1106 Endotoxin dose finding study in a septic shock rat model with Echo-Doppler

B RYS, C ROOSENS, P DEPAEPE, P SEGERS, R LEFEBVRE, P VERDONCK, J POELAERT
2006 European Journal of Echocardiography  
vided as a surrogate marker for LV-EF. Unfortunately, there are only few data on the relation between the WMSI and LV-EF. In addition, poor non-contrast enhanced echo windows can make the WMSI (and LV-EF) unreliable. The value of contrast imaging for WMSI assessment was not investigated before . Aim of the study: To compare segmental wall motion and WMSI interobserver agreement in patients who underwent both two-dimensional second harmonic (SH) and contrast left ventricular opacification (LVO)
more » ... chocardiography. Methods: The study comprised 100 consecutive patients (mean age 57±13 years, 85% males) who underwent both SH and SonoVue LVO echocardiography for clinical evaluation of LV function. Two independent physicians assessed segmental quality and wall motion for both the SH and LVO studies according to a 17-segment model. Systolic wall motion was defined as (1) normokinesia, (2) hypokinesia (systolic inward endocardial motion <7 mm), (3) akinesia, and (4) dyskinesia. LV-EF was assessed from the LVO images according to the biplane modified Simpson's method by a third blinded physician. Results: Of the 1,700 analyzed segments, 453 (26.6%) were poorly visualized with SH imaging, and 173 (10,2%) with LVO imaging (p<0.0001). The two independent observers agreed on segmental wall motion score in 1,299 of the 1,700 segments (agreement 76%, Kappa 0.60) with SH imaging and in 1,491 of the 1,700 segments (agreement 88%, Kappa 0.78) with LVO imaging. Interobserver correlation (R 2) was 0.86 for the SH-imaged WMSI and 0.93 for the LVO-imaged WMSI. The limits of agreement for interobserver LVO-imaged WMSI (mean relative difference -1.0%±6.8%, agreement -14.6%, 12.6%) were lower than those for SH-imaged WMSI (mean relative difference -2.3%±10.1%, agreement -22.5, 17.9). The LVO-imaged WMSI correlated well with LVO-imaged LV-EF (R 2=0.71). LV-EF could be estimated according to the formula 1.01-0.32xWMSI. Conclusion: Echo contrast improves interobserver agreement for wall motion and WMSI scoring. The LVO-imaged WMSI correlates well with LVOimaged LV-EF. Background: Primary PCI improves clinical outcome in patients with acute ST elevation myocardial infarction (STEMI). However, echocardiographic characterization of left ventricular (LV) remodeling using a contrast agent for LV opacification has not yet been performed in these patients. Purpose: To characterize LV remodeling after an anterior STEMI treated with primary PCI. Methods: One hundred and twelve patients treated with primary PCI for an acute anterior STEMI were prospectively enrolled. All patients underwent transthoracic echocardiography using harmonic imaging and LVO with perflutren within 8 days and at 6 months after MI. LV volumes and ejection fraction (EF) were assessed using the modified Simpson's rule. The wall motion score index (WMSI) was calculated from a 16-segment model with grading as suggested by the American Society of Echocardiography. Results: Mean age was 59±14 and 80/112 (71.4%) patients were male. Initial Thrombolysis In Myocardial Infarction (TIMI) flow in the infarct-related artery was grade 0/1 in 58.6%, grade 2 in 31.3% and grade 3 in 10.1% of patients. Post-PCI TIMI flow was grade 0/1 in 4.0%, grade 2 in 39.4% and grade 3 in 56.6% of patients. The mean time from symptom onset to revascularization was 5.8±4.7 h. Global LV systolic function significantly improved from baseline to 6 months with LVEF increasing from 42.0±10.3% to 47.3±11.0% (p<0.01) and WMSI decreasing from 2.60±0.57 to 1.96±0.84 (p<0.01). There was a trend toward increase in LV end-diastolic volume (EDV) from baseline to 6 months values (88.2±25.4 mL vs 95.5±25.5 mL; p=0.09). In 46/112 (41.1%) patients who showed LV dilatation from baseline to 6 months (>10% EDV increase), LVEF remained stable over time (42.7±9.8% to 45.0±10.8%; p=0.28) while LVEF significantly increased in patients without progressive LV dilatation (43.7±11.0% to 49.5±10.8%; p=0.01). Multivariate analysis revealed that peak CK level was inversely correlated with WMSI recovery (r=-0.56; p<0.0001) and correlated with LV dilatation (r=0.24; p<0.03) at 6 months. Improvement in WMSI was correlated with time from symptom onset to PCI (r=0.28; p=0.03), but not with improvement in TIMI flow grade after PCI (r=-0.13; p=0.32). Conclusion: After acute anterior STEMI treated by primary PCI, LVEF increased at 6 months and most patients did not display significant progressive LV dilatation. Even in the subgroup with adverse LV remodeling, LVEF remained stable over 6 months post-PCI. These data suggest that primary PCI for anterior STEMI may confer more favorable LV remodeling than thrombolysis.
doi:10.1016/s1525-2167(06)60711-7 fatcat:xglk5cooy5bnlnap5zz2vlav54