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PubMed1990

[Immediate and one-year evaluation of the benefit of aortic valvuloplasty in aortic stenosis with impaired ejection fraction].

Seventy-two consecutive patients with severe aortic stenosis and impaired by left ventricular ejection fractions (EF less than 40%) underwent percutaneous aortic valvuloplasty between September 1985 and November 1987. Forty-five patients had been turned down by the surgeons because of their age (29 patients over 80 years of age), their impaired left ventricular function or associated pathologies. Valvular dilatation with 15 to 23 mm diameter balloons resulted in a reduction of the transvalvular pressure gradient from 63 +/- 21 to 26 +/- 11 mmHg (p less than 0.001) and an increase in valve surface area from 0.48 +/- 0.15 to 0.91 +/- 0.32 cm2 (p less than 0.001) but with large individual variations. No cases of aggravation of associated aortic insufficiency were observed after the procedure. One 98-year old woman died during the dilatation and 4 other patients died during the hospital period. Immediate clinical improvement was observed in 80 per cent of patients. During the one-year follow-up period, 33 patients died, 31 of cardiac causes. Of the 34 survivors at one year, 21 had maintained their clinical improvement. A repeat hemodynamic study was performed in 22 patients 7 months after valvuloplasty. Eleven patients had restenosed and their hemodynamic parameters had practically returned to pre-valvuloplasty values. The left ventricular ejection fractions of the 11 patients without restenosis had increased from 28 +/- 7 to 40 +/- 18 per cent (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Left ventricular ejection fraction calculated from gated technetium-99-sestamibi SPECT.

BACKGROUND: The accuracy of the left ventricular ejection fraction (LVEF) calculated from gated single photon emission computed tomography (GSPECT) studies is dependent on the accuracy of the determination of the end-diastolic volume (EDV) and end-systolic volume (ESV) of the left ventricle (LV). In this study we evaluated the feasibility of calculating the EDV, ESV and LVEF from the area under the polar graph (APC) of the edges of the LV image determined by a first derivative edge-detection method. METHODS AND RESULTS: Technetium-99m ((99m)Tc) sestamibi GSPECT studies and planar equilibrium radionuclide ventriculography (ERNV) were performed on 15 male subjects in whom the LVEF ranged from 19% to 75%. Images were reconstructed to obtain short axis slices of the LV spanning the cardiac cycle. On each slice the LV edge points were determined at 10 degrees intervals using the APC method. The area of each short axis slice was determined by conversion to polar co-ordinates, interpolation and numerical integration of the graphs and multiplication by a pre-determined conversion factor. RESULTS: Edges were successfully determined in all 15 patients using the APC method. The LVEF results correlate well with conventional planar ERNV studies (r = 0.96, LVEF(GSPECT) = 8.80 + 0.66 LVEF( ERNV)). The absolute difference between the LVEF for ERNV and for the APC method was 6.1% with a standard deviation of 7.6%. The reproducibility of SPECT LVEF using the APC method was good (intra-observer r = 0.99, inter-observer r = 0.99). CONCLUSIONS: The APC method provides for easy and accurate ejection fraction determination with limited underlying mathematical assumptions. The ability to interpolate the edge points provides for stable edge detection even in hypoperfused myocardium.

Adult↗
PubMed1996

Comparison of isoflurane, halothane and fentanyl in patients with decreased ejection fraction undergoing coronary surgery.

The aim of the study was to compare three anaesthetic agents in patients with ejection fraction below 0.40 subjected to coronary revascularization surgery. Twenty five elective coronary surgical patients with ejection fraction below 0.40 were prospectively studied. Premedication was pethidine 1 mg/kg and induction was fentanyl 0.03 mg/kg and pancuronium 0.1 mg/kg. The patients were randomized to one of three maintenance techniques (fentanyl, isoflurane or halothane). Radial arterial pressure, heart rate, right atrial pressure, pulmonary arterial and occluded pressures, and thermodilution cardiac output were measured, and cardiac index and resistance calculated, at the following times: before induction; 5 min after intubation; 2 min after sternotomy; immediately after discontinuation of bypass; 15 min afterwards; immediately after sternal closure; during suture of the skin; 5 min after arrival in the postoperative care unit; and 60 min postoperatively. Mean arterial pressure decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction. Cardiac index decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction and after sternotomy. Neither pressure nor flow decreased in patients receiving fentanyl. Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.

Adjuvants, Anesthesia↗
PubMedDate not supplied

[Evaluation of different electrocardiographic scores (QRS score) for estimating the ejection fraction of the left ventricle after acute myocardial infarct].

We calculated the QRS score using both the simplified Selvester's method and the Hills' one, extended to the 12 standard leads, from the electrocardiograms registered on the fifth and thirtieth day from the ischemic event from 50 infarcted patients whose radionuclide left ventricular ejection fraction was known. The analysis of our results showed a very good correlation existing between the early and the late scores (r = 0.91 Hillis's method) as well as the equivalence of the two methods as witnessed by a correlation coefficient of 0.86 on the fifth day electrocardiogram and of 0.84 on the thirtieth day E.C.G. However the correlation between QRS score and left ventricular ejection fraction was quite weak ranging from -0.36 to -0.48 depending upon the method and the moment selected for the acquisition of the data. Even the attempt to correctly select patients with a higher risk identifying a QRS score able to predict a reduced left ventricular ejection fraction (i.e. less than 40%) failed because of the low sensitivity and specificity of the method. We therefore believe that the QRS score or, at least the simplified one, is not useful to assess the residual left ventricular function after a myocardial infarction and its use should be reduced to the evaluation of the infarct size.

Electrocardiography↗
PubMed1996

[Risk of mortality after myocardial infarction: value of heart rate, its variability and left ventricular ejection fraction].

Heart rate variability is a useful parameter for risk stratification after myocardial infarction. However, the relationship between heart rate itself and its variability has not been adequately studied. The authors compared the average RR interval of 24 hours recorded by Holter monitoring with the variability of heart rate and of left ventricular ejection fraction to assess the risk of death after myocardial infarction. A total of 579 patients was followed up for 2 years after acute myocardial infarction. During this period, there were 54 deaths, 42 of cardiac origin, 26 being classified as sudden death. The positive predictive value of left ventricular ejection fraction was lower than those of mean RR interval and the variability of heart rate for overall mortality, cardiac mortality and sudden death. The three indices were essentially equivalent for the prediction of non-sudden cardiac death. The positive predictive value of heart rate variability was better than the mean RR interval for sensitivities < 40%, for all cause mortality. However, for sensitivities > 40%, the two parameters were equivalent or slightly in favour of the mean heart rate over 24 hours. The authors conclude that the mean RR interval over 24 hours is an important prognostic index after myocardial infarction. This index is more powerful than left ventricular ejection fraction and comparable to heart rate variability.

Aged↗
PubMed1984

Right and left ventricular ejection fraction in acute inferior wall infarction with or without ST segment elevation in lead V4R.

To detect right ventricular involvement, lead V4R was recorded within 10 hours of the onset of chest pain in 42 consecutive patients admitted with acute inferior wall myocardial infarction. One week after the acute infarction, multigated equilibrium radionuclide ventriculography was performed to assess right and left ventricular ejection fraction. Two weeks after the acute infarction, coronary angiography was performed to determine the site and location of the obstruction leading to the infarction. Seventeen patients had an obstruction in the right coronary artery proximal to the first branch to the right ventricular free wall (group 1); all of these had ST segment elevation in lead V4R. Fourteen patients had an obstruction in the right coronary artery distal to the first branch to the right ventricular free wall (group 2); only two of these patients had ST segment elevation in lead V4R. In 11 patients, the obstruction was located in the circumflex coronary artery (group 3); none of these had ST segment elevation in lead V4R. Nineteen patients had ST segment elevation of 1 mm or greater in lead V4R (group 4). Left ventricular ejection fraction was not different among the four groups of patients, although the right ventricular ejection fraction was significantly lower in group 1 and group 4 patients. It is concluded that ST segment elevation in lead V4R reliably identifies the group of patients with inferior wall myocardial infarction with depressed right ventricular function. This phenomenon persists for at least 1 week after infarction.

Adult↗
PubMed2006

Does preoperative ejection fraction predict operative mortality with left ventricular restoration?

BACKGROUND: Ischemic cardiomyopathy and aneurysmal disease have been treated surgically with coronary artery bypass grafting in the past. The Dor technique for left ventricular restoration has demonstrated improved outcomes in patients with ischemic, akinetic ventricles. Our hypothesis was that even marked reduction in preoperative cardiac function (ejection fraction < .25) would not correlate with worse outcomes since the ventricle would be reshaped to improve function. METHODS: A retrospective analysis was performed on all patients who had undergone ventricular restoration with the Dor procedure from January 1996 through September 2005. Patients with a preoperative ejection fraction (EF) < .25 and those with a EF > or = .25 were compared. All Society of Thoracic Surgeons database characteristics, mortality, length of stay (LOS), and need for intraaortic balloon pump (IABP) were analyzed. RESULTS: The study included 89 patients (69 men, 20 women), 28 of whom had preoperative EFs < .25 (mean, .183 +/- .035; range, .08 to .25) and 61 had an EF > or = .25 (mean, .334 +/- .074; mean, .25 to .45). Overall operative mortality was 3.4% (3/89), with no statistically significant difference between the two groups (3.6% versus 3.3%). LOS was 7.4 +/- 3.6 days versus 8.9 +/- 15.6 days (p = NS), and need for IABP was 39.2% versus 8.1% (p < 0.05). Overall 5-year survival was 82%. Five-year survival in the EF < .25 cohort was 69.6% versus 88.3% in the EF > or = .25 cohort (p = 0.066). CONCLUSIONS: Ventricular restoration with the Dor technique is a safe procedure. Marked reduction in ejection fraction is not a contraindication to left ventricular restoration; however, increased usage of IABP should be anticipated.

Adult↗
PubMed1983

Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery.

Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed P less than 0.05 after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. We conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.

Aorta, Abdominal↗
PubMed1978

Comparison between videodensitometric and angiocardiographic determination of left ventricular ejection fraction in patients with cardiac disease.

Angiocardiograms have been widely used to calculate volumes of cardiac chambers. By determining the left ventricular volume in end-diastole and end-systole the ejection fraction can be calculated. The ejection fraction is considered a clinically useful index of left ventricular function and is widely used in the preoperative evaluation of patients with cardiac disease.

Absorptiometry, Photon↗
PubMed2000

Relation between myocardial viability and abnormalities on the signal-averaged electrocardiogram in patients with low (<40%) ejection fraction and coronary artery disease.

To determine a possible mechanism for the previously observed improved outcome after bypass surgery in patients with poor ventricular function and viable myocardium, we sought to examine the relation between the extent of viability and the frequency of an abnormal signal-averaged electrocardiogram (SAECG) in patients with reduced ejection fraction and coronary artery disease. Fifty-two patients with coronary disease and ventricular dysfunction underwent quantitative redistribution thallium-201 (Tl-201) scintigraphy at rest to determine the extent of viability. The presence of late potentials was assessed by SAECG. Long-term, cardiac event-free survival was determined. Patients with greater viability (group 1, n = 23) were similar to patients with less viability (group 2, n = 29) with respect to age, gender, ejection fraction, and incidence of arrhythmia. Fewer group 1 patients had late potentials (33% vs. 65%, p = 0.05) and individual parameters were significantly more abnormal in the group 2 patients. Patients with late potentials had less viability than patients without late potentials (viability index 0.61+/-0.15 vs. 0.69+/-0.14, respectively, p = 0.05). By multivariate analysis, only the extent of viable myocardium and the left ventricular end-diastolic pressure were independent predictors of late potentials. Survival free of cardiac death or transplantation was better in patients with a normal SAECG (p<0.04) and in patients with predominantly viable myocardium (p<0.005). Thus, patients with low ejection fraction, coronary disease, and viable myocardium have a lower frequency of late potentials, suggesting reduced susceptibility to ventricular arrhythmia.

Aged↗
PubMed1984

Superiority of supine bicycle over isometric handgrip exercise in the assessment of ischemic heart disease: an evaluation of left ventricular ejection fraction response using radionuclide angiography.

Left ventricular ejection fraction (LVEF) response to supine bicycle and isometric handgrip exercise was evaluated in 15 patients with documented coronary artery disease (CAD) and stress-induced ischemia using radionuclide angiography. For purposes of analysis, the patients were divided into two groups: group I (n = 7) with single-vessel disease and group II (n = 8) with multiple-vessel disease including 3 with left main artery disease. The studies were repeated 18 days later at similar external workloads to assess reproducibility of both tests. LVEF response to bicycle exercise was different for the two groups. The change in LVEF from rest to peak exercise was +0.04 +/- 0.02 for group I and -0.07 +/- 0.04 for group II (p less than .001). LVEP response to isometric handgrip exercise was not different between the two groups. The change from rest to end of handgrip exercise was -0.02 + 0.02 for group I and -0.05 +/- 0.02 for group II. The reproducibility of LVEF response to bicycle exercise at similar workloads on day 1 and day 19 was good (r = 0.85) while it was poor for isometric handgrip testing (r = 0.67). Our data demonstrate that radionuclide angiographic measurement of LVEF response to supine bicycle exercise testing is superior to LVEF response to isometric handgrip testing in the evaluation of patients with CAD.

Adult↗
PubMed2004

Evidence for left ventricular remodeling after percutaneous coronary intervention: effect of percutaneous coronary intervention on left ventricular ejection fraction and volumes.

BACKGROUND: Post-stress ejection fraction (EF), end-diastolic (EDV) and end-systolic (ESV) volumes by gated myocardial perfusion SPECT (MPS) are well validated, reproducible and of prognostic significance. However, little is known about the impact of percutaneous coronary intervention (PCI) on left ventricular volumes and remodeling. METHODS: Thirty-eight patients who underwent MPS before and 6 months after PCI were evaluated. MPS were interpreted deriving summed stress (SSS), rest (SRS) and difference (SDS = SSS-SRS; extent of ischemia) scores. EF, EDV and ESV were generated by QGS trade mark. Pre-PCI MPS were compared to post-PCI MPS. RESULTS: Single vessel disease was present in 63% of patients. PCI of one vessel was performed in 82% of patients. After 6 months, SSS (10.6 +/- 6.3 vs. 2.8 +/- 4.3, p < 0.001) and SDS (8.2 +/- 5.6 vs. 1.4 +/- 2.3, p < 0.001) had improved; however, EF did not change significantly (55 +/- 10 vs. 57 +/- 13, p = ns). Still, EDV (105 +/- 25 ml vs. 96 +/- 25 ml, p = 0.006) and ESV (49 +/- 19 ml vs. 41 +/- 18 ml, p = 0.001) were significantly reduced. CONCLUSION: Results of MPS documented the beneficial effect of PCI on symptoms and extent of ischemia. In addition, the findings showed a significant decrease in ESV and EDV after PCI as compared to pre-PCI findings which points to a positive effect on left ventricular remodeling even in the absence of significant changes in EF.

Aged↗
PubMed1986

Congestive heart failure and ejection fraction in acute myocardial infarction.

Left ventricular ejection fraction (EF) was determined by means of radionuclide ventriculography (RNV) in 477 patients 8-12 days after an acute myocardial infarction (AMI). EF was correlated to infarct size and clinical and radiological parameters of congestive heart failure (CHF). The 138 patients (29%) who had signs of CHF had a mean (+/- SD) EF of 35 +/- 14% and a relative heart volume of 597 +/- 112 ml/m2 compared to 51 +/- 14% and 487 +/- 88 ml/m2 among those without CHF. The 52 patients who also had radiological signs of CHF had a mean EF of 27 +/- 12% versus 35 +/- 14% among those with clinical signs and symptoms of CHF. Presence of CHF was positively correlated to the size of AMI and to the reduction of EF. CHF was seen with increasing frequency from 16% in small to 46% in large first infarctions. Patients with reinfarctions showed the same correlation between these parameters, however, with subsequently more depressed EF values and more frequent presence of CHF due to previous myocardial damage. CHF was seldom (8%) observed in patients with EF greater than 50%. In contrast, 67% of the patients with EF less than 35% had CHF. Thus patients with an EF less than 35% represent a high risk group with regard to development of CHF and should be followed closely. It is suggested that radionuclide measurement of EF adds important clinical information in patients with diagnostic uncertainty of CHF.

Cardiac Volume↗
PubMed1989

Right ventricular dysfunction in septic shock: assessment by measurements of right ventricular ejection fraction using the thermodilution technique.

Right ventricular ejection fraction (RVEF) was measured by the thermodilution technique in a series of 127 consecutive critically ill patients monitored with a modified pulmonary artery (PA) catheter equipped with a fast response thermistor. Thermodilution RVEF was significantly lower in septic shock (23.8 +/- 8.2%, 93 measurements) than in sepsis without shock (30.3 +/- 10.1%, 118 measurements) or in the absence of sepsis or cardiopulmonary impairment (32.5 +/- 7.1%, 62 measurements). Both myocardial depression and pulmonary hypertension could account for this impairment of RV function. RVEF decreased from 35.1 +/- 9.8 to 24.2 +/- 10.4% (P less than 0.01) during development of septic shock and increased from 25.0 +/- 7.6 to 29.8 +/- 8.5% (P less than 0.05) during recovery (14 patients). Initial RVEF in septic shock was 27.8 +/- 8.6% in 11 patients who survived but only 20.9 +/- 6.7% (P less than 0.02) in the 23 patients who eventually died. Thus, RV dysfunction is common during septic shock, is directly related to its severity, and can easily be recognized in patients monitored with a PA catheter.

Adult↗
PubMed1990

[Site and type of acute myocardial infarct in relation to myocardial infarct size--dynamics of global ejection fraction in acute myocardial infarct].

By the ejection fraction global (EFg) statements concerning the remaining function of the myocardium in acute myocardial infarction and thus individually concerning the prognosis (classification of risk groups) become possible. For the valuation of the dynamics of the EFg in a period up to 6 months after an acute myocardial infarction the EFg was multifariously controlled. Only patients with first myocardial infarction in localization on the anterior wall and Q-wave showed a significant dynamics of the EFg between the measurements acute and third week as well as acute and 6th month (absolutely 5.2%). --In re-infarction/Q-wave this could be confirmed also for the localization of the posterior wall in the period acute till third week. For the localization on anterior and posterior wall a dynamics of the EFg could also be calculated for the period acute and 6th month. Thereby the absolute increase of the EFg was between 4.0 and 4.6%. The dynamics of the EFg in the region of the anterior wall was 5.2% for the first infarction and only 4% for the reinfarction. Thus it is below the dynamics of the EFg in an effective thrombolytic therapy.

Angina Pectoris↗
PubMed1999

Cardiac troponin T and I, echocardiographic [correction of electrocardiographic] wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon.

Cardiac troponin T (cTnT) and troponin I (cTnI) are highly sensitive and specific for detecting myocardial damage even in the presence of skeletal muscle injury. In this study, we assessed whether ultraendurance exercise induced cardiomyocyte injury using plasma cTnT and cTnI measurements, quantitative echocardiographic wall-motion analysis, and ejection fraction measurement in athletes who participated in the Hawaii Ironman Triathlon. Twenty-three athletes (11 men) who completed the triathlon (3.9 km swim, 180.2 km bike, and 42.2 km run) participated in this study. Blood samples were obtained 2 days before and immediately after the triathlon for the determination of cTnT (Enzymun, Roche Diagnostics) and cTnI (Dade Behring) concentrations. Quantitative echocardiographic wall motion analysis and ejection fraction were obtained on 12 of the 23 participants before and immediately after the race. No subject had detectable cTnT or cTnI or abnormal echo score before the race. Following the race, 2 subjects (9%) had marked increases in both cTnT (0.15 and 0.33 microg/L) and cTnI (2.09 and 4.44 microg/L). Four additional subjects (17%) had moderate increases in cTnT (0.04 to 0.05 microg/L) but no detectable cTnI. Race time correlated inversely with cTnT (r = -0.65, p <0.01). Mean change in the number of abnormal echo segments after the race was 6.5 in those with a marked increase in cTnT and cTnI, 2.3 in those with a moderate increase in cTnT, and 1.7 in those with no increase. Ejection fraction decreased by an average of 24% after the race (p <0.002). Thus, ultraendurance exercise may cause myocardial damage as indicated by biochemical cardiac-specific markers and echocardiography. The cellular nature of this damage and whether it is transient or permanent is unclear at present.

Adult↗
PubMed2004

Measurement of ejection fraction after myocardial infarction in the population.

OBJECTIVES: To assess the secular trends in left ventricular ejection fraction (LVEF) assessment after myocardial infarction (MI) and to identify the determinants of testing. DESIGN: A population-based MI incidence cohort. METHODS: The use of tests measuring LVEF (echocardiography, radionuclide, and left ventricular [LV] angiography) was examined among all consecutive residents of Olmsted County, MN, hospitalized for a validated incident MI between 1979 and 1998. Baseline characteristics and outcome were ascertained from community medical records. RESULTS: Among 2,317 patients with incident MI, LVEF assessment increased from 1979 to 1986 (22 to 85%; p value for trend = 0.0001) to stabilize thereafter until 1998. During the most recent decade, LVEF was measured during the hospital stay in 81% of the patients. Characteristics associated with lesser use of tests included older age and measurement of ejection fraction within 1 year prior to the index MI. Larger MI size, prolonged hospital stay, and involvement of a cardiologist as a care provider were positively associated with determination of LVEF. CONCLUSIONS: Measurement of LVEF after MI increased in the last 2 decades, but there continues to be a group of patients in whom it is not done. Given the potential benefits of LVEF measurement, including knowledge for risk stratification and therapeutic choices as underscored in recent practice guidelines, there may be additional opportunities for improving outcomes by ensuring its more consistent use. However, as testing for LVEF differs according to patient characteristics, reliance on selected clinically performed LVEF measurements will result in biased estimates of the prevalence of LV dysfunction after MI.

Adult↗