Relative Prognostic Value of Clinical Heart Failure and Early Echocardiographic Parameters in Acute Myocardial Infarction

Berning, J; Steensgaard-Hansen, Frank; Appleyard, Merete

doi:10.1159/000174861

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…A 95% confidence interval for a single determination of LVEF of ± 16 LVEF units ( ± 0.16) is comparable with the results of previously published more elaborate échocardio graphie methods [32,33]. Despite the relative lack of accuracy of wall motion index and of the proposed wall motion derived estimate of LVEF, these indices neverthe less appear sufficiently accurate to contribute to the solu tion of clinical problems [4,34,35]. It is possible that a closer approximation of linearity could be obtained by giving wall motion scores from different segments differ ent weight in the index as suggested by Rifkin et al [27] and Rifkin and Koito [28]; however at the cost of increased complexity.…”

supporting

confidence: 79%

“…The reproducibility of wall motion index was not examined in this study, but a low interob server variability has previously been shown [4,30], Finally, it should be kept in mind that part of the described imprecision may be due to the fact that the radionuclide reference method used in this study -for the purpose of comparison -was defined as giving a true LVEF which is not quite the case. Also, it could be argued that the echo parameters contain physiological and prog nostic information in themselves, quite independent of their correlation with radionuclide LVEF [30,31,34].…”

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confidence: 99%

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Critical Reappraisal of Bedside Echocardiographic Parameters for Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction

Berning¹,

Høilund‐Carlsen²,

Nielsen³

et al. 1992

Am J Noninvas Cardiol

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The relative value of simple bedside M-mode and two-dimensional échocardiographie indices and their combinations for the estimation of the left ventricular ejection fraction (LYEF) in a single, large group of patients with acute myocardial infarction (AMI) has never been reported. Therefore, 79 patients with AMI were studied by echocardiography and radionuclide angiography within 12 h during the 2nd week following AMI. Parameters of left ventricular function by traditional M-mode indices (dimensions, fractional shortening, mitral-septal distance), by two-dimensional parameters (wall motion index, LVEF by Baran and by a truncated cone model), by statistical integration and by subjective evaluation were compared with radionuclide LVEF by linear regression. There was a clear trend towards a better accuracy by subjective evaluation of LVEF as compared with single parameter two-dimensional and M-mode methods. However, this difference of accuracy was only statistically significant with regard to M-mode dimensional parameters (R2 = 0.80 versus R^2 = 0.49 to R^2 = 0.24, p < 0.05). Thus, estimates of the LVEF can be obtained by multiple échocardiographie approaches which are all moderately inaccurate. The combination of parameters (wall motion index and end-systolic dimension) increased accuracy, but did not reach statistical significance. Estimates of LVEF based on a wall motion index are obtained in virtually all patients and have the additional advantage of providing data on the regional function in the same échocardiographie examination, contrary to subjective estimates of LVEF. Therefore, despite its inaccuracy, wall motion analysis appears to be the best presently known échocardiographie method for bedside estimation of LVEF in AML

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confidence: 79%

mentioning

confidence: 99%

Critical Reappraisal of Bedside Echocardiographic Parameters for Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction

Berning¹,

Høilund‐Carlsen²,

Nielsen³

et al. 1992

Am J Noninvas Cardiol

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“…6,7 Moreover, measurements of cardiac performance, such as left ventricular ejection fraction and wall motion index, have an important impact on the prognosis. 8,9 Levels of natriuretic peptides have been shown to reflect cardiac per-formance. This review focuses on the emerging role of these peptides in the early risk stratification of unstable CAD patients.…”

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confidence: 99%

Natriuretic peptides in unstable coronary artery disease

Jernberg¹,

James²,

Lindahl³

et al. 2004

European Heart Journal

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Patients with unstable coronary artery disease (CAD), i.e., unstable angina or non-STelevation myocardial infarction, vary widely in clinical presentation, prognosis and response to treatment. To select appropriate therapy, early risk stratification has become increasingly important. This review focuses on the emerging role of natriuretic peptides in the early assessment of patients with unstable CAD. We conclude that levels of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are strongly associated to mortality and the risk of future congestive heart failure, and carry important prognostic information independent from previously known risk factors in unstable CAD. There are some data indicating that these markers can also be helpful in the selection of appropriate therapy in these patients but further studies are needed. Before a routine use of BNP or NT-proBNP in unstable CAD can be recommended, the cost-effectiveness of adding these new markers to the currently routine markers and their impact on selection of treatment needs further evaluation.

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“…Vasodilating properties or partial agonist activity have been suggested to reduce some of the negative inotropic or chronotropic effects of ,B receptor antagonists, although concerns have been raised that the agonist activity could abolish the beneficial effect on mortality especially after myocardial infarction. "1 Xamoterol, a /3, receptor antagonist with high partial agonist activity improves symptoms and exercise tolerance in patients with mild to moderate chronic heart failure'2 without deleterious effects on prognosis, 3 although doubts have been raised in severe heart failure. '4 The effect of xamoterol on exercise tolerance was superior to that of digitalis.…”

mentioning

confidence: 99%

Effects of beta receptor antagonists in patients with clinical evidence of heart failure after myocardial infarction: double blind comparison of metoprolol and xamoterol.

Persson

Rythe'n-Alder

Melcher

et al. 1995

Heart

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Objective-To evaluate whether xamoterol, a partial agonist, would improve exercise time more than metoprolol in patients with mild to moderate heart failure after a myocardial infarction. Design-Single-centre double blind randomised parallel group comparison of metoprolol 50-100 mg and xamoterol 100-200 mg twice daily. Patients-210 patients aged 40-80 years (173 men) with clinical evidence of heart failure early after a myocardial infarction. 106 were given metoprolol and 104 xamoterol. Main outcome measures-Exercise test results and performance at three months; the exercise test, quality of life, and clinical assessments at baseline (5-7 days after the infarction) and after 3, 6, and 12 months. Results-Exercise time increased at three months by 22% in the metoprolol group and 29% in the xamoterol group, but with no significant difference between the groups. Patients taking xamoterol showed overall non-significantly higher mean values of exercise time achieved with higher heart rates at rest and exercise. Improvements in quality of life, clinical signs of heart failure, and New York Heart Association functional class were seen in both treatment groups over one year, with minor benefits of xamoterol on breathlessness, peripheral oedema, and functional class. Eighteen patients taking metoprolol and 22 taking xamoterol withdrew from the study during one year, with a low mortality, reinfarction rate, and progress of heart failure in both treatment groups. Mean dose from baseline to 3 months was 135 mg metoprolol and 347 mg xamoterol. Conclusion-fl, Receptor antagonists withor without partial agonist activity are safe to use in mild to moderate heart failure after a myocardial infarction. Exercise tolerance, quality of life, and clinical signs and functional class of heart failure improve, and few patients show deterioration in their condition. Exercise tolerance is no better with xamoterol than metoprolol. (Br Heart J7 1995;74:140-148)

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Relative Prognostic Value of Clinical Heart Failure and Early Echocardiographic Parameters in Acute Myocardial Infarction

Cited by 11 publications

References 17 publications

Critical Reappraisal of Bedside Echocardiographic Parameters for Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction

Critical Reappraisal of Bedside Echocardiographic Parameters for Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction

Natriuretic peptides in unstable coronary artery disease

Effects of beta receptor antagonists in patients with clinical evidence of heart failure after myocardial infarction: double blind comparison of metoprolol and xamoterol.

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