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At least 595 records · Page 33Linked to original sources
PubMed2005

Diagnostic ability of B-type natriuretic peptide and impedance cardiography: testing to identify left ventricular dysfunction in hypertensive patients.

BACKGROUND: Patients with hypertension are at high risk for the development of left ventricular dysfunction (LVD). Echocardiography is considered to be the gold standard for diagnosis of LVD; but its cost, complexity, and availability prevents its use for frequent evaluation. Brain natriuretic peptide (BNP) and N-terminal BNP (NT-BNP) can identify heart failure in dyspneic patients. Impedance cardiography (ICG) is a noninvasive method of measuring hemodynamic and electromechanical timing parameters. The objective of this study was to determine the ability of BNP, NT-BNP, and ICG to detect the presence of LVD in patients with hypertension. METHODS: A convenience sample of subjects undergoing echocardiography who had a history of hypertension or current systolic blood pressure >/=140 mm Hg were enrolled and retrospectively evaluated. Patients with known LVD were excluded. Diagnosis of LVD was determined by the presence of systolic or diastolic dysfunction, valvular or wall motion abnormalities, or left ventricular hypertrophy. RESULTS: A total of 193 subjects were enrolled: 189 men and four women, age 68.8 +/- 11.7 years. Multivariate regression analysis of history and symptoms, BNP, and ICG parameters identified significant predictor variables for LVD including cardiac index (P = .005), left cardiac work index (P = .008), BNP (P = .017), arrhythmia (P = .023), angina (P = .034), and systemic vascular resistance (P = .048). Receiver operating characteristic (ROC) analysis determined the area under the ROC curve (AUC) of BNP (0.60), NT-BNP (0.67), ICG velocity index (0.66), composite ICG (0.66), ICG combined with BNP (0.70), and ICG combined with NT-BNP (0.73). CONCLUSIONS: In this high-risk hypertensive population, BNP, NT-BNP, and ICG were useful to identify the presence of LVD. The use of ICG with natriuretic peptide testing may improve the ability to detect LVD.

Aged↗
PubMed2001

Exercise-induced ST-elevation is related to left ventricular dysfunction but not to myocardial viability in patients with healed myocardial infarction.

BACKGROUND: Exercise-induced ST-segment elevation was proposed as a marker of myocardial viability after a recent myocardial infarction. AIMS: The aim of this study was to evaluate whether exercise-induced ST segment elevation is related to viability or to left ventricular dysfunction in patients with history of old Q wave myocardial infarction. METHODS: Fifty patients (43 men, age 57+/-11 years) were studied 31+/-49 months after a Q wave myocardial infarction. They all underwent stress, reinjection-redistribution, and late redistribution Tl-201 SPECT, completed by equilibrium radionuclide angiography. Viability was defined by defect reversibility or significant (>60%) persistent Tl-201 uptake in dyssinergic segments on late redistribution SPECT. Relative post-exercise and reinjection-redistribution LV volumes were calculated using validated software (QGS). RESULTS: Twenty-one out of 50 patients (42%, G1) had significant stress-induced ST-elevation (>1 mm 80 ms after J point in at least 2 ECG leads with Q wave), and 29/50 (58%, G2) did not. Seventeen out of 50 patients (34%) demonstrated myocardial viability on late redistribution scan. The diagnostic accuracy of exercise-induced ST-elevation was only 52% for viability assessment. Significant LVEF reduction and increased relative LV volumes were observed in G1 compared to G2 (LVEF: 39+/-10% vs. 49+/-11%, P=0.003; post-stress LV volume: 134+/-98 ml vs. 81+/-41 ml, P<0.02; reinjection-redistribution LV volume: 123+/-86 ml vs. 79+/-40 ml; P<0.02). Perfusion defects were similar in G1 and G2 (post-exercise: 38+/-12% vs. 37+/-14%, ns; reinjection-redistribution: 31+/-11% vs. 30+/-11%, ns; late redistribution: 30+/-10% vs. 28+/-11%, ns). CONCLUSION: These results suggest that, in patients with history of myocardial infarction, exercise-induced ST-segment elevation is not related to persistent myocardial viability but is associated to left ventricular dysfunction.

Aged↗
PubMedDate not supplied

Current perspectives on beta-receptor antagonists in the treatment of symptomatic ventricular dysfunction.

Even though therapeutic advances have occurred, heart failure is still associated with significant morbidity and mortality. Digitalis, diuretics, and angiotensin-converting enzyme inhibitors have proven effective, but in many patients still do not prevent progressive and debilitating heart failure. Many hormonal factors are involved, but two, the renin-angiotensin-aldosterone (RAA) axis and the autonomic nervous system, apparently are critical in the pathophysiology of progressive ventricular dysfunction. Pharmacologic suppression of the RAA system is associated with significant clinical benefit, suggesting that antagonism of sympathetic nervous activity with beta-receptor-blocking agents might also be efficacious. Major alterations of the autonomic nervous system are characteristic of heart failure, with excessive sympathetic activity one of the earliest adaptations to the condition, and important in promoting the heart failure state and the progression of ventricular dysfunction. Certain beta-antagonists administered by careful and slow up-titration from small starting dosages proved effective in small trials. Large-scale, randomized, placebo-controlled studies continue to document that beta-blockers improve ventricular function and symptoms, and preliminary results suggests mortality and morbidity reductions as well. Although intolerance to beta-antagonism does occur, the majority of patients can be successfully treated with these agents.

Adrenergic beta-Antagonists↗
PubMed1999

Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction.

BACKGROUND: Studies have suggested that ACE inhibitors have an antiarrhythmic effect on ventricular arrhythmias. Whether they have an effect on atrial fibrillation is unknown. METHODS AND RESULTS: We investigated the effect of ACE inhibition with trandolapril on the incidence of atrial fibrillation in patients with reduced left ventricular function secondary to acute myocardial infarction. The patients in this study were those who qualified for inclusion into the TRAndolapril Cardiac Evaluation (TRACE) study, a randomized double-blind placebo-controlled study and who had sinus rhythm on the ECG obtained at randomization. Patients who fulfilled the criteria for inclusion were randomized to treatment with the ACE inhibitor trandolapril or placebo and were followed up for 2 to 4 years. Development and time to occurrence of atrial fibrillation in one 12-lead ECG recorded at the outpatient visits was the primary end point of this investigation. Of the 1749 patients included in the TRACE study, 1577 had sinus rhythm on the ECG recorded at randomization. Of these patients, 790 were randomized to trandolapril treatment and 787 to placebo treatment. The groups differed only slightly with respect to baseline characteristics. A total of 64 patients developed atrial fibrillation during the 2- to 4-year follow-up period. Significantly more patients developed atrial fibrillation in the placebo group than in the trandolapril group, 5.3% (n=42) versus 2.8% (n=22), respectively, P<0.05. Cox multivariable regression analysis, adjusting for important baseline characteristics, revealed that trandolapril treatment significantly reduced the risk of developing atrial fibrillation (RR, 0.45; 95% CI, 0.26 to 0.76; P<0.01). CONCLUSIONS: The results from the present study demonstrate that trandolapril treatment reduces the incidence of atrial fibrillation in patients with left ventricular dysfunction after acute myocardial infarction.

Aged↗
PubMed1986

Left ventricular dysfunction and altered autonomic activity: a possible link to sudden cardiac death.

There is now a growing body of clinical evidence that suggests a strong association between left ventricular dysfunction and sudden cardiac death in patients recovering from myocardial infarction. The mechanisms underlying this association remain to be determined. Alterations within the autonomic nervous system may represent one factor that links an impairment in cardiac function to an increased mortality. Since ventricular dysfunction would tend to reduce stroke volume, an increased sympathetic and/or decreased parasympathetic efferent activity may compensate for this fall in stroke volume by increasing heart rate and/or the force of contraction (inotropic state) in an attempt to maintain a more normal cardiac output. Similar changes in autonomic activity are, in fact, known to increase the vulnerability to ventricular fibrillation. Therefore, I propose that myocardial infarction induces changes in cardiac function which in turn elicits autonomic efferent changes. As a consequence of these compensatory reflex changes the heart becomes less electrically stable and thereby more prone to lethal arrhythmias.

Afferent Pathways↗
PubMed1983

Identifying patients at risk of sudden death after myocardial infarction: value of the response to programmed stimulation, degree of ventricular ectopic activity and severity of left ventricular dysfunction.

The ability of programmed ventricular stimulation to identify risk of sudden death after acute myocardial infarction (MI) was compared with 24-hour electrocardiographic assessment of ventricular ectopic activity and determination of left ventricular (LV) dysfunction. Forty-six patients underwent programmed stimulation 8 to 60 days (mean 22) after documented MI. Programmed stimulation consisted of single and double extrastimuli from the right ventricular apex at 2 times diastolic threshold during ventricular pacing and normal sinus rhythm. Of the 46 patients, 44 underwent electrocardiographic monitoring at least 6 days after MI. In 43 of the 46 patients, LV ejection fraction (EF) and the presence of LV aneurysm were determined. In response to programmed ventricular stimulation, 5 patients had sustained ventricular tachycardia (VT), 5 had nonsustained VT (greater than or equal to 4 beats), 13 had intraventricular reentrant repetitive responses, and 23 had either bundle branch reentrant repetitive responses or no extra responses to programmed ventricular stimulation (negative study). During a mean follow-up of 18 months, 10 patients died, 6 suddenly. One of the 10 patients with sustained or nonsustained VT died suddenly, compared with 3 of 13 patients with intraventricular reentrant responses and 2 of 23 patients with a negative study (difference not significant). Of 25 patients with Grade 0 to 2 ventricular ectopic activity, 3 died suddenly after MI, compared with 3 of 19 patients with Grade 3 or 4 activity (difference not significant). By comparison, the frequency of sudden death was greater in patients with an LVEF of less than 40% (5 of 16 versus 1 of 27 patients) or an LV aneurysm (5 of 13 versus 1 of 30 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Natriuretic peptides in assessment of left-ventricular dysfunction.

The heart secrets two different natriuretic peptides, atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), which have potent vasorelaxant, diuretic, and natriuretic actions. They are main tools in the body's defense against volume overload and hypertension. The natriuretic peptides (NP) are synthetized as prohormones. The C-terminal endocrinological active peptides and their N-terminal prohormone fragments are found in plasma. The NP system is maximally activated in ventricular dysfunction. However, NP:s are also increased in patients with renal failure or pulmonary hypertension, and increases may be found in arterial hypertension or liver cirrhosis. Among all NP and prohormone fragments currently BNP is the most promising candidate analyte for routine diagnosis. BNP is also superior to other neurohormones for diagnosis of left-ventricular dysfunction (LVD) or estimating prognosis in LVD or during the subacute phase of myocardial infarction. For primary care physicians BNP measurement is useful to decide which patient with suspected heart failure warrants further investigation, particularly when assessment of left ventricular function is not readily available. BNP has an excellent negative predictive value particularly in high risk patients. For the cardiologists the NP:s are helpful for monitoring therapy and disease course in LVD patients and for estimating prognosis in LVD and myocardial infarction patients. There is now sufficient evidence to encourage physicians to gain experience with NP as a supplement in the diagnosis of patients suspected of having heart failure. An increase in BNP is serious enough to warrant follow-up examinations.

Atrial Natriuretic Factor↗
PubMed2001

Prior coronary artery bypass surgery and risk of death among patients with ischemic left ventricular dysfunction.

BACKGROUND: Patients with ischemic LV dysfunction are at high risk of sudden death. However, no benefit from prophylactic defibrillator therapy was observed in a group of patients with LV dysfunction undergoing CABG (CABG Patch trial). Thus, the effect of CABG on future risk of sudden death in patients with LV dysfunction is of considerable interest. METHODS AND RESULTS: Mortality and modes of death in 5410 patients with ischemic LV dysfunction who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trials were evaluated. Outcomes of patients with (n=1870, 35%) versus without (n=3540) history of prior CABG were compared, and stratification by baseline ejection fraction (EF) values (<0.25, 0.25 to 0.30, and >0.30) was performed. Prior CABG was associated with a 25% (95% CI, 15% to 36%) reduction in risk of death and a 46% (95% CI, 30% to 58%) reduction in risk of sudden death independent of EF and severity of heart failure symptoms. As baseline EF declined, absolute reduction in risk of sudden death with prior CABG increased (P<0.01). No alteration in risk of death from progressive heart failure was observed with prior CABG. When these results were applied to a group of patients with LV dysfunction who had not undergone prior surgery (Coronary Artery Surgery Study Registry) predicted annual rates of death (8.2%) and sudden death (2.4%) were similar to those observed in the CABG Patch trial (7.9% and 2.3%, respectively). CONCLUSIONS: In patients with ischemic LV dysfunction, prior CABG is associated with a significant independent reduction in mortality. These results appear to account for the lack of benefit from defibrillator therapy in the CABG Patch trial.

Adult↗
PubMed2005

Coronary artery stenting in patients with severe left ventricular dysfunction.

PURPOSE: To assess the outcome of stenting in patients with severe left ventricular dysfunction, 149 consecutive patients undergoing coronary stenting with an ejection fraction less than or equal to 40% (mean 35 +/- 10%) were analyzed. Angiographic and clinical success were achieved in all patients. At follow-up of at least 6 months (mean: 24 months), 130 patients (89%) were alive and 124 (85%) were less symptomatic than before percutaneous coronary intervention (PCI). We conclude that PCI can be performed safely in patients with depressed left ventricular ejection fraction and is associated with improved symptoms at long-term follow-up.

Aged↗
PubMed2003

Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction.

BACKGROUND: In the post-myocardial infarction phase, mortality risk is related to the severity of mitral regurgitation (MR). Ischemic MR is a dynamic condition that can be studied during exercise. Whether the assessment of exercise-induced changes in the degree of MR provides prognostic information is unknown. METHODS AND RESULTS: Ninety-eight consecutive patients with chronic ischemic left ventricular dysfunction and at least mild MR who prospectively underwent quantitative measurement of the regurgitant volume and the effective regurgitant orifice (ERO) of MR at rest and during semisupine exercise test were followed up for 19+/-8 months. The 16 patients who underwent surgery were censored at the time of operation. Of the 82 patients who were medically treated, 9 (11%) died. No clinical data demonstrated a distinction between survivors and nonsurvivors. By multivariate Cox regression analysis, independent predictors of cardiac death were an increase in ERO by > or =13 mm2 (P=0.0045) during exercise, an ERO >20 mm2 at rest (P=0.01), and a shorter mitral deceleration time (P=0.044). Half of the patients with exercise-induced significant increases in MR who died had moderate MR at rest. In contrast, none of the 14 patients with a decrease in MR at exercise displayed cardiac death. CONCLUSIONS: In patients with ischemic MR and left ventricular dysfunction, quantitative assessment of exercise-induced changes in the degree of MR provides independent prognostic information. Significant exercise-induced increases in MR unmask patients at high risk of poor outcome.

Aged↗
PubMed1976

Use of the augmented ejection fraction to select patients with left ventricular dysfunction for coronary revascularization.

Thirty-three patients with angina (31 men and 2 women, age 33 to 68 years, 52), as well as signs and symptoms of severe left ventricular dysfunction, were evaluated for coronary revascularization surgery. All had multiple vessel coronary artery disease and at least one prior myocardial infarction. Cardiac catheterization demonstrated abnormally elevated left ventricular end-diastolic pressure (LUEDP), low cardiac output, and depressed resting biplane systolic ejection fraction (SEF) ranging from 18 to 45 per cent (31 per cent). To evaluate potential myocardial function, a premature ventricular contraction was introduced during the ventriculogram and the SEF of the postextrasystolic potentiated (PESP) beat calculated and compared to a sinus beat SEF. Patients were separated into two groups based on the increase in SEF: those with greater than 0.10 augmentation (24 patients) and those with less than 0.10 augmentation (9 patients). Coronary revascularization was carried out with at least two bypass grafts in each patient. The operative mortality in those with more than 0.1 SEF augmentation was 9 per cent (2/24), late mortality rate 5 per cent (1/22), and 20/21 became Class I or II in the follow-up period of 11 to 57 months (25). Operative mortality in those with SEF augmentation of less than 0.1 3/9 33 per cent), late mortality rate 1/6, and only 1/5 achieved Class 1 status during the follow-up period of 10 to 35 months (22) postoperatively. These data suggest that significant augmentation of SEF by a premature ventricular contraction is a simple and useful indicator to aid in selection of patients with left ventricular dysfunction for coronary revascularization.

Adult↗
PubMed1999

BMIPP imaging to improve the value of sestamibi scintigraphy for predicting functional outcome in severe chronic ischemic left ventricular dysfunction.

UNLABELLED: Mismatching between beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and perfusion accurately predicts functional outcome after acute myocardial infarction. The current investigation was aimed at evaluating the value of this method to predict the evolution of global function according to the applied treatment in patients with chronic ischemic heart disease. METHODS: Twenty patients with infarction and chronic left ventricular dysfunction were studied (median infarction age 12 wk, range 2 wk-15 y). Radionuclide angiography, two-dimensional echocardiography and BMIPP and gated sestamibi scintigraphy were performed with the patient at rest before and >6 mo after treatment (revascularization in 13 patients and conservative therapy in 7 patients). In 7 patients, radionuclide angiography was repeated after 1 y. RESULTS: On a patient basis, mismatching with BMIPP less than sestamibi was noted in 15 patients at baseline. Of these 15 patients, 11 had significant functional improvement at follow-up versus only 1 of the 5 patients with a matched decreased uptake. Hence, the combined sestamibi/BMIPP was 73% positive and 80% negative in predicting functional outcome, with a global accuracy of 75%. On a segmental basis, using an optimal threshold of uptake defined by receiver operating characteristic curve analysis, sestamibi was only 63% accurate in predicting regional outcome. Adding BMIPP improved the accuracy to 80% (P = 0.001). At follow-up, significant mismatching was still noted in 7 patients in the revascularized group and 1 in the medically treated group. The mismatch was associated with a further increase in ejection fraction at 1-y follow-up in only the revascularized group. CONCLUSION: In patients with chronic left ventricular dysfunction after infarction, a mismatching with BMIPP less than sestamibi reliably identifies jeopardized but viable myocardium and predicts functional recovery with an accuracy similar to that reported in the acute and subacute phases of the infarction.

Aged↗
PubMed1998

Medium-term results of coronary artery bypass surgery in patients with severe left ventricular dysfunction and preoperatively documented hibernating myocardium.

In patients with multivessel coronary artery disease (CAD), severe left ventricular dysfunction (LVD) and hibernating myocardium (HM) demonstrated on preoperative assessment, coronary artery bypass grafting (CABG) surgery can be performed safely with low operative morbidity and mortality rates. Surgical revascularization of reversibly dysfunctional myocardium improves significantly both patient's clinical status and left ventricular ejection fraction (LVEF). Diagnosis of HM prior to CABG surgery seems to be crucial because it does not leave the patient with multivessel CAD and LVD a candidate only for heart transplantation (HTX). In the presence of HM, more aggressive surgical approach could be recommended to salvage chronically jeopardized but viable myocardium using not only routine CABG procedures in extracorporeal circulation (ECC) but also alternative approach of coronary endarterectomy (EAE) or minimally invasive direct coronary artery bypass grafting (MIDCAB) procedures on beating heart, without any adverse impact on operative mortality.

Coronary Artery Bypass↗
PubMed2004

beta2 adrenoceptor gene therapy ameliorates left ventricular dysfunction following cardiac surgery.

OBJECTIVE: Heart surgery is associated with impairment of the myocardial beta-adrenoceptor (betaAR) system. Effective therapies for post-operative ventricular dysfunction are limited. Prolonged inotrope exposure is associated with further betaAR down-regulation. Left ventricular (LV) dysfunction and myocardial betaAR impairment were assessed following cardiopulmonary bypass (CPB) and cardioplegic arrest in a pig model. Transfer of the human beta2-adrenoceptor transgene (Adeno-beta2AR) during cardioplegic arrest was then tested as a potential therapy. METHODS: Five groups of six neonatal piglets were studied. One group did not undergo surgery (Group A). Adeno-beta2AR or phosphate buffered saline (PBS) were delivered via the aortic root during cardioplegic arrest. Groups B (PBS) and C (Adeno-beta2AR) were assessed at 2 days while Groups D (PBS) and E (Adeno-beta2AR) were assessed at 2 weeks from the time of surgery. An LV micromanometer was inserted under sedation to obtain pressure recordings following surgery. betaAR density was measured subsequently. RESULTS: Following cardiac surgery LV betaAR density was reduced (104+/-5.7 vs 135+/-6.1 fmol/mg membrane protein; P=0.007), and, in response to beta agonist stimulation, LV dP/dtmax was reduced (4337+/-405 vs 5328+/-194 mmHg/s; P<0.05) compared to animals which did not undergo surgery. Adeno-beta2AR therapy during cardiac surgery resulted in elevated LV betaAR density (520+/-250.9 fmol/mg) 2 days post-operatively compared to PBS (104+/-5.7 fmol/mg; P=0.002) and compared to the no surgery group (135+/-6.1 fmol/mg; P=0.002). Elevated LV betaAR density was also present at 2 weeks (315+/-74.1 vs 119+/-7.1 fmol/mg; P=0.002). In addition, Adeno-beta2AR therapy enhanced beta agonist stimulated LV dP/dtmax (5348+/-121 vs 4337+/-405 mmHg/s; P<0.05) and heart rate (209+/-6.9 vs 173+/-11.0 bpm; P<0.05), and reduced LVEDP (2.1+/-0.4 vs 6.4+/-1.8 mmHg; P<0.05) compared to PBS treatment. Interestingly, gene delivery was cardiac-selective and beneficial effects on function persisted for 2 weeks. Moreover, beta2AR gene transfer ameliorated LV dysfunction following surgery such that there were no significant differences between non-operated controls and animals treated with Adeno-beta2AR during CPB and cardioplegic arrest. CONCLUSIONS: Reduced betaAR density and impaired LV function were present following CPB and cardioplegic arrest. Cardiac-selective beta2AR gene transfer during CPB resulted in amelioration of LV dysfunction after cardiac surgery. Such a technique may offer a new approach to post-operative ventricular support.

Animals↗
PubMed2000

Right ventricular dysfunction after thrombolysis in patients with right ventricular infarction.

BACKGROUND: Right ventricular (RV) infarction is frequently associated with highest risk of death and major complications. Doppler echocardiography can be useful in the diagnosis of RV involvement. The goal of this study was to evaluate Doppler echocardiography features associated with RV involvement and a poor prognosis. METHODS: Two-dimensional Doppler echocardiography was performed before and after thrombolysis in 108 consecutive patients with an RV infarction. The bedside examination was performed before and 2 to 3 hours after thrombolytic therapy, and repeated after 1 and 7 days. All patients underwent coronary angiography after 20 days, and the perfusion of the coronary-related artery (> thrombolysis in myocardial infarction [TIMI] 3 grade) was evaluated. RESULTS: Patients were divided into 2 groups according to the recovery of global and regional RV function after thrombolytic therapy. In the group of patients who showed a normalization or improvement of RV wall motion (as assessed by RV wall motion score index), we found a TIMI grade III perfusion in 78% of patients. The analysis of interatrial septal motion and interventricular septal motion showed a normalization in all reperfused patients. Major complication and deaths were more frequent in patients with echocardiographic findings of RV dysfunction persisting after thrombolytic therapy. CONCLUSION: In patients with RV infarction treated with thrombolysis, persistent RV dysfunction is associated with a higher risk for the development of major cardiac complications and death.

Aged↗
PubMed2005

Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape.

AIMS: The aim of this study was to assess the relationship between exercise-induced changes in mitral regurgitation (MR) and echocardiographic characteristics of mitral deformation, global left ventricular (LV) function and shape at rest and after exercise. METHODS AND RESULTS: Forty consecutive patients with ischaemic MR due to prior myocardial infarction (MI), ejection fraction <45% in sinus rhythm underwent exercise-echocardiographic testing. Exercise-induced changes in effective regurgitant orifice (ERO) were compared with baseline and exercise-induced changes in mitral deformation and global LV function and shape. There was significant correlation between exercise-induced changes in ERO and changes in coaptation distance (r=0.80, P<0.0001), tenting area (r=0.79, P<0.0001) and mitral annular diameter (r=0.65, P<0.0001), as well as in end-systolic sphericity index (r=-0.50, P=0.001, respectively), and wall motion score index (r=0.44, P=0.004). In contrast, exercise-induced changes in ERO were not related to the echocardiographic features at rest. By stepwise multiple regression model, the exercise-induced changes in mitral deformation were found to independently correlate with exercise-induced changes in ERO (generalized r(2)=0.80, P<0.0001). CONCLUSION: Exercise-induced changes in severity of ischaemic MR in patients with LV dysfunction due to prior MI were independently related to changes in mitral deformation.

Echocardiography, Stress↗
PubMed2002

Coronary artery bypass in patients with severe left ventricular dysfunction.

We retrospectively reviewed the case records of 82 patients with severe left ventricular dysfunction (ejection fraction < 30%) who underwent coronary artery bypass grafting between March 1993 and February 2000. They were aged 28 to 76 years (mean, 60 years), and 66 of them were male. Significant comorbid factors included hypertension (93%), diabetes mellitus (85%), and hypercholesterolemia (49%). The number of grafts used ranged from 1 to 3. The majority of the patients (91%) belonged to the Canadian Cardiovascular Society angina class III. Coronary angiography revealed single-vessel (in 16% of the patients), double-vessel (52%), and triple-vessel disease (32%), and left main stem disease (18%). Seven patients (9%) died within 48 hours after surgery. The mean duration of hospital stay was 7 +/- 2 days. The 75 patients who survived were followed up for 3 months to 7 years. At the 1-year follow-up, 61 of the 68 patients (90%) who were alive moved up from angina class III to class I. Our observations suggest that coronary bypass carries an acceptable mortality risk and may offer a better quality of life in patients with poor ventricular function.

Adult↗