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PubMedDate not supplied

High-dose dipyridamole and gated sestamibi SPECT imaging provide diagnostic resting and stress ejection fractions useful for predicting extent of coronary artery disease.

A decline in ejection fraction at stress compared with rest images has been associated with increased severity of coronary artery disease (CAD) and suggests a poorer prognosis. Myocardial perfusion imaging (MPI) using high-dose dipyridamole (HDD) has been shown to more accurately detect CAD than either standard dose dipyridamole (SDD) or exercise-induced stress (EST), but has not been looked at to determine its usefulness in detecting changes in stress and rest ejection fractions. To determine the relationship between changes in left ventricular ejection fraction (LVEF) and the severity of CAD, 36 Individuals underwent gated single photon emission computed tomography (SPECT) MPI using HDD. In each case resting and stress LVEFs were determined along with MPI results. Subjects with single-vessel CAD demonstrated an increase in LVEF from 77.8% (sd +/-8.8%) to 85.6% (sd +/-8.4%) resulting in a statistically significant increase in LVEF of 7.8% (p = 0.009). Patients with two-vessel disease showed a smaller increase from 73.2% (sd + 8.3%) to 79.8% (sd + 9.8%) following HDD stress. This increase was statistically (p = 0.008) significant. Patients with triple-vessel CAD showed a reduction in LVEF from 67.4% (sd +/-14.07) to 65.1% (sd +/-16.5%) which represented a decrease in LVEF of 2.7% and approached (p = 0.25) but did not reach statistical significance. Both the resting and stress LVEFs were statistically lower (p<0.05) in patients with triple-vessel CAD. Changes in resting LVEF (REF) and HDD pharmacologically induced stress LVEF (SEF) provide a valuable diagnostic marker as to the number of significantly diseased coronary arteries and can be acquired from gated SPECT sestamibi images.

Adult↗

PubMed1982

Effect of the geometry of the left ventricle on the calculation of ejection fraction.

We used a cylindrical model for the left ventricle contracting both radially and longitudinally to show how the ejection fraction is related to different variables that describe the ventricular geometry. The relations during ventricular contraction between wall thickening, midwall radius shortening and longitudinal shortening are used to derive precise formulas for the calculation of ventricular blood flow velocity and ejection fraction. Validation of the model is given by results from the literature and by a study of 40 patients. The formulas derived can be used to validate angiographic measurements or to assess more precisely blood flow velocity and ejection fraction from the M-mode echocardiogram. Ejection fraction is determined not only by the extent of myocardial shortening, but also by the relationship of ventricular wall thickness to ventricular cavity size.

Cardiac Output↗

PubMed1993

Comparative neurohormonal responses in patients with preserved and impaired left ventricular ejection fraction: results of the Studies of Left Ventricular Dysfunction (SOLVD) Registry. The SOLVD Investigators.

OBJECTIVES: The aim of this study was to determine the differences in neurohumoral responses between patients with pulmonary congestion with and without impaired left ventricular ejection fraction. BACKGROUND: Previous studies have established the presence of neurohumoral activation in patients with congestive heart failure. It is not known whether the activation of these neurohumoral mechanisms is related to the impairment in systolic contractility. METHODS: The 898 patients recruited into the Studies of Left Ventricular Dysfunction (SOLVD) Registry substudy were examined to identify those patients with pulmonary congestion on chest X-ray film who had either impaired (< or = 45%, group I) or preserved (> 45%, group II) left ventricular ejection fraction. Plasma norepinephrine, plasma renin activity, arginine vasopressin and atrial natriuretic peptide levels were measured in these two groups of patients and compared with values in matched control subjects. RESULTS: Distribution of the New York Heart Association symptom classification was the same in the two groups of patients. Compared with control subjects, patients in group II with pulmonary congestion and preserved ejection fraction had no activation of the neurohumoral mechanisms, except for a small but statistically significant increase in arginine vasopressin and plasma renin activity. Compared with patients in group II, those in group I with pulmonary congestion and impaired ejection fraction had significant increases in plasma norepinephrine (p < 0.002), plasma renin activity (p < 0.02) and atrial natriuretic peptide levels (p < 0.0007). When we controlled for baseline differences between groups I and II, the between-group differences in plasma norepinephrine (p < 0.02) and atrial natriuretic peptide (p < 0.002) remained significant. However, plasma renin activity was not significantly different between groups I and II. When the effects of diuretic agents and angiotensin-converting enzyme inhibitors were adjusted, patients with lower ejection fraction were found to have significantly higher plasma norepinephrine and atrial natriuretic peptide levels. CONCLUSIONS: The results point to the importance of the decrease in left ventricular ejection fraction as one of the mechanisms for activation of neurohormones in patients with heart failure.

Adult↗

PubMed1996

Right ventricular ejection fraction in the preoperative risk evaluation of candidates for pulmonary resection.

The major determinants of postoperative morbidity and mortality after lung resection are the physiologic and functional statuses of the pulmonary and cardiac systems. In our previous study, serial measurements of right ventricular performance after pulmonary resection demonstrated significant right ventricular dysfunction in the postoperative period. This study evaluates the preoperative measurement of right ventricular ejection fraction as a predictor of postoperative complications. In addition to conventional cardiopulmonary functional tests, right ventricular function was assessed with a thermodilution technique at rest and during exercise in 18 patients before and 3 weeks after lobectomy or pneumonectomy. The patients were grouped according to severity of right ventricular functional defect: right ventricular ejection fraction of at least 45% (group Ia, n = 8), right ventricular ejection fraction less than 45% (group Ib, n = 10), exercise-induced increases in right ventricular ejection fraction (group IIa, n = 8), and exercise-induced decreases in right ventricular ejection fraction (group IIb, n = 10). Postoperative cardiopulmonary morbidity was recorded for two patients (25%) in group Ia, three patients (30%) in group Ib, no patients (0%) in group IIa, and five patients (50%) in group IIb. Postoperative hospital stay was 28.9 +/- 8.5 days in group Ia, 29.9 +/- 20.2 days in group Ib, 19.4 +/- 8.0 days in group IIa, and 37.5 +/- 15.9 days in group IIb (p < 0.05, group IIa vs group IIb). Although resection-induced changes in forced expiratory volume in 1 second did not differ significantly between group Ia and group Ib, these values appeared to be increased in groups IIa (not statistically significant) and IIb (significantly, p < 0.05). The measured postoperative values of forced expiratory volume in 1 second and vital capacity were significantly higher than the predicted postoperative values (p < 0.05) in group IIa, but not in groups Ia, Ib, and IIb. We conclude that evaluation of right ventricular performance is useful in determining which patients are at increased risk for medical complications after lung resection. Exercise-induced change in right ventricular ejection fraction may be a better indicator of high risk among candidates for pulmonary resection than the absolute value of this parameter.

Aged↗

PubMed2025

Finerenone-Related Risk of Hypotension in Heart Failure With Mildly Reduced or Preserved Ejection Fraction.

BACKGROUND: The nonsteroidal mineralocorticoid receptor antagonist finerenone reduces clinical events in heart failure with mildly reduced ejection fraction/preserved ejection fraction; however, the implications of treatment-related hypotension are unknown. OBJECTIVES: The authors investigated predictors of systolic blood pressure (SBP) <100 mm Hg and investigator-reported hypotension and their associations with randomized treatment and clinical outcomes in the FINEARTS-HF (Study to Evaluate the Efficacy [Effect on Disease] and Safety of Finerenone in Participants With Heart Failure and Left Ventricular Ejection Fraction [Proportion of Blood Expelled Per Heart Stroke]) trial. METHODS: FINEARTS-HF was a randomized, placebo-controlled trial of finerenone in symptomatic patients with chronic heart failure (left ventricular ejection fraction ≥40%). Predictors of SBP <100 mm Hg and hypotension were identified using Cox models. Associations between SBP <100 mm Hg and hypotension, treatment, and clinical outcomes were evaluated using time-updated Cox models. The primary outcome was a composite of total heart failure events and cardiovascular death. RESULTS: Among the 5,815 participants with available data, post-baseline SBP <100 mm Hg occurred in 899 (538 with finerenone vs 361 with placebo; odds ratio: 1.60; 95% CI: 1.38-1.85) and investigator-reported hypotension in 364 patients (225 with finerenone vs 139 with placebo; odds ratio: 1.67; 95% CI: 1.34-2.08). Participants experiencing SBP <100 mm Hg had lower baseline SBP, were older, had higher N-terminal pro-B-type natriuretic peptide levels, a history of smoking, and no diabetes. Treatment-related risk of the primary endpoint was reduced in patients with no/before SBP <100 mm Hg (rate ratio: 0.78; 95% CI: 0.67-0.90) and appeared to attenuate afterwards (rate ratio: 0.99; 95% CI: 0.70-1.39), although no formal statistical interaction was observed (Pinteraction = 0.33). CONCLUSIONS: In this prespecified analysis of the FINEARTS-HF trial, finerenone led to higher rates of post-baseline SBP <100 mm Hg and investigator-reported hypotension. Although hypotension should not prompt automatic treatment discontinuation, these patients should be carefully monitored. (Study to Evaluate the Efficacy (Effect on Disease) and Safety of Finerenone in Participants With Heart Failure and Left Ventricular Ejection Fraction (Proportion of Blood Expelled Per Heart Stroke) Greater or Equal to 40% [FINEARTS-HF]; NCT04435626).

Humans↗

PubMed2006

Diastolic heart failure or heart failure with a normal ejection fraction.

Nearly half of patients with symptoms of heart failure are found to have an left ventricular (LV) ejection fraction which is within normal limits. These patients have variously been labeled as having diastolic heart failure, heart failure with preserved LV function or heart failure with normal ejection fraction (HFNEF). Since recent studies have shown that systolic function is not entirely normal in these patients, HFNEF is the better term. More common in elderly females it has a mortality similar to heart failure with a reduced ejection fraction (HFREF). The exact pathophysiology of the symtpoms is still not clear and, therefore, debated. As heart failure is often episodic, the underlying abnormal mechanisms may not be completely apparent at rest. It is likely there is a mixture of systolic and diastolic dysfunction which will be different to some degree in individual patients and isolated diastolic dysfunction or primary abnormalities of relaxation are probably extremely rare. The main difference between HFNEF and HFREF is the degree of ventricular remodeling with increased ventricular volumes in HFREF. The time course of remodeling depends to some extent on the aetiology being quicker post myocardial infarction--the commonest cause of HFREF, and slower with hypertension which is the most frequent aetiological factor in HFNEF. Ventricular volumes rather than ejection fraction or the concept of a pure diastolic abnormality can be used to classify patients in a more rational manner.

Aging↗

PubMed1986

Yield of endomyocardial biopsy in patients with biventricular failure. Comparison of patients with normal vs reduced left ventricular ejection fraction.

Twenty five patients with biventricular failure underwent endomyocardial biopsy procedures. Twelve of these 25 patients had normal left ventricular ejection fraction. Endomyocardial biopsy sampling was useful in eight of 12 patients (67 percent) with biventricular failure and normal left ventricular ejection fraction. Biopsy specimens in five of these 12 patients demonstrated endocardial or infiltrative heart disease and excluded these diseases in three other patients with constrictive pericarditis. This study suggests that the clinical presentation of biventricular failure, combined with the noninvasive determination of a normal left ventricular ejection fraction, is helpful in selecting patients for endomyocardial biopsy study. Patients with biventricular failure and normal left ventricular ejection fractions have a high probability of having pericardial or infiltrative heart disease, conditions that often can be differentiated only by analysis of myocardial tissue. Hemodynamic assessment of patients without infiltrative processes further allows one to eliminate those patients with a high likelihood of having constrictive pericardial disease.

Adolescent↗

PubMed1998

Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions.

AIMS: This study assessed changes in left ventricular ejection fraction and regional radial shortening after successful angioplasty of chronic coronary occlusions. METHODS: We studied 95 patients with angina pectoris or exercise-induced ischaemia with a successfully recanalized chronic (median duration 4.3 months) coronary occlusion. Intracoronary stents were implanted in 71%. Left ventriculograms were obtained at baseline and after 6.7 +/- 1.4 months. Left ventricular ejection fraction and regional radial shortening were determined by a computer-assisted method. RESULTS: Left ventricular ejection fraction increased from 0.62 +/- 0.13 at baseline to 0.67 +/- 0.11 at follow-up (P < 0.001). The change in left ventricular ejection fraction in patients with a patent artery and in patients with reocclusion (n = 8) was 0.05 +/- 0.06 and 0.01 +/- 0.04, respectively (P = 0.04). Regional radial shortening in the territory of the recanalized artery increased by 16% (from 0.28 +/- 0.11 to 0.32 +/- 0.11, P < 0.001) in patients with a patent artery at follow-up, but was unchanged in patients with reocclusion. CONCLUSION: Long-term patency after recanalization of old, chronic coronary occlusions in patients with angina pectoris is associated with improvement in global and regional left ventricular function. This may be a result of recovery of hibernating myocardium and supports the strategy of recanalizing chronic coronary occlusions.

Adult↗

PubMed2003

Relationship between the changes in myocardial perfusion and left ventricular ejection fraction after acute myocardial infarction. Study with myocardial contrast echocardiography.

BACKGROUND AND OBJECTIVE: Myocardial contrast echocardiography has recently been proposed as a valid technique in the evaluation of myocardial perfusion after myocardial infarction. The objective of this study was to evaluate the relation between changes in myocardial perfusion assessed by myocardial contrast echocardiography and left ventricular ejection fraction after myocardial infarction. PATIENTS AND METHODS: We prospectively studied 17 patients with acute myocardial infarction, on whom two echocardiographic studies were performed, at 48-72 hours and at 6 months. Left ventricular ejection fraction and myocardial perfusion were evaluated with myocardial contrast echocardiography (Multiple-Frame Triggering and Harmonic Angio). Basal, medial and distal segments of the interventricular septum (anterior location infarction) and inferior wall (inferior infarction) were assessed. Myocardial perfusion was classified semi-quantitatively as grade 0, 1 or 2 (absent, heterogeneous or homogeneous opacification, respectively), giving a perfusion score. RESULTS: Left ventricular ejection fraction improved in 9 patients (53%), the proportion of grade 0 segments decreasing by 11 +/- 17%; by contrast, this proportion increased by 9 +/- 13% in patients with no improvement in ejection fraction (p = 0.028). Additionally, a significant correlation was observed between changes in ejection fraction and both perfusion score (r = 0.625; p = 0.007) and the proportion of grade 2 segments (r = 0.649; p = 0.005). CONCLUSION: After myocardial infarction, there is a significant relation between changes in left ventricular ejection fraction and myocardial perfusion assessed by myocardial contrast echocardiography with i.v. agents.

Aged↗

PubMed1986

Comparison of ejection fraction and pulmonary blood volume ratio as markers of left ventricular function change after coronary angioplasty.

Exercise-induced increases in pulmonary blood volume ratio have been shown to be a sensitive marker of coronary artery disease, and correlate well with exercise-induced increases in left ventricular filling pressure. To compare the impact of single vessel coronary disease on left ventricular systolic function (ejection fraction) versus diastolic filling pressure (pulmonary blood volume) before and after intervention, serial supine exercise gated blood pool scans were performed before and after coronary angioplasty in 32 patients with isolated left anterior descending coronary artery disease. By applying previously established criteria of abnormal ejection fraction (rest less than 50% or failure to rise by 5% with exercise) and pulmonary blood volume ratio (greater than 1.06), 66% of the patients were found to have abnormal responses before angioplasty by ejection fraction compared with 81% abnormal responses by pulmonary blood volume ratio (p = 0.15). After angioplasty, the proportion of patients with abnormal ejection fraction (59%) was essentially unchanged, whereas only 38% continued to have an abnormal pulmonary blood volume ratio (p less than 0.01 compared with before angioplasty). The mean pulmonary blood volume ratio also decreased significantly from 1.15 +/- 0.10 before angioplasty to 1.02 +/- 0.15 after angioplasty (p less than 0.001). It is concluded that in single vessel coronary artery disease: 1) pulmonary blood volume ratio is abnormal at least as frequently as is ejection fraction; 2) in contrast to ejection fraction, pulmonary blood volume ratio improves significantly after successful angioplasty; and 3) pulmonary blood volume ratio may be a more sensitive indicator of changes in ventricular function after an intervention in single vessel coronary disease.

Adult↗

PubMed1975

[The relationships between left ventricular volumes and ejection fraction in mitral and aortic regurgitation (author's transl)].

In 2 groups of patients with mitral valvular incompetence (MI, n equals 20) and aortic valvular incompetence (AI, n equals 22) intracardiac pressures as well as left ventricular volumes (enddiastolic volume, endsystolic volume, stroke volume, ejection fraction, regurgitant volume) were determined during routine left heart catheterization and left ventriculography. Data obtained were compared with a normal group (N, n equals 20). 1. Enddiastolic volume was increased by 32 per cent (MI) and 180 per cent (AI) respectively in comparison to normal. Endsystolic volume was increased by 85 per cent (MI) and 113 per cent (AI). Total stroke volume exhibited increases by 11 per cent (MI) and 86 per cent (AI) respectively. Regurgitant volume averaged 64 per cent (AI) of total stroke volume, and 47 per cent in MI. Left ventricular ejection fraction was reduced in both groups by about 12-14 per cent. 2. enddiastolic volume was significantly dependent on the amount of regurgitant volume in both groups (MI, AI). Likewise total stroke volume increased with increments in enddiastolic volume. This increase was far mor pronounced (up to 250 per cent of normal) in AI in comparison to MI and may be referred to an effective contribution of the Frank-Starling-Straub-mechanism, induced by increased preload following regurgitation. There existed no correlation between enddiastolic volume or regurgitant volume and the effective forward stroke volume and other parameters of forward pump function (effective cardiac output, cardiac index, external cardiac work). Left ventricular compliance, as determined by diastolic pressure-volume relationships, was nearly the same in the 3 groups (N, MI, AI). 3. Left ventricular ejection fraction was nearly unchanged with increments in enddiastolic volume over a range of enddiastolic volumes up to 400 ml. At higher enddiastolic volume (is greater than 400 ml) decreases were found. In the failing heart with AI left ventricular ejection fraction was reduced even at low enddiastolic volume, exerted by decreases of fibre shortening and contractility. In contrast, in MI ejection fraction decreased with increments of enddiastolic volume over the whole range investigated. The increase in total stroke volume in both groups therefore was produced by increases of enddiastolic volume and to a very small extent by an increase of the ejection fraction. 4. The large contractility reserve in compensated AI may be referred to the altered contraction mechanism in aortic valvular regurgitation associated with i) decrese of isovolumic pressure development and increase of isotonic contraction, ii) increase of diastolic fibre stretch (preload) and iii) decrease of mean wall tension. Contractility reserve was essentially influenced by myocardial contractility. With decreases of contractility consecutively decreases of the total and the effective pump function of the left ventricle may occur despite unchanged contraction form and left ventricular dimensions.

Animals↗

PubMed1979

Response of right ventricular ejection fraction to upright bicycle exercise in coronary artery disease.

The right ventricular (RV) response to exercise was assessed in 32 patients with angiographically documented coronary artery disease and in 14 normal controls without cardiopulmonary disease. The relationships between exercise RV reserve, exercise left ventricular (LV) reserve, and the presence of proximal right coronary stenosis were also evaluated. RV and LV ejection fractions were determined using first-pass radionuclide angiocardiograms. The normal response to exercise was at least a 5% absolute increase in RV and LV ejection fractions. In the group with coronary artery disease, RV ejection fraction either decreased or remained the same with exercise (abnormal exercise RV reserve) in 19 of 32 patients. LV exercise reserve was abnormal in 26 of 32 patients. All 19 patients with abnormal exercise RV reserve had abnormal exercise LV reserve, and all six patients with normal LV reserve had normal RV reserve. There was a significant linear relationship between the direction and magnitude of change from rest to exercise of LV ejection fraction and RV ejection fraction (r = 0.77). In contrast, the RV response to exercise was not primarily dependent upon the presence or absence of proximal right coronary stenosis. These data suggest that abnormal exercise RV reserve occurs frequently in coronary artery disease and that the concomitant LV response to exercise appears to be its major determinant.

Adult↗

PubMedDate not supplied

Automated echocardiographic quantification of left ventricular volumes and ejection fraction: validation in the intensive care setting.

To validate automated boundary detection measurements of left ventricular volumes, cardiac output, and ejection fraction, we studied 50 patients in the intensive care unit. End-diastolic volume, end-systolic volume, and ejection fraction were calculated by automated boundary detection and compared with two-dimensional echocardiographic images. Automated boundary detection-derived cardiac output was compared with thermodilution measurements and Doppler calculations of flow through the aortic and pulmonic valves. Automated boundary detection agreed well with two-dimensional measurements for end-diastolic volume (r = 0.98), end-systolic volume (r = 0.98), and ejection fraction (r = 0.91). Cardiac output derived from automated boundary detection correlated with two-dimensional echocardiographic measurements (r = 0.84), thermodilution (r = 0.83), aortic valve Doppler (r = 0.75), and pulmonic valve Doppler (r = 0.60). Automated boundary detection measurements of left ventricular volumes, ejection fraction, and derived cardiac output are feasible in patients in intensive care units. This method yields rapid, accurate result compared with thermodilution, two-dimensional images, and Doppler measurements.

Aged↗

PubMed1998

Quantitation of left ventricular volumes and ejection fraction in post-infarction patients from biplane and single plane two-dimensional echocardiograms. A prospective longitudinal study of 371 patients.

AIMS: To determine whether left ventricular volumes and ejection fractions calculated from single plane two-dimensional echocardiograms using the algorithm (0.85A2L) correlate with those calculated using the biplane Simpson's method, and whether small changes in volumes and ejection fraction occurring post-infarction could be detected from single-plane as well as from biplane two-dimensional echocardiograms. METHODS AND RESULTS: Serial two-dimensional echocardiograms were obtained in 371 patients from the DEFIANT II trial a mean of 2 days, 1 week and 6 months post-infarction. Single plane volumes from the apical four chamber and apical long axis correlated closely with biplane Simpson's left ventricular volumes. Both single-plane left ventricular volumes significantly over-estimated biplane Simpson's volumes. Biplane Simpson's ejection fractions were consistently slightly under-estimated from the single-plane images. Differences between biplane Simpson's and single-plane volumes increased independently with increasing left ventricular size and distortion. The small changes in left ventricular volumes and ejection fraction over time were as reliably detected from single plane as from biplane images. CONCLUSION: Single-plane left ventricular volumes over-estimate biplane Simpson's volumes and under-estimate ejection fraction, and these discrepancies are amplified in dilated hearts with abnormal shape.

Adult↗

PubMed1981

Relations between ejection fraction and ventricular volume, and their alteration by chronic beta-blockade.

This study describes the newly discovered relation between ejection fraction and end-systolic volume index (ESVI) of the left ventricle as obtained by angiography at the time of cardiac catheterisation. Linear regression analysis shows that ejection fraction (%)=82.0-0.62 ESVI (ml/m2) but the correlation for patients receiving beta-adrenergic blocking drugs is significantly lower compared with the untreated group. Non-linear analysis, applied to cover also the asymptotic range for ejection fraction less than 20%, shows similar results. The good relation between the two indices indicates that the index ejection fraction may derive its clinical importance directly from the more fundamental index end-systolic volume index by virtue of the operation of the beta-adrenergic system on the heart.

Adrenergic beta-Antagonists↗

PubMed2004

Survival benefit after revascularization is independent of left ventricular ejection fraction improvement in patients with previous myocardial infarction and viable myocardium.

PURPOSE: This study was designed to assess the relationships among myocardial viability, changes in left ventricular (LV) ejection fraction after coronary revascularization and long-term event-free survival in patients with previous myocardial infarction and LV dysfunction. METHODS: We studied 253 patients with previous myocardial infarction and evidence of dysfunctional viable myocardium as assessed by echocardiography and 99mTc-sestamibi imaging. Coronary revascularization was performed in 142 patients, while 111 were medically treated. In revascularized patients, echocardiography was repeated 12 months later to detect LV ejection fraction improvement, defined as an increase of > or =5% compared with baseline. All patients were followed for a mean period of 52+/-29 months. Cardiac death and non-fatal myocardial infarction were considered as events. RESULTS: Event-free survival was higher in revascularized than in medically treated patients (P<0.001). Ejection fraction increased by > or =5% in 82 (58%) revascularized patients, and the extent of viable myocardium was the strongest predictor of such improvement (P<0.001). Event-free survival was similar for patients with (n=82) and patients without (n=60) LV ejection fraction improvement after revascularization, and it was better in revascularized than in medically treated patients in the presence of either substantial (> or =5 viable segments) or low-intermediate (1-4 viable segments) viability (both P<0.01). CONCLUSION: In patients with previous myocardial infarction and evidence of viable myocardium, coronary revascularization procedures improve outcome at long-term follow-up independently of LV ejection fraction improvement.

Comorbidity↗

PubMed1977

The assessment of left ventricular ejection fraction in patients with ischaemic heart disease by contrast ventriculography and nuclear angiography.

1. In 18 patients with ischaemic heart disease left ventricular ejection fraction, measured by two different nuclear angiographic methods, has been compared with ejection fraction measured by single-plane contrast angiography. 2. The first nuclear angiographic technique involves detection of variation in the radio-activity from the left ventricle during the initial passage of a bolus of 99Tcm-labelled human serum albumin injected intravenously; the second is our own modification of a "gated" method, which accumulates the radioactivity detected during the continuing recirculation of the plasma bound radioisotope, so presenting an "averaged" ventricular volume curve. 3. Ejection fraction, measured by the "bolus" method, is lower than that measured either by contrast ventriculography or by the "gated" method. This may be due to a damping effect. 4. Ejection fraction measured by the "gated" method is well correlated with that measured by contrast ventriculography (r = 0-89). 5. Our modification of the "gated" method, which presents the changes in ventricular volume throughout the cardiac cycle, without needing computer facilities, is a useful non-invasive means for assessment of left ventricular function.

Angiography↗

PubMed1983

Left ventricular ejection fraction during cardiac surgery: a two-dimensional echocardiographic study.

Although long-term effects have been studied, the immediate effect of surgery for acquired heart disease on left ventricular function is not well defined. Accordingly, 44 adults with acquired heart disease underwent intraoperative two-dimensional echocardiography with a gas-sterilized transducer before and immediately after cardiopulmonary bypass. Ejection fraction was measured by short-axis area change at the maximum left ventricular cross section (SAAC-EF) and also by a method using multiple sections. Correction of both mitral and aortic regurgitation produced a significant intraoperative decrease in ejection fraction from 0.49 +/- 19 (SD) to 0.32 +/- 0.16 (p less than .02) and from 0.41 +/- 0.13 to 0.30 +/- 0.17 (p less than .0005), respectively. Relief of aortic stenosis and mitral stenosis resulted in an intraoperative increase in ejection fraction from 0.45 +/- 0.10 to 0.55 +/- 0.09 (p less than .02) and from 0.41 +/- 0.05 to 0.50 +/- 0.07 (p less than .05), respectively. Ejection fraction after coronary artery bypass grafting was unchanged. Preload (end-diastolic area) was significantly decreased after correction of aortic regurgitation (p less than .02) but unchanged in other lesions. We conclude that (1) correction of pure mitral and aortic valvular lesions produces characteristic alterations in ejection fraction in the immediate postoperative period; (2) with the possible exception of patients with aortic regurgitation, the observed change in ejection fraction does not appear to reflect changes in preload; (3) noninvasive assessment of left ventricular function by two-dimensional echocardiography during cardiac surgery appears feasible and could provide data important for clinical decision making in the early postoperative period.

Aged↗