Preinfarction angina prevents left ventricular remodeling in patients treated with thrombolysis for myocardial infarction.

BACKGROUND: It has been shown that preinfarction angina may have beneficial effects on infarct size and mortality. However, there are no studies that have serially assessed the impact of preinfarction angina on left ventricular (LV) function in a large series of patients. HYPOTHESIS: The study was undertaken to determine whether preinfarction angina (within 7 days before infarction) influences LV remodeling. METHODS: In all, 119 consecutive patients with acute myocardial infarction were serially evaluated by 2-dimensional echocardiography (on Days 1, 2, 3, and 7; at 3 and 6 weeks; and at 3, 6, and 12 months following infarction). Left ventricular volumes were determined using Simpson's biplane formula and normalized for body surface area. Wall motion score index and sphericity index were calculated for each study. Coronary angiography was performed before discharge. RESULTS: Preinfarction angina was detected in 39 of 119 patients. Initial echocardiographic and clinical data as well as the incidence of patent infarct-related artery and collaterals were similar for patients with and without preinfarction angina. In the subset of thrombolysed patients, patients with preinfarction angina showed decrease of LV end-diastolic and end-systolic volumes during the follow-up period (p = 0.033 and p = 0.001, respectively), and improvement of wall motion score index (p < 0.001) and ejection fraction occurred (p = 0.001), without changing of LV shape (p > 0.05); in addition, patients with preinfarction angina had smaller LV volumes and higher ejection fraction than did those without angina, from 3 weeks onward. These favorable effects were not detected in patients not treated with thrombolysis. CONCLUSIONS: These data indicate that preinfarction angina has an inhibiting effect on long-term LV remodeling in patients who underwent thrombolysis for first acute myocardial infarction. It appears that preinfarction angina has no impact on infarct size and early postinfarction LV function.

Single-day loading dose of oral amiodarone for the prevention of new-onset atrial fibrillation after coronary artery bypass surgery.

BACKGROUND: Various regimens have been proposed for the prevention of postoperative atrial fibrillation, including the use of intravenous and oral amiodarone. The purpose of this study was to determine the effectiveness of a single-day loading dose of oral amiodarone in prophylaxis of atrial fibrillation during the 7 days after coronary artery bypass surgery. METHODS: We conducted a double-blind, randomized, placebo-controlled study encompassing 315 consecutive patients who underwent coronary artery bypass surgery. They received either amiodarone (159 patients) or placebo (156 patients). Therapy consisted of a single oral loading dose of 1200 mg of amiodarone 1 day before surgery, followed by the maintenance dose of 200 mg daily during the next 7 days. Only episodes of atrial fibrillation lasting more than 1 hour or associated with hemodynamic compromise were taken into consideration. RESULTS: Overall, the incidence of atrial fibrillation was similar in patients who received amiodarone (31/159, 19.5%) and placebo (33/156, 21.2%) (P = .78). However, amiodarone reduced the incidence of atrial fibrillation in elderly patients (age > or = 60 years): it occurred in 20 of 75 (26.7%) patients on amiodarone and in 28 of 65 (43.1%) patients in the placebo group (P = .05). There were no differences between the study groups regarding the postoperative intrahospital morbidity and mortality and the duration of hospital stay. CONCLUSIONS: A single-day loading dose of oral amiodarone (1200 mg) does not prevent postoperative atrial fibrillation in a general population of patients undergoing coronary artery bypass surgery. However, it appears that this regimen reduces the occurrence of postoperative atrial fibrillation in elderly patients.

Short early filling deceleration time on day 1 after acute myocardial infarction is associated with short and long term left ventricular remodelling.

OBJECTIVE: To assess the relations between early filling deceleration time, left ventricular remodelling, and cardiac mortality in an unselected group of postinfarction patients. DESIGN AND PATIENTS: Prospective evaluation of 131 consecutive patients with first acute myocardial infarction. Echocardiography was performed on day 1, day 2, day 3, day 7, at three and six weeks, and at three, six, and 12 months after infarction. According to deceleration time on day 1, patients were divided into groups with short (< 150 ms) and normal deceleration time (>/= 150 ms). SETTING: Tertiary care centre. RESULTS: Patients with a short deceleration time had higher end systolic and end diastolic volume indices and a higher wall motion score index, but a lower ejection fraction, in the year after infarction. These patients also showed a significant increase in end diastolic (p < 0.001) and end systolic volume indices (p = 0.007) during the follow up period, while ejection fraction and wall motion score index remained unchanged. In the group with normal deceleration time, end diastolic volume index increased (p < 0.001) but end systolic volume index did not change; in addition, the ejection fraction increased (p = 0.002) and the wall motion score index decreased (p < 0.001). One year and five year survival analysis showed greater cardiac mortality in patients with a short deceleration time (p = 0.04 and p = 0.02, respectively). In a Cox model, which included initial ejection fraction, infarct location, and infarct size, deceleration time on day 1 was the only significant predictor of five year mortality. CONCLUSIONS: A short deceleration time on day 1 after acute myocardial infarction can identify patients who are likely to undergo left ventricular remodelling in the following year. These patients have a higher one year and five year cardiac mortality.

Echocardiographic evaluation of valvular stenosis: the gold standard for the next millennium?

Over the past decade, utilization of cardiac catheterization for preoperative hemodynamic assessment of patients with mitral and aortic stenosis has steadily decreased. The reason for this trend is the use of echocardiography, which is emerging as a gold standard for clinical characterization of valvular lesions. Since cardiac catheterization is an invasive procedure that is associated with a significant percentage of complications, echocardiographic evaluation of patients with valvular stenosis is safer and more cost-effective. In the next millennium, echocardiography will probably completely replace the use of catheterization for hemodynamic assessment of the severity of mitral and aortic stenosis.

Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking.

OBJECTIVES: This study sought to assess preclinical cardiac abnormalities in chronic alcoholic patients and possible differences among alcoholics related to the duration of heavy drinking. BACKGROUND: Chronic excessive alcohol intake has been reported as a possible cause of dilated cardiomyopathy. However, before the appearance of severe cardiac dysfunction, subtle signs of cardiac abnormalities may be identified. METHODS: We studied 30 healthy subjects (age 44 +/- 8 years) and 89 asymptomatic alcoholics (age 45 +/- 8 years, p = NS) divided into three groups, with short (S, 5-9 years, n = 31), intermediate (I, 10-15 years, n = 31) and long (L, 16-28 years, n = 27) duration of alcoholism. Transmitral early (E) and late (A) Doppler flow velocities, E/A ratio, deceleration time of E (DT) and isovolumic relaxation time (IVRT) were obtained. Left ventricular (LV) wall thickness and volumes were also determined by echocardiography, and LV mass and ejection fraction (EF) were calculated. RESULTS: The alcoholics had prolonged IVRT (92 +/- 11 vs. 83 +/- 7 ms, p < 0.001), longer DT (180 +/- 20 vs. 170 +/- 10 ms, p < 0.01), smaller E/A (1.25 +/- 0.34 vs. 1.40 +/- 0.32, p < 0.05), larger LV volumes (73 +/- 8 vs. 65 +/- 7 ml/m2, p < 0.001 for end-diastolic volume index; 25 +/- 4 vs. 21 +/- 2 ml/m2, p < 0.001 for end-systolic volume index), higher LV mass index (92 +/- 14 vs. 78 +/- 8 g/m2, p < 0.001) and thicker posterior wall (9 +/- 1 vs. 8 +/- 1 mm, p < 0.001). Ejection fraction did not differ between the two groups (66 +/- 4 vs. 67 +/- 2%). Deceleration time of the early transmitral flow velocity was longer in groups L (187 +/- 18 ms) and I (185 +/- 16 ms) compared with group S (168 +/- 17 ms, p < 0.001 for L and I vs. S), whereas A was higher in group L compared with S (43 +/- 10 vs. 51 +/- 10 cm/s, p < 0.005). Multiple regression analysis identified duration of heavy drinking as the most important variable affecting DT and A. CONCLUSIONS: Left ventricular dilation with preserved EF and impaired LV relaxation characterized LV function in chronic asymptomatic alcoholic patients. It appeared that the progression of abnormalities in LV diastolic filling related to the duration of alcoholism.

Partial left ventriculectomy improves left ventricular end systolic elastance in patients with idiopathic dilated cardiomyopathy.

OBJECTIVE: To assess the effect of partial left ventriculectomy (PLV) on estimate of left ventricular end systolic elastance (Ees), arterial elastance, and ventriculoarterial coupling. PATIENTS: 11 patients with idiopathic dilated cardiomyopathy before and two weeks after PLV, and 11 controls. INTERVENTIONS: Single plane left ventricular angiography with simultaneous measurements of femoral artery pressure was performed during right heart pacing before and after load reduction. RESULTS: PLV increased mean (SD) Ees from 0.52 (0.27) to 1.47 (0.62) mm Hg/ml (p = 0.0004). The increase in Ees remained significant after correction for the change in left ventricular mass (p = 0.004) and end diastolic volume (p = 0.048). As PLV had no effect on arterial elastance, ventriculoarterial coupling improved from 3.25 (2.17) to 1.01 (0.93) (p = 0.017), thereby maximising left ventricular stroke work. CONCLUSION: It appears that PLV improves both Ees and ventriculoarterial coupling, thus increasing left ventricular work efficiency.

Early predictors of mitral regurgitation after acute myocardial infarction.

We analyzed early predictors of mitral regurgitation after myocardial infarction in 131 consecutive patients with first acute myocardial infarction. Our data revealed that elderly patients with larger infarcts, multivessel coronary disease, and papillary muscle region asynergy are more likely to develop mitral regurgitation in the first year after infarction.

Immediate reoperation for perioperative stroke after 2250 carotid endarterectomies: differences between intraoperative and early postoperative stroke.

PURPOSE: After carotid endarterectomy, intraoperative findings and outcome of immediate reoperation of patients who had an intraoperative stroke were compared with those of patients who had an early postoperative stroke. METHODS: We retrospectively analyzed 2250 carotid endarterectomies performed between 1980 and 1997. Intraoperative stroke (group A) was detected after 41 of the 2250 operations (1.8%), whereas early postoperative stroke (group B) developed after 18 of the 2250 operations (0.8%). Patients from both groups were reoperated on within 1 hour after neurological examination. RESULTS: Positive intraoperative findings that could be corrected during immediate reoperation were: (1) thrombotic occlusion of the carotid artery that was operated on caused by technical error, which was found in nine of 41 patients (22%) in group A and in 11 of 18 patients (61%) in group B (P =.009); (2) mural thrombus caused by technical error without occlusion, which was detected in seven of 41 patients (17%) in group A and in two of 18 patients (11%) in group B (P >.05); and (3) technical error without a thrombus, which was found in eight of 41 patients (20%) in group A and in three of 18 patients (17%) in group B (P >.05). A patent carotid artery was found in 17 of 41 patients (42%) in group A and in two of 18 patients (11%) in group B (P =.046). Twenty of the 41 patients (49%) in group A died, and four of 18 patients (22%) in group B died (P > 0.05). Major neurological deficit remained in nine of 41 patients (22%) in group A and four of 18 patients (22%) in group B (P > 0.05). Total recovery occurred in seven of 41 patients (17%) in group A and in eight of 18 patients (45%) in group B (P = 0.058). CONCLUSION: Carotid artery thrombosis during immediate reoperation was more frequent in patients who had an early postoperative stroke than in patients who had an intraoperative stroke. It appears that patients who had an intraoperative stroke have a higher incidence of uncorrectable lesions.

Asymptomatic left ventricular outflow tract obstruction after mitral valve replacement with leaflet preservation.

It has been shown that inappropriate anterior mitral leaflet preservation during mitral valve replacement may cause left ventricular outflow tract (LVOT) obstruction, usually with dismal prognosis. In this report, we describe a patient with chronic asymptomatic LVOT obstruction after mitral valve replacement with leaflet preservation.

Acute effects of DDD pacing in patients with pulmonary infundibular stenosis.

We evaluated acute effects of DDD pacing (right atrium sensed and left ventricle paced) in 3 patients with pulmonary infundibular stenosis and found a decrease in dynamic right ventricular outflow gradient in all of them. It appears that acute temporary DDD pacing may decrease the dynamic obstruction of the right ventricular outflow tract in these patients, probably because of asynchronous contraction of the right ventricle induced by pacing from the left ventricular apex, with contraction of infundibular portion being delayed.

Old and new paradigms on diastolic function in acute myocardial infarction.

Although left ventricular systolic function after myocardial infarction has been the subject of detailed studies, diastolic phenomena during and after acute myocardial infarction are less well understood. The reasons for this are that catheterization studies, which are the gold standard, are not practical for serial measurements, whereas Doppler echocardiographic evaluation of diastolic function is based on the assessment of left ventricular filling only rather than on the pressure-volume relation. This article reviews invasive and noninvasive studies of diastolic function after myocardial infarction and proposes an integrated approach to the assessment of systolic and diastolic function that are simultaneously but independently impaired after myocardial infarction.

Low incidence of cardiac abnormalities in treated trichinosis: a prospective study of 62 patients from a single-source outbreak.

PURPOSE: The reported incidence of cardiac involvement in trichinosis is highly variable, ranging from 21% to 75%. This study sought to determine the incidence and type of cardiac lesions in trichinosis using serial echocardiographic examinations. SUBJECTS AND METHODS: Sixty-two consecutive patients admitted to the Banja Luka Medical Center during an outbreak of trichinosis (November to December 1996) were included in the study. Diagnosis was made by typical clinical presentation, positive epidemiologic history, serologic testing, and the detection of Trichinella larvae in contaminated meat. All patients underwent serial electrocardiograms and two-dimensional and Doppler echocardiographic examinations within 20 days after the onset of symptoms. Repeated echocardiographic examinations were performed weekly during the hospital stay in all patients with electrocardiographic abnormalities or an abnormal initial echocardiogram. RESULTS: Cardiac involvement (electrocardiographic and/or echocardiographic changes) was detected in 8 (13%) of the 62 patients. Nonspecific transient electrocardiographic ST-T changes were found in 6 patients (10%); 1 patient had frequent premature ventricular complexes. Echocardiographic examinations revealed pericardial effusions in 6 patients (10%), 5 of whom had minimal effusions without impairment of global and regional left ventricular systolic function. One patient had hypokinesis of the interventricular septum with a small pericardial effusion, both of which resolved within 2 weeks. Only 2 of the patients with electrocardiographic abnormalities lacked echocardiographic evidence of cardiac involvement. At 6-month follow-up, none of the patients had electrocardiographic or echocardiographic abnormalities. CONCLUSIONS: The incidence of cardiac involvement in trichinosis appears to be lower than previously reported. Pericardial effusion is the most common manifestation of cardiac involvement, and nonspecific transient electrocardiographic changes, traditionally ascribed to myocarditis, more frequently reflect pericarditis.

[Evaluation of left ventricular diastolic function using Doppler echocardiography]. / Procena dijastolne funkcije leve komore Dopler-ehokardiografijom.

INTRODUCTION: Clinical studies have shown that approximately 40% of patients with congestive heart failure have predominantly diastolic left ventricular dysfunction. Doppler echocardiography is a simple, noninvasive and safe technique that can be used for measurement of diastolic filling and, therefore for assessment of diastolic function. PHYSIOLOGY OF DIASTOLE: Diastole is divided into four phases: isovolumetric relaxation, rapid filling, slow filling (diastasis) and atrial contraction. Diastolic filling can be defined as the period from the onset of mitral valve opening to mitral valve closure. DETERMINANTS OF DIASTOLIC FILLING: The two major determinants of diastolic filling are ventricular relaxation (characterized by the rate and duration of the decrease of left ventricular pressure after systole) and compliance (defined by volume changes over the change in pressure during diastolic filling). NORMAL TRANSMITRAL FLOW PATTERN: When pulsed Doppler sample volume is placed at the tips of mitral leaflets, recorded transmitral velocity pattern is composed of two principal deflections: the E wave, occurring during the rapid filling phase, and the lower A wave, arising from atrial contraction. These two waves are usually separated with relatively low velocity signal during diastasis. Numerous indices derived from this pattern have been proposed as markers of diastolic function (peak and integrated velocities of the E and A waves, their ratio, and acceleration and deceleration times of the E wave). However, it should be noted that these indices, in fact, measure diastolic filling, rather than function. Even in healthy individuals, numerous factors may have impact on transmitral flow pattern, including age, heart rate, loading conditions and filling pressures. NORMAL PULMONARY VENOUS FLOW PATTERN: Analysis of pulmonary venous flow pattern (obtained by pulsed Doppler sample volume placed in pulmonary vein) gives additional information and may help in the assessment of left ventricular filling. Usually, three distinct velocity waves can be observed: S wave, occurring during ventricular systole; 1) wave, diastolic wave that begins after mitral wave opening: and finally, AR wave, reversal velocity during atrial contraction. When diastolic filling is altered, typically there is an inverse relationship between transmitral E and pulmonary venous S wave, as well as transmitral A and pulmonary venous D wave. PATHOLOGIC FILLING PATTERNS: There are three different pathologic filling patterns: 1) delayed (prolonged, impaired) relaxation pattern, characterized by prolonged isovolumetric relaxation time and deceleration time, low E and high A wave velocities with an E/A wave ratio typically 1; 2) restrictive pattern, associated with shortened isovolumetric relaxation time, increased peak E wave velocity with very short deceleration time, and small (or even absent) A wave, leading to an E/A wave ratio 2; and 3) pseudonormal pattern, usually an intermediate stage between delayed relaxation and restrictive filling, as a consequence of disease progression; it may be unmasked by Valsalva maneuver and is characteristically associated with atrial dilatation and prominent pulmonary venous AR reversal. CLINICAL APPLICATIONS: Impaired diastolic function is frequently the first detectable abnormality in many of cardiac diseases. With serial recordings, changing of filling patterns, from delayed relaxation, through pseudonormalization, and, finally, to restrictive filling pattern can be observed. These changes have been demonstrated to correspond well with progression of cardiac diseases. According to the severity of symptoms and transmitral filling pattern, four-grade model of diastolic dysfunction has been proposed. It has been shown that the E/A ratio 2 and deceleration time 150 ms indicate poor prognosis in patients with dilated cardiomyopathy, cardiac amyloidosis and old myocardial infarction, independently of the severity of systolic dysfunction. (ABS

Early mitral regurgitation after acute myocardial infarction does not contribute to subsequent left ventricular remodeling.

BACKGROUND: It is well known that mitral regurgitation may lead to left ventricular dilation; however, the relationship between progressive left ventricular dilation after acute myocardial infarction (MI) and mitral regurgitation has not yet been clarified. HYPOTHESIS: This study tested the hypothesis that early mitral regurgitation contributes to left ventricular remodeling after acute MI. METHODS: We prospectively evaluated 131 consecutive patients by serial two-dimensional and Doppler echocardiography on Days 1, 2, 3, and 7, after 3 and 6 weeks, 3 and 6 months, and 1 year following acute MI. Patients were divided into two groups: those with mitral regurgitation in the first week after acute MI (Group 1, n = 34) and those without mitral regurgitation (Group 2, n = 81). RESULTS: Over 1 year, a significant increase in end-diastolic volume index (from 62.1 +/- 12.9 to 70.5 +/- 23.6 ml/m2, p = 0.001) with a strong linear trend (F = 15.1, p < 0.001) was noted. Initial end-diastolic volume index was higher in Group 1 (65.6 +/- 13.3 vs. 60.4 +/- 12.5 ml/m2, p = 0.047), but this difference remained constant throughout the study (F = 1.76, p = NS). Therefore, the pattern of end-diastolic volume changes was similar in both groups during the period of observation. CONCLUSIONS: These data indicate that early mitral regurgitation after acute MI does not contribute to subsequent left ventricular remodeling in the first year after myocardial infarction.

Doppler-based diagnosis of restenosis after femoropopliteal percutaneous transluminal angioplasty: sensitivity and specificity of the ankle/brachial pressure index versus changes in absolute pressure values.

The aim of this study was to investigate the sensitivity and specificity of changes of the ankle/brachial pressure index (ABI) and changes in absolute ankle pressure values to detect restenosis in patients who underwent femoropopliteal percutaneous transluminal angioplasty (PTA). In total, 171 patients were followed up prospectively for 12 months; sensitivity and specificity of Doppler-based diagnosis were calculated with duplex scanning as the gold standard. The criteria for restenosis were: (1) a loss of 50% of the ABI increase or (2) loss of 50% of the absolute ankle systolic pressure, gained by PTA. For both criteria, different cut-off points (minimum increase of ABI or ankle pressure gained by PTA) were evaluated. The overall sensitivity and specificity of the ABI criterion was 67% and 80%, respectively. The introduction of cut-off points (the minimum ABI increase gained by PTA), ranging between > or = 0.13 and > or = 0.35, did not markedly improve the results. The overall sensitivity and specificity of the absolute ankle pressure criterion again was poor (59% and 81%). With the introduction of cut-off points (the minimum increase of absolute ankle pressure gained by PTA) ranging between > or = 15 mm Hg and > or = 20 mm Hg, the sensitivity and specificity of the criterion improved to acceptable 92% and 96%, respectively. It is concluded, that in the long-term follow-up of PTA patients, the "loss of 50% ankle pressure" criterion will detect restenosis with reasonable accuracy in those patients, in whom an increase in systolic ankle pressure > or = 20 mm Hg is warranted.

Association of Killip class on admission and left ventricular dilatation after myocardial infarction: a closer look into an old clinical classification.

BACKGROUND: Early identification of patients in whom left ventricular dilatation is likely to occur may have important therapeutic implications. Thus the purpose of this study was to evaluate the relation between Killip class on admission and subsequent left ventricular dilatation after acute myocardial infarction. METHODS AND RESULTS: We serially evaluated 129 consecutive patients by two-dimensional and Doppler echocardiography on days 1, 2, 3, and 7, at 3 and 6 weeks, and at 3, 6, and 12 months after infarction. Killip class on admission >1 was found in 29 of 129 (22.5%) patients, and they had significantly higher end-systolic and end-diastolic volume indexes and wall motion score index from day 1 onward compared with patients with Killip class 1, whereas ejection fraction was lower during the follow-up period in these patients. Patients with Killip class >1 showed the progressive increase of end-diastolic (68.2 +/- 2.99 to 88.0 +/- 7.55 ml/m2, p = 0.001) and end-systolic volume indexes (43.9 +/- 2.67 to 56.3 +/- 6. 18 ml/m2, p = 0.004) during the follow-up period, whereas ejection fraction and wall motion score index remained unchanged. In patients with Killip class 1, end-systolic volume index did not change (30.8 +/- 1.06 to 33.8 +/- 2.15 ml/m2, p = 0.064), ejection fraction increased (49.3% +/- 0.99% to 51.8% +/- 1.17%, p = 0.027), and wall motion score index decreased (1.50 +/- 0.03 to 1.35 +/- 0.04, p < 0. 001). End-systolic volume index was the major independent correlate of Killip class, followed by history of diabetes and peak creatine kinase level. No association was found between Doppler indexes of diastolic filling and Killip class on admission. CONCLUSIONS: Killip class >1 on admission is associated with both acute and long-term left ventricular dilatation. On the other hand, Killip class 1 is associated with favorable left ventricular functional indices, and it appears that left ventricular function in these patients may improve over time. Initial end-systolic volume index but not ejection fraction is the major correlate of Killip class.

Effects of partial left ventriculectomy on left ventricular performance in patients with nonischemic dilated cardiomyopathy.

OBJECTIVES: This study sought to assess the effects of partial left ventriculectomy (PLV) on left ventricular (LV) performance in a series of consecutive patients with nonischemic dilated cardiomyopathy. BACKGROUND: Reduction of LV systolic function in patients with heart failure is associated with an increase of LV volume and alteration of its shape. Recently, PLV, a novel surgical procedure, was proposed as a treatment option to alter this process in patients with dilated cardiomyopathy. METHODS: We studied 19 patients with severely symptomatic nonischemic dilated cardiomyopathy, before and 13+/-3 days after surgery, and 12 controls. Single-plane left ventriculography with simultaneous measurements of femoral artery pressure was performed during right heart pacing. RESULTS: The LV end-diastolic and end-systolic volume indexes decreased after PLV (from 169 to 102 ml/m2, and from 127 to 60 ml/m2, respectively, p < 0.0001 for both). Despite a decrease in LV mass index (from 162 to 137 g/m2, p < 0.0001), there was a significant decrease in LV circumferential end-systolic and end-diastolic stresses (from 277 to 159 g/cm2, p < 0.0001 and from 79 to 39 g/cm2, p = 0.0014, respectively). Ejection fraction improved (from 24% to 41%, p < 0.0001); the stroke work index remained unchanged. CONCLUSIONS: The PLV improves LV performance by a dramatic reduction of ventricular end-systolic and end-diastolic stresses. Further studies are needed to assess whether this effect is sustained during long-term follow-up and to define the role of PLV in the treatment of patients with dilated cardiomyopathy.

Myocardial tissue characterization after acute myocardial infarction with wavelet image decomposition: a novel approach for the detection of myocardial viability in the early postinfarction period.

BACKGROUND: Only a few texture measures can be used for texture characterization of infarcted myocardium and detection of reperfused myocardium early after infarction. This study was conducted to establish the relationship between texture properties of infarcted myocardium and infarct-related artery patency by quantitative computer analysis of 2-dimensional echocardiographic images with the wavelet-based method for texture characterization, evaluate the relationship between texture properties and myocardial viability, and correlate histopathologic changes after experimental infarction with the texture measures. METHODS AND RESULTS: We analyzed 2-dimensional transthoracic echocardiographic images in 18 patients at different time points after infarction using the wavelet transform method. Regional wall motion of infarcted segments was analyzed on a follow-up echocardiographic study obtained 6 months after infarction. To verify the accuracy of the proposed texture measure and energy difference cutoff value, we prospectively evaluated another group of 19 patients. In addition, histopathologic changes in 9 dogs with experimental infarction were correlated with the texture measures. Sensitivity, specificity, and accuracy of the wavelet method for detection of reperfusion in the study group were 73%, 86%, and 78%, respectively, on day 2; 91%, 86%, and 89%, at 1 week; and 100%, 100%, and 100% at 3 weeks. Among 9 patients with improvement in regional wall motion on a follow-up study, 7 on day 2, 8 at 1 week, and 9 at 3 weeks were classified into the reperfused group by the wavelet method. Histopathologic features associated with the classification of reperfusion by the wavelet method were infarct transmurality (P=0.024) and degree of necrosis (P=0.028). CONCLUSIONS: Our clinical and experimental data suggest that the wavelet method can be used to differentiate between viable myocardium with recovery potential and definite myocardial necrosis in the early postinfarction period.