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PubMed1998

Cardiac rehabilitation in a young patient with severe left ventricular dysfunction and stroke: a case study.

This is a case report of a 36 years old Puerto Rican female with dual disabilities: severe left ventricular dysfunction secondary to an extensive myocardial infarction and two stroke episodes, complicated with congestive heart failure, who underwent a comprehensive cardiac rehabilitation program which resulted in improvement. Strategies included a long term exercise program, with low increments, slow progression and close supervision; educational, nutritional and medical interventions, in addition to an orthotic device. This report discusses the health-related fitness and overall benefits that the patient obtained from this multifactorial program.

Adult↗
PubMedDate not supplied

Accuracy of the automated assessment of left ventricular function with gated perfusion SPECT in the presence of perfusion defects and left ventricular dysfunction: correlation with equilibrium radionuclide ventriculography and echocardiography.

BACKGROUND: Gated single photon emission computed tomography (SPECT) with automated methods allows the quantitative assessment of left ventricular function and perfusion; however, its accuracy must be defined for patients with large earlier infarctions and severe rest perfusion defects, in whom the estimation of endocardial and epicardial borders might be more difficult, even with automated edge-detection techniques. METHODS AND RESULTS: We prospectively compared the automated measurements of left ventricular ejection fraction (LVEF) and volumes from rest-injected gated Technetium 99m (Tc99m) perfusion SPECT with equilibrium radionuclide angiocardiography (ERNA) in 62 patients and the assessment of regional function with echocardiography in 22 patients. Forty-six patients had an earlier myocardial infarction (mean defect size, 34% of left ventricle; SD, 12.7%; range, 8% to 56%); 27 patients had large defects (> or = 20% of left ventricle; LVEF range, 8% to 75%). LVEF, as determined with Cedars-Sinai software (quantitative gated SPECT), correlated well with ERNA (r = 0.941; y = 1.003x + 1.15; P<.0001; SE of the estimate = 6.3%; mean difference -1.3% for LVEF) in the entire study population and in the subgroups of patients with an earlier infarction, severe defects, and large infarctions (> or = 20% of the left ventricle). A correlation existed between gated SPECT and ERNA volumes (r = 0.882, y = 1.040x - 14.7, P<.0001 for end-diastolic volume; r = 0.954, y = 1.147x - 13.9, P<.0001 for end-systolic volumes with the count-ratio technique), but with wider limits of agreement. The exact segmental score agreement between gated SPECT and echocardiography for regional function was 79.8% (281 of 352, kappa = 0.682). CONCLUSIONS: Automated gated SPECT provides an accurate assessment of ejection fraction and regional function, even in the presence of an earlier myocardial infarction with large perfusion defects and significant left ventricular dysfunction.

Echocardiography↗
PubMed1995

The genotype of the angiotensin-converting enzyme gene and global left ventricular dysfunction after myocardial infarction.

We examined the relation between the genotype of the angiotensin-converting enzyme (ACE) gene and the development of left ventricular dysfunction, as assessed by biplane left ventriculograms, after myocardial infarction. Seventy-nine patients (deletion homozygote [DD] = 13; insertion/deletion heterozygote [ID] = 38; insertion homozygote [II] = 28) underwent cardiac catheterization twice for reevaluation of percutaneous transluminal coronary angioplasty. Subjects who had their first cardiac catheterization within 2 months from the onset of myocardial infarction were enrolled. The second cardiac catheterization was performed from 4 to 7 months after the first cardiac catheterization. ACE genotypes were determined by using the polymerase chain reaction. Ejection fraction, and end-diastolic and end-systolic volume indexes at the first cardiac catheterization were not significantly different among the 3 groups. The end-diastolic volume index at the second cardiac catheterization was not significantly different among the 3 groups. Ejection fractions (mean +/- SD) at the second catheterization in the 3 groups were 0.51 +/- 0.15 (DD), 0.56 +/- 0.12 (ID), and 0.62 +/- 0.09 (II) (p = 0.02), and were significantly lower in the DD group than in the II group. The end-systolic volume indexes (mean +/- SD) were 46 +/- 21 (DD), 43 +/- 24 (ID), and 30 +/- 14 (II) ml/m2 (p = 0.01), and were significantly greater in the DD and ID groups than in the II group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1998

Rapid-staged strategy for concomitant critical carotid and left main coronary disease with left ventricular dysfunction: IABP use.

BACKGROUND: Few reports address the high-risk patient population with concomitant critical carotid and left main coronary disease with left ventricular dysfunction. To decrease the risks involved with the simultaneous and traditional staged surgical approaches, we developed a rapid staging strategy using an intraaortic balloon pump. METHODS: Between 1992 and 1996, 20 patients presented with a high-risk "triad" defined by greater than 70% stenosis of the left main coronary artery, ejection fraction less than 0.30, and greater than 90% stenosis of the internal carotid artery. An intraaortic balloon pump was placed immediately before carotid endarterectomy under angiographic guidance. Less than 24 hours later (mean, 18 hours) coronary artery bypass grafting was performed, and the intraaortic balloon pump was removed the day of coronary artery bypass grafting in all cases (total IABP duration, <36 hours). RESULTS: Eighteen patients (18/20) were extubated on the day of coronary artery bypass grafting (mean, 12 hours). Sixteen patients (16/20) were transferred from the intensive care unit within 48 hours, with total hospital stay ranging from 6 to 12 days (mean, 8 days). There were no 30-day postoperative deaths, myocardial infarctions, or neurologic, vascular, bleeding, or other major complications. At a mean 29.4-month follow-up, there were two noncardiac deaths and no neurologic events. Six-month, 1-year, and 2-year follow-up ultrasounds showed all operative carotid arteries remained patent. CONCLUSIONS: A rapid staged procedure with angiographically guided placement of the intraaortic balloon pump was safe and effective in this very high risk patient population. It may be an option to decrease the risks involved with simultaneous operations and increase the efficiency and safety of "traditional" staged carotid and coronary artery bypass grafting procedures.

Aged↗
PubMed2004

Natriuretic peptides as markers of mild forms of left ventricular dysfunction: effects of assays on diagnostic performance of markers.

BACKGROUND: We compared the performance of different natriuretic peptides to diagnose mild forms of left ventricular dysfunction (LVD) and investigated the influence of measuring B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) with different assays on the diagnostic performance of these markers. METHODS: We measured BNP (Triage BNP), NT-proBNP (Biomedica), and N-terminal pro-A-type natriuretic peptide (NT-proANP; Biomedica) in 130 consecutive patients (age range, 28-83 years) with clinically suspected mild LVD. In patients with sufficient sample volume, we measured BNP and NT-proBNP with additional assays (Shionoria and Roche, respectively). RESULTS: For identifying patients with mild systolic LVD, BNP and NT-proBNP were the best markers, with mean (95% confidence interval) areas under the curves (AUC) of 0.78 (0.63-0.89) and 0.75 (0.58-0.87), respectively. However, the diagnostic performance of NT-proANP [AUC, 0.64 (0.48-0.77)] was significantly worse than that of BNP (P = 0.014). Both BNP assays (Triage and Shionoria) and both NT-proBNP assays (Biomedica and Roche) performed equally well for the diagnosis of systolic LVD despite the poor agreement between NT-proBNP assays. In patients with isolated diastolic LVD, the diagnostic performance of the Triage BNP [AUC, 0.70 (0.56-0.81)] was significantly better (P = 0.006) than that of Biomedica NT-proBNP [0.49 (0.34-0.65)]. Furthermore, the performance of the Biomedica NT-proBNP assay was significantly worse (P = 0.03) than that of the Roche NT-proBNP assay for diagnosis of isolated diastolic LVD. CONCLUSIONS: The performance of BNP for the diagnosis of systolic or diastolic LVD is not affected by the assay used, whereas the performance of NT-proBNP for the diagnosis of isolated diastolic LVD is assay dependent.

Adult↗
PubMed1998

The complex relation between myocardial viability and functional recovery in chronic left ventricular dysfunction.

Preserved myocardial viability and recurrent symptomatic ischemia are the most widely accepted criteria indicating that coronary revascularization should take place in patients with postischemic left ventricular dysfunction. However, the presence of viable myocardium within the infarct zone does not necessarily imply recovery of function after coronary revascularization. The complex relation between the extent of transmural necrosis and the degree of residual perfusion within the infarct area plays an important role. However, independently of functional recovery, cell viability may have important clinical implications, since it may improve long-term prognosis by attenuating left ventricular remodeling processes. Several different methods are used to detect hibernating myocardium. Mounting evidence suggests that thallium-201 scintigraphy is most sensitive in identifying tissue viability, whereas dobutamine echocardiography is most specific in predicting functional recovery after revascularization. In between, myocardial contrast echocardiography is the only technique able to evaluate the microvascular integrity that is a condition sine qua non for both cell viability and later functional recovery. Combined information derived from these 3 different approaches might be considered as the best way to understand how the combination of contractile, viable but noncontractile, and dead tissue affect resultant function and prognosis.

Cardiotonic Agents↗
PubMed1988

Rapid-sequence induction technique in patients with severe ventricular dysfunction.

The hemodynamic effects of a rapid-sequence induction and intubation technique using etomidate, fentanyl, and succinylcholine for emergency surgery in patients with severe ventricular dysfunction were studied. Ten patients undergoing orthotopic heart transplantation received fentanyl, 10 microg/kg, etomidate, 0.3 mg/kg, and succinylcholine, 1.5 mg/kg, intravenously (IV) in rapid-sequence fashion for induction. Intubation was performed 60 seconds later. Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arterial occlusion pressure (PAo), and cardiac index (CI) were measured preinduction, postinduction, and 1 minute after intubation. Systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) were calculated from the measured data. No statistically significant changes in hemodynamics occurred with induction or intubation. These results indicate that etomidate, fentanyl, and succinylcholine given in a rapid-sequence technique produce a hemodynamically stable induction with minimal response to intubation in patients with end-stage cardiac disease.

Adult↗
PubMed1996

Absence of Q waves after thrombolysis predicts more rapid improvement of regional left ventricular dysfunction.

Although the natural history of regional left ventricular (LV) dysfunction after Q-wave and non-Q-wave myocardial infarction (MI) was well defined in the prethrombolytic era, the functional and structural implications of the absence of Q waves after thrombolysis are less clear. Echocardiography was performed within 48 hours of admission (entry) in 86 patients treated with thrombolysis for their first MI. The extent of abnormal wall motion (AWM; square centimeters) and LV endocardial surface area index (ESA; square centimeters per square meters) were quantified by using a previously validated echocardiographic endocardial surface-mapping technique. Electrocardiography (ECG) performed at 48 hours after thrombolysis was used to classify patients into groups with (Q; n=70) and without (non-Q; n=16) Q waves. All patients in the Q group had regional LV dysfunction on initial echocardiogram compared with 69 percent of those in the non-Q group (p<0.001). When the patients in the non-Q group without AWM were excluded from analysis, there was no significant difference in the extent of AWM between the Q and non-Q groups. Among those patients with AWM on entry, follow-up echocardiography at 6 to 12 weeks demonstrated a significant reduction in extent of AWM for both the Q and non-Q groups. However, the fractional change in AWM was significantly greater in the non-Q than in the Q group (-0.74 +/- 0.28 vs -0.29 +/- 0.44; p<0.02), with a trend toward less AWM at follow-up in the non-Q than in the Q group. The mean ESAi was not significantly different between the two groups at entry or at follow-up. In conclusion, failure to develop Q waves after thrombolysis predicts a lower likelihood of developing regional LV dysfunction and, when such dysfunction is present, predicts a greater degree of recovery.

Aged↗
PubMed2005

Implantable cardioverter defibrillators and cardiac resynchronization therapy in patients with left ventricular dysfunction: randomized trial evidence through 2004.

Although many studies have shown that implantable cardioverter defibrillator (ICD) therapy improves the survival of patients with significant left ventricular dysfunction, the magnitude of effectiveness of ICD therapy in clinically defined subgroups remains uncertain. Similarly, although studies have shown an improvement in patients' hemodynamics and quality of life with cardiac resynchronization therapy (CRT), there is a continuing uncertainty about the effect of CRT on patients' survival and the magnitude of improvement in quality of life with this therapy. On August 24, 2004, an ad hoc group of experts representing clinical cardiovascular medicine, biostatistics, economics, and health policy were joined by representatives of the Food and Drug Administration, Centers for Medicare and Medicaid Services (Baltimore, Md), Agency for Healthcare Research and Quality (Rockville, Md), and the device industry for a 1-day round table to review the available clinical trial evidence on the effect of ICD therapy in the primary prevention of sudden cardiac death and the effect of CRT in patients with congestive heart failure. The meeting was organized by the Duke Clinical Research Institute, Durham, NC, and funded in part by the Agency for Healthcare Research and Quality. This document summarizes the evidence reviewed at that meeting and the discussions of that evidence.

Death, Sudden, Cardiac↗
PubMed2003

Revascularization in patients with coronary artery disease, left ventricular dysfunction, and viability: a meta-analysis.

BACKGROUND: The effects of viability status and treatment allocation on long-term mortality in patients with left ventricular dysfunction and coronary artery disease have not been determined. Several observational studies with significant limitations have addressed this issue, and a recent meta-analysis has attempted to combine these results to increase statistical power. However, the analysis did not test for an interaction between viability status and treatment type, and included extraneous studies. We provide an alternate meta-analysis of this primary literature, utilizing interaction statistical methodology on relevant data and factoring in multiple limitations. METHODS: We examined papers from this prior meta-analysis examining viable and nonviable patients undergoing surgical or medical therapy. We determined an interaction odds ratio for each study and used an empirical Bayes random-effects model to obtain a combined interaction odds ratio that was tested for statistical significance. We compared our results against an interaction odds ratio we estimated from the primary studies included in the previous meta-analysis. RESULTS: Nine relevant studies with 1244 patients and 172 events were identified that utilized all 4 treatment/viability subsets. The interaction odds ratio was 2.76 (P =.0176, 95% CI 1.19-6.38), 2.5 times lower than our estimated interaction odds ratio of 7.27 for the prior meta-analysis. CONCLUSIONS: We found a markedly reduced but statistically significant interaction between viability status and treatment allocation. However, numerous limitations in the primary studies and the application of meta-analysis along with significant improvements in medical therapies render a randomized controlled trial necessary to reach a definitive conclusion to this critical question.

Coronary Artery Disease↗
PubMed1989

Effect of the second-generation calcium channel blocking drug nisoldipine on diastolic left ventricular dysfunction in heart failure.

The effect of intravenous nisoldipine (0.12 microgram/kg/min) on diastolic left ventricular (LV) dysfunction was studied from simultaneous hemodynamic and radionuclide measurements in 12 patients with New York Heart Association class II to IV cardiac failure. The initial LV filling fraction was low, the peak LV filling rate normalized for end-diastolic volume was decreased, and the pulmonary capillary wedge pressure (PCWP) was high and associated with clinical shortness of breath. Nisoldipine produced an increase in LV filling fraction from 36 +/- 17% to 43 +/- 20% (p = 0.003). The increase in filling took place in both early and late diastole: peak early filling rate (PFR) increased in 11 of the 12 patients (p = 0.02) and late diastolic filling rate (atrial [A] wave in eight of them (NS). When the determinants of these changes, were examined further, it was found that in the control state PFR was inversely related to LV end-systolic volume (r = 0.77), whereas the A wave was related in exponential fashion to PCWP (preload) (r = 0.79). Nisoldipine did not change the slope of these relationships, and it did not alter the end-diastolic pressure-volume relationship, implying that inherent myocardial relaxation and distensibility were unaltered by the drug. In summary, nisoldipine improved measurements of diastolic LV dysfunction in patients with cardiac failure. This study illustrates the importance of considering ventricular loading conditions when analyzing and interpreting measurements of diastolic ventricular dysfunction. The measured changes in diastolic LV function during infusion of nisoldipine appear to be due to alterations in ventricular loading conditions rather than to a direct myocardial effect of the drug.

Aged↗
PubMed1999

201Tl and 99mTc-MIBI gated SPECT in patients with large perfusion defects and left ventricular dysfunction: comparison with equilibrium radionuclide angiography.

UNLABELLED: Left ventricular ejection fraction (LVEF) is a major prognostic factor in coronary artery disease and may be computed by 99mTc-methoxyisobutyl isonitrile (MIBI) gated SPECT. However, 201Tl remains widely used for assessing myocardial perfusion and viability. Therefore, we evaluated the feasibility and accuracy of both 99mTc-MIBI and 201Tl gated SPECT in assessing LVEF in patients with myocardial infarction, large perfusion defects and left ventricular (LV) dysfunction. METHODS: Fifty consecutive patients (43 men, 7 women; mean age 61 +/- 17 y) with a history of myocardial infarction (anterior, 26; inferior, 18; lateral, 6) were studied. All patients underwent equilibnum radionuclide angiography (ERNA) and rest myocardial gated SPECT, either 1 h after the injection of 1110 MBq 99mTc-MIBI (n = 19, group 1) or 4 h after the injection of 185-203 MBq 201Tl (n = 31, group 2) using a 90 degrees dual-head camera. After filtered backprojection (Butterworth filter: order 5, cutoff 0.25 99mTc or 0.20 201Tl), LVEF was calculated from reconstructed gated SPECT with a previously validated semiautomatic commercially available software quantitative gated SPECT (QGS). Perfusion defects were expressed as a percentage of the whole myocardium planimetered by bull's-eye polar map of composite nongated SPECT. RESULTS: Gated SPECT image quality was considered suitable for LVEF measurement in all patients. Mean perfusion defects were 36% +/- 18% (group 1), 33% +/- 17% (group 2), 34% +/- 17% (group 1 + group 2). LVEF was underestimated using gated SPECT compared with ERNA (34% +/- 12% and 39% +/- 12%, respectively; P = 0.0001). Correlations were high (group 1, r= 0.88; group 2, r = 0.76; group 1 + group 2, r = 0.82), and Bland-Altman plots showed a fair agreement between gated SPECT and ERNA. The difference between the two methods did not vary as LVEF, perfusion defect size or seventy increased or when the mitral valve plane was involved in the defect. CONCLUSION: LVEF measurement is feasible using myocardial gated SPECT with the QGS method in patients with large perfusion defects and LV dysfunction. However, both 201Tl and 99mTc-MIBI gated SPECT similarly and significantly underestimated LVEF in patients with LV dysfunction and large perfusion defects.

Electrocardiography↗
PubMed2005

Hypercholesterolemia attenuates postischemic ventricular dysfunction in the isolated rabbit heart.

The effects of the chronic administration of cholesterol on the stunned myocardium have not been studied. The objective was to determine the effect of a cholesterol enriched diet on postischemic ventricular dysfunction. In group 1 (G1, n = 7) isolated rabbit hearts underwent a follow up of ventricular function during 30 min in aerobic conditions. In group 2 (G2, n = 6) G1 was repeated but the animals were subjected to a 1% cholesterol enriched diet during 4 weeks (hypercholesterolemic animals). In group 3 (G3, n = 8) hearts underwent 15 min of global ischemia followed by 30 min of reperfusion. In Group 4 (G4, n = 11) G3 was repeated, but in hypercholesterolemic animals. Since cholesterol decreased the inotropism in basal situation, and this makes the comparison between groups difficult, we performed a Group 5 (G5, n = 7), in which G4 protocol was repeated but isoproterenol (8 microg/kg/min) was administered 10 min before ischemia, in order to match the preischemic inotropic state with respect to the normocholesterolemic ones. G1 and G2 maintained a stable inotropism during the 30 min of perfusion. The preischemic left ventricular developed pressure (LVDP) in G3 and G4 was 91.4 +/- 4.3 and 70.8 +/- 3.4 mmHg (p < 0.05), respectively, and after 30 min of reperfusion differences were not observed between G3 and G4. Nevertheless, when LVDP is expressed as a percentage, we detected an attenuation of postischemic systolic alterations in hypercholesterolemic animals (67.3 +/- 3.6 in G4 vs. 90.8 +/- 3.1% in G3, p < 0.05). When LVDP in G5 was increased until matching the one of G3, there were no differences after 30 min of reperfusion. Left ventricular end diastolic pressure increased 285 +/- 46%, 61 +/- 25% (p < 0.05 vs. G3 and G5) and 216 +/- 25% in G3, G4 and G5 at 30 min of reperfusion. There were no differences either in the values of tau or infarct size between groups. Thus, in hypercholesterolemic animals, a decrease of the preischemic inotropism exists and there is an attenuation of the stunned myocardium. When contractility of the normo and hypercholesterolemic animals is matched, the beneficial effect disappears.

Animals↗
PubMed1994

Prediction of mortality in mild to moderately symptomatic patients with left ventricular dysfunction. The role of the New York Heart Association classification, cardiopulmonary exercise testing, two-dimensional echocardiography and Holter monitoring.

In order to investigate the value of peak oxygen consumption (peak VO2) in predicting mortality in mild to moderately symptomatic patients with left ventricular dysfunction, we studied 103 NYHA II/III class patients with a left ventricular ejection fraction (LVEF) < or = 40%. Heart failure was due to coronary artery disease (CAD) in 39 patients, idiopathic dilated cardiomyopathy in 54, hypertension in eight and surgically corrected valvular disease in two. The following variables were analysed: age, cause of heart failure (CAD vs no CAD), NYHA class, peak VO2, LVEF, left ventricular end-systolic volume index (LVESVI), ventricular tachycardia (VT) on Holter monitoring and the use of antiarrhythmic drugs. Statistical analysis was performed by Cox's proportional-hazards regression model. During a mean follow-up period of 20 months, there were 25 deaths. The estimated cumulative probabilities of survival were 88%, 73% and 58% at 1, 2 and 3 years, respectively. Cox's model identified CAD (P = 0.01), NYHA III class (P = 0.04) and LVEF (P = 0.02) as independent, statistically significant predictors of mortality. Peak VO2 had only a marginal statistical significance (P = 0.07). Age, LVESVI, VT on Holter monitoring and use of antiarrhythmic drugs were not related to mortality. These data can be important in patient clinical management and clinical trial design.

Adult↗
PubMed2001

Echocardiographic evolution of left ventricular and left atrial thrombi in a patient with left ventricular dysfunction due to alcoholic cardiomyopathy, chronic atrial fibrillation and multiple non-fatal systemic embolisms.

The echocardiographic characteristics and evolution of multiple pedunculated left atrial and left ventricular intracavitary thrombi in a patient with alcoholic cardiomyopathy are reported. The patient had a long history of left ventricular dysfunction and atrial fibrillation but the referring physician had not prescribed anticoagulant prophylaxis. Multiple, non-fatal, systemic embolizations occurred during hospitalization and echocardiography was used to monitor the effect of the anticoagulant therapy on the remodelling and final dissolution of intracavitary thrombi.

Atrial Fibrillation↗
PubMed2005

Beta-blockers improve in-hospital and long-term survival in patients with severe left ventricular dysfunction undergoing major vascular surgery.

OBJECTIVES: To study whether beta-blockers reduce in-hospital and long-term mortality in patients with severe left ventricular dysfunction (LVD) undergoing major vascular surgery. DESIGN: Observational cohort study. MATERIALS: Five hundred and eleven patients with severe LVD (ejection fraction<30%) undergoing major non-cardiac vascular surgery. METHODS: In all patients, cardiac risk factors, medication (including beta-blockers), and dobutamine stress echocardiography (DSE) results were noted prior to surgery. DSE was evaluated for rest and stress-induced new wall motion abnormalities. Endpoint was in-hospital and long-term mortality. Propensity scores for beta-blockers were calculated and regression models were used to analyse the relation between beta-blockers and mortality. RESULTS: Mean age was 64+/-11 years and 383 patients (75%) were male. 139 patients (27%) used beta-blockers. Stress-induced ischemia occurred in 82 patients (16%). Median follow-up was 7 years (interquartile range: 3-10). In-hospital and long-term mortality was observed in 64 (13%) and 171 (33%) patients, respectively. After adjusting for clinical variables, DSE results and propensity scores, beta-blockers were significantly associated with reduced in-hospital and long-term mortality (OR: 0.18, 95% CI: 0.04-0.74 and HR: 0.38, 95% CI: 0.22-0.65, respectively). CONCLUSION: In patients with severe LVD undergoing major vascular surgery, the use of beta-blockers is associated with a reduced incidence of in-hospital and long-term postoperative mortality.

Adrenergic beta-Antagonists↗
PubMed2005

[Quantification of valvular lesions in patients with left ventricular dysfunction].

Echocardiography is the preferred method for assessment of aortic and mitral valvular lesions. The pressure gradient in aortic stenosis may be misleading in patients with poor left ventricular function. Aortic valve area planimetry by transesophageal echocardiography results in a flow independent anatomic measurement. Low-dose dobutamine stress echocardiography provides important prognostic information. Quantitative Doppler echocardiography allows accurate assessment of mitral regurgitation severity. However, the definition of what is severe mitral regurgitation is different in patients with left ventricular dysfunction.

Aortic Valve↗
PubMed2004

Incidence of recovery of contractile function following revascularization in patients with ischemic left ventricular dysfunction.

Contractile function in patients with ischemic left ventricular (LV) dysfunction may improve after myocardial revascularization. Currently, the incidence of contractile function recovery after revascularization in these patients is unclear. The aim of this study was to assess the incidence of function improvement after myocardial revascularization in patients with ischemic LV dysfunction. A total of 258 consecutive patients (aged 59 +/- 12 years) with severely depressed LV ejection fractions (EFs) due to chronic coronary artery disease and heart failure symptoms were studied. All patients underwent radionuclide ventriculography and 2-dimensional echocardiography at rest before and 3 to 6 months after revascularization. At baseline, 1,330 segments (32%) were normal and 2,775 segments (68%) were dysfunctional. Improvement after revascularization occurred in 736 of the 2,775 dysfunctional segments (27%). Overall, LVEF improved from 29 +/- 7 to 32 +/- 9 (p <0.0001). A clinically significant improvement of LVEF (>/=5% postrevascularization) was present in 101 patients (39%). Improvement of LVEF after revascularization was frequently observed in patients with a more severely impaired baseline LVEF. At least 3 segments with improvement of function were needed for an improvement of LVEF of >/=5%.

Coronary Artery Disease↗