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PubMed1996

Post-exercise response of ventricular ejection fraction after total repair of congenital heart disease with left to right shunt.

A radioisotope first pass study was done on patients over a period of 1 to 15 years (average 4.6 years) after repair for ventricular septal defect or arterial septal defect with a left to right shunt. The age of the patients ranged from 6 to 32 years (average 14.2 year) at the time of the study. The total work of exercise and the right and left ventricular ejection fraction(EF) were evaluated at rest and after exercise. The results were compared with the preoperative hemodynamic findings and with the age of patient at the time of the operation. 1) When the total work of exercise was divided with the maximal exercise capacity of the normal individual corresponding to the patients' height and body surface area (the percentage of total work), it were very low with the average of 40% of normal. There was no sexual difference, but the percentage of total work of exercise had significant correlation with the patients' age at the time of operation (r = -0.52, p < 0.01) and post-exercise left ventricular ejection fraction (LVEF)(r = -0.39, p < 0.05). 2) LVEF at rest had some correlation with the preoperative mean pulmonary arterial pressure (r = -0.29, p = 0.05), but showed no relationship with Qp/Qs or Rp/Rs ratios. The right ventricular ejection fraction (RVEF) at rest had no relations with the preoperative hemodynamic findings with maximal workload. 3) The post-exercise RVEF showed linear correlation with the preoperative Rp/Rs ratio (r = -0.49, p < 0.005), and mean pulmonary arterial pressure (r = -0.37, p < 0.05). The post-exercise LVEF had no significant correlation with any preoperative hemodynamic factors. 4) When greater than 5% increase in ventricular EF after exercise is considered normal, the group with the normal right and left ventricular responses (n = 11) showed normal preoperative Rp/Rs ratio (7.6 +/- 4.1). In the group with normal left, but abnormal right ventricular response (n = 9) and the group with abnormal biventricular response (n = 11), both demonstrated incremental increase in Rp/Rs ratio (20.1 +/- 11.3, 26.3 +/- 19.8 respectively). Normal right, but abnormal left ventricular reaction (n = 2) was noted in patients with residual aortic valvular insufficiency and residual ventricular septal defect. In conclusion, post-operative ventricular response was much more sensitive and informative than that of ventricular function at rest and to detect subclinical cardiac dysfunction. Post-exercise RVEF was closely correlated with preoperative pulmonary vascular hemodynamics, while post-exercise LVEF seemed to be a major determinant of working capacity after repair.

Adolescent↗
PubMed1993

Electrocardiographic prediction of ejection fraction and site of LAD occlusion in anterior myocardial infarction.

Q-wave anterior myocardial infarctions due to occlusion of the left anterior descending artery (LAD) are generally associated with the most extensive left ventricular damage. The presence of abnormal Q waves on the electrocardiogram (ECG) provides important information to localize the site of left ventricular infarction. However, the relationship between abnormalities of the QRS morphology in the precordial leads and angiographic information such as ejection fraction and the site of LAD occlusion (before or after the first septal perforator) has not been studied extensively. Seventy-three patients with single-vessel disease with complete LAD occlusion, abnormal QRS morphology in leads V1-V4 on ECG, and abnormal wall motion with contrast ventriculography were studied retrospectively. LAD occlusions were proximal to the first septal perforator in 33 patients and distal in 40 patients. Q waves were present in 59 patients, and the other 14 patients had either minimal R waves (< 0.25 mm), poor R-wave progression, or R-wave regression. A significantly higher ejection fraction was associated with the presence of R wave in V2 (0.52 +/- 0.18 vs. 0.39 +/- 0.15 in the absence of R wave, p < 0.003). LAD occlusion after and before the first septal perforator was associated with R wave in V2 in 67 and 36% of patients, respectively. Sensitivity and specificity of predicting occlusion after the first septal perforator based on R wave in V2 was 0.68 and 0.64, respectively. In patients with anterior myocardial infarctions, occluded LAD artery, and abnormal QRS morphology in the precordial leads, the presence of R wave in V2 is a useful predictor of higher ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Sonographic evaluation of gallbladder volume and ejection fraction in obese women without gallstones.

PURPOSE: Obese people have an increased incidence of gallstones. Although the exact pathogenic mechanisms of gallstone development are unknown, impaired gallbladder emptying has been suggested as a possible underlying mechanism. Our aim was to investigate this possibility by evaluating gallbladder motility and related factors in obese and nonobese women without gallstones. METHODS: This study included 79 obese women and 25 nonobese healthy women. Using real-time sonography, we evaluated fasting and postprandial (15th-, 30th-, 45th-, 60th-, 75th-, 90th-, 120th-, and 150th-minute) gallbladder volumes and ejection fractions. The smallest postprandial volume was considered the residual volume. RESULTS: Mean (+/- standard deviation) fasting and residual gallbladder volumes were 43.2 +/- 18.3 cm(3) and 21.4 +/- 11.2 cm(3), respectively, in the obese women and 28.1 +/- 12.3 cm(3) and 7.9 +/- 3.4 cm(3), respectively, in the nonobese women. Maximal ejection fraction was 49 +/- 19% in obese women and 63 +/- 29% in nonobese women (p = 0.001). The fasting and residual volumes and the postprandial volumes at all time points were higher in obese women than in nonobese women (p < 0.001). In addition, 15th-, 30th-, 45th-, 60th-, 75th-, and 90th-minute postprandial ejection fractions were lower in obese women than in nonobese women (p < 0.001). Positive correlations were found between fasting gallbladder volume and body mass index and body fat weight and between residual volume and body mass index, waist circumference, body fat percentage, and body fat weight (p < 0.05 for all comparisons). CONCLUSIONS: Our results show that fasting and postprandial gallbladder volumes are higher and that postprandial gallbladder motility is lower in obese than in nonobese women. There are positive correlations between fasting gallbladder volume and body weight, body mass index, and body fat weight.

Adult↗
PubMed1995

Is reoperative coronary artery bypass grafting in patients with poor left ventricular ejection fractions < or = 25% worthwhile?

AIM: This study aimed to investigate whether patients with very low left ventricular ejection fractions (LVEF) should be accepted for reoperative coronary artery bypass grafting (CABG). STUDY POPULATION: Between January 1990 and December 1993, 1681 patients underwent primary CABG and 308 (15.5%) reoperative CABG. One hundred and eight patients (5.4%) had an LVEF < or = 25%, 91 patients for primary CAGB (group I) and 17 for CABG (group II). The mean age of the patients was 62 years. Sex distribution and preoperative risk factors did not differ. Urgent operations were more frequently necessary in group II (P < 0.01). Mitral regurgitation was present in 49% of the group I patients and 18% of the group II patients (P < 0.05). Pulmonary artery hypertension was observed in 24% of group I patients, but in only 6% in group II patients. The mean LVEF was 21% and left ventricular end-diastolic pressure 18 mmHg, without between-group differences. All patients had significant two- or three-vessel disease (stenosis > or = 70%). An average of 4.5 grafts per patient were performed. Mitral valve surgery was not performed in any of the patients. RESULTS: The postoperative mortality was significantly higher in reoperative CABG patients (group II; 23.5%) than in group I patients (12.1%; P < 0.05), whereas the incidence of non-fatal myocardial infarction did not differ. The incidence of postoperative complications did not differ between the groups, except for transient renal failure, more frequently encountered in group II (P < 0.05). After an average follow-up of 18 months, the New York Heart Association (NYHA) class and the LVEF were significantly improved in both groups (NYHA class from 3.5 to 1.8 and LVEF from 21% to 45%; P < 0.001). The mitral regurgitation had improved or completely disappeared at the end of follow-up in all patients in both groups. CONCLUSIONS: Our results suggest that patients with left ventricular ejection fraction < or = 25%, angina and significant two- or three-vessel coronary artery disease should not categorically be refused for reoperative CABG. Careful patient selection is necessary because of an increased operative risk.

Case-Control Studies↗
PubMed1991

Effects of injection site on the accuracy of thermal washout right ventricular ejection fraction measurements in clinical and model investigations.

The purpose of this investigation was to improve the accuracy of measurement of thermal right ventricular ejection fraction (RVEF) using the modified Swan-Ganz catheter. Three serial ejection fractions (EFs) (EF1, 2, 3) and the mean were calculated, based on Holt's theory. RVEFs were compared between right ventricular (RV) and atrial (RA) injection in ten intensive care unit (ICU) patients using a modified catheter having RV and RA orifices (15 cm and 30 cm from the distal end, respectively), and paired duplicate (two patients) or triplicate (eight patients) measurements were performed. To determine what factors interfere with RVEF, a model heart (with diastolic volume of 150 ml) was constructed, in which model injection of cold water to the direct inflow tract (RA), to the direct mixing chamber (RV), or through the catheter running in the inflow tract were compared. When EFs were compared between RV and RA injection, those for the former were greater (RV vs RA in EF1 and EFmean: 0.46 +/- 0.15 vs 0.23 +/- 0.11 in EF1, and 0.45 +/- 0.13 vs 0.28 +/- 0.11 in EFmean, mean +/- SD, p less than 0.01). When the serial EFs were compared in each injection type, in the RV injection EF3 was the smallest as was EF1 in the RA injection. The same phenomenon was observed in the model as in the patients, and moreover when cold water was injected in RA through a catheter running through the circuit, EFs were greatly underestimated (EF1 = 0.29 +/- 0.02 at preset EF = 0.4). We conclude that these phenomena were caused by sluggish movement of the cold indicator from RA to RV when injected into RA, and by interference with the cooled cardiac chamber and catheter. Consequently, the first or second EFs obtained from RV injection might be closest to the actual values because of the least interference with those factors.

Adult↗
PubMed1976

Radionuclide angiocardiographic measurement of left ventricular volume and ejection fraction.

In recent years a number of different radionuclidic techniques have been developed to measure left ventricular volume and ejection fraction. Area-measurement concepts have been applied to static and electrocardiographically gated radionuclidic images which have resulted in accurate measurement of left ventricular end-diastolic volume (LVEDV) and ejection fraction (LVEF). Gated (end-diastolic and end-systolic) image analysis has also proven capable of detecting regional left ventricular wallmotion abnormalities in patients with coronary disease. Time-activity curves can be extracted from left ventricular images, and several dynamic techniques have been developed and have also resulted in accurate measurement of LVEDV and LVEF. Radionuclide methods are currently available which are accurate and atraumatic and consequently applicable to the serial study of patients with heart disease. In particular, several of these radionuclide methods are relatively inexpensive and should be able to be performed in most hospitals.

Angiocardiography↗
PubMedDate not supplied

Long-term changes in left ventricular mass, chamber size and function after valve replacement in patients with severe aortic stenosis and depressed ejection fraction.

We studied 21 patients undergoing valve replacement for severe aortic stenosis and marked left ventricular dysfunction (mean ejection fraction 27 +/- 7.9%) without significant coronary disease or other valve diseases. At 5-60 months (average 26 +/- 18) after surgery, the patients underwent a clinical history, physical examination and a complete M-mode, two-dimensional and Doppler transthoracic echocardiographic study. Thirteen patients were examined with cardiopulmonary exercise testing. Two patients with a low preoperative transvalvular pressure gradient (<50 mm Hg) died postoperatively. Nineteen patients were tested at follow-up. All patients showed an improvement in functional class, an increase in ejection fraction (EF), a normalization in left ventricular diameters, volumes and stress indices and a reduction in left ventricular mass which correlated with EF increase. Cardiopulmonary exercise testing showed a good exercise capacity. In conclusion, in patients affected by severe aortic stenosis and marked preoperative left ventricular dysfunction valve replacement induces a favorable remodeling of the left ventricle, as shown by a late postoperative examination. The regression of hypertrophy is a positive event which correlates with the improvement in EF.

Aged↗
PubMed1990

Inter- and intrasubject variability of the thermodilution measurement of right ventricular ejection fraction and volume in patients with chronic obstructive pulmonary disease.

STUDY OBJECTIVE: To determine the spontaneous changes in volumetric indices of right ventricular function assessed by thermodilution. DESIGN: The study involved measurements of inter- and intraindividual variation of right ventricular function in human subjects at rest and at two different levels of low load supine bicycle exercise. SUBJECTS: The subjects were 23 patients with chronic obstructive pulmonary disease, referred for evaluation by right heart catheterisation. Mean (SEM) age was 55.4 (2.2) years and all were in sinus rhythm. MEASUREMENTS AND RESULTS: Successive measurements of ejection fraction and right ventricular end diastolic and end systolic volumes were made by thermodilution with a fast response thermistor mounted in a Swan-Ganz catheter. Five measurements were made at rest (R), and three measurements during each of two levels of exercise (E1, E2). Group average values for each period showed no significant changes with time; interindividual variability was expressed as the coefficient of variation (VC1 = SD/means), intraindividual variability (VC2) as square root of mean value of individual variances. Interindividual variability increased from rest to exercise, while intraindividual variability was lower during exercise, presumably because the variables were more steady. For ejection fraction, VC1, was 23% at rest, 29% for E1 and 32% for E2, while VC2 was 21%, 12% and 15% respectively; for right ventricular end diastolic volume, VC1 was 23% at rest, 29% and 28% during exercise, and VC2 was 17%, 12% and 11% respectively. In some patients cold injection induced bradycardia and spuriously high values of ejection fraction. CONCLUSIONS - It is important to monitor heart rate before and during thermodilution measurements and to take into account only those made with stable heart rate. Injectate temperature should be above 10 degrees C.

Cold Temperature↗
PubMedDate not supplied

Thermodilution measurement of the right ventricular ejection fraction.

This study addressed the clinical reproducibility and validity of the thermodilution (TD) measurement of the right ventricular ejection fraction (RVEF). Forty-one patients underwent right heart catheterization, including TD RVEF, within 2 h of gated first pass (GFP) and gated blood pool (GBP) radionuclide ventriculography; 21 had single plane contrast right ventricular angiography (ANGIO) during the same catheterization. Analysis of variance showed no difference among three successive TD RVEF measurements. (table; see text) Stroke volume by RV ANGIO correlated with Fick (n = 10, r = .86) and thermodilution stroke volume (n = 21, r = .88). It is concluded that although the thermodilution method is an accurate way to measure flow, it is not an accurate way to measure right ventricular ejection fraction, and by inference, ventricular volumes. The most likely explanation for this finding is incomplete mixing as in previous studies of indicator methods of measuring left ventricular volumes.

Analysis of Variance↗
PubMed1983

Prevention by nifedipine of cold pressor-induced decrease in left ventricular ejection fraction.

To examine the effects of nifedipine on changes in ventricular function produced by cold, the cold pressor test was administered to eight patients with angiographically documented coronary artery disease. Radionuclide ventriculograms were obtained at baseline and during the cold pressor stimulus both before and after administration of nifedipine, 10 mg buccally; thus, four serial radionuclide ventriculograms were obtained per patient. The cold pressor stimulus did not produce any significant difference in the mean (+/- standard deviation) peak rate-pressure product during the control or nifedipine test (10,900 +/- 3,390 versus 10,600 +/- 3,700). However, the increase in systolic blood pressure (p = 0.05) and the peak systolic blood pressure achieved (p less than 0.001) were greater during the control (134 +/- 19 to 160 +/- 25 mm Hg) than during the nifedipine (125 +/- 18 to 145 +/- 21 mm Hg) cold pressor test. The mean global left ventricular ejection fraction decreased during the control cold pressor test from a baseline value of 0.60 +/- 0.08 to 0.52 +/- 0.08 (p = 0.004). After nifedipine, this variable did not change during the repeat cold pressor test (0.63 +/- 0.09) compared with the repeat baseline value (0.63 +/- 0.11). Therefore, the difference in left ventricular ejection fraction response during control versus nifedipine cold pressor testing was highly significant (p less than 0.0001). In patients with obstructive coronary artery disease, nifedipine abolished the decrease in left ventricular ejection fraction observed during the control cold pressor test and may be of value to protect patients from cold-induced left ventricular dysfunction. The mechanism may be a combination of coronary artery vasodilation and systolic unloading of the left ventricle.

Adult↗
PubMed1996

A patent infarct-related artery is associated with reduced long-term mortality after percutaneous transluminal coronary angioplasty for postinfarction ischemia and an ejection fraction <50%.

BACKGROUND: Prognosis after myocardial infarction (MI) is influenced by the presence of post-MI ischemia and possibly the patency of the infarct-related artery. The purpose of this study was to compare long-term outcome (reinfarction and death) in patients with open versus closed coronary arteries after percutaneous transluminal coronary angioplasty performed for MI complicated by persistent ischemia. METHODS AND RESULTS: Between 1981 and 1989, 505 patients underwent percutaneous transluminal coronary angioplasty for post-MI ischemia at the Deaconess Hospital. Long-term incidence (mean follow-up, 34 months) of death, nonfatal reinfarction, repeated coronary angioplasty, and coronary bypass surgery was determined for 479 patients and then compared on the basis of the status of the artery, open versus closed, at the end of angioplasty. The 5-year Kaplan-Meier actuarial mortality rate was 4.9% for 456 patients with open infarct-related arteries and 19.4% for 23 patients with closed infarct-related arteries (P=.0008). Multivariate Cox proportional hazards analyses controlling for age, sex, number of diseased vessels, type and location of MI, and year of coronary angioplasty revealed a hazard ratio for death for closed compared with open arteries of 6.1 (95% CI, 1.8 to 20.0). Among patients with ejection fractions <50%, a closed artery was associated with a higher mortality (p=.0014) compared with patients with open arteries. The status of the artery was not associated with a difference in mortality in patients with ejection fractions > or = 50%. CONCLUSIONS: As open artery after coronary angioplasty for post-MI ischemia is associated with significantly lower long-term mortality, particularly in patients with ejection fractions <50%.

Adult↗
PubMed1987

Thermodilution determination of right ventricular volume and ejection fraction: a comparison with biplane angiography.

In 13 patients without tricuspid incompetence, we compared the values of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume (RVEDV) obtained with biplane angiography and thermodilution at end-inspiration. A modification of Simpson's rule was used to measure angiographic volumes, and a new pulmonary artery catheter equipped with a rapid response thermistor was used to measure the ejection fraction by the Holt plateau method. The correlation between the two methods was acceptable (r = 0.83 for RVEF, r = 0.71 for RVEDV) despite the limitations of both angiography and thermodilution. Thermodilution underestimated RVEF and overestimated RVEDV when compared to angiography. The variation coefficient with thermodilution for five measurements of the RVEF per patient was 12 +/- 5%. In addition to pressure and cardiac output measurements, monitoring of RVEF and RVEDV in the ICU should be possible with such a catheter. Further work is needed to assess the clinical relevance of these added data and their use for optimizing the therapy of right ventricular failure in acutely ill patients.

Adult↗
PubMed1997

Prognostic value of thrombolysis, coronary artery patency, signal-averaged electrocardiography, left ventricular ejection fraction, and Holter electrocardiographic monitoring for life-threatening ventricular arrhythmias after a first acute myocardial infarction.

Prognostic studies after acute myocardial infarction (AMI) have mainly been performed in the prethrombolytic era. Despite the fact that modern management of AMI has reduced mortality rates, the occurrence of malignant ventricular arrhythmias in the late phase of AMI remains an important issue. We prospectively studied 244 consecutive patients (97 treated with thrombolytics) who survived a first AMI. All patients underwent time domain signal-averaged electrocardiography (vector magnitude: measurements of total QRS duration, terminal low [<40 microV] amplitude signal duration, and root-mean-square voltage of the last 40 ms of the QRS complex), Holter electrocardiographic monitoring, and cardiac catheterization. Late life-threatening ventricular arrhythmias were recorded. Eighteen arrhythmic events occurred during a mean follow-up period of 57 +/- 18 months. Three independent factors were associated with a higher risk of arrhythmic events: (1) left ventricular ejection fraction (odds ratio 1.9/0.10 decrease), (2) terminal low-amplitude signal duration (odds ratio 1.5/5 ms increase), and (3) absence of thrombolytic therapy (odds ratio 3.9). Low-amplitude signal duration sensitivity for sudden cardiac death was low (30%). Left ventricular ejection fraction had the highest positive predictive value for sudden cardiac death (10%). Thus, thrombolysis decreases both the incidence of ventricular tachycardia and sudden cardiac death with a higher reopening rate of the infarct-related vessel. Signal averaging predicts the occurrence of ventricular tachycardia and an impaired left ventricular ejection fraction predicts the occurrence of sudden cardiac death.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[Correlation between left ventricular ejection fraction assessed by gated SPECT and radionuclide ventriculography in patients with ischemic cardiomyopathy].

BACKGROUND: Recently, the use of Gated SPECT to assess ejection fraction, volumes and ventricular wall motion has been suggested. The aim of this study is to compare the ejection fraction (EF) obtained by Gated SPECT (QGS, Cedars Sinai) with the values obtained through equilibrium ventriculography in patients with ischemic heart disease. METHODS: We studied 50 consecutive patients that were diagnosed by equilibrium radioisotopic ventriculography and Gated SPECT with a dual protocol (TI-201 rest/Tc-99m SestaMIBI stress) using the QGS, Cedars Sinai software. RESULTS: We found a 92% correlation between both tests. In the subgroup analysis, the higher correlation (r = 0.89) was found in group 2, which included patients with moderate ventricular dysfunction (EF 30-50%), whereas, in patients with severe ventricular dysfunction (group 3, EF < 30%), the correlation was lower (r = 0.76) than in group 2, but higher than in patients with EF > 50% (group 1). CONCLUSIONS: There is a good correlation between EF obtained with Gated SPECT and equilibrium ventriculography, regardless of the EF value.

Adult↗
PubMed2006

Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction.

BACKGROUND: flow-mediated arterial dilation (FMAD), an indicator of endothelial function, is reduced in patients with heart failure and reduced left ventricular ejection fraction (HFREF). Many elderly patients with heart failure exhibit a normal left ventricular ejection fraction (HFNEF). It is unknown whether FMAD is severely reduced in the elderly with HFNEF. METHODS AND RESULTS: 30 participants >60 yr of age, 11 healthy, 9 with HFNEF, and 10 with HFREF, underwent a cardiovascular magnetic resonance (CMR) assessment of FMAD in the superficial femoral artery followed within 48 h by symptom-limited exercise with expired gas analysis. Elderly patients with HFREF and HFNEF had severely reduced peak oxygen consumption (Vo(2 peak); 12 +/- 2 and 13 +/- 1 ml.kg(-1).min(-1), respectively) vs. their healthy age-matched contemporaries (20 +/- 3 ml.kg(-1).min(-1)). FMAD was 3.8 +/- 1.3% (0.85 +/- 0.22 mm(2)) in patients with HFREF; it was 12.1 +/- 3.6% (3.1 +/- 1.2 mm(2)) and 13.7 +/- 5.9% (3.9 +/- 1.7 mm(2)), respectively, in patients with HFNEF and age-matched healthy older individuals. After adjustment for age and gender, the association of FMAD with Vo(2) was high in healthy and HFREF subjects (P = 0.05 and 0.02, respectively) but less so in HFNEF participants (P = 0.58). CONCLUSIONS: elderly patients with HFNEF do not exhibit marked reduction in leg FMAD. These data suggest that mechanisms other than impaired femoral arterial endothelial function contribute to the severe exercise intolerance experienced by these individuals.

Aged↗
PubMed1992

Dietary fat modulation of left ventricular ejection fraction in the marmoset due to enhanced filling.

OBJECTIVE: The aim was to investigate the influence of long term dietary fish oil consumption on cardiac function in a non-human primate, to elucidate further the basis of the apparently reduced cardiovascular disease mortality associated with its consumption in man. METHODS: Adult male marmoset monkeys (Callithrix jacchus) were fed diets supplemented with polyunsaturated fatty acids (PUFA) of marine (tuna fish oil) or plant (sunflower seed oil) origin, saturated animal fat (sheep perirenal fat), or a low fat reference diet for 24 months. Cardiac function was assessed using radionuclide angiography under pentobarbitone anaesthesia with a counts based adaptation for ventricular volume estimations. Measures were made at rest and during infusion of adrenaline. RESULTS: The mean left ventricular ejection fraction was greater in the tuna fish oil group [55.0(SEM 1.1)% n = 7] and the sunflower seed oil group [58.1(2.4)% n = 8] than in the reference group [48.5(1.4)% n = 9] and the sheep fat group [47.6(1.8)% n = 8]. This was associated with a more than 25% greater end diastolic volume and 40-70% increases in stroke volume in tuna fish or sunflower seed oil fed animals. There was no evidence of cardiac hypertrophy. In contrast, adrenaline increased stroke volume and ejection fraction by increasing emptying, thus reducing residual end systolic. Tuna fish oil fed animals had a low resting heart rate. When this was raised to comparable levels by adrenaline, lower pressure-rate indices and greater cardiac minute work suggested higher myocardial energy efficiency in PUFA fed animals compared with the reference and sheep fat groups. CONCLUSIONS: Dietary fish oil and sunflower seed oil increased the left ventricular ejection fraction in the marmoset monkey by enhancing ventricular filling, thus providing an energy sparing promotion of diastolic relaxation.

Animals↗
PubMed1999

Effects of injectate volume on thermodilution measurements of cardiac output in patients with low ventricular ejection fraction.

OBJECTIVE: To determine the effect of 5-mL injectate on cardiac output measurements in critically ill patients with low ventricular ejection fraction (< 35%). METHODS: Thermodilution cardiac output measurements obtained with three 5-mL and three 10-mL (randomly ordered) iced injectates in 50 patients with low ejection fraction were averaged if the measurements were within 10% of the median. If the 3 measurements were not within those limits, additional measurements were obtained. RESULTS: Cardiac output measured with the 5-mL injectate (mean, 4.63 L/min) and cardiac output measured with the 10-mL injectate (mean, 4.52 L/min) were not significantly different (P = .64). Lower and upper limits of agreement were -1.7 L/min to +1.6 L/min. The bias (mean difference between 10- and 5-mL measurements) of all measurements was -0.09, and the precision was 1.43 L/min, with a 95% confidence limit (mean difference +/- 2 SD) of -1.7 to +1.6 L/min. An additional measurement was necessary in 77% of patients in the 5-mL group but in only 48% of the 10-mL group (P = .006). CONCLUSIONS: Cardiac outputs measured with 5- and 10-mL injectates do not differ significantly. The greater variability of measurements obtained with a 5-mL injectate suggests that more measurements, and thus more time, are needed to measure cardiac output accurately. Clinicians must weigh the benefit of minimizing fluid volume used against the potential decreased reliability of cardiac output measurements.

Adult↗
PubMed2001

[Clinical predictors of left ventricular function improvement after percutaneous coronary interventions in patients with ejection fraction below 45%].

BACKGROUND: The value of clinical predictors of left ventricle function recovery after surgical revascularization in patients with decreased ejection fraction is well documented. However, there are no clinical studies assessing factors which can influence left ventricle function in patients with coronary disease and low ejection fraction (LVEF) undergoing percutaneous coronary interventions (PCI). OBJECTIVE: We tried to assess clinical prognostic factors of left ventricle function improvement after PCI in patients with coronary artery disease and impaired LVEF. PATIENTS AND METHODS: We studied patients with LVEF < 45% undergoing PCI. We assessed duration and grade of symptoms of heart failure, angina class and echocardiographic parameters of LV systolic function. After 6 months follow-up LVEF was obtained again. We analyzed influence of baseline clinical factors on LVEF recovery after PCI. RESULTS: We studied 29 patients (mean age 54.4 +/- 11 years) before and after PCI. In the whole group of patients we found significant increase in EF (38.4 +/- 6% vs 50.4 +/- 15%, p = 0.005) at follow up examination. There was significant improvement of EF in patients with NYHA class I or II (from 40.4 +/- 5% to 58.1 +/- 9%, p < 0.0001) as compared to NYHA class III or IV (from 31.4% +/- 9% to 31.8 +/- 11, p = NS). In multivariate regression analysis correlation between NYHA class and LVEF at control examination (beta = -0.54, p = 0.03) was independent from epidemiological variables and baseline LVEF. There was significant increase in LVEF in patients with severe angina (CCS III or IV) as compared to patients without angina (DEF 21.3 +/- 5% vs 7.9 +/- 10%, p = 0.009). There was also higher increase in LVEF in patients with chest pain during balloon inflation (delta EF 17.4 +/- 9% vs 5.7 +/- 9%, p = 0.01). CONCLUSIONS: Mild symptoms of heart failure and independent predictors of left ventricle function recovery after PCI in patients with impaired LVEF. The lack of angina symptoms negatively influence LVEF recovery after PCI.

Adult↗