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PubMed2005

Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients.

BACKGROUND: Left ventricular function is a principal determinant of cardiovascular risk in patients with heart failure. The growing number of patients with preserved systolic function heart failure underscores the importance of understanding the relationship between ejection fraction and risk. METHODS AND RESULTS: We studied 7599 patients with a broad spectrum of symptomatic heart failure enrolled in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) Program. All patients were randomized to candesartan at a target dose of 32 mg once daily or matching placebo and followed up for a median of 38 months. We related left ventricular ejection fraction (LVEF), measured before randomization at the sites, to cardiovascular outcomes and causes of death. Mean LVEF in patients enrolled in CHARM was 38.8+/-14.9% (median LVEF 36%). Patients with lower LVEF tended to have higher baseline New York Heart Association class. The hazard ratio for all-cause mortality increased by 39% for every 10% reduction in ejection fraction below 45% (hazard ratio 1.39, 95% CI 1.32 to 1.46), with adjustment for baseline covariates. All-cause mortality, cardiovascular death, and all components of cardiovascular death declined with increasing ejection fraction until an ejection fraction of 45%, after which the risk of these outcomes remained relatively stable with increasing LVEF. The absolute change in rate per 100 patient-years for each 10% reduction in LVEF was greatest for sudden death and heart failure-related death. The effect of candesartan in reducing cardiovascular outcomes was consistent across LVEF categories. CONCLUSIONS: LVEF is a powerful predictor of cardiovascular outcome in heart failure patients across a broad spectrum of ventricular function. Nevertheless, once elevated to a range above 45%, ejection fraction does not further contribute to assessment of cardiovascular risk in heart failure patients.

Aged↗
PubMed1984

Radionuclide measurement of left ventricular ejection fraction in tricuspid atresia.

In 15 patients with tricuspid atresia and one with tricuspid stenosis the left ventricular ejection fraction was measured by equilibrium gated radionuclide angiography and the results compared with those from a control group of 16 patients. The patients with tricuspid atresia had a significantly depressed ejection fraction. Those who had a surgical shunt or who had had pulmonary artery banding had significantly lower ejection fractions than the remainder. There was no significant correlation between the ejection fraction and age, the arterial oxygen saturation, or the haemoglobin concentration. Five patients were also studied during isometric exercise; three had an abnormal response. Volume overload of the ventricle is identified as one cause of the dysfunction, but other factors may be important. Radionuclide angiography offers a non-invasive method of studying ventricular function in this condition.

Adolescent↗
PubMed1982

[Angiographic study of the ejection fraction by thirds of systole in coronary patients].

The parameters of myocardial function in the initial phase of ventricular ejection are theoretically more sensitive than the indices calculated over the total systolic ejection period. The object of this study was to evaluate whether the calculation of the ejection fraction by thirds of systole, giving a separate assessment of left ventricular performance at the beginning, the middle and end of ejection, could reliably detect minor changes in ventricular function unrecognised by the usual holosystolic indices. Seventy left ventricular angiograms were analysed in 20 normal subjects (Group I) and 50 patients with coronary artery disease whose ventricular function estimated by the usual parameters was either decreased (Group II, 20 patients) or normal (Group III, 30 patients). In Group I, the ejection fraction in the first third of systole (FE1/3) was much higher than the ejection fraction in the second third (FE2/3). On the other hand, in Groups II and III, all patients had a FE1/3 lower than the FE2/3 (specificity: 100 p. 100). In these two groups, the reduction of FE1/3 and the increase of FE2/3 were very significant compared to Groupe I (p less than 0,001). The ejection fraction of the lest third was identical in the 3 groups. This abnormal distribution of ejection was detected in all coronary patients and was the only alteration of ventricular performance in each of the 30 patients in Group III. In this group, this abnormality was detected equally in patients with triple vessel disease (Subgroup III a, 20 patients) and in patients with isolated left anterior descending disease (Subgroup III b, 10 patients) illustrating the high sensitivity of this index for the detection of a minor abnormality of myocardial function.

Adolescent↗
PubMed1976

Quantitative radionuclide angiocardiography. Determination of left ventricular ejection fraction in children.

A method is described for measuring left ventricular ejection fraction which uses high frequency computer recording of gamma scintillation camera data and peripheral venous injectinon of technetium-99m as sodium pertechnetate. Data from mechanical model experiments are used to show feasibility of this method. A phantom experiment is described which was used to develop a technique for accurate delineation of the ventricular outline in the presence of background. The left ventricular ejection was measured in 12 patients by radionuclide angiocardiography and biplane cineangiography. Comparison of these two methods gave a correlation coefficient of 0-91. In addition, left ventricular ejection fraction was measured in 34 patients (aged 7 weeks to 18 years) without evidence of cardiac disease using the radionuclide method alone. Average ejection fractions of 0-66 and 0-70 were found for children over 2 years of age and children 2 years of age or younger, respectively. In addition, an interobseerver comparison study was performed with the data from 10 patients, and only small differences were noted (SD 0-025).

Adolescent↗
PubMed1997

Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials.

OBJECTIVES: The aims of this study were to describe the incidence and spectrum of thromboembolic events experienced by patients with moderate to severe left ventricular systolic dysfunction in normal sinus rhythm and to study the association between ejection fraction and thromboembolic risk. BACKGROUND: The annual incidence of thromboembolic events in patients with heart failure is estimated to range from 0.9% to 5.5%. Previous studies demonstrating a relation between worsening left ventricular systolic function and thromboembolic risk are difficult to interpret because of the prevalence of atrial fibrillation, an independent risk factor for thromboembolism, in the patients with a lower ejection fraction. METHODS: This is a retrospective analysis of the Studies of Left Ventricular Dysfunction prevention and treatment trials data base. Patients with atrial fibrillation were excluded, resulting in 6,378 participants in sinus rhythm at the time of randomization. Thromboembolic events include strokes, pulmonary emboli and peripheral emboli. Separate analyses were conducted in each gender because there was evidence of a significant interaction between ejection fraction and gender on the risk of thromboembolic events (p = 0.04). RESULTS: The overall annual incidence of thromboembolic events was 2.4% in women and 1.8% in men. On univariate analysis, a decline in ejection fraction was [corrected] associated with thromboembolic risk in women (relative risk [RR] per 10% decrease in ejection fraction 1.58, 95% confidence interval [CI] 1.10 to 2.26, p = 0.01), but not in men. On multivariate analysis, a decline in ejection fraction remained independently associated with thromboembolic risk in women (RR per 10% decrease 1.53, 95% CI 1.06 to 2.20, p = 0.02), but no relation was demonstrated in men. CONCLUSIONS: In patients with left ventricular systolic dysfunction and sinus rhythm, the annual incidence of thromboembolic events is low. Ejection fraction appears to be independently associated with thromboembolic risk in women, but not in men.

Aged↗
PubMed1991

[Effect of barucainide on left ventricular ejection fraction in patients with ventricular cardiac arrhythmias].

We studied the effect of barucainide, an investigational class lb antiarrhythmic drug, on ventricular arrhythmias and left-ventricular ejection fraction in 10 patients with frequent and complex ventricular arrhythmias (Lown grade 4a/4b). The study was conducted as a single-blind and placebo-controlled trial. With placebo, mean frequency of ventricular arrhythmias was 6238 VPB/24 h, 510 couplets/24 h, and 24 salvos/24 h. Mean left-ventricular ejection fraction was 37.6%, ranging from 18% to 58%. Therapy with barucainide (300-400 mg/day) resulted in a significant reduction of ventricular arrhythmias in 7 of 10 patients; in one patient barucainide had a clear proarrhythmic effect. Over all, left-ventricular ejection fraction (37.6% +/- 12% with placebo vs 36.1% +/- 11% with barucainide) was not significantly altered. In one patient, however, it was depressed by more than 5%; one patient complained of shortness of breath during exercise. None of the four patients with an initial ejection fraction below 35% showed a drop of ejection fraction during therapy with barucainide. The only main adverse effect was a small, but significant (p less than 0.005) rise of serum-kreatinine (1.13 +/- 0.26 vs 1.39 +/- 0.38 mg%) in all patients. We conclude that barucainide has a good antiarrhythmic effect and is usually well tolerated in patients with markedly depressed left-ventricular function. The mechanism causing the rise of serum-kreatinin, however, needs to be clarified in further studies.

Aged↗
PubMed1987

First-pass anger camera radiocardiography: biventricular ejection fraction, flow, and volume measurements.

First-pass (FP) right and left ventricular ejection fraction results were compared with equilibrium radiocardiographic (ER) measurements, and FP left ventricular ejection fraction (LVEF) values were compared with biplane contrast angiographic (CA) measurements in 13 patients with and seven patients without regurgitant valvular disease. Regurgitant fractions were calculated from differences between the FP right and left ventricular stroke volumes. Ejection fractions determined by FP were precise (mean CV = 9.6% RVEF, 13.4% LVEF). Mean LVEF by FP and ER were essentially identical, and both were lower than by CA. LVEF(FP) correlated with LVEF by ER and CA (r = 0.88, p less than 0.001). Mean RVEF by both FP and ER were also correlated (r = 0.82, p less than 0.001). There was correlation between FP (corrected) and CA left ventricular stroke (r = 0.77), end-diastolic (r = 0.88), and end-systolic (r = 0.91) volumes, but underestimates were noted when uncorrected flows were used (r = 0.52-0.71). The FP regurgitant fraction measurements separated the patients with regurgitant valvular disease from those without and agreed well with CA grading of regurgitation.

Blood Volume↗
PubMed1981

Left ventricular ejection fraction and its response to therapy in essential hypertension.

Left ventricular ejection fraction at rest and during treadmill and isometric handgrip exercise were determined in 16 patients with essential hypertension (mean age 47.4 years) before and after therapy. The untreated hypertensive patient showed a linear correlation between mean blood pressure and LVEF (r = 0.62, p less than 0.01). The relation of sitting, resting LVEF with systolic blood pressure was highly significant (r = 0.88, p less than 0.001). Prior to therapy no significant change in LVEF in response to exercise was noted. After therapy with captopril, a normal isotonic exercise response occurred consisting of a highly significant increase in ejection fraction (p less than 0.0025). Subjects receiving propranolol had a fall in LVEF with isometric stress (p less than 0.0025). These data suggest an increased ejection fraction in patients with essential hypertension when all other parameters of the heart are normal and an abnormal response to isotonic exercise which may be reversed with therapy.

Adult↗
PubMed1982

Two-dimensional echocardiographic assessment of left ventricular volumes and ejection fraction in children.

The ability of two-dimensional echocardiography to measure left ventricular volumes and ejection fraction was evaluated in 25 children with congenital heart disease. Dimensions and planimetered areas were obtained in the short-axis view at the mitral valve and high and low papillary muscle levels and in the apical two- and four-chamber views. Eight algorithms using five geometric models were assessed. Left ventricular end-diastolic volume, end-systolic volume and ejection fraction were compared with data from biplane cineangiocardiograms. The correlation varied with the algorithm used. Algorithms using short-axis views appeared superior to those using only apical long-axis views. Four algorithms estimated left ventricular volumes with equal accuracy (Simpson's rule, assuming the ventricle to be a truncated cone; Simpson's rule, assuming the ventricle to be a truncated ellipse; hemisphere cylinder; and ellipsoid biplane). The single algorithm that best estimated left ventricular ejection fraction was the ellipsoid biplane formula using the short-axis view at the papillary muscle level (r = 0.91, slope = 0.94, SEE = 6.7%). Thus, two-dimensional echocardiography can accurately assess left ventricular volumes and ejection fraction in children with congenital heart disease.

Adolescent↗
PubMed1983

Value of left ventricular ejection fraction during exercise in predicting the extent of coronary artery disease.

To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease, but it was the absolute level of exercise ejection fraction that predicted the extent of disease.

Adult↗
PubMed1979

Validity of left-ventricular ejection fractions measured at rest and peak exercise by equilibrium radionuclide angiography using short acquisition times.

To validate ejection fraction (EF) calculations from 5 and 2 minutes of multiple-gated equilibrium radionuclide angiographic data and to establish its utility during alterations in cardiac performance, we studied 38 patients with chest pain suggestive of coronary artery disease. Twenty-four patients underwent contrast ventriculography (CV) as well as first-pass (FP) and equilibrium (EQ) radionuclide angiography at rest, and 14 additional patients had both radionuclide tests performed at rest as well as during peak supine bicycle exercise. The resting 5-min acquisition ejection fractions were compared between each method and the following correlations were generated: r = .92, n = 24 (CV-EQ), r = .92, n = 24 (CV-FP), and r = .95, n = 38 (FP-EQ). The variability of EQ-EF calculations between two independent observers was less than 2%; the mean absolute difference between two sequential 2-min acquisitions and the 5-min recordings was -.1 +/- 1.6%, and the reproducibility of sequential 2-min ejection fractions was excellent (r = .98). EQ and FP ejection fractions at symptom-limited exercise correlated well (r = .96, n = 14). We conclude that equilibrium radionuclide angiography is a valid method to measure EF both at rest as well as during peak exercise even when 2-min acquisition periods are used.

Adult↗
PubMed2001

Distribution and declines in cardiac allograft radionuclide left ventricular ejection fractions in relation to late mortality.

BACKGROUND: Cardiac allograft left ventricular ejection fraction (LVEF) is an important measure of left ventricular systolic function. Despite widespread use of LVEF after transplantation, its normal range and prognostic value in cardiac allografts has not been defined. METHODS: We conducted a retrospective cohort study among 292 consecutive adult heart transplant patients. Left ventricular ejection fractions were performed at 1, 3, 12, 24, and 48 months after transplantation using radionuclide ventriculography. Endomyocardial biopsies assessed rejection, right heart catheterization assessed loading conditions, and angiography assessed allograft coronary artery disease. We used Cox proportional hazards model to examine the predictive value of LVEF on late mortality. RESULTS: Of the patients who survived > or =4 years, the mean allograft LVEF decreased 4.7 units at 3 months, from 63.8 to 59.7; an additional 4.1 units at 12 months, from 59.7 to 55.6 (p < 0.001); and remained stable afterward. These changes were not associated with concurrent changes in loading conditions, episodes of rejection, or development of allograft coronary artery disease. Left ventricular ejection fraction lower than the 95% normal limit (<40%) at 12 months was inversely associated with risk for late cardiac mortality (relative risk = 3.5, 95% confidence interval = 1.0-12.2), while controlling for recipient age, sex, donor age, and rejection episodes. CONCLUSIONS: The cardiac-allograft LVEF frequently decreases in the first year after transplantation. The 95th percentile of allograft LVEF value (<40%) at Year 1 predicts late cardiac mortality among transplant recipients.

Adult↗
PubMed2005

The effect of Butterworth and Metz reconstruction filters on volume and ejection fraction calculations with 99Tcm gated myocardial SPECT.

This study was carried out to measure the differences produced by change of reconstruction filter in calculations of left-ventricular end-diastolic volumes, end-systolic volumes, stroke-volumes and left-ventricular ejection-fractions from (99)Tc(m) Sestamibi (Bristol-Myers Squibb) gated myocardial perfusion SPECT studies. 30 patients had gated SPECT myocardial perfusion imaging at rest. The acquired projections were separately filtered with two filters, a low-pass filter (Butterworth) and an edge-enhancement filter (Metz). Each study was then further processed to determine left-ventricular end-diastolic volume, end-systolic volume, stroke volume and ejection fraction, and to assess defect size. The results for each patient with the two filters were compared. Calculated end-diastolic volumes, end-systolic volumes and left-ventricular ejection fractions, for each filter, were well correlated. Stroke volumes showed worse correlation. The differences between left-ventricular ejection-fractions, end-diastolic volumes and end-systolic volumes were statistically significant. There was no significant difference in stroke volumes. Ejection fractions were inversely correlated with defect size, but change in ejection fraction due to filter was not. End-diastolic and end-systolic volumes were correlated with defect size, but change in volumes due to filter was not. Thus the results for changes produced by choice of filter are not dependent on defect size. Using different reconstruction pre-filters in gated myocardial perfusion SPECT significantly changes the results of calculations of physiological parameters. Each centre should be consistent in the use of filters as this may affect the clinical consequences of the result.

Adult↗
PubMed1982

Regional left ventricular ejection fraction from real-time two-dimensional echocardiography.

We studied regional left ventricular contraction patterns and ejection fraction from real-time two-dimensional echocardiograms in 8 normal subjects, 11 patients with coronary artery disease and 2 with congestive cardiomyopathy. The ventricle was divided into 12 regions and for each region, we calculated ejection fraction using a method which integrated the incremental volumes of a series of hemicylinders constructed within that region. The data obtained were displayed graphically to provide a detailed picture of regional ventricular function. Normal subjects had a uniform regional ventricular pattern (regional ejection fraction 54-74%). In patients with coronary disease, we found varying degrees of regional ventricular contraction abnormalities. In congestive cardiomyopathy global hypokinesis was present, and regional ejection fraction was reduced in all areas (11-39%). The study showed that two-dimensional echocardiography is a useful non-invasive bedside technique which may provide detailed quantitative information relating to regional left ventricular contraction abnormalities.

Adolescent↗
PubMed2001

Are ejection fractions from gated SPECT perfusion studies clinically useful? A comparison with radionuclide ventriculography.

Gated SPECT (GSPECT) was evaluated for the measurement of left ventricular ejection fraction (LVEF) by comparing with equilibrium gated radionuclide ventriculography (RNVG). A total of 99 subjects underwent GSPECT and RNVG imaging. All studies were acquired in list mode with GSPECT studies processed to give 16- and 8-frames per R-R interval, and RNVG studies 24 frames per R-R interval. The Cedars-Sinai QGS software was used to calculate ejection fraction from GSPECT studies. RNVG studies were processed using a manually drawn single region of interest technique. Comparison of LVEF from GSPECT with RNVG yielded correlation coefficients of 0.82 and 0.81 for 16- and 8-frame GSPECT studies respectively. The mean 95% prediction interval was 33 +/- 11 percentage points for both 16- and 8-frame studies, indicating a great disparity between predicted ejection fraction values from GSPECT and actual RNVG values. Subgroup analysis of 29 patients with pathological Q-wave evidence of myocardial infarction demonstrated a poorer correlation coefficient of r = 0.69. Subgroup analysis of 32 patients with end-diastolic volumes < 100 ml demonstrated a poorer correlation coefficient of r = 0.32. Ejection fractions calculated from 16- and 8-frame studies showed a correlation of 0.99 with a mean 95% prediction interval of 8.7 +/- 0.04 percentage points. The 8-frame studies underestimated LVEF by 3.6 +/- 2.3% compared to the 16-frame studies. In conclusion, left ventricular ejection fractions calculated using the QGS algorithm from GSPECT studies are inadequate for use in clinical practice.

Adult↗
PubMed1975

Nontraumatic determination of left ventricular ejection fraction by radionuclide angiocardiography.

Previous reports have suggested that left ventricular ejection fraction can be assessed by recording the passage of peripherally administered radioactive bolus through the heart. The accuracy and validity of this technique were examined in 20 patients undergoing diagnostic cardiac catheterization. 99m-Tc-human serum albumin was injected via a central venous catheter into the superior vena cava and precordial activity recorded with a gamma scintillation camera interfaced to a small digital computer. A computer program was designed to generate time-activity curves from the left ventricular blood pool and to calculate left ventricular ejection fractions from the cyclic fluctuations of the left ventricular time-activity curve which correspond to left ventricular volume changes during each cardiac cycle. The results correlated well with those obtained by biplane cineangiocardiography (r equals 0.94) and indicated that the technique should allow accurate and reproducible determination of left ventricular ejection fraction. The findings, however, demonstrated that the time-activity curve must be generated from a region-of-interest which fits the left ventricular blood pool precisely and must be corrected for contributions arising from noncardiac background structures. This nontraumatic and potentially noninvasive technique appears particularly useful for serial evaluation of the acutely ill patient and for follow-up studies in nonhospitalized patients.

Adult↗
PubMed2004

Impact of papillary muscles in ventricular volume and ejection fraction assessment by cardiovascular magnetic resonance.

Cardiovascular magnetic resonance (CMR) is an accurate tool for the determination of right and left ventricular volumes and ejection fractions. However, the current standard short-axis technique is time-consuming and thus, often not practicable for routine daily use, because papillary muscles and trabeculations have to be marked and their volumes subtracted from the total ventricular volume. To reduce calculation time we evaluated the volumetric data that included papillary muscle and trabecular volumes and compared the outcome with the results of the standard technique. Thirty patients (17 healthy, 13 with coronary heart disease) were examined by CMR using TrueFISP (Magnetom, Siemens, Erlangen, Germany). Right and left ventricular volumes and ejection fractions were calculated using the standard short-axis technique and then again without subtracting papillary and trabecular volumes. The two methods were compared by determining the differences in results for ventricular volumes and ejection fractions. Statistically significant differences were found between the two methods for right and left ventricular stroke volumes and end-systolic volumes, and left ventricular end-diastolic volumes (EDV) (p < or = 0.011). No significant difference was found for right ventricular end-diastolic volumes (p > or = 0.149) or left or right ventricular ejection fraction (p > or = 0.130). Except in the case of left ventricular EDV, the deviations in the results of method 1 and method 2 did not vary significantly with the presence or absence of heart disease. Measurements were obtained considerably more quickly with the modified method than with the standard short-axis method (25 +/- 4 min vs. 13 +/- 3 min, p = 0.000). Although systematic differences were found when papillary and trabecular volumes were not subtracted, these differences are small and may not be of clinical relevance in healthy subjects or patients with coronary heart disease. Not subtracting the volumes of these structures enables faster determination of right and left ventricular volumes and ejection fractions without loss of the accuracy associated with the standard short-axis technique.

Adult↗
PubMed1996

[Computer-assisted analysis of ultrasound sequences of the left ventricle for determining ejection fraction].

The present study describes an automatic procedure for calculating the ejection fraction on the basis of ultrasound images. This procedure is divided into three steps, and programmed in C/UNIX. In an initial step, an algorithm, known as sequence analysis, is used to identify the enddiastolic and endsystolic images from a series of ultrasound images. With the use of a template matching procedure for calculating displacement vectors, a method has been developed for the first time for analysing moving images for identification purposes. The subsequent image analysis employs various filter processes for noise suppression, contrast enhancement, image sharpening, edge detection and segmentation. On the basis of the geometrical data of the segmented left ventricle obtained in this way the respective volumes and ejection fraction are calculated. To validate this automatic procedure, the series of ultrasound images were examined by a cardiologist. It was found that the identification of the endsystolic and enddiastolic image was correct, and that there was good agreement between the automatically determined and manually determined ejection fraction.

Algorithms↗