Turk Kardiyol Dern Ars. 2006; 34(7): 425-431

New echocardiographic parameters in reperfusion therapy

Turgut Karabağ, Bülent Behlül Altunkeser, Kurtuluş Özdemir, Fatih Koç
University Of Selcuk, Faculty Of Medicine Of Meram, Department Of Cardiology, Konya/turkey

OBJECTIVES
We examined whether pulmonary venous flow parameters by Doppler echocardiography would throw light on the assessment of reperfusion therapy in acute myocardial infarction (AMI) with ST-segment elevation.

STUDY DESIGN
The study included 88 patients who were admitted to intensive care unit with AMI. Data obtained from standard echocardiographic parameters and mitral and pulmonary vein Doppler parameters were evaluated in the following groups: Patients with or without ST-segment resolution on electrocardiograms (n=47, mean age 57±11 years and n=41, mean age 59±11 years, respectively) and patients with (n=53) or without (n=35) fibrinolytic therapy. ST resolution was defined as the disappearance of at least 70% of elevation detected on initial electrocardiograms.

RESULTS
Compared to those without ST resolution, patients with ST resolution had significantly higher mitral E-wave deceleration time (EDT), mitral E-wave pressure half time (E-PHT), pulmonary antegrade systolic flow (PS), and ejection fraction (EF) (p<0.05, p<0.05, p<0.05, p<0.001, respectively), and significantly lower end-systolic volume and left ventricle end-diastolic pressure (p<0.001, p<0.05 respectively). There was a significant correlation between PS and EF (r= 0.41, p<0.01) in patients without ST resolution, whereas PS was not correlated with EF in those with ST resolution (r= 0.21, p>0.05). In both groups with (r= -0.30) and without (r= -0.34) ST resolution, PS exhibited a negative correlation with pulmonary artery systolic pressure (p<0.05). With fibrinolytic therapy, the presence of ST resolution was significantly associated with higher values of EDT, E-PHT, and PS (p<0.05). However, in those who did not receive fibrinolytic therapy, patients with ST resolution had higher EDT, E-PHT, and PS compared to those without ST resolution, but only PS reached significance (p<0.05). Deceleration time of the pulmonary antegrade diastolic flow was significantly lower in patients who did not receive fibrinolytic therapy (p<0.01).

CONCLUSION
In addition to electrocardiographic ST resolution, early echocardiographic variables such as PS, deceleration time of the pulmonary antegrade diastolic flow, and mitral EDT may contribute to noninvasive assessment of myocardial perfusion.

Keywords: Blood flow velocity, echocardiography, Doppler, mitral valve; myocardial infarction; myocardial reperfusion; pulmonary veins/ultrasonography; thrombolytic therapy

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