Systolic And Diastolic Velocities Biology Essay

Regional wall gesture abnormalcies are often seen in coronary arteria disease and diastolic map is impaired before systolic disfunction in these patients1. Reperfusion with transdermal coronary intercession has been shown to better the left ventricular systolic and diastolic map 2, 3.

Changes in the regional ventricular map may look before change of planetary ventricular map in coronary arteria disease 3.

The most recent attack to analysis of regional wall gesture is with Doppler tissue imagination or speckle tissue traction4.

Systolic and diastolic speeds of cardiac rhythm can be recorded quantitatively by tissue Doppler imagination and thereby provides a newer manner of measuring left ventricular map which is more sensitive than traditional methods5.

Tissue Doppler imagination has a high sensitiveness, high feasibleness, duplicability and easiness of application in acute coronary syndrome6.

Tissue Doppler imagination is easy available in most of the Centres. Tissue Doppler parametric quantities such as Sm, Em, and Am are powerful forecasters of cardiac mortality7.

We wanted to analyze the alterations in tissue Doppler imaging parametric quantities before and after transdermal coronary angioplasty as an easy available tool in Indian scenario to measure the functional betterment in left ventricular map.

REVIEW OF LITERATURE

REVIEW OF LITERATURE

J.M.Strotmann et al studied the consequence of myocardial ischaemia on longitudinal myocardial map in 30 patients before and after Percutaneous Transluminal Coronary Angioplasty of individual vas disease. Peak systolic speed increased in the ischaemic sections after Transdermal Transluminal Coronary Angioplasty3.

Derumeaux et Als have shown clear relationship between regional myocardial speed and myocardial perfusion in carnal models8.

Klisiewicz A et al consequence of angioplasty in 39 patients 1 to 6 months after myocardial infarction. Peak systolic speed increased and contractile modesty increased after angioplasty. Regional Em wave speed increased 24 hours after angioplasty, but there was no addition in Am wave speed 24 hours after angioplasty9.

Park SM et Al studied 20 patients with anterior wall myocardial infarction utilizing Doppler tissue imaging as a tool to foretell myocardial viability. They showed strain rate imagination was a better forecaster to demo feasible myocardium after transdermal coronary angioplasty10.

Minamihaba O et Al compared Pulse Doppler Tissue Imaging with 99mTc sestamibi perfusion imaging in 30 patients before and after coronary angioplasty. The peak systolic speed was positively correlating with Tc-MIBI consumption ( R=0.59, P & A ; lt ; 0.01 ) .The PEP/ET ( preejection period/ejection clip ) and peak systolic speed is holding higher diagnostic truth for observing feasible myocardium when compared with Tc-MIBI perfusion imagination ( 79 % and 80 % vs 90 % ) 11.

Tumuklu M et Al studied betterment in diastolic map after transdermal angioplasty in 31 patients. They showed a important addition in diastolic parametric quantities of left ventricle i.e. Sm, increased from 11.3 ± 3.1 cm/sec to 13.2 ± 3.6 cm/sec P = 0.03 ; isovolumetric relaxation clip ( IVRT ) decreased from 130 ± 37 millisecond to 108 ± 29 milliseconds p = 0.0001 ; IVCT ( isovolumetric contraction clip decreased from 84.1 ± 19.2 millisecond to 75.6 ± 12.2 msec.12

Hasan Shemirani et Al evaluated early changes in tissue Doppler findings of the septal and sidelong sections of left ventricle after coronary angioplasty in 40 patients with individual vas disease. Am and Em speed significantly improved in septum and Sm speed does increased, but non statistically important. This survey showed diastolic map improved instantly after coronary angioplasty but non the systolic function.13

Penicka M et al analyzed 43 patients with myocardial infarction and individual vas disease. They used positive pre expulsion speed to foretell recovery left ventricle contractile map. Their survey showed positive pre expulsion speed measured by tissue myocardial speed can foretell recovery of ischaemic myocardium.14

Myocardial perfusion imagination, Magnetic resonance imagination is the best clinical tools to measure the myocardial viability after angioplasty. They are expensive and non available in all Centres.

Tissue Doppler imagination is speedy quantitative method to measure the functional recovery of myocardium after coronary angioplasty.

Doppler Tissue Imaging

Doppler tissue imagination can be performed by utilizing pulse tissue Doppler imagination, colour 2D Doppler and colour M manner Doppler. Tissue Doppler imagination can be used as a noninvasive tool to measure the systolic and diastolic myocardial function.15

Doppler Effect

The Doppler Effect is the phenomenon whereby the frequence of a reflected moving ridge is altered by motion of reflecting surface off from or toward the beginning. The low Doppler displacement frequences of high energy generated by the wall gesture are filtered out. These low Doppler displacement frequences are produced by myocardium ; hence their appraisal is utile to cognize the ventricular function.16

Pulse Doppler technique can be used to obtain high quality Doppler signals, mensurating mean and instantaneous local acceleration, rapid quantification.

The restrictions of pulse TDI are

1. The demand for manual function

2. Limited spacial declaration

3. Coincident recording of different sections is non possible.

The longitudinal and circumferential fibres of ventricle contribute to overall map of left ventricle. Tissue Doppler imagination is influenced by overall cardiac motion and tethering by next myocardial tissues.17

The normal speed of Em for sidelong ring is more than 15 cm/sec and septate ring is above 10 cm/sec.This difference in speed between sidelong and septate ring is due to different orientation of myocardial fibres.Tissue Doppler speed is more at the base of ventricle than at mid ventricle and apex.18

Em speed indicates myocardial relaxation. Em is low and does non increase in patients with impaired myocardial relaxation. Em is the earliest marker of diastolic disfunction and is less in all phases of diastolic dysfunction.18

Normally Em/Am ratio is more than one.In class I diastolic disfunction Em is less than Am. Em and Am speed increasingly decreases from class II to rate III diastolic dysfunction.18

Normal values of TDI

In kids and immature grownups sidelong annulus speed is more than 20 cm/sec.

Lateral annulus speed more than 12 cm/sec in grownups above 30 old ages denotes normal left ventricle diastolic map.

Table No 1 demoing normal values in general population19

TDI

Septum

Lateral

Inferior

Anterior

S moving ridge, centimeter

Basal

5.97 ± 1.14

6.26 ± 2.44

6.52± 1.31

6.44± 2.32

Mid

6.29 ± 1.89

4.48± 0.92

5.21± 2.79

5.1 ± 1.16

Apical

4.42 ± 2.3

4.81 ± 1.97

2.97± 1.14

3.8 ± 2.66

E moving ridge, centimeter

Basal

7.91± 2.16

8.54± 2.77

9.01± 2.44

8.09± 2.48

Mid

8.39 ± 2.5

6.85± 1.86

6.82± 3.16

7.22± 2.04

Apical

6.03 ± 2.95

6.74± 2.58

4.76 ± 1.94

4.52± 2.95

A moving ridge, centimeter

Basal

5.99 ± 1.73

3.77 ± 1.95

5.84± 2.06

3.86 ± 1.75

Mid

4.87± 2.14

4.9 ± 1.72

2.62± 1.84

4.78 ± 1.7

Apical

2.69± 1.93

3.77 ± 2.1

3.08 ± 1.54

1.69± 1.45

Tissue Doppler image

Figure 1

TDI at sidelong wall of LV and septate wall of LV

Degree centigrades: UsersKalyanaramanDesktop di.JPG

Uses of Doppler tissue imaging

Global left ventricular systolic map

We can quantify the motion of cardiac basal septum and radical sidelong wall of left ventricle utilizing M manner echocardiography.Quatification of motion of basal sections of ventricle can besides be done utilizing Tissue Doppler echocardiography.

Gulati et Al showed that six site extremum annulate descent speed correlated linearly with radionuclide expulsion fraction ( r = 0.86, SEE = 1.02cm/sec ) .20

Peak systolic speed was less in dilated cardiomyopathy.Doppler Tissue Imaging extremum systolic speed correlated with angiographically calculated Ejection Fraction and top out dp/dt.21

Regional systolic map of ventricles

Regional myocardial speed varies among single sections of ventricle in normal patients.

Systolic myocardial speed is usually high at base of ventricles than at the mid wall and vertex. Systolic myocardial speed of Lateral tricuspid ring is more than the sidelong mitral ring speed. Tissue Doppler imagination is utile to observe regional alterations in myocardial contractility.22

Lateral annulus Systolic myocardial speed is used to see the longitudinal left ventricle systolic map and there is additive relationship with left ventricle expulsion fraction and left ventricle dp/dt.

Before and after angioplasty

Based on some surveies myocardial systolic speed was less in ischaemic and infracted sections of left ventricle. With rising prices of coronary balloon in coronary arteria extremum myocardial speed decreases with recoil addition after deflation of balloon and reperfusion.23

Changes in systolic myocardial speed depend on the ischaemic badness and there is a relation between myocardial speed and coronary perfusion.

Standardization of peak systolic speed with dobutamine emphasis echocardiogram and exercising is a marker of feasible myocardium.24

Appraisal of diastolic map by Doppler tissue imaging

Mitral inflow Doppler is preload dependent and its usage to measure the diastolic disfunction of left ventricle is limited.25

In patients with diastolic disfunction Em speed and Em/Am ratio was low when compared with normal persons. Coronary arteria disease patients with normal systolic map have abnormal diastolic map of left ventricle.26

Active relaxation of left ventricle

Early on diastolic myocardial speed indicates myocardial relaxation.Pre burden has less consequence on mensurating early diastolic speed.

Myocardial clip invariable of isovolumic relaxation Tau was linearly related to early diastolic speed and Em/Am ratio.27

AIM OF STUDY

AIM OF THE STUDY

1. To measure the Regional Myocardial Function utilizing Tissue Doppler Imaging before and after Percutaneous Transluminal Coronary Angioplasty.

2. To measure the extent to which these tissue Doppler indices change 24 hours before Transdermal Transluminal Coronary Angioplasty, 24 hours after Percutaneous Transluminal Coronary Angioplasty and 3 months after Percutaneous Transcutaneous Coronary Angioplasty.

3. To measure how this helps to cognize the success of Percutaneous Transluminal Coronary angioplasty.

MATERIAL AND METHODS

MATERIALS AND METHODS

This prospective non randomized follow up survey was carried out at Rajiv Gandhi Government General Hospital ; Chennai.This survey was done between March 2012 to January 2013.This survey was approved by our establishment ethical commission.

Choice OF STUDY SUBJECTS

INCLUSION CRITERIA

1. All patients with Stable angina with age above 30 old ages and both sex.

2. Patients with anterior coronary angiogram screening stray Left anterior falling coronary arteria disease suited for elected transdermal intercession and stenting were included.

EXCLUSION CRITERIA

Patients with any of the undermentioned standards were excluded from the survey

1. Patients with Non ST Elevation Myocardial Infarction, Unstable angina, Acute ST Elevation Myocardial Infraction

2. Patients with multivessel coronary arteria disease, left circumflex coronary arteria disease, right coronary arteria disease

3. Patients with valvular bosom disease, myocardiopathy, atrial fibrillation, prior coronary revascularization, inborn bosom disease, chair to severe left ventricular systolic disfunction ( Ejection Fraction less than 40 % ) .

STUDY PROTOCOL

Written informed consent was obtained from all the patients and this survey was approved by our hospital ethical commission. Patients with recent myocardial infarction with anterior coronary angiogram screening stray individual vas disease of Left Anterior Descending coronary arteria admitted for Percutaneous Transluminal Coronary Angioplasty with bare metal stent were selected. Patients belonged to both sex and of all ages. History and physical scrutiny was done for all patients in this survey. All everyday research lab probe was done. Patients were examined with echocardiogram 24 hours before Transdermal Transluminal Coronary Angioplasty ; 24 hours after Percutaneous Transluminal Coronary Angioplasty and 3 months after Percutaneous Transluminal Coronary Angioplasty.

Echocardiography

Everyday Echocardiographic rating and Tissue Doppler imagination was done for all the selected 93 patients 24 hours before PTCA,24 hours after PTCA and 3 months after PTCA.Philips XD7 with grownup transducer was used to get images utilizing tissue Doppler imagination package.

Echocardiographic scrutiny is done as per recommendations of the American Society of Echocardiography. Left ventricular expulsion Fraction was calculated utilizing simplified quinones method.

TISSUE DOPPLER Imagination

Tissue Doppler imagination of median mitral ring and sidelong mitral ring of Left Ventricle was performed in apical 4 chamber position within 1 centimeter of mitral cusps.Using Tissue Doppler imaging package preset, three major mitral annulate speeds were recorded with angulation less than 20 grades. Recording is done at sweep velocity of 50 to 100 mm/sec at terminal expiration.28 Average Peak myocardial systolic ( Sm moving ridge ) , peak myocardial early diastolic speed ( Em wave ) and peak myocardial late diastolic speeds ( Am wave ) of 3 values were recorded 24 hours before Transdermal Transluminal Coronary Angioplasty ; 24 hours after Percutaneous Transluminal Coronary Angioplasty and 3 months after Percutaneous Transluminal Coronary Angioplasty.

PERCUTANEOUS CORONARY INTERVENTION

Transdermal Transluminal Coronary Angioplasty of proximal or mid Left Anterior Descending coronary arteria with bare metal stenting was done utilizing Toshiba fixed catheterisation research lab harmonizing to criterion techniques. All patients had successful Percutaneous Transluminal Coronary angioplasty consequences with residuary stricture less than 30 % .None of the patients had any peri procedural myocardial infarction. All patients were discharged after 3-5 yearss with double antiplatelets, Angiotensin Converting Enzyme inhibitors, beta blockers and statins.They were on follow up every 15 yearss for drugs and repetition rating with echocardiogram was done after 3 months. Follow up Coronary Angiogram was non done at 3 months.

Statistical Analysis

Statistical analysis was done utilizing online paired two tailed t trial. A two tailed p value of less than 0.05 was required for significance.

RESULTS AND OBSERVATION

Consequence

RESULTS AND OBSERVATION

Age AND SEX DISTRIBUTION

Table 1

Age

sex

30 – 40

41 – 50

51 – 60

61 – 70

Entire

Male

12

33

30

10

85 ( 91.3 )

Female

1

3

2

2

8 ( 8.6 )

Entire

13 ( 13.9 )

36 ( 38.7 )

32 ( 34.4 )

12 ( 12.9 )

93

91.3 % of patients in were males and 8.6 % of patients were females in this survey. A youngest patient was 30 old ages old and the oldest patient age was 70.73 males were above the age of 40 old ages and 7 females were above the age of 40 years.12 males and 1 female were less than 40 old ages old.

13.9 % belong to the age group of 30-40 old ages ; 38.7 % were in the age group of 41-50 old ages ; 34.4 % were in the age group of 51-60 old ages ; 12.9 % were in the age group of 61-70 years.73 % of patients were in the age group of 41-60 old ages.

Average age of patients in this survey was 50.08±18.04 old ages.

ASSESSMENT OF RISK FACTORS

TABLE NO 2

Hazard FACTORS

Male

Female

Smoker

68

0

Diabetess mellitus

67

8

High blood pressure

20

1

Diabetess mellitus, Hypertension and Smoker

8

0

Diabetess Mellitus and Smoker

35

0

High blood pressure and Smoker

2

0

68 male patients were tobacco users in our study.67 males and 8 females have Diabetes Mellitus as hazard factor.

20 male and 1 female have Hypertension as coronary hazard factor.

8 patients had all the three hazard factors that is Smoker, Diabetes Mellitus and Hypertension.

35 patients had two hazard factors i.e. Diabetes mellitus and Smoking.2 patients had Hypertension and Smoking as hazard factor of coronary artery disease.

Majority of the patients were tobacco users and holding Diabetes Mellitus.

None of the female patient has more than one hazard factor.

BASELINE CHARECTERISTICS OF ALL PATIENTS IN OUR STUDY

Table 3

Parameters

Scope

Mean ± South Dakota

Age

30-70 old ages

50.08 ± 18.04 old ages

Male -no ( % )

85 ( 91.39 % )

Heart rate

50 – 94 beats per min

71.2 ± 20.92 beats per min

Systolic BP

110 – 160 millimeter of Hg

128 ± 25.78 millimeter of Hg

Diastolic BP

80 – 90 millimeter of Hg

80.36 ± 3.15 millimeter of Hg

Random blood glucose

79 – 206 mg/dl

126.22 ± 58.98 mg/dl

Blood carbamide

20 – 38 mg/dl

27.66 ± 6.64 mg/dl

Serum creatinine

0.4 – 1.1 mg/dl

0.81 ± 0.19 mg/dl

Bare metal stent diameter

2.5 – 3.5 millimeter

2.95 ± 0.54 millimeter

Bare metal stent length

12 – 30 millimeter

21 ± 9.2 millimeter

SD denotes Standard divergence

mg/dl denotes milligrams/deciliter and mm denoted millimetre.

The mean bosom rate in this survey was 71.2 ± 20.92 beats per min.The norm systolic blood force per unit area was 128 ± 25.78 millimeter of Hg and the mean diastolic blood force per unit area was 80.36 ± 3.15 millimeter of Hg.

The minimal bosom rate was 50 beats per minute and the maximal bosom rate was 94 beats per minute.

Random blood glucose was 126.22 ± 58.98mg/dl.Average blood carbamide and serum creatinine was 27.66 ± 6.64 mg/dl and 0.81 ± 0.19 mg/dl severally.

The average diameter and length of the bare metal stent used in this survey were 2.95 ± 0.54 millimeter and 21 ± 9.2 millimeter severally.

Table 4

Sm speed of radical median septum 24 hours before PTCA, 24 hours after PTCA, 3 months after PTCA

24hour before PTCA

24 hours after PTCA

3 months after PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Samarium

8.498

0.421

0.044

9.068

0.424

0.044

8.992

0.431

0.045

Two tailed Ps value

P & A ; lt ; 0.0001

Statistically important

P & A ; lt ; 0.0001

Statistically important

95 % CI

-0.636 to – 0.504

0.042 to 0.108

SD denotes standard divergence ; SEM denoted standard mistake of mean

The average Sm speed increased from 8.498cm/sec 24 hours before Transdermal Transluminal Coronary Angioplasty to 9.068cm/sec 24 hours after Percutaneous Transluminal Coronary Angioplasty and 8.992cm/sec three months after Percutaneous Transluminal Coronary Angioplasty.

P value was less than 0.0001 when comparing 24 hours before and 24 hours after Percutaneous Transluminal Coronary Angioplasty. This is highly important.

Similarly p value for Sm speed of basal septum was less than 0.0001

at 3 months post Percutaneous Transluminal Coronary Angioplasty which is important.

Table 5

Em speed of radical median septum 24 hours before PTCA,24 hours after PTCA,3 months after PTCA

24hour before PTCA

24 hours after PTCA

3 months after PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Em

5.141

0.679

0.070

5.09

0.684

0.071

5.0162

0.6968

0.072

Two tailed Ps value

P =0.0902

Not important

P & A ; lt ; 0.0001

important

95 % CI

-0.008 to 0.109

0.0445 to 0.1036

SD means standard divergence ; SEM means standard mistake of mean ; CI denotes assurance interval.

The average Em speed 24 hours before and 24 hours after Percutaneous Transluminal Coronary Angioplasty was similar i.e.5.141 V 5.09.when calculating P value 24 hours after Percutaneous Transluminal Coronary Angioplasty the alteration in average Em speed was non statistically important.

The average Em speed 3 months after Percutaneous Transluminal Coronary Angioplasty was 5.016cm/sec.Em speed at 3 months does non alter significantly after 3 months, even though the P value was less than 0.0001 significantly.

Table 6

Am speed of radical median septum 24 hours before PTCA, 24 hours after PTCA, 3 months after PTCA

24hour before PTCA

24 hours after PTCA

3 months after PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Americium

13.237

1.098

0.114

13.172

1.130

0.117

12.548

1.19

0.124

Two tailed Ps value

P= 0.0731

Not important

P & A ; lt ; 0.0001

Significant

95 % CI

-0.006 to 0.135

0.553 to 0.694

SD denotes standard divergence ; SEM denotes standard mistake of mean

The mean Am tissue speed 24 hours before Transdermal Transluminal Coronary Angioplasty was 13.237cm/sec and 24 hours after Percutaneous Transluminal Coronary Angioplasty was 13.172 cm/sec with p value of equal to 0.0731.This is non statistically important.

At 3 months post Percutaneous Transluminal Coronary Angioplasty, the average Em speed was 12.548 cm/sec with p value of less than 0.0001, is statistically important.

Figure 2 tendency of tissue Doppler imaging happening basal septum ventricle

Table 7

Sm speed of radical sidelong wall Left Ventricle 24 hours before PTCA, 24 hours after PTCA, 3 months after PTCA

24hour

before PTCA

24 hours

after PTCA

3 months

after PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Samarium

10.141

0.743

0.077

10.284

0.744

0.077

10.244

0.72

0.075

Two tailed Ps value

P & A ; lt ; 0.0001

Significant

P=0.0630

Not important

95 % CI

-0.189 to -0.097

-0.002 to 0.080

SD means standard divergence ; SEM means standard mistake of mean

The basal Sm speed 24 hours before Transdermal Transluminal Coronary Angioplasty increased from 10.141cm/sec to 10.284cm/sec 24 hours after Percutaneous Transluminal Coronary Angioplasty and 10.244cm/sec 3 months post Percutaneous Transluminal Coronary Angioplasty.

The P value 24 hours after Percutaneous Transluminal Coronary Angioplasty was less than 0.0001 and is more important. Three months post Percutaneous Transluminal Coronary Angioplasty, P value was equal to 0.0630 which is non important statistically.

The alteration in Sm speed 24 hours before ; 24 hours after Percutaneous Transluminal Coronary Angioplasty and 3 months after Percutaneous Transluminal Coronary Angioplasty was similar.

Table 8

Em speed of radical sidelong wall of Left Ventricle 24 hours before PTCA, 24 hours after PTCA, 3 months after PTCA

24hour before PTCA

24 hours after PTCA

3 months after PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Em

8.927

0.816

0.085

8.873

0.831

0.086

8.855

0.802

0.083

Two tailed Ps value

P= 0.0536

Not important

P= 0.3879

Not important

95 % CI

-0.001 to 0.108

-0.024 to 0.080

SD denotes standard divergence ; SEM denotes standard mistake of mean

Mean Early diastolic speed Em changed from 8.927 cm/sec 24 hours before Transdermal Transluminal Coronary Angioplasty to 8.873cm/sec 24 hours after Percutaneous Transluminal Coronary Angioplasty with p value =0.0536 which is non important.

The average early diastolic speed Em changed from 8.873cm/sec 24 hours after Percutaneous Transluminal Coronary Angioplasty to 8.855cm/sec 3 months after Percutaneous Transluminal Coronary Angioplasty.

This P value was equal to 0.38 and is non important.

Table 9

Am speed of radical sidelong wall of LV 24 hours before PTCA, 24 hours after PTCA, 3 months after PTCA

24hour before PTCA

24 hours after PTCA

3 months after PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Americium

14.637

0.997

0.103

14.570

0.959

0.099

14.511

0.97

0.101

Two tailed Ps value

P=0.0040

Significant

P=0.0004

Significant

95 % CI

0.022 to 0.112

0.027 to 0.091

SD denotes standard divergence ; SEM denotes standard mistake of mean

The extremum late diastolic speed Am changed from 14.637 cm/sec to 14.570 cm/sec 24 hours after Percutaneous Transluminal Coronary Angioplasty with P value=0.0040 which is important. Am velocity 3 months post Percutaneous Transluminal Coronary Angioplasty was 14.511cm/sec with P value=0.0004 and was important.

Figure 3 tendencies of tissue Doppler imaging values of sidelong mitral ring

Table 10

End Diastolic Dimension of Left Ventricle

24 hours before PTCA

24 hours after PTCA

3 months post PTCA

Variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

Doctor of education

51.49

3.43

0.36

51.40

2.65

0.28

50.88

2.57

0.27

Two tailed Ps value

P=0.6017

Not important

P=0.0064

Significant

95 % CI

-0.27 to 0.46

0.15 to 0.88

SD means standard divergence ; SEM denoted standard mistake of mean

End diastolic dimension 24 hours before Transdermal Transluminal Coronary Angioplasty was 51.49 centimeter and 24 hours after Percutaneous Transluminal Coronary Angioplasty was 51.40 centimeter with p value = 0.6017.There is no important alteration in End diastolic dimension. End diastolic dimension decreased significantly after 3 months post Percutaneous Transluminal Coronary Angioplasty to 50.88 centimeter with non important P value 0.0064.

Table 11

End Systolic Dimension of Left Ventricle

24 hours before PTCA

24 hours after PTCA

3 months post PTCA

variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

ESD

38.94

2.76

0.29

39.15

2.35

0.24

39.11

2.29

0.24

Two tailed

t trial P value

P=0.2673

Not important

P=0.8348

Significant

95 % CI

-0.60 to 0.17

-0.37 to 0.45

SD denoted standard divergence ; SEM denotes standard mistake of mean

End systolic dimension increased from 38.94 centimeter to 39.15 centimeter 24 hours post Percutaneous Transluminal Coronary Angioplasty with p value = 0.2673.This alteration in terminal systolic dimension was non important.

Three months post Percutaneous Transluminal Coronary Angioplasty the terminal systolic dimension was 39.11 with P value=0.8348 and was important with two tailed Ts trial

Table 12

Change in 2D Expulsion Fraction

24 hours before PTCA

24 hours after PTCA

3 months post PTCA

variables

Mean

South dakota

SEM

Mean

South dakota

SEM

Mean

South dakota

SEM

EF

48.834

1.836

0.190

49.79

2.426

0.252

49.095

2.295

0.238

Two tailed Ps value

P=0.0024

Significant

P=0.0285

Significant

95 % CI

-1.564 to -0.348

0.075 to 1.317

SD denotes standard divergence ; SEM denotes standard mistake of mean

Ejection Fraction 24 before Transdermal Transluminal Coronary Angioplasty was 48.834 % and 24 hours post Percutaneous Transluminal Coronary Angioplasty was 49.79 % .The P value was 0.0024 and was important.

Ejection Fraction 3 months post Percutaneous Transluminal Coronary Angioplasty was 49.095 % with p value of 0.0285 which was important.

Figure 4 tendencies of End Diastolic Dimension, End Systolic Dimension and Ejection Fraction

Table 13

Changes in Em/Am ratio

Variables

Basal septate wall of LV

Basal sidelong wall of LV

24 hour before PTCA

24 hour

after PTCA

3 months after

PTCA

24 hour before PTCA

24 hour after PTCA

3 months after

PTCA

Em

5.141

5.09

5.016

8.927

8.873

8.855

Americium

13.237

13.172

12.548

14.637

14.570

14.51

Em/Am

0.388

0.386

0.399

0.609

0.608

0.610

LV denoted left ventricle

Em speed of radical median septum and radical sidelong wall of left ventricle was similar 24 hours before,24 hours after and 3 months post Percutaneous Transluminal Coronary Angioplasty.

Similarly Am speed of radical median septum and radical sidelong wall of left ventricle besides does non alter significantly 24 hours before, 24 hours after and 3 months after Percutaneous Transluminal Coronary Angioplasty.

There was no important alteration in Em/Am ratio of both radical septum and radical sidelong wall of left ventricle.

Tendency of Em/Am ratio

Discussion

Discussion

Majority of patients in this survey were males and merely 8 females. There was choice prejudice and the sample volume was merely 93 which is less.

Smoke is the most common hazard factor in our survey followed by diabetes mellitus.35 tobacco users besides had diabetes mellitus as hazard factor for coronary bosom disease.

Peak systolic speed ( Sm ) of basal septum of left ventricle increased significantly 24 hours after PTCA and 3 months after Percutaneous Transluminal Coronary Angioplasty. This addition in peak myocardial systolic speed indicates there is a definite addition in left ventricle systolic map after transdermal coronary angioplasty.

There is a phenomenal addition in peak myocardial systolic speed of radical sidelong wall of left ventricle 24 hours after coronary angioplasty, but there is no addition after 3 months.

This addition in peak systolic myocardial speed indicates a really good recovery of myocardium after transdermal transluminal coronary angioplasty.

Em speed and Am speed of radical median septum does non increase significantly instantly after transdermal coronary angioplasty with stenting. Hence the diastolic map of left ventricle takes some clip to better after angioplasty even though the systolic map on ventricles addition within a twenty-four hours.

Early diastolic and late diastolic speed of radical median ring increased significantly after 3 months. So the diastolic map betterment takes more clip, in our survey.

The peak systolic myocardial speed basal sidelong wall changed upwards within a twenty-four hours after angioplasty, but really less alteration after 3 months. This may be due to the fact already there is good betterment in left ventricle systolic map.

Diastolic map of sidelong basal wall of left ventricle does non increase even after 3 months. The ground for deficiency of betterment in diastolic map may be because sidelong wall of left ventricle is non supplied by left anterior falling coronary arteria and these patients do non hold disease in left circumflex coronary arteria.

End diastolic and stop systolic dimension changed significantly after 3 months of angioplasty and expulsion fraction besides increased after few months.

As per anterior surveies, our survey in Indian patients besides showed the consequence of ischaemia on longitudinal map of left ventricle.

Based on our analysis regional contraction abnormalcy of ventricles could be derived with Doppler tissue imaging. More over the betterment in left ventricle systolic map is preserved after 3 months post coronary angioplasty.

Study restrictions

Tissue Doppler imaging values was affected by pull and retarding force of next myocardial sections taking to underestimate or overestimate. The exact topographic point were sample volume was placed can alter between scrutinies. The values obtained with tissue Doppler. This restriction can be removed by utilizing strain and strain rate image technique.

Again strain rate imagination is non available in all establishment. Myocardial speed gradient was non measured which indicates feasible myocardium. With speckle tracking there is no angle dependance during measurement.SPECT myocardial perfusion imagination is the gilded criterion to measure the reperfusion of ventricle, but once more it is dearly-won and non available in all Centres.

Decision

Decision

Our prospective follow up survey we showed that tissue Doppler myocardial imaging indices such as Sm, Em, Am will be assisting us to make up one’s mind the betterment in left ventricle map following angioplasty.

Our findings are similar to old animate being and human surveies. In decision we can utilize tissue Doppler imagination as an easy available technique to measure the reperfusion and alteration in regional ventricle map.

PROFORMA

Name: Age: Sexual activity: IP No:

Chief Ailments:

Past History:

Hazard Factors:

GENERAL EXAMINATION:

Pulsation Rate:

BLOOD Pressure:

Cardiovascular Examination:

Respiratory System:

Abdominal Examination:

NERVOUS SYSTEM EXAMINATION:

Probes:

RANDOM BLOOD SUGAR

BLOOD UREA

SERUM CREATININE:

Electrocardiogram:

CHEST Radiogram:

Echocardiogram:

PLAX

M MODE:

END DIASTOLIC DIMENSION

END SYSTOLIC DIMENSION

EJECTION FRACTION

TISSUE DOPPLER Imagination

24 HOURS BEFORE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

BASAL MEDIAL SEPTUM BASAL LATERAL WALL LV

Sm Em AM Sm Am Em

24 HOURS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

BASAL MEDIAL SEPTUM BASAL LATERAL WALL LV

Sm Em Am Sm Em Am

3 MONTHS POST PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

BASAL MEDIAL SEPTUM BASAL LATERAL SEPTUM

Sm Em Am Sm Em Am