SEARCH · Search PubMed

Results for “Ejection fraction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources

PubMedDate not supplied

Left ventricular ejection fraction test rates for Medicare beneficiaries with heart failure.

The left ventricular ejection fraction (LVEF) test rate is increasingly used as a quality of care indicator for patients with heart failure. Our study produced benchmark LVEF test rates in a Medicare fee-for-service population for consideration by a clinical panel assembled by the Health Care Financing Administration. Our sample consisted of 46,583 beneficiaries admitted to the hospital for heart failure and with a complete set of Medicare fee-for-service bills dated 1996 or 1997. The national 2-year LVEF test rate was 79% for Medicare fee-for-service beneficiaries hospitalized for heart failure. Except for 1 state, the test rate ranged from 61% to 89% across states. Our analysis demonstrates the feasibility of using billing data to compute LVEF test rates. Using a 2-year time window and measuring tests performed in outpatient as well as inpatient settings, we find a higher LVEF test rate than has been reported by most previous studies.

Aged↗

PubMed2004

Value of sequential monitoring of left ventricular ejection fraction in the management of thalassemia major.

Regular monitoring of left ventricular ejection fraction (LVEF) for thalassemia major is widely practiced, but its informativeness for iron chelation treatment is unclear. Eighty-one patients with thalassemia major but no history of cardiac disease underwent quantitative annual LVEF monitoring by radionuclide ventriculography for a median of 6.0 years (interquartile range, 2-12 years). Intraobserver and interobserver reproducibility for LVEF determination were both less than 3%. LVEF values before and after transfusion did not differ, and exercise stress testing did not reliably expose underlying cardiomyopathy. An absolute LVEF of less than 45% or a decrease of more than 10 percentage units was significantly associated with subsequent development of symptomatic cardiac disease (P <.001) and death (P =.001), with a median interval between the first abnormal LVEF findings and the development of symptomatic heart disease of 3.5 years, allowing time for intervention. In 34 patients in whom LVEF was less than 45% or decreased by more than 10 percentage units, intensified chelation therapy was recommended (21 with subcutaneous and 13 with intravenous deferoxamine). All 27 patients who complied with intensification survived, whereas the 7 who did not comply died (P <.0001). The Kaplan-Meier estimate of survival beyond 40 years of age for all 81 patients is 83%. Sequential quantitative monitoring of LVEF is valuable for assessing cardiac risk and for identifying patients with thalassemia major who require intensified chelation therapy.

Adolescent↗

PubMed1992

Magnetic resonance imaging--cardiac ejection fraction measurements. Phantom study comparing four different methods.

The accuracy of cardiac ejection fraction (EF) measurements with thin, contiguous cine-magnetic resonance imaging (MR) sections is well established. Still, faster imaging and measurement techniques would be desirable. The authors evaluated the accuracy of four different MR EF measurements methods in a biventricular, anthropomorphic, foam-latex rubber phantom which was connected via noncompliant fluid-filled tubing to a pulsatile flow pump. Nine contiguous 10 mm cine-MR sections (TR/TE, 25/13; flip angle, 45 degrees) were obtained through the heart in long and short cardiac axes at 16 frames per cardiac cycle at a pump rate of 60 beats/minute. EF measurements were based on either the multi-slice summation technique (nine contiguous 10-mm sections versus four 10-mm sections spaced 10 mm apart) or the area-length method (single largest long section versus combination of largest long- and short-axis section). Three replications were performed for each of the tested EFs (40.8%, 29.4%, and 13.4%), which were compared with actual EFs. EF measurements based on contiguous 1-cm sections correlated best with the actual EFs. Average relative errors ranged from 3.2% to 6.0%. EF measurements based on every other section were less accurate; average relative errors were between 5.2% and 10.2%. Single and biplane area-length algorithm EF measurements were significantly less accurate; average relative errors were as high as 59%. EF measurements based on multi-slice summation are more accurate than those based on the area-length algorithm. Contiguous 1-cm section acquisitions are most accurate and most time consuming. With slight decrease of accuracy, acquisition and processing times can be halved by skipping every other slice.

Humans↗

PubMedDate not supplied

The diagnostic value of immediate post-exercise left ventricular ejection fraction (LVEF).

The diagnostic value of immediate post-exercise left ventricular ejection fraction (LVEF) was assessed in 161 patients at rest, during maximal exercise, and immediately post-exercise by radionuclide angiography. Fifteen patients had a second examination, giving a total of 176 radionuclide examinations. Additionally, the correlation between post-exercise LVEF and physical validity was investigated. Sixty-one patients (35%) with a recent myocardial infarction (less than 4 weeks), 66 patients (37%) with an old myocardial infarction (greater than 4 weeks), and 21 patients (12%) with valvular lesions were studied. Twenty-eight patients (16%) with an abdominal aneurysm were considered as controls based on history and a normal resting and exercise electrocardiogram (ECG). LVEF and a cumulative regional wall motion (RWM) score for three regions were obtained. LVEF post-exercise was significantly increased compared to LVEF at maximal exercise in all four diagnostic groups. Absolute LVEF values were significantly dependent on the level of exercise. We conclude that immediate post-exercise LVEF should not be used for separating patients with and without coronary artery disease.

Adult↗

PubMed1986

Radionuclide cardiac ejection fractions: a useful disparity between LAO and LPO views.

The left ventricular ejection fraction (LVEF) was measured from ECG gated blood pool radionuclide studies. The LAO and LPO views gave different values for the LVEF, however, the difference was not a random error, but was specifically related to the site of impaired myocardial function, implying that the difference may have diagnostic significance.

Electrocardiography↗

PubMed1996

[Evaluation of left ventricular volume and ejection fraction using three-dimensional transesophageal echocardiography].

Left ventricular (LV) volume and ejection fraction (EF) derived from three-dimensional echocardiography using a multiplane transesophageal probe (3D-TEE) were compared with LV volume and EF obtained from left ventriculography (LVG) in 14 patients (mean age: 61 years). Left ventricular volumes were calculated using a summation of disks algorithm based on multiple reconstructed short-axis cross-sections from 3D data. Left ventricular volume (end-diastole and end-systole) and EF from 3D-TEE were compared with those from LVG using linear regression analysis. Three-dimensional TEE demonstrated excellent correlations with LVG for measuring LV volume (r = 0.97, SEE = 11 ml) and EF (r = 0.95, SEE-4%), respectively. Three-dimensional TEE is useful for the measurement of LV volume and EF in the clinical setting.

Echocardiography, Transesophageal↗

PubMed1984

Sources of variability in the radionuclide angiographic assessment of ejection fraction: a comparison of first-pass and gated equilibrium techniques.

Measurements of ejection fractions (EF) determined by first-pass and gated equilibrium radionuclide angiography are widely believed to be equivalent. To compare these measurements in a large group of patients over a wide range of EF values, left ventricular (LV) and right ventricular (RV) EFs at rest were measured in 135 consecutive patients who underwent the 2 methods of radionuclide angiography within 1 hour: first-pass upright with a multi-crystal camera in the anterior projection and gated equilibrium supine with a single-crystal camera in the left anterior oblique projection. The population included 18 normal patients and 117 patients with various cardiac and pulmonary disorders. First-pass and gated equilibrium LVEF correlated well (r = 0.83, p less than 0.001), but the slope of the regression line was different from unity, with the first-pass values lower than the gated equilibrium values (0.51 +/- 0.16 vs 0.56 +/- 0.15, p less than 0.05 [mean +/- standard deviation] ). Among the 45 patients with a gated equilibrium LVEF of less than or equal to 0.50, the correlation (r = 0.84) was better than that for the 90 patients with a LVEF greater than 0.50 (r = 0.44, p less than 0.05). However, in the latter group, the correlation remained good in the 15 patients with cardiomegaly due to aortic or mitral regurgitation (r = 0.80). Inter- and intraobserver error was similar for both methods. In contrast, there was a poor correlation between first-pass and gated equilibrium RVEF, with the first-pass values higher than the gated equilibrium values (0.51 +/- 0.11 vs 0.43 +/- 0.11, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Prostacyclin I2 (PGI2) increases left ventricular ejection fraction (LVEF).

In order to evaluate the effect of PGI2 on left ventricular ejection fraction (LVEF) an intravenous infusion in 10 patients (3 males, 7 females; 36 to 63 years) with an impaired LVEF (34.7 +/- 14.8%) was performed. LVEF was determined by means of 99mTc-pertechnetate radionuclide ventriculography. An increase of LVEF to 36.2 +/- 13.5% during administration of PGI2 at a rate of 1 ng/kg/min for 15 min and to 43.8 +/- 15.8% during a rate of 5 ng/kg/min (p less than 0.01) for an additional 15 min was observed. Analyzing the data in more detail in 6 patients, an improvement in LVEF became obvious during the administration of 1 ng/kg/min (108, 109, 116, 118, 121, and 123% of pre-infusion value, respectively). In 5 out of these 6 patients a dose-increment to 5 ng/kg/min further increased LVEF (139, 179, 187, 148, and 128% of pre-infusion value, respectively). In contrast, in the other 4 patients no response of LVEF to PGI2 at a rate of 1 ng/kg/min could be observed. However, in 2 out of these 4 patients LVEF increased during the administration of 5 ng/kg/min (111 and 117% of pre-infusion value). Individual changes in hemodynamic parameters showed no correlation to the improvement seen in LVEF in response to PGI2. It is concluded that PGI2 may exert beneficial effects on LVEF, and might be used in certain clinical conditions, such as before heart transplantation, to achieve a temporary improvement in LVEF.

Adult↗

PubMed2004

Effects of carvedilol on plasma B-type natriuretic peptide concentration and symptoms in patients with heart failure and preserved ejection fraction.

Although the benefits of carvedilol in patients with heart failure and depressed ejection fraction (EF) have been elucidated, those in patients with preserved EF are not understood. We enrolled 40 patients with mild or moderate heart failure and EF >/=45%. They were randomly assigned to carvedilol (n = 19) or conventional therapy (n = 21). After 12 months of treatment, carvedilol significantly improved all end points (plasma concentration of B-type natriuretic peptide [BNP] from 175 (35 to 209) to 106 (52 to 160) pg/ml, mean (95% confidence interval) p <0.01; New York Heart Association functional class from 2.37 (2.13 to 2.61) to 1.56 (1.21 to 1.91), p <0.01; exercise capacity estimated with the Specific Activity Scale from 4.75 (4.50 to 5.00) to 5.68 (5.22 to 6.14) METs, p <0.02), whereas conventional therapy did not (plasma BNP concentration from 150 (114 to 186) to 174 (100 to 248) pg/ml; New York Heart Association functional class from 2.29 (2.08 to 2.50) to 2.11 (1.73 to 2.49); exercise capacity from 4.57 (4.34 to 4.80) to 4.72 (4.41 to 5.03) METs). Univariate regression analyses showed that only the use of carvedilol was correlated with the decrease in plasma BNP concentration (p <0.03). Multivariate analyses demonstrated that an ischemic cause of heart failure (p <0.02), high plasma concentration of BNP (p <0.02), left ventricular dilation (p <0.03), and use of carvedilol (p <0.04) at baseline were predictive of a decrease in plasma concentration of BNP. In conclusion, carvedilol potentially decreased neurohumoral activation, decreased symptoms, and increased exercise capacity in patients with heart failure and preserved EF.

Activities of Daily Living↗

PubMed2006

Comparison of the effect of anemia on in-hospital mortality in patients with versus without preserved left ventricular ejection fraction.

Patients with symptomatic heart failure (HF) frequently have preserved left ventricular (LV) ejection fractions (LVEFs). Although anemia is a common finding in this patient population, its prognostic role has not been well studied. This study's aim was to assess if the LVEF interferes in the association between anemia and in-hospital mortality in patients with severe HF. Consecutive patients admitted to an intensive care unit with decompensated chronic HF were prospectively enrolled. The diagnosis of HF was based on clinical criteria. Patients with LVEFs > or =45% (on echocardiography) were diagnosed as having preserved LVEFs. Multivariate analysis was performed to test the independent association between anemia and in-hospital mortality and to evaluate an interaction between anemia and systolic function. In all, 303 patients were recruited (mean age 69 +/- 13 years; 45.5% women). Preserved LVEFs were present in 34% of the population. The prevalence of anemia in this group was 58%, compared with 43% in the group with systolic dysfunction (p = 0.01). Dilated left ventricles, left bundle branch blocks, and valvular dysfunction were significantly more frequent in patients with systolic heart failure. In-hospital mortality was similar in the groups with preserved LVEFs and systolic dysfunction (p = 0.71). On multivariate analysis, anemia was independently associated with in-hospital mortality (odds ratio 2.7, 95% confidence interval 1.43 to 5.04, p = 0.002). There was no interaction between anemia and systolic function (p = 0.08 for interaction). In conclusion, anemia was an independent predictor of in-hospital mortality in symptomatic patients with severe HF, regardless of whether the patients had preserved or impaired LV systolic function.

Aged↗

PubMed2004

Myocardial systolic synchrony measured by Doppler tissue imaging as a role of predictor of left ventricular ejection fraction improvement in severe congestive heart failure.

BACKGROUND: The recovery of left ventricular ejection fraction (LVEF) appears to be prognostic of survival in congestive heart failure (CHF). The aim of our study was to evaluate which parameters appear to predict LVEF improvement in CHF. METHODS: In all, 85 patients (age 64 +/- 12 years) with CHF and LVEF <35% were enrolled. Doppler tissue imaging was performed on 5 basal and 5 midsegments to assess the time from R wave to peak systolic velocity (Ts). The standard deviation (SD) of Ts was an indicator of systolics synchrony. After at least 3 months of intensive medical therapy with beta-blocker and angiotensin-converting enzyme inhibitors, follow-up echocardiography was performed. By the change in LVEF, we divided patients into group I (<5%, n = 47) and group II (>/=5%, n = 38). RESULTS: Baseline clinical and echocardiographic parameters were similar in both groups. There was negative correlation between SD of Ts and change of LVEF ( r = -0.43, P < .001). The multivariate analysis shows that SD of Ts and dose of beta-blocker were independent predictors of LVEF improvement. CONCLUSION: Myocardial systolic synchrony measured by Doppler tissue imaging is a predictor for LVEF improvement in severe CHF independently from QRS duration, cause of CHF, baseline LVEF, and chamber dimension.

Aged↗

PubMedDate not supplied

Contribution of systolic and diastolic abnormalities to heart failure with a normal and a reduced ejection fraction.

Heart failure (HF) has traditionally been divided into HF with a reduced ejection fraction (EF; systolic HF) and HF with a normal EF (diastolic HF). Both groups have reductions in exercise tolerance, neurohumoral activation, and abnormal left ventricular (LV) filling dynamics and impaired relaxation. Although the normal EF indicates that pump performance is adequately compensated, some of the patients with HF and a normal EF have reduced longitudinal systolic velocity indicating cardiac muscular contractile dysfunction. Regardless of EF, the severity of HF and its prognosis and degree of exercise intolerance are closely related to the degree of diastolic filling abnormalities. Patients with HF and a reduced EF have ventricular dilatation and elongated myocytes, whereas patients with HF and a normal EF do not. Thus, patients with HF have diastolic abnormalities regardless of EF and many patients with HF and a normal EF have contractile abnormalities despite preserved systolic pump performance. Heart failure with a normal EF and a reduced EF differs in the systolic LV pump performance and the type of remodeling. The mechanism of the differing remodeling responses is not known, but aging, sex differences, and diabetes may contribute.

Cardiac Output, Low↗

PubMed1990

A rapid method for standardization of the gated radionuclide left ventricular ejection fraction.

Radionuclide ventriculography has become the standard method for serially evaluating left ventricular ejection fraction (EF). The "gold standard" for evaluating EF is the contrast ventriculogram, which uses mathematical models to arrive at the volumes used to calculate EF. These models are subject to possible error. This paper reports the standardization of volume measurements of a digital angiographic camera system using a series of cardiac phantoms and the correlation of measurement of the EF of a series of patients whose EF was determined by digital angiography and radionuclide ventriculography.

Aged↗

PubMed1986

Left ventricular ejection fraction determined with the nuclear stethoscope, gamma camera and contrast ventriculography.

Left ventricular ejection fractions (EF) were measured with a nuclear stethoscope (NSt, beat-to-beat and ECG gated summation method) and contrast ventriculography (VG) immediately following one another (IFOA) (r X 0.96 and 0.95, respectively, n = 13). NSt and ECG gated gamma camera (MUGA) recordings IFOA were compared (r = 0.97 and 0.96, respectively, n = 23) as were non-IFOA recordings (r = 0.90 and 0.91, respectively, n = 13). Correlation between repeated NSt EF measurements gave: r = 0.91 (n = 22) for both methods. Paired NSt recordings in an invasive test situation (during invasive angiocardiography) and in a noninvasive situation (supine, 30 min of rest) gave for patients with EF less than 50 (mean +/- S.D.): EF invasive = 36 +/- 12, EF noninvasive = 41 +/- 13 (n = 4, p less than 0.05), and for patients with EF greater than or equal to 50: EF invasive = 59 +/- 7, EF noninvasive = 57 +/- 7 (n = 9, N.S.). The mean paired differences (EF noninvasive -EF invasive) in the low (less than 50) and high (greater than or equal to 50) EF range differed significantly: +5.3 versus -1.3, respectively (p less than 0.001). The recordings with the ECG-gated summation method gave similar results. The heart rate (beats min-1) in the noninvasive and invasive situation were (mean +/- S.D.): 68 +/- 11 and 78 +/- 16, respectively (p less than 0.01). We conclude that the patients were in a higher level of stress in the invasive situation. Accordingly ventricles with normal contractility (EF greater than or equal to 50) reacted with a slight increase in EF, and ventricles with compromised function (EF less than 50) reacted with a decrease in EF, compared to the values in the noninvasive situation. Incorporated in a correlation between MUGA and VG are, besides methodologically based differences, test-situation based systematical differences. Consequently the results of MUGA method should be given uncorrected. The results documents the accuracy and reliability of the NSt.

Adolescent↗

PubMed2005

The feasibility of repeated left ventricular ejection fraction analysis with sequential single-dose radionuclide ventriculography.

OBJECTIVE: Repeated left ventricular ejection fraction (LVEF) analyses with sequential single-dose radionuclide ventriculography might be an interesting technique for monitoring the effect of positive inotropic interventions. The aim of the study was to assess the reproducibility of LVEF measurement with planar radionuclide ventriculography within 3 h, using a standard single dose of radioactive tracer. METHODS: Sixteen patients underwent routine planar radionuclide ventriculography with a standard dose of 500 MBq of [Tc]pertechnetate and returned after 3 h for a repeat planar radionuclide ventriculography without administration of additional tracer. RESULTS: The average initial LVEF was 35.1+/-18.6%-point (range, 12%-point to 68%-point). The mean difference of the LVEF between the initial planar radionuclide ventriculography and the repeat planar radionuclide ventriculography was 2.8%+/-6.3% (range, -11.8% to 13.3%, P=NS). The correlation between both measurements was significant with a correlation coefficient of 0.995 (P<0.01). Bland-Altman analysis revealed a mean LVEF difference of 0.94%-point between the baseline planar radionuclide ventriculography and the repeat planar radionuclide ventriculography (95% confidence interval: -2.7%-point to 4.5%-point). The visual wall motion assessment showed excellent reproducibility, with a kappa-statistic of 0.98. CONCLUSION: Repeated radionuclide ventriculography with a 3 h interval using a single standard dose of 500 MBq of [Tc]pertechnetate is highly reproducible and will be useful for monitoring the effect of positive inotropic interventions.

Feasibility Studies↗

PubMed1982

Radionuclide assessment of right ventricular ejection fraction: a comparison of first pass studies with 133Xe and 99Tcm.

Right ventricular ejection fraction (RVEF) was determine in 26 patients using the first pass radionuclide angiocardiography with 133Xe and 99Tcm as tracers. A good correlation (r = 0.88) was found. Duplicate determinations in 13 patients with 133Xe showed good reproducibility, the absolute value for the standard error of a single determination being 2.6% and the coefficient of variation 5.7%. In a reference group of 17 individuals RVEF was 49 +/- 5% (range 42-61%). It is concluded that 133Xe can be used for RVEF determinations. Due to the rapid elimination and the low radiation dose 133Xe is preferable when repeated determinations of RVEF are desired.

Adult↗

PubMed1982

A noncomputerized count-based technique for the determination of resting left ventricular ejection fraction.

A noncomputerized, count-based technique for the determination of left ventricular ejection fraction (LVEF), which does not use geometric assumptions of left ventricular shape, was developed. The noncomputerized technique and computerized multigated ventriculography using both fixed and variable region-of-interest (ROI) methods were performed on 16 patients. The LVEFs obtained with the noncomputerized technique correlated well with both the fixed ROI computerized technique (r = .87) and the variable ROI computerized technique (r = .86). It is concluded that when a computer is not available, the noncomputerized technique is a valid alternative for the determination of LVEF in resting patients in stable sinus rhythm.

Cardiac Output↗

PubMed2006

[Characteristics and prognosis of heart failure with a normal ejection fraction].

Some 40%-50% of patients with heart failure present with a normal ejection fraction. Today, it is thought that this clinical syndrome is caused by diastolic dysfunction. However, the concept is still controversial because echocardiographic assessment is difficult and misdiagnosis is frequent. Although the epidemiological characteristics of these patients have been shown to differ from those of patients with systolic heart failure, both clinical features and prognosis are similar: medium-term mortality is elevated due to the high prevalence of comorbid conditions and no randomized clinical trial has identified an effective therapy able to change the natural history of this disease. In addition, a significant increase in all-cause mortality has even been observed in patients with asymptomatic diastolic dysfunction, a condition which occurs frequently in the general population.

Diastole↗