A simple, reproducible, noninvasive myocardial performance index (MPI) for the assessment of overall cardiac function has been described previously. The purpose of this study was to compare the MPI obtained by pulse Doppler method with the MPI obtained by tissue Doppler echocardiography (TDE) in normal subjects and patients with dilated cardiomyopathy (DCMP). Fifteen patients with DCMP and 15 healthy subjects were included. In order to calculate MPI by TDE, isovolumetric contraction (IVCT), relaxation time (IVRT), and ejection time (ET) were measured at two different sites of mitral annulus: septum and lateral. MPI was calculated by dividing the sum of IVCT and IVRT by ET at each site of measurement. The mean MPI value was found by dividing the sum of these MPI values into two. The same parameters were measured using the mitral inflow and left ventricular outflow velocity time intervals in pulsed Doppler method. At all sites measured, MPI by TDE correlated well with conventional MPI both in healthy subjects and patients with DCMP. The highest correlation was observed in mean values of MPI by TDE:r = 0.94, P < 0.0001in healthy subjects; andr = 0.95, P < 0.0001in patients with DCMP. In conclusion, this study clearly demonstrated that MPI could be measured by TDE and it correlated well with conventional MPI in normal and diseased heart.

Objective: To evaluate the efficacy of trimetazidine (TMZ) in the prevention of contrast-induced nephropathy (CIN) in patients with high serum creatinine levels undergoing coronary angiography/angioplasty. Methods: TMZ (20 mg thrice daily) was administered orally for 72 h starting 48 h before the procedure. All patients were given intravenous saline (0.9%) at a rate of 1 ml/kg of body weight per hour for 24 h starting 12 h beforehand. Serum creatinine levels were measured before the procedure, 48 h and 7 days after the procedure. Increase in serum creatinine level exceeding 0.5 mg/day or one quarter of the basal value is considered as CIN. Venous blood samples for serum total antioxidant capacity (TAC) measurement were drawn before and after coronary angiography. Results: Basal serum creatinine levels and TAC were similar in TMZ and control groups. Serum creatinine levels in the control group increased significantly 2 days after the procedure, and returned to the baseline values on the seventh day. However, it did not change significantly on the second day, and even significantly decreased on the seventh day in the TMZ group. CIN developed in 2.5% (1/40) of patients in the TMZ group and in 16.6% (7/42) of patients in the control group (p,0.05). TAC values were not different between treatment groups. Conclusion: TMZ along with isotonic saline infusion is more effective than isotonic saline alone in reducing the risk of CIN in patients with pre-existing renal dysfunction. C ontrast-induced nephropathy (CIN) is a serious complication of coronary angiography that is associated with considerably increased mortality and morbidity, including the need for short-term haemodialysis, extended hospitalisation and permanent impairment of renal function.1 2 CIN after coronary angiography is observed more frequently in patients with chronic renal insufficiency, particularly in patients with diabetes mellitus and/or dehydration and/or congestive heart failure.2-5 Larger doses of contrast medium and intravascular injection of contrast agent are also associated with higher incidence of CIN.6 CIN has been reported to occur in 11-44% of patients with moderate renal insufficiency.2 3 6 7 Pre-existing renal dysfunction is the greatest independent predictor of CIN, and its severity directly correlates with the incidence of CIN. 3 6 8-10 Previous reports suggest that the formation of reactive oxygen radicals, renal medullar ischaemia during reperfusion after contrast-induced vasoconstriction and direct tubular damage secondary to the contrast agent have an important role in the injury mechanisms of CIN.11-14 Many types of prophylaxis regimens have been used in an attempt to prevent CIN. But, to date only hydration with isotonic saline is generally accepted in the prevention of CIN. [14][15][16][17][18] Trimetazidine (TMZ) has been described as a cellular antiischaemic agent. 19 Previous studies demonstrated that TMZ prevents the deleterious effects of ischaemia-reperfusion at both the cellular and the mitochondrial levels, and exert...

SUMMARYMyocardial performance index (MPI) is a simple and reproducible method for the assessment of overall cardiac function. In this study, we evaluated the applicability and usefulness of pulsed-wave tissue Doppler echocardiography (TDE) as a tool to calculate MPI in comparision with a conventional Doppler method.Twenty-five patients with previous myocardial infarction (MI) and 15 healthy subjects were included. In order to calculate MPI by TDE, isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), and ejection time (ET) were measured at four different sites in the mitral annulus: septum, lateral, anterior, and inferior. MPI was calculated by dividing the sum of IVCT and IVRT by ET at each site of measurement. The mean MPI value was found by dividing the sum of these MPI values into four. The same parameters were measured using the mitral inflow and left ventricular outflow velocity time intervals by a conventional method.MPI by TDE correlated well with conventional MPI in healthy subjects (r = 0.81, P < 0.0001). Although it continued to be statistically significant, the correlation between the two methods of measuring MPI, TDE and conventional, in patients with previous MI was not as high as it was in healthy individuals (P < 0.001, r = 0.62). This is due to the lesser degree of correlation between IVRT and IVCT values obtained by TDE and the conventional method (r = 0.49, P < 0.05; r = 0.56, P < 0.05; respectively).In conclusion, this study has demonstrated that MPI could be measured by tissue Doppler and that it correlated well with conventional MPI. Moreover, MPI by TDE has the advantage of assessing both regional and global myocardial performance. (Jpn Heart J 2003; 44: 403-416)

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In this study, we measured the effects of spinal anesthesia on the corrected QT (QTc) interval in women with severe preeclampsia. Twenty-five preeclamptic (preeclamptic group) and 25 healthy pregnant women with normal arterial blood pressure and QTc interval (control group) were enrolled in this prospective, case-controlled study. Arterial blood pressure, heart rate, and QTc interval values were obtained before (baseline value) and at 5, 10, 20, 30, 60, and 120 min after initiation of spinal anesthesia. Total ephedrine dose, time elapsed until sensory block, and Apgar scores were recorded. Prior to spinal anesthesia, QTc interval values were significantly higher in the preeclamptic group (452 +/- 17.5 ms) when compared with that in controls (376 +/- 21.4 ms). Although the QTc interval shortened during spinal anesthesia when compared with baseline value in the preeclamptic group (P < 0.05), it showed no significant change in the control group. In conclusion, the QTc interval may be prolonged in severe preeclamptic patients who have hypertension and hypocalcemia. Spinal anesthesia for cesarean delivery may normalize that prolonged QTc interval due to sympathetic blockade.