Assessment of the p wave dispersion and duration in elite women basketball players.

BACKGROUND: P wave dispersion is an independent predictor of atrial fibrillation. P wave dispersion is associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate P wave dispersion and transthoracic echocardiographic findings in elite women basketball players. METHODS: We recruited 27 well-trained woman athletes with a training history of many years (11.9 +/- 3.6 years). All of the athletes were elite women basketball players and they were regularly maintaining sportive activities and training programs. Twenty-six age and sex matched healthy sedentary subjects consisted of control group. The difference between P maximum and P minimum durations was defined as P wave dispersion. The echocardiographic parameters were assessed in detail in the standard left lateral decubitus position. RESULTS: The body height, body weight, body surface area, metabolic equivalent, maximum P wave duration and P wave dispersion were increased in the elite basketball athletes as compared with healthy sedentary subjects. On the contrary; the heart rate, ejection fraction and interventricular septum thickness in diastole were decreased in athletes. The body height (p=0.006, r=0.37), body weight (p=0.04, r=0.28), body surface area (p=0.01, r=0.33) and heart rate (p=0.01, r=-0.32) were correlated with P wave dispersion. CONCLUSIONS: P wave dispersion was increased in elite woman basketball players as compared with healthy sedentary subjects. P wave dispersion was correlated with heart rate, body height, body weight and body surface area.

Assessment of left ventricular function by Doppler tissue imaging in patients with atrial fibrillation following acute myocardial infarction.

AIMS: We studied tissue Doppler parameters in patients with atrial fibrillation following acute myocardial infarction, and their relation to P wave durations and P dispersion. METHODS: Echocardiographic examination was performed in 84 consecutive patients with first anterior acute myocardial infarction. In addition to other conventional echocardiographic parameters, the peak systolic (Sm), early diastolic (Em) and late diastolic (Am) velocities were obtained at the lateral corner of the mitral annulus by pulsed wave tissue Doppler. The Em/Am ratio and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a marker of diastolic filling pressure, were calculated. Electrocardiogram was recorded from all patients on admission; P wave measurements were also performed. RESULTS: Atrial fibrillation occurred in 20 (23.8%) of 84 patients. The patients with atrial fibrillation had significant reduction of Em (5.6+/-1.5 vs. 8.7+/-2.7 cm/s, p < 0.001), Em/Am (0.61+/-0.27 vs. 0.84+/-0.23, p = 0.001) and Sm (7.1+/-1.0 vs. 8.3+/-1.9 cm/s, p < 0.001) values compared with those without. The E/Em ratio (14.45+/-4.62 vs. 7.47+/-2.79, p < 0.001), P maximum (102+/-11 vs. 95+/-11 ms, p = 0.02) and P dispersion (35+/-7 vs. 26+/-7 ms, p < 0.001) were significantly higher in patients with atrial fibrillation than in those without. In all patients, P dispersion showed significant correlation with Em (r = -0.33, p = 0.002), Sm (r = -0.40, p < 0.001) and E/Em (r = 0.32, p = 0.003). When E/Em > or = 10 was used as cutpoint, atrial fibrillation could be predicted with a sensitivity of 90%, and a specificity of 84%. CONCLUSIONS: The patients with atrial fibrillation following acute myocardial infarction have reduced systolic and diastolic mitral annular velocities and increased E/Em ratio, P maximum and P dispersion values compared to those without. P dispersion is correlated with systolic and diastolic left ventricular function after acute myocardial infarction. The E/Em ratio appears to be a useful parameter for assessing the risk of atrial fibrillation occurrence after anterior acute myocardial infarction.

Assessment of mitral annular velocities by Doppler tissue imaging in predicting left ventricular thrombus formation after first anterior acute myocardial infarction.

The aim of this study was to determine whether early assessment of left ventricular (LV) systolic and diastolic functions by pulsed wave Doppler tissue imaging predicts LV thrombus formation after acute anterior myocardial infarction. Echocardiography was performed in 87 consecutive patients with first acute anterior myocardial infarction within 24 hours after arrival to the coronary care department. Mitral inflow velocities and early diastolic (Em), late diastolic (Am), and peak systolic (SM) mitral annular velocities were measured. Em/Am and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a reasonably good index for predicting elevated LV filling pressure, were calculated. To detect LV thrombus, 2-dimensional echocardiography was repeated on days 3, 7, 15, and 30. Patients were divided into two groups according to LV thrombus formation: group 1 (n = 29; aged 59 +/- 11 years; 4 women) with thrombus; and group 2 (n = 58; aged 57 +/- 9 years; 6 women) without thrombus. Members of group 1 had significantly lower Em, a lower SM, a lower peak systolic mitral annular velocity, and a lower Em/Am than those in group 2 (6.4 +/- 2.0 cm/s vs 8.9 +/- 2.7 cm/s, P < .001; 7.3 +/- 1.6 cm/s vs 8.6 +/- 1.7 cm/s, P = .001; 0.65 +/- 0.25 cm/s vs 0.89 +/- 0.27 cm/s, P < .001, respectively). The E/Em was significantly higher in group 1 than in group 2 (12.5 +/- 5.0 vs 7.2 +/- 2.8, P < .001). The sensitivity of an E/Em ratio greater than 9 in predicting LV thrombus formation was 69%, the specificity 79%, the positive predictive value 63%, and the negative predictive value 84%. Mitral annular velocities derived by pulsed wave Doppler tissue imaging are simple to obtain even in technically suboptimal studies, and can be used for predicting LV thrombus formation after myocardial infarction.

Pulsed wave tissue Doppler-derived myocardial performance index for the assessment of left ventricular thrombus formation risk after acute myocardial infarction.

BACKGROUND: Assessment of left ventricular (LV) thrombosis risk after acute myocardial infarction (AMI) is important because of potential embolic sequelae that are reduced by oral anticoagulant agents. The goal of this study was to investigate whether early assessment of LV systolic and diastolic performance with pulsed wave tissue Doppler ultrasound scanning (PWTD) predicts LV thrombosis after AMI. METHODS: Two-dimensional and Doppler ultrasound scanning echocardiographic examinations were performed in 92 consecutive patients (age, 58 +/- 10 years; 11 women) with first anterior AMI within 24 hours after arrival to the coronary care unit. From the apical 4-chamber view, the mitral annular velocities were recorded at the lateral corner of the mitral annulus with PWTD. The myocardial performance index (MPI), which combines parameters of both systolic and diastolic ventricular function, was calculated from the PWTD recordings. To analyze LV thrombus formation, the 2-dimensional echocardiographic examination was repeated on days 3, 7, 15, and 30. The patients were divided in 2 groups according to LV thrombus formation. RESULTS: LV thrombus was found in 32 of 92 patients (35%; group 1) and was not found in 60 patients (65%; group 2). The MPI was significantly higher in group 1 than in group 2 (0.73 +/- 0.20 vs 0.53 +/- 0.14; P <.001). When an MPI >0.6 was used as the cutoff, LV thrombus formation could be predicted with a sensitivity rate of 81%, a specificity rate of 73%, a positive predictive value of 62%, and a negative predictive value of 88%. In multivariate analyses, only MPI and LV wall motion score index were independent predictors of LV thrombus formation (P = .038 and P = .047, respectively). CONCLUSIONS: The MPI derived with PWTD soon after admission appears to be a useful parameter for assessing the risk of LV thrombosis after AMI. Patients with an MPI >0.6 after AMI seem to be at a higher risk for thrombus formation.

Left ventricular diastolic function assessment by tissue Doppler echocardiography in relation to hormonal replacement therapy in postmenopausal women with diastolic dysfunction.

The objective of this study was to evaluate the effect of hormone replacement therapy (HRT) regimens on left ventricular diastolic function by using mitral pulsed wave Doppler (MPWD) and tissue Doppler velocities (TDE). Seventy-eight postmenopausal women with normotensive and impaired diastolic left ventricular filling were included in the study. All the patients began a six-cycle HRT course. This formulation consisted of E2 valerate plus Medroxy progesterone acetate (MPA). Left ventricular diastolic function at rest was evaluated by M-mode, two-dimensional, MPWD and TDE in 78 postmenopausal women with normal blood pressure before the treatment for 6 months of HRT. The M-mode, two-dimensional, and MPWD parameters assessed were heart rate, systolic blood pressure, diastolic blood pressure, left ventricular mass index, ejection fraction of the left ventricle (EF), septal (IVS) and posterior wall (PW) thickness, left ventricular end-systolic (LVESD) and end-diastolic (LVEDD) diameter, left atrial diameter, peak early diastolic velocity (E), peak atrial velocity (A), E/A ratio, E acceleration time, E deceleration time, diastolic filling period, and isovolumic relaxation time (IVRT). The TDE parameters assessed were peak early diastolic velocity (E'), peak late diastolic velocity (A'), peak systolic velocity, E'/A' ratio, E' acceleration time, E' deceleration time, IVRT', and E/E' ratio. Quantitative data were analyzed using Student t test. Among the MPWD parameters, peak A velocity, E deceleration time, and IVRT significantly decreased, while peak E velocity and E/A ratio increased after a 6-month treatment. From the point of TDE parameters, E' velocity and E'/A' ratio increased, while A' velocity, E' deceleration time, E/E' ratio and IVRT' decreased. Some MPWD and TDE parameters were partially reversed after HRT. TDE velocities and especially E/E' ratio may provide better and true information of the diastolic function. TDE parameters were independent from the preload and did not produce pseudonormal pattern. HRT may cause increase in the blood volume and produce pseudonormal pattern in transmitral flow. In that case, TDE may be a beneficial method for evaluation of diastolic function.