Document Detail


Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dt(max) complementary or redundant?
MedLine Citation:
PMID:  22307667     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Among the various cardiac contractility parameters, left ventricular (LV) ejection fraction (EF) and maximum dP/dt (dP/dt(max)) are the simplest and most used. However, these parameters are often reported together, and it is not clear if they are complementary or redundant. We sought to compare the discriminative value of EF and dP/dt(max) in assessing systolic dysfunction after myocardial infarction (MI) in swine. A total of 220 measurements were obtained. All measurements included LV volumes and EF analysis by left ventriculography, invasive ventricular pressure tracings, and echocardiography. Baseline measurements were performed in 132 pigs, and 88 measurements were obtained at different time points after MI creation. Receiver operator characteristic (ROC) curves to distinguish the presence or absence of an MI revealed a good predictive value for EF [area under the curve (AUC): 0.998] but not by dP/dt(max) (AUC: 0.69, P < 0.001 vs. EF). Dividing dP/dt(max) by LV end-diastolic pressure and heart rate (HR) significantly increased the AUC to 0.87 (P < 0.001 vs. dP/dt(max) and P < 0.001 vs. EF). In naïve pigs, the coefficient of variation of dP/dt(max) was twice than that of EF (22.5% vs. 9.5%, respectively). Furthermore, in n = 19 pigs, dP/dt(max) increased after MI. However, echocardiographic strain analysis of 23 pigs with EF ranging only from 36% to 40% after MI revealed significant correlations between dP/dt(max) and strain parameters in the noninfarcted area (circumferential strain: r = 0.42, P = 0.05; radial strain: r = 0.71, P < 0.001). In conclusion, EF is a more accurate measure of systolic dysfunction than dP/dt(max) in a swine model of MI. Despite the variability of dP/dt(max) both in naïve pigs and after MI, it may sensitively reflect the small changes of myocardial contractility.
Authors:
Kiyotake Ishikawa; Elie R Chemaly; Lisa Tilemann; Kenneth Fish; Dennis Ladage; Jaime Aguero; Torsten Vahl; Carlos Santos-Gallego; Yoshiaki Kawase; Roger J Hajjar
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-02-03
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  302     ISSN:  1522-1539     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  2012-05-15     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H1423-8     Citation Subset:  IM    
Affiliation:
Cardiovascular Research Center, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Area Under Curve
Blood Pressure / physiology
Cardiac Volume / physiology
Diastole / physiology
Heart Rate / physiology
Myocardial Contraction / physiology
Myocardial Infarction / physiopathology*
ROC Curve
Stroke Volume / physiology*
Swine
Ventricular Dysfunction, Left / diagnosis,  physiopathology*,  ultrasonography
Ventricular Pressure / physiology*
Grant Support
ID/Acronym/Agency:
HL-071763/HL/NHLBI NIH HHS; HL-080498/HL/NHLBI NIH HHS; HL-083156/HL/NHLBI NIH HHS; HL-088434/HL/NHLBI NIH HHS; P20-HL-100396/HL/NHLBI NIH HHS; R01-HL-093183/HL/NHLBI NIH HHS; T32-HL-007824/HL/NHLBI NIH HHS
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