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PubMed1978

Time- and dose-dependent changes in ejection fraction determined by radionuclide angiography after anthracycline therapy.

Twenty patients receiving anthracycline chemotherapy were studied by the technique of radionuclide ejection fraction (EFrn). This technique is capable of detecting noninvasively small changes in left ventricular function. Two patterns of anthracycline toxicity emerged: (a) an acute toxicity observable between 24 and 72 hours after administration of greater than 60 mg/m2 of anthracycline with some recovery noted by 72-96 hours (no changes were observed within the first 4 hours after administration of the drug), and (b) a chronic dose-dependent decrease in left ventricular function when studies were performed 3 weeks after the last dose of anthracycline. After anthracyclines were stopped, four of four patients showed significant recovery in left ventricular function. We concluded that the radionuclide EFrn is a sensitive noninvasive index of left ventricular function which can be used to serially study patients receiving anthracycline therapy and can potentially be used to evaluate pharmacologic means for preventing anthracycline cardiotoxicity.

Adult↗
PubMed1996

Does impedance cardiography reliably estimate left ventricular ejection fraction?

OBJECTIVE: The objective of our study was to evaluate impedance cardiography (IMP) as a noninvasive method to determine the left ventricular ejection fraction (LVEF). METHODS. A total of 24 patients, 8 men and 16 women, aged 45.0 +/- 12.9 years, participated in the study. They used cardiotoxic chemotherapeutic drugs or suffered from cardiac failure. LVEF was measured by means of IMP (LVEFimp) and radionuclide ventriculography (LVEFnuc). LVEFimp was calculated in three ways. Capan and colleagues [13] proposed a formula in which LVEF (LVEFCap) can be calculated from the systolic time intervals, namely, left ventricular ejection time and preejection time. Judy and colleagues [14] described a systolic (S) and a diastolic (D) part in the first derivative curve of the impedance signal. The ratio S/D might equal the LVEF (LVEFJud). A new LVEF calculation was introduced (LVEFimp) in this study based on the first derivative of the impedance signal, the thoracic impedance, and heart rate. RESULTS: Mean LVEFCap was 59.9 +/- 8.4%, which did not differ from LVEFnuc (59.9 +/- 7.1%). However the correlation between both methods was not significant (r = 0.29). Mean LVEFJud was 63.9 +/- 17.4%, which was not significantly different from LVEFnuc, with a fair correlation (r = 0.55). Mean LVEFimp was 59.2 +/- 9.4%, with a better correlation with radionuclide ventriculography (r = 0.75). CONCLUSIONS: The results of this study indicate that the equations that have been used until now can be improved. The new equation provides reliable LVEF values in this group of patients.

Antibiotics, Antineoplastic↗
PubMed1991

Evaluation of the densitometric method of ejection fraction by direct digital subtraction left ventriculography.

The aim of the present study was to test the hypothesis that the densitometric ejection fraction (EF) could be calculated by direct contrast digital subtraction left ventriculography in a single heartbeat. Thirty patients underwent direct contrast digital subtraction left ventriculography and biplane conventional left ventriculography. The values of EF were obtained from digital subtraction ventriculograms of the first cardiac cycle after completion of the injection of the contrast medium by the videodensitometric technique and were compared with those obtained from conventional ventriculograms by the area-length method in the same patients. There was a close correlation between the densitometric EF from digital subtraction ventriculograms and the volumetric EF from conventional ventriculograms (r = 0.78). Densitometric EF measured in the 30 degree right anterior oblique projection highly correlated with densitometric EF measured in the 60 degree left anterior projection (r = 0.98). These data suggest that this densitometric technique is available in any projection and is a simple procedure for the accurate measurement of left ventricular EF.

Absorptiometry, Photon↗
PubMed1995

Visual estimation of ejection fraction by two-dimensional echocardiography: the learning curve.

Our purpose was to determine the learning curve of visual estimation of ejection fraction (EF) by echocardiography. Sixty consecutive patients, who had clinically indicated echocardiography and radionuclide ventriculography (RVG) within 1 month were selected. Five standard views were reviewed independently by a first-year cardiology fellow, a private cardiologist, and an experienced echocardiographer. Observers were given feedback of the RVG EFs immediately after estimating the EF on each study. To assess the effect of learning, the echocardiographic studies were divided into three groups of 20 and were read successively by each observer. A statistical comparison of the two methods was performed for each group. The correlation between the two techniques for the first group of studies was marginal. There was a significant improvement in the correlation with subsequent groups. The correlation did not change significantly with the last group of studies compared with the second group. In conclusion, visual estimation of EF by two-dimensional echocardiography can be learned, with a learning curve of approximately 20 studies if immediate feed-back is available.

Echocardiography↗
PubMed1986

Right ventricular ejection fraction: comparison of technetium-99m first pass technique and ECG-gated steady state krypton-81m angiocardiography.

Right ventricular ejection fraction (RVEF) calculated from ECG-gated steady-state 81mKr angiocardiography and from 99mTc first-pass studies were compared in 30 patients using a digital, single crystal, gamma-camera. Despite the two entirely different approaches RVEF values obtained by the two methods were comparable (r = 0.97): the mean absolute difference between the two techniques was 2.5% +/- 1.5% and the largest observed absolute difference was 5%. In the absence of an accepted reference method for measuring RVEF, this close correlation provides indirect validation of both techniques. The choice of method will therefore depend on several factors, including radiotracer availability, the characteristics of the gamma-camera and the protocol of clinical investigation.

Adult↗
PubMedDate not supplied

Rest and treadmill exercise first-pass radionuclide ventriculography: validation of left ventricular ejection fraction measurements.

BACKGROUND: To assess the accuracy of rest and treadmill exercise first-pass radionuclide ventriculographic measurements of left ventricular ejection fraction (LVEF), 40 patients underwent treadmill exercise first-pass and bicycle exercise equilibrium radionuclide ventriculography. To determine the frequency of technically adequate treadmill exercise first-pass studies, an additional 128 consecutive patients undergoing treadmill exercise first-pass procedures during stress 99mTc-labeled sestamibi myocardial perfusion studies were assessed. METHODS AND RESULTS: The treadmill exercise first-pass procedure used a multicrystal camera and an 241Am point source to allow for correction of patient motion. Excellent correlations were observed between resting first-pass and resting equilibrium LVEF (r = 0.91; standard error of the estimate = 5.6). A high correlation was also observed between treadmill exercise first-pass and bicycle equilibrium exercise LVEF measurements (r = 0.85, standard error of the estimate = 7.6). Treadmill first-pass LVEF systematically underestimated the bicycle equilibrium LVEF. Intraobserver agreement for rest and exercise first-pass LVEF was high (r values of 0.98 and 0.94, respectively). Of the 168 consecutive treadmill exercise first-pass studies evaluated for technical adequacy, 21 (12.5%) were deemed technically inadequate, with most of the sources of error being avoidable. The frequency of technically adequate studies was as high (87%) in high levels of exercise (Bruce stages 3 and 4) as in lower levels (88%). The findings of this study validate the first-pass treadmill exercise LVEF measurement. CONCLUSION: This procedure now provides the option for combining the information of peak treadmill exercise LVEF with measurements of exercise myocardial perfusion from the same injection of radioactivity.

Adult↗
PubMed1985

Value and limitations of radionuclide angiography in determining the cause of reduced left ventricular ejection fraction: comparison of idiopathic dilated cardiomyopathy and coronary artery disease.

The radionuclide angiograms of 59 patients with a left ventricular (LV) ejection fraction (EF) less than 0.40, 23 with idiopathic dilated cardiomyopathy (IDC) and 36 with coronary artery disease (CAD) were analyzed to assess the usefulness of radionuclide angiography in distinguishing these conditions. Mean right ventricular EF was lower in the IDC group than in the CAD group, 0.31 vs 0.45 (p less than 0.01). LV wall motion was scored from 3 (normal) to -1 (dyskinesia). The incidence of akinesia was similar in IDC and CAD groups, 70% and 83%, respectively. Dyskinesia was more common in the CAD group (42% vs 17%), but the difference was not statistically significant. Segmental wall motion analysis showed similar patterns of wall motion in both groups, with contraction best preserved in the anterobasal, posterobasal and superolateral segments. Patients in the CAD group had worse apical motion (p less than 0.01) and better wall motion in the anterobasal (p less than 0.05) and superolateral walls (p less than 0.01), compared with patients in the IDC group. To assess symmetry of contraction, a maximum difference score was derived for each patient. Symmetry (a score less than 1) was present in 5 IDC and no CAD patients, whereas asymmetry (a score of 2 or more) was present in 27 CAD and 7 IDC patients (p less than 0.01). Wall motion became more symmetric in both groups when LVEF was less than 0.20. Logistic regression analysis revealed that the maximum difference score was the best predictor of the diagnosis, but only because of better separation at the extremes of maximum difference score values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Accuracy of left ventricular ejection fraction using the nuclear stethoscope in left ventricular aneurysm.

Although the nuclear stethoscope, a nonimaging probe, accurately determines left ventricular (LV) ejection fraction (EF), its reliability in patients with LV aneurysm has not been established. Accordingly, LVEF was determined using the nuclear stethoscope and compared with that determined by equilibrium gated blood pool scanning in 29 patients, 1 studied on 2 separate occasions, for a total of 30 patient studies. Patient studies were separated into 2 groups. Patients in group I (n = 20) had no gated blood pool evidence for aneurysm, and those in group II (n = 10) had discrete focal akinesia or dyskinesia. Nineteen patients (13 in group I and 6 in group II) had 2 separate nuclear stethoscope acquisitions. In group I, EF determined by gated blood pool scanning (53 +/- 4%, mean +/- standard error) did not differ from that determined by nuclear stethoscope (51 +/- 4%). EF determined using either gated blood pool scanning (32 +/- 6%) or nuclear stethoscope (35 +/- 5%) was significantly lower in group II than in group I, although nuclear stethoscope and gated blood pool scanning did not differ. Reproducibility was excellent (r = 0.96). Overall, nuclear stethoscope and gated blood pool EFs correlated closely (r = 0.93), and the correlation coefficients were similar in groups I (r = 0.92) and II (r = 0.92). The slopes of the regression curves for group I (0.97) and group II (0.92) were not statistically different. These results confirm the accuracy and reproducibility of LVEF determination by nuclear stethoscope and specifically demonstrate its reliability in patients with LV aneurysm.

Adult↗
PubMed2006

Differences in left ventricular ejection fraction and volumes measured at rest and poststress by gated sestamibi SPECT.

BACKGROUND: Some studies suggested that the poststress left ventricle ejection fraction (LV EF) is lower than rest LV EF in patients with stress-induced ischemia. METHODS AND RESULTS: By using a 2-day protocol and 30 mCi Tc-99m sestamibi, LV EF, end-systolic volume (ESV), and end-diastolic volume (EDV) were measured with gated SPECT. Of 99 eligible patients, 91 had technically adequate studies. Poststress LV EF minus rest LV EF was defined as DeltaLV EF. DeltaEDV and DeltaESV were similarly defined. Rest and poststress LV EF (r = 0.89), EDV (r = 0.78), and ESV (r = 0.93) were highly correlated (P <.001). Rest LV EF, EDV, and ESV were not significantly different between patients with and without stress-induced ischemia. DeltaLV EF was significantly lower in patients with stress-induced ischemia (-3.5% +/- 4.5% vs -1.1% +/- 4.7%, P = .02). Mean LV EF poststress in ischemic patients was 55.0% +/- 10.5% vs 61.2% +/- 10.0% in nonischemic patients (P = .008). However, only 1 patient (3%) with ischemia had DeltaLV EF that exceeded the 95% confidence limit of DeltaLV EF for normal patients. Ischemia was significantly associated with increased DeltaEDV and DeltaESV (P < .01). CONCLUSIONS: Stress-induced ischemia is associated with poststress reduction in LV EF and increased poststress EDV and ESV. However, the effect of ischemia on the difference between poststress and rest EF measurements is modest and rarely exceeds the confidence limits in normal patients undergoing 2-day protocols. In most patients, poststress LV EF is an accurate reflection of rest LV EF.

Aged↗
PubMed1997

Comparison of left ventricular ejection fraction in congenital heart disease by visual versus algorithmic determination.

Two-dimensional (2D) echocardiographic visual estimation of left ventricular (LV) ejection fraction (EF) in patients with acquired heart disease yields results that are comparable to those obtained by recommended algorithms. However, there is no information concerning its accuracy in congenital heart disease. This study compares applicability, accuracy, and reproducibility of LVEF by visual estimation with that by currently used algorithms (cylinder hemiellipsoid, ellipsoid biplane, and biplane method of disks) in 92 consecutive patients with congenital heart disease but unrepaired complete atrioventricular septal defect, univentricular heart, and hypoplastic left ventricle, using 3D echocardiography as the reference method. Visual estimation of LVEF could be applied in all cases. Because of technically inadequate 2D echocardiographic images for volume measurement, analysis for comparison could be performed in 71 patients (77%), aged 1 day to 47 years. The correlation between 3D echocardiographic and visual estimation was 0.91 (SEE 3.3%), cylinder hemiellipsoid, 0.86 (SEE 3.9%), ellipsoid biplane 0.87 (SEE 3.9%), and biplane method of disks 0.93 (SEE 3.2%). Intraobserver variability was similar for all 2D echo methods. Interobserver variability was greater for visual estimation. In conclusion, visual estimation of LVEF is applicable to most patients with congenital heart disease, yielding results that are comparable to those obtained by currently used 2D echocardiographic algorithms.

Adolescent↗
PubMed2003

Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial.

BACKGROUND: The improvement in left-ventricular ejection fraction (LVEF) in response to beta blockers is heterogeneous in patients with heart failure due to ischaemic heart disease, possibly indicating variations in the myocardial substrate underlying left-ventricular dysfunction. We investigated whether improvement in LVEF was associated with the volume of hibernating myocardium (viable myocardium with contractile failure). METHODS: We did a double-blind, randomised trial to compare placebo and carvedilol for 6 months in individuals with stable, chronic heart failure due to ischaemic left-ventricular systolic dysfunction. We enrolled 489 patients, of whom 387 were randomised. Patients were designated hibernators or non-hibernators according to the volume of hibernating myocardium. The primary endpoint was change in LVEF, measured by radionuclide ventriculography, in hibernators versus non-hibernators, on carvedilol compared with placebo. Analysis was by intention to treat. RESULTS: 82 patients dropped out of the study because of adverse events, withdrawal of consent, or failure to complete the investigation. Thus, 305 (79%) were analysed. LVEF was unchanged with placebo (mean change -0.4 [SE 0.9] and -0.4 [0.8] for non-hibernators and hibernators, respectively) but increased with carvedilol (2.5 [0.9] and 3.2 [0.8], respectively; p<0.0001 compared with baseline). Mean placebo-subtracted change in LVEF was 3.2% (95% CI 1.8-4.7; p=0.0001) overall, and 2.9% (0.7-5.1; p=0.011) and 3.6% (1.7-5.4; p=0.0002) in non-hibernators and hibernators, respectively. Effect of hibernator status on response of LVEF to carvedilol was not significant (0.7 [-2.2 to 3.5]; p=0.644). However, patients with more myocardium affected by hibernation or by hibernation and ischaemia had a greater increase in LVEF on carvedilol (p=0.0002 and p=0.009, respectively). INTERPRETATION: Some of the effect of carvedilol on LVEF might be mediated by improved function of hibernating or ischaemic myocardium, or both. Medical treatment might be an important adjunct or alternative to revascularisation for patients with hibernating myocardium.

Adrenergic beta-Antagonists↗
PubMed1986

Prospective, randomised, double-blind study of radionuclide determination of left-ventricular ejection fraction in acute myocardial infarction.

In a controlled, randomised, double-blind study to see whether knowledge of left-ventricular ejection fraction (LVEF) could reduce the frequency of left-sided heart failure after acute myocardial infarction, LVEF was determined a few days before hospital discharge in a consecutive series of 60 patients. Subsequently, the patients were randomly assigned to two groups. The cardiologist responsible for their treatment was aware of the LVEF result in group I but not in group II. A month after hospital discharge there was no significant difference in the LVEF between the groups. 2 months after discharge there were no significant differences between the groups in clinical and radiological signs of left-ventricular heart failure or the use of drugs. The cardiologist's clinical estimate of the LVEF and the result of the radionuclide determination were significantly correlated. Thus, the use of LVEF did not change the clinical outcome. The need for randomised controlled studies in the evaluation of diagnostic methods is emphasised.

Adult↗
PubMed1997

Left ventricular filling and ejection fraction after successful percutaneous balloon mitral valvuloplasty.

The effect of percutaneous balloon mitral valvuloplasty (PBMV) on left ventricular (LV) filling and ejection fraction (EF) still remains controversial. We evaluated LV filling and EF in 23 patients (19 women and four men, mean age 35.6+/-9.6, range 17-56 years) with mitral stenosis (MS) and sinus rhythm immediately before and after successful PBMV not complicated with significant mitral regurgitation and arrhythmia during left ventriculography. After PBMV mean mitral valve area increased from 1.4+/-0.2 to 2.2+/-0.3 cm2 (P<0.01), mean mitral valve gradient (MVG) decreased from 18.6+/-5.7 to 6.9+/-3.2 mmHg (P<0.01) and mean left atrial pressure (LAP) decreased from 26.0+/-8.2 to 12.3+/-5.2 mmHg (P<0.01). We did not determine any change in EF (before PBMV 61.8+/-9.3% and after PBMV 61.8+/-7.6% (P>0.05)). Heart rate did not change significantly before and after valvuloplasty (P>0.05). Despite the decrease in LAP and MVG, the early diastolic filling fraction of left ventricle did not change (before PBMV 59.5+/-7.5%, after PBMV 57.8+/-8.9% (P>0.05)). Also, we did not determine any increase in LV end diastolic volume index (before PBMV 89.9+/-27.7 cm3/m2 and after PBMV 84.6+/-20.9 cm3/m2 (P>0.05)). However, LV end diastolic pressure increased significantly after PBMV (from 6.6+/-3.0 to 11.3+/-4.9 mmHg (P<0.01)). We conclude that in patients with MS, LV diastolic performance is impaired and LV EF does not change acutely after PBMV.

Adolescent↗
PubMedDate not supplied

Accurate determination of left ventricular ejection fraction by transesophageal echocardiography with a nonvolumetric method.

The multiple diameter method previously described and validated for transthoracic echocardiography (TTE) determines ejection fraction (EF) by use of the average of several left ventricular (LV) diameters from multiple views measured at the base, midthird, and distal third of the LV combined with an estimate of the shortening fraction of the long axis (delta L). This method may be ideal for transesophageal echocardiography (TEE) because it does not require tracing of the endocardial contour or volume determinations. Accordingly, EF was calculated with the multiple diameter method in 20 patients in whom TTE and TEE were performed within 1 hour of each other. EF by TTE averaged 49% +/- 20% and ranged from 14% to 80%. The multiple diameter method was modified for TEE as follows: (1) three diameters were taken from the four-chamber view (base, mid-LV, and distal LV) and four from the transgastric view (approximately at 45 degrees from each other), (2) because the LV apex is not well seen by TEE, delta L was estimated from the descent of the mitral anulus towards the apex as 0.15, 0.10, 0.05, or 0 for a descent of > or = 10, 6 to 9, 3 to 5 or < or = 2 mm, respectively. EF by TEE averaged 48% +/- 21% and correlated very well with EF by TTE (r = 0.98; y = 1.03x-2.7). The diameter method was tested prospectively in 30 patients undergoing coronary artery bypass surgery. TEE and TTE were performed within 5 minutes of each other with the patients asleep before initiation of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography, Transesophageal↗
PubMed2001

Influence of right ventricular pre- and afterload on right ventricular ejection fraction and preload recruitable stroke work relation.

When right ventricular (RV) afterload is abnormally increased, it correlates inversely with right ventricular ejection fraction (RVEF). We tested, whether this would be different with normal afterload. Additionally, we investigated whether previous studies on the slope of RV preload recruitable stroke work (SW) relation, which used rather non-physiological measures to change RV preload, could be transferred to more physiological loading conditions. RV volumes were determined by thermodilution in 16 patients with stable coronary artery disease and normal pulmonary artery pressure (PAP) at rest. Pre- and afterload were varied by body posture, nitroglycerin (NTG) application and by exercise at different body positions. At rest, the change from recumbent to sitting position decreased PAP, cardiac index (Ci), RV diastolic and systolic volumes, and RVEF. Additionally, mean pulmonary artery pressure (MPAP) correlated positively with both RVEF and cardiac index. After correction for mathematical coupling, the RV preload recruitable SW relation was: right ventricular stroke work index (RVSWi) (103 erg m-2)= 8.1 x (RV end-diastolic volume index -4.9), with n=96, r=0.57, P< or =0.001. Exercise abolished this correlation and led to an inverse correlation between RV end-systolic volume (ESV) and RVSW. In conclusion, (i) RVEF correlates positively with RV afterload when afterload varies within normal range; (ii) the slope of the RV preload recruitable SW relation, which is obtained at steady state under normal loading conditions, is substantially flatter than previously described for dynamic changes of RV preload. With increasing afterload, preload loses its determining effect on RV performance, while afterload becomes more important. This puts earlier assumptions of an afterload independent RV preload recruitable SW relation into question.

Aged↗
PubMed2004

Time-effectiveness, observer-dependence, and accuracy of measurements of left ventricular ejection fraction using 4-channel MDCT.

PURPOSE: To evaluate the time-effectiveness, inter-observer variance, and accuracy of left ventricular ejection fraction (EF) measurements using retrospectively ECG-gated four-channel multi-detector row CT (MDCT) angiography in comparison with biplane cine-ventriculography. MATERIALS AND METHODS: Twenty consecutive patients underwent retrospectively ECG-gated MDCT angiography and conventional coronary angiography with biplane ventriculography. Raw MDCT data were reconstructed at 0 % - 90 % of the cardiac cycle in increments of 10 %. Ten geometrically identical multiplanar reformations parallel to the short axis of the heart were reconstructed in each patient. Three blinded readers segmented the left ventricle in the end-systolic and end-diastolic phase using standardized window settings in order to determine the EF. The EF was measured with biplane cine-ventriculography by two blinded readers and was compared with MDCT. The time needed for post-processing was recorded and the inter-observer agreement for both imaging techniques was assessed. RESULTS: Mean post-processing time was 63 +/- 3 min per patient for MDCT and 5.5 +/- 1.2 min for ventriculography. MDCT and ventriculography showed a good correlation (r = 0.83, p < 0.0001) for measurement of the EF. Mean errors of EF measurements for the three MDCT readers compared with the mean of the ventriculography were - 6.3 +/- 6.6 %, - 4.7 +/- 7.1 % and - 4.6 +/- 5.7 %, respectively. The mean differences between the three readers assessing MDCT were - 1.6 +/- 3.2 % (reader 1 versus 2, r = 0.96), - 1.6 +/- 5.6 % (1 versus 3, r = 0.95) and - 0.011 +/- 2.9 % (2 versus 3, r = 0.97, p < 0.0001). The mean differences between the two readers assessing ventriculography was 0.32 +/- 5.1 % (r = 0.88, p < 0.0001). CONCLUSIONS: MDCT correlates well with biplane cine-ventriculography but has the tendency to underestimate the left ventricular EF. Measurements using MDCT have a high inter-observer agreement, however, the time needed for additional MDCT data post-processing is still unacceptably long.

Aged↗
PubMedDate not supplied

Predictors of improvement in left ventricular ejection fraction with carvedilol for congestive heart failure.

BACKGROUND: Beta-blocker therapy has been reported to improve survival and left ventricular ejection fraction (LVEF) in the setting of congestive heart failure (CHF). The magnitude and predictors of improved LVEF are unclear. METHODS: A total of 295 patients were enrolled in the study. Inclusion criteria were LVEF <35% at baseline and symptomatic (New York Heart Association class II to IV) CHF despite treatment with at minimum an angiotensin-converting enzyme inhibitor. Carvedilol was initiated at 3.125 mg twice daily and titrated to a target dose of 25 or 50 mg twice daily, depending on the patient's weight. Paired pretreatment baseline and 9 months with treatment follow-up quantitative LVEFs (assessed by resting radionuclide ventriculograms) were obtained in 161 (55 %) of the patients. RESULTS: LVEF improved from 25% +/- 6% at baseline to 36%+/-12% at follow-up (P<.001). Mean change in LVEF (deltaLVEF) was greater for nonischemic cardiomyopathy (NICM) (+14.5+/-2 LVEF points) than ischemic cardiomyopathy (deltaLVEF +/- 7.6+/-10 EF points, P = .001). The deltaLVEF was > or =21 LVEF points in 30% of the NICM group versus 10% of the ischemic cardiomyopathy group. Conversely, the deltaLVEF was unchanged to minimally improved (< or =5 LVEF points) in 21% of the NICM group versus 52% of the ischemic cardiomyopathy group. Multivariable analysis identified NICM and recent onset of congestive heart failure as correlates of improved LVEF. CONCLUSIONS: Carvedilol significantly improved LVEF, especially in patients with NICM and those with recent onset of CHF.

Adrenergic beta-Antagonists↗
PubMed1998

Ejection fraction improvement by beta-blocker treatment in patients with heart failure: an analysis of studies published in the literature.

Because ejection fraction (EF) is one of the most important predictors of survival in patients with left ventricular (LV) dysfunction and because Packer showed a large reduction in mortality figures with carvedilol, in contrast to former studies with bisoprolol and metoprolol, we investigated if this difference in survival may be related to a difference in improvement of LV function by different beta-blockers. We searched the MEDLINE database and all reference lists of articles obtained through the search for the relation between beta-blocker treatment and improvement in EF. Forty-one studies met the criteria and we added two of our own studies. Four hundred and fifty-eight patients were treated with metoprolol with a mean follow-up of 9.5 months and a mean increase in EF of 7.4 EF units. One thousand thirty patients were treated with carvedilol with a mean follow up of 7 months and a mean increase in EF of 5.7 EF units. One hundred ninety-nine patients were treated with bucindolol with a mean follow-up of 4 months and a mean increase in EF of 4.6 EF units. Several small studies with nebivolol, atenolol, and propranolol were also studied and, when combined, the mean increase in EF was 8.6 EF units. When patients with idiopathic and ischemic cardiomyopathies were compared, the average increase in EF units was 8.5 vs. 6.0, respectively. The use of beta-blocker treatment in heart failure patients, irrespective of the etiology, improved LV function in almost all studies and it appears that the differences among beta-blockers and among etiologies is small and probably insignificant. However, there is a difference in survival rate when the various beta-blockers are compared, suggesting that mechanisms other than improvement of LV function by beta-blockers are responsible for the difference in survival.

Adrenergic beta-Antagonists↗