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PubMedDate not supplied

[Cardiac right ventricular function and hemodynamics during resection of the lungs].

Right-ventricular function and hemodynamics were studied in 48 patients during resections of the lungs (lobectomy and pneumonectomy) under total noninhalation anesthesia. Approaches to compensation of circulation in resection of different volume of lung tissue were determined. The leading role of the diastolic function of the right heart ventricle in realization of hemodynamic response in pneumonectomy is revealed. Volumetric monitoring of right-ventricular function during extensive lung resections is highly informative.

Anesthesia, General↗
PubMed1986

Left ventricular function in acute myocardial infarction: assessment by nuclear angiography.

Left ventricular function was assessed in 38 patients two to six days after acute myocardial infarction using nuclear angiocardiography and the following parameters were measured: Left ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV), ejection fraction (LVEF), indices of left ventricular filling and emptying, right ventricular ejection fraction and ejection rate. Their clinical significance was assessed by their relationship to the patients site and size of infarction, functional capacity, morbidity and mortality. The most sensitive indices of depressed left ventricular function were the EF and ESV. Thus, function was preserved in patients with a small inferior infarction (LVEF = 0.57 +/- 0.07, LVESV = 69 +/- 14 ml) and in Killip Class I (LVEF = 0.48 +/- 0.13, LVESV = 80 +/- 20 ml). Function was disturbed most in patients with extensive anterior infarction (LVEF = 0.18 +/- 0.12, LVESV = 131 +/- 46 ml), Killip Class IV (LVEF = 0.13 +/- 0.07, LVESV = 160 +/- 35 ml), cardiogenic shock (LVEF = 0.14 +/- 0.07, LVESV = 160 +/- 35 ml), pulmonary edema (LVEF = 0.11 +/- 0.06, LVESV = 166 +/- 25 ml) and pulmonary capillary wedge pressure greater than 20 mm Hg (LVEF = 0.14 +/- 0.07, LVESV = 160 +/- 33 ml). Previous infarction was associated with LV dilatation and a greater LVEDV. A lower ejection fraction signified a large infarct and poor left ventricular function. If the ejection fraction was less than 0.15, the patients were unlikely to leave the hospital alive, or if less than 0.25, they were left with poor residual ventricular function and either had significant cardiac failure or high late mortality. Nuclear angiocardiography was a simple method of predicting the clinical pattern and prognosis in each patient and emphasized the importance of limiting infarct size in acute myocardial infarction.

Adult↗
PubMed1979

Normal left ventricular function.

The Starling relationship in the normal human ventricle may be different than usually portrayed. In normal, resting, supine man the ventricular function curve is at its peak at a left ventricular end-diastolic pressure of approximately 10 mm Hg. Below this point is a strong direct relation between filling pressure and stroke work, while at higher filling pressures, a plateau occurs. Limitation of ventricular response is related to a sharply rising ventricular pressure-volume curve at a normal level of filling pressure. Thus, in the supine position, the normal heart is not on the active portion of the ventricular function curve, but is in a unique position in which cardiac output is probably controlled by factors other than ventricular filling pressure. In ventricular failure, the peak of the ventricular function curve is displaced to a higher level.

Blood Pressure Determination↗
PubMed1983

Early assessment of rest and exercise left ventricular function following coronary artery surgery.

Radionuclide assessment of rest and exercise left ventricular function was performed in 14 patients before, eight days after, and three months after coronary artery bypass grafting (CABG). Resting function was unaltered after operation, although mild increases in heart rate and end-diastolic volume were observed on the eighth postoperative day. In contrast, exercise function was significantly improved at both postoperative time periods. Exercise ejection fraction was 0.54 +/- 0.10 before operation, 0.73 +/- 0.12 at eight days, and 0.64 +/- 0.13 at three months. Before CABG, the exercise-induced increase in stroke volume was achieved by an increase in end-diastolic volume, whereas eight days after CABG this increase was achieved by an increase in contractility (systolic blood pressure/end-systolic volume). By three months, both contractility and end-diastolic volume increased with exercise. Thus, improvement in left ventricular function during exercise can be documented as early as eight days after coronary revascularization. This change may be less pronounced after three months of convalescence, but considerable improvement in ventricular function persists compared to preoperative assessment.

Aged↗
PubMed1996

Left ventricular function after late thrombolysis with alteplase in myocardial infarction.

OBJECTIVE: Late thrombolytic treatment (after 6 hours from pain onset) for acute myocardial infarction has been shown to improve survival in a cohort of patients. The mechanisms underlying such benefit have been debated and a controversy exists about the influence of late thrombolysis over left ventricular function as one potential mechanism. The present study intended to clarify the effects of late thrombolysis with alteplase on left ventricular function parameters. DESIGN: Prospective, multicenter, randomised, double-blind study. Ancillary study to LATE trial. PATIENTS: We studied 103 patients, 81.6% men, randomly allocated to alteplase (100 mg over 3 hours) or placebo 6 to 24 hours after onset of myocardial infarction. METHODS: Left ventricular function parameters by radionuclide ventriculography were evaluated at 1 and 6 months after myocardial infarction. RESULTS: At 1 month, left ventricular ejection fraction was 48.86% on alteplase and 43.19% in placebo group (p = 0.028), with greater benefits for septal and apical regions. At 6 months no significant differences were found. CONCLUSIONS: Those data suggest that late thrombolysis with alteplase improves left ventricular function 1 month after myocardial infarction although the difference did not persist at 6 months. Improvement of left ventricular function shall, therefore, be considered as one of the possible mechanisms underlying the benefit of late thrombolysis.

Double-Blind Method↗
PubMed2005

The effect of ventricular pacing on measurements of left ventricular function: a comparison between echocardiographic methods and with radionuclide ventriculography.

AIMS: Different methods exist for measuring left ventricular function echocardiographically; each may be error prone due to the abnormal pattern of ventricular activation during pacing. METHODS AND RESULTS: Echocardiography was undertaken on 307 patients with permanent pacemakers; a subset of 57 underwent radionuclide ventriculography. Intrinsic and paced beats were analysed for left ventricular function by: Simpson's bi-plane, Teicholz M-mode, wall-motion scoring and 'eyeball' assessment. Agreement between techniques and with radionuclide ventriculography were compared according to intrinsic or paced beats. Echocardiographic measures of ejection fraction give mean values 5% higher than radionuclide ventriculography (Simpson's 30+/-9%, vs. Teicholz 30+/-13% vs. radionuclide ventriculography 25+/-9%, p=0.03). Agreement between Simpson's, Teicholz and radionuclide ventriculography by Bland-Altman analysis showed poor agreement (Simpson's vs. Teicholz range (4xSD)=57%, Simpson's vs. radionuclide ventriculography=36%, Teicholz vs. radionuclide ventriculography=46%, p=0.02), the level of agreement deteriorates with ventricular pacing (Simpson's vs. Teicholz range=61%, Simpson's vs. radionuclide ventriculography=34%, Teicholz vs. radionuclide ventriculography=47%, p=0.02). The correlation between wall motion analysis and radionuclide ventriculography is moderately poor (all subjects r=0.58, ventricular pacing r=0.52, not pacing r=0.66). CONCLUSION: Echocardiography and radionuclide ventriculography are the only non-invasive techniques to assess left ventricular function in the paced population. Results are poorly interchangeable and the accuracy of any comparison dependent on the underlying rhythm.

Echocardiography↗
PubMed1981

Accuracy of diagnosis of coronary artery disease by radionuclide management of left ventricular function during rest and exercise.

Rest and exercise radionuclide angiocardiographic measurements of left ventricular function were obtained in 496 patients who underwent cardiac catheterization for chest pain. Two hundred forty-eight of these patients also had an exercise treadmill test. An ejection fraction less than 50% was the abnormality of resting left ventricular function that provided the greatest diagnostic information. In patients with normal resting left ventricular function, exercise abnormalities that were optimal for diagnosis of coronary artery disease were an injection fraction at least 6% less than predicted, an increase greater than 20 ml in end-systolic volume and the appearance of an exercise-induced wall motion abnormality. The sensitivity and specificity of the test were lower in patients who were taking propranolol at the time of study and in patients who failed to achieve an adequate exercise end point. In the 387 patients with an optimal study, the test had a sensitivity of 90% and a specificity of 58%. Radionuclide angiocardiography was more sensitive and less specific than the exercise treadmill test. The high degree of sensitivity of the radionuclide test suggests that it is most appropriately applied to patient groups with a high prevalence of disease, including those considered for cardiac catheterization.

Adult↗
PubMed1979

Changes in the diastolic pressure-diameter relation after ventricular function curves.

Systolic performance depends on end-diastolic muscle fiber length, contractility, and afterload. Ventricular function curves are constructed using end-diastolic pressure instead of end-diastolic dimensions, on the assumption that end-diastolic pressure and end-diastolic dimensions (reflecting muscle fiber length) have a constant relation. That assumption has been rejected. Theorectically, ventricular function curves should change with changes in the diastolic pressure-dimension relation as well as with contractility or afterload. We measured pressures and dimensions in ventricles of six open-chest dogs before and after opening the pericardium to alter diastolic pressure-dimension relations with afterload constant. When an indicator of systolic performance (developed pressure times diameter change during systole) was plotted against end-diastolic pressure, data obtained with the pericardium closed and open resulted in two distinct curves, suggesting an increase in contractility with the pericardium open. However, when systolic performance was plotted against end-diastolic diameter, data obtained with the pericardiumclosed and open fell along one curve, indicating no change in contractility. Therefore, changes in the diastolic pressure-dimension relation to shift conventional ventricular function curves.

Animals↗
PubMed1993

[Evaluation of the right ventricular function in postoperative esophageal cancer patients].

We evaluated the right ventricular function in pre- and post-operative esophageal cancer patients who had no complications after surgery by measurement of cardiopulmonary hemodynamics, right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) using Swan-Ganz catheter and the thermodilution technique. The measurement of RVEF, RVEDVI and other cardiopulmonary hemodynamics were performed from the preoperative day to the 3rd postoperative day. The values of RVEF were stable about 40% from preoperative day to 3rd. RVEDVI was varied at 93.6 +/- 26.3 ml/m2 (preoperative day), 83.6 +/- 15.0 ml/m2 (after surgery), 70.2 +/- 10.6 mg/m2 (morning of the 1st POD), 95.6 +/- 19.4 ml/m2 (evening of the 1st POD), 103.2 +/- 17.9 m/lm2 (morning of the 2nd POD), 1108.3 +/- 14.2 ml/m2 (evening of the 2nd POD) and 112.4 +/- 31.0 ml/m2 (morning of the 3rd POD). The values of RVEDVI on the morning of the 1st POD were statistically lower than those at other times (p < 0.05). The values of RVEDVI were not correlated with mean pulmonary arterial pressure and pulmonary arteriolar resistance which were the afterload of the right ventricle. These data suggest that the right ventricular function of the patients who underwent esophagectomy with no complication does not change and that the changes of RVEDVI are influenced by the preload of the right ventricle.

Cardiac Output↗
PubMed1994

No differences in hemodynamics, ventricular function, and oxygen delivery in septic and nonseptic patients with the adult respiratory distress syndrome.

OBJECTIVE: To determine whether there are differences in hemodynamics, ventricular function, oxygen delivery, and oxygen consumption between septic and nonseptic patients who have the adult respiratory distress syndrome (ARDS). DESIGN: Cohort analytic study. SETTING: Tertiary care medical and surgical intensive care unit, university hospital. PATIENTS: Eighteen septic (survivors, n = 8; nonsurvivors, n = 10) and 14 nonseptic (survivors, n = 7; nonsurvivors, n = 7) patients studied within 24 hrs of the diagnosis of ARDS. INTERVENTIONS: Simultaneous hemodynamic, radionuclide cineangiographic, and oxygen delivery and consumption measurements. MEASUREMENTS AND MAIN RESULTS: Cardiac index, right and left ventricular ejection fractions, end-diastolic volume indices, oxygen delivery, and oxygen consumption were measured. There were no differences in mean systemic and pulmonary arterial pressures, cardiac index, systemic vascular resistance, right and left ventricular ejection fractions, end-diastolic volumes, and oxygen delivery and consumption between septic and nonseptic patients. CONCLUSIONS: Early in the course of ARDS, there were no differences in hemodynamics, ventricular function, and oxygen delivery and consumption between septic and nonseptic patients. Sepsis does not account for the previously reported differences in hemodynamics, ventricular function, and oxygen delivery and oxygen consumption between survivors and non-survivors of ARDS. We speculate that both ARDS and sepsis cause release of mediators which cause similar changes in hemodynamics, ventricular function, and oxygen delivery and consumption.

Adult↗
PubMed1991

Therapeutic approaches affecting diastolic ventricular function.

The therapeutic approaches affecting diastolic ventricular function are conditional on underlying physiology, especially as it relates to calcium cycling, early relaxation and rapid filling abnormalities, atrial function, hemodynamics, the presence of hypertrophy, and neurohormonal milieu. A wide variety of treatment considerations are discussed, with particular attention to the management of cardiomyopathy characterized by pure or predominant diastolic failure (Table 1).

Cardiovascular Agents↗
PubMed2002

Evaluation of native left ventricular function during mechanical circulatory support: theoretical basis and clinical limitations.

Left ventricular function on patients with heart disease is now evaluated by echocardiography, but these dimensional changes are erroneous in the patient supported by left ventricular assist device because of mechanical unloading for the failing heart. Left ventricular end-systolic pressure-volume relationship provides theoretically most reliable left ventricular contractility. Recently, some patients have weaned from the device because of unexpected recovery of myocardial contractility. But it is very important to evaluate the left ventricular function just before the weaning, and to predict the longevity of the recovered function to keep the good quality of life. Current clinical situation in the patients with ventricular assist device, and theoretical limitations to evaluate the recovering myocardium are discussed.

Heart Failure↗
PubMed1989

The interaction between diltiazem and left ventricular function after myocardial infarction. Multicenter Diltiazem Post-Infarction Research Group.

The interactions between diltiazem and three parameters of left ventricular function using cardiac death as the end point were investigated in 2,466 patients, aged 25-75 years, who were involved in the long-term diltiazem postinfarction trial. Indexes of left ventricular function included pulmonary congestion on chest x-ray, acute anterolateral Q wave myocardial infarction on electrocardiogram, and radionuclide ejection fraction. Pulmonary congestion and acute anterolateral infarction had significant (p less than 0.01) interactions with treatment allocation, and the third variable, ejection fraction, showed a similar trend (p less than 0.1). There was a diltiazem-related reduction in cardiac death (Cox hazard ratio, 0.76-0.86) for each of the parameters reflecting good ventricular function, and a significant diltiazem-related increase in cardiac death (Cox hazard ratio, 1.52-1.85) for each of the parameters associated with impaired function. Three-factor interactions highlighted the extremes of the favorable and adverse effects of diltiazem in subsets with unimpaired and impaired left ventricular function. These findings permit more appropriate selection of patients for the safe and effective administration of diltiazem to postinfarction patients.

Adult↗
PubMed1996

[Effect of infusion of hyperosmolar mannitol on left ventricular function in essential hypertension].

The left ventricular function of the heart was examined by means of the method of equilibrium-radionuclide ventriculography in 40 patients with essential hypertension (EH)--20 patients in stage I (H1), 20 patients in stage II (H2) according to WHO criteria--and in 18 normotensives (N). The examination was performed at rest and immediately after stress by intravenous infusion of hyperosmolar mannitol. At rest, the parameters of global systolic and diastolic functions of the left ventricle in normotensives do not differ significantly from the values in both groups of hypertensives. The global ejection fraction (GEF), peak ejection rate (PER) and peak filling rate (PFR) were in H2 significantly lower than in H1. Sectorial ejection fraction (SEF) in the apicoseptal area is in H2 significantly lower than H1 and N. After infusion of hyperosmolar mannitol the GEF and PFR increased in N and H1 only. When comparing all groups after infusion of mannitol the PFR in H2 is significantly lower also in comparison with N with the tendency (significant limit) to lower values of GEF and PER. PER and PFR were significantly lower and the end-diastolic volume (EDV) was significantly higher in H2 in comparison with H1. SEF was significantly lower in H2 in comparison with N in 3 out ot 9 sectors and in comparison with H1 in 8 out of 9 sectors. The infusion of hyperosmolar mannitol reveals subclinical disturbances of the diastolic and partially also of the systolic function of the left ventricle in stage II of EH which is very useful for diagnosis and treatment. (Tab. 4, Fig. 3, Ref. 22.).

Adult↗
PubMed1992

RETRACTED: Right ventricular function in patients with aortic stenosis undergoing aortic valve replacement.

The effects of aortic stenosis (AS) on right ventricular function during cardiac surgery are not fully understood. Forty patients undergoing aortic valve replacement with either a systolic transvalvular gradient of less than 100 mm Hg (82.1 +/- 5.5 mm Hg; group 1, n = 20) or greater than 120 mm Hg (131.1 +/- 6.9 mm Hg, group 2, n = 20) were investigated with regard to right ventricular function in the perioperative period. Right ventricular ejection fraction (RVEF), right ventricular end-systolic volume (RVESV), and right ventricular end-diastolic volume (RVEDV) were measured by means of the thermodilution technique. Before cardiopulmonary bypass (CPB), RVEF was significantly lower in group 2 patients (34% +/- 6%) than in group 1 (45% +/- 5%). After CPB, RVEF increased significantly in group 2 (28% +/- 4% to 49% +/- 5%), and no further differences were noted between the groups. In the patients with a higher systolic transvalvular gradient, RVEDV and RVESV were lower at the start of surgery, but increased after opening the pericardium. Cardiac index was also lower in these patients. Pericardiotomy resulted in a decrease in right ventricular end-systolic pressure (RVESP) only in the patients of group 2. In these patients more epinephrine was necessary to maintain stable hemodynamics during the post-bypass period. It is concluded that patients with AS are at risk of reduced right ventricular function when the systolic transvalvular pressure gradient is more than 120 mmHg. Knowledge of the complex interaction between the two sides of the heart may enable anesthesiologists to optimize management during the perioperative period.

Aged↗
PubMed1994

Right ventricular function early after total or standard orthotopic heart transplantation.

Right ventricular failure after orthotopic heart transplantation (OHT) is classically related to preoperative pulmonary hypertension. However, the role of the enlarged atria in right ventricular dysfunction after OHT remains unclear. For that purpose, the right ventricular function in the first 2 days after OHT was compared in two groups of transplant recipients: 11 patients who underwent standard OHT (group I) and 9 patients who underwent total OHT, which consisted of total excision of both the left and right atria and OHT of an intact donor heart with its atria as well as its ventricle (group II). Right ventricular ejection fraction, cardiac index, and right-sided pressures were recorded at baseline and 4, 8, 12, 24, and 48 hours after OHT using a Swan-Ganz catheter with a rapid-response thermistor. Right ventricular function parameters did not differ between groups; they were characterized by a decrease in right ventricular ejection fraction and an increase in right ventricular end-diastolic volume index whereas cardiac index and right-sided pressures remained normal or slightly increased. Ischemic time (177 +/- 41 minutes in group I versus 178 +/- 39 minutes in group II) and preoperative pulmonary vascular resistance (1.9 +/- 0.7 Wood units in group I versus 3.0 +/- 1.5 Wood units in group II) were not different between groups. These results suggest that the anatomic and physiologic advantages offered by the modified technique of OHT had no clinical relevance in this group of patients with low preoperative pulmonary vascular resistances when compared with a group of patients who underwent transplantation with the standard technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Static left latissimus dorsi cardiomyoplasty: effect on left ventricular function.

When the latissimus dorsi is used for ventricular augmentation in cardiomyoplasty, a delay of several weeks occurs before the muscle revascularizes, adheres to the heart, and is transformed to fatigue-resistant status. This study analyzes the effect of static (unstimulated) cardiomyoplasty on left ventricular function. Four mongrel dogs underwent staged left latissimus dorsi cardiomyoplasty. Left ventricular pressure was measured with a micromanometer catheter. Left ventricular volume was measured by sonomicrometry. Cardiac output, heart rate, preload recruitable stroke work, maximum elastance, left ventricular end-diastolic volume, left ventricular end-diastolic pressure, stroke work, and the diastolic relaxation constant were measured before and immediately after cardiomyoplasty with the myoplasty static. Results, expressed as mean +/- standard error of the mean, showed no significant differences in indexes of systolic function (stroke work, 1017 +/- 223 gm.cm to 984 +/- 403 gm.cm; preload recruitable stroke work, 110 +/- 13 gm.cm/cm3 to 115 +/- 19.8 gm.cm/cm3; maximum elastance, 10.38 +/- 5.6 mm Hg/ml to 13.59 +/- 6.5 mm Hg/ml; cardiac output 4.51 +/- 0.43 L/min to 4.21 +/- 0.34 L/min) or diastolic function (left ventricular end-diastolic volume, 21 +/- 5.2 ml to 20 +/- 5.3 ml; left ventricular end-diastolic pressure, 13 +/- 3.5 mm Hg to 15 +/- 3 mm Hg; diastolic relaxation constant 42.8 +/- 5.2 msec to 42.5 +/- 4.5 msec). Heart rate also remained unchanged (131 +/- 8.9 beats/min to 140 +/- 9.8 beats/min). The static (unstimulated) left latissimus dorsi cardioplasty can be done with little effect on left ventricular systolic or diastolic function in the normal canine heart.

Animals↗