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PubMed1989

Percutaneous balloon valvuloplasty in patients with severe aortic stenosis and low ejection fraction. Immediate results and 1-year follow-up.

The efficacy, morbidity, and 1-year follow-up of balloon aortic valvuloplasty in patients with low ejection fraction (less than 40%) were studied on a consecutive series of 55 patients (mean age, 77 years) treated from September 1985 to February 1987. Because of their age (20 patients greater than 80 years old), poor left ventricular function, and associated diseases, 45 patients were definitely not surgical candidates. Balloon dilatation with 15-23-mm diameter balloon catheters decreased the transvalvular gradient from 66 +/- 24 to 28 +/- 14 mm Hg (p less than 0.001) and increased the valve area from 0.47 +/- 0.15 to 0.83 +/- 0.27 cm2 (p less than 0.001). Immediately after dilatation, ejection fraction mildly increased from 29 +/- 7% to 34 +/- 9% (p less than 0.001) in 38 patients who had undergone a second left ventricular angiogram after dilatation. No significant change in the degree of aortic regurgitation was found after the procedure. Three patients died in hospital (femoral arterial complications in two, septicemia in one). Immediate clinical improvement was noted in 80% of the patients. During the follow-up (mean, 11 months), 22 patients died (heart failure in 15 patients, sudden death in five patients, myocardial infarction in one patient, cancer in one patient). Thirty patients survived, 21 with persistent clinical improvement. Repeat cardiac catheterization was performed at 6 months in 20 patients, of whom eight had recurrence of symptoms. Nine patients had restenosis: their hemodynamic indexes had returned to prevalvuloplasty values.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1998

Transmyocardial laser revascularization (TMLR) in patients with unstable angina and low ejection fraction.

OBJECTIVE: Does perioperative use of the intraaortic balloon pump (IABP) improve the postsurgical outcome of patients presenting with endstage coronary artery disease, unstable angina and low ejection fraction transferred for transmyocardial laser revascularization (TMLR)? METHODS: TMLR, as sole therapy combined with the perioperative use of an intraaortic balloon pump has been assessed in seven patients with endstage coronary artery disease, unstable angina and low ejection fraction (EF < 35%). Six out of seven patients had signs of congestive heart failure. These patients are compared with 23 patients with endstage coronary artery disease, stable angina and EF > 35%, who were treated with TMLR as sole therapy without the use of IABP. The creation of transmural channels was performed by a CO2-laser. All patients were evaluated by hybrid positron emission tomography (perfusion SPECT and viability PET) and ventriculography preoperatively. Echocardiography, clinical status and hemodynamic assessment by Swan Ganz catheter were performed perioperatively. RESULTS: The perioperative mortality of this combined procedure (TMLR and IABP) was zero. Three out of seven patients had pneumonia with complete recovery. Swan Ganz catheter examinations showed deterioration of LV-function after TMLR intraoperatively and improvement after 2 h and further after 6 h on ICU (P < 0.05). In contrast, a decrease of LV-function in sole TMLR patients with an EF > 35%) has not been observed. Patients with EF < 35% needed the IABP for 2.3 days and moderate dose catecholamines for a mean of 3.0 days. The postoperative EF and resting wall motion score index (WMSI) of all analysed LV segments (evaluated by echocardiography) did not change compared to baseline (EF 31.3+/-2.6 preop. to 32.8+/-3.2 postop.; WMSI: 1.75+/-0.14 at baseline to 1.71+/-0.17 postop.). The average Canadian Angina Class at the time of discharge decreased from 4.0+/-0 (baseline) to 2.3+/-0.5 (P < 0.05) and the NYHA-Index from 3.9+/-0.3 to 2.7+/-0.5. No patient had signs of angina pectoris, whereas two patients still had signs of congestive heart failure. CONCLUSIONS: The reported data support our concept to start IABP preoperatively in patients with reduced LV contractile reserve in order to provide cardiac support during the postoperative phase of reversible decline of LV-function induced by TMLR.

Aged↗
PubMed1984

[Determination of left ventricular volume and ejection fraction by ECG-gated computer tomography. Comparison of various methods with biplane ventriculography].

End-systolic and end-diastolic left ventricular volume, stroke volume, and ejection fraction were measured by biplanar and monoplanar angiography in 2 groups of 20 patients. Stroke volume was also determined by the Fick principle. Within 24 h ECG-gated "stop action" computed tomography was performed in all patients and all data were compared statistically. End-systolic volumes were measured more accurately than end-diastolic volumes. Ejection fraction was determined much more accurately than stroke volume. Even though some highly significant correlations exist, stop action computed tomography, at the moment is not recommended for clinical use in evaluation of left ventricular function. Technical problems must first be solved using models.

Adult↗
PubMed2000

Real-time 3-D ultrasound acquisition and display for cardiac volume and ejection fraction evaluation.

The objective of this study was to test if three-dimensional (3-D) ultrasound (US) provides accurate determination of the cardiac volumes and ejection fraction. The 3-D device (Model 1-Volumetrics, ) is a 3-D acquisition system using a 2-Mhz matrix probe that insonates the whole cardiac volume in a 4-chamber view and collects the entire backscattered US echoes from this volume within one cardiac cycle. The complete 3-D US information stored in the memory can then be cut into 2-D views of any arbitrary orientation. For volume determination, the best 4-chamber view was selected into the memory, then 6 transverse views were displayed at different depths along the ventricle long axis, and the contour of the ventricle was drawn on each of these views. The left ventricle volume in diastole (LVDV) and the ejection fraction (EF) obtained by 3-D US were compared with those from x-ray and isotopic angiographies, and 2-D echo-time motion (2-D Echo-TM). The variations in stroke volume (SV) during a stand test, measured by 3-D US, and aortic Doppler were compared. The correlation between EF evaluated from 3-D US and x-ray or isotopic angiographies was found to be good (r = 0.80 p < 0.001; r = 0.86 p < 0.001), but lower with 2-D Echo-TM (r = 0.59 p < 0.001). For LVDV, the correlation was acceptable with x-ray angiography (r = 0.75 p < 0.001), but much lower with isotopic angiography and 2-D Echo-TM (r = 0.47 p < 0.001; r = 0.55 p < 0.001). A good correlation was also found between the SV changes measured by 3-D US and aortic Doppler (r = 0.79 p < 0.001).

Aged↗
PubMed1995

RF-transmitted CsI radio-isotopic ambulatory recorder for left ventricular ejection fraction monitoring.

We have developed a CsI multidetector probe in order to produce a nuclear ambulatory recorder to study simultaneously cardiac electric activity and the left ventricular ejection fraction. To make the device lighter, the electronics were designed with surface-mounted technology, and a serial data RF transmission system was used. The data are processed on a real-time basis using a portable microcomputer. Unlike other commercially available devices, this monitor avoids the problems of volume, weight, recording time capacity and slow off-line data processing. Our device permits global and regional analysis of the ejection fraction for a moderate manufacturing cost. It is intended primarily for ambulatory use and can easily be adapted to perform a monitoring function. The first tests on patients conducted using the prototype demonstrate the technical reliability and satisfactory operation of the device.

Cesium↗
PubMed2005

Improved assessment of left ventricular volumes and ejection fraction by contrast enhanced harmonic color Doppler echocardiography.

AIMS: Test the accuracy of contrast enhanced harmonic color Doppler technique (CHCD) to determine left ventricular volumes and ejection fraction (LVEF) compared to equilibrium radionuclide ventriculography (MUGA). METHODS AND RESULTS: A total of 35 patients were enrolled (male 74.3%) with the mean age of 64.5 +/- 10 years and 6.8 +/- 4.9 days between echo and MUGA scans. The correlation of LVEF by CHCD with MUGA was better (R2 = 0.89) than that of harmonic 2D (H2D) and of contrast enhanced harmonic 2D (CH2D) (R2 = 0.74, R2 = 0.82, respectively). The RMS residual of CHCD (0.056) was smaller than that of H2D and CH2D (0.079, 0.067, respectively). The LVED and LVES volumes by H2D, CH2D and CHCD correlate well with MUGA but there was a significant over estimation of LVED and LVES volumes by H2D and CH2D as compared to MUGA. Also, the RMS residuals were the lowest for the CHCD method. The CHCD had the highest mean inter-observer agreement (90.9%) for LVEF compared with H2D and CH2D (78.9% and 88.1%, respectively). CONCLUSIONS: CHCD has been feasible in all patients in the present study and it has shown a good concordance with ejection fraction and volumes provided by MUGA.

Aged↗
PubMed2001

Automatic determination of left ventricular ejection fraction from gated blood-pool tomography.

UNLABELLED: The aim of this study was to develop and validate a new algorithm to automatically compute left ventricular ejection fraction (LVEF) from gated blood-pool tomography (GBPT). The results were compared with those of conventional planar radionuclide angiocardiography (PRNA). METHODS: Fifty-three consecutive patients received an injection of 740 MBq (99m)Tc-labeled human serum albumin. PRNA and GBPT were performed consecutively in a random sequence. PRNA served as the reference, and GBPT images were processed using a new edge detection algorithm. The algorithm is fast (<45 s), fully automatic, and works in three-dimensional space. The method includes identification of the valve plane and the septum. The left ventricular cavity at end-diastole is delineated by segmentation using an iterative threshold technique. An optimal threshold is reached when the corresponding isocontour best fits the first derivative of the end-diastolic count distribution in three dimensions. This optimal threshold is then applied to delineate the left ventricular cavity on the other time bins. The data are corrected for the partial-volume effect. Left ventricular volumes are determined using a geometry-based method and are used to calculate the ejection fraction. RESULTS: The success rate of the new algorithm was 94%. LVEFs calculated from GBPT agreed well with those calculated from PRNA (r = 0.78; GBPT = 0.94 PRNA + 6.33). The systematic error was 2.8%, and the random error was 8.8%. Excellent inter- and intraobserver reproducibility was found, with average differences of 1.1% +/- 4.6% and 1.1% +/- 5.0%, respectively, between the two measurements. CONCLUSION: This new algorithm provides a fast, automated, and objective method to calculate LVEF from GBPT.

Adult↗
PubMed1984

Differences of global and regional left ventricular function in anterior and inferior myocardial infarction: assessment by the use of a regional ejection fraction.

Radionuclide angiography was performed on 41 patients with transmural myocardial infarction (MI) [17: anterior MI, 24: inferior MI] and 10 normal subjects in order to evaluate the influence of the infarct site on the global and the regional left ventricular function. The severity of the wall motion abnormality agreed closely with the reduction in the relative regional ejection fraction (%REF). The depression of the left ventricular ejection fraction (LVEF) in anterior MI was greater than that in inferior MI (p less than 0.01). We also found that the depression of the performance in the infarcted zone in anterior MI was more marked than that in inferior MI (p less than 0.01). However, function in the non-infarcted zone was almost the same in the anterior MI as in the inferior MI. As to the extent of the hypokinetic area, there was no significant difference between the patients with anterior MI and those with inferior MI. The above results indicated that the infarct site is an important determinant of the regional and the global left ventricular function after MI.

Adult↗
PubMed1990

[Left ventricular ejection fraction estimated by 2-dimensional echocardiography].

Visual assessment of the reduction of left ventricular volumes during the cardiac cycle, which is the basis for calculation of the left ventricular ejection fraction followed up from several planes in real time is close to the objectively assessed changes estimated by various time consuming methods from two-dimensional echocardiography by the one- or two-plane method. The author's method makes it possible to assess the left ventricular ejection fraction and to divide it for clinical needs into four groups: normal above 60%, slightly reduced 45-60%, reduced 30-45% and markedly reduced 30% or less. The described echocardiographic examination method is invaluable when practiced by an experienced worker with restricted time for examination.

Echocardiography↗
PubMed1986

Response of left ventricular ejection fraction to recovery from general anesthesia: measurement by gated radionuclide angiography.

To test the hypothesis that, after anesthesia for noncardiac surgical procedures, the increased cardiac work during recovery induces wall motion and ejection fraction (EF) abnormalities in patients with mild angina pectoris, gated radionuclide angiography was performed in patients undergoing simple cholecystectomy under narcotic-relaxant general anesthesia. The ejection fraction was determined during anesthesia at the end of surgery, and then determined 3 min and 3 hr after extubation. A new angiography was performed 24 hr later, and a myocardial scintigraphy (Thallium 201) was performed during infusion of the coronary vasodilator, dipyridamole. In the first part of the investigation, eight patients without coronary artery disease (CAD) (group 1) and 20 patients with mild angina (group 2) were studied. In the second part of the study, seven patients (group 3) with mild angina pectoris received an intravenous infusion of 0.4 microgram X kg-1 X min-1 of nitroglycerin started before surgery and gradually decreased 4 hr after extubation. In group 1, EF remained unchanged at recovery. In contrast in group 2, EF responded abnormally to recovery: EF decreased from 55% during anesthesia to 45% 3 min after extubation (P less than 0.001). Patients in group 3, who received intravenous nitroglycerin, showed no change of EF at recovery. This study demonstrates that recovery from general anesthesia causes abnormalities in left ventricular function in patients suffering from CAD. These abnormalities are prevented by prophylactic intravenous nitroglycerin.

Aged↗
PubMed2000

Utility of positron emission tomography in predicting improved left ventricular ejection fraction after coronary artery bypass grafting among patients with ischemic cardiomyopathy.

The objective of this study was to determine whether preoperative estimates of regional myocardial uptake of (18)-F-fluorodeoxyglucose (FDG) could predict postoperative improvement in ejection fraction in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy. 20 consecutive patients [left ventricular ejection fraction (LVEF) </=27%] were referred for preoperative positron emission tomography (PET) to measure regional myocardial FDG uptake and were deemed candidates for CABG. All individuals had technically adequate vessels and significant viability. The left anterior descending (LAD) coronary artery was severely diseased in all patients. Because of the importance of the anterior wall to overall ventricular performance, FDG uptake was semiquantitated in those regions and related to postoperative LVEF. 17 patients underwent CABG with an uneventful recovery. LVEF increased from 22 +/- 4 to 26 +/- 7% 2 weeks postsurgery (p < 0.05), with >/=5% change noted in 7 patients (group 1) and <5% noted in 10 patients (group 2). No preoperative or perioperative clinical variable could predict those with improved ventricular function. The relative amount of FDG uptake in the anterior wall was higher in group 1 compared with group 2 (93 +/- 9 vs. 81 +/- 13%; p < 0.05) and correlated with the change in LVEF post-CABG (r = 0.50; p < 0.05). >88% of FDG uptake in the LAD region had a positive predictive accuracy of 67% and negative predictive accuracy of 88% for improved LVEF postbypass. Late follow-up estimates of LVEF (median of 10 months) showed that early changes in function were sustained. In summary, among patients with severe coronary artery disease and depressed LVEF, ventricular function may improve early postrevascularization. PET estimates of relative FDG uptake in the anterior wall help predict those individuals who are likely to have the greatest increment in LVEF.

Aged↗
PubMed1988

Revascularization of the right coronary artery: influence on thermodilution right ventricular ejection fraction.

This study was designed in order to evaluate the influence of right coronary artery (RCA) disease and its revascularization on right heart performance monitored by measuring thermodilution right ventricular ejection fraction (RVEF). Forty patients undergoing elective aortocoronary bypass surgery were divided into two groups: group 1, with RCA revascularization, n=20; and group 2, without RCA disease or revascularization, n=20. RVEF was measured using a pulmonary arterial catheter mounted with a fast-response thermistor and a bedside microprocessor ejection fraction computer. The major finding of the study was that myocardial revascularization with extracorporeal circulation was followed by a decrease in RVEF which was significantly more pronounced in group 1 (-13.1%) in comparison to group 2 (-5.0%). RVEF gradually increased after bypass, but did not reach baseline values. By the first postoperative day, RVEF had reached baseline values again in group 1 and had increased beyond baseline values in group 2. Traditionally measured hemodynamic parameters could not be correlated with the course of RVEF, except for cardiac index. The present study further suggests that right-sided events may have clinical effects on left-sided function. Inadequate protection of the right heart, especially in patients with RCA stenosis, may result in depression of right ventricular myocardial performance, which can be monitored serially by measuring RVEF.

Blood Pressure↗
PubMed2003

Treatment of pacemaker induced severe mitral regurgitation with biventricular pacing in two patients with a normal left ventricular ejection fraction.

This report describes two patients who developed severe mitral regurgitation and drug refractory congestive heart failure after implantation of a conventional pacemaker. Both patients had a normal left ventricular ejection fraction. Dramatic long-term improvement occurred following the institution of biventricular pacing that resulted in mild mitral regurgitation. The findings illustrate the benefit of cardiac resynchronization therapy in pacemaker induced left ventricular dyssynchrony causing severe mitral regurgitation and severe congestive heart failure in selected patients with a normal left ventricular ejection fraction.

Aged↗
PubMed1989

Interobserver agreement and accuracy of bedside estimation of right and left ventricular ejection fraction in acute myocardial infarction.

Ninety-eight patients with acute myocardial infarction were examined by 3 clinicians who, independently of each other, gave an estimate of left ventricular (LV) and right ventricular (RV) ejection fraction (EF) in each patient. Their estimates were based on physical examination, chest x-ray, electrocardiogram, patient history and clinical course during admission. Ejection fractions were estimated as belonging to 1 of 4 categories: normal (LVEF greater than or equal to 0.53, RVEF greater than or equal to 0.57), mildly reduced (LVEF 0.40 to 0.52, RVEF 0.45 to 0.56), moderately reduced (LVEF 0.30 to 0.39, RVEF 0.35 to 0.44) or severely reduced (LVEF less than 0.30, RVEF less than 0.35). Radionuclide ventriculography was carried out immediately after the physical examination. LVEF was correctly estimated in 43% of all examinations, deviated from radionuclide LVEF by 1 LVEF category in 45% and by 2 LVEF categories in 12%. The 3 clinicians agreed on estimated LVEF in only 32% of the patients. RVEF was correctly estimated in 67% of the examinations, but none of the clinicians identified greater than 43% of the relatively few patients with reduced radionuclide RVEF and they greatly disagreed as to who among the patients had a reduced RVEF. Previous myocardial infarction, electrocardiographic infarct location, Killip class, physical signs of left- and right-sided heart failure, radiographic pulmonary congestion and cardiomegaly were analyzed to determine which were the most helpful in predicting LVEF and RVEF. The results disclosed that several variables, traditionally believed to be reliable indexes of reduced ventricular function, were surprisingly poor predictors of LVEF and RVEF.

Adult↗
PubMed2000

The relation between mitral annulus motion and left ventricular ejection fraction in atrial fibrillation.

Mitral annulus motion (MAM) has recently been introduced as an index of left ventricular function. Previous studies have shown a good agreement between MAM (mm) x 5 and ejection fraction in middle-aged and elderly patients. These studies only included patients with sinus rhythm, while patients with atrial fibrillation were excluded. In the present study, MAM was reduced in patients with atrial fibrillation while ejection fraction (EF) did not differ from age-matched control patients with sinus rhythm. The 'conversion factor' (EF/MAM) was 7.2 in the group with atrial fibrillation and 5. 1 in controls with sinus rhythm. This difference must be taken into account when MAM is used to estimate left ventricular function in patients with atrial fibrillation. Patients with atrial fibrillation had lower stroke volume and higher heart rate than patients with sinus rhythm. A decreased systolic long-axis shortening was found (P<0.005) compared to patients with sinus rhythm, but no difference in short-axis diameter shortening.

Aged↗
PubMed1991

Use of intravenous digital subtraction ventriculography in the evaluation of left ventricle volumes and ejection fraction.

Although intravenous digital subtraction ventriculography (IDSV) is increasingly used to estimate end-diastolic left ventricular volume (EDV), end-systolic left ventricular volume (ESV) and left ventricular ejection fraction (EF), its ability to reproduce the precise estimates provided by left ventricle cineangiography (LVCA) and its role in clinical cardiology have not been unequivocally established. In 32 patients subjected to cardiac catheterization for a variety of cardiac disorders and a normal or reduced left ventricular function the EDV, ESV and EF provided by a 30 degrees right anterior oblique LVCA were compared with those provided by a 30 degrees right anterior oblique IDSV. The mean EDV, ESV and EF obtained by IDSV in the 32 patients were superimposable on those obtained by LVCA. The individual EDV, ESV and EF values provided by the two methods were all related in a close linear fashion. For EF the correlation coefficient was 0.98 and the 90% confidence interval of the mean difference between the two series of values was +/- 6.1%, i.e. +/- 10% error compared to the mean EF provided by LVCA. Thus IDSV is a reliable and not too invasive method for estimating left ventricle volumes and ejection fraction. It might provide serial estimations with a better assessment of the evolution of a patient's disease and the effect of treatment.

Adult↗
PubMed2001

Digoxin withdrawal in patients with dilated cardiomyopathy following normalization of ejection fraction with beta blockers.

BACKGROUND: The effect of withdrawal of digoxin on left ventricular function in patients with a history of idiopathic dilated cardiomyopathy (IDCM) following normalization of left ventricular ejection fraction (LVEF) with beta blockers remains unknown. HYPOTHESIS: This study was undertaken to determine the effect of digoxin withdrawal on left ventricular function in patients with IDCM. METHODS: In 8 consecutive patients with IDCM (5 men, 3 women) who had normalization of LVEF following beta-blocker treatment, digoxin was withdrawn as part of an office protocol. and LVEF was followed. Baseline EF prior to beta blocker initiation (carvedilol = 6, atenolol = 1, metoprolol 1) was measured with isotope ventriculography (IVG), echocardiography, or left ventriculography. Post beta blocker ejection fraction (post BB EF) was measured in all patients with IVG at a mean of 17.25 +/- 5.38 months. Follow-up EF was measured using IVG after digoxin withdrawal at a mean of 6.99 +/- 4.34 months. RESULTS: An experienced blinded reader interpreted the IVG scans. Baseline EF was 28.5 +/- 8.26; post BB EF and follow-up EF were 56.1 +/- 4.65 and 51.0 +/- 7.35, respectively (p = 0.05). CONCLUSION: These data provide potential evidence that digoxin withdrawal can result in a small but significant reduction in LVEF in patients with IDCM who had normalization of LVEF after treatment with beta blockers. Mean LVEF, however, remained within normal (> 50%) on beta-blocker therapy and without digitalis. Large, randomized controlled trials are needed to confirm these findings.

Adrenergic beta-Antagonists↗
PubMed1999

Ejection fraction by radionuclide ventriculography and contrast left ventriculogram. A tale of two techniques. SAVE Investigators. Survival and Ventricular Enlargement.

OBJECTIVES: We assessed the abilities of two methods to measure ejection fraction (EF)-radionuclide ventriculography (RVG) and contrast left ventriculography (Cath-EFa) to predict cardiovascular events. BACKGROUND: Both RVG and Cath-EFa are commonly used methods to measure left ventricular performance and assess prognosis. Their comparative abilities to predict clinical events have not been reported. METHODS: Both RVG EF and Cath-EFa were measured within 16 days of myocardial infarction (MI) in 688 patients. The results were divided into terciles. Prognosis by terciles was assessed for each technique. A multivariate analysis was performed to determine which EF measurement was a better predictor of prognosis. RESULTS: Average RVG-EF was 32%+/-7, while Cath-EFa was 42%+/-10. Both RVG and Cath-EFa were poorly correlated (R=0.42). Event rate declined across terciles with increasing EF for both techniques (events in lowest to highest tercile of Cath-EFa 40.7%, 25.9%, 11.6%, p < 0.001; and RVG-EF 39.9%, 26.1%, 15.6%, p < 0.001). There was concordance of terciles in 303 of 688 patients (44%). When patients in the highest RVG terciles were in the highest Cath-EFa tercile, the event rate was 7%. However, when patients in the highest RVG terciles were in the lowest Cath-EFa tercile, the event rate was 19%. Both Cath-EFa (p < 0.001) and RVG-EF (p < 0.001) were independent predictors of cardiovascular events. CONCLUSIONS: Ejection fraction measured by RVG or during catheterization is a valuable tool in the risk stratification of postinfarct patients. When disagreement is present between clinical impression and measurement by either method, the use of an alternative measurement is warranted and complementary.

Adult↗