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PubMedDate not supplied

Effect of contrast media on left ventricular function during left coronary arteriography in dogs.

The effect of contrast media on the left ventricular function of the heart was assessed by left coronary administration of contrast media using canine models. Following insertion of the catheter into the left coronary artery, 0.5 ml/kg of a test solution was injected at a rate of 1 ml/s. The test solutions included isotonic saline, meglumine/sodium diatrizoate, iopamidol and ioxaglate. The mean systemic pressure, left ventricular end-systolic and end-diastolic pressures and the first derivative of left ventricular pressure were continuously measured until five min post-injection. Left ventricular function decreased immediately by 15 s post-injection and recovered quickly by one min. The inhibition of myocardial contractility was observed with diatrizoate and ioxaglate to the same degree. These changes were statistically more pronounced than those with iopamidol, which showed changes similar to those with saline in all parameters except for the positive inotropic effects. These observations suggest that not only hyperosmolality but also ionic composition and chemotoxicity are the factors responsible for the myocardial depression and that no single factor dominates in their effects.

Animals↗
PubMed1985

Relation of left ventricular function and prognosis in hypertrophic cardiomyopathy: an angiographic study.

Left ventricular cineangiograms performed at the time of diagnosis in 88 patients with hypertrophic cardiomyopathy were digitized to evaluate the relation of left ventricular function and prognosis in hypertrophic cardiomyopathy. Eleven patients died suddenly after a mean follow-up period of 7.5 +/- 7 years, 10 patients died of congestive heart failure or after cardiac surgery and 67 were alive after a mean follow-up period of 8.6 +/- 4 years. Measurements of left ventricular volume, ejection fraction, peak rate of ejection and filling and time to peak rate of ejection and filling were derived from curves of ventricular volume and its rate of change during the cardiac cycle. Patients who died suddenly had a lower peak rate of ventricular ejection (stroke volume-normalized peak ejection rate 5.41 +/- 0.69 versus 6.24 +/- 1.33 s-1; p = 0.006) and lower peak rate of ventricular filling (end-diastolic volume-normalized peak filling rate 4.02 +/- 0.94 versus 4.88 +/- 1.53 s-1; p = 0.02) and stroke volume-normalized peak filling rate (4.75 +/- 1.08 versus 5.82 +/- 1.70 s-1; p = 0.01) compared with survivors. Stepwise regression analysis revealed that sudden death was best predicted by the combination of increased end-diastolic volume, small end-systolic volume and low peak filling rate (predictive accuracy 32%, false negative 18% and false positive 28%). The addition of clinical features and hemodynamic measurements to the analysis improved predictive accuracy to 43% (false negative 18% and false positive 18%). Ambulatory electrocardiographic monitoring performed in 57 of the 88 patients 1 month to 17 years (median 8 years) after diagnosis revealed ventricular tachycardia in 14 (25%). Of these, 10 who survived had hyperkinetic systolic function at diagnosis, whereas the 4 who died suddenly had impaired systolic function (end-diastolic volume-normalized peak ejection rate 5.93 +/- 1.2 versus 4.01 +/- 1.2 s-1, respectively; p = 0.04). In hypertrophic cardiomyopathy, ventricular tachycardia is a sensitive but nonspecific marker of adults who are at risk of sudden death. Impaired systolic function may be an important determinant of which patients with ventricular tachycardia die suddenly. This study shows that indexes of ventricular function contribute to the identification of patients at particular risk of sudden death. However, the predictive power of the clinical features and hemodynamic and angiographic measurements that could be assessed was poor.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1980

Effects of isometric handgrip and dynamic exercise on left-ventricular function.

Radionuclide angiocardiography was used to assess cardiac function during isometric handgrip and bicycle exercise in ten normal volunteers and in 20 patients with documented coronary artery disease. Handgrip stress evoked a small increase in cardiac output that resulted from a concomitant increase in heart rate and no change in left-ventricular function. The most reliable criterion for diagnosis of coronary artery disease by handgrip was development of a new well-motion abnormality. However, abnormal wall motion was observed in only 45% of patients with coronary artery disease and in one of the ten normal subjects. In normal subjects, left ventricular function during bicycle exercise was characterized by an increase in left-ventricular ejection fraction with little change in cardiac volumes. The failure to increase left-ventricular ejection fraction by at least 0.05 identified 19 to 20 patients with coronary artery disease with no false positives. Therefore, bicycle exercise evokes a more dramatic cardiovascular response than handgrip stress and is the preferable stress modality for inducing abnormalities of left-ventricular function for detection of coronary artery disease.

Adult↗
PubMed1981

The effect of prolonged cardioplegic arrest on long-term ventricular function.

Twenty-five patients (15 coronary revascularizations and 10 valve replacements) having ischemic arrest times longer than 120 minutes (121 to 184 min) were studied by scintigraphy 7 to 27 months after operation. We sought to define if prolonged cardioplegic arrest could be correlated with late postoperative ventricular functional deterioration. Each patient had serial enzymes, EKG analyses, and a technetium pyrophosphate (PYP) scan immediately following operation to determine if an intraoperative infarct occurred which could predispose to functional deterioration. One coronary bypass patient (6.7%) suffered a perioperative myocardial infarct. After a follow-up period of 7 to 25 (mean 17.9) months, none of the 15 patients has developed recurrent angina, infarction or congestive heart failure. Comparing preoperative and late postoperative ventricular function, 3 patients (20%) had a greater than 10% fall in ejection fraction (EF) and 3 (20%) a greater than 10% rise. Mean EF (15 patients) prior to operation was 57.8 +/- 4.7% and at restudy 59.0 +/- 4.6%. One valve replacement patient (10%) suffered a perioperative infarction. After a follow-up period of 16 to 27 (mean 19.9) months, all patients continue to do well. Comparing preoperative to late postoperative ventricular function, 3 patients (30%), had a greater than 10% fall in EF and 2 (20%) a greater than 10% rise. Mean EF (10 patients) prior to operation was 60.5 +/- 5.0% and at restudy 60.1% +/- 5.8%. It is concluded that prolongation of cardioplegic arrest beyond 2 hours is well-tolerated in most patients. Routine early postoperative tests were not useful in prognosticating late functional deterioration in 4 of 6 patients not suffering a perioperative infarction, and in these patients depressed function may be secondary to myocardial fibrosis.

Coronary Disease↗
PubMed2005

Predischarge ST segment and T wave patterns in predicting left ventricular function and myocardial viability in Q wave anterior myocardial infarction patients.

The aim of this study was to investigate the correlation between ECG changes prior to discharge and findings of early low dose dobutamine stress echocardiography (LDSE) performed in 6 +/- 2 days, in patients experiencing their first acute anterior MI. A total of 62 patients admitted with their first acute anterior MI were divided into three groups according to the findings of electrocardiograms performed on the 7-10th days: group A, isoelectric ST and negative or positive T wave; group B, ST elevation (> 0.1 mV) and negative T wave; and group C, ST elevation and positive T wave. There were no significant differences between the groups with respect to thrombolytic therapy and reperfusion criteria. In addition, 90% of the patients in group A (20/22), 66% in group B (12/18, P < 0.05 versus group A), and only 54% in group C (12/22, P < 0.01 versus group A) responded to LDSE. The infarct zone wall motion score index (WMSI) measured by LDSE was significantly decreased in group A compared to basal values (from 2.71 +/- 0.65 to 2.07 +/- 0.71 P = 0.02), and it was significantly different compared to groups B and C. Moreover, the serum creatinine kinase level of the patients in group C was higher (P < 0.01 versus group A), whereas the ejection fraction was inferior (group A 48%, group B 47%, and group C 41%, P = 0.04 versus group A). When the correlations between good left ventricular function and terminal QRS distortion, sum ST elevation, the number of leads with ST elevation, ST elevation shape on admission, and ST and T alterations in ECG at discharge were investigated, an independent correlation was found between ST and T alteration in ECG and a WMSI value < 2 at rest or after LDSE (P = 0.03, OR 3.08, 95%CI 1.05-8.98). At the infarct zone of patients with ST elevation and positive T waves, left ventricular function is worse and the viability is less. This simple classification may be useful in predicting left ventricular function at the time of discharge.

Aged↗
PubMed1994

[A study on the radionuclide method for assessment of right ventricular function in COPD with cor pulmonale].

Right ventricular ejection fraction (RVEF), right ventricular peak filling rate (RVPFR) and right atrial early diastolic emptying rate (RAER) were measured with radionuclide gated blood pool scintigraphy in 19 healthy subjects and 15 cases of COPD with cor pulmonale and right heart catheterization was performed in the latter group. It was shown that RVEF in the group of cor pulmonale patients with pulmonary arterial hypertension (PAH) was significantly lower than that of the group of healthy subjects and cor pulmonale patients without PAH (P < 0.001, P < 0.001), no difference in RVEF was found between cor pulmonale patients without PAH and healthy subjects. As pulmonary arterial pressure increased, RAER and RVPFR decreased gradually, and the reduction of RAER and RVPFR occurred earlier than that of RVEF. It is suggested that right ventricular diastolic function may be impaired before right ventricular systolic function.

Adult↗
PubMed2000

Left ventricular function and mass after orthotopic heart transplantation: a comparison of cardiovascular magnetic resonance with echocardiography.

OBJECTIVE: We compared the assessment of left ventricular function and mass by M-mode echocardiography (echo) with fast breath-hold cardiovascular magnetic resonance (CMR) in patients who received orthotopic heart transplantation. We also sought to establish the reproducibility of breath-hold CMR in this patient population. METHODS: We prospectively acquired 51 sets of echo and CMR data in 21 patients who had undergone orthotopic heart transplantation. We examined the intraobserver and interobserver reproducibility of breath-hold CMR in this group and compared it with published data. We compared the left ventricular ejection fraction (EF) and mass determined by echo with the CMR data. RESULTS: The average time between CMR and echo was 0 +/- 7 days (mean +/- SD), the time between each set of CMR-echo data acquisition was 5.1 +/- 4.1 months. Cardiovascular magnetic resonance showed good reproducibility in this population, with intraobserver percentage variability of 2.2% +/- 2.4% for EF and 3. 2% +/- 2.7% for mass, and interobserver percentage variability of 2. 4% +/- 1.9% for EF and 2.2% +/- 1.9% for mass. The Bland-Altman limits of agreement between echo and CMR were wide for both EF (-9. 6% to 15%) and mass, irrespective of the formula used (-61.3 to 198 g for the Bennett and Evans formula, -65.4 to 196.8 g for the American Society of Echocardiography (ASE) formula, -65.3 to 181 g for the Devereux formula, and -95.2 to 64.6 g for the Teichholz formula). CONCLUSION: Fast-acquisition CMR is reproducible in recipients of transplanted hearts. We found poor agreement with the results of echo. The choice of technique will depend on local resources as well as the clinical importance of the result. Echo remains readily available and gives rapid assessment of volumes, EF, and mass. However, the good reproducibility of CMR may make it a more suitable technique for long-term follow-up of an individual or of a study population.

Cardiac Volume↗
PubMed2002

[Left ventricular function and infarction size after primary angioplasty for acute myocardial infarction].

BACKGROUND: There is little information available on long-term changes in left ventricular function and infarct size after acute myocardial infarction treated with primary angioplasty. MATERIAL AND METHODS: From 1996 to 1998, 100 consecutive patients were treated with primary angioplasty for acute ST-elevation myocardial infarction. Left ventricular ejection fraction was determined by radionuclide ventriculography before discharge, after six weeks and after a mean follow-up time of 20 months (range 11-37). Infarct size was assessed by technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) at rest, performed at the same time intervals. RESULTS: Mean ejection fraction was 56% at discharge, 55% after six weeks and 57% after 20 months of follow-up. A mean perfusion defect of 19% was measured by SPECT after one week. After six weeks and 20 months of follow-up, the mean perfusion defects were reduced to 14% (p < 0.001) and 15%, respectively. INTERPRETATION: Left ventricular function was well preserved and infarct sizes small to moderate 20 months (range 11-37) after primary angioplasty for acute myocardial infarction, demonstrating that the initial successful effect of the treatment was maintained.

Aged↗
PubMed1986

Prognostic significance of right ventricular ejection fraction for persistent complex ventricular arrhythmias and/or sudden cardiac death after first myocardial infarction: relation to infarct location, size and left ventricular function.

To assess the prognostic significance of right ventricular dysfunction after a first myocardial infarction for complex ventricular arrhythmias and or sudden cardiac death in relation to infarct location, size and left ventricular function, a series of 127 consecutive patients was prospectively studied and followed up for one year. Prior to hospital discharge, a 24-hour electrocardiographic recording and radionuclide angiocardiography were performed. Right ventricular ejection fraction was related to inferior infarct location and size (r = 0.45, P less than 0.01): similarly left ventricular ejection fraction was related to anterior infarct location and size (r = 0.76, P less than 0.001). The incidence of severe ventricular arrhythmias was significantly higher in patients with isolated right or left ventricular dysfunction compared to patients with normal function; it was highest in patients with severe depression of both ventricles. Patients with complex ventricular arrhythmia and/or sudden cardiac death had significantly reduced left and right ventricular ejection fractions. Detailed analysis in patients with left ventricular ejection fraction greater than 0.40 vs. less than or equal to 0.40 showed that presence of complex ventricular ectopic activity and/or sudden cardiac death after myocardial infarction was related not only to left, but also independently to right ventricular dysfunction. These results imply a significant prognostic contribution of right ventricular dysfunction to the occurrence of severe ventricular arrhythmias and/or sudden cardiac death after myocardial infarction independent of and additive to left ventricular dysfunction.

Adult↗
PubMed1989

Detecting abnormalities in left ventricular function during exercise by respiratory measurement.

The degree of exercise-induced cardiac dysfunction and its relation to the anaerobic threshold were evaluated in 23 patients with chronic heart disease. A symptom-limited exercise test was performed with a cycle ergometer with work rate increased by 1 W every 6 seconds. Left ventricular function, as reflected by ejection fraction, was continuously monitored with a computerized cadmium telluride detector after the intravenous injection of technetium-labeled red blood cells. The anaerobic threshold (mean, 727 +/- 166 ml/min) was determined by the noninvasive measurement of respiratory gas exchange. As work rate rose, the left ventricular ejection fraction increased but reached a peak value at the anaerobic threshold and then fell below resting levels. Ejection fraction at rest, anaerobic threshold, and peak exercise were 41.4 +/- 11.3%, 46.5 +/- 12.0%, and 37.2 +/- 11.0%, respectively. Stroke volume also increased from rest (54.6 +/- 17.0 ml/beat) to the point of the anaerobic threshold (65.0 +/- 21.2 ml/beat) and then decreased at peak exercise (52.4 +/- 18.7 ml/beat). The slope of the plot of cardiac output versus work rate decreased above the anaerobic threshold. The anaerobic threshold occurred at the work rate above which left ventricular function decreased during exercise. Accurate determination of the anaerobic threshold provides an objective, noninvasive measure of the oxygen uptake above which exercise-induced deterioration in left ventricular function occurs in patients with chronic heart disease.

Anaerobic Threshold↗
PubMed1991

Pulmonary vasodilatation and augmentation of right ventricular function following terbutaline infusion in severe chronic pulmonary disease.

Twenty patients with a median age of 61 years and a median forced expired volume in 1 s (FEV1) after bronchodilating therapy of 0.55 l were studied in order to measure the effect of intravenous terbutaline on bronchial tone, cardiac function, pulmonary haemodynamics, gas exchange, and oxygen transport capacity during rest and in 10 patients during exercise. Terbutaline infusion during rest resulted in an increase in heart rate from 84 to 103 beats min-1 (P less than 0.01), a decrease in mean systemic arterial pressure from 95 to 80 mmHg (P less than 0.02), an unchanged mean pulmonary arterial pressure (18 mmHg), an increase in cardiac index from 2.89 to 3.86 l min-1 m-2 (P less than 0.01), an increase in right ventricular ejection fraction from 45 to 53% (P less than 0.01), an increase in left ventricular ejection fraction from 63 to 67% (NS), an unchanged arterial oxygen tension, and an increase in calculated oxygen delivery from 533 to 638 ml O2 min-1 m-2 (P less than 0.01). During exercise terbutaline infusion resulted in an increase in heart rate from 108 to 120 beats min-1 (P less than 0.05), a decrease in mean systemic arterial pressure from 117 to 106 mmHg (P less than 0.01), a decrease in mean pulmonary arterial pressure from 29 to 22 mmHg (P less than 0.01), an increase in cardiac index from 4.53 to 4.64 min-1 m-2 (NS), an unchanged arterial oxygen tension, and an increase in the calculated oxygen delivery from 834 to 856 ml O2 min-1 m-2 (NS). It was concluded that terbutaline augments right ventricular function: increases right ventricular ejection fraction and decreases right ventricular end-diastolic volume, and further decreases pulmonary vascular resistance without decreasing arterial oxygen tension, and increases oxygen delivery in patients with chronic pulmonary disease during rest and exercise.

Aged↗
PubMed1993

Increased tolerance of ventricular function and energy metabolism to hypoxia in cardiomyopathic hamsters.

To study the responses of myocardial function and metabolism to hypoxia in normal hamsters and cardiomyopathic hamsters (Bio 14.6), left ventricular pressure was measured in an isolated isovolumically beating heart preparation, and myocardial high energy phosphates (ATP and creatine phosphate), inorganic phosphate, and intracellular pH were also measured by 31P nuclear magnetic resonance spectroscopy. In 20-week-old cardiomyopathic hamsters, the heart weight was increased and the baseline left ventricular developed pressure, peak positive dP/dt, and peak negative dP/dt were decreased, indicating depression of left ventricular function. In control hamsters, left ventricular end-diastolic pressure rose markedly (+481 +/- 70%), and left ventricular developed pressure decreased (-57 +/- 6%) during 30 mins period of hypoxic perfusion. Correspondingly, myocardial content of ATP (-42 +/- 17%) and creatine phosphate (-48 +/- 14%) was decreased and that of inorganic phosphate was increased (+185 +/- 127%). Intracellular pH was also decreased (-0.20 +/- 0.13). In contrast, cardiomyopathic hamsters, showed a relatively slight increase in left ventricular end-diastolic pressure (+106 +/- 83%, P < 0.01 vs. control hamsters), although the decrease in left ventricular developed pressure (-50 +/- 5%) was comparable to that in control hamsters. The recovery of left ventricular end-diastolic pressure and developed pressure during reoxygenation was better in cardiomyopathic hamsters. The decrease in myocardial ATP (-13 +/- 26%, P < 0.01 vs. control hamsters), the increase in inorganic phosphate (+95 +/- 88%, P < 0.05 vs. control hamsters), and the decrease in intracellular pH (-0.06 +/- 0.06, P < 0.01 vs. control hamsters) during hypoxia were much less marked in cardiomyopathic hamsters. Only the decrease in creatine phosphate (-32 +/- 16%) was comparable to that in control hamsters. Thus, in cardiomyopathic hamsters, the deterioration of left ventricular diastolic function, systolic function, and myocardial energy metabolism during hypoxia was mild compared with the change in control healthy hamsters. This increased tolerance of cardiomyopathic hearts to hypoxia may be related to alterations in myocardial contractile proteins and/or energy utilization, or substrate availability.

Animals↗
PubMed1993

Reproducibility of assessment of left-ventricular function using intraoperative transesophageal echocardiography.

Reproducibility of results is an important point in assessing the utility of intraoperative transesophageal echocardiography for evaluating changes in left-ventricular function. The purpose of the present study was to define the intra- and interobserver reproducibility of the qualitative assessment of left-ventricular regional wall motion and the quantitative assessment of global left-ventricular function. In addition, the interstudy reproducibility of two examinations was tested when the probe was displaced and replaced in the esophagus. A transesophageal short-axis view at the level of the papillary muscles was obtained in 86 patients undergoing cardiac surgery. In the 80 patients with adequate images, regional wall motion was visually graded and area ejection fraction was calculated by two observers and assessment was repeated by the same observer one day later. The same observer graded wall motion differently in only 5% (24/480) of segments. Grading by two observers differed in 9% (43/480) of segments. Assessment differed by one grade at the most and in not more than 2 out of 6 segments per patient. Repeated measurements of area ejection fraction (AEF) by the same observer correlated well (r = 0.97 before and r = 0.97 after cardiopulmonary bypass) with a mean percent difference of 6%. A similarly close correlation was found for measurements of two observers (r = 0.90 and r = 0.93, respectively) with a mean percent difference of 10% for area ejection fraction. The correlation for the first and second examination in the same patient by one observer was acceptable (r = 0.78 and r = 0.80, respectively) with a mean percent difference of 15% for area ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Non-invasive evaluation of global ventricular functions in coronary artery disease by exercise radionuclide angiocardiography.

Rest and exercise radionuclide angiocardiographic measurement of left ventricular functions were obtained in 12 normal subjects (group I) and 42 patients with well documented coronary artery disease (group II). Additionally thirty-five patients had an exercise tread mill test. Resting left ventricular ejection fraction less than 50% provided the greatest diagnostic information. Exercise was induced by supine bicycle exercise ergometer. In group II 32 patients of coronary artery disease with normal global ventricular function at rest, new regions of dysfunction developed during exercise and global ejection fraction fell by 8 to 15 percent while in group I there was an increase in LVEF and no areas of any ventricular wall motion abnormalities were detected. Exercise radionuclide angiocardiography is a useful non invasive technique which permits accurate assessment of the presence and functional severity of coronary artery disease.

Adult↗
PubMedDate not supplied

Measurement of tricuspid annular diastolic velocities by Doppler tissue imaging to assess right ventricular function in patients with congenital heart disease.

We assessed the clinical utility of using diastolic tricuspid annular velocities obtained by Doppler tissue imaging as a noninvasive index of right ventricular function in patients with congenital heart disease. Doppler tissue imaging at the tricuspid annulus and pulsed Doppler echocardiography of the right ventricular inflow were performed in 71 children with congenital heart disease, with and without elevated right ventricular pressure. Cardiac catheterization was performed in all patients with congenital heart disease, and the hemodynamic determinants of the tricuspid annular and inflow velocities were determined. In patients with congenital heart disease, the ratio of the late-to-early diastolic tricuspid annular velocity (Aa/Ea) showed a highly significant correlation with right ventricle pressure/left ventricle pressure (r = 0.79, p < 0.0001), right ventricular end diastolic pressure (r = 0.46, p < 0.0001), and the first derivatives of the change in right ventricle pressure during diastole (r = 0.72, p < 0.0001). However, the late-to-early diastolic tricuspid inflow velocity (A/E) did not correlate with any invasively measured index of right ventricular function. Aa/Ea, derived from tricuspid annular velocities as measured by Doppler tissue imaging, is a valuable, noninvasive tool for detecting an elevated right ventricular pressure in patients with congenital heart disease.

Blood Flow Velocity↗
PubMed1985

Emergency bypass surgery: late effects on size of infarction and ventricular function.

Using thallium myocardial scintigraphy and radionuclide ventriculography, we assessed size of infarction and left ventricular function at late follow-up (greater than 2 months) in 13 patients who underwent emergency coronary artery bypass surgery (ECABS) during evolving myocardial infarction and in 26 controls who received conventional treatment for acute infarction. Thallium scans were quantitatively analyzed. The thallium defect, expressed as a numerical value in arbitrary units, was smaller after early revascularization (within 4 hr of the onset of symptoms, n = 10) than in the controls: 397 +/- 232 vs 2779 +/- 972 for anterior infarction (p less than .001) and 475 +/- 511 vs 1454 +/- 960 for inferior infarction (p less than .05). The patients undergoing revascularization late (4 to 5 hr after the onset of symptoms, n = 3) had thallium defects comparable to those in the controls. Regional ejection fraction of the involved left ventricular segment was higher after early revascularization (41 +/- 9% vs 21 +/- 8% for anterior infarction, p less than .005; 67 +/- 14% vs 51 +/- 11% for inferior infarction, p less than .01). Global ejection fraction was higher after early revascularization in patients with anterior infarction (57 +/- 10% vs 37 +/- 9%, p less than 0.02), but not in those with inferior infarction (60 +/- 11% vs 54 +/- 8%, p greater than .05). After late revascularization, regional and global ejection fraction were comparable to those in controls. In selected patients, early reperfusion of acutely ischemic myocardium by ECABS can limit size of infarction and preserve left ventricular function, but time constraints may be severe.

Adult↗
PubMed1991

Right and left ventricular function after cardiac transplantation. Changes during and after rejection.

BACKGROUND: Attempts to identify noninvasive markers of ventricular dysfunction accompanying acute rejection have been hampered by a lack of detailed simultaneous hemodynamic data. Therefore, we prospectively performed serial monitoring of detailed left and right heart hemodynamic parameters in cardiac transplant recipients at the time of routine endomyocardial biopsy to better define the physiology of the allograft heart during and after acute rejection. METHODS AND RESULTS: To better assess the pathophysiology of the rejection process, 18 cardiac transplant patients were prospectively studied by serial right heart micromanometer catheterization and digital image processing at the time of routine endomyocardial biopsy. Eleven patients had 18 episodes of rejection. Studies of baseline (negative biopsy preceding rejection), rejection (acute moderate rejection), and resolved (first negative biopsy after rejection) states were compared. Seven patients who did not experience an episode of rejection served as the control group. Right ventricular minimum and end-diastolic pressures increased from baseline values of 0.9 +/- 3.2 and 6.9 +/- 3.7 mm Hg, respectively, to 3.2 +/- 5.5 and 9.9 +/- 6.6 mm Hg, respectively, with rejection (both variables, p less than 0.05) and remained elevated despite histological resolution of rejection (4.3 +/- 5.5 and 10.0 +/- 7.1 mm Hg, respectively; p less than 0.05 for both variables compared with baseline values). Concurrently, right ventricular end-diastolic volumes (133 +/- 29, 119 +/- 27, and 114 +/- 30 ml; baseline, rejection, and resolved, respectively) and left ventricular end-diastolic volumes (133 +/- 24, 117 +/- 20, and 113 +/- 30 ml; baseline, rejection, and resolved, respectively) significantly decreased during rejection and remained decreased after resolution of rejection (rejection and resolved compared with baseline values, p less than 0.05). Right ventricular chamber stiffness (0.055 +/- 0.035, 0.085 +/- 0.057, and 0.092 +/- 0.076 mm Hg/ml; baseline, rejection, and resolution, respectively; rejection and resolved compared with baseline values, p less than 0.05) increased with rejection and remained elevated after resolution of rejection. Right ventricular peak filling rate also increased from a baseline value of 2.48 +/- 0.45 to 2.76 +/- 0.63 ml end-diastolic volumes per second with rejection (p less than 0.05). Elevation of right ventricular filling pressures, peak filling rate, and chamber stiffness with a concomitant decrease in end-diastolic volume is consistent with a restrictive/constrictive physiology. Mean arterial blood pressure and systemic vascular resistance were elevated after the resolution of rejection (compared with either rejection or baseline values, p less than 0.05) associated with a higher mean daily dose of prednisone (resolved compared with either baseline or rejection values, p less than 0.05). The control group experienced a time-dependent increase in mean and diastolic systemic arterial pressures (both comparisons, p less than 0.05) without detectable diastolic dysfunction. CONCLUSIONS: Persistence of biventricular diastolic dysfunction may be due to an irreversible effect of rejection, although multifactorial changes in left ventricular afterload occur that may complicate serial assessment of ventricular function.

Adult↗
PubMed2005

Validation and application of single breath-hold cine cardiac MR for ventricular function assessment in children with congenital heart disease at rest and during adenosine stress.

PURPOSE: To validate the accuracy of ventricular function analysis using a single breath-hold real-time steady sate free precession (SSFP) cine MR method and demonstrate its application during adenosine stress imaging in children with congenital heart disease. MATERIALS AND METHODS: Twenty-eight subjects with congenital heart disease were studied (mean age 12.4 +/- 2.3 years) with MR imaging at 1.5 T. Short-axis images covering the entirety of both ventricles were acquired at rest, with a conventional segmented SSFP cine sequence acquired over multiple breath-holds and a single breath-hold real-time SSFP sequence. Seventeen subjects were given an infusion of adenosine, and the single breath-hold real-time short-axis stack was repeated during stress. Two independent observers performed the ventricular function analysis. Data was compared between the 2 acquisition methods at rest and between the single breath-hold acquisition at rest and during adenosine stress. RESULTS: There was good agreement between the multiple breath-hold and single breath-hold methods for measurement of end-diastolic volume (r = 0.95 and 0.96, p < .0001) and end-systolic volume (ESV) (r = 0.76 and 0.90, p < .0001) for the left and right ventricles respectively, and the left ventricular mass (r = 0.97, p < .0001). Adenosine was administered safely to all subjects. During stress there were significant changes in the heart rate and ESV, which led to a significant increase in cardiac output (mean 1.5 +/- 1.0 L/min, p < .001). CONCLUSION: Single breath-hold real-time SSFP cine imaging is robust and accurate in assessing cardiac function in children with congenital heart disease. An application of this method is the rapid assessment of cardiac function during adenosine stress.

Adenosine↗