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PubMed2005

Ascending aortic blood pressure-derived indices are not correlated with the extent of coronary artery disease in patients with impaired left ventricular function.

BACKGROUND: Ascending aortic blood pressure-derived indices were shown to be related to coronary atherosclerosis. Unfortunately, most studies published so far included patients with preserved left ventricular function. Therefore, the aim of the present study was to investigate the relation between ascending aortic blood pressure-derived indices and the extent of coronary atherosclerosis in patients with impaired left ventricular function. METHODS: The study group consisted of 375 patients (302 men and 73 women; mean age: 59.0+/-10.1 years) with angiographically confirmed coronary artery disease and ejection fraction < or =55%. Invasive ascending aortic blood pressure during catheterization and conventional sphygmomanometer measurements were taken. RESULTS: None of the brachial or aortic blood pressure-derived indices differed between patients with one-, two- and three-vessel coronary artery disease. They were not independently related to the risk of having three-vessel coronary artery disease in none of the constructed models in logistic regression analysis. Moreover, none of the studied indices was correlated with Gensini or severity scores. We also did not find any significant correlation between blood pressure-derived indices and extent of coronary atherosclerosis in patients with ejection fraction < or =25%, 25-40% or >40%. CONCLUSION: Ascending aortic blood pressure-derived indices are not correlated with the severity of coronary atherosclerosis in patients with coronary artery disease and impaired left ventricular function.

Aorta, Thoracic↗
PubMed2005

[Left ventricular functional parameters: comparison of 16-slice spiral CT with MRI].

PURPOSE: The quantitative measurement of left ventricular functional parameters using multislice computed tomography (MSCT) with retrospective ECG-gating and comparison of the results with magnetic resonance imaging (MRI). MATERIALS AND METHODS: Thirty-one patients with suspected or known coronary artery disease underwent MSCT angiography with retrospective ECG-gating (Sensation 16, Siemens). Based on the CT data set, short axis reformations of the left ventricle were performed for functional analysis. On a commercially available workstation, end-diastolic- (EDV), end-systolic- (ESV), stroke volume (SV), ejection fraction (EF) and myocardial mass (MM) were calculated from MSCT (temporal resolution 105 - 210 ms) data according to the modified Simpson's rule and compared to MRI (1.5 T scanner, temporal resolution 48 ms) using a 2D TrueFISP cine sequence with respiration hold. RESULTS: In all cases, the quality was adequate for both MSCT and MRI. MSCT and MRI had an excellent correlation for EDV (r = 0.86), ESV (r = 0.91), EF (r = 0.87) and MM (r = 0.88), and a good correlation for SV (r = 0.70). The mean difference was 13.2 +/- 21.9 ml for EDV, 8.7 +/- 15.9 ml for ESV, 4.6 +/- 12.3 ml for SV, 1.4 +/- 5.2 % for EF, and 11.9 +/- 13.8 g for MM. However, EDV (p = 0.002), ESV (p = 0.005), SV (p = 0.048), and MM (p < 0.0001) were significantly overestimated with MSCT compared to MRI. For EF, no significant difference between MSCT and MRI was found (p = 0.15). CONCLUSION: For left ventricular functional parameters, MSCT of the heart with retrospective ECG-gating showed a high correlation with MRI, which has an important implication when using MSCT for non-invasive cardiac imaging. Despite the high correlation, overestimation of EDV, EVS, SV, and MM with MSCT has to be taken into account when applying this technology in clinical practice. EF was not significantly different between both modalities.

Aged↗
PubMed1997

[Right ventricular function and pulmonary hypertension].

BACKGROUND: Hypothetically the right ventricular function measured by Equilibrium Radionuclide Ventriculography (RNV) is determined by the right ventricular ejection fraction and depends on the afterload. We investigated the possibility to evaluate the increased pulmonary artery pressure (PAP) by using this method. PATIENTS AND METHOD: We examined 109 patients (54.6 +/- 11 years) with chronic obstructive pulmonary disease (COPD). Lung function test, analysis of blood gases, pulmonary artery catheterisation and RNV were done within one week. RESULTS: There are 52 patients with non. 37 with labile and 20 with fixed pulmonary hypertension. Patients with normal PAP and nearly normal RVEF (49.2 +/- 8) were used as control group. Patients with pulmonary hypertension have had a lower mean RVEF, but there was no significant difference to the control group. Furthermore there was no significant correlation between mean PAP and RVEF detectable. By using RNV we diagnosed fixed pulmonary hypertension with a sensitivity of 95% and a specificity of 33% reduced RVEF and partial respiratory failure as a second noninvasive parameter achieved a more precise but not sufficient prediction of pulmonary hypertension, tested in Chi Square-Test. Obviously the RVEF depends not only on the afterload but also on the preload and contractility. However, influences on contractility are multidimensional and difficult to assess and to determine. CONCLUSION: Eventually it is not possible to use the RNV for measuring RVEF to diagnose pulmonary hypertension in COPD.

Adult↗
PubMed1991

Effect of controlled mechanical ventilation without positive end-expiratory pressure on right ventricular function after coronary artery bypass graft surgery.

To evaluate the changes in right ventricular function during controlled mechanical ventilation (CMV) without positive end-expiratory pressure (PEEP) and during spontaneous breathing, we compared right ventricular ejection fraction (RVEF), right ventricular end-diastolic volume index (RVEDVI), and right ventricular end-systolic volume index (RVEDVI) using a thermodilution technique after coronary artery bypass graft surgery. Patients were divided into two groups on the basis of changes in RVEDVI from CMV to spontaneous breathing: group U (n = 6) consisted of patients whose RVEDVI increased during spontaneous breathing compared with mechanical ventilation, group D (n = 3) consisted of patients whose RVEDVI decreased during spontaneous breathing compared with mechanical ventilation. PVRI values during CMV in group D were significantly larger than those in group U. Patients in group U showed no increase in RVEDVI, or decrease in RVEF during CMV without PEEP. However, the remaining 3 patients in group D showed an increase in RVEDVI and a decrease in RVEF during CMV. Mean PAP, RAP, RV systolic pressure, RV end-diastolic pressure, PWP, HR, and mean arterial pressure in both groups were comparable, and showed no significant difference at each of the measured points by 24 hrs postoperatively. Then, RVEF, RVEDVI and RVESVI measured by thermodilution technique is useful in evaluating ventricular function at bedside in ICU.

Journal Article↗
PubMed1993

Within-breath modulation of left ventricular function during normal breathing and positive-pressure ventilation in man.

1. To investigate how intrathoracic pressure affects left ventricular function during normal breathing and positive-pressure ventilation, beat-by-beat measurements of left ventricular stroke volume (LVSV; pulsed Doppler ultrasound), heart rate and blood pressure were made in five normal subjects breathing actively and then undergoing passive positive-pressure ventilation. 2. To assess the within-breath effects of positive-pressure ventilation on left ventricular function in the clinical setting, further measurements were made in six patients sedated, paralysed and ventilated because of brain injuries, who had no disease of the heart or lungs. 3. In the normal subjects, there were minimal phasic variation in LVSV during positive-pressure ventilation with the subject passive. Heart rate and blood pressure also stayed relatively constant throughout the ventilator cycle. During active breathing at the same depth and rate, there were large phasic respiratory variations in LVSV, with the lowest values occurring during inspiration. 4. In the paralysed and unconscious patients, an increase in LVSV was associated with the increase in airway pressure which occurred during lung inflation; however, the phase lag between the rise in airway pressure and the rise in LVSV varied widely between patients. These changes occurred whether or not sinus arrhythmia was present. 5. Addition of 4.6 +/- 1 cmH2O of positive end-expiratory pressure (PEEP) did not increase the within-breath LVSV variations, but resulted in a mean depression of LVSV of 5.4% (paired t test, P = 0.035). 6. The smaller variations in LVSV during positive-pressure ventilation compared to normal breathing in the conscious subjects may reflect (a) the smaller magnitude of positive, compared to negative, pleural pressure excursions which accompany a given tidal volume, and (b) an asymmetry between the effects of positive and negative pleural pressure on the heart. 7. The prominent effects of positive-pressure ventilation on LVSV in unconscious patients, compared to the minimal effects seen in ventilated normal subjects, may result from reduced lung compliance and a degree of pulmonary vascular congestion in the patients which was undetectable clinically or radiologically.

Adolescent↗
PubMed1989

Improvement of left ventricular function in chronic alcoholics following abstinence from ethanol.

Preclinical abnormalities of left ventricular function are frequently found in chronic alcoholics. In 12 chronic alcoholics without cardiomyopathy and in 12 healthy controls, systolic time intervals and echocardiograms were investigated before and after 12 months of abstinence from alcohol. In chronic alcoholics, an increase was found in the PEP/LVET ratio (0.31 +/- 0.06; in controls 0.24 +/- 0.05; t = 3.11; p less than 0.005), the diastolic interventricular septal thickness (6.0 +/- 2.0 mm/m2; in controls 4.1 +/- 1.0; t = 2.95; p less than 0.01), the left ventricular wall thickness (6.3 +/- 1.0 mm/m2; in controls 4.9 +/- 1.0; t = 3.43; p less than 0.005) and the left ventricular diastolic dimension (29 +/- 4 mm/m2; in controls 26 +/- 3; t = 2.08; p less than 0.05). The left ventricular mass (135 +/- 33 g/m2; in controls 113 +/- 40; t = 1.47) did not differ from the controls. After 12 months of abstinence a significant decrease was found in the PEP/LVET ratio (0.26 +/- 0.05, i.e. -16%; t = 3.59; p less than 0.005), the diastolic interventricular septal thickness (4.7 +/- 0.9 mm/m2, i.e. -22%; t = 2.73; p less than 0.02), the left ventricular posterior wall thickness (5.6 +/- 1.0 mm/m2, i.e. -11%; t = 4.08; p less than 0.001) and the left ventricular mass (109 +/- 24 g/m2, i.e. -21%; t = 6.53; p less than 0.001). The left ventricular diastolic dimension (27 +/- 2 mm/m2, i.e. -7%; t = 1.3) did not change. In conclusion, in chronic alcoholics, the abstinence from alcohol can be followed by an improvement of left ventricular function.

Adult↗
PubMed1994

Left ventricular function at 3 months after successful thrombolysis. Impact of reocclusion without reinfarction on ejection fraction, regional function, and remodeling.

BACKGROUND: After successful thrombolysis for acute myocardial infarction, reocclusion is observed in about 30% of patients after 3 months and usually occurs without reinfarction. We studied the impact of reocclusion without reinfarction on global and regional left ventricular function and on remodeling during that period. METHODS AND RESULTS: The patients for this analysis constituted a subset of those enrolled in the APRICOT-trial, which was designed to study the efficacy of antithrombotics on the prevention of reocclusion. Patients were selected who had a left anterior descending- or right coronary artery-related myocardial infarction, had an angiographically patent infarct-related vessel when studied < 48 hours after intravenous thrombolysis, and underwent repeat cardiac catheterization at 3 months. Paired contrast ventriculograms of quality sufficient to analyze regional wall motion, global ejection fraction, and ventricular volumes were analyzed in 129 patients. Enzymatic infarct size and baseline left ventricular function as well as other baseline characteristics were similar in patients with (n = 34) and without (n = 95) reocclusion. Ejection fraction improved in anterior infarction without reocclusion from 47 +/- 10% to 54 +/- 13% (P = .0001) but not with reocclusion (baseline, 48 +/- 13%; 3 months, 48 +/- 16%). No improvement was seen in inferior infarction with or without reocclusion. Persistent patency allowed preservation of end-systolic volume index (ESVI) at 3 months (37 +/- 14 mL/m2) to baseline level (38 +/- 13 mL/m2), with a better chance for improvement of > 10 mL/m2 without reocclusion in those with baseline values > 40 mL/m2. After reocclusion, in contrast, ESVI increased from 37 +/- 14 to 43 +/- 20 mL/m2 (P = .08). Comparable mean changes of ESVI in response to persistent patency or reocclusion were seen in anterior versus inferior infarction. Recovery of infarct zone contractility was impaired by reocclusion, both in terms of abnormality of segment shortening and expressed in the number of segments showing abnormal wall motion. In anterior but not in inferior infarction, infarct zone contractility was better with good collaterals to the reoccluded artery compared with poor collaterals. CONCLUSIONS: After successful thrombolysis for acute myocardial infarction, reocclusion without reinfarction withholds salvaged myocardium from regaining contractility. This has deleterious consequences for regional and global left ventricular function and for remodeling. To further optimize prognosis in patients after thrombolysis, future research should focus on the prevention of reocclusion and should evaluate revascularization therapy in patients with reocclusion.

Collateral Circulation↗
PubMed1991

[Improved left ventricular function and perfusion at rest following transluminal coronary angioplasty].

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201TI myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201TI uptake defects, showed normal 201TI distribution patterns on post-PTCA scintigrams. Post-exercise 201TI uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake.

Adult↗
PubMed2004

A novel method to assess systolic ventricular function using atrioventricular plane displacement--a study in young healthy males and patients with heart disease.

Analysis of atrioventricular plane displacement (AVPD) is a well established method for assessment of both systolic and diastolic ventricular function. For several years, AVPD has been a clinical tool and there are many current, as well as potential, areas of application. However, clinical work has shown that the traditional method for evaluation of systolic ventricular function, called total AVPD, does not temporally reflect true systole. Systolic AVPD is a new approach for measuring AVPD to assess ventricular systolic function. We wished to apply this new model in healthy subjects and in patients with different common heart diseases. Twenty-eight young healthy males and 30 patients (aortic stenosis, left sided regurgitant lesions, postmyocardial infarction) were enrolled. AVPD was obtained at the four standard sites by M-mode. Total AVPD was measured in the conventional way and systolic AVPD by identifying true systole, by means of mitral- and aortic valve closure respectively. Ventricular volumes were calculated according to biplane Simpson's rule. The systolic AVPD measurements were significantly lower than the total measurements, at both atrioventricular planes in all groups (P<0.001). This discrepancy was greater at the mitral than at the tricuspid annulus in the patients 24.2% vs. 15.5% (P<0.001), but did not differ in the healthy subjects. At the mitral annulus, this discrepancy also seemed to be more pronounced in the patients than in the healthy subjects 24.2% vs. 10.7%. When assessing ventricular systolic function by AVPD, the conventional method overestimates the amplitude in relation to true systolic function in both patients with heart disease and in young healthy males. Thus, there are uncertainties regarding earlier estimations of AVPD in terms of expression of systolic function and regarding previously presented reference values. We recommend the proposed methodology.

Adult↗
PubMed2000

Echocardiographic validation of gated SPECT ventricular function measurements.

UNLABELLED: Left ventricular (LV) volumes are valuable prognostic indicators in the management of coronary artery disease and traditionally have been obtained by x-ray contrast angiography or echocardiography. There now are several scintigraphic methods to compute volumes that are based on different LV modeling assumptions. Both the reasons that calculations from different nuclear techniques can disagree with one another and the relationship of these values to the more conventional echocardiographic measurements must be investigated thoroughly for calculations to be interpretable for individual patients. METHODS: Echocardiographic volumes were determined in 33 retrospective subjects with coronary artery disease (mean age, 61 +/- 12 y; 42% men; 70% with abnormal perfusion and 58% with abnormal segmental wall motion) using the modified Simpson's rule technique applied to digitized apical 4-chamber and apical 2-chamber views of 4 averaged heartbeats. These volumes were compared with those from 3 gated SPECT methods based on Simpson's rule LV modeling similar to standard echocardiographic algorithms (SPECT EF from St. Luke's-Roosevelt Hospital) (method 1), Gaussian myocardial count profile curve fitting (QGS from Cedars-Sinai Medical Center) (method 2), and an endocardial model based on perfusion sampling and count-based thickening (Cardiac Toolbox from Emory University) (method 3). RESULTS: By ANOVA, there were no significant differences among ejection fractions (EFs), but there were for volumes. Paired t test analysis showed volumes from methods 2 and 3 to be significantly larger than echocardiographic volumes and larger than those of method 1. Linear regression analysis comparing gated SPECT and echocardiographic volumes showed a nearly identical strong correlation (r = 0.92; P < 0.000001) for all 3 methods. Excellent correlation also was found among gated SPECT volumes from the 3 methods (r = 0.94). Bland-Altman analysis and t tests showed that method 1 volumes (70 +/- 61 mL) were the same as for echocardiography (77 +/- 55 mL), but volumes were overestimated by method 2 (105 +/- 74 mL) and method 3 (127 +/- 92 mL), particularly for larger volumes. Pearson coefficients for EFs compared with echocardiography were r = 0.82, 0.75, and 0.72 for methods 1-3, respectively. EFs correlated strongly among the 3 gated SPECT methods (r = 0.86-0.92). The Fisher z test showed no differences among these methods for any of the volume or EF linear correlation analyses. CONCLUSION: All gated SPECT parameters correlated well with echocardiographic values. However, the gated SPECT method for which underlying assumptions most closely resembled those commonly used in echocardiography produced mean volume values closest in agreement with echocardiographic measurements.

Analysis of Variance↗
PubMed1984

Effects of spontaneous respiration on left ventricular function assessed by echocardiography.

The effects of quiet respiration on assessment of left ventricular function by two-dimensional echocardiography were investigated in 12 healthy men. End-diastolic area in the parasternal short-axis view decreased with inspiration (from 17.3 +/- 2.1 [mean +/- SD] to 16.0 +/- 2.1 cm2, p less than .01), while end-systolic area did not change (from 7.6 +/- 1.4 to 7.7 +/- 1.5 cm2; NS). A fixed cursor that was located through the center of the left ventricular area at end-expiration made a tangential cut of the area at end-inspiration were smaller along the cursor than through the center of the short-axis area both at end-diastole (1.9 +/- 1.7 mm; p less than .01) and end-systole (3.8 +/- 4.0 mm; p less than .01). Our results suggest a need for standardization with regard to respiratory phases in assessment of left ventricular function by two-dimensional echocardiography and indicate the occurrence of inspiratory reduction of left ventricular stroke volume associated with decreased diastolic filling. Motion of the heart relative to the echo beam may play a part in the respiratory variations in left ventricular dimensions assessed by M mode echocardiography.

Adult↗
PubMed2001

Reference values for left ventricular function in subjects under general anaesthesia and controlled ventilation assessed by two-dimensional transoesophageal echocardiography.

BACKGROUND AND OBJECTIVE: Transoesophageal echocardiography is increasingly used for evaluation and monitoring of left ventricular function in anaesthetized patients. However, the only available reference values for transoesophageal echocardiography were derived from studies in awake subjects. METHODS: We determined left ventricular dimensions and systolic function in 45 patients without clinical evidence of heart disease who voluntarily underwent transesophageal echocardiography under conditions of balanced general anaesthesia, controlled fluid administration, supine position, muscle relaxation and controlled ventilation. RESULTS: The left ventricular dimensions obtained during these conditions were lower than the published normal values in awake subjects. The indices of global left ventricular function, however, were similar to the normal values obtained by either awake transesophageal echocardiography or transthoracic echocardiography. CONCLUSION: We propose using the values obtained in our study as reference values for evaluation of left ventricular function in patients under general anaesthesia and controlled ventilation.

Adult↗
PubMed2006

Angiotensin-converting enzyme inhibition in patients with coronary artery disease and preserved left ventricular function Ischemia Management with Accupril post-bypass graft via inhibition of angiotensin-converting enzyme (IMAGINE) compared with the other major trials in coronary artery disease.

It has been hypothesized that angiotensin-converting enzyme (ACE) inhibition, independent from its effect on ventricular function and blood pressure, could affect the atherosclerotic process and reduce the incidence of ischemic events and its complications. Several large clinical outcome trials were designed to test this hypothesis: QUIET, HOPE, EUROPA, PEACE, and IMAGINE. The results of the PEACE study were recently reported, leaving the IMAGINE study as the last chapter in our efforts to evaluate the role of ACE inhibition in coronary artery disease with preserved left ventricular function. In this report, we compare these studies with respect to their methodology and patient population and analyze the unique nature of the last ongoing study, IMAGINE. The reported studies show that patients with coronary artery disease who are at low-to-moderate or high risk should receive an ACE inhibitor if tolerated. However, when the absolute risk of a patient decreases, and intensive contemporary management is given, with good control of risk factors, the absolute and perhaps relative benefits of an ACE inhibitor decrease and their routine use in these patients may not be warranted. The role of ACE inhibition started early post-coronary artery bypass graft in patients with preserved left ventricular function, and intensive contemporary management remains to be determined and should get answered by the IMAGINE study. Moreover, the IMAGINE population is not only a lower risk population than those enrolled in HOPE or EUROPA, but also the risk for this population is bimodal in nature (early post-revascularization inflammation and thrombosis vs long-term atherosclerosis progression) and may provide further insight into underlying mechanisms.

Aged↗
PubMed1991

Late variation in ventricular function after myocardial infarction.

To assess the possible role of variables not related to early infarct artery reperfusion in predicting late changes in ventricular function after infarction, paired early (mean 6.6 +/- 3.5 days after admission) and late (12.7 +/- 7.0 months later) cross-sectional echocardiograms from 54 infarction survivors were retrospectively reviewed. Ejection fraction was calculated from digitized biapical echocardiographic views on a graphics tablet. Changes of 0.10 or more in LVEF were correlated with 23 clinical variables. By stepwise regression analysis, Q-wave infarction and low early LVEF independently predicted late improvement in function. Early high LVEF and interval infarction were the only independent predictors of late declines in function. Overall, when patients were indexed by early left ventricular systolic function, a pronounced late "regression to the mean" was noted with initially high values tending to fall and low values to rise (r = -0.44, p less than 0.001). This effect must be accounted for in any acute intervention trial in myocardial infarction. The occurrence of Q-wave infarction does not exclude late improvement in ventricular function.

Echocardiography↗
PubMed1994

Right ventricular function and oxygen transport patterns in patients with acute respiratory distress syndrome.

We investigated the impact of right ventricular performance on oxygen kinetics in 15 consecutive patients with acute respiratory distress syndrome. Six hundred and twenty-two complete assessments of haemodynamics, right ventricular function and oxygenation were used for evaluation. Patients were grouped as survivors (n = 8) and nonsurvivors (n = 7) and studied during four phases of lung failure. Oxygen delivery and consumption were significantly higher in survivors compared to nonsurvivors despite comparable arterial oxygen saturation. Right ventricular end-diastolic volumes were similar for both groups, while end-systolic volumes were significantly higher in nonsurvivors due to depressed ejection fraction (40.5 (SD 1.2) versus 34.4 (SD 2.8)%) during all phases of lung failure. No clinically relevant differences in right ventricular function or oxygenation were observed between periods of moderate or severe pulmonary hypertension. Nonsurvivors have depressed cardiac function caused by reduced contractility and not by inadequate right ventricular end-diastolic volume (preload) or increased pulmonary artery pressure (afterload). Maintenance of oxygen delivery in ARDS is predominantly a function of cardiac performance and not of pulmonary gas exchange.

Adult↗