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PubMed1993

[Long-term follow-up in patients operated on for aortic coarctation. The echo-Doppler and MRI assessment of left ventricular function and the transisthmic gradient].

BACKGROUND: Hyperdynamic left ventricular function and increased left ventricular mass has been recently reported in the long-term follow-up of patients after successful repair of aortic coarctation (AoCo). METHODS: We studied 35 patients, mean age 22.7 years (range 1-47), following repair of AoCo in order to evaluate: 1) left ventricular mass and systolic function by M-mode echocardiography in comparison with 20 healthy control subjects; 2) the prevalence of systemic hypertension; 3) systolic blood pressure and the trans-isthmic gradient by CW Doppler at rest and after exercise; 4) subjects with a hypertensive response and/or with a significant trans-isthmic gradient during exercise, correlating such parameters with indexes of left ventricular function and the ratio of aortic isthmus/aortic diaphragmatic diameters (AOI/AOD) by means of Magnetic Resonance (MR). At the time of operation, mean age was 12.4 years (range 1 mo-40 yrs) and the follow-up period was 10.1 years (range 6 mo-26 yrs). RESULTS: Left ventricular mass index (Mi) was significantly greater in comparison with that of the controls (96.5 +/- 25 vs 71.5 +/- 16.6 g/m2; p < 0.001); the mean velocity of circumferential shortening (mVCFc) was increased (1.4 +/- 0.25 vs 1.2 +/- 0.16 circ/s; p < 0.005); the end systolic meridional stress (ESS) was decreased (37.3 +/- 11.1 vs 47.9 +/- 13.1 g/cm2; p < 0.005) while the peak systolic meridional stress (PSS) was not significantly different in the two groups. Fourteen out of 35 patients (40%) showed an exaggerated mVCFc for the level of ESS, which indicates an increased inotropic state. Hypertension at rest was present in 10 patients (28%). Mean age at the time of operation of the hypertensive group was higher than that of the normotensive one (21.4 +/- 10 vs 8.9 +/- 8.6 yrs; p < 0.001). All patients showed a small systolic gradient across the side of coarctation repair at rest (mean 13.1 mmHg; range 0-30). The exercise test was stopped in 5 patients because of hypertension (> 250 mmHg); 24 patients (80%) showed an exercise-induced hypertension. The mean gradient at maximal exercise was 25.9 mmHg (range 0-52); 6 patients (20%) developed a diastolic gradient. With MR it was possible to evaluate the anatomy of the aortic arch and the descending aorta in all cases. The mean ratio AOI/AOD was 0.81 (range 0.63-1). The age at the time of operation showed a positive correlation with the systolic blood pressure (r = 0.63; p < 0.001) and with Mi (r = 0.45; p < 0.005). The systolic blood pressure and the gradient at maximal exercise also showed a positive correlation (r = 0.40; p < 0.01). CONCLUSIONS: In the long-term follow-up of patients after successful coarctation repair there are persistent alterations of left ventricular function with hypertrophy, hyperkinesia and increased inotropic state. Hypertension at rest and after exercise could persist despite good surgical results.

Adolescent↗
PubMed2001

The structure and function of the helical heart and its buttress wrapping. VII. Critical importance of septum for right ventricular function.

The macroscopic structure of the right ventricle includes a transverse basal loop for the free wall, and oblique septal components, originating from the descending and ascending segments of the apical loop. Data is presented that determines why right ventricular function is related principally to intraventricular septal function, and why right ventricular failure is magnified by septal stunning caused by poor myocardial protection. The background of this architectural/functional change can explain normal right ventricular function, the relationship of right ventricular performance to pulmonary vascular resistance, experimental studies that characterize right ventricular performance after architectural free wall ablation, right ventricular disconnection, right coronary occlusion, and free wall replacement. These basic science studies are related to perioperative right ventricular performance, involving methods of myocardial protection, protamine reaction, right coronary occlusion and reperfusion, right ventricular dyskinesia, chronic aortic and mitral valve replacement (MVR) replacement, congenital heart disease, right and left ventricular assist devices (LVADs), and transplantation. The predominant focus is related to the septum and how it can be evaluated perioperatively. Septal evaluation by echocardiogram should become an essential feature during intraoperative management.

Cardiovascular Diseases↗
PubMed1986

Changes in ventricular function associated with coronary reperfusion in acute myocardial infarction.

Currently there is no accepted method for measurement of myocardial infarct size in humans. Analysis of both global and regional left ventricular function provides an indirect indication of extent of myocardial necrosis. Acute coronary occlusion results in cessation of function and in some cases dilatation of the involved myocardial segment. Often there is reciprocal hyperfunction of the non-ischemic segments resulting in little impairment of global ventricular function. Average global left ventricular function does not change from hospital admission through hospital discharge in patients with acute myocardial infarction, treated conventionally. With successful coronary reperfusion, however, both regional and global ventricular function have been reported to improve over several weeks after the initial ischemic insult. Improvement in ventricular function is most likely to occur in patients with collaterals or some preservation of antegrade flow to the involved myocardial segment who successfully undergo reperfusion. Return of function occurs in 82% of patients successfully treated within two hours after onset of chest pain. Approximately 50% of patients successfully treated two to 18 hours after onset of chest pain have demonstrated significant improvement in function. Patients admitted with normal ventricular function are less likely to demonstrate improved global ventricular function than those admitted with ejection fractions less than 45%. Acute PTCA with or without thrombolysis may result in a greater return in function than thrombolysis alone. Delayed revascularization more than 48 hours after successful reperfusion does not appear to affect ventricular function a late follow-up but may improve probability of survival. Patients discharged with ejection fractions greater than 45% clearly have an improved prognosis compared to those with depressed ejection fractions post-myocardial infarction.

Angioplasty, Balloon↗
PubMed1998

[Coronary artery bypass grafting in cases with poor left ventricular function].

From January 1987 through June 1992, 18 patients with poor left ventricular function (left ventricular ejection fraction [LVEF] less than 0.3) underwent elective isolated primary coronary artery bypass surgery. The mean age was 56.4 years (range, 46 to 72 years), and 15 were males and 3 were females. Mean pre-operative LVEF measured by ventriculography was 0.26 +/- 0.03 (range, 0.19 to 0.30). Sixteen patients (88.9%) had a prior myocardial infarction and 9 (50%) had a history of congestive heart failure. Complete revascularization was the goal for all patients, and the mean number of bypass grafts was 3.0 +/- 0.8 per patient. The left anterior descending coronary artery (LAD) was revascularized in all patients. There were no operative deaths. Post-operative LVEF improved significantly from 0.26 +/- 0.03 to 0.42 +/- 0.11 (p = 0.0002), and the regional left ventricular wall motion improved in the diaphragmatic and posterobasal regions (p < 0.01). The patency of the grafts was 93.9% in all, and 100% for LAD. The mean follow-up period was 77 months, and the overall actuarial survival rate was 88.9% at 10 years. During follow-up periods, two patients died of congestive heart failure (CHF), and two required three rehospitalizations because of CHF. The overall cardiac event free rate was 75.8% at 10 years. In patients with poor left ventricular function, surgical revascularization can be performed safely, but congestive heart failure sometimes occurs during follow-up periods and may be the cause of death. Therefore alternate forms of therapy such as cardiac transplantation and/or TMLR should be considered in selected patients.

Aged↗
PubMed2006

Right ventricular function predicts transplant-free survival in idiopathic dilated cardiomyopathy.

BACKGROUND: Right ventricular function may be reduced in patients with idiopathic dilated cardiomyopathy (IDC). The prognostic implications of right ventricular dysfunction have not been investigated in this group of patients. METHODS: In a series of 120 consecutive patients with IDC [defined as a left ventricular ejection fraction (LVEF) < 55%, normal coronary arteries and no other causes for left ventricular dysfunction], right ventricular function was prospectively evaluated by means of angiocardiography at the time of catheterization. A head-to-head comparison of ventricular volumes, ejection fraction, end-diastolic pressure, stroke work index and end-systolic pressure/volume ratio of the left and right ventricle was performed according to the Cox's proportional hazard method for the pre-defined end-point of transplant-free survival. RESULTS: In the study population, LVEF was 31 +/- 11% and right ventricular ejection fraction (RVEF) was 34 +/- 10%. After a mean follow-up of 30 months (range 12-120 months), 26 patients died (22%) and 14 (12%) underwent heart transplantation. At univariate analysis, all the above mentioned parameters were significantly (P < 0.0001) associated with outcome except left and right ventricular end-systolic pressure/volume ratio. At multivariate analysis, independent predictors of transplant-free survival were RVEF (P = 0.001), right ventricular stroke work index (P = 0.015), right ventricular end-diastolic volume (P = 0.034) and left ventricular end-diastolic volume (P = 0.048), but not LVEF. The same relation holds true considering the end point of total mortality. CONCLUSIONS: Parameters of right ventricular function are strong predictors of survival in IDC, even in patients enrolled over a wide range of LVEFs. The present study suggests that right ventricular function should be evaluated in patients with IDC. A large non-invasive based study on right ventricular function in IDC appears to be warranted.

Adult↗
PubMed1975

Left ventricular function in acute and chronic coronary artery disease.

The evaluation of left ventricular function in patients with acute myocardial infarction has shown: 1. Limitations in the use and interpretation of central venous pressure. 2. Pulmonary artery end-diastolic pressure reflects left ventricular end-diastolic pressure in the absence of pulmonary vascular or mitral valve disease. 3. Frequent elevations of left ventricular filling pressure in mild or clinically uncomplicated infarction. 4. Anterior infarctions present greater depression of left ventricular function than inferior infarctions. 5. Initial hemodynamic measurements in cardiogenic shock can predict prognosis with medical management. 6. Left ventricular function frequently improves during the early convalescent period. 7. Hemodynamic monitoring can be useful in following changes in left ventricular function and the response to therapy. The assessment of left ventricular performance in patients with chronic heart disease has shown: 1. Resting hemodynamic measurements are often normal but abnormalities can be observed in patients with disease of the left anterior descending coronary artery, diffuse coronary involvement, and after myocardial infarction. 2. Increases in end-diastolic volume or dilatation and left ventricular mass or hypertrophy can develop in severe coronary disease and after myocardial infarction. 3. The size of abnormally contracting segment after myocardial infarction is related to abnormalities in compliance, ventricular end-diastolic pressure, end-diastolic volume, and clinical manifestations of heart failure. 4. Exercise and atrial pacing can produce clinical and hemodynamic abnormalities. 5. The ejection fraction is significantly related to the slope of the ventricular function curve. 6. Angiographic abnormalities of left ventricular wall motion can be increased with atrial pacing and reduced with nitroglycerin or epinephrine.

Acute Disease↗
PubMed1991

[Effects of aging on right and left ventricular function in patients with right bundle branch block].

The effect of aging on cardiac function in patients with right bundle branch block (RBBB) was commonly unknown, so left ventricular function and right ventricular function were investigated, using first-pass radionuclide angiography. Twenty-six patients with RBBB and 28 normal subjects were studied at rest and during bicycle exercise. Patients with RBBB but normal cardiovascular systems aged 33 to 75 years were divided into those within 60 years (n = 17) and those over 65 years (n = 9). Using the same method, normal subjects aged 38 to 83 years were divided into those within 60 years (n = 18) and those over 65 years (n = 10). Mean age between normal subjects and patients with RBBB didn't differ significantly. The response of left ventricular ejection fraction in normal groups rose during exercise, but its exercise tolerance function declined with aging. Left ventricular diastolic filling in normal groups declined at rest and during exercise with aging. Left ventricular function in RBBB groups showed the same results as those of normal groups. The response of right ventricular ejection fraction and its exercise tolerance function in normal groups was not influenced by aging. However, in contrast, right ventricular function in RBBB groups decreased with aging. We suggest that the mechanism of decrease of right ventricular function in aging patients with RBBB may be caused by the change of right ventricular contraction which is affected by the aging process.

Adult↗
PubMed1986

Radionuclide measurement of right ventricular function in atrial septal defect, ventricular septal defect and complete transposition of the great arteries.

Right ventricular (RV) function was assessed in 80 patients with congenital heart disease by first-pass and gated equilibrium radionuclide angiography. In 30 patients with a ventricular septal defect (VSD) the mean RV ejection fraction (+/- standard deviation) was 64 +/- 7%. In 30 patients with a secundum atrial septal defect it was 61 +/- 9% and in 20 patients with surgically corrected complete transposition of the great arteries it was 49 +/- 13%. These values are in close agreement with values established with cineangiography for similar groups of patients. The mean ejection fraction in the group with transposition of the great arteries was significantly less than in the group with VSD (p less than 0.001). Phase analysis of the equilibrium studies showed that there was delayed RV contraction in many patients in the absence of conduction abnormalities. This delay was significantly greater in patients with atrial septal defect than in those with VSD (p less than 0.05). There was a strong correlation between size of left-to-right shunt and phase delay in patients with VSD (r = -0.72). Thus, first-pass gated radionuclide angiography provides a valid measurement of RV ejection fraction, and delayed RV contraction on phase analysis may be a sensitive index of early RV dysfunction.

Adolescent↗
PubMed2005

Marked improvement in left ventricular function and significant reverse left ventricular remodeling within 3 months of cardiac resynchronization therapy in patients with dilated cardiomyopathy.

We monitored reverse left ventricular (LV) remodeling and LV function during the first 6 months of cardiac resynchronization therapy (CRT) in 34 patients (mean age = 55.3 +/- 13.6 years, 28 men) with dilated cardiomyopathy (DCM), left bundle branch block, in stable New York Heart Association class III, and on fixed drug regimen who underwent implantation of CRT systems with or without cardioverter defibrillator back-up. QRS-complex duration was reduced from 169.69 +/- 19.6 ms (SD) to 144.1 +/- 23.4 ms during CRT. Parasternal M-mode and apical 2D-echocardiography was performed before and 3 and 6 months after device implantation. LV enddiastolic (EDD) and endsystolic (ESD) diameters were measured, and biplane LV enddiastolic (EDV), and endsystolic (ESV) volumes and ejection fractions (EF) were calculated using a modified Simpson formula. Significant decreases in LVEDD (P = 0.0064 at 3 months and P = 0.021 at 6 months), LVESD (P = 0.023 at 3 months, and P = 0.003 at 6 months), and LVESV (P = 0.006 resp. P = 0.007), and increases in LVEF (P = 0.003 at 3 months and P < 0.001 at 6 months) were observed. Mean LVEF increased from 23% at baseline to 39% at 6 months. CRT induced prominent reverse LV remodeling and significantly increased LVEF within a few months in patients with DCM.

Cardiac Pacing, Artificial↗
PubMed2001

Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in nonischemic cardiomyopathy.

OBJECTIVES: The purpose of this study was to determine whether higher left ventricular inotropic reserve, defined as the increase in left ventricular ejection fraction (LVEF) in response to intravenous dobutamine infusion, or other ventriculographic variables predict the increase in LVEF after beta-blocker therapy in patients with nonischemic cardiomyopathy (NICM). BACKGROUND: Long-term beta-blocker therapy increases LVEF in some patients with NICM. Other than dose, there are no definite predictors of LVEF increase. METHODS: Thirty patients with LVEF < or = 0.35 and NICM underwent assessment of LVEF at rest and after a 10-min intravenous infusion of dobutamine at 10 microg/kg/min, using equilibrium radionuclide ventriculography. Age was 49 +/- 11 years, 33% women, functional class 2.6 +/- 0.5, duration of chronic heart failure 3.2 +/- 2.9 years, LVEF 0.21 +/- 0.07, left ventricular end-diastolic volume index 180 +/- 64 ml/m2. Right ventricular ejection fraction (RVEF) was abnormal in 37%. Mean dobutamine-induced augmentation of LVEF (DoALVEF) was 0.12 +/- 0.08. Patients were started on one of three beta-blockers (carvedilol, bucindolol or metoprolol) and the dose was advanced to the maximum tolerated. RESULTS: Left ventricular ejection fraction, reassessed 7.4 +/- 5.9 months after maximum beta-blocker dose was reached, increased to 0.34 +/- 0.13 (p = 0.0006). The following baseline variables correlated with improvement of LVEF: DoALVEF (p = 0.001), RVEF (p = 0.005), systolic blood pressure at end of dobutamine infusion (p = 0.02) and dose of beta-blocker (p = 0.07). In a multivariate analysis, only DoALVEF (p = 0.0003) and RVEF (p = 0.002) were predictive of the increase in LVEF. CONCLUSIONS: Patients with nonischemic cardiomyopathy who have higher left ventricular inotropic reserve and normal RVEF derive higher increase in LVEF from beta-blocker therapy.

Adrenergic beta-Antagonists↗
PubMed2000

Transesophageal echocardiographic (TEE) evaluation of ventricular function.

Transesophageal echocardiography (TEE) provides excellent delineation of ventricular function in the ambulatory and critical settings. Major indications include the acutely ill patient with suboptimal images with other techniques and the intraoperative assessment of patients undergoing cardiac surgery and of cardiac patients undergoing noncardiac surgery. The methodology of quantification of ventricular function is quite accurate, though it has inherent limitations. Newer technologies, such as edge enhancement techniques, three-dimensional acquisition, and contrast agents, all have the potential to improve evaluation of ventricular function with TEE. Stress imaging with TEE is possible with dobutamine and with pacing techniques. This is sage and accurate, and it is indicated in patients, such as the morbidly obese, who are impossible to image by other methods.

Cardiac Output↗
PubMed1986

Right ventricular function in the hypoxaemic fetal sheep.

Right ventricular function was investigated in seven fetal sheep (125-130 days gestation) hypoxaemic at a mean of 5 days postoperation, and were compared to nine normoxaemic fetal sheep of the same gestation. Arterial O2 and CO2 tensions, pH, and haematocrit values for the hypoxaemic and normoxaemic fetuses were 15.6 +/- 1.0 vs. 20.6 +/- 1.8 torr, 49.4 +/- 4.1 vs. 46.1 +/- 1.6 torr, 7.38 +/- 0.02 vs. 7.39 +/- 0.02, and 29 +/- 7.5 vs. 31 +/- 5.3%, respectively. Right ventricular output and stroke volume were similar in the two groups, 241 +/- 57 vs. 247 +/- 75 ml X min-1 X kg-1 and 1.5 +/- 0.4 vs. 1.5 +/- 0.4 ml X kg-1, respectively. Filling and afterload pressures were also similar in the hypoxaemic and normoxaemic fetuses with right atrial pressure of 3.0 +/- 1.0 vs. 3.7 +/- 1.2 mmHg, and arterial pressure of 42 +/- 5 vs. 43 +/- 4 mmHg, respectively. Ventricular function curves were produced by rapid withdrawal and re-infusion of fetal blood producing curves with a steep ascending limb and a plateau phase. The breakpoint joining the limbs of the control function curve for the hypoxaemic and normoxaemic fetuses were right atrial pressure 2.9 +/- 1.0 vs. 3.4 +/- 1.2 mmHg and a stroke volume of 1.5 +/- 0.5 vs. 1.5 +/- 0.4 ml X kg-1, respectively. Linear regression of stroke volume against arterial pressure from 30-90 mmHg during infusions of nitroprusside and phenylephrine at right atrial filling pressures greater than breakpoint was stroke volume = 0.018 ml X kg-1 X mmHg-1 arterial pressure +/- 2.25 ml X kg-1. This equation is not different from that calculated in normoxaemic fetuses, and demonstrates that the fetal right ventricle is quite sensitive to changes in arterial pressure. These data indicate that reduction in fetal oxygen content by an estimated 40% does not affect fetal right ventricular function.

Animals↗
PubMed1978

Noninvasive assessment of left ventricular function in myotonic muscular dystrophy.

In order to assess left ventricular function, measurements of left ventricular internal dimension and its rate of change have been made by echocardiography in 7 patients with myotonic dystrophy and the three children of one of them, who were clinically normal but had abnormal muscle biopsies. Electrocardiograms and systolic time intervals were also recorded in all. Only one patient had signs of overt heart disease and an abnormal electrocardiogram (type B WPW). Systolic time intervals were normal in all 7 patients. Five subjects had echocardiographic abnormalities, which were of minor degree except in the patient with overt heart disease who had considerable impairment of both systolic and diastolic left ventricular function. Another patient had abnormalities of both systolic and diastolic function; systolic abnormalities occurred alone in one patient and diastolic abnormalities alone in one relative. It is concluded that patients with myotonic dystrophy and no clinical signs of heart disease may have minor abnormalities of left ventricular function as shown by echocardiography. Echocardiography is more sensitive than systolic time intervals in detecting these abnormalities; both systolic and diastolic function abnormalities, alone or together, can occur. There seems to be no relation between involvement of skeletal and cardiac muscle.

Adolescent↗
PubMed2005

Effect of transthoracic shocks on left ventricular function.

Although defibrillating shocks are thought to depress ventricular function transiently, the independent effects of high strength shocks (without the metabolic sequelae of pre-shock fibrillation) have not been assessed systematically in humans. Therefore, we delivered three consecutive synchronized monophasic transthoracic shocks (200, 200 and 360 J) at 60s intervals during sinus rhythm and evaluated the effect on left ventricular chamber size and function as determined by transesophageal echocardiography in 11 patients (mean age 67+/-8 years, 9M/2F) with depressed left ventricular function (left ventricular ejection fraction: 14-37%). The shocks did not alter hemodynamics consistently. On average, the shocks did not alter stroke volume, cardiac output, left ventricular ejection fraction or regional wall thickening (all p>0.05 versus baseline). This effect was highly variable and 36% of patients experienced a >25% reduction in cardiac output by the final shock. There was a tendency for regional wall thickening to worsen in the best baseline sextant with an offsetting significant increase in thickening in the worst baseline sextant (p=0.05). Thus, repetitive defibrillation strength transthoracic shocks do not impair left ventricular function consistently in patients with cardiomyopathy. However, the effect is widely variable and potentially important depression of left ventricular function does occur in some patients.

Aged↗
PubMed1999

Real-time interactive magnetic resonance imaging with multiple coils for the assessment of left ventricular function.

Interactive real-time examination of left ventricular function in healthy volunteers both under rest and stress conditions has been performed. For this purpose, a system combining an interactive user interface, an ultrafast segmented echo-planar imaging sequence, and real-time reconstruction and display of the acquired images was designed. Magnetic resonance images were acquired at rates of up to 20 images per second with multiple receiver coils. By using a sliding window reconstruction technique, reconstruction rates of up to 60 images per second were achieved with a latency of < 100 msec. The quality of the real-time images was evaluated both qualitatively and quantitatively and was found to be appropriate for the determination of left ventricular function. It is concluded that the combination of dedicated components provides a convenient modality for the high-quality visualization of left ventricular function under rest and stress conditions at video frame rates with magnetic resonance imaging. J. Magn. Reson. Imaging 1999;10:826-832.

Echo-Planar Imaging↗
PubMed1989

Effect of pyruvate on regional ventricular function in normal and stunned myocardium.

The prolonged ventricular dysfunction following brief periods of coronary artery occlusion that does not produce irreversible damage has been termed the "stunned" myocardium. Although ventricular function returns to preischemic values by 1 to 7 days after reperfusion is established, inotropic therapy may be necessary to enhance contractility in the stunned heart. The purpose of this study was to determine the effect of pyruvate on ventricular function in normal and stunned myocardium. Eight chloralose/urethane anesthetized dogs were instrumented with ultrasonic crystals to measure systolic wall thickening in the left anterior descending artery (LAD) and left circumflex artery perfused regions of the left ventricle. Pyruvate (1 ml/min of 150 mM sodium pyruvate, pH 7.4) was infused directly into the LAD prior to and 30 minutes after a 10 minute LAD occlusion. Prior to LAD occlusion, LAD pyruvate infusion increased systolic wall thickening in the LAD-perfused region from 16.2% +/- 4.3% to 23.4% +/- 5.1% (p less than 0.05). Thirty minutes after LAD occlusion, regional wall thickening was depressed (3.3% +/- 2.6%; p less than 0.05), which is indicative of stunned myocardium. Subsequent LAD pyruvate infusion increased wall thickening in the stunned myocardium to 12.7% +/- 2.5%. The improvement of regional ventricular function was maintained only during the pyruvate infusion, as function returned to prepyruvate levels within 20 minutes after cessation of pyruvate infusion. These data indicate that pyruvate exerts a positive inotropic effect in normal and stunned myocardium. If pyruvate, a key intermediate in energy-producing pathways, exerts its inotropic effect through an enhancement of the energy state of the heart, it may have advantages over traditional inotropic agents in the treatment of postischemic contractile dysfunction.

Animals↗
PubMed1995

Left ventricular function following thrombolytic therapy for myocardial infarction.

1. The aim of this study was to evaluate the utility of measurement of left ventricular function in assessing the efficacy of thrombolytic agents. 2. All published studies were reviewed. 3. The major effect of the introduction of thrombolytic therapy on mortality after myocardial infarction has been a dramatic decrease in the number of patients dying from cardiac failure. In the thrombolytic era, left ventricular function has remained the most important prognostic factor after recovery from acute myocardial infarction. There are three trials with the statistical power to evaluate left ventricular function, where both left ventricular function and survival were improved compared to placebo or control treatment. The recent Global Utility of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) Trial supports these findings, with left ventricular function being strongly correlated with mortality reduction. Left ventricular function, measured at 90 min either as ejection fraction, end-systolic volume or infarct zone contractility, closely correlated with 30 day mortality, P < 0.01. 4. Left ventricular function remains an important factor in the evaluation of the efficacy of different thrombolytic and adjuvant regimens.

Humans↗
PubMedDate not supplied

Effect of ageing on the relationship between early diastolic left ventricular function and mitral valve motion.

OBJECTIVE: The relationships between age and diastolic left ventricular function, and age and mitral valve motion were studied. DESIGN: The maximum velocity of circumferential fibre lengthening (negative peak Vcf) of left ventricular function and mitral valve motions, such as mitral valve E and A wave amplitude, D-E and E-F slopes, and their relationships were assessed. SUBJECTS: Twenty young, healthy persons (10 males and 10 females) from 20 to 47 years old (mean 34.5), and 26 older healthy subjects (five males and 21 females) from 62 to 94 years old (mean 80.0) were studied. INTERVENTION: M-mode echocardiography of left ventricular function and mitral valve motion were recorded and digitized for the assessment. MAIN RESULTS: Age showed a significant (P = 0.0001) correlation with negative peak Vcf (r = -0.62), with E wave amplitude (r = -0.83), with D-E slope (r = -0.71) and with E-F slope (r = -0.83). Negative peak Vcf was correlated with E wave amplitude (r = 0.51, P = 0.0007), with D-E slope (r = 0.31, P = 0.058), with E-F slope (r = 0.53, P = 0.0005). Its relations with mitral valve A wave amplitude was r = -0.30, P = 0.17 in the elderly group and r = 0.003, P = 0.99 in the younger group. A significant (P < 0.001) positive, linear correlation was observed between age and mitral A/E ratio (r = 0.82). CONCLUSIONS: The easily measurable mitral valve E-F slope and E wave amplitude can be used to assess early diastolic left ventricular function in ageing. Left atrial contraction appears to play a more important role in the elderly, compensating for the decline in early diastolic left ventricular function.

Adult↗