GLOBAL MYOCARDIAL PERFORMANCE INDEX.pdf

Seminars in Cardiology, 2003, Vol. 9, No. 4 ISSN 1648-7966

GLOBAL MYOCARDIAL PERFORMANCE INDEX INPATIENTS WITH ACUTE MYOCARDIAL INFARCTION:SERIAL CHANGES AND PROGNOSTIC IMPLICATION

Virginija Grabauskiene 1, Jelena Čelutkiene 1, Živile Lileikiene 1, Pranas Šerpytis 1,Žana Majorova 2, Aleksandras Laucevičius 1

1 Clinic of Heart Diseases, Vilnius University; Center of Cardiology and Angiology,Vilnius University Hospital Santariškiu Klinikos, Lithuania

2 Department of Statistics, Vilnius University, Lithuania

Received 27 October 2003; accepted 1 December 2003

Keywords: myocardial performance index, Doppler echocardiography, acute myocardial infarction.

SummaryObjectives: The purpose of the study was to investigate serial changes and prognostic value of a

Doppler-derived global myocardial performance index (MPI) in patients with acute myocardial infarction(AMI).

Design and Methods: The Doppler-derived MPI was measured in 30 patients (22 men; mean age62 ± 13 years) with anterior AMI and left ventricular (LV) ejection fraction (EF) < 40%. The patients werestudied within 72 hours of arrival at the coronary care unit and in the follow-up period: 10–30 days; 3–6 and9–12 months after AMI.

Results: The MPI was significantly higher in patients with AMI on admission than during outcomes(p < 0.05). The MPI (72 hours) was significantly correlated to peak creatine kinase-MB and LV EF (r =0.32 [p < 0.01] and r = 0.51 [p < 0.001], respectively). During hospitalisation, a higher MPI, lower EFand deceleration time (DcT) were observed in patients with an adverse outcome than in patients whosurvived without developing of congestive heart failure (CHF). The MPI was significantly lower and EF wassignificantly higher during follow-up in patients who received reperfusion therapy than in those who havenot. During 9.2 ± 5.5 months of follow-up, 6 patients died, CHF developed in 6 patients, and reinfarctionand unstable angina occurred in 4 patients.

Conclusion: The Doppler-derived myocardial performance index reflects the severity of left ventriculardysfunction and may be useful after acute myocardial infarction in predicting patients at high risk for cardiacevents in the follow-up period.

Seminars in Cardiology 2003; 9(4): 21–27

Left ventricular (LV) dysfunction after acute my-ocardial infarction (AMI) has been related to an ad-verse outcome [1]. Two-dimensional and Dopplerechocardiography is a reliable and practical non-invasive method for diagnosing systolic and diastolicdysfunction in cardiac disease and suitable for lon-gitudinal follow-up studies [2–6]. LV systolic functionis usually described in terms of stroke volume, car-diac output and ejection fraction, whereas LV dias-tolic function is defined by Doppler measurementsof mitral inflow during early and late diastole and theduration of the myocardial relaxation phase. A mea-surement of LV myocardial performance combining

Corresponding address: Virginija Grabauskiene, Centerof Cardiology and Angiology, Vilnius University HospitalSantariškiu Klinikos, Santariškiu 2, 2021 Vilnius, Lithuania.Tel.: +370 5 2365 123.E-mail: [email protected].

systolic and diastolic function can be a useful pa-rameter in the assessment of cardiac function andmay be a predictor of the outcome after acute my-ocardial infarction [7]. A relatively new Doppler indexof combined systolic and diastolic myocardial perfor-mance of the left ventricle was reported by Tei et al in1995 [8,9]. This myocardial performance index (MPI)is easily obtained, reproducible, has a narrow rangein normal subjects, does not depend on LV geom-etry, and correlates with invasively obtained mea-surements of systolic and diastolic cardiac function[7,10]. The MPI has shown potential clinical applica-tion in dilated cardiomyopathy and cardiac amyloido-sis [11–13]. The present study describes changesin the MPI in patients with AMI during 1 year offollow-up and evaluates the prognostic significanceof the MPI in relation to the development of majorcardiac events following AMI.

21


Design and Methods

Study populationWe studied 30 patients (22 men and 8 women;

mean age 62 ± 13 years) who were admitted to thecoronary care unit with anterior AMI and LV ejec-tion fraction (EF) < 40%. AMI was defined by atleast 2 of the following criteria: (1) transient ele-vation of creatine kinase ≥195 IU/l and/or creatinekinase-MB ≥25 IU/l, or (2) electrocardiographic ev-idence of AMI (ST elevation > 1 mm in contiguousleads or subendocardial injury pattern) and (3) typ-ical chest pain lasting >30 minutes. All the pa-tients were in sinus rhythm and all echo imagesand Doppler data of the patients were adequate toaccurately assess. The exclusion criteria were: leftbundle branch block, valvular heart disease and di-lated cardiomyopathy. Major cardiac events were de-fined as cardiac death, heart failure, unstable anginaor recurrent AMI. The degree of hemodynamic de-rangement in patients with AMI was based on clin-ical evaluation according to the Killip classification.Sixteen patients were treated with primary percu-taneous transluminal coronary angioplasty (PTCA)and 4 patients – with thrombolysis. Heart failurein the follow-up period was graded according toNYHA class. Two-dimensional and pulsed Dopplerechocardiography was performed within 72 hours af-ter arrival to the coronary care unit and repeatedafter 10–30 days, within 3–6 and 9–12 months afterAMI. The patients were divided retrospectively intofour groups according to: (1) either survivors withoutthe development of congestive heart failure (CHF)and other major cardiac events (group 1, n = 14)or the presence of major cardiac events (group 2,n= 16) during the follow-up period; (2) the treatmentof AMI without reperfusion therapy (group 3, n= 10)or with PTCA and thrombolysis (group 4, n= 20).

The study complied with Declaration of Helsinki.

EchocardiographyTwo-dimensional, pulsed Doppler, and colour

flow Doppler echocardiographic examinations wereperformed with a Hewlett-Packard SONOS 2500cardiac ultrasound unit with a 2.5-MHz transducer.Two-dimensional echocardiographic and pulsedDoppler data were recorded and stored on a video-tape for later analysis.

LV end-diastolic volume (EDV) and end-systolicvolume (ESV) and ejection fraction (EF) were ob-tained by the Simpson’s biplane method. Ventricularvolumes were corrected for body surface area asEDVI and ESVI. LV end-diastolic diameter (LVEDD)was measured from M-mode parasternal long axisview and corrected for body surface area as LVEDDindex. Pulsed Doppler recordings of mitral flow ve-locities were obtained from the apical four-chamberview placing the sample volume between the tips ofthe mitral leaflets, and LV outflow velocities were ob-

tained placing the sample volume in the outflow tractbelow the aortic valve. Each Doppler measurementwas calculated from the average of three consecu-tive cardiac cycles. The following parameters weremeasured: peak early (E) and late transmitral fillingvelocities (A), E/A, and deceleration time (DcT) ofE wave. Doppler time intervals were measured frommitral inflow and LV outflow velocity time intervals(Figure 1). The time interval a from the cessation tothe onset of mitral inflow was equal to the sum ofisovolumic contraction time, ejection time and iso-volumic relaxation time. LV ejection time b was theduration of LV outflow velocity profile. Thus, the sumof isovolumic contraction time and isovolumic relax-ation time was obtained by subtracting b from a. Themyocardial performance index (MPI) of combined LVsystolic and diastolic function (the sum of isovolumiccontraction time and isovolumic relaxation time di-vided by ejection time) was calculated as (a− b)/b.The MPI 0.39 ± 0.05 (mean ± SD) was defined asnormal [9]. IMP-EF was calculated from formula:MPI-EF = 60 − (34× MPI) as described by Lax [14].

Statistical analysisAll the results are expressed as mean ± SD.

Chi-square and t tests were used for comparisonsbetween groups. Changes in echocardiographicvariables over time were assessed by repeated-measures analysis of variance. Patients who diedor had reinfarction, unstable angina or worsening ofCHF during the first 12 months were included intothe analysis until the event occurred. A p value of<0.05 was considered significant.

Results

Clinical baseline characteristicsBaseline characteristics are listed in Table 1. Pa-

tients with AMI received the following medical ther-apy at arrival: aspirin – 100%; alpha-blocking agents– 23%; long-acting nitrates – 27%; calcium antago-nists – 5%; diuretics – 20%; angiotensin-convertingenzyme inhibitors – 100%; digoxin – 10 %; heparin– 88%; beta-blockers – 74%.

Follow-up and clinical outcomePatients were followed up for 9.2 ± 5.5 months.

During this period, 6 patients died (5 of them fromcardiac causes: 4 – from sudden death syndromeand 1 – from end-stage heart failure). Heart failuredeveloped in 6 patients (in 5 patients during primaryhospitalisation and in 1 patient who was readmitted).Reinfarction and unstable angina occurred in 4 pa-tients (in 2 patients within the first 3 months and in2 patients – after 3 months). Three patients under-went additional revascularization procedures (2 pa-tients after 6 months and 1 patient – after 9 monthsof follow-up).

22


Figure 1. Schema for measurements of Doppler intervals. The a is an interval between cessation and the onsetof mitral inflow. It includes isovolumic contraction time (ICT), ejection time (ET) and isovolumic relaxation time(IRT). LV ejection time b is the duration of LV outflow velocity profile. The sum of isovolumic contraction time andisovolumic relaxation time was obtained by subtracting b from a. The index of combined LV systolic and diastolicfunction (the sum of isovolumic contraction time and isovolumic relaxation time divided by ejection time) wascalculated as (a− b)/b

Table 1. Patients’ baseline characteristics

Age (years) 62 ± 12.75

Man/women 22/8

Diabetes mellitus 4 (13.3%)

Hypertension 13 (43.3%)

Smokers (included previous smokers) 9 (30%)

Total serum cholesterol (mmol/l) 5.60 ± 1.19

Q wave anterior wall AMI 26 (86%)

EF at the time of inclusion into the study (%) 34.00 ± 2.77

Thrombolysis 4 (13%)

PTCA 16 (53%)

Heart rate (bmp) 77 ± 11

SBP (mmHg) 134 ± 18

DBP (mmHg) 78 ± 13

Myocardial infarction in history 5 (16%)

PTCA in history 3 (10%)

Coronary artery bypass surgery in history 1 (3%)

Peak CK-MB (IU/l) 322.10 ± 234.91

AMI – acute myocardial infarction; CK – creatine kinase; DBP – diastolic blood pressure; EF – ejection fraction;PTCA – percutaneous transluminal coronary angioplasty; SBP – systolic blood pressureMean values ±SD

23


Serial changes in left ventricular function inpatients with acute myocardial infarction

Comparative echocardiographic features in 30patients with AMI from the time of arrival (72 hoursafter AMI) to 1 year of the follow-up period are sum-marized in Table 2. Patients with AMI were charac-terised by an initially higher value of the MPI compar-ing with 1 year follow-up, when MPI significantly de-creased (0.54± 0.12 vs 0.44± 0.13, p = 0.05). Thisis in accordance with changes in global LV systolicfunction expressed by EF, which increased at one-year follow-up period (0.34 ± 0.03 vs 0.47 ± 0.04,p < 0.001). Whereas LV end-diastolic volume in-dex and LV end-diastolic diameter index at one-yearfollow-up period increased (60.5± 15.38 vs 68.53 ±12.18, p < 0.01 and 2.7 ± 0.72 vs 3.24 ± 0.49, p <

0.05, respectively). This reflects the LV remodelling

after anterior AMI. The MPI (72 hours) was signifi-cantly correlated to peak creatine kinase-MB and LVejection fraction (r = 0.32, p < 0.01 and r = 0.51,p < 0.001, respectively).

Comparison of left ventricular function insurvivors with or without congestive heartfailure or other major cardiac event

2D and Doppler echocardiographic measure-ments in survivors without heart failure and patientswith heart failure or those who died or had other ma-jor cardiac events during follow-up are summarizedin Table 3. The MPI was significantly higher in pa-tients who developed heart failure or had other majorcardiac events (group 2) than in survivors withoutheart failure during follow-up (group 1) (0.63 ± 0.07vs 0.54 ± 0.14, p < 0.05). During hospitalisation,

Table 2. Serial echocardiographic measurements in patients with acute myocardial infarction

No Parameters 72 hours 10–30 days 3–6 months 9–12 months p value

n = 30 n = 11 n = 17 n = 16

1 HR 77.44 ± 10.71 74 ± 16.97 68.39 ± 8.44 69.67 ± 8.71 <0.01

2 E/A 0.91 ± 0.42 0.90 ± 0.40 1.18 ± 0.62 1.17 ± 0.66 <0.05

3 DcT 189 ± 47.6 210 ± 42.43 190 ± 65.52 210 ± 80.57 NS

4 MPI 0.54 ± 0.12 0.52 ± 0.15 0.49 ± 0.15 0.44 ± 0.13 <0.05

5 EF-MPI 41.75 ± 4.0 41.89 ± 5.13 43.29 ± 5.08 45.17 ± 4.36 <0.05

6 EF 0.34 ± 0.03 0.41 ± 0.06 0.44 ± 0.10 0.47 ± 0.04 <0.001

7 EDVI 60.5 ± 15.38 68.71 ± 11.26 67.17 ± 13.16 68.53 ± 12.18 <0.01

8 ESVI 39.3 ± 9.57 40.64 ± 9.73 37.01 ± 12.50 35.89 ± 6.71 NS

9 LVEDDI 2.7 ± 0.72 2.82 ± 0.12 2.99 ± 0.32 3.24 ± 0.49 <0.05

DcT – deceleration time; EDVI – end diastolic volume index; EF – ejection fraction; ESVI – end systolic volumeindex; HR – heart rate; LVEDDI – left ventricular end diastolic diameter index; MPI – myocardial performance indexMean values ±SD

Table 3. Comparison in echocardiographic measurements of patients free of congestive heart failure and majorcardiac events (group 1) with patients who developed congestive heart failure or had major cardiac events (group 2)after acute myocardial infarction

No Parameters Group 1 Group 2 p value

(n = 14) (n = 16)

1 HR 75.2 ± 10.35 81.54 ± 10.41 NS

2 E/A 0.83 ± 0.34 1.04 ± 0.39 NS

3 DcT 210 ± 37.9 150 ± 49.1 <0.001

4 MPI 0.54 ± 0.14 0.63 ± 0.07 <0.05

5 EF-MPI 41.49 ± 4.65 37.79 ± 2.25 <0.05

6 EF 0.36 ± 0.03 0.32 ± 0.04 <0.01

7 EDVI 60.71 ± 13.5 89.39 ± 36.01 NS

8 ESVI 35.77 ± 6 38.63 ± 9.28 NS

9 LVEDDI 2.86 ± 0.35 2.81 ± 0.8 NS

DcT – deceleration time; EDVI – end diastolic volume index; EF – ejection fraction; ESVI – end systolic volumeindex; HR – heart rate; LVEDDI – left ventricular end diastolic diameter index; MPI – myocardial performance indexMean values ± SD

24


Table 4. Serial changes in left ventricular function in patients treated without (group 3) and with (group 4) reperfu-sion therapy

Parameters Group 3 (n = 10) Group 4 (n = 20)

72 hours 9–12 months p value 72 hours 9–12 months p value

HR 76.7 ± 10.8 69.5 ± 7.56 <0.05 78.94 ± 10.84 71.21 ± 10.66 <0.05

E/A 0.72 ± 0.2 0.96 ± 0.61 NS 1.03 ± 0.4 1.43 ± 0.75 <0.05

DcT 214 ± 49 206.25 ± 69.06 NS 166 ± 47.5 181.43 ± 53.9 NS

MPI 0.51 ± 0.15 0.47 ± 0.08 NS 0.6 ± 0.07 0.42 ± 0.16 <0.001

EF-MPI 42.75 ± 5.06 43.16 ± 4.13 NS 39.68 ± 2.5 45.66 ± 5.24 <0.001

EF 0.35 ± 0.03 0.32 ± 0.08 NS 0.33 ± 0.04 0.45 ± 0.09 <0.001

EDVI 61.08 ± 13.56 63.92 ± 17.76 NS 81.65 ± 116.56 72.52 ± 19.75 NS

ESVI 39.23 ± 8.91 42.01 ± 9.79 NS 36.21 ± 7.79 41.33 ± 16.19 NS

LVEDDI 2.96 ± 0.39 3.16 ± 0.47 NS 2.77 ± 0.68 3.11 ± 0.42 NS

DcT – deceleration time; EDVI – end diastolic volume index; EF – ejection fraction; ESVI – end systolic volumeindex; HR – heart rate; LVEDDI – left ventricular end diastolic diameter index; MPI – myocardial performance indexMean values ± SD

lower EF and deceleration time (DcT) were observedin patients with an adverse outcome than in pa-tients who survived without developing heart failure(0.32±0.04 vs 0.36±0.03, p < 0.01 and 150±49.1vs 210± 37.9, p < 0.001, respectively).

Serial changes in left ventricular function inpatients treated without and with reperfusiontherapy

Serial changes of Doppler echocardiographicmeasurements in patients treated without (group 3)and with (group 4) reperfusion therapy are summa-rized in Table 4. The MPI and EF did not changesignificantly during follow-up in patients of group 3,whereas the MPI was significantly lower (0.6 ± 0.07vs 0.42 ± 0.16, p < 0.001) and EF was significantlyhigher (0.33±0.04 vs 0.45±0.09, p < 0.001) duringfollow-up in patients who were treated with reperfu-sion therapy (group 4). Thus, MPI can be a markerof successful reperfusion therapy after AMI in thefollow-up period.

Discussion

A number of clinical, biochemical, electrocar-diographic, and hemodynamic variables have beenused to define subgroups of patients with AMI atrisk for major cardiac events [15–18]. Measures ofLV global and segmental systolic performance havebeen shown to be among the strongest short andlong-term prognostic predictors in patients with AMI[19–21]. In our study, EF, the most commonly usedindex of LV function, also differentiated patients withand without a complicated follow-up clinical course.However, when geometry is irregular, as it is typicalafter AMI, the assessment of EF and volumes is lessaccurate [22], requires a well-trained observer and istime-consuming. Recent studies have demonstrated

that the MPI may have important clinical advantagesrelative to other assessments of LV function, espe-cially ejection fraction [8,9]. It is shown that the MPIin patients with either idiopathic cardiomyopathy oramyloidosis was more closely related to morbidityand mortality than any other measurement of my-ocardial performance [11,13]. Because both LV sys-tolic and diastolic functions are affected by AMI, andthe geometry of the left ventricle is distorted duringthe LV remodelling process, the MPI may theoret-ically be an attractive alternative to standard mea-sures of LV function after AMI.

The present study demonstrates that a Doppler-derived MPI and a non-geometric Doppler indexwere useful as indicators of LV function and pre-dictors of the outcome after AMI. The MPI is repro-ducible, quick, non-invasive, easily performed at abedside, and is not affected by LV geometry. Our ob-servations detected by the MPI are in accordancewith previous findings in which LV systolic and dias-tolic dysfunction is present very early in AMI, and theprogression of impaired relaxation of the left ventri-cle due to the development of compensatory hyper-trophy. Recent studies have demonstrated that thepresence of a restrictive LV filling pattern with short-ened DcT is associated with elevated LV filling pres-sure, the development of LV dilatation, heart failure,and a higher risk of cardiac death in patients withAMI [23,24]. Heart failure after infarction is often dueto LV systolic and diastolic dysfunction. In this study,the MPI was also found to be significantly higher inpatients who developed heart failure or other majorcardiac events than in survivors without heart failureduring follow-up. The MPI allowed good discrimina-tion of patients with and without events, similar EFand provided statistically significant additional infor-mation. Differences in LV function detected by the

25


MPI were supported by differences in the more es-tablished indicators of systolic and diastolic function,such as ejection fraction and deceleration time. Ourstudy suggests that MPI can be a marker of suc-cessful reperfusion therapy after AMI in the follow-upperiod and can be use for the assessment of LVremodelling and treatment monitoring in patients af-ter AMI.

Recently, new echocardiographic parametershave been shown to provide information about LV di-astolic function. In the study of Yamamoto et al [25]the ratio of mitral E velocity to annular E′ veloc-ity (E/E′) measured with tissue Doppler imagingtechnique was useful not only in detecting pseudo-normal LV mitral filling patterns, but also was themost powerful predictor of cardiac death or hospi-talisation for worsening heart failure compared withclinical, hemodynamic, and other echocardiographicvariables [26,27]. Studies should be designed to

compare the MPI index with the newer parametersof LV diastolic function.

Conclusion

These data suggest that the Doppler-derivedmyocardial performance index reflects the severityof left ventricular function and may be useful afteracute myocardial infarction in predicting patients athigh risk for cardiac events in the follow-up period.

Study Limitations

Because the intervals between the onset andend of mitral inflow and ejection time are measurednot simultaneously, the MPI is less reliable in thepresence of arrhythmias. However, in the presentstudy, only patients with sinus rhythm were included.The study population was selected according to age,which must be taken into account when interpretingthese data.

References

1. Pierard LA, Albert A, Chapelle JP, Carlier J, Kul-bertus HE. Relative prognostic value of clinical, biochem-ical, echocardiographic and haemodynamic variables inpredicting in-hospital and one-year cardiac mortality af-ter acute myocardial infarction. Europ Heart J 1989; 10:24–31.

2. Schiller NB, Shah PM, Crawford M, et al. Rec-ommendations for quantification of the left ventricle bytwo-dimensional echocardiography. J Am Soc Echocar-diogr 1989; 2: 358–367.

3. Feigenbaum H. Echocardiographic examination ofthe left ventricle. Circulation 1975; 51: 1–7.

4. Rockey R, Kuo LC, Zoghbi WA, et al. Determinationof parameters of left ventricular diastolic filling with pulsedDoppler echocardiography: comparison with cineangiog-raphy. Circulation 1985; 71: 543–550.

5. Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Assess-ment of diastolic function of the heart: background andcurrent applications of Doppler echocardiography. Part II.Clinical Studies. Mayo Clin Proc 1989; 64: 181–204.

6. Nishimura RA, Tajik AJ. Evaluation of diastolic fillingof left ventricle in health and disease: Doppler echocardio-graphy is the clinician’s rosetta stone. J Am Coll Cardiol1997; 30: 8–18.

7. Poulsen SH, Jensen SE, Tei C, Seward JB, EgstrupK. Value of the Doppler index of myocardial performancein the early phase of acute myocardial infraction. J Am SocEchocardiogr 2000; 13: 723–730.

8. Tei C. New no-invasive index for combined systolicand diastolic ventricular function. J Cardiol 1995; 26: 135–136.

9. Dujardin KS, Tei C, Yeo TC, et al. New index ofcombined systolic and diastolic myocardial performance:a simple and reproducible measure of cardiac function –a study normal and dilated cardiomyopathy. J Cardiol1995; 26: 357–366.

10. Ling LH, Tei C, McCully RB, et al. Analysis ofsystolic and diastolic time intervals during dobutamine-

atropine stress echocardiography: diagnostic potencial ofthe Doppler myocardial performance index. J Am SocEchocardiogr 2001; 14: 978–986.

11. Dujardin KS, Tei C, Yeo TC, et al. Prognostic valueof a Doppler index combining systolic and diastolic perfor-mance in dilated cardiomyopathy. Am J Cardiol 1998; 82:1071–1072.

12. Tei C, Nishimura RA, Seward JB, Tajik AJ. Non-invasive Doppler-derived myocardial performance index:correlation with simultaneous measurements of cardiaccatheterization measurements. J Am Soc Echocardiogr1997; 10: 169–178.

13. Tei C, Dujardin KS, Hodge DO, et al. Doppler indexcombining systolic and diastolic myocardial performance:clinical value in cardiac amyloidosis. J Am Coll Cardiol1996; 27: 658–664.

14. Lax JA, Bermann AM, Cianciuli TF, et al. Estima-tion of the ejection fraction in patients with myocardial in-farction obtained from the combined Index of systolic anddiastolic left ventricular function: a new method. J Am SocEchocardiogr 2000; 13: 116–123.

15. Norris RM, Brandt PW, Caughey DE, Lee AJ, ScottPJ. A new coronary prognostic index. Lancet 1969; 1:274–278.

16. Chapelle JP, Albert A, Heusghem C, Smeets JP,Kulbertus HE. Predictive value of serum enzyme deter-minations in acute myocardial infarction. Clin Chim Acta1980; 106: 29–38.

17. Mauri F, Gasparini M, Barbonaglia L, et al. Prog-nostic significance of the extent of myocardial injury inacute myocardial infarction treated by streptokinase (theGISSI trial). Am J Cardiol 1989; 63: 1291–1295.

18. Pierard LA, Albert A, Gillis F, Sprynger M, Carier J,Kulbertus HE. Hemodynamic profile of patients with acutemyocardial infarction at risk of infarct expansion. Am J Car-diol 1987; 60: 5–9.

19. Stadius MI, Davis K, Maynard C, Ritchie JL,Kennedy JW. Risk stratification for 1 year survival based

26


on characteristics identified in the early hours of acute my-ocardial infarction: the Western Washington intracoronarystreptokinase trial. Circulation 1986; 74: 703–711.

20. Pierard LA, Albert A, Chapelle JP, Carier J, Kul-bertus HE. Relative prognostic value of clinical, biochem-ical, echocardiographic and haemodynamic variables inpredicting in-hospital and one year cardiac mortality afteracute myocardial infarction. Eur Heart J 1989; 10: 24–31.

21. Berning J, Steensgaard-Hansen F. Early estima-tion of risk by echocardiographic determination of wallmotion index in an unselected population with acute my-ocardial infarction. Am J Cardiol 1990; 65: 567–576.

22. Kuroda T, Seward JB, Rumberger JA. LV volumeand mass: comparative study of two-dimensional echocar-diography and ultrafast computed tomography. Echocar-diography 1994; 11: 1–9.

23. Cerisano G, Bolognese L, Carabba N, et al. Dop-pler derived mitral deceleration time. An early strong pre-dictor of left ventricular remodeling after reperfused an-

terior acute myocardial infarction. Circulation 1999; 99:230–236.

24. Oh JK, Ding ZP, Gersh BJ, et al. Restrictive leftventricular diastolic filling identifies patients with heart fail-ure after acute myocardial infarction. J Am Soc Echocar-diogr 1992; 5: 497–503.

25. Yamamoto T, Oki T, Yamada H, et al. Prognosticvalue of the atrial systolic mitral annular motion velocity inpatients with left ventricular systolic dysfunction. J Am SocEchocardiogr 2003; 16: 333–339.

26. Tabata T, Tanaka H, Harada K, et al. Assessmentof the ventricular diastolic function independent of car-diac translation using a newly developed tissue strain rateimaging (abstr.) J Am Soc Echocardiogr 2003; 16: 556.

27. Whalley GA, Wright SP, Gamble GD, et al. E/Eprime predict hospitalization in patients with breathless-ness in the community (abstr.) J Am Soc Echocardiogr2003; 16: 561.

27

GLOBAL MYOCARDIAL PERFORMANCE INDEX.pdf

Documents

Transcript of GLOBAL MYOCARDIAL PERFORMANCE INDEX.pdf