Reverse Δ-wave as a possible sign in electrocardiography to diagnose mitral valve prolapse

<p>Abstract</p> <p>Background</p> <p>Mitral valve prolapse (MVP) is defined as superior displacement of the mitral valve leaflets more than 2 mm into the left atrium during systole. Easier and cheaper assessment of this common disease is a priority in cardiac health care facilities.</p> <p>Presentation of the hypothesis</p> <p>In this study I addressed electrocardiographic presentation in 300 patients with MVP compared with 100 healthy individuals. I faced a novel finding in electrocardiogram (ECG) examination of these patients. It was a notch (reverse Δ-wave) in descending arm of QRS observed in 79% (237/300) of patients, consisting of 58% (174/300) in inferior leads and 21% (63/300) in I and aVL leads. The notch was identified only in 6 men in control group.</p> <p>Testing the hypothesis</p> <p>Considering the relatively higher prevalence of disease, a population-based diagnostic clinical trial study is appropriate to test the hypothesis.</p> <p>Implications of the hypothesis</p> <p>The hypothesis on diagnostic value of reverse Δ-wave in MVP may help in decreasing the rate of unnessessary echocardiography in some patients.</p

Arrhythmia in Acute Right Ventricular Infarction

Acute inferior myocardial infarction (MI) frequently involves the right ventricle (RV).1-3 We assessed the prognostic impact of RV myocardial involvement in patients with inferior MI. One hundred seventy patients were admitted to the cardiac care unit of Madani Heart Hospital (Tabriz-Iran) with the diagnosis of inferior MI with (group1) or without (group2) the simultaneous involvement of RV during the study period (from 2005 to 2006). Patients presenting within 12h of symptom onset were eligible for inclusion. Patients with simultaneous anterior wall MI or renal impairment (creatinine > 2 mg/dl), as well as those undergoing primary percutaneous translational coronary angioplasty, were excluded. Eighty eight percent of the patients with RVMI and 75% of those with isolated inferior MI had some type of arrhythmia. Atrioventricular (AV) block occurred in 42% of the infarctions with RV involvement and only in 29% of the control group. Intra-ventricular conduction disturbance (IVCD) was also more frequent in RVMI (29.4% vs. 13.1%, p=0.021), especially right bundle branch block (RBBB) (20% vs. 7.4%, P=0.003). There was, however, no meaningful difference in the incidence of left bundle branch block (LBBB) between the two groups (3.5% vs. 2.35%, P=0.95). Ventricular fibrillation (VF) was observed in 5.2% and 1.2% and ventricular tachycardia in 26% and 12.2% of the patients in groups 1 and 2, respectively. In 27% of patients with RVMI, it was necessary to implant a pacemaker as compared to 10% of those in the control group. Mortality was higher in the patients with inferior infarction extended to the RV (15.3% vs. 3.5%, P= 0.0001). Thus, the differences between the findings in the two groups in terms of the occurrence of post-MI arrhythmias and conduction disorders were quite significant, but there was no meaningful difference with respect to the incidence of LBBB between the two groups. Additionally, patients with inferior MI who also had RV myocardial involvement were at increased risk of death and arrhythmias. This suggests that the RV may be more arrhythmogenic than the LV; a hypothesis that warrants further investigation

Non Invasive Assessment of Myocardial Perfusion After First Myocardial Infarction with Transthoracic Echocardiography

Background: Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow (CSBF) is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) and to assess its relation with left ventricular ejection fraction (LVEF), wall motion scoring index (WMSI), and in-hospital mortality.Methods: This case-control study evaluated 20 patients (pts) with anterior AMI and 20 healthy individuals as controls over a 6-month period (in 2005) in Madani Heart Center in Tabriz (Iran). All the patients received the same drugs for AMI treatment (e.g. fibrinolytic). CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Results: Baseline variables were similar between the two groups (P>0.05). CSBF in the AMI group was 287.8±128 ml/min and in the control group was 415±127 ml/min (P=0.001). There was a significant correlation between CSBF and LVEF (r=0.52, P=0.01), between CSBF and WMSI (r=-0.77, P=0.0001), and between CSBF and in-hospital mortality (r=0.58, P=0.03). Conclusion: Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality

Trial design: The effect of high-dose rosuvastatin on echocardiographic parameters in patients with intermediate- and high-risk pulmonary embolism – A randomized placebo-controlled trial

Background: It has been shown recently that a considerable burden of pulmonary embolism (PE) roots from an inflammatory response. The activated inflammatory cascade will be responsible for the final fibrotic response of pulmonary vascular bed, creating further mechanical obstruction which results in subsequent right ventricular (RV) dysfunction, influencing functional capacity and future prognosis. Although anticoagulants represent the cornerstone treatment of PE, the drug class has a minimal effect on the mentioned pathology. Study Design: The present study is a single-center randomized, double-blind, parallel group controlled trial with placebo which will evaluate the effect of high-intensity statin – rosuvastatin 20 mg daily on patients with intermediate-to-high-risk PE. Study population will be selected from patients for whom statin is not otherwise indicated. Primary end point of the present trial will be echocardiographic measures of RV function. We believe that the mentioned indexes represent an accurate surrogate for the functional capacity and prognosis. Our secondary end point will be the composites of PE recurrence and exertional capacity measured by 6-minute walk test. Conclusions: The result of the present trial might influence the complimentary treatment of acute PE