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PubMed1995

A new, simple and accurate method for determining ejection fraction by Doppler echocardiography.

OBJECTIVE: To evaluate the feasibility, accuracy and reproducibility of a new and simple method for determining ejection fraction by Doppler echocardiography. This method should theoretically be less influenced by the distortions of left ventricular geometry caused by prior myocardial infarction. DESIGN: Two groups of patients (total 114) were evaluated independently at the Quebec and Ottawa Heart Institutes (60 and 54 patients, respectively). All were referred for radionuclide angiography performed within 24 h of the echocardiogram. Regional asynergy was present in 59% of Quebec patients and 37% of Ottawa patients. The new method for calculating ejection fraction consisted of dividing Doppler derived stroke volume in the left ventricular outflow tract by left ventricular end-diastolic volume calculated by Teichholz's formula; for comparison, ejection fraction was also measured by single plane area length or multiple disc planimetry as well as by the Quinones method at the Quebec Heart Institute. RESULTS: Feasibility of the new method was 97% in Quebec and 100% in Ottawa. Compared with radionuclide angiography, the correlation coefficient for the new method was 0.92 (standard error of estimate [SEE] = 7.3) in Quebec compared with 0.88 (SEE = 8.5 and 8.1) for both the Quinones and single plane area length methods, and 0.84 (SEE = 12.0) in Ottawa compared with 0.77 (SEE = 10.9) for the single plane multiple disc method. Correlations in patients with regional asynergy were 0.90 in Quebec and 0.75 in Ottawa compared with 0.81 and 0.54 with planimetry. Correlation coefficients for interobserver variability in 12 patients were 0.97 with the new method compared with 0.83 with the Quinones method and 0.85 with single plane planimetry. CONCLUSION: This new and simple method is feasible, accurate and reproducible even in patients with regional asynergy. Provided there is no significant mitral regurgitation, it is a time-saving alternative for the routine evaluation of ejection fraction by Doppler echocardiography.

Angiocardiography↗
PubMedDate not supplied

[Right and left ventricular ejection fraction evaluation in patients with chronic pulmonary disease. Comparison of nuclear medicine methods].

UNLABELLED: Our aim was to evaluate right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF) in patients with chronic pulmonary disease (CPD) during a standard 99mTc-isonitrilium myocardial perfusion study. Forty patients (14 women and 26 men, mean age 67.7 +/- 7 years old) suffering from CPD enrolled in this study. Patients were consecutively submitted to: a) First pass (FP) angiocardiography with 99mTc (Tauc-FP). b) Multigated angiocardiography (MUGA). c) FP with 99mTc-sestamibi (MIBI-FP). d) Gated FP (MIBI-gFP) and GatedSPECT was performed in 23 patients. A simple SPECT study was performed to the rest of them. Our results showed: For the RV: RVEF measured by each method: Tauc-FP =49.09+/-8.4%, MUGA =48.51+/-10.6%, MIBI-FP =49.45+/-7.8 % and MIBI-gFP =52.49+/-6.05%. No difference among these methods was noted (P=0.674). MIBI-FP ejection fraction range was wider than MIBI-gFP and narrower than MUGA. A strong correlation (r=0.88 P<0.01) and good agreement was found between MIBI-gFP and MIBI-FP. Less strong correlation was estimated between not only Tc-FP and MUGA (r=0.76 P<0.01) but MIBI-FP and MUGA (r=0.68 P<0.01) as well with no sufficient agreement. For the LV: LVEF was also measured by each method: Tauc-FP=61,1+/-8,5%, MUGA=61,2+/-10%, MIBI-FP=61,8+/-6%,EF GSPECT=60,2+/-7%. There was a strong correlation (r=0.87 P<0.01) with good agreement between Tauc-FP and MUGA. For all patients, correlation between MIBI-FP and GSPECT was weak (r=0.62 P<0.01) but ameliorated by the exclusion of 4 patients with small end diastolic volumes (EDV) (r=0.82 P<0.01). The correlation between MUGA and GSPECT got stronger (r=0.85 P<0.01) by the same exclusion. Finally, a strong correlation (r=0.81 P<0.01) with sufficient agreement was noted between MIBI-FP and MUGA. IN CONCLUSION: For the RV: simple or gated FP are reliable with good agreement methods of RVEF evaluation in patients with CPD that can easily be performed during every radionuclide isonitrilium myocardial perfusion study. MUGA is proved to be comparative to the FP estimation of RV EF. The gFP affords the narrowest range of RVEF calculated, allowing the more accurate functional identification of RV borders. For the LV: FP (with 99mTc or with sestamibi-99mTc) is a reliable method of LVEF measurement in patients with CPD when compared with MUGA. MuIotaBetaIota-FP can evaluate LVEF during a standard myocardial perfusion study with radionuclide isonitrilium. GSPECT-EF correlation with EF measured by MUGA or FP is strongly affected by EDV.

Aged↗
PubMedDate not supplied

Effect of background correction on left ventricular ejection fraction calculation through analysis of a simple cardiac model.

The dependence of the left ventricular ejection fraction calculation on the background correction in gated cardiac blood pool studies is examined by analyzing a simple cardiac model. It is shown that the ejection fraction is relatively insensitive to the background correction when an accurately determined variable region of interest is used, but that with a fixed region of interest the background correction must be accurately estimated. A similar ejection fraction-background correction relationship is obtained in the analysis of clinical cardiac data. Based on the cardiac model, two methods are suggested which, with further investigation and refinement, may lead to a more accurate and consistent technique for determining ejection fraction and background.

Heart↗
PubMed1979

Approaches to determination of left ventricular volume and ejection fraction by real-time two-dimensional echocardiography.

Left ventricular volumes and ejection fraction were derived from real time two-dimensional echocardiographic images (2 DE) and single plane (RAO) left ventricular cineangiograms in a series of 50 patients. Prospective application of a series of 6 alternate algorithms showed that a modified Simpson's rule approach using mitral and papillary muscle cross sections and an apical four chamber view provided the best 2 DE - angiographic correlations: for end-diastolic volume r = 0.82, SEE = 39 ml; for end-systolic volume r = 0.90, SEE = 29 ml and for ejection fraction r = 0.80, SEE = 0.09. The large SEE for volume determination indicates that further refinements are necessary to predict left ventricular volumes adequately; however, ejection fraction can be derived with an accuracy which allows practical clinical decisions in patients with satisfactory 2 DE images.

Cardiac Output↗
PubMed1996

Interaction between exercise training and ejection fraction in predicting prognosis after a first myocardial infarction.

BACKGROUND: Although recent meta-analysis trials have shown that exercise training may improve survival after myocardial infarction, the mechanism of this beneficial effect is still unknown. The purpose of this study was to detect possible interactions between exercise training and predictors of prognosis after a first myocardial infarction. METHODS AND RESULTS: Patients with uneventful clinical courses after a first myocardial infarction were randomly assigned to a 4-week training period (125 patients, group 1) or to a control group (131 patients, group 2). Before randomization, all patients underwent a symptom-limited exercise test (28 +/- 2 days after myocardial infarction), 24-hour Holter monitoring, and coronary arteriography (31 +/- 3 days after the acute episode). After a mean follow-up period of 34.5 months, 18 patients had cardiac deaths (5 in group 1 and 13 in group 2). Multivariate analysis by Cox regression model showed that ejection fraction was the only independent prognostic indicator (P = .03). Evidence existed of an interaction between ejection fraction and exercise training, showing an effect of physical training on survival that depended on the patient's ejection fraction. Among patients with ejection fractions < 41%, the relative risk for an untrained patient was 8.63 times higher than for a trained patient (P = .04), whereas for ejection fractions > 40%, the estimated risks for trained and untrained patients were similar. CONCLUSIONS: These data show that exercise training may prolong survival in post-myocardial infarction patients with depressed left ventricular function. A randomized trial in such patients seems warranted.

Adult↗
PubMed1991

[Indications for aortocoronary shunting in relation to ejection fraction and segmental activity of the left ventricle (data of the coronarography, ventriculography and intra-cardiac hemodynamics)].

The left-ventricular ejection fraction, reflecting the contractile capacity of the myocardium according to the clinical data, is the most objective criterion in indication for the operation for aortocoronary shunting. The indices of central hemodynamics appearing in response to the exercise test during intracardiac catheterization of the right heart and monitor-computer control with mathematical analysis were used in objective appraisal of the left-ventricular ejection fraction in selecting for surgical treatment patients suffering from ischemic heart disease with normal and reduced ejection fraction of the left ventricle. Two gradations of patients with ischemic heart disease were set apart during the hemodynamic exercise test: the first--patients with a high and effective chronotropic reserve--subgroup I("+X") and the second--patients with a poor and ineffective chronotropic reserve--subgroup II("--X"). It was found that in a single-valued left-ventricular ejection fraction (normal or low) in patients with ischemic heart disease there may be the presence or absence of latent cardiac insufficiency according to the results of the hemodynamic exercise test which must be determined in indications for surgical treatment.

Cardiac Output↗
PubMed1984

Ejection fraction and regional wall motion at rest and during stress in the diagnosis of coronary artery disease.

Stress radio nuclide ventriculography is used to determine ejection fraction and changes in regional wall motion for the detection of ischemia-induced left ventricular dysfunction in patients with coronary artery disease. We have evaluated the relative sensitivity of regional wall motion and of ejection fraction during hand-grip and cold pressor test, in 21 patients with angina pectoris and documented coronary artery disease at angiography. Regional wall motion appeared a more sensitive index than global ejection fraction producing only two false negative cases. Ejection fraction showed great variability among the patients during both hand-grip and cold pressor test. This might be explained by the fact that both tests do not produce a sufficient degree of ischemic stress on the left ventricle. Hand-grip and cold pressor tests appear useful alternative to dynamic exercise in the diagnosis of coronary artery disease being also safe and simple to perform.

Adult↗
PubMed1992

Establishment of signal-averaged electrocardiographic criteria with Frank XYZ leads and spectral filter used alone and in combination with ejection fraction to predict inducible ventricular tachycardia in coronary artery disease.

Signal-averaged electrocardiographic criteria are reported for corrected Frank XYZ leads and a spectral filter. The new criteria were used alone and in combination with ejection fraction to predict inducibility of ventricular tachycardia (VT) at electrophysiologic testing. Signal-averaged electrocardiographic criteria were developed in 87 control subjects and validated in 182 patients (aged 63 +/- 10 years) with coronary artery disease and QRS duration less than 118 ms. Patients underwent electrophysiologic testing in which up to 3 extra-stimuli were used during 2 paced drives from 2 right ventricular sites. A positive finding was monomorphic VT lasting 30 seconds or needing intervention. An ejection fraction less than 40% was considered abnormal. Signal-averaged electrocardiographic variables that best characterized control subjects and separated patients with and without inducible VT were filtered QRS duration less than 120 ms, low-amplitude signal duration less than 38 ms and root-mean-square voltage greater than 20 muv. With these criteria, signal-averaged electrocardiographic and ejection fraction sensitivities were 87 and 45%, respectively, and specificities were 65 and 77%, respectively. Combining signal-averaged electrocardiography with ejection fraction improved the predictive accuracy. In conclusion, diagnostic criteria for signal-averaged electrocardiography with use of Frank XYZ leads and a spectral filter produced results similar to those reported for use of bipolar XYZ leads and a Butterworth filter. Signal-averaged electrocardiography was a better predictor of VT than was ejection fraction.

Adult↗
PubMed1998

Estimation of the right ventricular volume and ejection fraction by transthoracic three-dimensional echocardiography. A validation study using magnetic resonance imaging.

AIMS: To validate the use of three-dimensional transthoracic echocardiography compared with the magnetic resonance imaging for determination of right ventricular volume and ejection fraction. METHODS AND RESULTS: We recorded transthoracic echocardiographic images starting from the apical four-chamber view in which the RV is clearly visualized in 15 healthy volunteers. The scanning plane of the RV was obtained by the rotational scanning technique in 2 degree angular increments for three-dimensional reconstruction. The RV volumes in end-diastole and end-systole were calculated using a Tomtec three-dimensional reconstruction computer. We also assessed the RV by cine magnetic resonance imaging using the Siemens Magnetom Impact Expert (1.0 T). Cine gradient echo images were obtained in the short axis of the RV. The RV volume at each phase was calculated by Simpson's method. We also calculated the RV ejection fraction. The RV volumes in end-diastole and end-systole were 111 +/- 22 ml and 52 +/- 13 ml, respectively as determined by three-dimensional echo, and 115 +/- 18 ml and 55 +/- 14 ml determined by MRI. The right ventricular volumes at end-diastole and end-systole determined by three-dimensional echo were correlated with the volumes determined by MRI (r = 0.94 and 0.97, respectively, p < 0.001). The RV ejection fraction determined by three dimensional echo was also correlated with the ejection fraction determined by MRI (r = 0.90, p < 0.01). CONCLUSIONS: Three-dimensional transthoracic echocardiography provided reliable calculations of the right ventricular volume and ejection fraction.

Adult↗
PubMed2006

[Should Angiotensin-converting enzyme inhibitors be continued over the long term in patients whose left ventricular ejection fraction normalizes after an episode of acute myocarditis?].

It is well established that long-term administration of angiotensin-converting enzyme (ACE) inhibitors has a favorable effect in patients with chronic heart failure and dilated cardiomyopathy. However, less information is available on patients whose left ventricular ejection fraction normalizes after an episode of systolic dysfunction secondary to acute myocarditis. We followed 35 patients who were diagnosed at our center between 1987 and 1995 with acute myocarditis and an ejection fraction<45%. All were taking ACE inhibitors. After 34 (23) months of follow-up, the left ventricular ejection fraction was >50% in all 35 patients. Treatment with ACE inhibitors was discontinued in 15 of the 35 patients, while the other 20 continued ACE inhibitor therapy. After 3 years of follow-up, no death had occurred, but the incidence of new episodes of heart failure with a left ventricular ejection fraction<45% was higher in patients who stopped taking ACE inhibitors (33% vs 5%, P=.064), and their ejection fraction was lower (47 [12%] vs 57 [11%], P=.002). These results suggest that ACE inhibitors should be continued over the long term in these patients.

Acute Disease↗
PubMed1989

Effects of massive ascites on measurement of cardiac ejection fraction via multi-gated acquisition (MUGA) scanning.

A patient with massive ascites secondary to ovarian carcinoma was found to have a low cardiac ejection fraction as measured by multi-gated acquisition (MUGA) scanning. Because of this low measurement, she was not treated with Adriamycin for fear of cardiac toxicity. Because the MUGA was felt to be incorrect, we performed simultaneous echocardiography and then repeated the MUGA scan after removal of 9000 cc of ascites fluid. The echocardiogram showed an ejection fraction in excess of 50% and the MUGA performed after paracentesis revealed an ejection fraction of 63% (an increase of 133%). We conclude that the MUGA is an inaccurate way to assess cardiac ejection fraction in the presence of massive ascites and that other ways to assess cardiac function should be used when there is need to determine such function in patients with massive ascites.

Adult↗
PubMed1990

Influence of age and sex on left ventricular volumes and ejection fraction during upright exercise in normal subjects.

To determine the effects of age and sex on exercise left ventricular volume indexes and ejection fraction, a cross-sectional study was performed in 18 young volunteers (nine men and nine women) and in 17 older volunteers (nine men and eight women) without evidence of coronary artery disease by exercise electrocardiographic and thallium-201 criteria. All subjects performed a multistage maximal upright exercise with measurements of maximal oxygen consumption and heart rate; left ventricular ejection fraction and absolute volume indexes were measured at rest and during submaximal and maximal exercise using equilibrium radionuclide ventriculography. At rest, no effect of age or sex on any parameter was observed. At peak exercise, an age-related increase in mean blood pressure, end-diastolic and end-systolic volume indexes, and decrease in ejection fraction, cardiac index, heart rate and oxygen consumption were noticed. Sex had a significant effect on maximal workload, maximal oxygen consumption and ejection fraction.

Adolescent↗
PubMed1992

Thermodilution right ventricular ejection fraction measurement reproducibility--a study in patients undergoing coronary artery bypass graft surgery.

OBJECTIVE: To assess the effects of heart rate, right ventricular systolic performance (ejection fraction), chamber dimensions, and flow rate (cardiac index) on the reproducibility of algorithm-derived triplicate thermodilution right ventricular ejection fraction measurements. DESIGN: Prospective study; combined hemodynamic and echocardiographic clinical evaluation. SETTING: Operating room in a university hospital. PATIENTS: Twenty-one coronary artery bypass graft patients. MEASUREMENTS AND MAIN RESULTS: The right atrial delivery site was positioned by analysis of transduced pressure waveform and echocardiographic imaging of tracer agitated saline cavitations. Measurement reproducibility was quantified by determining the variation (standard deviation) within 101 triplicate thermodilution measurement sets. There was no significant relationship between measurement reproducibility and estimates of right atrial area (21.6 +/- 6.9 cm2), diameter (5.1 +/- 0.8 cm) and supero-inferior length (5.1 +/- 0.9 cm) and right ventricular maximal minor axis diastolic diameter (4.21 +/- 1.05 cm). Reproducibility was also unrelated to right ventricular end-diastolic volume index (97.9 +/- 32.7 mL/m2) and cardiac index (2.9 +/- 0.9 L/min/m2). Measurement reproducibility was directly related to mean right ventricular ejection fraction (0.39 +/- 0.14) and inversely related to heart rate (80.8 +/- 18.6 beats/min) (p < .01 and < .001, respectively). CONCLUSIONS: Thermodilution-derived right ventricular ejection fraction measurement reproducibility was unrelated to estimates of right atrial and ventricular dimensions and cardiac index. Measurement reproducibility was a direct function of right ventricular systolic performance and an indirect function of heart rate. Measurement should be interpreted with these constraints in mind.

Adult↗
PubMed2006

Elevated plasma brain natriuretic peptide level in cardiac sarcoidosis patients with preserved ejection fraction.

We sought to examine whether the plasma brain natriuretic peptide (BNP) levels are elevated in the cardiac sarcoidosis patients even with a preserved ejection fraction. The data from the patients with either pulmonary sarcoidosis without any evidence of cardiac involvement (n = 13) or cardiac sarcoidosis (n = 8) with a preserved ejection fraction (>55%) on echocardiography were analyzed. The median plasma BNP levels were significantly higher in the patients with cardiac sarcoidosis than in those with pulmonary sarcoidosis (101.5 +/- 65.1 vs. 15.6 +/- 10.5 pg/ml, p < 0.001), although there was no significant difference in left ventricular ejection fraction between the two populations. The plasma BNP level is thus considered to be a useful non-invasive biomarker for identifying a possible cardiac involvement in the sarcoidosis patients with a preserved ejection fraction.

Adult↗
PubMed2001

[Evaluation of the ejection fraction tomoscintigraphy synchronised with an electrocardiogram].

Electrocardiographic gated myocardial scintigraphy (gated SPECT) allows simultaneous evaluation of left ventricular perfusion and contractility. The aim of this study was to assess the impact of the type of tracer and temporal sampling on the measurement of the ejection fraction by gated SPECT. Eighty-six consecutive patients (59 men, 27 women, average age 62 +/- 11 years) with a history of myocardial infarction (anterior N = 50--inferior N = 36) were studied. All had measurement of the isotopic ejection fraction by equilibrium angioscintigraphy and by gated SPECT sampled at 8 (N = 45, 52%) or 16 images/cycle RR (N = 41, 48%). After filtered retroprojection, the ejection fraction was calculated by a validated method (QGS). A better correlation between gated SPECT and equilibrium angioscintigraphy was observed at 16 images/cycle (r = 0.90) compared with 8 (r = 0.80). The Bland-Altman curves showed improved accuracy of the measurement of the ejection fraction by gated SPECT with 16 compared with 8 images/cycles sampling (mean differences of 0.37 +/- 6.06% and 4.3 +/- 7.71%, respectively). Multivariable analysis showed that temporary sampling was the only parameter to significantly affect the difference between the two methods. There was no difference between the use of Thallium and that of 99mTc-sestamibi. Gated SPECT, therefore, provides an accurate measurement of the ejection fraction for routine clinical usage, providing the acquisition is made at 16 images/cycle.

Electrocardiography↗
PubMed1981

Right ventricular ejection fraction and volumes after mustard repair: correlation of two dimensional echocardiograms and cineangiograms.

The right ventricular ejection fractions derived from two dimensional echocardiograms and cineangiograms were compared in 24 children. All patients (aged 2.1 to 16 years) had undergone Mustard repair for transposition of the great arteries 1 to 12 years earlier. The correlation of the two methods was excellent (r = 0.977), confirming the usefulness of echocardiography for deriving ejection fraction. The volume components of the ejection fraction were less well estimated from the echocardiograms, but the ratios of end-diastolic to end-systolic volumes estimated from each method were similar.

Adolescent↗
PubMed1988

Alternative method for calculating right ventricular ejection fraction from first-pass time-activity curves.

Single-beat right ventricular ejection fraction (RVEF) determined using the first-pass method changes with rapid variations in the concentration of radionuclide tracer in the ventricle. Underestimation of single-beat RVEF occurs when radionuclide tracer rapidly enters the ventricle, and overestimation results when the tracer quickly flows out of the ventricle. In order to attenuate this effect, a data processing technique employing the relative "time-volume" curve was proposed. In the present paper, it was assumed that this time-volume curve could be approximated by dividing the original time-activity curve by a gamma variate function representing the time-concentration curve. Each single-beat ejection fraction calculated from the time-volume curve agreed well with the known phantom ejection fraction although the concentration of tracer varied rapidly. This new method was applied to several clinical cases.

Heart↗
PubMed2001

Heart Failure with Normal Ejection Fraction.

Heart failure with normal ejection fraction, also known as diastolic heart failure, is a major problem for patients and health-care providers and is a substantial expense to society. The main pathophysiologic processes involved are increased left ventricular stiffness and abnormal relaxation, with resulting impaired left ventricular filling. These processes typically displace the pressure-volume relationship in an upward direction, resulting in increased left ventricular end-diastolic, left atrial, and pulmonary capillary wedge pressures, leading to symptoms of pulmonary congestion. The most common clinical disorders leading to diastolic heart failure are 1) hypertension with concentric left ventricular hypertrophy, 2) coronary artery disease with decreased left ventricular compliance, 3) hypertrophic cardiomyopathy, and 4) aortic stenosis with concentric left ventricular hypertrophy. Echocardiography and cardiac catheterization with magnetic resonance imaging hold promise as future diagnostic tools. The approach to the treatment of diastolic heart failure is focused on four treatment goals: 1) persistent control of elevated blood pressure, with regression of left ventricular hypertrophy, 2) careful reduction of central blood volume (diuretics), 3) maintenance of atrial contraction and control of heart rate (beta-blockers, digoxin, atrioventricular pacing); and 4) improvement of left ventricular relaxation. There is currently no drug treatment specific for abnormal relaxation, although efforts are being made to develop such compounds. A promising future therapy includes agents that lyse advanced glycation end-products as an approach to relieving increased ventricular stiffness. In addition to pharmacotherapy, maintaining ideal body weight and a regular exercise program are also helpful in the treatment of diastolic heart failure. Although the overall prognosis of patients with diastolic dysfunction is more favorable than that of patients with systolic dysfunction, the frequency of treatment failure and recurrent symptoms underscores the need for further improvement in treatment of this condition.

Journal Article↗