Exercise Echocardiography on LV Mechanics in Patients With CAD: a Speckle-tracking Echocardiography

Study Overview
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Brief Summary
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Recovering blood flow to a coronary stenosis may improve left ventricular (LV) function in patients with coronary artery disease (CAD). However, the reported data about evaluation of LV function post-percutaneous coronary intervention (PCI) in CAD was limited. The aim of this study was to compare the LV function measured by 3 min low dose exercise stress echocardiography (ESE) combined 2D speckle tracking echocardiography (STE) in patients with CAD underwent PCI, and to identify factors affecting the change of LV function. Patients with CAD who underwent acute PCI were enrolled.

Detailed Description
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The assessment of temporal changes in systolic and diastolic regional left ventricle function by 2D-STE after successful reperfusion therapy of acute myocardial infarction (AMI).The estimated total number of participants is 90 patients with AMI and treated with successful percutaneous coronary intervention were included in this study. The echocardiographic measurements were performed in all patients within in-hotpital after PCI procedure, and then followed up at 7, 14, 30, 60 and 180 days after discharge. Recovery of regional systolic and diastolic myocardial function after acute myocardial infarction evaluated by ESE-STE.

Official Title
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Using Exercise Echocardiography to Investigate the Effects of Different Exercise Trainings on Left Ventricular Mechanics in Patients With Coronary Artery Disease: a Speckle-tracking Echocardiography

Conditions
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Cardiovascular Diseases, STEMI, NSTEMI

Intervention / Treatment
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* Other: exercise stress echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: acute myocardial infarction diagnosed by a physician undergoing percutaneous coronary intervention Exercise testing and stress echocardiography are performed with the approval of the physician. Exclusion Criteria: Severe cardiac valve disease Left bundle branch block Uncontrolled diabetes or hypertension Orthopedics or other conditions that hinder from exercise Uncontrolled sinus tachycardia (greater than 120 beats per minute)

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| STEMI<br>ST-segment elevation myocardial infarction (STEMI) is defined by symptoms of myocardial ischemia accompanied by a persistent elevation of the ST segment on the electrocardiogram (ECG) and the subsequent release of biomarkers of myocardial necrosis. | Other: exercise stress echocardiography<br>* Stress echocardiography test. The standardized exercise test was conducted by 50-W semi-recumbent cycling for 3 min. Stress echocardiograph images were acquired at the third minute of cycling to ensure that subjects had reached a steady-state HR.<br>|
| NSTEMI<br>If there is elevation of the blood markers suggesting heart damage, but no ST elevation seen on the EKG tracing, this is known as a non ST-elevation myocardial infarction (NSTEMI). | Other: exercise stress echocardiography<br>* Stress echocardiography test. The standardized exercise test was conducted by 50-W semi-recumbent cycling for 3 min. Stress echocardiograph images were acquired at the third minute of cycling to ensure that subjects had reached a steady-state HR.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The alterations of LV mechanics responses to a 3-min low dose exercise stress echocardiography following time. | The STE was performed at rest, during exercise and recovery to compare the changes of LV machines following discharge. The standardized exercise test was conducted by 50-W semirecumbent cycling (Cardiac Stress Table w/Angio) for 3 min. Stress echocardiograph images were acquired at the third minute of cycling to ensure that subjects had reached a steady-state HR. | detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiopulmonary fitness | The graded exercise test (GXT) was performed with a cycle ergometer at the day 30 and 180 after discharge. The GXT comprised of unloaded pedaling for 2 min followed by a continuous increase in work rate (20-30 W) every 3 min until exhaustion (i.e., V˙ O2max). Minute ventilation (V˙ E), V˙ O2, and CO2 production (V˙ CO2) were measured breath-by-breath using a computer-based system (MasterScreen CPX; Cardinal Health Germany). | detected at the day 30, 60, and 180 after discharge. | 
| The brain-type natriuretic peptide (BNP) levels | BNP levels (picograms/milliliter) will be analysed from blood samples taken by a registered phlebotomist. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The high-sensitivity CRP (hsCRP) levels | hsCRP levels (picograms/milliliter) will be analysed from blood samples taken by a registered phlebotomist. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The creatine kinase (CK) levels | The CK levels (picograms/milliliter) will be analysed from blood samples taken by a registered phlebotomist. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The creatine kinase-MB (CK-MB) levels | The CK-MB levels (picograms/milliliter) will be analysed from blood samples taken by a registered phlebotomist. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The troponin I levels | The troponin I levels (picograms/milliliter) will be analysed from blood samples taken by a registered phlebotomist. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The left ventricle wall and cavity dimensions | M-mode images were used to determine the LV wall and cavity dimensions at end-systole and end-diastole from a parasternal long axis view. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The left ventricle mass | Measurements of LVmass and the short fraction index were automatically derived using standard equations as followed: LVmass(gm) = 0.77 X 10^-3X [(IVS + LVIDd +PW)^3 - (LVIDd)^3 + 2.4] | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The left ventricle ejection fraction | LV ejection fraction (LVEF) was determined using the modified Simpson's method from the apical four-chamber views. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 
| The left ventricle diastolic functions | Analysis of Doppler pulsed wave was performed to determine diastolic transmitral blood flow velocities for peak early (E) and late (A) fillings and was also detected the diastolic mitral annular tissue velocities for peak early (E') and late (A') fillings. | detected at the detected at the in-hospital and the day 7, 14, 30, 60, and 180 after discharge.ay 30, 60, and 180 after discharge. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stress echocardiography, speckle tracking