A novel index combining diastolic and systolic tissue Doppler parameters for predicting cardiac resynchronization therapy response

Use of Indices Combining Diastolic and Systolic Tissue Doppler Variables to Evaluate Right Ventricular Function in Dogs With Pulmonary Stenosis

BACKGROUND

Indices combining diastolic and systolic tissue Doppler variables, the Ee's' index (E/[e' × s']) and e'a's' index (e'/[a' × s']), have aided detection of myocardial dysfunction and in prediction of poor outcomes in humans with cardiovascular diseases. Studies of Ee's' and e'a's' indices in dogs have not been performed.

HYPOTHESIS/OBJECTIVES

Dogs with pulmonary stenosis (PS) have elevated right ventricular (RV) Ee's' and e'a's' indices compared to healthy dogs, which will decrease after pulmonary balloon valvuloplasty (BV) or stent implantation.

ANIMALS

Thirty client-owned dogs (15 healthy, 15 with PS).

METHODS

Cross-sectional study. All dogs had echocardiography performed, including the measurement of RV diastolic and systolic variables and calculation of the Ee's' and e'a's' indices. Dogs with PS had echocardiography performed prior to and after interventional procedures.

RESULTS

The Ee's' index was lower (p = < 0.001) in healthy dogs (median 0.43, range 0.23-0.74) compared to dogs with PS pre-operatively (1.49, 0.28-3.79). The e'a's' index was lower (p = 0.039) in healthy dogs (mean 8.03 ± 3.28) compared to dogs with PS pre-operatively (11.39 ± 4.03). Compared to pre-operative values, the Ee's' index (1.01, 0.36-1.62) and e'a's' index (8.35 ± 3.29) decreased (p = 0.018, p = 0.001, respectively) after pulmonary intervention in dogs with PS.

CONCLUSIONS AND CLINICAL IMPORTANCE

Dogs with PS have RV myocardial dysfunction that can be measured with Ee's' and e'a's' indices, and these values can be used to monitor response to pulmonary intervention over time. These findings suggest that calculation of Ee's' and e'a's' indices might have clinical importance in long-term management of dogs with PS.

An early echocardiographic prediction for functional myocardial recovery after ST elevation myocardial infarction

Goals Discrimination of the time course of functional recovery in early period following ST elevation myocardial infarction (STEMI) has prognostic importance. This study aims to establish the ability of the combined systolic-diastolic index (E / (Ea x Sa), for differentiating recoverable myocardium or persistent non-viability in subjects with STEMI.Material and methods 77 patients with first acute STEMI were enrolled to the study. Serial transthoracic echocardiography (TTE) examinations were performed at the time of the admission (immediately after reperfusion), hospital discharge (5±1 days) and control examination (30±2 days). To assess the association between E / (Ea×Sa) index and myocardial recovery, two categories (Transient stunning and persistent non-viability) were defined on basis of improvement of left ventricle ejection fraction (LV EF) (Improvement was defined as an increase more than 10 % in LV EF at day 30 compared to baseline).Results 55 patients (71.4 %) had improvement of LV EF and 24 patients (28.6 %) had no recovery of systolic function (30 days LV EF 48.78±6.1 vs. 39.31±8.1 %, p=0.01). The E / (Ea×Sa) index were significantly higher in the "non-viability" than in stunning group on predischarge and 1 month (1.61±0.64 vs 1.25±0.43, p=0.01 and 1.33±0.25 vs 1.14±0.21, p=0.01, respectively). The change in the E / (Ea×Sa) index in early period (within 5±1 days) was higher in the stunning group (26 %) compared to non-viability group (15 %) (p=0.033). E / (Ea×Sa) index was found to be a significant predictor of myocardial recovery in multivariable logistic regression (OR 0.91, 95 % CI 0.83-0.98, p=0.001). Roc curve showed that the cutoff value of E / (Ea×Sa) index is 1.29 with 73 % of sensitivity and 61 % of specificity (AUC: 0.71, p=0.01, CI: 0.54-0.89).Conclusions Our findings suggest that E / (Ea×Sa) index is a strong predictor of functional recovery; the odds of recovery decreases as E / (Ea×Sa) index value increases.