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PubMed1991

Treatment of recurrent ischemia after thrombolysis and successful reperfusion for acute myocardial infarction: effect on in-hospital mortality and left ventricular function.

To determine the effect of treatment of recurrent ischemia after reperfusion for acute myocardial infarction on in-hospital mortality and left ventricular function recovery and to identify patients at highest risk of serious consequences in the event of recurrent ischemia in this setting, 405 consecutively treated patients were studied retrospectively. All patients received intravenous thrombolytic therapy within 6 h of ST segment elevation-documented infarction and had angiographic confirmation of their reperfusion status performed within 120 min of treatment. Three hundred three patients had successful reperfusion with or without rescue angioplasty and had no recurrent ischemia (group 1), 74 patients had initially successful reperfusion but subsequent recurrent ischemia (group 2) and 28 patients had failed reperfusion (group 3). The in-hospital mortality in groups 1 to 3 was 2.0%, 14.9% and 32.1%, respectively (p less than 0.001) and the change from baseline to prehospital discharge left ventricular ejection fraction was 1.2 +/- 9.3%, -0.8 +/- 8.7% and -4.3 +/- 5.3%, respectively (p = NS). Within the recurrent ischemia group (group 2), multiple regression analysis found absence of cardiogenic shock at presentation (p = 0.002) and successful treatment initiated within 90 min of recurrent ischemia (p = 0.045) to be the only variables independently correlated with in-hospital survival. Later successful reperfusion was not associated with improved hospital survival. The timing and success of treatment did not affect recovery of global or regional left ventricular function in the patients with paired angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2003

Right ventricular function in congenital cardiac disease: noninvasive quantitative parameters for clinical follow-up.

Right ventricular function is of great importance in patients with both acute and chronic ventricular overload. The early detection of right ventricular dysfunction may have an impact on therapeutic decision making, helping to prevent or further delay functional deterioration of the right ventricle. In patients with right ventricular overload due to congenital cardiac diseases, dobutamine stress testing combined with magnetic resonance imaging, electrocardiographic changes, and monitoring of concentrations of plasma brain natriuretic peptide are very suitable parameters for the early detection of ventricular dysfunction, and should therefore be used in the follow-up of these patients. It is apparent that no single measurement of anatomy or function can ever adequately describe the form or performance of the right ventricle. Rather, we should be looking more towards an integrated approach of different parameters for right ventricular function. The quantitative parameters described in this study can serve this purpose. The strong correlation found between these non-invasive and independent parameters encourages their clinical implementation.

Child↗
PubMed1996

Effects of positive end-expiratory pressure on right ventricular function in COPD patients during acute ventilatory failure.

OBJECTIVE: To examine the effects of external positive end-expiratory pressure (PEEP) on right ventricular function in chronic obstructive pulmonary disease (COPD) patients with intrinsic PEEP (PEEPi). DESIGN: Prospective study. SETTING: General intensive care unit in a university teaching hospital. PATIENTS: Seven mechanically ventilated flow-limited COPD patients (PEEPi = 9.7 +/- 1.3 cmH2O, mean +/- SD) with acute respiratory failure. INTERVENTION: Hemodynamic and respiratory mechanic data were collected at four different levels of PEEP (0-5-10-15 cmH2O). MEASUREMENTS AND RESULTS: Hemodynamic parameters were obtained by a Swan-Ganz catheter with a fast response thermistor. Cardiac index (CI) and end-expiratory lung volume (EELV) reductions started simultaneously when the applied PEEP was approximately 90% of PEEPi measured on 0 cmH2O (ZEEP). Changes in transmural intrathoracic pressure (PEEPi,cw) started only at a PEEP value much higher (120%) than PEEPi. The reduction in CI was related to a decrease in the right end-diastolic ventricular volume index (RVEDVI) (r = 0.61; p < 0.001). No correlation between CI and transmural right atrial pressure was observed. The RVEDVI was inversely correlated with PEEP-induced changes in EELV (r = -55; p < 0.001), but no with PEEPi,cw (r = -0.08; NS). The relationship between RVEDVI and right ventricular stroke work index, considered an index of contractility, was significant in three patients, i.e., PEEP did not change contractility. In the other patients, an increase in contractility seemed to occur. CONCLUSIONS: In COPD patients an external PEEP exceeding 90% of PEEPi causes lung hyperinflation and reduces the CI due to a preload effect. The reduction in RVEDVI seems related to changes in EELV, rather than to changes in transmural pressures, suggesting a lung/heart volume interaction in the cardiac fossa. Thus, in COPD patients, application of an external PEEP level lower than PEEPi may affect right ventricular function.

Acute Disease↗
PubMedDate not supplied

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

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

Echocardiography↗
PubMed1985

Effect of nitroglycerin on left ventricular function in patients with ischemic heart disease.

To evaluate the effects of nitroglycerin on left ventricular function in 27 patients with ischemic heart disease, ejection fraction (EF) was measured every 1 to 5 min by a nuclear stethoscope after sublingual administration of nitroglycerin (0.3 mg). There was a good correlation between EF determined by the nuclear stethoscope and EF by left ventriculography (r = 0.80, p less than 0.001). EF showed a rise after sublingual nitroglycerin, which was most marked at 4 to 7 min and returned to the control level in 20 to 25 min. There were no significant differences in the maximum percent increase in EF among patients with 0, 1, 2 and 3 vessel disease. The maximum percent increases in EF were 34.0 +/- 10.0% in the normal contraction group, 24.0 +/- 8.5% in the hypokinesis group (p less than 0.05 vs the normal contraction group) and 15.2 +/- 8.5% in the akinesis group (p less than 0.01 vs the normal contraction group, p less than 0.05 vs the hypokinesis group). There was a weak correlation between the maximum percent increase in EF and the changes in heart rate (r = 0.49, p less than 0.05) and there was an inverse correlation between the maximum percent increase in EF and the changes in systolic blood pressure (r = -0.65, p less than 0.01). It was shown that the improvement in EF by sublingual nitroglycerin was greatest in the normal contraction group, somewhat less in the hypokinesis group and least in the akinesis group. The nuclear stethoscope is useful in monitoring changes in left ventricular function during intervention.

Adult↗
PubMed1994

[Left ventricular function and secondary angioplasty after anterior infarction in simple coronary vessel disease].

Arterial patency is a good prognostic factor in terms of survival and left ventricular function after myocardial infarction. The aim of this prospective study was to evaluate the benefit of secondary angioplasty of the infarct-related artery in single vessel, left anterior descending disease, on regional and global left ventricular function. Initial coronary angiography was undertaken at the 7th +/- 2 days after the onset of infarction. Arterial patency was assessed by the TIMI criteria and by percentage stenosis on quantitative angiography. Forty consecutive patients (Group I) underwent conventional angioplasty of the left anterior descending artery at the 9th +/- 2 days. Twelve consecutive patients (Group II) did not undergo angioplasty. A repeat coronary angiographic study was performed at 3 months. The results showed no difference between the two groups of patients in base line values. A significant improvement in arterial patency was observed in Group I (TIMI Grades II or III) and in residual stenosis at 3 months (54.7 +/- 13% versus 80.6 +/- 13%, p < 0.05). In addition, a significant improvement in ejection fraction of +4.7% (p < 0.02), of left anterior descending myocardial regional wall motion of +7.6 (p < 0.02) and a reduction of induced left ventricular end systolic volume of -2.2 ml/m2 (p < 0.05) were observed in Group I. Initial segmental hypokinesia or akinesia improved in 67.5% of patients. However, 50% of patients in Group II improved their segmental wall motion abnormalities at 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Is post-infarction angina related to poor residual left ventricular function?

To investigate the relationship between left ventricular function and presence and type of myocardial ischaemia in the post-acute phase of myocardial infarction (MI) 313 patients admitted consecutively to our Center of Rehabilitation were studied. In all subjects a good quality two-dimensional echocardiogram, 24-h ambulatory electrocardiogram and in 308 of them a symptom-limited exercise test were performed. Clinical observation was for 3 months since MI occurrence. Transient episodes of post-MI ischaemia were observed in 164 patients (52%). No differences in left ventricular asynergy or ejection fraction were noted among patients with and without post-MI ischaemia as a whole, nor in subsets identified on the basis of occurrence of pain or ischaemia characteristics (at rest or exercise-induced). Episodes of left ventricular failure occurred more frequently in patients with silent, myocardial ischaemia at rest. Sublingual isosorbide dinitrate (5 mg), administered to 20 patients, did not differently change asynergy and ejection fraction in patients with and without documented post-MI ischaemia. In conclusion, extent of asynergy and degree of left ventricular dysfunction at rest seem to be: unrelated to the risk of post-MI ischaemia occurrence; related to the infarct size and not to the presence of stunned myocardium.

Aged↗
PubMed1985

[Right ventricular function during the convalescence phase of posterior primary infarction].

Right ventricular extension is very common in inferior myocardial infarction and the resulting haemodynamic changes are well documented. The aim of this prospective study was to assess the consequences on regional and global right ventricular function at a distance from the initial episode. The study population included 32 patients (29 men and 3 women; mean age 52.7 +/- 6 years) admitted consecutively to the coronary care unit for acute inferior wall myocardial infarction with right ventricular extension (group A: 14 patients) or without (group B: 18 patients), based on the initial haemodynamic data. All patients underwent right and left cardiac catheterisation with selective biplane right and left ventriculography and coronary angiography, 2.9 +/- 1 months after the acute episode. In group A, there was a normalisation of the haemodynamic changes observed during the acute phase of myocardial infarction, complete occlusion (10 cases) or a significant residual stenosis (3 cases) of the right coronary artery proximal or immediately distal to the right marginal artery and persistence of an alteration of global right ventricular systolic function when compared with group B (increased end systolic volume: RVESV = 43 +/- 11 ml/m2 vs 35 +/- 9 ml/m2, p less than 0.02, and a decreased ejection fraction: RVEF = 49 +/- 7 p. 100 vs 57 +/- 9 p. 100, p less than 0.01, resulting from hypokinesia or akinesia of the right ventricular inferior wall; mean shortening delta R = 11 +/- 6 p. 100 vs 17 +/- 7 p. 100, p less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Effects of intravenous N-acetylprocainamide on hemodynamics and left ventricular function in man.

N-acetylprocainamide (NAPA) is the active metabolite of procainamide currently undergoing evaluation for its antiarrhythmic properties. Its effects on hemodynamic variables and on ventricular function in man are poorly defined. The effects of intravenously administered NAPA (18 mg/kg over 30 minutes; mean plasma level 40.2 +/- 6.2 micrograms/ml) on hemodynamics and left ventricular ejection fraction (LVEF) assessed by radionuclide ventriculography were therefore determined in 14 patients undergoing diagnostic cardiac catheterization. The peak effects of the drug with respect to most measured variables were seen at 30 minutes and were still apparent at 60 minutes. NAPA increased heart rate (3% at 10 minutes; p less than 0.01), decreased mean pulmonary arterial pressure (14%; p less than 0.05) and capillary wedge pressure (27%; p less than 0.01), decreased mean arterial pressure (12%; p less than 0.01), cardiac index (8%; p less than 0.01), LV dp/dtmax (9%; p less than 0.05), and stroke work index (17%; p less than 0.01). The LVEF increased 5% (p less than 0.05). There was a trend for the systemic vascular resistance to decrease, but this did not reach statistical significance. The data show that NAPA exerts relatively weak peripheral arteriolar and venodilator effects associated with a mild reduction in contractility and cardiac output but an increase in LVEF in patients with preserved ventricular function.

Acecainide↗
PubMed1989

Effect of intravenous streptokinase as compared with that of tissue plasminogen activator on left ventricular function after first myocardial infarction.

In a double-blind trial comparing two thrombolytic agents as treatment for acute myocardial infarction, we randomized 270 consecutive patients an average (+/- SD) of 2.5 +/- 0.6 hours after the onset of chest pain from a first myocardial infarction--135 to receive intravenous streptokinase (1.5 million units over 30 minutes) and 135 to receive intravenous recombinant tissue plasminogen activator (rt-PA) (100 mg over three hours). The primary end point was left ventricular function as assessed by cineangiography performed three weeks after infarction. The effects of the two agents on left ventricular function were similar. The ejection fraction was identical (58 +/- 12 percent) in both groups. The end-systolic volume was 61 +/- 29 ml in the streptokinase group and 66 +/- 31 ml in the rt-PA group (P not significant). Patency rates at three weeks for the infarct-related artery were also similar (75 percent in the streptokinase group and 76 percent in the rt-PA group). Reinfarction rates at 30 days were the same (5 percent) in both groups. One patient had a fatal intracerebral hemorrhage 13 hours after receiving rt-PA, and another had a fatal cerebellar hemorrhage 21 hours after receiving rt-PA for reinfarction nine days after treatment with streptokinase. An intention-to-treat analysis revealed that mortality at 30 days was 3.7 percent in the rt-PA group as compared with 7.4 percent in the streptokinase group (P greater than 0.2). Follow-up for a mean of 9.0 months revealed no significant difference in survival; we observed 12 deaths (8.9 percent) in the streptokinase group and 8 deaths (5.9 percent) in the rt-PA group (P = 0.34). We conclude that rt-PA and streptokinase, in the doses given, have similar effects on left ventricular function after a first myocardial infarction. Because of the small number of deaths, it is not possible to determine whether their effects on mortality are similar.

Double-Blind Method↗
PubMed1981

Left ventricular end-diastolic pressure in evaluating left ventricular function.

There are several factors that could affect the left ventricular end-diastolic pressure. These include heart rate, preload, afterload, pericardial or pleural pressure, diastolic properties of the ventricle, and the left ventricular inotropic state. Recognition of these factors appears important when considering the left ventricular end-diastolic pressure as an index of left ventricular function.

Blood Pressure↗
PubMed1986

[Echocardiography evaluation of left ventricular function in mitral valve stenosis].

It is reported on results of echocardiographic investigations concerning the left ventricular function in 60 patients with mitral stenosis (30 patients in stage II, 30 patients in stage III of the classification after NYHA) and the results are compared with those of 30 normal persons. The echocardiographic parameters 'systolic shortening fraction of the left ventricle' (FS), mean circumferential shortening speed of the fibre (mVCF) and the ejection fraction (EF) are suitable for the assessment of the functional condition of the left ventricle. On the basis of these parameters a determination of the degree of severity of the mitral stenosis is not possible, since there are no significant differences between the degrees of severity. The clear restriction of the left ventricular function in mitral stenoses which is partly described in the literature cannot be confirmed. In the two stages the parameters investigated lie widely within the norm. Significant differences in comparison to normal persons can be realized only in the determination of the early diagnostic filling speed of the left ventricle in the two stages.

Adult↗
PubMed1975

[Ventricular function following reinforcement of the mitral ostium].

After implantation of a metal ring into the mitral position the ventricular function seems to be slightly impaired in the early postoperative phase. 6 months after operation, however, ventricular function is unchanged which excludes a significant hemodynamic influence of mitral valve stiffening.

Animals↗
PubMed2005

Semi-automatic boundary detection to improve reporting of regional left ventricular function.

AIMS: The reporting of regional left ventricular function is based on subjective assessment of endocardial motion and thickening and has a significant learning curve. We hypothesized that the use of an semi-automatic boundary detection system generating images with superimposed moving endocardial borders and a fixed end-diastolic reference border could improve the reporting of regional function. METHODS: We obtained 58 resting contrast images of 15 patients and using a new boundary detection system (Quamus), generated images with superimposed endocardial borders. The contrast images, images with additional Quamus borders and Quamus borders alone were assessed by two level 1 and two level 2 echocardiographers. They scored regional function and results were compared to two level 3 experienced stress echocardiography readers. RESULTS: The addition of borders improved the agreement of level 1 echocardiographers (weighted Kappa increased from 0.55 to 0.64) but did not change for level 2 echocardiographers (0.63 to 0.64) and has the potential to be a useful training tool.

Contrast Media↗
PubMed1990

[A new Doppler echocardiography parameter of diastolic ventricular function].

The evaluation of flow velocities in left ventricular inflow tract (LVIT) by Doppler echocardiography gives information about the diastolic ventricular function. In late diastole, shortly after the flow velocity of atrial contraction V(A), we notice in the left ventricular outflow tract (LVOT) a laminar flow velocity directed to the aortic valve. The purpose of this study was to compare this flow velocity V(A*) in the LVOT with the flow velocity of the atrial contraction V(A), and the flow velocity of early diastole V(E) in LVIT, to determine whether such comparison would provide information concerning diastolic function. We studied three groups: 39 patients with left ventricular hypertrophy (HY) (mean age 56 +/- 12 y, 77% male), 41 patients with coronary heart disease (KHK) (mean age 53 +/- 10 y, 85% male) and 41 healthy subjects (N) (mean age 50 +/- 16 y, 51% male); all three groups were studied by pulsed Doppler from apical 4 chamber view in LVOT for maximal velocity (Vmax-A*) and time velocity integral of A* (TVI-A*), and in LVIT for maximal velocity of early diastole (Vmax-E), maximal velocity of atrial contraction (Vmax-A), ratio Vmax-E/Vmax-A, and the time velocity integrals (TVI-E, TVI-A). A slight correlation between Vmax-A* and Vmax-A was found (r = .60), being nearly the same as for TVI-A* and TVI-A (r = .64).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Improved neurohormonal markers of ventricular function after restoring sinus rhythm by the Maze procedure.

BACKGROUND: Clinical results of the Maze procedure for treatment of atrial fibrillation (AF) are excellent, suggesting improved ventricular function after restoring sinus rhythm. However, long-term corresponding effects on the release of cardiac natriuretic peptides and other vasoactive hormones are incompletely investigated after isolated Maze surgery. METHODS: Plasma levels of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), antidiuretic hormone, aldosterone, and angiotensin II were measured in 15 patients (mean age, 52 +/- 11 years) undergoing isolated surgical Maze (III) procedures for medically refractory AF, preoperatively and 6 months postoperatively. At the time of blood sampling, hemodynamic correlates were obtained at baseline and after 6 and 12 minutes of rapid ventricular pacing at 150 stimulations/minute. RESULTS: All patients were free of AF at 6-month follow-up. The measured plasma levels of BNP, ANP, and angiotensin II were all significantly lower (p = 0.03) late after the isolated Maze procedure. Cardiac output was significantly higher postoperatively (p < 0.01). Other hemodynamic values and left atrial size were unchanged after surgery. Ventricular pacing caused almost identical hemodynamic changes in atrial pressures before and late after surgery, but the associated plasma ANP response was significantly attenuated postoperatively (p < 0.001). CONCLUSIONS: Levels of cardiac natriuretic peptides and angiotensin II as markers of ventricular function are improved in the long term after clinically successful isolated Maze procedures. ANP response to hemodynamic challenge by ventricular pacing was attenuated postoperatively, possibly due to atrial scarring.

Adult↗
PubMed1994

Right ventricular function during weaning from respirator after coronary artery bypass grafting. Comparison of two different weaning techniques.

The purpose of this investigation was to determine right ventricular function during weaning from controlled ventilation comparing a biphasic positive airway pressure ventilatory support system (BiPAP [Respironics]) with pressure support ventilation (PSV). In 22 patients following coronary artery bypass grafting, both weaning techniques were used in randomized chronological order for 60 min each. Right ventricular end-systolic (RVESV) and end-diastolic volume (RVEDV) and ejection fraction (RVEF) were evaluated using the fast-response Swan-Ganz catheter. In comparison to PSV, the BiPAP system resulted in a significantly higher mean pulmonary artery pressure (20.6 +/- 5.0 vs 19.3 +/- 4.2 mm Hg, p = 0.0158), pulmonary vascular resistance index (206 +/- 55 vs 181 +/- 61 dyn.s.cm-5.m2, p = 0.0355), RVESV (92.2 +/- 36.3 vs 77.2 +/- 30.4 ml, p = 0.0017), and RVEDV (176.4 +/- 48.5 vs 161.8 +/- 43.3 ml, p = 0.0061), while the RVEF was significantly lower (46.0 +/- 11.9 vs 51.8 +/- 12.4 percent, p = 0.0012). No differences in left ventricular function or arterial blood gas analyses were measured during both study periods. In summary, the RV afterload was higher with the BiPAP system compared with PSV which suggested that this was due to differences in the respiratory support between both weaning modes. Because of the Frank-Starling mechanism, this higher afterload did cause a small but significant increase in RV volumes and a significant decrease in RV ejection fraction with the BiPAP system.

Aged↗
PubMed1992

Effect of propranolol and disopyramide on left ventricular function at rest and during exercise in hypertrophic cardiomyopathy.

In 19 patients with hypertrophic cardiomyopathy (15 males, 4 females, mean age 49.2 +/- 10.8 years) left ventricular function was studied with radionuclide ventriculography at rest and during exercise in a crossover design without intervention and after disopyramide and propranolol treatment. 15 of the 19 patients had a resting or latent intraventricular gradient of more than 30 mm Hg. Left ventricular function at rest and during exercise was evaluated before medication, 90 min after oral administration of 200 mg disopyramide or 160 mg propranolol and after 3 weeks of oral therapy with disopyramide 200 mg 2 times a day or propranolol 80 mg 4 times a day. After long-term treatment with disopyramide, resting ejection fraction decreased from 72 +/- 12 to 69 +/- 14% (p less than 0.01) and peak ejection rate (PER) decreased from 3.46 +/- 135 to 3.24 +/- 65 end-diastolic volume (EDV).s-1 (p less than 0.01). Peak filling rate (PFR) at rest decreased from 3.01 +/- 0.8 to 2.77 +/- 0.63 EDV.s-1 (p less than 0.05). Time to peak filling rate (TPFR) at rest and during exercise after acute and chronic therapy did not change compared to control values. Acute and long-term administration of propranolol lead to a significant reduction in heart rate at rest and during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗