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PubMed1982

Measurement of left ventricular ejection fraction with ionic 113mIn and a cardiac probe.

Left ventricular ejection fraction (LVEF) was measured with a cardiac probe (Nuclear Stethoscope, Bios Inc., Valhalla, New York) and 113mIn in 28 normal subjects and 86 patients with coronary artery disease (CAD). In 20 normal subjects 99mTC-RBCs were compared with 113mIn which binds to transferrin after IV injection. With 99mTc-RBCs, average LVEF was 57 +/- 7% (1 SD); with 113mIn, average LVEF was 55 +/- 8% (N.S.). Sequential measurements at different times over 60 min revealed good reproducibility. Comparison of LVEFs obtained using 99mTc-RBCs with a gamma camera and cardiac probe revealed a good correlation. The correlation coefficients were 0.92 in 25 patients with CAD and 0.95 in 10 patients with LV wall motion abnormalities. The LVEF obtained using a cardiac probe and 113mIn increased in 28 normals from 57 +/- 9% to 64 +/- 13% (P less than 0.001) during handgrip exercise, while the LVEF decreased from 45 +/- 9% to 41 +/- 10% (P less than 0.01) in patients with acute myocardial infarction 4-7 weeks after episode, from 48 +/- 11 to 40 +/- 12% (P less than 0.001) in patients with old myocardial infarction, and from 52 +/- 9 to 42 +/- 9% (P less than 0.001) in patients with angina pectoris. The cardiac probe and 113mIn provide a useful alternate means of determining left ventricular dysfunction in facilities where 99mTc and a gamma camera computer system are not readily available.

Cardiac Output↗
PubMed1983

Measurement of left ventricular ejection fraction by videodensitometric analysis of digital subtraction angiograms.

Left ventricular ejection fraction (LVEF) was calculated from 25 first-pass digital subtraction angiograms using a densitometric analysis. Digital subtraction angiograms are obtained in a computerized format; therefore, they can be readily analyzed with computer software to measure the density of the iodine signal within the image. The video signals from the image intensifier were logarithmically amplified so that there was a linear correlation between the video signal intensity and the depth of the iodine contrast material represented by that video signal. LVEF was also calculated by the area-length method from the same digital subtraction angiograms. There was close correlation between these two techniques (r = 0.94, standard error of the estimate = 5.04%). The videodensitometric EF technique is simple to perform, it correlates well with the standard area-length method, and is not dependent on geometric assumptions of LV geometry.

Absorptiometry, Photon↗
PubMedDate not supplied

Compared with 3-dimensional analysis, 2-dimensional gated SPECT analysis overestimates left ventricular ejection fraction in patients with regional dyssynchrony.

BACKGROUND: Left ventricular (LV) ejection fraction (EF) is a powerful prognostic predictor in patients with heart disease. However, LVEF calculated by 2-dimensional (2D) modalities such as echocardiography by use of the "modified" Simpson's rule may be incorrect in patients with regional dyssynchrony, presumably because regions of dyssynchrony are excluded from analysis. METHODS AND RESULTS: To elucidate the difference between 2D and 3-dimensional (3D) methods with regard to LVEF calculation in patients with regional dyssynchrony, we compared LVEF derived from 8-frame gated technetium 99m sestamibi stress perfusion tomograms using commercially available 2D single photon emission computed tomography (SPECTEF) software that uses the modified Simpson's rule, 3D QGS, and investigational 3D p-FAST software in 136 left bundle branch block patients. Twenty-four patients had normal wall motion, whereas one hundred twelve showed septal dyssynchrony. Bland-Altman plots demonstrated that compared with QGS and p-FAST, SPECTEF overestimated LVEF in patients with septal dyssynchrony systemically by 8.6% and 11.3%, respectively. CONCLUSIONS: We conclude that compared with 3D modalities, 2D modalities that use the modified Simpson's rule, such as SPECT EF, overestimate LVEF in patients with dyssynchronous septal wall motion. Therefore 3D modalities are preferred to evaluate patients with regional dyssynchrony.

Aged↗
PubMed1997

Cholecystectomy alleviates acalculous biliary pain in patients with a reduced gallbladder ejection fraction.

BACKGROUND: We sought to determine whether a reduced gallbladder ejection fraction, (GBEF) ascertained by cholecystokinin-cholescintigraphy (CCK-CS), predicts symptomatic improvement after cholecystectomy. METHODS: Medical records of patients who had had CCK-CS as well as negative results of gallbladder ultrasonography were reviewed, and patients were contacted by telephone to determine whether they had benefited from cholecystectomy. RESULTS: There were 35 patients (33 female, 2 male) who had a decreased GBEF. Cholecystectomy was done in 30, of whom 20 (67%) had resolution of pain, 8 (27%) had partial improvement, and 2 (7%) had no change. The 5 who declined cholecystectomy included none (0%) who were pain free, 2 (40%) who had partial improvement, and 3 (60%) who had no change. The clinical outcome of the two groups was significantly different. There were 14 patients (10 female, 4 male) with a normal GBEF. The 2 patients who had cholecystectomy were asymptomatic. Of the 12 patients who did not have cholecystectomy, 9 (75%) were asymptomatic, 1 (8%) had some improvement, and 2 (17%) had no change. CONCLUSIONS: Cholecystectomy is indicated for patients with acalculous biliary pain and reduced GBEF, since symptoms will likely resolve with surgery and will persist without it. Cholecystectomy for patients with a normal GBEF should be considered only after failure of a nonoperative trial, since improvement usually occurs over time.

Adolescent↗
PubMed2005

The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616].

BACKGROUND: Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial. METHODS: Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge. RESULTS: There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 +/- 228 U/L in the GIK group and 240 +/- 200 U/L in the control group (NS). The mean LVEF was 43.7 +/- 11.0 % in the GIK group and 42.4 +/- 11.7% in the control group (P = 0.12). A LVEF < or = 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01). CONCLUSION: Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients.

Aged↗
PubMedDate not supplied

Cross sectional echocardiographic left ventricular ejection fraction: method based variability.

Cross-sectional echocardiographic left ventricular ejection fraction (LVEF) by five different Methods (Teichholz, Area-length, single-plane Simpson, Bullet and Baran Formulae) was determined in 24 normal healthy volunteers (male-17, female-7, age range 16-80 years, mean 37 +/- 13) to assess the method-dependent variability in left ventricular volumes and LVEF. Although the Teichholz and Bullet methods gave somewhat higher values, there was no significant difference between LVEF determined by any of the methods (F = 0.16, p greater than 0.50). There was an a symmetrical distribution of LVEF in this normal group with an absolute mean positive skewness of 6 per cent (range 4-7 percent, coefficient of skewness = +0.43 to +0.87). A cut-off normal lower limit of LVEF at 50 per cent encompassed 88-100 per cent (mean 93.3) of subject population depending upon the method used. Similarly there was no significant difference between left ventricular volumes obtained by various methods. Therefore all the above five methods for quantitation of left ventricular global function are equally useful in clinical studies in patients with normal left ventricular geometry and in absence of segmental asynergy.

Adolescent↗
PubMed1993

[Digital subtraction angiocardiography: reliability of densitometric determination of left ventricular volume and ejection fraction].

The angiographic assessment of left ventricular volume (LV) and ejection fraction (EF) by means of the area-length method (ALM) is based upon geometric assumptions, which might lead to erroneous results. With the development of digital subtraction angiocardiography in real-time, densitometric procedures of calculating left ventricular parameters can be used on-line. This study examines both reliability and accuracy of a densitometric technique for evaluating LV and EF in comparison to the single-plane ALM. Contrast images of heart casts and left ventricular angiograms of 54 patients suffering from different cardiac diseases were obtained by the image acquisition and processing system Polytron 1000 VR (Siemens AG, Erlangen, FRG). Digital images of both heart casts and patients were evaluated densitometrically and geometrically by two independent observers. In the phantom study the densitometric method exhibited a significantly (p < 0.01) better agreement with the true values than the ALM. The evaluation of left ventricular angiograms in patients comparing densitometry with the ALM demonstrated a relatively high residual deviation (enddiastolic volume Syx = +/- 27 ml, endsystolic volume Syx = +/- 19.4 ml). This is mainly due to systematic, method-related errors of densitometry and the morphometric technique. The intra- and interobserver variability in calculating EF showed a significantly (p < 0.05) smaller residual deviation for densitometry than for ALM; no significant differences were found for the calculation of LV. In conclusion, we demonstrated that the presented densitometric technique offers an objective and simple means of determining LV and EF with comparable reliability and validity to the area-length method.

Absorptiometry, Photon↗
PubMed2002

Biological correlates of QT interval and QT dispersion in 2,265 patients with left ventricular ejection fraction < or =40%.

Increased QT interval and QT dispersion have been associated with increased mortality in a variety of cardiovascular disorders including heart failure. However, the biological correlates of these abnormalities are not clear. QTc and QTd were measured in an automated fashion from digitized electrocardiograms in 2,265 patients with an LV ejection fraction </=40% and were related to clinical, electrocardiographic, and echocardiographic variables. The QTc interval increased with increasing age (P =.0003), heart rate (P <.0001), LV dimensions (P <.0001), left atrial diameter (P <.0001), estimated right atrial pressure (P <.0001), QRS duration (P <.0001), bundle branch blocks (P <.0001) and degree of mitral and tricuspid regurgitation (P <.0001) and decreasing LV ejection fraction (P <.0001) QT dispersion increased with increasing LV isovolumic relaxation time (P =.004) and QTc (P <.0001) and decreased with faster heart rate (P <.0001) and higher right atrial pressure (P =.0007). The biological relationships of QTc and QTd warrant further investigations.

Aged↗
PubMed2003

[Comparative study of left ventricular ejection fraction and volume by 2 isotopic methods and contrast angiography].

The tomographic mode has replaced the planar mode for radióisotopic studies of myocardial perfusion but not for the study of systolic ventricular function. The aim of this study was to compare monophotonic emission tomography (MPET), the planar mode (PM) and contrast angiography (Angio). The left ventricular volumes and ejection fractions were measured in 111 patients by the tomographic and planar modes and by biplane angiography in 70 of them. The MPET algorithm (QBS software) identified the ventricular endocardium in 96 of the 111 procedures (86%). The mean left ventricular ejection fractions (LVEF) were 57 +/- 17% (MPET, N = 96), 55 +/- 15% (PL, N = 96) and 57 +/- 15% (Angio, N = 70). There was a good correlation of LVEF between MPET and PL and MPET and Angio with negligible bias of 3 +/- 6% and 2 +/- 4% respectively and high correlation coefficients, r = 0.94 (MPET = 1.05*PL-0.2) and r = 0.93 (MPET = 1.1 x Angio-3). The differences between the 95% confidence intervals between MPET and PL and MPET and Angio may be explained by an overestimation of normal LVEF by MPET, especially in patients with low end systolic volumes. In these cases, the difference in LVEF by MEPT and the average LVEF from the 3 techniques was greater: 6 +/- 4% (< or = 20 ml) vs 0 +/- 3% (> 20 ml) (p < 0.0001). The authors conclude that, with the reserve that a high percentage of investigations could not be analysable. MPET seems to be a method of choice for assessing left ventricular systolic function.

Adolescent↗
PubMedDate not supplied

Left ventricular ejection fraction and volumes from gated blood pool tomography: comparison between two automatic algorithms that work in three-dimensional space.

BACKGROUND: Two different algorithms, which are fast and automatic and which operate in 3-dimensional space, were compared in the same group of patients to compute left ventricular ejection fraction (LVEF) and volumes from gated blood pool tomography. One method, developed at Cedars-Sinai Medical Center (CS), was dependent on surface detection, whereas the other method, developed at the Free University of Brussels (UB), used image segmentation. METHODS AND RESULTS: Gated blood pool tomograms were acquired in 92 consecutive patients after injection of 740 MBq of technetium 99m-labeled human serum albumin. After reconstruction and reorientation according to the left ventricular long axis, LVEF and left ventricular volumes were measured with the CS and UB algorithms. Measurements of LVEF were validated against planar radionuclide angiocardiography (PRNA) results. The success rates of the algorithms were 87% for CS and 97% for UB. Agreement between LVEF measured with CS and UB (LVEF(CS) = 0.91. LVEF(UB) - 0.85; r = 0.87) and between LVEF measured with CS and PRNA (LVEF(CS) = 1.04. LVEF(PRNA) - 4.75; r = 0.80) and UB and PRNA (LVEF(UB) = 0.98. LVEF(PRNA) + 4.42; r = 0.82) was good. For left ventricular volumes, linear regression analysis showed good correlation between both methods with regard to end-diastolic volumes (r = 0.81) and end-systolic volumes (r = 0.91). On average, end-diastolic volumes were similar and end-systolic volumes were slightly higher with CS than with UB. Consequently, significantly lower LVEFs were observed with CS than with UB. CONCLUSIONS: Good correlation was observed between CS and UB for both left ventricular volumes and ejection fraction. In addition, measurements of LVEF obtained with both algorithms correlated fairly well with those obtained from conventional PRNA over a wide range of values.

Adult↗
PubMed1996

Verapamil and angiotensin-converting enzyme inhibitors in patients with coronary artery disease and reduced left ventricular ejection fraction.

Verapamil is effective as antianginal medication but contraindicated in patients with congestive heart failure. Angiotensin-converting enzyme (ACE) inhibitors improve survival in patients with congestive heart failure but have limited effect on patients with angina pectoris. No studies have been published on the combined treatment with verapamil and ACE inhibitors in patients with stable angina pectoris and left ventricular dysfunction. We performed an open study in 14 patients with angina pectoris and ejection fraction < 40%. The patients received verapamil 180 mg and trandolapril 2 mg twice daily for 3 months. We found a significant increase in ejection fraction from 28 +/- 6 to 35 +/- 11 (p < 0.03), wall motion index from 1.0 +/- 0.3 to 1.2 +/- 0.3 (p < 0.03), exercise duration from 6.9 +/- 2.5 to 7.7 +/- 2.9 minutes (p < 0.01), and ratio of exercise to rest rate-pressure product from 2.2 +/- 0.4 to 2.5 +/- 0.6 (p < 0.02). Use of nitroglycerin and number of angina pectoris attacks were both significantly reduced after 3 months of treatment. These findings support the hypothesis that the combination of verapamil and trandolapril is useful in patients with attenuated left ventricular function and angina pectoris.

Aged↗
PubMed2007

Low-level exercise echocardiography fails to elicit left ventricular contractile reserve in patients with aortic stenosis, reduced ejection fraction, and low transvalvular gradient.

BACKGROUND: Low-level exercise echocardiography is useful to assess left ventricular (LV) contractile reserve after an acute myocardial infarction. Whether low-level exercise can elicit LV contractile reserve in patients with severe aortic stenosis, reduced LV systolic function and low transvalvular gradient are unknown. Accordingly, the value of low-level exercise to elicit contractile reserve was assessed in these patients using dobutamine administration as the gold standard method. METHODS AND RESULTS: Seventeen patients with severely decreased aortic valve area (0.75 +/- 0.03 cm(2)), reduced LV ejection fraction (35 +/- 2%) and low mean transvalvular gradient (23 +/- 3 mmHg) underwent low-level exercise and dobutamine echocardiography. Ejection fraction increased by 23% (P < 0.001) with dobutamine and decreased by 8% (P = 0.2) with low-level exercise. Left ventricular outflow tract velocity time integral increased from 13 +/- 1 to 16.7 +/- 1 cm (P < 0.001) with dobutamine but did not change with low-level exercise (13 +/- 1 vs. 13.5 +/- 1, P = 0.5). CONCLUSION: Low-level exercise fails to elicit LV contractile reserve in patients with severe aortic stenosis, reduced LV systolic function, and low transvalvular gradient.

Aged↗
PubMed1994

[Immediate and long-term results of coronary angioplasty in patients with low ejection fraction].

Left ventricular function is the main predictive factor for survival in coronary patients and the results of coronary bypass surgery in left ventricular dysfunction have been widely reported. The authors undertook a retrospective study of the success rate, the risks and clinical outcome after coronary angioplasty of 182 patients with a left ventricular ejection fraction < or = 35% (30 +/- 4%). The average age was 61 +/- 10 years and 78% were men. One hundred and fifty three patients had a history of myocardial infarction. The primary success rate of angioplasty was 95% (271/284 lesions) including the multiple procedures in 24% of cases. There was a 7.1% frequency of major complications (7 deaths, 3 non-Q wave infarctions, 4 emergency coronary bypass procedures). An average follow-up period of 32 months was obtained in 98.4% of patients. Seven patients developed a myocardial infarction and 14 patients were rehospitalized for cardiac failure (N = 6) or severe ventricular arrhythmias (N = 8). A control coronary angiography was performed in 100 cases either as a routine investigation or for recurrence of symptoms. Restenosis was demonstrated in 33 cases, an aggravation of lesions on another vessel in 12 cases and restenosis associated with aggravation of other lesions in 5 cases, leading to redilatation in 26 cases, atherectomy in 2 cases and coronary bypass surgery in 16 cases. Forty-one patients died (25%). Ten patients died before the 6th month and 31 died secondarily. The only parameter which was significantly correlated with survival was the value of the ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

Estimation of left ventricular volume and ejection fraction by two-dimensional transoesophageal echocardiography: comparison of short axis imaging and simultaneous radionuclide angiography.

We have compared short axis images of the left ventricle (LV) obtained with transoesophageal echocardiography (TOE) to assess LV size and function with those obtained by radionuclide angiography (RNA). Simultaneous TOE and RNA images were attempted in 14 patients and results obtained in 12 patients undergoing repair of abdominal aortic aneurysms. The area of the LV cavity seen in the short axis images at a mid-papillary muscle level at end-systole (ESA) and end-diastole (EDA) were compared with volumes measured by RNA at end-systole (ESV) and end-diastole (EDV). An area ejection fraction (AEF) calculated from the TOE images (AEF = EDA-ESA/EDA) was compared with the RNA ejection fraction (EF) where EF = EDV-ESV/EDV. Good correlations were found between TOE log EDA and RNA log EDV (r = 0.86), TOE log ESA and RNA log ESV (r = 0.92) and TOE AEF and RNA EF (r = 0.96). This suggests that TOE short axis imaging at a mid-papillary muscle level is generally adequate for monitoring LV function during operation.

Echocardiography↗
PubMed1989

Radionuclide left ventricular absolute volume determination by ejection fraction measurement data and a left posterior oblique blood pool image.

A new method for the calculation of left ventricular volumes called the "semi-geometric" method, was reported by Nichols et al in 1984. This method, however, still had certain limitations for practical use. This paper describes a modified semi-geometric method in which the left ventricular volume was obtained from conventional left ventricular ejection fraction measurement data collected from the modified left anterior oblique position with a caudal tilt of 10 degrees or more and a left posterior oblique blood pool image. The left ventricular end-diastolic volumes obtained by this method were compared with those calculated by combining the thermodilution cardiac output and the left ventricular ejection fraction. The correlation coefficient was r = 0.93 (n = 20). In the phantom experiment, the true volumes and those obtained by this method showed an excellent correlation (r = 0.99). This method is considered accurate and practical.

Adult↗
PubMed2002

Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.

BACKGROUND: Patients with reduced left ventricular function after myocardial infarction are at risk for life-threatening ventricular arrhythmias. This randomized trial was designed to evaluate the effect of an implantable defibrillator on survival in such patients. METHODS: Over the course of four years, we enrolled 1232 patients with a prior myocardial infarction and a left ventricular ejection fraction of 0.30 or less. Patients were randomly assigned in a 3:2 ratio to receive an implantable defibrillator (742 patients) or conventional medical therapy (490 patients). Invasive electrophysiological testing for risk stratification was not required. Death from any cause was the end point. RESULTS: The clinical characteristics at base line and the prevalence of medication use at the time of the last follow-up visit were similar in the two treatment groups. During an average follow-up of 20 months, the mortality rates were 19.8 percent in the conventional-therapy group and 14.2 percent in the defibrillator group. The hazard ratio for the risk of death from any cause in the defibrillator group as compared with the conventional-therapy group was 0.69 (95 percent confidence interval, 0.51 to 0.93; P=0.016). The effect of defibrillator therapy on survival was similar in subgroup analyses stratified according to age, sex, ejection fraction, New York Heart Association class, and the QRS interval. CONCLUSIONS: In patients with a prior myocardial infarction and advanced left ventricular dysfunction, prophylactic implantation of a defibrillator improves survival and should be considered as a recommended therapy.

Adrenergic beta-Antagonists↗
PubMed1985

Left ventricular volume and ejection fraction determined by gated blood pool emission tomography.

Electrocardiogram gated single photon emission computed tomography of the intracardiac blood pools is a recent development that involves the acquisition of images in multiple projections after in vivo erythrocyte labelling with technetium-99m and reconstruction of these images into tomographic sections in any desired plane. The technique was used in 25 subjects to measure left ventricular volume, by summing the areas of the ventricle in each of the tomographic sections, and the results compared with those using a counts based (non-geometric) technique from planar radionuclide ventriculography. Endocardium was defined with the aid of a contour at 43% of maximum left ventricular counts, and this contour was validated for a left ventricular phantom. Correlation between tomographic and counts based left ventricular volume was close. Similarly, ejection fraction correlated well. The technique is therefore an accurate method for determining left ventricular volume and ejection fraction, avoiding the assumptions about shape made by other geometric methods.

Cardiac Output↗
PubMed2001

Coronary artery bypass grafting in patients with left ventricular ejection fraction of 30% or less.

BACKGROUND: The results of a merely pharmacological therapy in patients with advanced left ventricular dysfunction are unsatisfactory. Coronary artery bypass grafting is frequently the only therapeutic option, but ventricular dysfunction is generally considered to be a risk factor. AIM: To find out the frequency of coronary artery bypass grafting and its outcome in patients with a ejection fraction of 30% or less who were operated on at a single institution. METHODS: Between January 1st, 1996 and October 30th, 1999, 90 patients (4.6% of all patients operated on due to of coronary artery disease) with EF of 30% or less underwent coronary artery bypass grafting. This group consisted of 12 women and 78 men at an average age of 60.2 +/- 9.4 years (range, 33 to 78 years); 75.6% patients were in functional class III or IV and 80.0% had three-vessel disease. On the average, 2.5 grafts per patient were implanted, the left internal mammary artery was used in 24.4% patients, and 10.0% of patients had cardiac surgery without cardiopulmonary bypass. RESULTS: Hospital mortality was 10%. The main cause of death was cardiac or multiorgan failure. Low cardiac output syndrome and supraventricular dysrrhythmias were the most common postoperative complications. Advanced age and low cardiac output syndrome were found to be risk factors of early mortality. Five other patients died during the follow-up (4 to 48 months). One- and three-year survival rate were 83.1% and 81.9%, respectively. Ejection fraction improved during the follow-up from 27.5% to 33.7%. The improvement was more pronounced in patients in whom preoperative end-diastolic diameter of the left ventricle was below 70 mm, and in patients with two and more hibernating segments on dobutamine stress echo. CONCLUSIONS: Successful results of surgical revascularization in patients with severe impairment of left ventricular function can be achieved by careful selection of patients (the presence of viable myocardium is necessary) and management. Early mortality and morbidity was higher than in patients with normal ventricular function. Age and low cardiac output syndrome were revealed as risk factors of early mortality. Long-term prognosis for hospital survivals was satisfactory. (Tab. 5, Fig. 1, Ref. 13.)

Adult↗