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      The Effect of Slow Coronary Flow on Right and Left Ventricular Performance

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          Abstract

          Objective

          To evaluate left and right ventricular functions using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) methods in patients with slow coronary flow (SCF) and to determine the relationship between these parameters and thrombolysis in myocardial infarction frame count in SCF patients.

          Subjects and Methods

          Thirty-five patients (20 males and 15 females) with SCF who underwent coronary angiography and 35 age- and sex-matched controls (14 males and 21 females) without SCF who underwent elective coronary angiography were enrolled in the study. Left ventricular (LV) and right ventricular (RV) functions were examined using conventional echocardiography and TDE.

          Results

          LV systolic myocardial velocity (Sm), early myocardial velocity (Em), late myocardial velocity (Am), and Em/Am ratio were similar in both the SCF and control groups; however, isovolumetric relaxation time (IRT) was higher in the SCF group compared to the control group (IRT: 99 ± 17 vs. 88 ± 20; p = 0.01). In patients with SCF, LV MPI was higher than in the control group, but this was not statistically significant (0.61 ± 0.11 vs. 0.56 ± 0.12; p = 0.07). The RV tricuspid annular velocities and MPI were similar in the SCF and control groups.

          Conclusion

          This study showed that SCF affected LV functions echocardiographically and could cause partially reduced LV performance. In addition, SCF did not affect RV functions echocardiographically.

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          Most cited references27

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          TIMI frame count: a quantitative method of assessing coronary artery flow.

          Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is valuable and widely used qualitative measure in angiographic trials, it is limited by its subjective and categorical nature. In normal patients and patients with acute myocardial infarction (MI) (TIMI 4), the number of cineframes needed for dye to reach standardized distal landmarks was counted to objectively assess an index of coronary blood flow as a continuous variable. The TIMI frame-counting method was reproducible (mean absolute difference between two injections, 4.7 +/- 3.9 frames, n=85). In 78 consecutive normal arteries, the left anterior descending coronary artery (LAD) TIMI frame count (36.2 +/- 2.6 frames) was 1.7 times longer than the mean of the right coronary artery (20.4 +/- 3.0) and circumflex counts (22.2 +/- 4.1, P < .001 for either versus LAD). Therefore, the longer LAD frame counts were corrected by dividing by 1.7 to derive the corrected TIMI frame count (CTFC). The mean CTFC in culprit arteries 90 minutes after thrombolytic administration followed a continuous unimodal distribution (there were not subpopulations of slow and fast flow) with a mean value of 39.2 +/- 20.0 frames, which improved to 31.7 +/- 12.9 frames by 18 to 36 hours (P < .001). No correlation existed between improvements in CTFCs and changes in minimum lumen diameter (r=-.05, P=.59). The mean 90-minute CTFC among nonculprit arteries (25.5 +/- 9.8) was significantly higher (flow was slower) compared with arteries with normal flow in the absence of acute MI (21.0 +/- 3.1, P < .001) but improved to that of normal arteries by 1 day after thrombolysis (21.7 +/- 7.1, P=NS). The CTFC is a simple, reproducible, objective and quantitative index of coronary flow that allows standardization of TIMI flow grades and facilitates comparisons of angiographic end points between trials. Disordered resistance vessel function may account in part for reductions in flow in the early hours after thrombolysis.
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            Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding.

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              Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements.

              A simple, reproducible, noninvasive Doppler index for the assessment of overall cardiac function has been described previously. The purpose of this study was to correlate the Doppler index with accepted indexes of cardiac catheterization of left ventricular performance. Thirty-four patients with ischemic heart disease or idiopathic dilated cardiomyopathy prospectively underwent a simultaneous cardiac catheterization and Doppler echocardiographic study. Invasive measurements of peak +dP/dt, peak -dP/dt, and tau were obtained from the high-fidelity left ventricular pressures. A Doppler index of myocardial performance was defined as the summation of isovolumetric contraction and relaxation time divided by ejection time. There was a correlation between Doppler measurement of isovolumetric contraction time and peak +dP/dt (r = 0.842; p < 0.0001) and Doppler measurement of isovolumetric relaxation time and peak -dP/dt (r = 0.638; p < 0.001). Left ventricular ejection time correlated with both peak +dP/dt (r = 0.539; p < 0.001) and peak -dP/dt (r = 0.582; p < 0.001). The Doppler index correlated with simultaneously recorded systolic peak +dP/dt (r = 0.821; p < 0.0001) and diastolic peak -dP/dt (r = 0.833; p < 0.001) and tau (r = 0.680; p < 0.0001). This study documents that a simple, easily recordable, noninvasive Doppler index of myocardial performance correlates with invasive measurement of left ventricular systolic and diastolic function and appears to be a promising noninvasive measurement of overall cardiac function.
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                Author and article information

                Journal
                Med Princ Pract
                Med Princ Pract
                MPP
                Medical Principles and Practice
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1011-7571
                1423-0151
                December 2013
                5 November 2013
                5 November 2013
                : 23
                : 1
                : 34-39
                Affiliations
                Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
                Author notes
                *Fatih Altunkas, MD, Gaziosmanpasa Universitesi, Arastirma Hastanesi Kardiyoloji AD, Eski rektorluk binası, TR-60100 Tokat (Turkey), E-Mail faltunkas@ 123456yahoo.com
                Article
                mpp-0023-0034
                10.1159/000355471
                5586939
                24217066
                46310d49-cb3b-4715-ba54-d4692312cc94
                Copyright © 2013 by S. Karger AG, Basel

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.

                History
                : 25 December 2012
                : 5 September 2013
                Page count
                Figures: 3, Tables: 3, References: 28, Pages: 6
                Categories
                Original Paper

                right ventricular function,left ventricular function,myocardial performance index,slow coronary flow,tissue doppler echocardiography,coronary artery disease

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