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At least 631 records · Page 35Linked to original sources
PubMed1987

Left ventricular function in adults with atrial septal defect.

Sixteen patients with secundum atrial defect were catheterized giving emphasis to the analysis of the left ventricle at end systole and mid-ejection. The mean ejection fraction of the group was subnormal 57 + 8% when compared with 30 normal patients (71 + 109) P less than .005. Eight patients showed elevated end-diastolic volumes (156 + 10cc) when compared to our normal group (95% + 10cc) P less than .005. A total of 32 hypokinetic and 35 tardokinetic areas were found. Eight patients were restudied after nitroglycerin (0.4 mg sublingually) with an improvement in the ejection fraction from 54% to 70% (P less than .005) and normalization of most of the hypokinetic areas. No correlation was found between total ejection fraction or total systolic wall motion and the shunt size. Probably these left ventricular wall motion abnormalities are primary and not due to the shunt size.

Adolescent↗
PubMed1994

Influence of heart rate and left atrial pressure on pulmonary venous flow pattern in dogs.

In six open-chest anesthetized dogs we investigated the effect of heart rate (HR) on the relationship between left atrial pressure (LAP) and pulmonary venous flow (QPV). QPV was measured by ultrasonic transit time during volume loading and right atrial pacing. Consistent with previous studies, we found a negative correlation between LAP and mean flow rate during atrial systole divided by mean flow rate in the R-R interval. However, this relationship was shifted upward by tachycardia. The QPV maximum amplitude divided by mean flow rate in the R-R interval increased with loading but decreased with tachycardia. mean flow rate during ventricular systole divided by mean flow rate during the R-R interval increased with both loading and tachycardia. Regression coefficients for HR and LAP as predictors of these indexes were all significantly different from zero (P = 0.0001). We conclude that HR significantly influences the relationship between the QPV pattern and LAP. This could be a limitation of the pulmonary venous flow pattern as an indicator of left ventricular diastolic function.

Animals↗
PubMedDate not supplied

Capacity of intrinsic cardiac neurons to modify the acutely autotransplanted mammalian heart.

The capacity of the intrinsic cardiac nervous system to modify the acutely autotransplanted heart was investigated in eight anesthetized open-chest canine preparations in which the adrenal glands had been removed from the circulation. Cardiac effects elicited by isoproterenol and nicotine were also examined before and after heart-lung transplantation. Cardiac augmentation induced by isoproterenol was similar before and immediately after cardiopulmonary transplantation, indicating that the surgery did not obtund cardiac myocyte function significantly. The initial bradycardia induced by nicotine was greater before transplantation. The subsequent augmentation in left atrial systolic pressure, as well as right and left ventricular intramyocardial systolic pressures, induced by nicotine were similar before and after transplantation. When nicotine was administered to transplanted preparations after atropine administration, cardiac augmentation was induced. Cardiac augmentation was not induced by nicotine after subsequent beta-adrenergic blockade. These data indicate that nicotine-sensitive adrenergic neurons which accompany the transplanted heart are capable of inducing considerable cardiac augmentation. Power spectral analysis of heart rate and left ventricular chamber rate of pressure rise variability indicated an almost complete lack of power in these indexes after, as opposed to before, transplantation. Together with intrinsic cardiac cholinergic neurons, intrinsic cardiac adrenergic neurons may be responsible for physiologically and pharmacologically induced alterations in cardiac variables that occur in acutely transplanted hearts.

Adrenal Glands↗
PubMed2004

Systolic left atrial failure in elderly women with severe aortic stenosis: mitral and pulmonary vein Doppler analysis by transesophageal echocardiography.

We studied prospectively 35 elder women aged 65-82 years, with isolated severe symptomatic aortic stenosis, referred for aortic valve surgery. We assessed diastolic function by TEE before and after cardiac surgery, although follow-up data were collected in 26 patients. The examination was performed prior to surgery and 6 months after. The control group consisted of 32 patients referred for TEE. In the preoperative study, the velocities and integrals of the waves in the pulmonary vein flow were similar to the people of their same age, except the A-wave of atrial contraction and the integral of the systolic wave, which were significantly smaller (Control A-wave 26.1 +/- 5.1 vs preoperative A-wave 22.6 +/- 5.6, P = 0.009 and control double product A vel xA dur 2,748 +/- 835 vs preoperative 2,273 +/- 968, P = 0.03; systolic integral 14.6 +/- 3.8 vs 11.3 +/- 4, P = 0.0009). Six months after surgery, the PV flow was similar to the control group except for the wave of atrial contraction, which was significantly smaller but tended to normalization (postoperative A-wave 23.3 +/- 5, P = 0.04 vs control, and postoperative double product A vel x A dur 2460 +/- 893, P = 0.21 vs control). Mitral flow parameters did not change in the preoperative and postoperative period. Left ventricular mass index changed from 166 +/- 54 g/m(2) to 105 +/- 39 g/m(2) (P< 0.0001). The results of this study show that in elderly women with symptomatic severe AS, diastolic function does not change, left ventricular mass reduces, with improvement in symptoms, and the left atrium function, considered by pulmonary vein flow, is preoperative depressed and tends to mild recovery in the postoperative period, suggesting systolic LA failure.

Aged↗
PubMed2001

Relation between paroxysmal atrial fibrillation and left ventricular diastolic function in patients with acute myocardial infarction.

The relation between left ventricular filling pattern and the occurrence of paroxysmal atrial fibrillation was evaluated using Doppler echocardiography in a prospective series of 157 patients with acute myocardial infarction. Paroxysmal atrial fibrillation after acute myocardial infarction was often associated with a higher restrictive filling pattern.

Aged↗
PubMed1996

Load dependence of left atrial and left ventricular filling dynamics by transthoracic and transesophageal Doppler echocardiography.

This article evaluates the pattern and effect of varying loading conditions on pulmonary venous flow and transmitral flow obtained by transthoracic and transesophageal echocardiography. We have conducted a two-stage study. A transthoracic echocardiographic study was performed in 15 patients with coronary artery disease and preserved left ventricular function. The transesophageal approach was used before open heart surgery where hemodynamic conditions were invasively monitored. Sublingual nitroglycerin (NTG) was administered to lower systolic blood pressure (mean 18 mm Hg) and resulted in a significant decrease in the peak passive left ventricular diastolic filling velocity (E wave) from 72 +/- 23 to 49 +/- 16 cm/s without marked changes in pulmonary venous flow pattern. In the transesophageal part of the study, Doppler-derived systolic (J), diastolic (K), and retrograde (R) phases of pulmonary venous flow, and passive (E) and active (A) phases of mitral flow were measured. Hemodynamic data were obtained invasively. Loading conditions were increased by infusion of saline and phenylephrine and reduced by NTG. Increased preload resulted in an augmented mitral E wave, an increased J wave, and an increased retrograde flow wave from the pulmonary veins. These changes were reversed by reduction of preload with NTG. Monitoring mitral and pulmonary venous flow may provide a relatively noninvasive means to assess directional changes in left ventricular preload.

Aged↗
PubMed1989

Comparison of Doppler indexes of left ventricular diastolic function with simultaneous high fidelity left atrial and ventricular pressures in idiopathic dilated cardiomyopathy.

Doppler echocardiographic indexes of ventricular inflow have been used clinically to characterize left ventricular (LV) diastolic function. The reliability of these indexes as markers for intrinsic myocardial diastolic properties has been questioned. Micro-manometer left atrial (LA) and LV pressures as well as transmitral Doppler flow velocity signals and M-mode and 2-dimensional echocardiograms were simultaneously recorded. These unique measurements were acquired in patients with dilated cardiomyopathy under baseline conditions and during infusion of high dose amrinone. The response to amrinone was chosen as a hemodynamic model because this drug has previously been described as having beneficial effects on overall LV systolic and diastolic performance. At peak amrinone effect, LV contractility increased (as assessed using load independent end-systolic indexes) and early diastolic relaxation improved whereas passive chamber stiffness, heart rate and stroke volume were unchanged. There was a significant decrease in LV end-diastolic pressure as well as a parallel downward shift of the entire LV diastolic pressure-dimension relation. These findings, which indicated an improvement in overall LV diastolic properties, probably represent the combination of more rapid early diastolic relaxation in conjunction with a reduction in venous return, the relief of pericardial restraint or the reduction in right ventricular-LV interaction. In contrast, the ratios of Doppler-determined peak transmitral early-to-late flow velocities and early-to-late diastolic flow velocity integrals decreased with amrinone infusion, thereby suggesting a drug-induced decrease in LV diastolic compliance. Thus, in patients with idiopathic dilated cardiomyopathy, administration of amrinone has a complex effect on LV diastolic properties.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Ambulatory pulse pressure, left ventricular hypertrophy and function in arterial hypertension.

BACKGROUND: A wide pulse pressure (PP) can provide important risk assessment information about myocardial infarction, carotid artery atherosclerosis, and global cardiovascular risk. Ambulatory pulse pressure (APP) does not have a well-known prognostic value in hypertensive patients. METHODS: To evaluate the relationship among high APP, atrial volumes, and cardiac function, an observational study was performed on 108 untreated non-elderly hypertensive patients (mean age 54.23 +/- 7.12). Twenty-four-hour ambulatory blood pressure monitoring, Doppler and echocardiographic measurements of systolic, diastolic function, left and right atrial volumes, left ventricular mass index and dimensions, were performed in subjects with both clinic and APP > 60 mmHg (APP1 Group). A control group of hypertensive selected subjects with both clinic and APP < 60 mmHg was chosen (APP 2 Group). RESULTS: The APP1 group showed left atrial volume enlargement, high left ventricular mass index, and impaired diastolic function. A positive correlation was found in the APP1 group results among left ventricular end diastolic diameter (r = 0.39, P < 0.01), left atrial volume (0.38, P < 0.05), and left ventricular mass index (r = 0.33, P < 0.05); clinic PP showed a statistically significant correlation with left atrial volume, left ventricular end diastolic diameter, and left ventricular mass index only in the APP1 group. CONCLUSIONS: These results suggest that elevated APP can be considered an effective predictor of cardiovascular risk in hypertensive subjects. In these patients echocardiographic evaluation of left ventricular function and morphology can increase the prognostic value of PP.

Adult↗
PubMed1996

Assessment of mean left atrial pressure from the left ventricular pressure tracing in patients with cardiomyopathies.

The direct measurement of mean left atrial pressure is difficult and the ability to assess mean left atrial pressure from the left ventricular (LV) pressure tracing obtained at cardiac catheterization is clinically useful. The current study describes the limitations of using LV pre-a-wave pressure or LV end-diastolic pressure to estimate mean left atrial pressure and describe another index, mean LV diastolic pressure, which provides a better assessment of mean left atrial pressure.

Atrial Function, Left↗
PubMedDate not supplied

Echocardiographic assessment of mitral regurgitation.

Although the natural history of mitral regurgitation (MR) is poorly defined, evidence has been found for excess mortality and morbidity in patients with severe MR who are managed conservatively. With improved mortality and morbidity in the surgical management of this condition, we are becoming increasingly aggressive in offering surgery to patients with severe MR. Surgery may be offered even in the absence of symptoms or left ventricular dysfunction, provided that the valve seems reparable, the patient's MR is severe, and the surgical team is experienced in valve repair. Echocardiography is critically important in determining the feasibility of valve repair and accurately assessing the severity of the patient's MR. It also allows assessment of the effect of MR on the left ventricle and the left atrium.

Atrial Function, Left↗
PubMed1998

[Cardiac amyloidosis with atrioventricular valve thickening and left atrial dysfunction: a case report].

A 70-year-old man with cardiac amyloidosis was referred to our hospital because of exertional chest pain accompanied by ischemic changes on electrocardiography on April 2, 1997. Transthoracic echocardiography revealed a normal size and normally contracted left ventricle without hypertrophy and "granular sparkling" quality of the myocardium, thickening of the mitral and tricuspid valves, and enlargement of the left atrium with reduced booster pump function. Pulsed Doppler mitral inflow velocity wave showed a pseudonormalized pattern, and pulmonary venous flow velocity wave showed a non-compliant pattern. Transesophageal echocardiography revealed thickening and reduced movement of the interatrial septum and reduced flow velocity in the left atrial appendage, suggesting left atrial dysfunction. Adenosine triphosphate (ATP) stress thallium-201 myocardial scintigraphy showed reversible patchy defect mainly in the posterolateral wall. Left ventricular end-diastolic and pulmonary capillary wedge pressures were mildly elevated. Angiography showed normal coronary arteries, but coronary flow reserve measured by administering intravenous ATP in the left anterior descending artery was severely impaired. A rectal biopsy specimen was positive by Congo red staining. Thus, angina pectoris in this patient may be due to amyloid infiltration of the small intramural coronary arteries. Atrioventricular valve thickening and left atrial dysfunction are important clues to diagnose cardiac amyloidosis.

Adenosine Triphosphate↗
PubMed2004

Left atrial myopathy in cardiac amyloidosis: implications of novel echocardiographic techniques.

AIMS: To assess left atrial (LA) function and determine the prevalence of LA dysfunction in AL amyloidosis (AL) using conventional and strain echocardiography. METHODS AND RESULTS: LA ejection fraction, LA filling fraction, LA ejection force, peak LA systolic strain rate (LAsSR), and LA systolic strain (LA epsilon) were determined in 95 AL patients (70 with and 25 without echocardiographic evidence of cardiac involvement, abbreviated CAL and NCAL, respectively), 30 age-matched controls (CON), and 20 patients with diastolic dysfunction and LA dilatation (DD). Peak LAsSR >2 standard deviations below mean CON value was used as the cut-off for normal LA function. LA ejection fraction was lower in CAL when compared with CON (40.4+/-13.6 vs. 67.0+/-6%, P=0.01). Left atrial septal strain rate and strain were lower in CAL (0.8+/-0.5 s(-1) and 5.5+/-4%, respectively) compared with CON (1.8+/-0.8 s(-1) and 14+/-4%, respectively, P=<0.0001), NCAL (1.6+/-0.8 s(-1) and 13+/-7%, respectively, P<0.0001) and DD (1.3+/-0.4 s(-1) and 10+/-2%, respectively, P<0.0001). Based on peak LA systolic strain rate criteria, the cut-off values for normal LA function were -1.1 s(-1) and -1.05 s(-1) for lateral and septal walls. Using these criteria, LA dysfunction was identified in 32% (lateral LA criteria) and 60% (septal LA criteria) of CAL patients. Lateral and septal LAsSR were lower in CAL patients with vs. those without symptoms of heart failure. Inter- and intra-observer agreement was high for LA strain echocardiography. CONCLUSION: LA function assessment using strain echocardiography is feasible with low intra- and inter-observer variability. LA dysfunction is observed in AL patients without other echocardiographic features of cardiac involvement and may contribute to cardiac symptoms in CAL.

Aged↗