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Shock, arrythmias, angina

Abbreviations: PPA, positive predictive accuracy; NPV, negative predictive value. bThrombolysis was not used in these studies.

Abbreviations: PPA, positive predictive accuracy; NPV, negative predictive value. bThrombolysis was not used in these studies.

Fig. 6. Effect of LV function on survival following MI; (A) Prethrombolytic era; the curvilinear relationship between radionuclide ejection fraction and 1-yr cardiac mortality showing a sharp increase in mortality with ejection fraction <40%. (B) Thrombolytic era: although not strictly comparable to panel A, the same curvilinear relationship between echocardiographic ejection fraction and 6-mo mortality rates suggest that the use of thrombolytic therapy shifts the mortality curve to the left. Reproduced with permission from ref. 27.

Fig. 6. Effect of LV function on survival following MI; (A) Prethrombolytic era; the curvilinear relationship between radionuclide ejection fraction and 1-yr cardiac mortality showing a sharp increase in mortality with ejection fraction <40%. (B) Thrombolytic era: although not strictly comparable to panel A, the same curvilinear relationship between echocardiographic ejection fraction and 6-mo mortality rates suggest that the use of thrombolytic therapy shifts the mortality curve to the left. Reproduced with permission from ref. 27.

Fig. 7. Pulsed-wave doppler recording of mitral inflow velocities to identify diastolic filling patterns. Normal, DT > 160-240 ms with E/A ratio >1.0; Impaired relaxation, DT >240 ms with E/A ratio < 1.0; Pseudonormal, DT 160-200 ms with E/A ratio 1-1.5; Restrictive, DT <160 ms with E/A ratio >1.5. DT, deceleration time; E, early rapid filling wave; A, filling wave due to atrial contraction; ms, milliseconds.

Fig. 7. Pulsed-wave doppler recording of mitral inflow velocities to identify diastolic filling patterns. Normal, DT > 160-240 ms with E/A ratio >1.0; Impaired relaxation, DT >240 ms with E/A ratio < 1.0; Pseudonormal, DT 160-200 ms with E/A ratio 1-1.5; Restrictive, DT <160 ms with E/A ratio >1.5. DT, deceleration time; E, early rapid filling wave; A, filling wave due to atrial contraction; ms, milliseconds.

size, larger LV end-diastolic and end-systolic vol indexes, lower ejection fractions, higher wall motion score index, and more frequent symptoms of heart failure than patients without restrictive patterns.

Sakate et al. (82) examined 44 patients after MI with cardiopulmonary exercise testing and echo Doppler studies. LV ejection fraction did not correlate to exercise capacity, whereas Doppler echo indices of LV diastolic function correlated with exercise capacity in this cohort of patients with mild cardiac dysfunction. Similar results were reported by Miyashita et al. (83).

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