stress echocardiography (DSE) with wall motion analysis (WMA) was performed,
followed by coronary angiography within 24 hours. Using DTI, systolic, early and late
diastolic myocardial velocities were recorded near the mitral annulus at 4 left ventricular
(LV) sites, and near the tricuspid annulus in the right ventricular free wall. The myocardial
performance index (MPI), a Doppler-based, combined measure of systolic and diastolic
function, was calculated as the sum of the isovolumic time intervals divided by the ejection
time derived from DTI at the 4 LV sites. Forty-one aged-matched healthy subjects served
as controls.
In patients with complete normalization of conventional parameters of LV function at
follow-up, peak systolic as well as early diastolic LV myocardial velocities were
significantly reduced compared with those in healthy subjects, possibly reflecting a
residual subendocardial damage.
Using peak systolic velocity in the right ventricular (RV) free wall as a marker of RV
function, sensitivity and specificity of DTI in identifying patients with electrocardographic
signs of RV infarction (ST-elevation in ECG lead V4R) were 89% and 71%, respectively.
Furthermore, peak RV systolic velocities remained reduced in patients with RV infarction,
even after resolution of ECG changes and were still evident at 6 months’ follow-up.
Use of the MPI as a marker of ischemia during DSE was shown to be feasible, and
although the majority of patients did not achieve an optimal level of stress, relative
changes in MPI between rest and peak stress offered reasonable diagnostic properties,
superior to those of WMA. Sensitivity and specificity for detection of left anterior
descending, left circumflex and right coronary artery disease were 80% and 87%, 59% and
80% and 85% and 72%, respectively.
Finally, we found that MPI during low-dose dobutamine infusion exhibits a specific
pattern, similar to that of WMA, predicting late recovery of LV systolic function.
In conclusion, the use of DTI during echocardiography at rest and during dobutamine
stress is feasible and allows evaluation of LV and RV function in the acute as well as the
late phase after a STEMI. Furthermore, changes in MPI derived from DTI during DSE
identify patients with residual CAD and predict late recovery of LV function,
independently of age, troponin level and time to reperfusion treatment
- …