Effects of carvedilol on right ventricular ejection fraction and cytokines levels in patients with systolic heart failure.

BACKGROUND: Right ventricular (RV) dysfunction frequently complicates advanced left ventricular (LV) heart failure and contributes to an unfavorable prognosis. It is known that carvedilol increases left ventricular ejection fraction (LVEF) significantly, and carvedilol reduces mortality by associating with improvement in LV function. However, the effect of carvedilol on RV function in heart failure has not adequately been studied, so far. The objective is to establish whether the addition of carvedilol has an additive beneficial effect on RVEF and cytokines levels in patients with heart failure who are already receiving treatment with angiotensin-converting enzyme (ACE) inhibitors, digoxin and diuretics. METHODS: In this single-centre, prospective, randomized study, 74 patients with heart failure with an LVEF less than 40% and already receiving digoxin, ACE inhibitors and diuretics for 6 months as the standard therapy were randomly assigned to receive either carvedilol (n=44) or placebo (n=30). Patients received an initial dosage of 6.25 mg carvedilol or placebo twice daily for 2 weeks, which was then increased at 2-week intervals (if tolerated), first to 12.5 mg and, finally, to a target dosage of 25 mg twice daily. Clinical examinations, radionuclide studies, and determinations of plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-2 and IL-6 were performed at baseline and repeated 4 months after random assignment. Primary end points were New York Heart Association functional class, RVEF and plasma cytokines levels. RESULTS: Patients treated with carvedilol had a significant improvement in functional class compared with the baseline values (P=0.001), with a decrease in the levels of cytokines (IL-6 [P=0.02] and TNF-alpha [P=0.02]). LVEF increased from 21.4+/-8.8% to 27.8+/-10.8% and RVEF increased from 28.8+/-4.2% to 36.3+/-2.6% in the carvedilol group (P=0.003). CONCLUSIONS: Carvedilol treatment for 4 months resulted in a significant improvement of RVEF, which paralleled the improvement of LVEF and the decreasing of TNF-alpha and IL-6 levels in patients with systolic HF.

Right coronary artery aneurysm: possible relation with obesity?

Aneurysms of the coronary arteries are uncommon occurrences that usually develop secondary to atherosclerosis and are often asymptomatic. We present a 57-year-old male patient who presented with the diagnosis of an inferior wall acute myocardial infarction with a large aneurysm of the right coronary artery and with morbid obesity. To the best of our knowledge, a relationship between body mass index and coronary artery aneurysm has not been reported in the literature so far. We speculated that there is a relationship between coronary artery aneurysm and body mass index.

Arterial distensibility in Wegener's granulomatosis: a carotid-femoral pulse wave velocity study.

OBJECTIVE: The purpose of this study was to test the hypothesis; that chronic inflammation may impair vascular function and lead to an increase of arterial pulse wave velocity (PWV) in patients with Wegener's granulomatosis (WG). METHODS: We recruited 5 patients with WG and 5 healthy age and sex matched controls in this cross-sectional case-controlled study. Aortic PWV was determined by using an automatic device (Complior Colson, France), which allowed on-line pulse wave recording and automatic calculation of PWV. RESULTS: The carotid-femoral (aortic) PWV was increased in patients with WG as compared with control group (p=0.04). Although we found positive correlation between PWV and heart rate (r=0.75, p=0.01), we did not find any significant correlation between PWV and anthropometric and other hemodynamic parameters (p>0.05). In addition, we found positive correlation between PWV and erythrocyte sedimentation rate in patients with WG (r=0.90, p=0.03). CONCLUSION: Pulse wave velocity is increased and arterial distensibility decreased in patients with WG. Measurements of carotid-femoral (aortic) PWV may provide an easy and noninvasive technique to identify patients at increased risk of arterial disease.

Incidence of antiheparin-platelet factor 4 antibodies and heparin-induced thrombocytopenia in Turkish patients undergoing cardiac surgery.

The frequency of antiheparin-platelet factor 4 antibodies by means of antigenic and functional assays ((14) C-serotonin release assay and citrated plasma platelet aggregation) was determined in 115 Turkish patients undergoing cardiac surgery. Blood samples were taken immediately before surgery and on days 5 and 10 +/- 2. Platelet counts were recorded and thrombotic events were determined by clinical methods. Antibody generation measured by enzyme-linked immunosorbent assay before surgery (n = 44) and on days 5 (n = 44) and 10 (n = 115) was 15.9%, 34.1%, and 65.2%, respectively. Positive samples from functional assays were 4.4% on day 0 and 7.0% on day 10. All positive samples had been negative on day 0. A high frequency of antiheparin-platelet factor 4 antibody generation and a low frequency of clinical heparin-induced thrombocytopenia were determined in these patients. These results obtained for Turkish patients are similar to those of other studies of heparin-induced thrombocytopenia.

The effects of nebivolol on fibrinolytic parameters in mild and moderate hypertensive patients.

BACKGROUND: The aim of the present study was to investigate the effects of nebivolol (5 mg daily) on plasma levels of hemostatic and fibrinolytic endothelial function markers in mild or moderate hypertensive patients. METHODS AND RESULTS: Thirty-five (22 female, 13 male; mean +/- SD 54.7 +/- 11.3 years of age) mild and moderate hypertensive patients were included the study. The mean systolic blood pressure [BP] was 160 mmHg (range 150 mmHg to 165 mmHg) and the mean diastolic BP was 100 mmHg (range 90 mmHg to 100 mmHg). Plasma tissue plasminogen activator antigen (tPA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1-Ag), PAI-1 activity, tPA-Ag/PAI-1-Ag index, fibrinogen and euglobulin lysis time were determined before and after two months of therapy. tPA-Ag and PAI-Ag levels were measured by ELISA. After this period, treatment with nebivolol (5 mg/day) in all patients was associated with a significant decrease in systolic BP and diastolic BP (P<0.001 for each), heart rate (P<0.01), fibrinogen (P<0.005) and euglobulin lysis time (P<0.01). The tPA-Ag and tPA-Ag/PAI-1-Ag index levels were increased significantly (P<0.001 for each) in all patients, but the PAI-1-Ag (P>0.05) and PAI-1 activity (P>0.05) did not show significant change. In the present study, there was no correlation between decreases in arterial BP and decreases in fibrinolytic parameters (P>0.05), but there was a positive, statistically significant correlation between fibrinogen and body mass index (P<0.001). CONCLUSIONS: The results indicated that, compared with no treatment, a two-month treatment trial with nebivolol was associated with a more favourable modification of hemostatic and fibrinolytic status in addition to antihypertensive effects.

Analysis of intervariable relationships between major risk factors in the development of coronary artery disease: a classification tree approach.

OBJECTIVE: The purpose of this study is to determine how the major risk factors are related to each other in the development of coronary artery disease (CAD) using Chi-squared Automatic Interaction Detection (CHAID). METHODS: All patients with suspected CAD seen in the cardiology clinic between January 1999 and February 2003 who underwent coronary angiography were included in the study. A retrospective analysis was performed in 1381 patients. In all patients' sex, age, type II diabetes mellitus, hypercholesterolemia, systemic hypertension, smoking status, family history of CAD, body mass index (BMI) were assessed. RESULTS: According to classification tree, first-level split produced the two initial branches: female (unadjusted presence percentage = 48.07%) versus male (unadjusted presence percentage = 78.02%). For the male aged between 49-81 years and the female aged between 15-48, 49-60 and 61-71 years, diabetes mellitus was the most prominent risk factor. However, hypercholesterolemia was the best predicting variable for the females aged between 72-81 years. For the females of 15-48 years and 49-60 years age categories without diabetes mellitus, smoking status and family history of CAD had important contribution to the model. CONCLUSION: Sorting the major risk factors of CAD from the most to least according to the classification importance was resulted as sex, age, diabetes mellitus, hypercholesterolemia, family history of CAD and smoking status.

Effects of carvedilol on plasma levels of pro-inflammatory cytokines in patients with ischemic and nonischemic dilated cardiomyopathy.

We prospectively investigated the effects of adding carvedilol to the standard treatment of ischemic and nonischemic dilated cardiomyopathy (DCM), by measuring the plasma levels of pro-inflammatory cytokines. Sixty patients with DCM (35 ischemic and 25 nonischemic) were divided into 2 subgroups: patients on standard therapy alone (digoxin, angiotensin-converting enzyme inhibitors, and diuretics) and patients on standard therapy plus carvedilol. Study participants' serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), and interleukin-6 (IL-6) were measured at the beginning and again at the end of the study. Left ventricular ejection fraction and left ventricular diastolic function were evaluated by means of radionuclide ventriculography. In ischemic patients on carvedilol, levels of IL-6 and TNF-alpha dropped significantly (P= 0.028 and P=0.034, respectively). In ischemic patients on standard treatment, plasma IL-2 levels were elevated after treatment (P=0.047). No significant differences occurred in IL-6 levels, while TNF-alpha levels were elevated (P=0.008). In nonischemic patients on carvedilol, IL-6 and TNF-alpha levels dropped significantly (P=0.018 and P=0.004, respectively). The left ventricular ejection fraction increased significantly (P=0.006). In nonischemic patients on standard treatment, no significant change occurred in any value. Carvedilol suppressed the plasma levels of TNF-alpha and IL-6 in both ischemic and nonischemic patients. The carvedilol effect was more pronounced in patients with nonischemic dilated cardiomyopathy than in those with ischemic disease.

Spontaneous coronary artery dissection after heavy lifting in a 25-year-old man with coronary risk factors.

Spontaneous coronary artery dissection (SCAD) is a clinical condition rarely leading to acute myocardial infarction (AMI). We report the case of SCAD presenting AMI in a 25-year-old man with coronary risk factors after strenuous exercise, who was successfully treated with systemic thrombolysis. Coronary angiography revealed spiral dissection of the proximal part of the left anterior descending artery. The present case supports the occurrence of SCAD as a cause of AMI in young male patients who have coronary risk factors, after heavy lifting.

Differentiating the infarct-related artery on initial electrocardiogram in single or multi-vessel disease in acute inferior myocardial infarction and evaluating involvement of vessels using correspondence analysis.

Initial electrocardiography changes were compared prospectively with the findings of coronary angiography to predict the infarct-related artery (IRA) in cases of single- and multi-vessel disease and to demonstrate the relationship between other coexisting coronary involvements and IRA in patients who presented with acute inferior myocardial infarction (AMI). ST elevations or depressions of at least 1 mm (0.1 mV) were evaluated in the leads I, aVL, and V1-V6. Of the 160 patients hospitalized due to inferior AMI, 153 (96%) underwent coronary angiography using standard methods. The angiograms were screened for stenotic lesions using quantitative coronary angiography to confirm significance, which was considered >50% vessel lumen diameter reduction. Among single-vessel involvements, the IRA was either the circumflex artery (Cx) or right coronary artery (RCA). In conditions in which IRA was detected as either Cx or RCA, 1-, 2-, and 3-vessel involvements were also detected. Correspondence analysis was performed to show the vessel involvements accompanying IRA. Compared with patients with IRA as RCA, the presence of ST depressions in the leads V1 or V2 and aVL were more frequently seen in patients with IRA as Cx (p=0.000, p=0.015, respectively). Among all vessel involvements in which IRA was either Cx or RCA, a ST-segment depression in leads V1 or V2 (p=0.000) and aVL (p=0.000) and a ST-segment elevation in lead I (p=0.005) were considered to be significant for Cx, and a ST-segment depression in lead I for RCA involvement (p=0.010). According to correspondence analysis, the most frequent single-vessel involvement seen in inferior AMI was RCA; when IRA was RCA, a multi-vessel involvement included RCA and Cx; and when IRA was Cx, a single-vessel involvement included the left anterior descending (LAD) artery most frequently, and RCA+LAD less frequently (p=0.000). In inferior AMI, RCA was the most common IRA; however, the possibility of multi-vessel disease is increased when Cx is found to be the IRA. In patients presenting with inferior AMI, the presence of ST-depression in the leads aVL and V1-2 is a sensitive finding that indicates Cx stenosis rather than RCA stenosis and is not affected by coexisting other coronary artery involvements.

A controlled study of the effects of carvedilol on clinical events, left ventricular function and proinflammatory cytokines levels in patients with dilated cardiomyopathy.

BACKGROUND: Carvedilol is known to decrease the severity of ventricular dysfunction, to increase the left ventricular ejection fraction (LVEF), and, consequently, to reduce morbidity and mortality in patients with dilated cardiomyopathy. There is accumulating evidence that inflammatory cytokines have an important role in the pathogenesis of heart failure. OBJECTIVE: To establish whether the addition of carvedilol has an additive beneficial effect on cytokines in patients with dilated cardiomyopathy who are already receiving treatment with angiotensin-converting enzyme (ACE) inhibitors, digoxin and diuretics. METHODS AND RESULTS: In this single-centre, prospective, randomized study, 60 patients with dilated cardiomyopathy with an LVEF less than 40% and already receiving digoxin, ACE inhibitors and diuretics for six months as the standard therapy were randomly assigned to receive either carvedilol (n=30) or placebo (n=30). Patients received an initial dosage of 3.125 mg carvedilol or placebo twice daily for two weeks, which was then increased at two-week intervals (if tolerated), first to 6.25 mg, then to 12.5 mg, and, finally, to a target dosage of 25 mg twice daily. Clinical examinations, radionuclide studies, and determinations of plasma levels of tumour necrosis factor-alpha (TNF-a), interleukin (IL)-2 and IL-6 were performed at baseline and repeated four months after random assignment. Primary end points were New York Heart Association functional class, LV function and plasma cytokines levels. Eight patients died (seven in the placebo group, P=0.05). Patients treated with carvedilol had a significant improvement in functional class compared with the baseline values (P=0.001), with a decrease in the levels of cytokines (IL-6 [P=0.001] and TNF-a [P=0.001]). LVEF increased from 22.14+/-7.85% to 27.85+/-11.80% (P=0.002), but diastolic function did not change in the carvedilol group. CONCLUSIONS: In patients with dilated cardiomyopathy, the addition of carvedilol to treatment with digoxin, ACE inhibitors and diuretics is associated with a significant improvement in symptoms and in LV function, and suppression of inflammatory cytokines.

[Comparison of multiple prediction models for hypertension (Neural networks, logistic regression and flexible discriminant analyses)]. / Hipertansiyonun tahmini için çoklu tahmin modellerinin karsilastirilmasi (Sinir aglari, lojistik regresyon ve esnek ayirma analizleri).

OBJECTIVE: In this study, we compared performances of logistic regression analysis (LR), flexible discriminant analysis (EAA) and neural networks (SA) in prediction of primary hypertension. METHODS: Predictor variables were family history, lipoprotein A, triglyceride, smoking and body mass index. The data were collected from Cardiology Clinic of Trakya University Medical Faculty in Turkey, 2001. Logistic regression analysis, flexible discriminant analysis and neural networks were used for prediction of control and hypertension groups. Comparison of the performance of all models was done using receiver operating characteristic (ROC) curve analysis. RESULTS: All models had areas under the ROC curve in the range of 0.793-0.984 and SA had sensitivity, specificity, and accuracy greater than 90% at ideal threshold. ROC curve areas of SA and LR, and SA and EAA were statistically different (p<0.001 and p<0.001 respectively), while ROC curve areas of EAA and LR did not differ (p>0.05). CONCLUSION: We concluded that family history, lipoprotein A, triglyceride, smoking and body mass index variables can be used for prediction of control and hypertension groups with statistically better performance of SA over LR and EAA.

Arterial distensibility as determined by carotid-femoral pulse wave velocity in patients with Behçet's disease.

Behçet's disease (BD) is a chronic, multisystem disorder characterized by genital and oral aphthae, skin lesions, uveitis, and tendency to thrombosis. Pulse wave velocity (PWV) is an important factor in determining cardiovascular mortality and morbidity. It is an index of arterial wall stiffness and inversely related to the arterial distensibility. In this study we investigated the arterial distensibility in BD by PWV. We studied 14 patients with BD (18-44 years old, 10 men) and 28 healthy subjects (18-39 years old, 21 men) without known cardiovascular disease. Arterial distensibility was assessed by automatic carotid-femoral PWV measurement using the Complior Colson device. PWV is calculated from measurements of pulse transit time and the distance traveled by the pulse between two recording sites, according to the following formula: pulse wave velocity (m/s)=distance (m)/transit time(s). The mean ages, systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate, and PWV of Behçet's disease and control subjects were 32.1+/-7.4 vs 27.9+/-6.1 years, 112.9+/-12.0 vs 108.7+/-10.0 mmHg, 72.1+/-10.7 vs 67.7+/-7.5 mmHg, 40.7+/-12.2 vs 41.0+/-10.7 mmHg, 74.1+/-10.2 vs 77.2+/-10.1 bpm, and 8.4+/-1.4 vs 8.5+/-1.1 m/s, respectively. Differences between all parameters studied were not found to be statistically significant (p>0.05). The carotid-femoral PWV, an index of arterial stiffness and a marker of atherosclerosis, is not increased in patients with BD compared with control subjects.

Increased pulse wave velocity and shortened pulse wave propagation time in young patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a systemic immune and inflammatory disease associated with excess cardiovascular morbidity and mortality. Pulse wave velocity (PWV) is an index of arterial stiffness and a marker of cardiovascular events. OBJECTIVE: To investigate arterial stiffness using carotid-femoral (aortic) PWV measurements in young patients with RA. PATIENTS AND METHODS: Eight patients (aged 21 to 34 years, seven women, mean RA duration 13.8+/-12.6 months) with RA according to the criteria of the American College of Rheumatology, and eight age- and sex-matched control subjects (aged 22 to 34 years, seven women) were recruited. Aortic PWV was determined using an automatic device, the Complior (Complior Colson, France), which allowed on-line pulse wave recording and automatic calculation of PWV. RESULTS: The carotid-femoral PWV, systolic blood pressure and heart rate were higher in young patients with RA than in sex- and age-matched control subjects (P=0.03, P=0.02 and P=0.002, respectively). In the young patients with RA, pulse wave propagation time between measurement sites was significantly shorter than in the control group (P=0.02). There were no significant differences in the sex, age, body mass index, waist to hip ratio, diastolic blood pressure, mean blood pressure or pulse pressure between the two groups (P=1.00, P=0.71, P=0.20, P=0.66, P=0.55, P=0.07 and P=0.11, respectively). CONCLUSION: The carotid-femoral PWV is increased and pulse wave propagation time is decreased in young patients with RA. Measurements of carotid-femoral PWV may provide a simple and noninvasive technique for identifying patients at increased risk of vascular disease.

The potential cardioprotective effects of amifostine in irradiated rats.

PURPOSE: The aim of this study is to determine the cardioprotective efficacy of amifostine. The study consists of researching the relationship between plasma brain natriuretic peptide levels and the electrical and morphologic changes in irradiated rats with or without amifostine. METHODS AND MATERIALS: Sixty Wistar albino rats were divided into 4 groups, and their hearts were given 15 Gy/fraction with (60)Co. In Groups I and II, the rats were killed after 24 hours to detect early effects; in Groups III and IV, the rats were killed 100 days after irradiation to detect late effects. Before irradiation, Groups I and III received 0.9% saline solution, whereas Groups II and IV received amifostine (200 mg/kg). Twenty rats were used as a control group. RESULTS: On the 100th day, mild myocardial degeneration was detected in 5 rats (33%) from Group III (no amifostine). This percentage was statistically different from that of Group IV (treated with amifostine) and the controls (p = 0.042). There was no statistically significant difference between the mean plasma brain natriuretic peptide values of the groups (p > 0.05). There was no significant difference in electrocardiographies between the groups. There was no correlation between continuous variables. CONCLUSION: In the amifostine group (IV) on the 100th day, there was no myocardial degeneration, suggesting that amifostine has a cardioprotective effect.

Acute myocardial infarction in a patient with essential thrombocythemia treated with glycoprotein IIb/IIIa inhibitor.

Essential thrombocythemia (ET) rarely causes obstruction of coronary arteries or acute myocardial infarction. Treatment of acute myocardial infarction in patients with ET may be a problem due to the important role of platelets in the pathogenesis of infarction. There is no reported case of acute myocardial infarction with essential thrombocythemia treated with a glycoprotein IIb/IIIa inhibitor. In this report, a 49-year-old woman with essential thrombocythemia, admitted with a diagnosis of acute inferolateral myocardial infarction, was treated with tirofiban, a glycoprotein IIb/IIIa receptor blocker.

Relationship with plasma neurohormones and dyssynchrony detected by Doppler echocardiography in patients undergoing permanent pacemaker implantation.

OBJECTIVE: To determine whether isovolumic relaxation flow (IRF) and isovolumic contraction flow (ICF) resulted from asynchrony and asynergy due to VVI and DDD pacemakers modulated neurohormones, we measured neurohormone levels in plasma and investigated the characteristics of IRF and ICF using Doppler echocardiography. METHODS AND RESULTS: We studied 11 patients with dual-chamber pacemakers (DDD) and 11 patients, with ventricular inhibiting mode (VVI). All patients underwent Doppler echocardiography of the left ventricle. Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), renin and aldosteron were measured. The LV was scanned for the presence of intracavitary flow during the isovolumic relaxation and isovolumic contraction period. The plasma levels of BNP and ANP were significantly lower in DDD mode than in VVI mode (56 +/- 32 pg/ml vs. 94 +/- 32 pg/ml, p = 0.022 and 98 +/- 20 pg/ml vs. 134 +/- 17 pg/ml, p = 0.042, respectively). There were no significant differences in the plasma level of renin or aldosteron. VVI mode versus DDD mode increased isovolumic relaxation flow time (129 +/- 41 vs. 111 +/- 36 sec, p = 0.020) and isovolumic relaxation flow velocity (50 +/- 4 vs. 37 +/- 2 cm/s, p = 0.018). A strong relationship between blood ANP and BNP levels and IRF velocity was found in patients with a VVI pacemaker (r: 0.632, p: 0.028; r: 0.528, p: 0.024, respectively). CONCLUSION: VVI mode has a longer isovolumic relaxation time, isovolumic relaxation flow velocity and has higher ANP and BNP plasma levels than DDD mode. IRF resulting from asynergy and asynchrony in VVI mode pacemakers versus DDD mode pacemakers affects the plasma levels of ANP and BNP compared to renin and aldosteron.

Predictive value of admission electrocardiogram for multivessel disease in acute anterior and anterior-inferior myocardial infarction.

BACKGROUND: Our aim was to investigate the correlation between admission ECG and coronary angiography findings in terms of predicting the culprit vessel responsible for the infarct or multivessel disease in acute anterior or anterior-inferior myocardial infarction (AMI). METHODS: We investigated 101 patients with a diagnosis of anterior AMI with or without ST-segment elevation or ST-segment depression in at least two leads in DII, III, aVF. The patients were classified as those with vessel involvement in the left anterior descending (LAD) coronary artery and patients with multivessel disease. Vessel involvement in LAD + circumflex artery (Cx) or LAD + right coronary artery (RCA) or LAD + Cx + RCA were considered as multivessel disease. Thus, (a) anterior AMI patients with reciprocal changes in inferior leads, (b) anterior AMI patients with inferior elevations, (c) all anterior AMI patients according to the ST-segment changes in the inferior region were analyzed according to the presence of LAD or multivessel involvement. RESULTS: Presence of ST-segment depression in aVL and V6 was significantly correlated with the presence of multivessel disease in anterior AMI patients with reciprocal changes in the inferior leads (P = 0.005 and P = 0.003, respectively). No statistically significant difference between the leads were detected in terms of ST-segment elevation in predicting vessel involvement in the two groups of anterior AMI patients with inferior elevations. When all the patients with anterior AMI were analyzed, the presence of ST-segment depression in leads aVL, V4, V5 and V6 were significantly associated with the presence of multivessel disease (P = 0.035, P = 0.010, P = 0.011, P = 0.001, respectively). CONCLUSIONS: The presence of ST-segment depression in anterolateral leads in the admission ECG of anterior AMI patients with reciprocal changes in inferior leads was associated with multivessel disease.

Automatic backscatter analysis of regional right ventricular systolic function using colour kinesis in patients with inferior wall acute myocardial infarction with or without right ventricular involvement.

BACKGROUND: In patients with inferior acute myocardial infarction (AMI), right ventricular (RV) function is an important determinant of global cardiac performance, prognosis, and exercise capacity. Several echocardiographic methods for quantifying RV function have been developed over the years but the usefulness of colour kinesis (CK) and acoustic quantification (AQ) have not yet been investigated. AIM: To test whether AQ and CK may provide quantitative assessment of global and regional RV function in patients with inferior AMI. METHODS: Thirty two consecutive patients with recent inferior AMI with or without RV involvement (n=17 and n=15, respectively), and 15 age- and gender-matched controls were studied. The graphs of RV fractional area change were displayed along with ECG and the concurrent cross sectional image. CK digitised end-systolic images of RV and were evaluated by reviewing the stored loops obtained from normal subjects and patients. To evaluate the entire RV systolic endocardial excursion, further quantitative CK analysis was performed by measuring the systolic segmental endocardial motion (SEM). RESULTS: In comparison with the control group, patients with inferior AMI with or without RV involvement had reduced RV fractional area change (30+/-7%, 36+/-6%,45+/-6%, p<0.05, p<0.01 respectively), reduced mean free wall SEM (3.9+/-1.1 mm, 5.2+/-1.3 mm, 6.3+/-1.4 mm, p<0.05, p<0.01 respectively) and mean septal wall SEM (4.9+/-1.2 mm, 6.4+/-1.5 mm, 7.2+/-1.4 mm, p<0.05, p<0.05, respectively). CONCLUSIONS: Our results confirmed that RV systolic functions are significantly more altered in patients with inferior AMI than in controls, and that RV abnormalities are more pronounced in patients with rather than without RV involvement. AQ and CK are able to detect wall motion disturbances in patients with inferior AMI with RV involvement.