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PubMed1977

Cardiac size and function in acromegaly.

Sixteen acromegalic patients underwent echocardiography, phonocardiography, stress electrocardiography with Thallium perfusion scanning and gated radioisotope left ventricular angiocardiograms. Abnormalities consisting of increased echo left ventricular mass index, low velocity of circumferential fiber shortening or elevated pre-ejection period to left ventricular ejection time ratio were found in six patients with coexistent hypertension or coronary disease. Concentric left ventricular hypertrophy was also found in three patients with no known etiology other than acromegaly of greater than thirteen years' duration or with fasting growth hormone concentrations greater than 100 ng/ml. One of these three also had left ventricular dysfunction. Neither hypertrophy nor ventricular dysfunction was found in other acromegalics with shorter duration of disease or lower growth hormone concentrations or with normal growth hormone concentrations after therapy. A high prevalence of coronary artery and hypertensive heart disease is associated with acromegaly. A few patients with acromegaly have a specific, potentially reversible cardiomyopathy probably related to prolonged acromegaly or very high growth hormone concentrations.

Acromegaly↗

PubMed1979

Noninvasive screening criteria for enhanced 4-year survival after aortocoronary bypass surgery.

Two thousand one men with coronary heart disease (CHD) who were enrolled in the Exercise Testing Registry of the Seattle Heart Watch had symptom-limited maximal exercise tests at the initial clinical examination and follow-up surveillance of subsequent mortality for 4.1 +/- 1.6 years. When subdivided into three mutually exclusive subgroups, 636 patients did not have exertional myocardial ischemia, left ventricular dysfunction or cardiomegaly; 885 without cardiomegaly had only exertional ischemia; 480 had left ventricular dysfunction by either cardiomegaly and/or two noninvasive exertional criteria, with or without exertional myocardial ischemia. Three hundred thirty-one men had aortocoronary bypass surgery, while 1670 remained unopened for at least 4 years. Only 34% of the operated patients who had left ventricular dysfunction, as defined, showed a marked improvement in 4-year survival rates (p less than 0.01). Differences in the annual CHD mortality rates in relation to surgical treatment in the other two groups were not statistically significant. Restricting the analysis to a subset of patients who had invasive studies did not alter the conclusion. Accordingly, we suggest the use of noninvasive criteria to aid preliminary screening of patients for invasive studies and surgical treatment.

Adult↗

PubMed2026

Cine-derived mitral annular relaxation velocity for detection of preclinical left ventricular diastolic dysfunction.

OBJECTIVES: Imaging diastolic dysfunction in pre-clinical heart failure (HF) is challenging. We evaluated a novel cardiac MRI (CMR) biomarker, CMR e-prime (CMR-MARV), in patients at risk of HF. METHODS: In this substudy of the PARABLE trial (NCT04687111), 236 patients (71.6 ± 7.7 years, 61.6% male) fulfilling trial-defined ALVDD citeria underwent CMR with measurement of mitral annular relaxation velocity (CMR-MARV) at four mitral annular anchor points. Diastolic strain rates from FT were also assessed. Twenty-five age- and sex-matched controls were included (73.8 ± 3.1 years, 52% male). Group differences were tested with t-tests, diagnostic accuracy with ROC analysis, and predictors of diastolic dysfunction with adjusted logistic regression. RESULTS: Compared with controls, patients had significantly higher indexed maximal left atrial volume (LAVimax), LV end-diastolic and end-systolic volumes, and LV mass (all p < 0.001). Of FT variables, only peak diastolic longitudinal velocity differed between groups (p < 0.001). In multivariate models, CMR-MARV correlated with radial, circumferential, and longitudinal diastolic strain rates, radial and longitudinal diastolic velocities (all p < 0.001), echocardiographic e' (r = 0.20, p = 0.007), LV mass (r = -0.18, p = 0.008), LAVimax (r = -0.18, p = 0.008), and NT-proBNP (r = -0.30, p < 0.0001). LAVimax and CMR-MARV were strongly independently associated with ALVDD (AUC 0.89 and 0.76, respectively; p < 0.0001). A combined model (LAVimax + CMR-MARV) achieved excellent discrimination (AUC 0.91, 95% CI 0.86-0.97, p < 0.0001). Independent predictors included LAVimax, CMR-MARV, and peak diastolic longitudinal velocity (all p < 0.001). CONCLUSION: CMR-MARV provides a simple cine-derived measure of longitudinal relaxation that correlates with established structural and biochemical markers of diastolic burden. Within an at-risk population, it offers incremental functional information beyond conventional parameters and may support multiparametric CMR phenotyping of preclinical diastolic dysfunction.

Aged↗

PubMed1979

[Short- and mean results of mitral and aortic valve replacement with a Björk-Shiley disc prosthesis. Thromboembolic and hemorrhagic complications].

96 patients with a Björk aortic valve and 112 patients with a Björk mitral valve were followed up for four and a half years and five years after operation respectively. The actuarial survival rate was 82.5% in the aortic and 73% in the mitral patients. Late death was observed in 7.3% of mitral patients with thromboembolic complications and 4.2% of mitral patients with left ventricular dysfunction, compared to 2.6% of aortic patients with thromboembolism and 3.6% with left ventricular dysfunction. The incidence of thrombolic complications was three times as great with the prosthesis in the mitral position. The probability of absence of thromboembolic complications, studied by actuarial methods, was 93% at 4 1/2 years in aortic prostheses compared to 82% at 5 years in the mitral prostheses. 12 haemorrhagic complications (5.7%), with one fatality, were observed. Aortic valve replacement with a Björk prosthesis is a very satisfactory operation and the results compare favourably with other prostheses. However, the risk of thromboembolic complications should be seriously considered in the surgical indications when this prosthesis is to be used for mitral valve replacement.

Adolescent↗

PubMed1978

[Exercise haemodynamics and ECG in the evaluation of the severity of coronary heart disease (author's transl)].

Myocardial scarring and coronary insufficiency give rise to regional changes in left ventricular function, often leading to generalized left ventricular dysfunction during physical activity only. The main purpose of this study was to evaluate the relations between left ventricular function determined by ECG and measurements of pulmonary artery pressure during exercise and the severity of coronary artery disease. Simultaneous measurements in the pulmonary artery and in the left ventricle in 76 patients revealed that the enddiastolic pulmonary pressure (PAEDP) was lower than the enddiastolic pressure in the left ventricle (LVEDP) by a mean value of 10.5 mm Hg in the presence of ventricular dysfunction. This difference was smaller in congestive heart failure than in cases of acute myocardial ischaemia. Correlation coefficients of mean pulmonary wedge pressure (PCm), PAEDP, mean pulmonary pressure (PAPm), and LVEDP were 0.90, 0.86, and 0.81, respectively, thus allowing only an approximate estimate of the left ventricular filling pressure. In 150 angiographically documented cases of coronary heart disease, haemodynamic measurements were performed during stepwise-increased, symptom-limited supine exercise on a bicycle ergometer. All patients limited at 25 watts had either triple vessel disease or stenosis of the trunk of the left coronary artery or of the proximal section of the left anterior descending artery (RIVA). In comparison with subjects with single vessel disease, patients with triple vessel involvement tolerated only a smaller exercise load and reached higher values of PAEDP (30.4 +/- 9.0 versus 24.0 +/- 7.7 mm Hg, p less than 0.001). Analysis of data of patients with a single coronary stenosis showed the exercise-PAEDP to be largely independent of the myocardial condition, but to depend upon the location of the stenosis, the highest pressure values being observed with stenoses of the main left coronary artery or the proximal segment of the RIVA. Based on these findings a simple coronary score system was delineated to determine the severity of the disease, taking into account the location of an obstruction, in particular, and, to a lesser amount, the degree of the stenosis and the type of coronary artery distribution. The score yielded essentially better correlations to work load and filling pressures during exercise than did the number of obstructed vessels. The regression line of the PAEDP versus the coronary score was flatter in patients with angiographically documented collaterals than in cases without, indicating the functional significance of these vessels. In patients with stenoses confined to the arteries supplying infarcted areas and, consequently, without signs of ischaemia during exercise a close relation was obtained between the left ventricular ejection fraction (EF) and the maximum PAEDP, best expressed by a third order regression equation (r = 0.79), p less than 0.001, SEE +/- 6.1). A PAEDP exceeding 25 mm Hg is, thus, a reliable sign of an EF of less than 40%...

Blood Pressure↗

PubMed1979

[Non-invasive effects of cigarette smoking on left ventricular function at rest and with exercise in normal individuals (author's transl)].

The effect of cigarette smoking on systolic time intervals at rest, with volume overload and with dynamic exercise was studied in nine healthy cigarette smokers. For heart rate, PEP, LVET and blood pressure, reactions to smoking demonstrated considerable interindividual variations with comparable work loads and volume loads. More than half of the subjects developed significant left ventricular dysfunction by these parameters after smoking ten cigarettes. The negative inotropic effect was felt to be caused in these subjects by carbon monoxide. The remaining subjects did not show left ventricular dysfunction with smoking. In these subjects the stimulating effect of nicotine on the nervous system was covering the negative inotropic effect of carboxy hemoglobin.

Adult↗

PubMed1979

[Pulmonary stenosis with intact ventricular septum. Surgical experience in 200 cases, excluding the neonatal period].

Experience over 10 years, studying two groups of patients (group I: 79 cases aged between 2 months and 2 years, group II: 151 cases aged over 2 years) has shown that the operative prognosis of severe forms is now the same as in simple forms. Interest is now focused on the long term function of the right ventricle with regard to the surgical procedure. The main discussion in management is between isolated pulmonary commissurotomy, whatever the anatomical form, and operations such as we perform which associate ventricular resection with or without an infundibular patch in severe cases. The possible causes of late ventricular dysfunction are discussed, especially the muscular resection, the operative myocardial protection and the preoperative myocardial sclerosis. The good results observed in this series as opposed to the doubt as to the cause and variability of late ventricular dysfunction do not justify a change in our management at present.

Adolescent↗

PubMed1977

Coronary artery aneurysms: study of the etiology, clinical course and effect on left ventricular function and prognosis.

Coronary artery aneurysms were found in 16 men between 37 and 62 years of age, mean 51 years. Aneurysms were of two types: saccular and fusiform. They involved the right coronary artery in 13 (87 per cent), the circumflex artery in eight (50 per cent) and the left anterior descending artery in five (31 per cent). In some patients, more than one vessel was involved. Twelve patients presented with angina pectoris, three with congestive heart failure and one with both. Five were in functional class II, eight were in class III and three were in class IV at the beginning of the study. The electrocardiogram showed evidence of previous myocardial infarction in four patients; four patients had left ventricular hypertrophy, one had left axis deviation, one had left bundle branch block, one had right bundle branch block, two had first degree atrioventricular block and seven had abnormalities in the S-T segment and T wave. Obstructive coronary disease was present in all; the obstruction score was from 1 to 4 in three patients, from 5 to 9 in four patients and from 10 to 14 in the remaining nine. Similar aneurysms were found in the pulmonary artery of one patient and in the abdominal aorta of three patients; in seven of 14 patients with adequate venous angiograms, varicosities of the coronary venous tree were observed. Left ventricular dysfunction and angina pectoris were noted in patients with significant obstructive coronary disease (greater than 70 per cent) and also in patients without obstruction but with coronary aneurysms. Ten patients were treated surgically; nine underwent aortocoronary bypass and one mitral valve replacement. Criteria for bypass was the presence of obstructive disease and medically unresponsive angina pectoris. All but one surgically treated patient showed improvement. The functional class in medically treated patients was unchanged. Fourteen patients were still alive at the completion of the study. The findings of this study suggest that angina pectoris and left ventricular dysfunction can occur with coronary artery aneurysm without coronary artery obstructions. Coronary aneurysms may be a subset of atherosclerosis, and this process may involve other vascular territories. The prognosis in those patients appears to be no worse than in patients with obstructive coronary disease and no aneurysms.

Adult↗

PubMed1979

Acute renal failure following cardiac surgery.

In a prospective 6 month study of 204 patients requiring cardiac operations, five (2.5 percent) developed acute renal failure (ARF) and five (2.5 percent) had documented renal dysfunction (RD). Preoperative left ventricular dysfunction and prolonged cardiopulmonary bypass (CPB) were important predictors of subsequent RD/ARF; CPB pressure per se was not. Physiological and clinical studies in 51 selected patients studied over an 18 month period documented the effectiveness of low flow, low pressure CPB in preserving postoperative renal function. Twenty-two patients with nonazotemic postoperative courses demonstrated moderate depression of cardiac function while the glomerular filtration rate (GFR) was normal (98 +/- 30 ml./min/1.73 M.2) within 24 hours of operation. Seventeen high risk patients developed AFF (65 percent mortality rate) and 12 experienced severe RD without ARF (17 percent mortality). ARF (65 percent mortality rate) and 12 experienced severe RD without ARF (17 percent mortality). Eleven patients with ARF and 11 with RD were studied in the early postoperative period; at this time, all 22 patients demonstrated RD with equivalent severe depression of cardiac and renal function. Superposition of further hemodynamic or toxic insults upon ischemic kidneys was usually necessary for ARF to occur.

Acute Kidney Injury↗

PubMed1979

[Left ventricular function in chronic obstructive pulmonary disease after decompensation (author's transl)].

13 patients with chronic obstructive pulmonary disease (COPD) were studied for left ventricular function immediately after acute decompensation. Parameters of right and left ventricular function were measured. Mean pulmonary wedge pressure (Paw) was elevated (11.9 mm Hg) but there was no correlation between Paw and left ventricular end-diastolic pressure (LVEDP). The indices of left ventricular contractility were in the normal range. In 4 patients, LVEDP was too high. A correlation was established between RVEDP and LVEDP. Left ventricular compliance, as studied by the index of Diamond and Forrester, was abnormal. Two conclusions are discussed: (1) in COPD, Paw cannot indicate left ventricular dysfunction; (2) alteration of left ventricular compliance is possibly related to an elevation of RVEDP.

Aged↗

PubMed1979

Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.

In 43 patients left ventricular micromanometry and cineangiography were performed preoperatively and and 20 months after aortic valve replacement. A score of left ventricular functional impairment, derived from 5 to 8 haemodynamic variables, was calculated as: number of pathological indices x 100/total number of determined indices. Preoperatively the score of left ventricular functional impairment amounted to 35 per cent in group 1 (aortic stenosis: n = 19), to 61 per cent in group 2 (combined lesion:n = 15) (P less than 0.05), and to 87 per cent in group 3 (aortic regurgitation: n = 9) (P less than 0.001). In contrast, the functional classification according to the NYHA showed similar impairment in the 3 groups. Postoperatively the score of left ventricular functional impairment decreased significantly in all 3 groups to 10, 16, and 27 per cent, respectively, but the score of group 3 remained raised (P less than 0.05) as compared with that of group 1. The patients with residual left ventricular dysfunction had a higher preoperative left ventricular muscle mass than the patients with normal or near normal postoperative left ventricular function. It is concluded that (1) at similar functional impairment according to the NYHA classification left ventricular contractile function is more severely impaired in aortic regurgitation and in aortic regurgitation + aortic stenosis than in aortic stenosis alone, (2) left ventricular function improves significantly after valve replacement in all three forms of aortic valve disease, (3) residual functional impairment is greater in aortic regurgitation than in aortic stenosis or aortic stenosis + aortic regurgitation, and (4) persistent postoperative left ventricular functional impairment is found in the patients with severe preoperative hypertrophy.

Adult↗

PubMed1979

Influence of post-extrasystolic potentiation on left ventricular function estimated by means of systolic time intervals.

Systolic time intervals were measured in 50 patients with frequent premature ventricular beats. The patients were divided into two groups: group I included those which showed in the beat that preceded an extrasystole a pre-ejection period/left ventricular ejection time (PEP/LVET) ratio greater than or equal to 0.43, and group II with PEP/LVET ratio greater than 0.44. Systolic time intervals recorded during post-extrasystolic potentiation were compared with those measured in the preextrasystolic complex. Also the measured intervals were tested against the hourly rate of premature beats obtained by electrocardiographic telemetric monitoring. The results confirmed the following results of previous reports: a) ventricular premature beats are followed by sinus-potentiated contractions inversely related to the coupling interval and dependent on adequate compensatory pauses; b) potentiated contractions are greater in patients with ventricular dysfunction. No relationship was found between left ventricular performance and the rate of premature beats. It is concluded that the effect of an antiarrhythmic intervention on the left ventricular function might be adequately evaluated by means of systolic time intervals and provoked post-extrasystolic potentiation, with the advantage of using totally non-invasive procedures.

Cardiac Complexes, Premature↗

PubMed1979

Management of intractable ventricular tachyarrhythmias after myocardial infarction.

Twenty-five patients with recent or old myocardial infarction were studied because they had life-threatening ventricular arrhythmias that required repeated cardioversions and were intractable to medical management. All patients had had a large anterior infarction a mean of 4.6 weeks before the emergence of the arrhythmias and all had severe left ventricular dysfunction. Cardiac catheterization or autopsy revealed a left ventricular aneurysm in 18 of 18 patients and obstruction of the left anterior descending coronary artery in 20 of 20 patients. Of 16 patients treated surgically with aneurysm resection or coronary bypass grafting, or both, 10 (62 percent) were alive after 3 to 39 (mean 26) months of follow-up. The perioperative mortality rate was 31 percent and only one patient died during the postoperative follow-up period 4 months after discharge from the hospital. By contrast, all nine medically treated patients died either in the hospital (four patients) or suddenly within 2 months of discharge (five patients). Ventricular fibrillation was documented as the cause of death in five of these patients. Surgical intervention was found to improve significantly the survival of these patients (P less than 0.02). The perioperative mortality rate was lower when at least 4 weeks had elapsed from acute infarction to surgery (10 versus 67 percent) and when the procedure included coronary bypass grafting (13 versus 50 percent), although these differences were not statistically significant (P greater than 0.05).

Adult↗

PubMed1979

Detection of early cardiac dysfunction in patients with severe beta-thalassemia and chronic iron overload.

To detect early left ventricular dysfunction, we used radionuclide cineangiography to determine left ventricular ejection fraction during exercise in 24 patients with transfusion-dependent, congenital anemias, 21 of whom had severe beta thalassemia. Ejection fraction at rest was normal in 21 patients (greater than 45 per cent) and in all patients was 53 +/- 2 per cent (mean +/- S.E.M.)--not significantly different from the value in normal subjects. However, ejection fraction during exercise was normal in only 11 patients (53 +/- 3 per cent in all patients, P less than 0.001 as compared with the normal value). All eight patients who had received fewer than 100 transfusions but only three of 16 (19 per cent, P less than 0.001) who had received 100 or more transfusions had normal responses during exercise. Whereas echocardiographic fractional shortening at rest was normal in 16 of 19 patients studied, eight patients with normal fractional shortening had abnormal ejection-fraction responses to exercise. Thus, radionuclide cineangiography during exercise is a highly sensitive technique for detecting preclinical myocardial dysfunction in patients with systemic iron overload.

Adolescent↗

PubMed1975

Ventricular function in experimental hemorrhagic shock.

Hemorrhagic shock was induced in 20 spontaneously breathing adult greyhounds by lowering the mean arterial pressure to 40 millimeters of mercury. In the first group of six dogs, reinfusion was carried out without delay; in a second group of six dogs, hypovolemia was continued for two hours, during which time the arterial pressure was permitted to rise in response to intact cardiovascular reflexes; in a third group of eight dogs, the mean arterial pressure was artificially maintained at 40 millimeters of mercury for two hours, initially by further bleeding. In all dogs in the latter group, take-up of blood from the reservoir was required during the second hour to maintain the arterial pressure, this being indicative of irreversible shock. In two of this group, fatal arrhythmias developed during reinfusion. All three groups showed evidence of ventricular dysfunction during and immediately after reinfusion, as indicated by disproportion between left ventricular stroke work and left ventricular end diastolic pressure, these data being used to construct ventricular function curves. Measurement of dP/dt maximum suggested that this dysfunction was due to impairment of myocardial contractility. The first two groups recovered normal function within one hour; the third group failed to have such a recovery. Evidence indicates that generalized tissue hypoxia, in addition to myocardial hypoxia, is important in the cause of cardiac dysfunction in irreversible shock.

Animals↗

PubMed1979

Analysis of exercise-induced R wave amplitude changes in detection of coronary artery disease in asymptomatic men with left bundle branch block.

The exercise electrocardiograms of 44 asymptomatic men with acquired left bundle branch block were analyzed for changes in R wave amplitude. Results were correlated with findings on selective coronary angiography. There were two subgroups: 7 men with significant angiographic coronary artery disease (Group I) and 37 with normal coronary angiograms (Group II). Exercise induced an increase in R wave amplitude in all seven men with coronary artery disease but in only 10 of the 37 men without significant coronary artery disease. This criterion thus had a sensitivity of 100 percent but a poor specificity of 73 percent, a predictive value of 41 percent and an accuracy rate of 77 percent for the diagnosis of coronary artery disease. The greater the increase in R wave amplitude the greater was the likelihood of some degree of left ventricular dysfunction as measured by wall motion abnormalities and elevated left ventricular end-diastolic pressure. The increase in R wave amplitude with exercise appears to be a sensitive test in identifying coronary artery disease in asymptomatic men with acquired left bundle branch block.

Adult↗

PubMed1979

Ventricular pump performance during hypocalcemia: clinical and experimental studies.

We have compared indices of ventricular function during rapid transfusion of citrated (1.5 ml/kg/min) or heparinized (1.5 ml/kg/min) autologous blood in six patients following discontinuation of cardiopulmonary bypass. Infusion of citrated blood was associated with a lowering of plasma ionized calcium concentration ([Ca++], from 0.90 +/- 0.04 to 0.71 +/- 0.4 mM, p less than 0.001) and an increase in pulmonary artery balloon-occluded pressure (PA0, from 9.4 +/- 2.6 to 15.5 +/- 1.7 mm Hg, p less than 0.u1), without a change in left ventricular stroke work index, stroke index, or cardiac index. Transfusion of heparinized blood caused no change in plasma [Ca++]. A rise in PA0, which was similar in magnitude to that observed during citrated blood transfusion, was associated with increased left ventricular stroke work index, stroke index, cardiac index, and mean arterial pressure. Although data obtained during citrated blood transfusion suggest the presence of transient left ventricular dysfunction, its magnitude is not readily expressed in terms of ventricular function curves when accompanied by a simultaneous change in [Cized closed-chest dog by volume loading during hypocalcemia, when mean arterial pressure, heart rate, and [Ca++] were in a steady state, both prior to and following beta blockade with propranolol. Function curves obtained during severe hypocalcemia ([Ca++] = 0.43 +/- 0.02 mM) were shifted significantly to the right and downward, when compared to those obtained during normocalcemia ([Ca++] = 1.06 +/- 0.03 mM). Hypocalcemia combined with beta blockade resulted in severe left ventricular failure, as demonstrated by a flat ventricular function curve.

Aged↗

PubMed1978

Left ventricular anomalies associated with Ebstein's malformation of the tricuspid valve.

Seventeen patients with Ebstein's malformation of the tricuspid valve have been evaluated. The majority of patients (11/17) presented in the newborn period with cyanosis and cardiomegaly. The remainder (6/17) were referred because of cardiomegaly on chest X-ray and/or a heart murmur heard on routine examination. Three patients have died; one in the newborn period and two suddenly at the age of 11 and 15 years. Thirteen patients have undergone right and left heart cardiac catheterization within the last seven years. Twelve of these 13 patients (92%) had angiocardiographic left ventricular contraction abnormalities. Five patients also had mitral valve prolapse associated with left ventricular dysfunction. Since many patients with Ebstein's anomaly may have significant left ventricular abnormalities, careful and systematic evaluation of the left ventricle is warranted.

Adolescent↗