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PubMed1981

[The left ventricular function in bicycle ergometric stress before and after aortocoronary bypass surgery].

Biplane left ventricular cineangiograms and pressure measurements were performed in 44 patients with coronary heart disease at rest and during submaximal or symptom-limited supine bicycle exercise before and 7 +/- 3 months after bypass surgery. Revascularization was complete in 12 (group 1) and incomplete in 32 patients (group II). Preoperative left ventricular ejection fraction (EF) was within normal limits at rest and declined during exercise in both groups (group I from 59 to 51%, p less than 0.01; group II from 61 to 48%, p less than 0.001). Postoperative EF at rest was nearly identical to preoperative EF in both groups and remained unchanged during exercise (group I from 65 to 63%; group II from 58 to 56%). Peak systolic pressure to end-systolic volume index ratio (LVSP/ESVI in mm Hg/ml . m-2) also decreased during exercise in both groups peroperatively (group I from 3.7 to 3.2 [n.s.]; group Ii from 3.4 to 2.6, p less than 0.005). Postoperative LVSP/ESVI at rest was again unchanged as compared to preoperative LVSP/ESVI. During exercise, however, it increased in both groups, reaching higher values in group I than in group II (5.1 vs. 3.7, p less than 0.05). Whereas both parameters indicate improvement of global left ventricular function following surgery, LVSP/ESVI also suggests more marked recovery of function in patients with complete revascularization than in those where revascularization is incomplete.

Adult↗
PubMed1997

Opposite effects of the remodeling of infarcted and non-infarcted myocardium on left ventricular function early after infarction in humans. An echocardiographic study in patients examined before and after myocardial infarction.

OBJECTIVE: The purpose of this study was to evaluate infarction-related changes in the infarcted and the non-infarcted myocardium using a baseline assessment of ventricular function obtained prior to the infarction. BACKGROUND: Experimental studies have shown that both infarcted and non-infarcted myocardium contribute to the process of left ventricular dilatation soon after the infarction, but no data exist on the effect that the infarct has on the pre-infarct ventricular morphology in humans. METHODS AND RESULTS: 10 patients, out of 721 admitted to our coronary care unit with a first acute myocardial infarction over a 3-year period, had had an echocardiographic examination performed before (354 +/- 407 days) and after (10 +/- 9 days) the infarction which were adequate for quantitative evaluation. Ventricular volume (Simpson) and regional wall motion (Centerline method) were evaluated by biplane apical sections and the endocardial length of the infarct and the non-infarct segments, imaged in a cross-sectional view at the papillary muscle level, were measured. After the infarction end-diastolic and end-systolic ventricular volume increased (P = 0.0003 and P < 0.0001, respectively); diastolic and systolic infarct segment length increased (P = 0.011 and P = 0.0008, respectively), while non-infarct segment had only diastolic lengthening (P = 0.019), without systolic changes. The ejection fraction decreased after the infarction (P < 0.0001), in inverse relation to infarct size and in direct relation to diastolic non-infarct segment lengthening. In the five patients in whom there was a significant diastolic lengthening of non-infarct segment (larger than mean +/- 2 S.D. of the interobserver variability) the decrease in ejection fraction was less than in the patients without significant lengthening of this segment (P = 0.017), despite a similar echocardiographic infarct size index. CONCLUSION: Ventricular enlargement early after myocardial infarction is due to both infarct expansion and lengthening of non-infarct segment. However, while systolic stretching of the infarct segment is a deleterious process that accounts for the increase in end-systolic volume, diastolic non-infarct segment lengthening is the expression of a functional compensatory mechanism that counteracts the reduction of the ventricular pump function secondary to the infarction.

Aged↗
PubMed2005

[Improved analysis of left ventricular function using three-dimensional echocardiography].

Left ventricular geometry and function are important pathophysiologic and prognostic parameters. However, especially in patients with cardiac pathologies left ventricular geometry can be complex. Quantification of left ventricular volumes using conventional two-dimensional echocardiography is only possible when simplifying assumptions of left ventricular geometry are made. In contrast three-dimensional echocardiography allows direct quantification of left ventricular volumes even in complex distortions of left ventricular shape. The availability of real-time three-dimensional echocardiography has brought this technique into clinical practice. Three-dimensional echocardiography is a technique that may be used as a routine echocardiographic method in the near future.

Cardiac Volume↗
PubMed1988

Changes of right ventricular function with positive end-expiratory pressure (PEEP) in man.

The side effects of positive pressure ventilation on cardiovascular function are well known. However, in most clinical studies its influence on left ventricular function was examined. In the present study right ventricular (RV) performance was studied in 13 patients undergoing coronary artery bypass grafting during mechanical ventilation with and without positive end-expiratory pressure (PEEP). In the majority of patients (10/13), PEEP caused a decrease in RV end-diastolic volume (by 18%) whereas RV ejection fraction did not change. In the remaining 3 patients, end-diastolic and end-systolic RV volumes increased by 25% and 50% respectively and ejection fraction decreased by 29%. These results suggest that PEEP can affect RV function in two different ways: first, in the majority of patients studied, PEEP exerted an unloading effect on the RV whereas second, in 3 patients RV dilatation and a decrease in ejection fraction was observed.

Aged↗
PubMed2006

Pulmonary vein vestibule ablation for the control of atrial fibrillation in patients with impaired left ventricular function.

INTRODUCTION: Congestive heart failure (CHF) and atrial fibrillation (AF) are frequently linked, and when associated produce additive deleterious effects. In this prospective study, the effects of catheter ablation for AF in patients with impaired left ventricular (LV) function are presented. METHODS: Baseline data and clinical outcome have been prospectively collected in 105 consecutive patients who underwent pulmonary vein ablation for the control of AF. We evaluated 40 patients affected by LV dysfunction with ejection fraction (EF)<40% and compared them to the remaining 65 patients with normal ventricular function in terms of changes in LV function, maintenance of sinus rhythm, and quality of life during follow-up. RESULTS: After a mean follow-up of 14+/-2 months, 87% of patients with impaired LV function and 92% of patients with normal ventricular function were in sinus rhythm, with or without antiarrhythmic therapy (P=NS). A significant improvement in LVEF and fractional shortening was documented in patients with CHF (33+/-2% vs 47+/-3%, and 19+/-4% vs 30+/-3%, P<0.01 for both comparisons). Evaluation of exercise capacity and quality of life documented better improvements in patients with CHF compared to patients without CHF. CONCLUSIONS: Catheter ablation in patients with LV dysfunction is feasible, not associated with higher procedural complications, and provides a significant improvement in LV performance, symptoms, and quality of life during follow-up.

Atrial Fibrillation↗
PubMed2005

Evaluating ventricular function with B-type natriuretic peptide in obstetric patients.

OBJECTIVE: To determine if a rapid serum assay for B-type natriuretic peptide (BNP) provides information regarding ventricular function in obstetric patients with acute dyspnea. STUDY DESIGN: A review of 17 charts for 15 patients was undertaken. Seven patients had preeclampsia, 3 had preterm labor treated with aggressive tocolysis, and 5 had underlying cardiac and/or pulmonary disease. Each presented with signs and symptoms consistent with acute dyspnea. Serum BNP levels were obtained and other standard diagnostic procedures performed. Each patient was treated based on the findings of the standard diagnostic procedures. RESULTS: For the 7 patients with preeclampsia, elevated serum BNP levels correlated with acute ventricular overload that responded to volume management and diuresis. Two patients had marked elevation of serum BNP levels and were found to have significant left ventricular dysfunction that was not apparent by standard clinical evaluation. For preterm labor patients on tocolysis and patients with underlying cardiac or pulmonary disease, serum BNP levels were elevated for 5 of 6 patients with evidence of acute volume overload. CONCLUSION: Serum BNP levels provided useful information for the clinical evaluation and management of obstetric patients with acute dyspnea. In 2 patients, more serious cardiac dysfunction was detected with BNP than with clinical evaluation alone.

Acute Disease↗
PubMed1994

Prediction of improvement of ventricular function after first acute myocardial infarction using low-dose dobutamine stress echocardiography.

This study was performed to assess the prevalence of spontaneous improvement of regional left ventricular function in patients after acute myocardial infarction, and to evaluate the role of low-dose dobutamine stress echocardiography for its prediction. In 57 patients with a first acute myocardial infarction (thrombolysis, n = 27; Q-wave, n = 49), regional wall motion was evaluated with 2-dimensional echocardiography at rest, during a low-dose dobutamine stress test performed within 1 week after hospital admission, and at 3-month follow-up. Myocardial viability was considered if there was an improvement of > or = 1 grade in dyssynergic segments from rest to low-dose dobutamine infusion; recovery of regional function was defined as an improvement of > or = 1 grade between rest and follow-up echocardiograms. Wall motion score index decreased from rest to low-dose dobutamine echocardiography (1.46 +/- 0.29 to 1.39 +/- 0.30, p < 0.0001), and this change persisted at follow-up study (1.37 +/- 0.30). No differences were found between patients who did and did not undergo thrombolyis, or between those who had Q-wave and non-Q-wave infarction. At baseline echocardiography, 189 of 627 segments were dyssynergic (85 hypokinetic, 104 akinetic). Viability at low-dose dobutamine stress echocardiography was more frequent in hypokinetic than in akinetic segments (30 of 85 vs 12 of 104, odds ratio 4.18, 95% confidence interval [CI] 1.87 to 9.48).(ABSTRACT TRUNCATED AT 250 WORDS)

Dobutamine↗
PubMed1975

Acute effects of low doses of alcohol on left ventricular function by echocardiography.

The ultrasound method for measuring the dimensions of the left ventricle was utilized to study the effect of oral doses of alcohol on left ventricular function in normal volunteers. Systolic time intervals were also measured. Seven subjects received 0.7 g/kg of ethanol (group I) and six subjects recieved 1.15 g/kg (group II). The peak of blood alcohol levels in the two groups were 75 mg/100 ml and 138 mg/100 ml respectively. There was a 6% decrease in the fractional change in the minor axis of the left ventricle in group I patients which resulted in a decrease in ejection fraction (p greater than 0.05). In group II patients, there was a 3% decrease in the fractional change in the minor axis of the left ventricle, but the change of ejection fraction was not significant. Since there was no significant difference between the physiological effects observed in groups I and II, the two groups were combined. In the combined group, at 30 minutes after the ingestion of alchol, the heart rate was increased by 11%, the fractional change in the minor axis of the left ventricle decreased by 6%, the ejection fraction decreased by 4% (p greater than 0.01) and Vcf decreased by 5%. These data suggest that in normal subjects myocardial contractility is depressed following the ingestion of alcohol.

Administration, Oral↗
PubMed1998

Assessment of right ventricular function postretrograde cardioplegia by transesophageal echocardiography.

UNLABELLED: The impact of continuous retrograde cardioplegia (RCP) on right ventricular (RV) function was evaluated prospectively with intraoperative transesophageal echocardiography (TEE) in 36 patients (23 males, 13 females) with a mean age of 60.4 years (ages 24-82). Operative procedures included 12 aortic valve replacements, 16 mitral valve repair/replacements, both with or without an associated cardiac operation, and 8 Ross procedures. Mean cardiopulmonary bypass (CPB) time was 123.3 minutes (66-280 minutes) with an average cross-clamp time of 88.9 minutes (43-199 minutes). The amount of cold blood RCP ranged from 3160-18,500 mL (mean = 7382.5), and the average pulmonary artery pressure was 35/18 mmHg. The coronary sinus was distally snared in 11 patients. TEE documented biventricular global dysfunction in two patients and post-CPB with preservation of the left ventricular function in all other patients. Localized akinesis of the RV apex and outflow tract were noted in three patients, and isolated worsening tricuspid insufficiency of moderate to severe intensity in six patients. Two of the six patients with worsening tricuspid insufficiency belonged to the snared coronary sinus group (11 patients). All of the documented RV dysfunctions were new and showed no correlation with the perfusion data. IN CONCLUSION: (1) RV apex, RV outflow tract and tricuspid valve were particularly subject to important dysfunction post-RCP; (2) RCP did not protect RV adequately in 11 patients (31%); and (3) TEE is a convenient intraoperative technique in evaluating RV dysfunction.

Cardiac Surgical Procedures↗
PubMed1981

Nifedipine and left ventricular function in beta-blocked patients.

We studied the acute effects of nifedipine on left ventricular function and haemodynamics at constant heart rate in patients on beta-blocker therapy. Nifedipine significantly depressed left ventricular peak dP/dt and peak dP/dt x P-1. Nifedipine also significantly reduced systemic vascular resistance: this was associated with decreased systolic blood pressure and increased left ventricular stroke output, with slight non-significant increases of ejection fraction and mean circumferential shortening velocity. There was no change in left ventricular end-diastolic pressure. This clinical study shows that nifedipine increases cardiac output in association with arterial dilatation despite evidence for a negative inotropic effect. Such intrinsic negative inotropic effects would normally be masked by compensatory sympathetic activity.

Atenolol↗
PubMed1975

[Left ventricular function of the coronary patient: relation between ventricular kinetic disorders and alterations of myocardial contractility].

The left ventricular kinaetics of 29 coronary patients (pure angina and with sequela of myocardial infarction) was studies by biplane angiocardiography. Their contractility was assessed by measurement of the Vmax and VECmax indices derived from the relationship between contractile elements shortening speed-overall wall tension, in isovolumetric phase. An excellent relationship links the hypokinaetic area with decrease of the ejection fraction (SV/LSV): when the hypokinaetic area exceeded 20% of the overall endocardial surface, the ejection fraction deveased below 0.40, and signs of cardiac failure were manifest. Pure anginal patients at rest kept normal kinaetics, late diastolic volume, ejection fraction and myocardial mass. A myocardial hypertrophy develops in the areas adjacent to the fibrous scar. In some cases (group I) it compensates for the ventricular dysfunction; in other cases, it is not sufficient to compensate for the ejection fraction reduction. One must then admit the presence of diminished contractility in the areas adjacent to the fibrous scar, as is suggested by the increase of the late diastolic pressure, the decrease of the externel work of the left ventricle and of the contractility indices. Analysis of both the natural and post-operative courses in these patients shows that Vmax the ejection fraction and the hypokinaetic areas afford excellent criteria for prognosis and operability.

Angina Pectoris↗
PubMed1982

[Evaluation of left ventricular function in patients with dilated cardiomyopathy by exercise echocardiography].

In order to evaluate left ventricular function of dilated cardiomyopathy, 24 patients and ten healthy subjects were studied by exercise echocardiography. The patients with dilated cardiomyopathy were classified into 3 groups according to the presence or absence of mitral regurgitation and the severity of left ventricular dilatation: Group I was consisted of five cases with mitral regurgitation. Group II was consisted of seven cases without mitral regurgitation who had marked left ventricular dilatation, where the left ventricular end-diastolic dimension index (DdI) was greater than 46 mm/m2 and left ventricular end-systolic dimension index (DsI) was greater than 40 mm/m2. Group III was consisted of 12 cases without mitral regurgitation who had moderate left ventricular dilatation, where the DdI was less than 46 mm/m2 or DsI was less than 40 mm/m2. The ergometer exercise tests were performed for 3 min at 25 watts in a supine position. There was no significant differences of exercise-induced increases in heart rate, elevations of systolic blood pressure and increases of rate pressure product, respectively, between healthy subjects and each group of dilated cardiomyopathy. In healthy subjects, both DdI and DsI were unchanged on exercise. In Group I, DdI was unchanged but DsI decreased (p less than 0.02), thus percent fractional shortening of the left ventricle (delta D) was increased (p less than 0.05). In Group II, both DdI and DsI were unchanged. In Group III, DdI was increased (p less than 0.05) while DsI was unchanged, thus delta D was increased (p less than 0.02). These results suggested that the left ventricle is able to respond to exercise by its further dilatation (increase of preload) in mild to moderate dilated cardiomyopathy (Group III). On the other hand, in cases with marked left ventricular dilatation (Group II), the further dilatation is not induced. The same was true in dilated cardiomyopathy with mitral regurgitation (Group I), where the left ventricle had almost the same size as in Group II, although changes in DsI and delta D were not evaluated precisely because of the associated regurgitation.

Blood Pressure↗
PubMed1992

Effects of the dipyridamole test on left ventricular function in coronary artery disease.

The dipyridamole stress test is used with thallium-201 to detect areas of inhomogeneity of blood flow that point to coronary artery disease (CAD). It is unclear whether dipyridamole produces inhomogeneous perfusion only or whether it actually decreases net flow in the obstructed vessels and produces true ischemia. It is also unclear what effect dipyridamole has on global and segmental left ventricular function. Therefore, ejection fraction, segmental wall motion and ventricular volume equivalents were measured before and after dipyridamole in 113 patients and 32 normal subjects. Ejection fraction responded in an abnormal fashion in 98 patients (87%), decreasing from 49 +/- 11% to 43 +/- 13% (p less than 0.0001), whereas it increased in 29 normal subjects (90%) from 57 +/- 6% to 64 +/- 10% (p less than 0.0001). Wall motion worsened distinctly in 75 patients (66%), and pressure/volume ratio deteriorated in 72%. The effect of dipyridamole lasted between 10 and 25 minutes, but was promptly reversed by aminophylline. These findings indicate that dipyridamole generally induces true ischemia in CAD. Furthermore, the degree of dysfunction is related to the angiographically assessed severity of CAD. The shortness of breath (seen in 10% of patients) may be partially explained by the findings, and it seems advisable to give aminophylline to every patient in order to promptly correct left ventricular dysfunction.

Adult↗
PubMed1991

Ventricular function in the single ventricle before and after Fontan surgery.

To better delineate the importance of ventricular function in patients with a single ventricle and assess its relation to outcome after the Fontan procedure, 47 patients with a single ventricle were studied. Ventricular ejection fraction was estimated by radionuclide angiocardiography. Before Fontan surgery, ejection fraction was 0.57 +/- 0.10 (mean +/- standard deviation). This differed significantly from the normal mean left ventricular ejection fraction of 0.68 +/- 0.09 (p less than 0.001) derived in our laboratory by radionuclide angiocardiographic methods. Age, ventricular morphology and the presence of pulmonary artery band or systemic to pulmonary artery shunts had no statistical relation to ventricular ejection fraction in patients with a single ventricle. Serial preoperative evaluation in 15 patients over 3.8 +/- 1.3 years revealed no significant change in ventricular ejection fraction; however, increased atrioventricular valve regurgitation was documented in 4 of these 15. Modified Fontan procedure was performed in 24 of the 47 study patients; 7 have died, 1 has undergone cardiac transplantation and 1 faces possible transplantation. No difference was noted in preoperative ejection fraction between survivors and nonsurvivors. Ventricular morphology, age at Fontan surgery and operative factors such as bypass and cross-clamp time were not related to functional outcome. Preoperative ejection fraction of 0.52 +/- 0.08 decreased to 0.39 +/- 0.11 (p less than 0.001) when evaluated 1.16 +/- 0.44 years after Fontan surgery. In patients with a single ventricle (1) ventricular ejection fraction is less than that of the normal systemic ventricle; (2) during childhood, ejection fraction is not related to age or ventricular morphology; and (3) ventricular ejection fraction frequently decreases after a Fontan repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1980

Effect of atenolol on left ventricular function in hypertensive patients.

No information is available about the effects of oral atenolol, a cardioselective beta-adrenergic blocking agent with no intrinsic sympathomimetic activity, on left ventricular function. Atenolol, 100 mg/day, was given to 12 hypertensive patients for 8 weeks, and its effects on mean arterial pressure (MAP), cardiac index (CI) and ejection indexes of myocardial performance were examined by echocardiography. Echocardiographic studies were performed before treatment, after 4 weeks of placebo, and repeated after 4 and 8 weeks of atenolol therapy. MAP fell by 14% and 21% after 4 and 8 weeks, respectively. CI fell by 22% and 20% and stroke index (SI) fell by 11% and 7%. Calculated peripheral resistance did not change significantly. Fractional shortening, ejection fraction and normalized mean rate of circumferential fiber shortening did not change. The normalized mean posterior wall velocity decreased after 4 weeks but returned to pretreatment levels after 8 weeks. The septal velocity increased after 8 weeks. End-diastolic volume index (EDVI) did not change, and there was no relationship between changes in heart rate and EDVI. The study shows that atenolol in the resting state has no effect on certain echocardiographic indexes of left ventricular (LV) function when given orally to hypertensive patients with normal LV size and function. The reduction in CI and SI were presumably secondary to a decrease in cardiac venous filling.

Adult↗
PubMed1992

[Left ventricular function assessed by multigated blood pool single photon emission computed tomography with 99mTc].

To evaluate the usefulness of gated blood pool single photon emission computed tomography with 99mTc (gated SPECT) for assessing left ventricular function, we performed gated SPECT in 2 normal subjects and 18 patients including 13 with ischemic heart disease, 3 with hypertrophic cardiomyopathy and 2 with dilated cardiomyopathy. Left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF) and regional wall motion obtained by gated SPECT were compared with the results of contrast left ventriculography (contrast LVG), echocardiography and planar multigated blood pool imaging (planar blood pool). After the patients' red blood cells were labelled with 30 mCi (1,110 MBq) 99mTc in vivo, gated SPECT was performed in each of 32 projections through a 360 degree arc for each of the cardiac cycle divided into 16. From these images, the left ventricular vertical long-axis image, the horizontal long-axis and short-axis images were reconstructed. To calculate LVEDV, we used serial short-axis images which were composed of the left ventricle. To define left ventricular and left atrial borders, we used amplitude images and cinematic displays of the vertical long-axis image. The level of the optimal cut for delineating the left ventricular border was determined from the volume-cut-level-graph at each background activity, which was constructed by a phantom study. Left ventricular wall motion by gated SPECT was compared with the results of contrast LVG according to segmental analysis. LVEDV obtained by gated SPECT showed an excellent linear correlation with LVEDV calculated by echocardiography (r = 0.98, p < 0.01) and by contrast LVG (r = 0.89, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Echocardiographic study of left ventricular function in type 1 diabetes mellitus: hypersensitivity of beta-adrenergic stimulation.

Systolic left ventricular function was investigated by echocardiography in 23 young, type 1 diabetics and 11 control subjects. A stimulation by isoproterenol was performed in order to study beta-adrenergic cardiac responsiveness. M-mode recordings were digitized and analyzed by computer. Systolic parameters such as left ventricular fractional shortening and mean velocity of circumferential shortening were not different, but maximal velocity of shortening was increased both at rest (P less than 0.01) and with isoproterenol (P less than 0.05) in the diabetics. An abnormal systolic anterior motion of the mitral valve was found during administration of isoproterenol in 65% of the diabetics and in only one control. These findings are suggestive of a hyperkinetic state, associated with a poor metabolic control (high value of HbA1), together with adrenergic hypersensitivity in type 1 diabetes mellitus.

Adult↗
PubMed1985

Assessment of ventricular function by radionuclide angiography in patients receiving 4'-epidoxorubicin and mitoxantrone.

Serial assessment of ventricular function by means of radionuclide angiography was performed in 50 patients with malignant neoplasms who received either 4'-epidoxorubicin or mitoxantrone for longer than 3 months. In 9 of 30 patients given 4'-epidoxorubicin, a decrease of greater than or equal to 10% in the left ventricular ejection fraction (LVEF) was documented at doses of 143-1200 mg/m2. Two patients developed clinical signs of cardiotoxicity at a dose of greater than 1000 mg/m2. In 6 of 20 patients given mitoxantrone a decrease of greater than or equal to 10% in the LVEF occurred at doses of 26-98 mg/m2.

Adolescent↗

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