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PubMed1986

Relationship between the degree of coronary artery disease and of left ventricular function and the duration of the QT-interval in ECG.

Advanced coronary artery disease (CAD), impaired left ventricular function and prolongation of the QT-interval are considered risk factors for sudden cardiac death in CAD-patients. So far, however, there are no studies investigating in detail whether there is a correlation between the QT-interval and changes in coronary anatomy or changes in left ventricular function. Therefore, coronary angiographic data were related to QT-intervals in 304 patients, who were catheterized because of suspected coronary artery disease. QT-intervals were expressed as QTc = QT/square root RR (Bazett's correction for heart rate), left ventricular function was assessed by the ejection fraction of the ventricular angiogram, and coronary angiograms were classified according to the Gensini score as well as into 1-, 2- and 3-vessel disease (stenoses greater than or equal to 50%). A multidimensional linear regression model was employed to eliminate the effects of varying mean rates still present after application of Bazett's formula. In patients with 1-, 2- and 3-vessel disease, significant changes of QTc were observed only in patients with impaired left ventricular function (EF less than 60%). In these patients the QTc-interval increased significantly from 1- to 3-vessel disease. If the critical degree of coronary stenosis was changed from greater than or equal to 50% to greater than or equal to 90% further prolongations of QTc were noted. In patients with 1-, 2- and 3-vessel disease the QTc-duration difference was further enhanced if either the proximal part of the descending branch of the left coronary artery (LAD) or the left main stem were affected (stenoses greater than or equal to 50%). The data reveal that prolongation in the duration of electrical systole correlates with known cardiac risk factors for sudden death, i.e. 3-vessel-disease, proximal LAD or left main stem stenosis and impaired left ventricular function. In the individual patient, however, the prognostic value of a single QTc-determination is limited because of a large interindividual variation of the data.

Adult↗
PubMed1995

Role of pericardial constraint for right ventricular function in humans.

STUDY OBJECTIVE: To analyze the extent of pericardial constraint on right ventricular function in humans. PATIENTS AND METHODS: Twenty patients, 59 +/- 2 (mean +/- SEM) years old, undergoing coronary bypass surgery. Right ventricular volumes and pressures were evaluated using a rapid response Swan-Ganz thermodilution catheter. INTERVENTIONS: Parameters were determined before and after pericardiotomy, both before and during increased right ventricular systolic pressure by partial compression of the pulmonary artery (before pulmonary compression: 25 +/- 1 mm Hg; during: 39 +/- 1 mm Hg). RESULTS: Pericardiotomy alone did not significantly affect right ventricular end-diastolic volume (before: 79 +/- 4 mL m-2; after: 78 +/- 3 mL m-2), right ventricular ejection fraction (before: 48 +/- 1%; after: 48 +/- 2%), and right atrial pressure (before: 4.3 +/- 0.8 mm Hg; after: 4.3 +/- 0.7 mm Hg). Before pericardiotomy, the increase in right ventricular afterload significantly increased right atrial pressure (to 5.5 +/- 0.7 mm Hg, p < 0.05) and reduced right ventricular ejection fraction (to 43 +/- 2%, p < 0.01). Right ventricular end-diastolic volume remained unchanged. After pericardiotomy, the increase in right ventricular afterload significantly increased right ventricular end-diastolic volume (to 85 +/- 3 mL m-2, p < 0.01) and also reduced right ventricular ejection fraction (to 42 +/- 2%, p < 0.01), while right atrial pressure was not significantly changed. During increased right ventricular afterload, the right ventricular diastolic pressure-volume relation was shifted rightward. CONCLUSIONS: At normal levels of right ventricular diastolic filling, the pericardium does not exert constraining effects on right ventricular function. However, with increasing levels of right ventricular preload, pericardial constraint significantly influences right ventricular function in humans.

Aged↗
PubMed1981

Ventricular function before and after mitral valve replacement.

To evaluate right ventricular function following mitral valve replacement, we studied 84 patients with isolated mitral valve disease with the use of first-pass radionuclide angiography before, 1 week after, and up to 1 year after operation. The right ventricular ejection fraction for the entire group improved from 29% +/- 11% to 43% +/- 10% (p less than 0.001) at 1 week. This increase was maintained at 3 months (41% +/- 10%) and up to year after operation (40% +/- 12%). The improvement was found not to be influenced by either the type of valvular lesion or the presence and/or level of pulmonary hypertension. When the patients were grouped according to the type of prosthetic valve placed at operation, the right ventricular ejection fraction increased in all patients within 1 week of operation, with sustained improvement at 3 months postoperatively. Thereafter, it began to decline in patients receiving a Carpentier bioprosthesis while being maintained in those patients who received disc valves. Further analysis revealed that those patients who receiving the larger Carpentier bioprostheses had a greater deterioration of right ventricular function than those receiving the smaller Carpentier valves. Left ventricular function in the entire group was normal preoperatively (62% +/- 16%) and was unchanged at 1 week (60% +/- 16%) and a 1 year (59% +/- 16%) after operation.

Adult↗
PubMed2000

Positron emission tomography and low-dose dobutamine echocardiography in the prediction of postrevascularization improvement in left ventricular function and exercise parameters.

BACKGROUND: We studied the value of low-dose dobutamine echocardiography (LDDE) and positron emission tomography (PET) in predicting improvement of left ventricular function and exercise parameters after revascularization. METHODS: Forty-six consecutive patients with ischemic heart disease and an ejection fraction (EF) of 35% +/- 7% were included. Before revascularization, the patients underwent exercise testing and myocardial viability testing by LDDE and fluoride 18-fluoro-2-deoxyglucose PET. Six months after revascularization they underwent coronary angiography to study graft patency, and echocardiographic examination and the exercise test were repeated. RESULTS: In the prediction of the presence or absence of improved postrevascularization function in left ventricular regions with patent grafts, PET was more sensitive than LDDE (42/52 regions [81%] vs 27/52 regions [51%], P <.01), whereas LDDE was more specific than PET (187/209 regions [89%] vs 118/209 regions [56%], P <.001). Improvement of regional myocardial dysfunction was found in 19 patients, but their global left ventricular function did not improve significantly (EF 34% +/- 6% and 36% +/- 7%). In the remaining 27 patients with irreversible dysfunction, EF decreased (EF 36% +/- 7% vs 32% +/- 8%, P <.05). Among patients with reversible myocardial dysfunction, the rate pressure product (RPP) increased after revascularization (19,522 +/- 5474 vs 26,190 +/- 5610 mm Hg/min, P <.01), whereas the RPP did not change in patients with irreversible myocardial dysfunction (21,546 +/- 5450 and 22,774 +/- 8249 mm Hg/min). The number of PET viable segments was a predictor of the postoperative increase in the RPP in univariate (P <.04) and multivariate analyses (P <.001). In contrast, LDDE did not bear any prognostic information about improvement in the RPP. CONCLUSIONS: This study confirms earlier findings of higher sensitivity and lower specificity of PET compared with LDDE in predicting improvement of regional left ventricular function after revascularization. However, the feasibility of predicting postrevascularization improvement of exercise parameters seems unique for PET. The potential prognostic value of this finding needs further investigation.

Cardiotonic Agents↗
PubMed1989

[Serial assessment of cardiac function during and after exercise by an ambulatory ventricular function monitor (VEST)].

Cardiac function was serially assessed during and after exercise by an ambulatory ventricular function monitor (VEST) in 31 patients who received coronary angiography. Based on the study of fluctuation during the baseline recording, greater than or equal to 6% change in ejection fraction (EF) was considered significant. The serial changes in EF during exercise was divided into 5 types, including continuous increase (type A), initial increase but return to the baseline (type B), no change (type C), initial increase but later decrease below the baseline (type D), and continuous decrease (type E). Among 8 normal subjects, their EF changes during exercise showed type A in 3, type B in 2, type C in 2, and type D in 1. Among 21 patients with coronary artery disease, the EF changes showed type A in 5, type B in 4, type C in 4, type D in 5 and type E in 3. Thus, there was a significant overlap in EF response between normal and coronary patients. However, every patient showing type A and B had single-vessel disease, and 63% of them had persistent thallium defect without redistribution. After the exercise, 29 patients showed rapid increase in EF. The time to the peak EF was significantly longer in coronary patients (1.88 +/- 1.24 min) than that in normal cases (0.88 +/- 0.55 min) (p less than 0.05) particularly in patients with multi-vessel disease (2.22 +/- 1.29 min). In addition, those showing type C, D or E tended to have a longer time to peak EF and more increase in EF after exercise than those showing type A or B. These data suggest that VEST is suitable for continuous measurement of cardiac function during and after exercise which provided valuable indices for assessment of severity of ischemia in coronary artery disease.

Adult↗
PubMed1981

Possibilities and limitations of non-invasive techniques for the study of left ventricular function in chronic pulmonary disease.

The authors examined systolic time intervals, apexcardiograms and left ventricular echocardiograms in 151 patients with chronic disease of the airways. Their study showed that unlike apexcardiograms and echocardiograms, which can be performed in 33.8% and 56.7% of patients respectively, systolic time intervals can be assessed in 90.1% of patients. Pathological values of left ventricular function parameters were a comparatively common finding: 49.2% in systolic time intervals, 35.1% in apexcardiograms and 23.5 % in echocardiograms. There was no relation between the parameters of pulmonary function and those of left ventricular function. The authors hold that non-invasive examination of the left ventricular function in pulmonary disease is most valuable in long-term follow-up studies of the changes of the above parameters.

Chronic Disease↗
PubMed2005

Non-invasive assessment of right ventricular function in the late follow-up of the Senning procedure.

Deteriorating ventricular function is a major concern after the Senning operation. A Doppler-derived non-geometric measurement, the so-called myocardial performance index, has been described for use in adults and children. We aimed to assess the utility of this index as a method for quantification of right ventricular function in patients in the late follow-up of the Senning procedure, and to correlate the right ventricular ejection fraction and the first derivative of right ventricular pressure as derived using echocardiography with the ejection fraction determined using magnetic resonance imaging. We studied 44 patients within a mean postoperative period of 15.3 years. We calculated the right ventricular myocardial performance index by pulsed wave Doppler interrogation of tricuspid inflow and aortic outflow, the ejection fraction by Simpson's rule, and the first derivative of right ventricular pressure by continuous wave Doppler from tricuspid regurgitation. Mean values of right ventricular myocardial performance index, ejection fraction, and the first derivative of right ventricular pressure were 0.50, 39 percent and 1,398 millimetres of mercury per second, respectively. A cut-off value of 0.47 for the right ventricle myocardial performance index was determined, with a sensitivity of 75 percent and a specificity of 62.5 percent. We found no correlation between ejection fraction and the first derivative of right ventricular pressure as estimated by echocardiography and the ejection fraction as shown by magnetic resonance imaging (r2 equal to 0.29 and 0.04 respectively). We concluded, first, that patients with preserved right ventricular function had values for the right ventricular myocardial performance index lower than 0.47, and second, that ejection fraction and the first derivative of right ventricular pressure as determined echocardiographically did not correlate with values derived using magnetic resonance imaging.

Adolescent↗
PubMed2003

Usefulness of tissue Doppler echocardiography for evaluating ventricular function in children without heart disease.

Tissue Doppler echocardiographic imaging (TDI) is a novel method for accurately evaluating ventricular function. Currently, scant data are available on the distribution of tissue Doppler indexes in healthy children in the age range of 1 to 18 years. The aims of this study were to assess the distribution of tissue Doppler indexes of systolic and diastolic ventricular function in healthy children, to assess the influence of age on these indexes, and to compare them with conventional Doppler indexes. A total of 151 consecutive children aged 1 to 18 years were enrolled in the study. Nine different (7 diastolic and 2 systolic) TDI parameters were assessed. Peak velocities of systolic and diastolic excursions of the mitral and tricuspid annuli were obtained from the apical 4-chamber view. Mean velocities of early diastolic recoil of mitral and tricuspid annuli were measured from the apical 4-chamber view. The mean velocity of early diastolic relaxation of the left ventricular posterior wall was measured in the parasternal long-axis view. Results showed a statistically significant difference in some of the TDI indexes among the different pediatric age groups. Most of the TDI indexes showed a very weak correlation with age. There was no significant correlation (p >0.05) between peak velocities of the early diastolic mitral inflow Doppler pattern (E wave) and the corresponding TDI index. In contrast, there was a significant (p <0.001) correlation between the corresponding Doppler indexes in the tricuspid annulus. We conclude that TDI is a valuable tool for assessing ventricular function, particularly diastolic function. Establishment of normative data for TDI in the pediatric age group should broaden the clinical applicability of this useful modality for assessing ventricular function.

Adolescent↗
PubMed1993

Protamine and left ventricular function: a transesophageal echocardiography study.

The effect of protamine sulfate on left ventricular function was evaluated in 23 patients undergoing heart surgery requiring cardiopulmonary bypass (CPB). Ventricular function was assessed by measuring cardiac index with a thermodilution pulmonary artery catheter and fractional shortening with transesophageal echocardiography (TEE). After CPB, a heparin-neutralizing dose of protamine was infused continuously for 5 min. Hemodynamic variables were obtained and fractional shortening was measured before protamine administration (time 0), during protamine infusion (2.5 and 5 min), and after the infusion (10 and 15 min after the start of protamine). Patients with a preoperative ejection fraction > or = 50% had no statistically significant changes in either cardiac index or fractional shortening with protamine administration, when compared to time 0. However, patients with a preoperative ejection fraction < 50% had a significant decrease in fractional shortening which occurred during and immediately after protamine administration when compared to time 0 (P < 0.01), with no associated change in hemodynamics. Our results suggest that protamine may have a negative inotropic effect that is apparent in patients with impaired ventricular function.

Adult↗
PubMed1999

Value of ST-segment elevation pattern in predicting infarct size and left ventricular function at discharge in patients with reperfused acute anterior myocardial infarction.

BACKGROUND: The implication of the shape of ST elevation in the acute phase of myocardial infarction (MI) remains unclear. METHODS AND RESULTS: We examined the relation between the shape of ST elevation and infarct size in 77 patients who had a first acute anterior MI with successful reperfusion within 6 hours from symptom onset. A 12-lead electrocardiogram was recorded immediately before reperfusion confirmed by coronary angiography. The shape of ST elevation in lead V3 was classified into 3 types: concave type (n = 24), straight type (n = 41), and convex type (n = 12). For concave type, straight type, and convex type, a median value of peak creatine kinase was 2287, 4371, and 5322 mU/mL, and left ventricular ejection fraction measured by left ventriculography at discharge (14 days after MI) was 58%, 48%, and 41% (P <.05; concave type versus the other 2 types), respectively. A multivariate logistic regression model demonstrated that the concave type of ST elevation was a strong predicting factor for preserved left ventricular function (left ventricular ejection fraction >/=50% at discharge; odds ratio 6.2, 95% confidence interval 1.6 to 20.8, P =.019). CONCLUSIONS: In patients with reperfused acute anterior MI, left ventricular function was excellent in patients with concave type, intermediate in those with straight type, and relatively poor in those with convex type ST elevation at discharge. This simple classification is useful for predicting left ventricular function at discharge.

Adult↗
PubMed1984

[Echocardiography in the study of left ventricular function].

Ultrasound provides anatomical (wall thickness, diameter) and functional (thickening of the wall, ventricular ejection, ventricular filling) information about the left ventricle. The reliability and reproducibility of these measurements have been improved by the development of mono and bidimensional techniques, so that, today, ultrasound is the method of choice for the investigation and surveillance of left ventricular function, provided it is of good quality. Apart from the indirect information about left ventricular function drawn from mitral or aortic traces, the echocardiogram has proven to be a reproducible method for estimation of the thickness of the ventricular wall, the ventricular diameters and the left ventricular muscle mass. Whatever the geometry of the left ventricle, the ventricular volume is assessed most accurately by bidimensional ultrasound.

Cardiac Volume↗
PubMed1998

Contribution of the interventricular septum to maximal right ventricular function.

OBJECTIVE: Maximal right ventricular (RV) function is influenced by left heart hemodynamics, possibly mediated by the interventricular scpturn (IVS). We examined the potential contribution of the IVS function to right heart function. METHODS: In 12 canine isovolumic right heart preparations, incremental volumes were introduced into a high compliance RV balloon until RV failure occurred. Maximal RV developed pressure (RVDP) and maximal positive RV dP/dt were determined with a working IVS at a constant left ventricular (LV) output of 2 l/min and at a constant mean arterial pressure of 80 mmHg. Thereafter the IVS was thermally inactivated, and measurements were repeated using the same protocol. RESULTS: At constant arterial pressure and constant LV output, thermal inactivation of the IVS led to a significant decrease in maximal RVDP (inactivated vs. working IVS: 36.1+/-9.8 vs. 56.8+/-16.2 mmHg, respectively, P < 0.001), and RV dP/dt (inactivated vs. working IVS: 720+/-220 vs. 1350+/-190 mmHg/s, respectively, P < 0.001). CONCLUSIONS: These results suggest that the functional status of the IVS is a major determinant of maximal RV function. At constant LV conditions and arterial pressure, an inactivated IVS leads to a significant decrease in maximal RVDP and RV dP/dt under the conditions of this study.

Animals↗
PubMed1982

Improvement of left ventricular function after percutaneous transluminal coronary angioplasty.

Cardiac function and left ventricular dynamics were measured in seven consecutive patients 1 day before and 6 months after percutaneous transluminal balloon angioplasty of subtotal proximal stenosis of the left anterior descending coronary artery. Before angioplasty all patients had obvious left ventricular dysfunction during exercise and to a smaller degree during isoproterenol infusion; the condition of all patients was greatly improved 6 months after angioplasty. After angioplasty, left ventricular end-diastolic pressure was normal at rest and decreased from a mean (+/- standard error of the mean) of 33.8 +/- 1.6 to 19.2 +/- 0.5 mm Hg on exercise. Left ventricular ejection fraction, measured by a gated blood pooling technique with technetium-99m, improved on exercise from 46 +/- 5.0 percent to 69 +/- 1.0 percent. Cardiac output and stroke volume index increased significantly with exercise after angioplasty. The peak negative rate of pressure reduction in the left ventricle (dP/dt/min), an index of left ventricular relaxation, was highly abnormal on exercise before (2,307 +/- 260 mm Hg/s) and increased to the normal range (3,154 +/- 200 mm Hg/s) after angioplasty. The improvement in left ventricular function after transluminal angioplasty in these cases of proximal left anterior descending coronary arterial stenosis is extremely encouraging.

Adult↗
PubMed1977

[Application of non-invasive methods to assessment of left ventricular function in cardiomyopathy (author's transl)].

Left ventricular function in cardiomyopathy was studied by non-invasive methods. Various indices of left ventricular function were measured in patients with cardiomyopathy by mechanocardiography and echocardiography and were compared with indices in normal subjects and the following conclusions were obtained. 1) Patients with Congestive cardiomyopathy had high PEP/LVET, low mVcf, low EF, and low mPWV, suggesting depressed cardiac function. 2) Patients with Hypertrophic obstructive cardiomyopathy had characteristic findings, such as low DDR, high IVST/PWT, and SAM. 3) Patients with Hypertrophic non-obstructive cardiomyopathy had no characteristic changes in indices, however in some of the findings transition to Hypertrophic obstructive cardiomyopathy was suggested.

Cardiomyopathies↗
PubMed2006

[Clinical observation on shufei granule in improving right ventricular function of patients with chronic pulmonary heart disease].

OBJECTIVE: To observe the effect of Shufei Granule (SG) on right ventricular function in patients with chronic pulmonary heart disease (CPHD). METHODS: One hundred CPHD patients were randomly divided into two groups, the control group (n = 40) treated with fleroxacin 0.2 g twice per day by intravenous dripping and diprophylline 0.2 g 3 times per day orally, the treatment group (n = 60) treated with SG 10 g 3 times a day orally additionally besides the treatment given to the control group. The therapeutic course for both groups was 3 weeks. The changes of the cardiac function, the right ventricular function [A peak velocity (VA), E peak velocity (VE), VA/VE, systolic pulmonary artery pressure (SPAP), pre-ejection period (PEP), right ventricular ejection time (RVET), PEP/RVET], and blood-gas analysis were investigated, the condition of clinical symptoms and signs as well as tongue pictures were observed also. RESULTS: The total effective rate was 91.6% in the treated group, significantly higher than that in the control group (70.0%, P < 0.01); the improvements in symptom score, cardiac function and the other laboratory indexes were all superior in the treatment group to those in the control group (P < 0.05, P < 0.01). CONCLUSION: SG is an effective drug for improving right ventricular function in CPHD patients.

Adult↗
PubMed1999

Ventricular function.

Multiple modalities contribute to the evaluation of ventricular function. The role of cineangiography, echocardiography, MR imaging, ultrafast CT, and nuclear medicine continue to evolve and improve our understanding of the physiology and pathophysiology of ventricular function. This article discusses the use and limitation of each modality.

Cineradiography↗
PubMed2001

[Postoperative right ventricular function after repair of tetralogy of Fallot with respect to the method of right ventricular outflow tract reconstruction].

We evaluated postoperative right ventricular function in the sixty-four consecutive patients with tetralogy of Fallot underwent total correction. The patients were divided to three groups according to the method of right ventricular outflow tract reconstruction: transannular patching (TA group; n = 31); right ventricular outflow patching with preservation of pulmonary valve ring (RV group; n = 12) and transatrial-transpulmonary approach without right ventriculotomy (no-RV group; n = 21). The early results of postoperative cardiac catheterization and echocardiography were compared among the three groups. Degree of pulmonary regurgitation was significantly low in the RV group and no-RV group compared with TA group (p < 0.005). Right ventricular ejection fraction was the highest in the no-RV group (p < 0.002). The repair without right ventriculotomy for tetralogy of Fallot can provide the best results with respect to postoperative right ventricular function.

Cardiac Surgical Procedures↗