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PubMed2003

Factors affecting left ventricular ejection fraction using automated quantitative gated SPECT.

BACKGROUND: Factors affecting the accuracy of left ventricular ejection fraction (LVEF) quantification using automated quantitative gated SPECT have not been adequately investigated in patients in the clinical setting. Therefore, the authors studied the effect of defect size and Tc-99m tetrofosmin dose on the accuracy of LVEF calculation using the automated QGS program. MATERIALS AND METHODS: Thirty-two consecutive patients underwent gated rest and stress myocardial perfusion SPECT after administration of 8 and 27 mCi Tc-99m tetrofosmin, respectively. The LVEF was obtained for both the rest and stress studies using the QGS program and compared with the LVEF obtained using quantitative echocardiography performed within 2 weeks. Myocardial perfusion defects were recorded as scarring, ischemia, or mixed scarring and ischemia in 12 left ventricular segments. The defect size was evaluated by adding the number of affected segments. RESULTS: The mean LVEF calculated using high-dose stress QGS, low-dose rest QGS, and echocardiography was 49.2% +/- 15%, 46.2% +/- 17% and 48.7% +/- 16.9% respectively, with no statistically significant differences. The LVEF obtained using high-dose stress QGS correlated better with echocardiography than did that obtained using low-dose rest QGS (r = 0.86 versus 0.76). In addition, when the high-dose stress LVEF in the 14 patients with normal myocardial perfusion was compared with that in 11 patients who had one- or two-segment perfusion defects, and 7 patients who had perfusion defects in > or = three segments, there was good correlation with echocardiography in the three patient groups (r = 0.85, 0.88, and 0.91, respectively). CONCLUSIONS: Myocardial perfusion defects do not affect the accuracy of LVEF calculation using automated QGS. High-dose gated myocardial SPECT demonstrated better correlation with quantitative echocardiography LVEF results.

Adult↗
PubMed2004

Mortality and morbidity reduction with Candesartan in patients with chronic heart failure and left ventricular systolic dysfunction: results of the CHARM low-left ventricular ejection fraction trials.

BACKGROUND: Patients with symptomatic chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) have a high risk of death and hospitalization for CHF deterioration despite therapies with angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and even an aldosterone antagonist. To determine whether the angiotensin-receptor blocker (ARB) candesartan decreases cardiovascular mortality, morbidity, and all-cause mortality in patients with CHF and depressed LVEF, a prespecified analysis of the combined Candesartan in Heart Failure Assessment of Reduction in Mortality and morbidity (CHARM) low LVEF trials was performed. CHARM is a randomized, double-blind, placebo-controlled, multicenter, international trial program. METHODS AND RESULTS: New York Heart Association (NYHA) class II through IV CHF patients with an LVEF of < or =40% were randomized to candesartan or placebo in 2 complementary parallel trials (CHARM-Alternative, for patients who cannot tolerate ACE inhibitors, and CHARM-Added, for patients who were receiving ACE inhibitors). Mortality and morbidity were determined in 4576 low LVEF patients (2289 candesartan and 2287 placebo), titrated as tolerated to a target dose of 32 mg once daily, and observed for 2 to 4 years (median, 40 months). The primary outcome (time to first event by intention to treat) was cardiovascular death or CHF hospitalization for each trial, with all-cause mortality a secondary end point in the pooled analysis of the low LVEF trials. Of the patients in the candesartan group, 817 (35.7%) experienced cardiovascular death or a CHF hospitalization as compared with 944 (41.3%) in the placebo group (HR 0.82; 95% CI 0.74 to 0.90; P<0.001) with reduced risk for both cardiovascular deaths (521 [22.8%] versus 599 [26.2%]; HR 0.84 [95% CI 0.75 to 0.95]; P=0.005) and CHF hospitalizations (516 [22.5%] versus 642 [28.1%]; HR 0.76 [95% CI 0.68 to 0.85]; P<0.001). It is important to note that all-cause mortality also was significantly reduced by candesartan (642 [28.0%] versus 708 [31.0%]; HR 0.88 [95% CI 0.79 to 0.98]; P=0.018). No significant heterogeneity for the beneficial effects of candesartan was found across prespecified and subsequently identified subgroups including treatment with ACE inhibitors, beta-blockers, an aldosterone antagonist, or their combinations. The study drug was discontinued because of adverse effects by 23.1% of patients in the candesartan group and 18.8% in the placebo group; the reasons included increased creatinine (7.1% versus 3.5%), hypotension (4.2% versus 2.1%), and hyperkalemia (2.8% versus 0.5%), respectively (all P<0.001). CONCLUSIONS: Candesartan significantly reduces all-cause mortality, cardiovascular death, and heart failure hospitalizations in patients with CHF and LVEF < or =40% when added to standard therapies including ACE inhibitors, beta-blockers, and an aldosterone antagonist. Routine monitoring of blood pressure, serum creatinine, and serum potassium is warranted.

Aged↗
PubMed1979

Effects of maximal exercise stress on left ventricular function in patients with coronary artery disease using first pass radionuclide angiocardiography: a rapid, noninvasive technique for determining ejection fraction and segmental wall motion.

Angiographically determined changes in segmental wall motion (SWM) and ejection fraction (EF) are sensitive indices of left ventricular (LV) function. To compare the effects of exercise on LV function, first pass radionuclide angiocardiography was used before and during maximal upright bicycle stress in patients with nonsignificantly stenosed coronary arteries, and in those with greater than 75% stenosis. Gamma camera acquisitions were made in the 30 degree RAO projection using a 20 mCi I.V. bolus of 99mTc-pertechnetate. In the control group (seven normals, one nonsignificant (CAD) the EF significantly increased between rest and exercise (0.65 +/- 0.03 to 0.81 +/- 0.03 (mean +/- SEM), p less than 0.005). In this group SWM measured over the two anterior and two inferoposterior segments uniformly increased. In the 11 patients with a history of angina and significant coronary artery obstruction, the EF did not change in three and significantly decreased in the remaining eight (0.57 +/- 0.04 to 0.45 +/- 0.03, p less than 0.005). In all 11 patients SWM either decreased or did not increase in the areas supplied by the significantly stenosed coronary arteries. Upright maximal stress angiocardiography appears to be well-suited for diagnosing ischemic heart disease and localizing the area of ischemic dysfunction.

Adult↗
PubMed1981

A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography.

A new method to determine left ventricular (LV) ejection fraction (EF) with wide-angle, two-dimensional echocardiography (2-D echo) has been developed using the parasternal long-axis, apical four-chamber and apical long-axis views. End-diastolic and end-systolic measurements of LV short axes at the base and mid-LV cavity in the parasternal long-axis view and at the upper, middle and lower thirds of the cavity in the apical views are made, from which an averaged minor axis at end-diastolic and at end-systole is calculated. Fractional shortening of the LV long axis (delta L) is estimated from apical contraction. Satisfactory 2-D echoes were obtained in 55 of 58 nonselected patients (all three views in 32 patients, two views in 22 and one view in one); 42 of 55 patients had coronary artery disease. EF by 2-D echo was compared with EF by gated cardiac blood pool imaging in all patients (r = 0.927, SEE = 6.7%) and to EF by single-plane cineangiography (angio) in 35 of 55 patients (r = 0.913, SEE = 7.4%). LV dyssynergy was frequently present and involved the apex in 29 of 55 patients. Using angio as the standard for evaluating wall motion at the apex, 2-D echo was 100% sensitive and specific in detecting abnormal apical wall motion. We conclude that EF can be determined accurately with 2-D echo in a large group of patients with and without dyssynergy by a simple method that eliminates the need for planimetry or computer assistance.

Adult↗
PubMed2026

Downregulation of Trpv4 and Klf2 in brain microvessels is associated with the progression of neurovascular dysfunction and cognitive impairment in a model of heart failure with preserved ejection fraction.

Vascular cognitive impairment (VCI) shares major risk factors with heart failure with preserved ejection fraction (HFpEF), including obesity, diabetes and hypertension. Yet VCI research often relies on single-stimulus models, whereas patients experience combined risk factors. We therefore assessed cerebrovascular and cognitive phenotypes in an HFpEF model and investigated underlying mechanisms. Male Lean and Obese ZSF1 rats underwent longitudinal assessments of blood pressure, glucose, cardiac function and behavioural performance. Cerebral blood flow and neurovascular coupling were assessed by laser speckle contrast imaging. White matter integrity, blood-brain barrier (BBB) permeability and vascular density were analyzed by (immuno)histochemistry. Cortical microvessels were isolated for transcriptomic profiling, and selected targets were validated using multiplex in-situ hybridization. Obese rats exhibited neurovascular uncoupling and impaired short- and long-term memory and spatial learning, accompanied by brain atrophy and reduced myelin. BBB permeability increased at 22-23&#x2009;weeks and vascular density at 34-35&#x2009;weeks in Obese versus Lean rats. Transcriptomic analysis of brain microvessels revealed altered processes related to angiogenesis, vasoreactivity, immune mechanisms and vascular remodelling, with consistent downregulation of Trpv4 and Klf2. Obese ZSF1 rats develop progressive neurovascular dysfunction associated with HFpEF onset and reduced Trpv4 and Klf2 expression in cerebral microvessels, two key vasoprotective genes.

Diastolic dysfunction↗
PubMed2005

[Maximal functional capacity, ejection fraction, and functional class in Chagas cardiomyopathy. Are these indices related?].

OBJECTIVE: Left ventricular ejection fraction (LVEF) and maximal functional capacity (VO2max) have both been shown to be related to a poor long-term survival in Chagas' disease patients. The aim of this study was to estimate the potential association of VO2max, LVEF, and NYHA functional class in patients with Chagas' disease cardiomyopathy. METHODS: One hundred four male patients, aged 40.3+/-9.0 years (range, 18 to 65), with a definite diagnosis of Chagas disease cardiomyopathy were studied. LVEF and VO2max were both classified into 3 degrees: LVEF 0.50 and VO2max < or = 10, 10 < VO2max < or = 20, and VO2max > 20 ml.kg(-1).min(-1), respectively. RESULTS: Thirty-one patients (29.8%) were in NYHA functional class II, 41 (39.4%) in functional class III, and 32 (30.8%) in functional class IV. The corresponding values of VO2max and LVEF for functional classes II, III, and IV were 21.5+/-4.0 ml.kg(-1).min(-1), 18.3+/-5.8 ml.kg(-1).min(-1), and 14.7+/-4.9 ml.kg(-1).min(-1) and 0.50+/-0.6, 0.35+/- 0.9, and 0.29+/-0.7, respectively. LVEF = < or = 0.30 and VO2max = < or = 10 ml.kg(-1).min(-1) were found in the majority of patients in NYHA functional class IV. Conversely, patients in functional class II were mostly those with LVEF > 0.50 as well as VO2max > 20 ml.kg(-1).min(-1). CONCLUSION: A convincingly good association exists between NYHA functional class, functional capacity and LVEF in patients with Chagas' disease cardiomyopathy. These data may be helpful in the management of heart failure in Chagas' disease patients.

Adolescent↗
PubMed2001

Myocardial tracking, a new method to calculate ejection fraction with gated SPECT: validation with (201)Tl versus planar angiography.

UNLABELLED: Left ventricular ejection fraction (LVEF) and viability are essential variables for the prognosis of myocardial infarction and can be measured simultaneously by (201)Tl gated SPECT; however, most algorithms tend to underestimate LVEF. This study aimed to evaluate a new myocardial tracking algorithm, MyoTrack (MTK), for automatic LVEF calculation. METHODS: A rest/redistribution (20 min/4 h) (201)Tl gated SPECT protocol followed immediately by a (99m)Tc equilibrium radionuclide angiography (ERNA) was performed in 75 patients with history of myocardial infarction. Quality of myocardial uptake was evaluated from count statistics and automatic quantification of defect sizes and severities (CardioMatch). LVEFs were calculated both with Germano's quantitative gated SPECT (QGS) algorithm and with MTK. Briefly, the originality of this algorithm resides in the unique end-diastole segmentation, matching to a template and motion field tracking throughout the cardiac cycle. RESULTS: ERNA LVEF averaged 33% +/- 14%. QGS significantly underestimated this value at 20 min (30% +/- 13%, P < 0.001) and at 4 h (30% +/- 13%, P < 0.0001). By contrast, MTK did not miscalculate LVEF at 20 min (34% +/- 14%, probability value was not significant) though a similar underestimation occurred at 4 h (31% +/- 13%, P < 0.02). Individual differences between early and late gated SPECT values and differences between gated SPECT and ERNA values did not correlate with the extension of perfusion defects, count statistics, or heart rate. CONCLUSION: MTK algorithm accurately calculates LVEF on early/high-count images compared with ERNA [corrected], even in patients with severe perfusion defects, but tends to underestimate LVEF on delayed/low-contrast images, as other algorithms do.

Adult↗
PubMed1990

[Measurement of left ventricular ejection fraction in myocardial infarction by 2-dimensional echocardiography--comparison with radionuclide angiography].

Left ventricular ejection fraction (LVEF) with 4 different algorithms (biplane and single-plane Simpson's rule and ellipsoid area-length method) was measured by 2-dimensional echocardiography (2 DE) in 42 patients with myocardial infarction (MI), and the results were compared with those with equilibrium radionuclide angiography (ERNA). The correlation coefficients were 0.98 for biplane Simpson's rule (apical 4 and 2 chamber view), 0.96 for biplane area-length method (apical 4 and 2 chamber view), 0.81 for single-plane Simpson's rule (apical 4 chamber view), and 0.77 for single-plane area-length method (apical 4 chamber view). The results indicated that biplane method is superior to single-plane method. Biplane area-length method is an alternative simple method for LVEF measurement in patients with MI.

Echocardiography↗
PubMed1993

[Monitoring of right ventricular ejection fraction with a modified pulmonary artery catheter].

The thermodilution method for measuring right ventricular ejection fraction (RVEFTD) is described. The reproducibility of RVEFTD measurements was determined in 48 critically ill patients who all needed pharmacological inotropic support and mechanical ventilation. A coefficient of variance of 12.6% on RVEFTD determinations was found. In 46 of 48 patients (96%), the catheter did not need repositioning.

Cardiac Catheterization↗
PubMed1985

[Course of ejection fraction, regurgitation fraction and ventricular volumes during exertion in chronic aortic insufficiency. Study using technetium 99m gamma-cineangiography].

Previous studies have shown that variations of the ejection fraction (EF) during exercise were representative of the contractile state of the left ventricle: an increased EF on effort is considered to be physiological, whilst a decrease would indicate latent LV dysfunction unmasked during exercise. This hypothesis was tested by performing Technetium 99 gamma cineangiography at equilibrium under basal conditions and at maximal effort in 8 healthy subjects and 44 patients with pure, severe aortic regurgitation to measure the ejection and regurgitant fractions and the variations in end systolic and end diastolic LV volume. In the control group the EF increased and end systolic volume decreased significantly on effort whilst the regurgitant fraction and end diastolic volume were unchanged. In the 44 patients with aortic regurgitation no significant variations in EF, end systolic and end diastolic volumes were observed because the individual values were very dispersed. Variations of the EF and end systolic volume were inversely correlated. The regurgitant fraction decreased significantly on effort. Based on the variations of the EF and end systolic volume three different types of response to effort could be identified: in 7 patients, the EF increased on effort and end systolic volume decreased without any significant variation in the end diastolic volume, as in the group of normal control subjects; in 22 patients, a reduction in EF was observed on effort, associated with an increased end systolic volume. These changes indicated latent IV dysfunction inapparent at rest and unmasked by exercise; in a third group of 15 patients, the EF decreased on effort despite a physiological decrease in end systolic volume due to a greater decrease in end diastolic volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

First-pass left ventricular ejection fraction with 95mAu on a 1/4 in. crystal gamma camera.

First-pass left ventricular ejection fraction was determined in 21 patients using 195mAu. The technical aspects of the application are discussed with particular reference to the thin crystal (1/4 in.) gamma camera. The use of diverse catheter types and combinations were also investigated so that optimal administration of the radionuclide could be achieved.

Cardiac Output↗
PubMed1988

Estimating left ventricular ejection fraction after myocardial infarction by various clinical parameters.

The clinical predictors of left ventricular (LV) ejection fraction (EF) were determined in 760 survivors of an acute myocardial infarction (AMI). LVEF was dichotomized at less than or equal to 0.40 (n = 269) and greater than 0.04 (n = 491). Logistic regression showed that 4 of 20 preselected, clinically meaningful variables were strong and independent (p less than 0.001) predictors of LVEF less than or equal to 0.40. Independent variables together with their odds ratio (odds of having a LVEF less than or equal to 0.40 with factor present to odds with factor absent) in order of decreasing importance were: anterior AMI (4.7), congestion on chest x-ray (2.9), previous AMI (2.3) and creatine kinase greater than 1,000 U (2.1). There was a stepwise decrease in LVEF and an increase in the proportion of patients with a low LVEF for each additional clinical variable. A general estimate of LVEF was made by simply considering the total number of clinical factors present. The presence of 0 or 1 clinical variable (n = 466) predicted a high LVEF (greater than 0.40) with an accuracy of 80%. Two or more variables (n = 294) predicted a low LVEF (less than or equal to 0.40) with an accuracy of 60%. The overall predictive accuracy was 72%. Clinically significant major misclassifications were rare (less than 10%). Readily obtainable clinical variables provide the clinician with a useful bedside method of estimating LVEF after AMI.

Heart Function Tests↗
PubMed1980

Measurement of ejection fraction in the elderly.

A simple, virtually non-invasive, radionuclide method of measurement of ejection fraction has been evaluated in a study of 60 elderly patients. The causes of difficulty are described. The mean difference between duplicate measurements is 4.9%. The range of values obtained corresponds well to that found by others, as does the relationship to systolic time intervals. The method should be of value particularly for the assessment of the effects of drugs on the myocardium.

Aged↗
PubMed2001

Thallium gated SPECT: relation between immediate post-stress evolution of ejection fraction and severity of perfusion pattern.

BACKGROUND AND AIMS: A significant decrease of left ventricular ejection fraction (LVEF) at stress has been reported with 99Tc(m) gated single-photon emission computed tomography (gSPECT) in severe myocardial stunning up to 1 h after exercise. This study was designed to show whether 201Tl gSPECT can measure LVEF evolution from rest to stress in routine examination and give additional information to perfusion interpretation since acquisition starts immediately after stress test. METHODS: Post-exercise and rest 201Tl gSPECT were performed in 187 patients with suspected coronary artery disease. Myocardial perfusion was quantified by 20-segment analysis. Patients were divided into four groups according to their summed perfusion score, reversibility rate and electrocardiographic findings, i.e. in order of severity: I = normal perfusion, II = fixed defect owing to a myocardial infarction, III = full reversible ischaemia, and IV = partial reversible ischaemia. LVEF was calculated by Germano's automatic algorithm. RESULTS: Normal subjects (n = 29) and infarcted patients (n = 34) showed a significant LVEF increase between rest and stress, +7 +/- 9% and +5 +/- 7% respectively. In full reversible ischaemic patients (n = 46), stress LVEF showed no increase (+1 +/- 8%) and this group was statistically different from both group I and group II. Furthermore, when ischaemia was partially reversible (n = 31), LVEF decreased significantly (-3 +/- 8%), particularly when exercise tests were abnormal (-4 +/- 8%). Group IV was statistically different from groups I and II. CONCLUSIONS: Good agreement exists between the severity of ischaemic perfusion pattern and LVEF degradation at stress, which is consistent with previously published data using 99Tc(m) gSPECT. Additionally, the use of 201Tl for immediate post-exercise imaging allows the observation of a physiological LVEF increase in normal and infarcted patients.

Adult↗
PubMed2005

Freehand three-dimensional echocardiography with rotational scanning for measurements of left ventricular volume and ejection fraction in patients with coronary artery disease.

BACKGROUND: Measurement of left ventricular (LV) volumes and ejection fraction (EF) is important in managing patients with coronary artery disease (CAD). Introduction of free-hand three-dimensional echocardiography (3DE) system which is equipped with small magnetic tracking system and average rotational geometry for LV volumes may provide easy and accurate quantification of LV systolic function in CAD patients. PURPOSE: To evaluate the feasibility and accuracy of LV volumes and EF measurement by free-hand 3DE with rotational geometry in patients with CAD. METHODS AND RESULTS: The study subjects consisted of consecutive 25 patients with CAD who were scheduled for quantitative gated single-photon emission computed tomography (QGS). LV end-diastolic volume (EDV), end-systolic volume (ESV), and EF were determined by conventional two-dimensional echocardiography (2DE), 3DE, and QGS. Three-dimensional echocardiography data acquisition and analysis were possible in 22 of 25 subjects (feasibility 88%). In this 3DE system, image acquisition time was 2 minutes, and 5 minutes were needed for off-line analysis of LV volumes and EF. Correlations and the limits of agreement between 3DE and QGS (r = 0.97, 0.0 +/- 9.1 ml for EDV, r = 0.99, 0.0 +/- 5.0 ml for ESV, and r = 0.97, 0.5 +/- 3.3% for EF, respectively) were superior to those between 2DE and QGS (r = 0.85, 12.6 +/- 26.8 ml for EDV, r = 0.85, 9.7 +/- 26.1 ml for ESV, and r = 0.90, -1.3 +/- 6.9% for EF, respectively). Inter- and intra-observer variabilities of 3DE were smaller than that of 2DE (5% vs 10%, 5% vs 10% for EDV, 6% vs 13%, 5% vs 9% for ESV, and 4% vs 11%, 4% vs 6% for EF, respectively). CONCLUSION: Three-dimensional echocardiography using magnetic tracking system and average rotational geometry offered a feasible and accurate method for quantification of LV volumes and EF in patients with CAD.

Aged↗
PubMed1992

Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis.

Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculography (RNV) and contrast ventriculography measurements of LVEF for comparison. ECHO-LVEF from the 41 patients correlated well with the reference methods (y = 1.5x - 14.7, r = 0.93; linear regression analysis; 95% confidence limit for a single determination of ECHO-LVEF was 17.2). Interobserver variability by linear regression was r = 0.89, SEE = 7.1 with a mean difference between paired observations of -1.5 +/- 6.9 (SD). In a random sample of 18 patients (45 observations), ECHO-LVEF allowed separation between RNV-LVEF values greater than or equal to 40 and less than 40, representing low and high risk groups following AMI. Thus, the results showed that simple, readily available wall motion-derived estimates of LVEF were as closely associated with LVEF measured by standard reference methods as were previously published, more cumbersome, planimetric echocardiographic methods. Reporting on global LVEF function in LVEF units rather than in nonstandardized wall motion scores of index values may facilitate intra- and interhospital communication and the use of optimized echocardiographic risk stratification after AMI.

Echocardiography↗
PubMed1995

Comparative assessment of right ventricular volumes and ejection fraction by thermodilution and magnetic resonance imaging in dilated cardiomyopathy.

Measurements of right ventricular (RV) ejection fraction (EF) and volumes using a new thermodilution technique were compared to serially performed magnetic resonance imaging (MRI) in 21 patients with dilated cardiomyopathy. For RVEF (%) and RV volume indices (ml/m2) the following correlation coefficients were found: RVEF r = 0.82; end-diastolic volume index (EDVI) r = 0.45; end-systolic volume index (ESVI) r = 0.65; stroke volume index (SVI) r = 0.61; all p < 0.05. However, RVEF by thermodilution was significantly lower (RVEF thermo = 31 +/- 14 vs. RVEF MRI = 50 +/- 14, p < 0.01) and RV EDV and ESVI were significantly higher compared to MRI, while SVI showed no significant difference. Exclusion of patients with atrial fibrillation (n = 8) improved the correlations (RVEF r = 0.94, EDVI r = 0.77, ESVI r = 0.87, SVI r = 0.65, all p < 0.05), but did not reduce the mean difference between both methods.

Cardiomyopathy, Dilated↗
PubMed1998

Personality, disease severity, and the risk of long-term cardiac events in patients with a decreased ejection fraction after myocardial infarction.

BACKGROUND: Patients with myocardial infarction (MI) with a decreased left ventricular ejection fraction (LVEF) have a poor prognosis, but the role of emotional stress in prognosis is not known. We hypothesized that emotional stress in these patients (1) is unrelated to the severity of cardiac disorder, (2) predicts cardiac events, and (3) is a function of basic personality traits. METHODS AND RESULTS: Eighty-seven patients with MI (age, 41 to 69 years) with an LVEF of < or =50% underwent psychological assessment at baseline. Patients and their families were contacted after 6 to 10 years (mean, 7.9 years); cardiac events were defined as cardiac death or nonfatal MI. Emotional distress was unrelated to the severity of cardiac disorder. At follow-up, 21 patients had experienced a cardiac event (13 fatal events). These events were related to LVEF of < or =30%, poor exercise tolerance, previous MI, anxiety, anger, and depression (all P< or =.02). Patients with a distressed personality (type D; ie, the tendency to suppress negative emotions) were more likely to experience an event over time compared with non-type D patients (P=.00005). Cox proportional hazards analysis yielded LVEF of < or =30% (relative risk, 3.0; 95% confidence interval, 1.2 to 7.7; P=.02) and type D (relative risk, 4.7; 95% confidence interval, 1.9 to 11.8; P=.001) as independent predictors. Anxiety, anger, and depression did not add to the predictive power of type D; these negative emotions were highly correlated and reflected the personality domain of negative affectivity. CONCLUSIONS: Personality influences the clinical course of patients with a decreased LVEF. Emotional distress in these patients is unrelated to disease severity but reflects individual differences in personality. Clinical trials should take a broad view of the target of intervention; assessment of LVEF and personality may identify patients at risk.

Adult↗