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Echocardiography in tm mode in the assessment of left ventricular function in patients convalescing after a recent infarction correlations with hemodynamic parameters recorded at rest and after a cycloergometric test



Echocardiography in tm mode in the assessment of left ventricular function in patients convalescing after a recent infarction correlations with hemodynamic parameters recorded at rest and after a cycloergometric test



Annales de Cardiologie et d'Angeiologie 35(1): 7-14



133 patients (50 .+-. 11 years), under observation at 1 to 2 months after the acute episode (38 .+-. 10 days) and in the absence of medical treatment in most cases (90%), underwent the same day a maximal cycloergometic test, limited to symptoms of clinostatism with hemodynamic monitoring (Swan-Ganz 7F for pressure and thermodilution), and a good quality echocardiogram in TM mode (semi-automatic reading) in order to identify every valvulaire lesion. The ECHO-TM parameters of the left ventricular function (LV) taken into consideration (circumferential velocity of shortening of LV:CVSLF, percentage of systolic shoretning of LV, telediastolic dimension of LV,E-septum distance, PR-AC, relation between the intervals Q-mitral block and aortic block-mitral point E,QC/A2E, left auricular dimension and mitral point B) have shown a low correlation (0.31) with the telediastolic pulmonary arterial pressure (TDPAP) at rest and after effort. The ECHO-TM parameters have not demonstrated significant differences when the patients are grouped according to the locus of the infarction (76 inferior, 50 anterior and 7 antero-inferior) and age (36 younger than 45 years, 87 aged between 45 and 64 years and 10 older than 64 years), whereas significant differences were found on segregating the patients according to the value of the last level at a threshold of 75 watts (44 patients did not attain 75 watts and 89 exceeded it), according to the values of TDPAP at rest at a threshold of 12 mmHg (80 patients with TDPAP .ltoreq. 12 mmHg and 53 with TDPAP > 12 mmHg) and according to a heodynamic classification which takes into account the normal values of TDPAP and the cardiac output, at rest and during a test of effort, in relation to age and the load tolerated at the last level. The ECHO-TM parameters the best correlated with hemodynamic parameters are the telediastolic diameter of LV (normal < 56 mm) and the E-septum distance (normal < 12 mm). In fact, segregation of the patients on the basis of these values significant correlations are encountered for TDPAP at effort and even on being limited to E-septum parameter correlations are found with the maximal tolerated load and the TDPAP at effort. The ECHO-TM parameters which show least correlation are PR-AC and QC/A2E. In 29 patients with a mitral point B no significant difference was encountered for the ECHO-TM parameters and the hemodynamic parameters at rest and at effort. In conclusion, the ECHO-TM parameters considered did not appear to be useful for a quantitative assessement of the left ventricular function in a population of 133 asymptomatic patients with a recent myocardial infarct.

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