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PubMed1988

Sequence of mechanical and electrical changes during myocardial ischemia: assessment by an ambulatory left ventricular function monitor.

To investigate the relationship between left ventricular function and electrical changes during myocardial ischemia, ambulatory left ventricular function monitoring and ECG recording were made during the ergometer exercise test in 14 patients with coronary artery disease. An ambulatory ventricular function monitor consists of a small cadmium telluride (CdTe) radionuclide probe (250 g) affixed to the patient's chest wall, a preamplifer (10 g), and a portable data acquisition unit (600 g). Left ventricular time-activity curves were recorded continuously using this monitor, and the end-systolic count (volume), end-diastolic count (volume) and ejection fraction were calculated after background subtraction. Twenty-eight exercise tests were performed in the supine and upright positions. In 15 tests, left ventricular dysfunction, i.e., an increase in the end-systolic count (greater than or equal to 10%) and a decrease in ejection fraction (greater than or equal to 5%), and ST depression (greater than or equal to 0.1 mV) were observed. In these 15 tests, exercise duration was 362 +/- 27 sec. Left ventricular dysfunction occurred earlier than ST depression and the time difference was 97 +/- 19 sec. Left ventricular function recovered 33 +/- 8.5 sec after discontinuation of exercise, while ST depression continued for the additional 85 +/- 18.5 sec after recovery of left ventricular function. In conclusion, 1) left ventricular dysfunction occurs earlier than electrical changes during exercise-induced ischemia; 2) left ventricular dysfunction improves earlier than electrical changes after exercise; and 3) the same temporal sequence exists in the restoration from myocardial ischemia.

Coronary Disease↗
PubMedDate not supplied

Left ventricular function during respiratory failure.

Indirect measures of left ventricular function were studied in seven patients with respiratory failure secondary to chronic obstructive pulmonary disease to determine if there were a relationship between left ventricular function and treatment of the pulmonary disease. All patients were studied during acute episodes while in respiratory failure having arterial Pco2 (Paco2) values greater than 49 torr with no clinical evidence of left ventricular failure. Indirect methods to evaluate left ventricular function included the use of the Swan-Ganz catheter for pulmonary capillary wedge pressure measurement, systolic time intervals, and cardiac output. There was improvement in left ventricular function with treatment of the respiratory failure manifested by decreases in the wedge pressure and pre-ejection period/left ventricular ejection time ratio, and an increase in the dp/dt/pulmonary capillary wedge pressure with treatment of the chronic obstructive pulmonary disease. The improvement in left ventricular function suggests that there is a depression of left ventricular function in respiratory failure. The depressed function improved with therapy of the lung disease without additional medication directed at cardiac function.

Adult↗
PubMed1999

ACE inhibition with ramipril improves left ventricular function at rest and post exercise in patients with stable ischaemic heart disease and preserved left ventricular systolic function.

AIMS: To assess the effects of 6 months intervention with +ramipril on resting and post exercise left ventricular function in patients with stable ischaemic heart disease and preserved left ventricular systolic function. METHODS AND RESULTS: Patients (n=98, age 65+/-9 years, 37% women) were randomized to double-blind treatment with ramipril 5 mg. day(-1)(n=32), ramipril 1.25 mg. day(-1)(n=34), or placebo (n=32). Resting and post maximum exercise echocardiography/Doppler examinations were performed at baseline and after 6 months. Changes over 6 months in resting transmitral E-wave deceleration time (Edt) and Edt adjusted for heart rate (Edt/RR) differed between the ramipril 5 mg, ramipril 1.25 mg, and placebo groups: Edt 24+/-82, -1+/-69, and -29+/-64 ms, respectively, P=0. 012; Edt/RR 30+/-105, 2+/-61, and -28+/-69 ms, respectively, P=0.015. Changes in the difference between resting and post exercise Edt/RR also varied between groups: -53+/-137, -28+/-118, and 35+/-101 ms, respectively, P=0.029. No differences in E/A indices were noted. Resting atrioventricular plane displacement improved in the combined ramipril groups vs the placebo group: 0.2+/-0.8 vs -0.2+/-1.3 mm, P<0.05.Conclusion Six months ramipril treatment in patients with stable ischaemic heart disease and preserved left ventricular systolic function improved resting left ventricular function and reduced the exercise induced diastolic filling abnormalities usually seen in these patients.

Aged↗
PubMed2003

Haemodynamic and catecholamine response to simulated ventricular tachycardia in man: effect of baseline left ventricular function.

OBJECTIVE: To examine the effects of baseline left ventricular function on the haemodynamic and catecholamine responses to ventricular tachycardia. DESIGN: Experimental cohort study. SETTING: Cardiac catheterisation laboratory in tertiary referral centre. SUBJECTS: 24 patients (19 male, 5 female; mean (SD) age, 59 (10) years) without coronary artery disease, divided into two groups with normal or impaired left ventricular function: group A, ejection fraction > 65% (n = 10); group B, ejection fraction < 45% (n = 14). Other medical and demographic factors were similar in the two groups. INTERVENTIONS: Ventricular tachycardia was simulated with rapid pacing at 150 beats/min for 10 minutes. MAIN OUTCOME MEASURES: Arterial blood pressure; venous plasma catecholamine concentrations. RESULTS: During rapid pacing, blood pressure was lower in group B (with impaired left ventricular function) than in group A: systolic blood pressure, 102 (11) v 115 (9) mm Hg (p = 0.005); mean blood pressure, 79 (6) v 85 (6) mm Hg (p = 0.02). The ejection fraction correlated with the lowest systolic blood pressure (r = 0.64, p = 0.0006). Although the rise in adrenaline was comparable between the two groups, the rise in noradrenaline was more pronounced (p < 0.05) in patients in group B. CONCLUSION: At low rates and in selected patients, the underlying state of left ventricular function affects haemodynamic tolerance of ventricular tachycardia. Patients with impaired left ventricular function have a lower blood pressure during ventricular tachycardia, despite an exaggerated noradrenaline release.

Blood Pressure↗
PubMedDate not supplied

Comparison of preoperative left ventricular function with postoperative left ventricular response to exercise in patients with chronic aortic regurgitation and aortic stenosis.

The relation between preoperative left ventricular (LV) systolic function at rest and postoperative LV response to exercise was assessed in 13 patients with aortic regurgitation (AR) and nine patients with aortic stenosis (AS). Preoperative end-systolic volume index (ESVI) and ejection fraction (EF) determined by LV angiography were compared with postoperative exercise-induced changes of LV fractional shortening (delta %FS) and mean velocity of fiber shortening (delta mVcf) assessed by echocardiography. Preoperative EF and ESVI in 13 patients with AR correlated well with postoperative delta %FS and delta mVcf. Similarly, preoperative EF and ESVI in nine patients with AS correlated well with postoperative delta %FS and delta mVcf. Our study demonstrated that preoperative LV systolic function in AR and AS patients closely reflected postoperative LV response to exercise. Preoperative smaller ESVI will be warranted to expect a favorably good postoperative LV response to exercise.

Adult↗
PubMed1980

Effect of graded narrowing of left main coronary artery on left ventricular function.

The relationship between left ventricular function and coronary blood flow was studied in 16 chloralose-anesthetized dogs with an intact coronary circulation and left ventricle. Left ventricular dimensions, hemodynamic function indices, and coronary blood flow were measured simultaneously as the origin of the left coronary artery was narrowed by a calibrated snare. With a left coronary blood flow reduction of 17% (average), left ventricular minor axis diameter increased and maximum aortic blood flow acceleration and maximum rate of rise of left ventricular pressure decreased. Other measured indices of ventricular function did not change significantly. Larger coronary flow decrements caused a decrease in aortic systolic and diastolic pressures, stroke volume and cardiac output and an increase in heart rate and left ventricular end-diastolic pressure. These results confirm a close relationship between left ventricular function and blood supply.

Animals↗
PubMed1983

Use of computer analysis of echocardiograms for assessment of left ventricular function.

Computer analysis of M-mode echocardiograms has been used for evaluation of left ventricular function. Ventricular dimensions and velocities of heart wall movement have been measured. In addition, a non-invasive estimate of ventricular wall stress has been obtained using the systolic cuff blood pressure combined with echocardiogram data, and simultaneous apex cardiography has been employed to look for any disruption in the timing of changes in ventricular dimension and wall stress. Various parameters have been calculated from the data to provide a quantitative indication of changes in the ventricle. A study has been carried out of 117 patients divided into four groups; one of normal subjects and the others containing patients with ischaemic heart disease, hypertrophic cardiomyopathy and dilated cardiomyopathy. Abnormal features of the echocardiograms have been evaluated from comparisons with data for normal subjects. Relationships between the quantities measured have been studied to give a fuller understanding of changes taking place in the ventricle, so that the data can be employed as the basis for a non-invasive assessment of ventricular function.

Adult↗
PubMed1986

Radionuclide assessment of left ventricular function in hypertrophic cardiomyopathy.

To determine the relationship of left ventricular function and ventricular tachycardia, 48 hour ECG monitoring and technetium-99m gated equilibrium radionuclide angiography were performed in 84 consecutive patients with hypertrophic cardiomyopathy and sinus rhythm. Measurements of ejection fraction (EF), peak ejection rate (PER, edv/s), peak filling rate (PFR, edv/s) and time to peak filling rate (PFR, ms) were derived from radionuclide activity time curves generated from data acquired in list-mode. Left ventricular function was compared in patients with and without ventricular tachycardia. Left ventricular ejection fraction was significantly lower in 16 patients with ventricular tachycardia compared to 68 patients without (67 +/- 17 vs 78 +/- 10, P less than 0.05) and time to peak filling rate was significantly prolonged (152 +/- 32 vs 120 +/- 36, P less than 0.05). Thus patients with hypertrophic cardiomyopathy at greatest risk of sudden death had significant impairment of systolic and diastolic left ventricular function.

Adolescent↗
PubMed1981

Improvement in global and segmental left ventricular function after coronary bypass surgery.

Ventricular function was assessed at rest and during exercise by multiple gated cardiac blood pool scintigraphy before and after coronary artery bypass surgery in 21 patients. Resting left and right ventricular ejection fraction and segmental wall motion were unchanged by surgery. However, the postoperative exercise response of left ventricular ejection fraction (-1 +/- 12% vs 6 +/- 9%) and segmental wall motion score (medium -2.7 [range -8 to 2] vs -0.4 [range -6 to 2]) were significantly improved (p less than 0.05). The normal right ventricular ejection fraction exercise response was maintained after surgery. Previous myocardial infarction in 15 patients did not attenuate the observed improvement in ventricular function. In addition, normal postoperative left ventricular ejection fraction response to exercise was associated with symptomatic improvement. In three of six patients a normal preoperative left ventricular ejection fraction response to exercise was not maintained. Therefore, global and regional left ventricular reserve is improved by coronary bypass surgery and this improvement is not affected by previous myocardial infarction.

Adult↗
PubMed1976

Relative insesitivity of isovolumic phase indices in the assessment of left ventricular function.

1. The authors compared the sensitivity of the isovolumic phase indices (contractility indices) against LV function curves ("pump-function" indices) in assessing ventricular performance. 2. Certain modifications of the usual isovolumic phase indices, especially those introducing the concept of comparison of exercise with rest, seemed to us to be slightly more helpful in separating normal subjects from the patient with coronary artery disease or cardiomyopathies, but these differences were not striking when statistically evaluated, and could not be utilized in assessment of left ventricular function in individual patients. 3. The construction of left ventricular function curves, in our hands, yielded equally as satisfactory information and, in addition, was much simpler to perform. 4. It is concluded that contractility indices are relatively insensitive in the assessment of left ventricular function, and that they offer little advantage over "pump-function" indices for this purpose.

Angiocardiography↗
PubMed2004

[Right ventricular function in ARDS and mechanical respiration].

The right ventricle is the stepchild of intensive care medicine. In diseases of the lung mainly when the relationship between ventilation and perfusion is disturbed, assisted respiration with positive end-expiratory pressure (PEEP) is essential to improve oxygenation. The serious damage to the lung parenchyma as seen in adult (acute) respiratory distress syndrome (ARDS) and pneumonia has considerable consequences for cardiac function. Whereas left ventricular function remains almost completely unaffected well into late stages of the disease, the right ventricle is subjected early to stress from the underlying disease and mechanical ventilation. The effects of therapeutic measures aimed at maintaining oxygenation and ventilation partially have negative consequences for right ventricular function and encourage the development of acute cor pulmonale. They can be the cause of right-sided heart failure.

Heart Failure↗
PubMed2002

Evolution of ventricular function during permanent pacing from either right ventricular apex or outflow tract following AV-junctional ablation for atrial fibrillation.

AIMS: To compare acute and chronic ventricular function between patients, without cardiac failure, paced at either right ventricular apex or outflow tract. METHODS: Twenty patients. 10 paced apically and 10 in the outflow tract, underwent two radionuclide ventriculograms. Eight parameters of systolic or diastolic function were compared at each assessment, as were changes within each group over time. RESULTS: No differences were identified in systolic function between pacing sites 6 weeks after pacing or 23 weeks later. Peak filling rate was lower (P=0.04) at the second assessment with outflow tract pacing. No other diastolic differences were identified. Between assessments, time to peak filling rate prolonged (P=0.04) with apical pacing, while left ventricular area reduced (P=0.04) and peak filling rate decreased (P=0.04) with outflow tract pacing. Septal motion was better preserved with outflow tract pacing. No other parameter changed over time. ECG measures were similar at 14.7 months. CONCLUSIONS: No major differences were identified in systolic function between pacing sites. Some systolic parameters were better preserved with outflow tract pacing and diastolic function deteriorated subtly over time in both groups. Right ventricular pacing adversely affects left ventricular function.

Aged↗
PubMed1990

Preservation of ventricular function by treatment of ventricular fibrillation with phenylephrine.

Epinephrine promotes resuscitation from ventricular fibrillation because of its peripheral vasoconstrictive effects. However, the beta-adrenergic effects of epinephrine may be detrimental because of the stimulation of myocardial oxygen demand. To test whether functional recovery from fibrillation in hearts treated with a selective alpha-adrenergic agent is greater than in hearts treated with epinephrine, ventricular fibrillation was induced in eight isolated dog hearts while coronary perfusion pressure was maintained at 30 mm Hg. In random order, epinephrine (5 micrograms/min), phenylephrine (50 micrograms/min) or no drug was infused for 5 min. The heart was then defibrillated, the drug infusion stopped and coronary perfusion pressure increased to 100 mm Hg. Coronary blood flow (ml/min per 100 g), arteriovenous oxygen difference (ml O2/dl) and myocardial oxygen consumption (ml O2/min per 100 g) measured after 4 min of ventricular fibrillation were greater with epinephrine (mean +/- SD 30.9 +/- 11.7, 17.5 +/- 1.6 and 5.4 +/- 1.9, respectively) than with phenylephrine (24.4 +/- 6.0, 15.7 +/- 2.6 and 3.8 +/- 1.1, respectively) or no drug (19.8 +/- 5.2, 12.8 +/- 1.8 and 2.6 +/- 0.7, respectively) (p less than 0.05, p less than 0.05 and p less than 0.05, respectively). The slope of the end-systolic pressure-volume relation 10 min after defibrillation and restoration of normal coronary perfusion pressure was depressed (percent of prefibrillation value) most by epinephrine infusion (72 +/- 17%, n = 6), less by no drug infusion (82 +/- 12%, n = 4) and was increased after phenylephrine infusion (143 +/- 17%, n = 6) (p less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[Assessment of coronary bypass surgery by continuous ventricular function monitoring].

The sequential change of left ventricular function during exercise and recovery after exercise was assessed in 50 patients who had undergone coronary bypass surgery before and after the operation by means of continuous ventricular function monitoring system (VEST). Cardiac response was divided into 4 types with respect to the profiles of the left ventricular ejection fraction during exercise. Type A continued to increase; type B initially increased but decreased in severe exercise stages; type C did not change during exercise; type D continued to decrease. Most patients showed type C or D before surgery but showed type A after surgery. 9 patients with occluded grafts or ungrafted coronary arteries showed type B, C or D. Two patients with extended infarction and poor left ventricular function showed type C after surgery. In recovery period after exercise, the ejection fraction showed an overshoot. The mean ratio of peak ejection fraction during recovery to ejection fraction at rest increased from +62 +/- 12% before operation to +68 +/- 16% after operation (p less than 0.05). The recovery time after exercise was decreased from 195 sec before operation to 98 sec after operation (p less than 0.01). VEST revealed response of left ventricular function during exercise and recovery after exercise as far as detail abnormalities.

Adult↗
PubMed2001

Recovery of ventricular function after myocardial infarction in the reperfusion era: the healing and early afterload reducing therapy study.

BACKGROUND: Patients with reduced left ventricular function and ventricular enlargement after myocardial infarction are at significantly greater risk for congestive heart failure and death. Nevertheless, recovery of ventricular function occurs in a significant proportion of patients after myocardial infarction, and modern reperfusion strategies have been associated with increased recovery of function. OBJECTIVE: To determine the extent and predictors of recovery of ventricular function after anterior Q-wave myocardial infarction in the reperfusion era. DESIGN: Subgroup analysis of the Healing and Early Afterload Reducing Therapy study. SETTING: 35 medical centers in the United States and Canada. PATIENTS: 352 patients with Q-wave anterior myocardial infarction. INTERVENTION: Placebo for 14 days, followed by full-dose (10 mg) ramipril until day 90; low-dose (0.625 mg) ramipril for 90 days; or full-dose ramipril for 90 days. All patients underwent reperfusion therapy. MEASUREMENTS: Echocardiography was performed on day 1 (before randomization), day 14, and day 90 after myocardial infarction. Left ventricular volume and ejection fraction were measured and wall-motion analyses were performed at all three time points in 249 patients and at baseline in an additional 12 patients who died during follow-up. Echocardiographic and nonechocardiographic predictors of ventricular recovery were examined. RESULTS: By day 90, 55 of 252 (22%) patients who had abnormal ejection fraction and wall-motion abnormalities on day 1 demonstrated complete recovery of function (ejection fraction in the normal range and infarct segment length of 0%), and an additional 36% (91 of 252 patients) demonstrated partial recovery of function. At 90 days, 53% (132 of 249) of patients had greater than 5% improvement in ejection fraction, whereas only 16% (39 of 249) had a decrease in ejection fraction of more than 5%. The majority of functional improvement occurred by day 14 after infarction. Of various clinical and echocardiographic measures obtained on day 1, peak creatine kinase level was the strongest independent predictor of subsequent recovery of ventricular function in multivariate analysis. Each 100-unit increase in peak creatine kinase was associated with a 4.3% decreased odds of recovery (P < 0.001) after adjustment for ejection fraction on day 1, extent of akinesis or dyskinesis, treatment regimen, Killip class, age, and sex. CONCLUSION: Significant myocardial stunning with subsequent improvement of ventricular function occurred in the majority of patients after Q-wave anterior myocardial infarction. A lower peak level of creatine kinase, an estimate of the extent of necrosis, is independently predictive of recovery of function. Early functional assessment (day 1 after acute myocardial infarction) had limited ability to predict recovery of ventricular function.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

[Evaluation of right ventricular function by tissue Doppler echocardiography and Tei index in right ventricular myocardial infarction].

OBJECTIVE: With tissue Doppler imaging and right ventricular Tei index, right ventricular function in patients with right ventricular myocardial infarction (RVMI) was assessed. METHOD: 51 patients admitted to coronary care units and diagnosed as acute inferior myocardial infarction were further studied with the ECG criterion of ST segment elevation >or= 1mm in V(4R) to establish the diagnosis of RVMI. 23 patients were thus diagnosed as RVMI and 28 patients not. 20 healthy subjects served as controls. Clinical and echocardiography index were recorded. Peak systolic and peak early and late diastolic velocities (Sm, Em, Am) and Em/Am were acquired from the apical four-chamber view at the lateralside of tricuspid annulus, the septal side of the tricuspid annulus and the RV free mid-wall using DTI. Interval between tricuspid closing and reopening and ejection time (ET) from parasternal short-axis view were recorded by pulse-wave Doppler. RV Tei index was calculated. RESULTS: Sm and Em at the lateral side of tricuspid annulus and the RV free mid-wall reduced significantly in patients with RVMI as compared with those without RVMI and healthy individuals (Sm at the lateral (7.0 +/- 2.0) cm/s vs (8.7 +/- 1.9) cm/s and (10.6 +/- 2.1) cm/s, P < 0.01; Em at the lateral (6.3 +/- 1.9) cm/s vs (7.9 +/- 1.8) cm/s and (9.6 +/- 1.9) cm/s, P < 0.01; Sm at the RV free mid-wall (6.4 +/- 1.9) cm/s vs (8.0 +/- 1.9) cm/s and (9.4 +/- 2.0) cm/s, P < 0.05; Em at the RV free mid-wall (6.1 +/- 2.0) cm/s vs (7.6 +/- 2.0) cm/s and (9.2 +/- 2.3) cm/s, P < 0.05). RV Tei index in patients with RVMI also increased as compared with that in the other two groups (0.65 +/- 0.19 vs 0.40 +/- 0.15 and 0.26 +/- 0.10; P < 0.01). CONCLUSIONS: The evaluation of velocities at the lateral side of tricuspid annulus and the RV free mid-wall using DTI and RV Tei index provides a noninvasive and rapid method for assessing right ventricular function in patients with RVMI.

Adult↗
PubMed2004

The additive value of combined assessment of myocardial perfusion and ventricular function studies.

In addition to providing quantitative ventricular function information, gated SPECT and radionuclide angiocardiographic studies can evaluate regional wall motion and ventricular volumes. This review focuses on the combined assessment of myocardial perfusion and left ventricular function. Two clear roles for nuclear imaging in clinical practice include the diagnosis of coronary artery disease and assessment of prognosis in patients with known coronary artery disease. Ventricular function information can help differentiate an attenuation artifact from an infarct and is helpful in diagnosing 3-vessel coronary disease. Additionally, several studies have highlighted the prognostic benefit to combined assessment of myocardial perfusion and ventricular function. Several new modalities have recently been reported that promise to continue to solidify the place of nuclear imaging in the diagnosis and prognosis of coronary artery disease.

Coronary Artery Disease↗
PubMed1997

Left ventricular function after repeated episodes of ventricular fibrillation and defibrillation assessed by transoesophageal echocardiography.

BACKGROUND: Investigators studying the effects of cardioverter-defibrillators on left ventricular systolic function have given only minor attention to the diastolic effects. OBJECTIVES: The purpose of this study was to investigate the impact of repeated episodes of ventricular fibrillation and defibrillation on systolic function and diastolic filling of the left ventricle during non-thoracotomy implantation of a cardioverter-defibrillator. METHODS: Systolic function and diastolic filling of the left ventricle were assessed peri-operatively on a beat-by-beat basis using a transoesophageal echo-Doppler technique in 12 patients during > or = 4 episodes of ventricular fibrillation and defibrillation. Systolic function was assessed from the fractional area change and diastolic filling from the E/A ratio. Arterial blood pressure and the ECG were recorded continuously. RESULTS: Blood pressure and heart rate did not change significantly throughout the procedure. The systolic function, similarly, was not significantly affected; the only changes were seen in the first two beats after defibrillation when the mean fractional area increased from 0.2 +/- 0.01 to 0.4 +/- 0.02 and 0.3 +/- 0.02, respectively (P < 0.001). Diastolic filling was, however, impaired as reflected by a decrease in the E/A ratio from 2.6 +/- 0.5 before to 1.6 +/- 0.4 (P < 0.01) after repeated threshold tests. CONCLUSIONS: While the combined ischaemic and electrical trauma caused by repeated episodes of ventricular fibrillation and defibrillation during the implantation of a cardioverter-defibrillator did not cause any systolic dysfunction, diastolic filling was significantly impaired.

Adult↗