The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic stable angina as of November 17, 2002





The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or a full revision is needed This process gives priority to areas in which major changes in text, and particularly recommendations, are merited on the basis of new understanding or evidence Minor changes in verbiage and references are discouraged

The ACC/AHA/American College of Physicians–American Society of Internal Medicine (ACP-ASIM) Guidelines for the Management of Patients With Chronic Stable Angina, which were published in June 1999, have now been updated The full-text guideline incorporating the updated material is available on the Internet (wwwaccorg or wwwamericanheartorg) in both a track-changes version showing the changes in the 1999 guideline in strike-out (deleted text) and highlighting …

https://cdr.lib.unc.edu/downloads/bz60cz34d

ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina)

Methodology These Guidelines are based on the Diagnostic and Therapeutic Guidelines published in 1995 and 1997, respectively, and have now been combined into one paper. Where new information is available an update has been performed while other parts are unchanged or adjusted to a limited extent. The aim of this report is to provide practical guidelines for the diagnosis, assessment and treatment of heart failure for use in clinical practice and in addition for epidemiological surveys and clinical trials. They are intended as a support for practising physicians and other health care professionals concerned with the management of heart failure patients and provide advice on how to manage these patients including recommendations for referral. The recommendations in these guidelines should always be considered in the light of local regulatory requirements for the administration of any chosen drug or device. This report was drafted by a Task Force (see Appendix 1) appointed by the Committee for Practice Guidelines and Policy Conferences of the European Society of Cardiology (ESC). It was circulat d among the Nucleus of the Working Group on Heart Failure, other Working Groups, and several experts in the field of heart failure. It was updated based on comments received. It was then sent to the Committee and after their input the document was approved for publication.    Recommendations regarding treatments have been based on the degree of available evidence.

Guidelines for the diagnosis and treatment of chronic heart failure

Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function.

American Society of Echocardiography Recommendations for Use of Echocardiography in Clinical Trials A Report from the American Society of Echocardiography's Guidelines and Standards Committee and The Task Force on Echocardiography in Clinical Trials

OBJECTIVES
This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function.


BACKGROUND
Mitral inflow velocity recorded by Doppler echocardiography has been widely used to evaluate left ventricular diastolic function but is affected by other factors. The mitral annulus velocity profile during diastole may provide additional information about left ventricular diastolic function.


METHODS
Mitral annulus velocity during diastole was measured by Doppler tissue imaging (DTI) 1) in 59 normal volunteers (group 1); 2) in 20 patients with a relaxation abnormality as assessed by Doppler mitral inflow variables (group 2) at baseline and after saline loading; 3) in 11 patients (group 3) with normal diastolic function before and after intravenous nitroglycerin infusion; and 4) in 38 consecutive patients (group 4) undergoing cardiac catheterization in whom mitral inflow velocity and tau as well as mitral annulus velocity were measured simultaneously.


RESULTS
In group 1, mean +/- SD peak early and late diastolic mitral annulus velocity was 10.0 +/- 1.3 and 9.5 +/- 1.5 cm/s, respectively. In group 2, mitral inflow velocity profile changed toward the pseudonormalization pattern with saline loading (deceleration time 311 +/- 84 ms before to 216 +/- 40 ms after intervention, p < 0.001), whereas peak early diastolic mitral annulus velocity did not change significantly (5.3 +/- 1.2 cm/s to 5.7 +/- 1.4 cm/s, p = NS). In group 3, despite a significant change in mitral inflow velocity profile after nitroglycerin, peak early diastolic mitral annulus velocity did not change significantly (9.5 +/- 2.2 cm/s to 9.2 +/- 1.7 cm/s, p = NS). In group 4, peak early diastolic mitral annulus velocity (r = -0.56, p < 0.01) and the early/late ratio (r = -0.46, p < 0.01) correlated with tau. When the combination of normal mitral inflow variables with prolonged tau (> or = 50 ms) was classified as pseudonormalization, peak early diastolic mitral annulus velocity < 8.5 cm/s and the early/late ratio < 1 could identify the pseudonormalization with a sensitivity of 88% and specificity of 67%.


CONCLUSIONS
Mitral annulus velocity determined by DTI is a relatively preload-independent variable in evaluating diastolic function.

Assessment of Mitral Annulus Velocity by Doppler Tissue lmaging in the Evaluation of Left Ventricular Diastolic Function

Echocardiographic recording of the atrioventricular (AV) plane displacement during the cardiac cycle was used to assess left ventricular (LV) global function in patients with congestive heart failure (CHF) The study population consisted of 70 patients with chronic CHF (NYHA functional groups III and IV) following dilated cardiomyopathy (DCM) or myocardial infarction (MI), and 35 age-matched healthy subjects The AV plane displacement was recorded from the apical 4- and 2-chamber views at four LV sites located about 90 degrees apart and representing the septal, anterior, lateral and posterior parts of the LV wall A mean value was calculated from the above sites (AV-mean) Patients with CHF showed a significant generalized reduction of AV plane displacement compared to healthy subjects (56 mm vs 145 mm, P less than 0001) Thirty CHF patients also underwent radionuclide angiography in order to determine the ejection fraction (EF) The correlation between AV-mean and EF was good (r = 082, P less than 0001) The selection of an AV-mean of less than 7 mm to define a severely depressed LV function (EF less than 30%) gave a sensitivity of 92% and a specificity of 67% It is concluded that the AV plane displacement can be used to estimate LV systolic function in patients with CHF

Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction.

Echocardiographic quantitative assessment of the atrioventricular plane displacement (AVPD) in systole towards the apex has been used to estimate global left ventricular (L V) function. The study population consisted of 106 patients with coronary artery disease (CAD) with or without previous myocardial infarction and 40 age-matched healthy subjects. The AVPD was recorded from the apical four-and two-chamber views at four sites corresponding to the septal, lateral, anterior and posterior walls of the left ventricle. A mean displacement (A Vmean) was calculated from the above sites. A Vmean was significantly decreased in patients with CAD compared to healthy subjects (P<0.001). In patients in whom the left ventricular ejection fraction (L VEF) was calculated from cineangiograms a good correlation between A Vmean and LVEF was found (r = 0.89, P < 0.001, SEE= 6.4). Selecting an A Vmean of 10 min or more to define a normal L VEF ( 2.55%) resulted in a sensitivity of 92% and a specificity of 87% in predicting a normal versus abnormal left ventricular systolic function. It is concluded that the ease of recording the A VPD by echocardiography provides a simple and valuable non-invasive method to assess global left ventricular function in patients with CAD.

Haemodynamic significance of the atrioventricular plane displacement in patients with coronary artery disease

Recent echocardiographic studies have shown that the atrioventricular (AV) valve plane displacement toward the apex in systole plays an important role in the pump function of the left ventricle. 1–6 The method of recording the AV plane displacement is simple and the magnitude of the AV plane displacement can be used to assess left ventricular systolic function in patients with acute myocardial infarction, coronary artery disease and severe chronic congestive heart failure. 5–7 At the start of diastole, the AV plane begins to ascend rapidly toward the atrium away from the apex. Atrial systole also contributes to ventricular filling by further displacing the AV plane in the same direction, and this is noticed in the last part of the diastolic phase of AV plane displacement and is associated with the P wave of the electrocardiogram. 8 The purpose of this study was to evaluate the diastolic function in healthy control subjects of different age groups by relating the motion of the AV plane due to atrial systole to the total diastolic ascent of the AV plane.

Assessment by echocardiogram of left ventricular diastolic function in healthy subjects using the atrioventricular plane displacement.

The effects of acute myocardial infarction (MI) on the displacement of the left ventricular (LV) atrioventricular (AV) plane is presented The material consisted of 40 patients with first-time Q-wave MI (26 pts with ant MI and 14 with post MI) Nineteen age-matched healthy subjects were used as controls The displacement of the AV plane was determined at four sites corresponding to anterior (AV-A), septal (AV-S), posterior (AV-P) and lateral (AV-L) parts of the LV wall In anterior and posterior MI all the sites showed significantly reduced AV-plane displacement compared to healthy subjects (P less than 0001) Moreover, within the anterior MI group the AV-A and AV-S displacements were significantly reduced compared to the points AV-L and AV-P (P less than 0001) and the AV-L displacement was reduced compared to AV-P (P less than 0001) In posterior MI the displacement at AV-P was reduced compared to other points (P less than 0001) and, to a certain extent, AV-S was reduced compared to the points AV-A and AV-L (P less than 0001) The reduced magnitude of the AV plane displacement seems to be an expression of regionally reduced systolic function The method described may provide a simple means of defining regional wall motion abnormalities of the LV following MI

Effects of acute myocardial infarction on the displacement of the atrioventricular plane: an echocardiographic study.

The acute effects of smoking on left ventricular (LV) function were studied in 36 healthy participants (mean age 38 +/- 10 years). The studies were made before and immediately and 30 minutes after smoking a cigarette. From apical 4- and 2-chamber views, the mitral annular velocities, determined by pulsed wave Doppler tissue imaging, were measured at 4 LV sites corresponding to the septum and the anterior, lateral, and inferior walls. A mean value from the 4 sites was used to assess LV function. The peak systolic, early diastolic, late diastolic, and the ratio of early to late diastolic velocities were recorded. In addition, other conventional Doppler echocardiographic diastolic parameters were also determined. Heart rate was increased immediately after smoking (from 67 +/- 8 to 74 +/- 10 bpm, P <.001). There was no change in systolic mitral annular velocity. Diastolic LV function was changed significantly immediately after smoking. The transmitral A wave increased (0.55 +/- 0.1 vs 0.7 +/- 0.1 m/s, P <.001), the transmitral E/A ratio decreased (1.5 +/- 0.6 vs 1.1 +/- 0.3, P <.001), and the transmitral E-wave deceleration time increased (186 +/- 42 vs 211 +/- 44 ms, P <.05). The diastolic myocardial velocity at the mitral annulus also changed significantly: the early diastolic velocity decreased (16 +/- 3 vs 15 +/- 3 cm/s, P <.001), the late diastolic velocity increased (10.9 +/- 2.2 vs 12 +/- 2.4 cm/s, P <.001), and the ratio of early to late diastolic annular velocities decreased (1.5 +/- 0.5 vs 1.2 +/- 0.4, P <.001). The changes in the transmitral flow velocities remained unaltered even 30 minutes afterward, although the heart rate returned to normal. The results were similar in both smokers and nonsmokers. Acute smoking of a cigarette influences LV diastolic function in healthy participants. The mechanism behind this effect cannot be explained only by changes in the heart rate or loading conditions. The mechanism is probably more complex.

Acute effects of smoking on diastolic function in healthy participants: studies by conventional doppler echocardiography and doppler tissue imaging.

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