الفهرس 
DIASTOLIC FUNCTIONOnly 14 pages are availabe for public view
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Abstract
Diastolic dysfunction of the left ventricle (LV) is commonly accepted as an important mechanism for clinical signs and symptoms in coronary artery disease (CAD).
Several studies have suggested that such dysfunction may precede systolic dysfunction (Solomon et al., 2002).
Several non-invasive methods have been used for clinical assessment of diastolic function. In MI, Doppler echocardiography can be used to determine LV diastolic function the limitations of Doppler flow patterns are related to the difficulties in distinguishing between the normal and the pseudo normal filling pattern and to the influence of heart rate, age and loading conditions upon the measurements. Such significant limitations necessitate new improved methods to be used. (Ommen et al., 2000).
Recently, colour M-mode Doppler has been used for assessment of LV filling in early diastole & was obtained from the apical long axis view. The ultrasound beam interrogated from the apex of the heart toward the center of the mitral orifice as parallel to the filling flow as possible. (Garcia et al., 2000).
The flow propagation velocity of early diastolic filling flow was determined as the slope of the peak velocities of early diastolic filling flow on the color M-mode Doppler image.
Aim of this study is to assess the ability of E /Vp to predict in-hospital heart failure in an unselected consecutive population with first Anterior MI and to assess the short –term prognostic value of E/Vp on cardiac morbidity and mortality.
The study population consists of 50 consecutive patients admitted to the coronary care unit at Ain shams university hospital, with first anterior AMI diagnosed by at least two of the following criteria:
1. Characteristic chest pain,
2. Electrocardiographic signs of anterior MI,
3. Elevation of serum level of creatine kinase >2 times of upper normal limits.
Patient who had rhythm disturbance, history of Myocardial infarction / uncontrolled hypertension/ Valvular or myocardial diseases / previous coronary artery bypass graft (CABG) surgery or percutaneous coronary artery intervention (PCI) was excluded from the study.
In this study, 27 patients (54 %) were reported with varying degrees of diastolic dysfunction during early period of Myocardial infarction.
Vp correlated insignificantly with heart rate, Ejection fraction and LV diastolic volume. Also no significant correlation between wall motion index (WMI) & Vp was noted
Despite poor correlation between E-wave velocity and Vp and despite Vp is not affected by factors influence PWD- conventional indices, mean value of Vp was normal in patients with pseudonormal filling pattern (0.51 m/sec) thus Vp has failed to differentiate between normal from pseudonormal filling pattern.
Furthermore, mean value of Vp in patients with impaired relaxation patterns was normal (0.50 m/sec).
Also mean value of Vp in patients with AMI was 0.53 m/sec compared to controls with mean value 0.55 m/sec, such difference is statistically insignificant (P-value =0.416).
All these findings suggesting poor correlation between Vp and LV compliance. Such data however must be confirmed by invasive measurements.
Mortality rate in this study is small. This can probably be related to the study design, where numbers of patients was small, in addition to short term follow up.
In this study, Clinical and echocardiographic comparison were not significantly different between patients without or with congestive heart failure. This result could be due to small numbers of patients who developed congestive heart failure (mostly killip stage II heart failure) during hospitalization and short term follow up
Our result revealed no significant difference in development of heart failure among study groups of E/Vp ratio.
Apart from 2 cases of death which was reported during hospitalization among group 2 patients with E/Vp ratio ≥ 1.5 which is statistically insignificant, both groups of E/Vp have favorable prognosis over short term follow up. These findings are in the same line to previous data that didn’t support the routine use of M-mode colour Doppler in examination of patients with the suspicion of heart failure during acute myocardial infarction due to its lack of capacity to predict in-hospital heart failure after AMI (Juan et al., 2004) and these are in disagreement to Moller JE et al, showed that over period of 35 days after myocardial infarction, a group of patients with E/Vp ratio≥ 1.5 had a poor prognosis (14 of 24 patients died) while group of patients with E/Vp ratio <1.5 had a very favorable prognosis (1 of 58 patients died) (Moller et al., 2000).
In this study, Univariate analysis proved that LV ejection fraction, wall motion index and E-wave deceleration time as significant correlates to the development of congestive heart failure during follow-up.
Also in this study, Univariate analysis proved that LV volume, LA size as poor predictor of in hospital heart failure. This finding could be explained by the fact that Left ventricular or atrial dilatation require longer time to occur.