SEARCH · Search PubMed

Results for “Ejection fraction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 199 records · Page 11Linked to original sources

PubMed1989

[Determination of the right ventricular ejection fraction from the exponential decrease in the thermodilution curve--a comparison with biplanar cineventriculography].

Using the exponential downslope of the thermodilution curve right ventricular ejection fraction and volumes can be calculated. To evaluate the accuracy of this method for clinical application thermodilution measurements were compared to the results of biplane cineventriculography in 40 patients. Mean right ventricular ejection fraction was 52 +/- 9% determined by thermodilution (Th), and 53 +/- 8% determined by angiography (A). Mean enddiastolic volume was 189 +/- 74 ml (Th) and 162 +/- 42 ml (A) and mean endsystolic volume 92 +/- 42 ml (Th) and 75 +/- 20 ml (A). Ejection fraction of thermodilution measurements correlated with the results of angiography (r = 0.59; SEE = 7%; % SEE = 13 rel. %; p less than 0.001). The correlation for endsystolic volume was: r = 0.50; SEE = 36 ml; % SEE = 48%; p less than 0.001, and for enddiastolic volume: r = 0.36; SEE = 70 ml; % SEE = 43%; p less than 0.05. The differences in ejection fraction calculated by the two different methods were especially high (up to 25%) in patients (n = 10) with low (less than 110 ml) or high (greater than or equal to 200 ml) enddiastolic volume. For the other 30 patients the correlation for right ventricular ejection fraction was: r = 0.82; SEE = 5%; % SEE = 9 rel. %; p less than 0.001. Thus, the thermodilution method allows an approximative assessment of right ventricular ejection fraction only in patients with a normal right ventricle. Since right ventricular ejection fraction cannot be determined with sufficient accuracy in patients with right ventricular dilatation, the clinical application of this method is limited.

Cardiac Output↗

PubMed1988

[Surgical tactics and results of aortocoronary shunting in patients with chronic forms of ischemic heart disease and reduced left-ventricular ejection fraction].

Two groups of patients whose ejection fraction was below 0.45, underwent aortocoronary shunting of one to five arteries: patients without myocardial scarry changes (group 1) and those with expansive intra- and transmural myocardial scarry changes (group 2). The latter group was more difficult in terms of coronary bed affection, myocardial contractility and a greater proportion of patients with circulatory insufficiency, which dictated the type of anesthesia, myocardial protection and the surgical techniques in these patients. Aortocoronary shunting is shown to be quite justified and effective in patients with reduced left-ventricular ejection fraction, particularly so in group 1, yet it requires careful selection of patients, provision of adequate myocardial protection and maintenance of myocardial activity at all stages of the intervention.

Adult↗

PubMed2001

Incremental prognostic value of RNA ejection fraction measurements during pharmacologic stress testing: a comparison with clinical and perfusion variables.

UNLABELLED: This investigation examined the prognostic power of first-pass radionuclide angiocardiography (RNA) ejection fraction compared with clinical information and myocardial perfusion imaging in patients undergoing pharmacologic stress testing. The value of RNA and myocardial perfusion imaging in predicting death or nonfatal myocardial infarction (MI) is well established. However, limited information exists on the usefulness of combined myocardial perfusion imaging and RNA to predict prognosis, especially in patients undergoing pharmacologic stress testing. METHODS: We identified 240 patients who underwent pharmacologic stress testing with myocardial perfusion imaging and combined RNA. The patients were followed for a mean of 1.4 y. Cox proportional hazards models were used to assess the value in predicting death and MI. Multivariable models were generated to assess the independent incremental predictive value of clinical and nuclear imaging variables. Kaplan-Meier survival and event-free survival estimates were examined in patients with low (< or = 45%) versus high (>45%) ejection fractions. RESULTS: Clinical information, myocardial perfusion imaging, and RNA ejection fraction were significant predictors of the death/MI composite outcome (chi(2) = 7.4, 14.0, and 21.8, respectively). The addition of myocardial perfusion imaging to the clinical information provided incremental prognostic information (chi(2) = 15.2). The addition of RNA ejection fraction provided further predictive information (chi(2) = 22.5). However, when RNA ejection fraction was first added to the clinical information, myocardial perfusion imaging had no incremental prognostic value. CONCLUSION: For hard cardiac events, RNA ejection fraction provides prognostic information besides that provided by clinical and myocardial perfusion imaging. In patients who cannot exercise and are undergoing noninvasive evaluation with pharmacologic stress testing and myocardial perfusion imaging, ejection fraction should be measured simultaneously for risk assessment optimization.

Adenosine↗

PubMed2002

Relation of ejection fraction and inducible ventricular tachycardia to mode of death in patients with coronary artery disease: an analysis of patients enrolled in the multicenter unsustained tachycardia trial.

BACKGROUND: Fifty percent of deaths in patients with coronary disease occur suddenly. Although many factors correlate with increased mortality, there is little information regarding the influence of these factors on mode of death. As such, optimum methods to determine patients most likely to benefit from implantable defibrillator therapy are unclear. METHODS AND RESULTS: We analyzed the relation of ejection fraction and inducible ventricular tachyarrhythmias to mode of death in all 1791 patients enrolled in the Multicenter Unsustained Tachycardia Trial who did not receive antiarrhythmic therapy. Total mortality and arrhythmic deaths/cardiac arrests occurred more frequently in patients with ejection fraction <30% than in those with ejection fraction of 30% to 40%. The percentage of deaths classified as arrhythmic was similar in patients with ejection fraction <30% or > or =30%. The relative contribution of arrhythmic events to total mortality was significantly higher in patients with inducible tachyarrhythmia (58% of deaths in inducible patients versus 46% in noninducible patients, P=0.004). The higher percentage of events that were arrhythmic among patients with inducible tachyarrhythmia appeared more distinct among patients with an ejection fraction > or =30% (61% of events were arrhythmic among inducible patients with ejection fraction > or =30% and only 42% among noninducible patients, P=0.002). CONCLUSIONS: Both low ejection fraction and inducible tachyarrhythmias identify patients with coronary disease at increased mortality risk. Ejection fraction does not discriminate between modes of death, whereas inducible tachyarrhythmia identifies patients for whom death, if it occurs, is significantly more likely to be arrhythmic, especially if ejection fraction is > or =30%.

Canada↗

PubMed1997

Inhaled nitric oxide reduction in systolic pulmonary artery pressure is less in patients with decreased left ventricular ejection fraction.

OBJECTIVE: To assess whether inhaled nitric oxide decreases pulmonary artery pressure in patients with depressed left ventricular ejection fraction. DESIGN: Randomized, blinded, crossover clinical trial. SETTING: Tertiary care university referral hospital. PATIENTS: Thirty-three patients with pulmonary hypertension and left ventricular dysfunction or valvular heart disease were recruited by convenience. INTERVENTIONS: Systolic pulmonary artery pressure was measured by Doppler echocardiography during randomized inhalation of either 20 ppm or 40 ppm nitric oxide in 30% oxygen as well as during control periods without nitric oxide. MAIN RESULTS: Systolic pulmonary artery pressure was significantly (P < 0.05) decreased with 20 ppm nitric oxide (53.4 +/- 13.9 mmHg) and 40 ppm nitric oxide (53.1 +/- 14.4 mmHg) compared with either initial control (55.8 +/- 15.3 mmHg) or terminal control (56.3 +/- 15.2 mmHg) values. The regression equation for the change in systolic pulmonary artery pressure (y) as predicted by the left ventricular ejection fraction (x) alone for 20 ppm nitric oxide was y = 13.8x-2.9; R2adj = 0.30, P < 0.0001. For 40 ppm nitric oxide alone, the regression equation was y = 16.3x-3.3; R2adj = 0.25, P < 0.0001. Left ventricular ejection fraction was the most explanatory independent variable in the multivariate equation for nitric oxide-induced change in systolic pulmonary artery pressure (R2 = 0.61, P = 0.0000). The change in systolic pulmonary artery pressure was -5.1 +/- 5.2 versus 0.8 +/- 4.9 mmHg (P < 0.0000) in patients with left ventricular ejection fractions greater than 0.25, and 0.25 or less, respectively. CONCLUSIONS: These data imply that in patients with left ventricular ejection fraction of 0.25 or less, nitric oxide may not decrease systolic pulmonary artery pressure. Nitric oxide inhalation may result in a paradoxical increase in systolic pulmonary artery pressure in patients with severely depressed left ventricular ejection fraction. This effect would significantly limit the therapeutic role of nitric oxide in patients with severe heart failure.

Administration, Inhalation↗

PubMed1987

Radionuclide left ventricular ejection fraction: a comparison of three methods.

Three commercially available computer programs (a semiautomatic method, a manual method, and a regional method) were used to calculate left ventricular ejection fraction from the equilibrium multiple gated radionuclide ventriculograms obtained from 24 normal male subjects and 20 men with heart failure. In the normal subjects the ejection fraction values calculated by each method were significantly different (mean SD) difference between semiautomatic and manual 3.3 (5.8); between semiautomatic and regional 12.0 (6.3); and between manual and regional 8.7 (6.9]. In the patients with heart failure the ejection fraction values calculated by the semiautomatic method differed significantly from those calculated by the manual and regional methods (mean (SD) difference between semiautomatic and manual 3.4 (4.7); between semiautomatic and regional 4.9 (4.9); and between manual and regional 1.5 (6.2]. The ejection fraction values obtained by the semiautomatic method were generally higher and more consistent than those derived from the manual and regional methods. An ejection fraction of greater than or equal to 50% with the semiautomatic method would be regarded as normal but if the same normal range was applied to the regional method nine (38%) of the 24 normal subjects would appear to have an abnormal left ventricular function. Clinicians should be aware that the method used to generate a time-activity curve is an important consideration in the calculation of ejection fraction. Each centre should establish its own range and reproducibility for the method it uses to measure ejection fraction. These values should not be assumed to apply to any other method.

Adult↗

PubMed2002

Usefulness of dobutamine Tc-99m sestamibi-gated single-photon emission computed tomography for prediction of left ventricular ejection fraction outcome after coronary revascularization for ischemic cardiomyopathy.

Gated single-photon emission computed tomography (SPECT) imaging allows analysis of myocardial perfusion and assessment of baseline global and regional left ventricular (LV) function and their changes during low-dose dobutamine infusion. The study examined whether the changes in LV ejection fraction induced by dobutamine and evaluated using technetium-99m sestamibi- gated SPECT predict the evolution of ejection fraction after revascularization in patients with ischemic cardiomyopathy. Thirty-seven patients underwent resting and dobutamine nitrate-enhanced sestamibi-gated SPECT before revascularization and baseline-resting sestamibi gated SPECT after intervention to assess global functional changes. A postrevascularization improvement in ejection fraction > or =5 U was defined as significant. At follow-up, ejection fraction increased significantly in 19 patients. According to receiver-operating characteristic curve analysis, an increase in ejection fraction > or =5 U during dobutamine was the optimal cutoff value for predicting a significant postrevascularization improvement, with 79% sensitivity, 78% specificity, and 78% accuracy. A significant correlation was found between dobutamine and postrevascularization ejection fraction (r = 0.85; p <0.0001). The increase in ejection fraction during dobutamine is a good predictor of an improvement in ejection fraction after revascularization. This represents another important diagnostic contribution obtained using gated SPECT imaging for the assessment of myocardial viability in patients with ischemic cardiomyopathy.

Adrenergic beta-Agonists↗

PubMed1997

Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure.

BACKGROUND: The prognosis of chronic heart failure has been studied extensively, but factors predicting short-term outcome in patients with severe chronic heart failure are still poorly defined, and the current indications for heart transplantation as a treatment for end-stage heart failure need on objective analysis. METHODS: Purpose of the study was to identify the determinants of short-term prognosis in a group of 142 consecutive ambulatory patients (mean age 49.8 +/- 11 years). Referred for heart transplantation because of severe chronic heart failure, the patients were admitted with left ventricular ejection fraction markedly depressed and had had symptoms in spite of an optimal standardized medical therapy for at least 1 month. Baseline clinical and instrumental evaluation included right-sided heart catheterization with a flow-directed multilumen thermodilution catheter, which enables determination of pressures, cardiac output, right ventricular volumes, and ejection fraction. RESULTS: Most patients were in New York Heart Association class III (61%) and IV (24%), and the hemodynamic profile was characterized by mean left ventricular ejection fraction of 20.2% +/- 6%, cardiac index of 2.13 +/- 0.6 l/min/m2, pulmonary capillary wedge pressure of 23.1 +/- 11 mm Hg, right atrial pressure of 7.9 +/- 6 mm Hg, right ventricular ejection fraction of 23.2% +/- 12.4%. During a mean follow-up of 11.1 +/- 9.4 months, 33 patients underwent transplantation (23.4%), 41 died (28.8%), and 68 were still alive (47.8%). There was a substantial overlap in left ventricular ejection fraction between patients divided on the basis of outcome, whereas right ventricular ejection fraction was significantly lower in patients who died or underwent transplantation. Cox multivariate analysis showed three independent prognostic variables: cause (p = 0.03), heart failure score (p = 0.001), and right ventricular ejection fraction (p = 0.000). Short-term survival (10 months) was significantly (p = 0.000) different in patients with > or = 24% or < 24% right ventricular ejection fraction. Statistical analysis identified right ventricular ejection fraction as the single variable to be highly correlated with an increased risk of early death. CONCLUSIONS: This study suggests that right ventricular function is a crucial determinant of short-term prognosis in severe chronic heart failure. Statistical analysis identified right ventricular ejection fraction, determined by thermodilution during right-sided heart catheterization, as the single most important predictor of short-term prognosis in a large cohort of patients who had symptoms in spite of a standardized, optimized, multipharmacologic treatment. The variable allows a useful risk stratification in patients with severe chronic heart failure and uniformly depressed left ventricular ejection fraction and provides guidance in the assessment of indications and timing for transplantation.

Adolescent↗

PubMedDate not supplied

Cross sectional echocardiographic assessment of cardiac chamber size and ejection fraction in children.

Cross sectional echocardiography can be used to determine left ventricular size and ejection fraction in children. We used two orthogonal planes from the apical four and two chamber planes to calculate the left ventricular volume in 20 children with a variety of congenital heart lesions and compared these volumes with those calculated using angiography. Better correlations were achieved at end diastole than at end systole. Comparisons between ejection fraction calculated by angiography and echocardiography showed the correlation was closer for two-dimensional than M-mode techniques. Studies using newer two-dimensional methods suggest that an even closer correlation for volume and ejection fraction can be achieved than those reported in our initial studies. Most studies which have determined right ventricular volume have used biplane methods combining short axis and four chamber images. We used single plane area-length methods from parasternal short axis and apical four chamber planes to calculate right ventricular volume in 20 children undergoing angiocardiography for a variety of congenital heart diseases. The single plane volume method underestimated the volume calculated from angiography uniformly so that a good estimate of the angiographic ejection fraction was obtained. Adding the volumes derived from each plane provided a closer approximation of the angiographic volumes and a good estimate of the ejection fraction. High resolution ultrasound equipment and computer assisted tracing devices have made accurate noninvasive assessment of volume and function accurate and practical.

Adolescent↗

PubMed2001

Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction.

BACKGROUND: Evidence for the role of right ventricular (RV) function is emerging in patients with heart failure of different etiologies. Studies conducted in dilated cardiomyopathy (IDC) showed a high prevalence of RV dysfunction unrelated to the severity of pulmonary hypertension. The aim of the study was to investigate the role of RV dysfunction in ischemic versus nonischemic patients. METHODS: A series of 153 patients with left ventricular (LV) dysfunction (defined as a LV ejection fraction <45%) of either ischemic (n = 61, coronary artery disease [CAD] group) or nonischemic (n = 92, IDC group) origin were studied invasively. Besides routine catheterization data, RV volumes and ejection fractions were obtained angiographically. Reference data were collected in a control group of healthy subjects. RV dysfunction was defined as a RV ejection fraction <35% and ventricular concordance as a <10% difference between RV and LV ejection fraction. The LV/RV end-diastolic volume ratio was calculated to assess the relative dilatation of the ventricular chambers. Hemodynamic and angiographic data were compared in the 2 groups by univariate and multivariate logistic regression analysis. RESULTS: Patients with IDC and CAD had comparable LV ejection fractions (29% +/- 3% vs 31% +/- 8%, P not significant) and mean pulmonary pressures (27 +/- 12 mm Hg vs 26 +/- 11 mm Hg, P not significant); the LV/RV end-diastolic volume ratio was identical in the 2 groups (1.26 +/- 0.4 vs 1.24 +/- 0.4, P not significant). RV ejection fraction was significantly lower in IDC compared with CAD (33% +/- 10 % vs 46% +/- 11%, P <.0001), with a prevalence of RV dysfunction in the IDC group of 65% compared with 16% in the CAD group (P <.0001); similarly, the prevalence of ejection fraction concordance was 74% versus 33%, respectively (P <.0001). At multivariate analysis, a low RV ejection fraction was a powerful independent predictor of IDC compared with CAD (odds ratio 0.91, 95% confidence interval 0.87-0.94, P <.0001). RV dysfunction had a positive predictive value of 75% and a negative predictive value of 78% for the diagnosis of IDC; for ventricular concordance, these values were 81% and 69%, respectively. The correlation between mean pulmonary artery pressure and RV ejection fraction was weaker in the IDC group compared with the CAD group (R(2) = 0.032, P =.047 and R(2) = 0.172,P <.0001, respectively). CONCLUSION: In the presence of LV dysfunction, a reduced RV ejection fraction is a powerful marker for IDC compared with CAD, independent of age, pulmonary hypertension, LV function, and ventricular dimensions. These findings support the concept that IDC is frequently characterized by a biventricular involvement and that the presence of RV dysfunction represents a distinguishing feature of this disease.

Adult↗

PubMed1996

Relationship among homocyst(e)ine, vitamin B-12 and cardiac disease in the elderly: association between vitamin B-12 deficiency and decreased left ventricular ejection fraction.

We evaluated the association of moderate hyperhomocyst(e)inemia and vitamin B-12 status with coronary artery disease (CAD) and left ventricular ejection fraction in 367 elderly patients undergoing coronary angiography. The extent of CAD was scored, left ventricular ejection fraction was assessed and vitamins B-12 and folate and the metabolites homocyst(e)ine, methylmalonic acid and 2-methylcitric acid were measured. There was no significant trend in change in homocyst(e)ine as the extent of CAD increased. There was an association between vitamin B-12 deficiency, i.e., vitamin B-12 < 221 pmol/l and homocyst(e)ine > 16 nmol/ml and low left ventricular ejection fraction (P = 0.014). Of 105 samples, selected for vitamin B-12 < 221 pmol/l or high normal vitamin B-12 and folate levels, metabolites including methylmalonic acid revealed a specific diagnosis of vitamin B-12 deficiency in 18 patients. The trend among these vitamin B-12-deficient patients and low left ventricular ejection fraction was significant (P = 0.028). In vitro studies on rat heart revealed that nitrous oxide in the presence of 200 microM/l methionine reduced contractility of the heart. In conclusion, vitamin B-12-deficient patients had significantly lower left ventricular ejection fractions than nonvitamin B-12-deficient patients. Whether low left ventricular ejection fraction results in malabsorption of vitamin B-12 and vitamin B-12 deficiency, or conversely, whether vitamin B-12 and its marker, elevated homocyst(e)ine, depress left ventricular function warrants further evaluation.

Aged↗

PubMedDate not supplied

Automatic analysis of left ventricular ejection fraction using stroke volume images.

The purpose of this study was to analyze, validate, and report on an automatic computer algorithm for analyzing left ventricular ejection fraction and to indicate future applications of the technique to other chambers and more advanced measurements. Thirty-eight patients were studied in the cardiac catheterization laboratory by equilibrium radionuclide ventriculography and concurrent contrast ventriculography. The temporal and spatial behavior of each picture element in a filtered stroke volume image series was monitored throughout the cardiac cycle. Pixels that met specific phase, amplitude, and derivative criteria were assigned to the appropriate chamber. Volume curves were generated from regions of interest for each chamber to enable calculation of the left ventricular ejection fraction. Left ventricular ejection fractions showed a good correlation (r = 0.89) between the two techniques. Ejection fractions ranged between 0.12 and 0.88, showing a wide range of application. It is concluded that automatic analysis of left ventricular ejection fraction is possible using the present algorithm and will be useful in improving the reproducibility and providing more accurate information during exercise protocols, pharmaceutical interventions, and routine clinical studies.

Cardiac Output↗

PubMed1983

Effect of timolol on exercise-induced reduction in regional ejection fraction in patients with coronary artery disease.

In order to evaluate the effects of timolol, a new beta-adrenergic blocking agent, on exercise-induced left ventricular wall motion abnormalities, we studied nine patients with chronic, angiographically-documented coronary artery disease. A computerized technique for determining apical, anteroseptal and inferoposterior regional ejection fractions during gated radionuclide ventriculography was used to assess left ventricular dysfunction. During exercise prior to the administration of timolol, the apical regional ejection fraction fell from 0.62 +/- 0.08 to 0.51 +/- 0.08 (p less than .01). The anteroseptal ejection fraction fell from 0.50 +/- 0.08 to 0.41 +/- 0.05 (p less than .05), and the inferoposterior ejection fraction fell from 0.75 +/- 0.10 to 0.59 +/- 0.06 (p less than .05). Three days after beginning therapy with 10-30 mg of timolol, this reduction was markedly attenuated. The apical ejection fraction fell from 0.59 +/- 0.09 to 0.54 +/- 0.08 (p = NS), the anteroseptal ejection fraction fell from 0.49 +/- 0.07 to 0.47 +/- 0.18 (p = NS) and the inferoposterior ejection fraction fell from 0.62 +/- 0.06 to 0.59 +/- 0.07 (p = NS). Furthermore, several individual regions showed increases in ejection fraction. This study demonstrates a previously unreported and beneficial anti-ischemic effect of timolol.

Cardiac Output↗

PubMed1981

Intravenous xenon- 133 for the determination of radionuclide first pass right ventricular ejection fraction.

The use of intravenous xenon- 133 for determination of radionuclide first pass right ventricular ejection fraction is described. First pass determinations of right ventricular ejection fraction were made with both xenon- 133 and technetium-99m in 13 subjects (15 right ventricular ejection fraction determinations); results obtained with xenon- 133 show an excellent correlation (r = 0.98, p less than 0.002) with results obtained using technetium-99m. Because of rapid pulmonary elimination of xenon- 133 from the body, the use of this radioisotope allows multiple first pass right ventricular ejection fraction determinations within a short period of time, without significant radiation exposure for the patient.

Acute Disease↗

PubMed2000

Evaluation of left ventricular ejection fraction as a measure of pump performance in patients with chronic mitral regurgitation.

Left ventricular (LV) ejection fraction may not adequately detect a reduction in LV systolic performance resulting from chronic mitral regurgitation (MR), due to ventricular unloading into the low-impedance left atrium. To determine whether LV ejection fraction sufficiently gauges myocardial function in MR, nine patients were studied using micromanometer-measured LV pressures and biplane cineventriculography before and 1 year after mitral valve surgery. Six control patients were also studied. LV ejection fraction was normal in MR patients, despite an increase in LV end-systolic volume index. LV end-systolic pressure-volume and stress-volume ratios in MR patients were lower than in controls (P < 0.05 and P < 0.01), suggesting that LV systolic performance fell. One year after mitral valve surgery, LV ejection fraction decreased (P < 0.05) even though LV end-systolic volume index (P < 0.05), pressure-volume (P < 0.05), and stress-volume ratios (P < 0.01) all improved. Thus, LV ejection fraction inadequately reflected LV systolic function in MR patients before and after mitral valve surgery.

Chronic Disease↗

PubMedDate not supplied

Prediction of the left ventricular ejection fraction response to doxorubicin using a multiple linear regression model.

The aim of this study was to develop a model for predicting clinically significant deterioration in the left ventricular ejection fraction due to chronic doxorubicin administration. Twenty-six patients were monitored during their courses of doxorubicin chemotherapy with serial gated equilibrium radionuclide angiography. Multiple linear regression analysis was used to derived the best combination of clinical and radionuclide angiographic predictors of resting left ventricular ejection fraction at any point during the course of chemotherapy. The final model consisted of five variables: left ventricular ejection fraction at the previous monitoring point; cumulative dose of doxorubicin achieved at the previous monitoring point; increment in dose from the previous monitoring point; age of the patient; and time to peak left ventricular emptying at the previous monitoring point. The cumulative dose, the ejection fraction at the previous monitoring point and the final model, respectively, explained 11%, 33% and 53% of the variability in ejection fraction determinations during the 26 patient courses. The final model also forecast a potentially very low resting left ventricular ejection fraction (less than 35%) at the cumulative doses of doxorubicin which provoked serious clinical cardiotoxicity in two patients. A multivariate model is a useful aid in timing discontinuation of doxorubicin prior to the development of a clinically significant deterioration in left ventricular ejection fraction.

Computer Simulation↗

PubMed1988

Effect of exercise on circulating atrial natriuretic peptide and left ventricular ejection fraction in healthy persons and patients with coronary artery disease.

Radionuclide angiographic measurements of left ventricular ejection fraction were performed at rest and during exercise in 10 normal persons and 11 patients with coronary artery disease. Exercise was continued on a supine bicycle exercise table up to a symptom-limited maximum. Plasma levels of atrial natriuretic peptide (ANP) were also determined at rest and during exercise. Ejection fraction in the normal volunteers was 59 +/- 3% (mean +/- SEM) at rest and increased significantly (p less than 0.01) to 69 +/- 3% during exercise. Ejection fraction in the patients was 47 +/- 5% at rest and did not change significantly during exercise (51 +/- 7%). Plasma ANP in the normals rose significantly (p less than 0.01) from 62 +/- 16 pg/ml at rest to 454 +/- 94 pg/ml during exercise. Plasma ANP in the patients also rose significantly (p less than 0.01) from 231 +/- 102 pg/ml to 794 +/- 170 pg/ml. The response of plasma ANP to exercise was enhanced significantly (p less than 0.05) in the patients as compared with the normals in relation to ejection fraction by analysis of covariance. In both the normals and the patients, plasma ANP was inversely and significantly correlated with ejection fraction during exercise (r = -0.46, p less than 0.05, n = 21), however, not at rest. Because it has been reported that plasma ANP is correlated positively with pulmonary artery wedge pressure, the estimation of plasma ANP during an exercise stress test might be used for the evaluation of cardiac reserve in coronary artery disease.

Adult↗

PubMed1993

Quantitative relation of myocardial infarct size and myocardial viability by positron emission tomography to left ventricular ejection fraction and 3-year mortality with and without revascularization.

OBJECTIVES: The purpose of this study was to determine the clinical prognostic value, with and without revascularization, of the size of myocardial infarction and viability as measured by positron emission tomography (PET). BACKGROUND: Poorly contracting but viable myocardium recovers contractile performance after revascularization. However, the quantitative relation among size of infarction and viability by PET, ejection fraction and long-term survival with and without revascularization in patients after myocardial infarction has not been previously reported. METHODS: Infarct size and viability imaged by PET using generator-produced rubidium-82 were quantified objectively by automated software and related to coronary arteriography, left ventricular ejection fraction, revascularization and 3-year mortality. RESULTS: Myocardial infarction or scar > or = 23% of the left ventricle was associated with a 3-year mortality rate of 43% versus that of 5% associated with scar < 23% of the left ventricle (p = 0.014). An ejection fraction < or = 43% correlated with a 3-year mortality rate of 38% compared with 6% for an ejection fraction > or = 43% (p = 0.029) because infarct size > or = 23% of the left ventricle was also associated with an ejection fraction < or = 43%. For patients with a low ejection fraction (< or = 43%) or large infarcts/scar (> or = 23% of the left ventricle), ejection fraction value or infarct size did not predict mortality. However, in patients with an ejection fraction < or = 43%, the absence of viable myocardium in arterial zones at risk was associated with a mortality rate of 63% versus 13% in subjects with viable myocardium, a difference with only a 5.9% probability of occurring by chance alone (p = 0.059). For all patients with viable myocardium in arterial zones at risk, the mortality rate was 8%, and 80% had revascularization over 3 years. For patients with only fixed scar in arterial zones at risk, the mortality rate was 50% versus 8% (p = 0.018), and 40% had revascularization, with no difference in mortality with or without revascularization, thereby suggesting no benefit in this subgroup. CONCLUSIONS: Size of scar and viable myocardium by PET in arterial zones at risk in patients after myocardial infarction are highly predictive of 3-year mortality, particularly in patients with low ejection fraction, and identify patients who are suitable candidates for revascularization after myocardial infarction.

Adult↗