الفهرس 
TISSUE DOPPLER IMAGING (TDI)Only 14 pages are availabe for public view
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Abstract
This study was conducted in the National Heart Institute, Giza, Egypt Aiming at:
1. Study regional diastolic left ventricular function by tissue Doppler
Imaging in patients with microvascular angina
2. To study the role of tissue calcium channel blockers (deltiazem) therapy
on tissue Doppler findings in those patients.
The study included 30 consecutive patients with microvascular angina
with the following inclusion criteria: Patients had chest pain, Positive stress
perfusion study for ischemia or positive exercise stress ECG and Normal
coronary angiogram. Exclusion criteria were: Any concomitant valvular or
congenital heart disease, Cardiomyopathy, Left ventricular hypertrophy of any
cause, Previous myocardial infarction and atrial fibrillation or complete heart
block.
All patients included in the study were subjected to: Full history taking with
special emphasis on history of chest pain and risk factors of coronary artery
disease, full general examination and local examination of the heart, chest and
abdomen. twelve leads resting ECG. Exercise stress testing using Bruce protocol
to exclude CAD or thallium perfusion scanning, laboratory investigations
including: fasting and 2 hours post-prandial blood sugar level, Renal function
and liver function tests, and lipid profile and Echocardiographic study which
included:
M-mode and two-dimensional echocardiography with continuous and
pulsed wave Doppler studies.
TISSUE DOPPLER ECHOCARDIOGRAPHY: Tissue Doppler
echocardiography studies were performed with HP SONOS 5500 equipment
incorporating both 2.5 MHz transducers or General electric vived three and
facilities for pulsed, continuous, colour and tissue Doppler. The present thesis
deals with two- and four-chamber TTE only, as these images are easily obtained
and hold information about long axis function. Schematic drawings of how these
planes appear in ultrasound images
Statistical analysis: The data of each patient were collected in a special file,
then it was coded and fed to the computer on a statistical package SPSS version
9.05 for windows for statistical analysis. Descriptive statistics were done
including mean, standard deviation and prevalence. Chi-square test was done to
find out the presence of significant difference between the before and after
therapy regarding the non-parametric variables. Paired student T-test was done
to find out the presence of significant difference between the before and after
therapy regarding the parametric variables. P < 0.05 was considered significant
with a confidence interval of 95%.
Results: The study included 30 patients with chest pain. Twelve (40%)
patients had positive exercise ECG and 18 patients (60%) had positive
radionuclide study and normal coronary arteries as diagnosed by coronary
angiography.
They were 26 females (86.7%) and 4 males (14.3%), Their mean age was
53 ± 7.2 years, their mean pulse rate was 87 ± 9.4 b/min, their systolic BP was
127 ± 11.6 mm Hg, their diastolic BP was 80 ± 7 mm Hg. Nine patients patients
(30%) had angina class I, 17 patients (56.7%) had angina class II and 4 patients
(13.3%) had angina class III. Fourteen patients (46.7%) had dyspnoea functional
class I, 9 patients (30%) had dyspnoea functional class II and 7 patients (23.3%)
had dyspnoea functional class III.
Eight patients (26.%) had hypertension, 7 (23%) patients had diabetes
mellitus, 7 patients (23%) were smokers, 11 patients (37%) had dyslipidemia, 6
patients (20%) had positive family history of CAD, and 18 patients (60%) were
obese.
Our results showed that there was no significant difference between
before and after 1 month of calcium channel blockers regarding the systolic
parameters (EDD, ESD, EF% and FS%), (P > 0.05). There was significant
difference between before and after therapy regarding the E wave, A wave, E/A
ratio, TVIE, TVIA, TVIE/TVIA, time A, Time E/Time A, deceleration time and
IVRT (P < 0.05). There was no significant difference between the two groups
regarding time E (P > 0.05).
The diastolic mitral flow pattern of all the studied patients was normal pattern in
9 patients (30%), 11 patients (36.7%) had stage I diastolic dysfunction, 7
patients (23.3%) had stage II diastolic dysfunction and 3 patients (10%) had
stage III diastolic dysfunction.
Exercise test characteristics among all patients before and after
Delaytiazem therapy: There was significant difference between before and
after therapy regarding all the exercise test characteristics studied. There was
significant decrease in the resting heart rate and peak diastolic blood pressure (P
< 0.05) , significant increase in the peak heart rate, peak systolic blood pressure,
exercise capacity, exercise duration and proportion of the predicted target heart
rate during exercise (P < 0.001).
Our results showed that the tissue Doppler echocardiographic study of patients
with anterior wall ischemia (SPECT and exercise ECG) before and after therapy.
Our results showed that there was significant improvement in the E wave in the
midanterior wall after therapy in patients with anterior wall ischemia (P < 0.05).
There was also significant improvement in the E wave in the midlateral wall
after therapy in patients with anterior wall ischemia (P < 0.05). There was
significant improvement of the S wave of the apicolateral wall after therapy (P <
0.05). There was no significant change in the other tissue Doppler
echocardiographic parameters of ther segments after calcium channel blocker
therapy (P > 0.05).
Our results showed that the tissue Doppler echocardiographic study of
patients with inferior wall ischemia (SPECT study 12 patientsd) before and after
therapy. Our results showed that there was significant improvement in the E
wave in the midlateral, basal lateral, apicolateral wall, basal inferior wall after
therapy in patients with inferior wall ischemia (P < 0.05). There was also
significant improvement in the E wave in the midlateral wall after therapy in
patients with anterior wall ischemia (P < 0.05). There was significant
improvement of the S wave of the apicolateral wall after therapy (P < 0.05).
There was no significant change in the other tissue Doppler echocardiographic
parameters of the segments after calcium channel blocker therapy (P > 0.05