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At least 1,063 records · Page 59Linked to original sources
PubMed2004

Assessment of left ventricular function in healthy subjects by pusled wave Doppler tissue imaging.

OBJECTIVE: To examine the clinical application of pulsed Doppler tissue imaging (DTI) for regional left ventricular function assessment in normal subjects. METHODS: We examined 50 healthy subjects (range 12-42 years, mean age 28.3 +/- 6.9 years) using pulsed Doppler tissue imaging to characterize the diastolic and systolic velocity profiles of mitral annulus. Recordings were made along the long axis in the apical 4-chamber, 2-chamber, and long apical views of 6 sites (posterior-septum, lateral, anterior, inferior, anterior-septum, posterior) at the mitral annulus. Myocardial velocities were determined with use of variance F statistical analysis. Correlation analysis was employed to test the relationship between age and mitral annular velocities. RESULTS: Both early diastolic and systolic velocities at the septum were lower than other sites. There were no differences in mitral annulus late diastolic velocities. Mean early diastolic and systolic velocities was negatively correlated with age. CONCLUSIONS: Doppler tissue imaging can directly reflect regional left ventricular function.

Adolescent↗
PubMed2004

[Assessment of myocardial viability and recovery of the left ventricular function in postmyocardial infarction patients].

AIM: To evaluate prognostic significance of myocardial viability (MV) depending on treatment policy in postmyocardial infarction (PMI) patients. MATERIAL AND METHODS: The study included 196 patients (172 males, 24 females, age 30-75, mean age 53 +/- 8.6 years). Standard stress dobutamine echocardiography was made 14 +/- 6 days (8-21 days) after macrofocal MI. Reperfusion therapy was made in 138 (70%) patients. X-ray contrast coronary angiography was performed in all the patients as the criterion of the immediate effect of reperfusion was achievement of residual stenosis of MI-related coronary artery < 50%. Late after MI (18 +/- 7 months after MI) a comparative analysis of the left ventricular function was made in three groups of patients depending on the clinical response to the treatment. MV criterion was based on a fall in the index of infarction zone wall movement (IZWM) under low-dose dobutamine stress test reflecting contractile reserve of the infarction zone (CR). Left ventricular function recovery was judged by a decrease in initial IZWM index 18 months later vs the initial IZWM 14 days later. Thus contractile reversibility of the infarction zone (CRIZ) was determined. LV function was also assessed by the index of left ventricular end diastolic volume (LVEDV), by the index of left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF). RESULTS: 18 months after MI, CRIZ was higher in group 1 (after effective reperfusion) and group 3 (after myocardial revascularization) compared to group 2 (medication only): 0.33 +/- 0.01, 0.39 +/- 0.02 and 0.23 +/- 0.01, respectively. LVEDV and LVESV in group 1 and 3 diminished while LVEF increased. LVEDV in group 2 remained elevated though EF rose considerably. CONCLUSION: Recovery of LV contractile function depends much on reestablishment of adequate myocardial perfusion by reperfusion therapy or myocardial revascularization. Chronic myocardial hypoperfusion leads to LV remodeling. CRIZ proved a significant prognostic criterion of the IZWM index 18 months after MI only in patients given effective reperfusion therapy.

Adult↗
PubMed2003

Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: a randomized trial.

HYPOTHESIS: To evaluate the effects of high thoracic epidural anesthesia (TEA) on global and regional myocardial function and on perioperative coronary risk in patients undergoing coronary artery bypass grafting. DESIGN, SETTING, AND PATIENTS: Prospective and randomized clinical trial blinded for the primary outcome measure of 73 patients scheduled for coronary artery bypass grafting who had a left ventricular ejection fraction of 50% or more conducted from February 1, 2000, through August 31, 2000, at University Hospital, Münster, Germany. INTERVENTIONS: Of 73 randomized patients, 37 were control subjects (who received general anesthesia only) and 36 were in the group who received general anesthesia and high TEA. MAIN OUTCOME MEASURES: The primary outcome measure was regional left ventricular function after myocardial revascularization, assessed by transesophageal echocardiography. We further determined the plasma concentrations of cardiac troponin I and atrial and brain natriuretic peptides. Secondary outcome measures were postoperative complications recorded to 14 days and mortality recorded to 720 days. RESULTS: High TEA was effective in all patients of this group, the somatosensory block extended from T1 through T7 vertebrae. Regional left ventricular function was significantly improved (mean [SD] global wall motion index, 0.74 [0.18] vs 0.38 [0.16]; P<.05), and cardiac troponin I concentrations were reduced by 72% (mean [SD], 5.7 [1.5] vs 1.6 [0.7] ng/mL, P<.05) in patients with high TEA. Natriuretic peptide concentrations peaked during reperfusion (atrial natriuretic peptide) and 24 hours after reperfusion (brain natriuretic peptide). High TEA reduced the mean (SD) peak concentrations of atrial natriuretic peptide by 54% (211 [63] vs 98 [33] ng/mL, P =.03) and brain natriuretic peptide by 43% (189 [39] vs 108 [21] ng/mL, P =.01). One of 36 patients who received high TEA and 3 of 37 controls died. CONCLUSIONS: Reversible cardiac sympathectomy by high TEA improves regional left ventricular function and reduces postoperative ischemia after coronary artery bypass grafting. These effects of high TEA may improve the long-term outcome after myocardial revascularization.

Anesthesia, Epidural↗
PubMed1999

Long-term preservation of left ventricular function in medically treated patients with coronary artery disease and persistent exercise-induced ischemia.

Little information is available on the long-term evolution of left ventricular function of medically treated patients with coronary artery disease and gross limitation of coronary flow reserve. The aim of this study was to assess the long-term evolution of effort tolerance and left ventricular function and their relation to the control of ischemic events in patients with coronary artery disease and prolonged inducible exercise-induced myocardial dysfunction who either declined or were ineligible for cardiac revascularization.

Aged↗
PubMedDate not supplied

Gated SPECT perfusion imaging for the simultaneous assessment of myocardial perfusion and ventricular function in the BARI 2D trial: an initial report from the Nuclear Core Laboratory.

BACKGROUND: The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial, a National Heart, Lung, and Blood Institute-sponsored study in type 2 diabetic patients with coronary artery disease, completed patient recruitment in March 2005. This trial had a nuclear substudy in addition to many other substudies. METHODS AND RESULTS: After patient enrollment, adenosine gated single photon emission computed tomography perfusion imaging is performed at years 1 and 3. The images are interpreted at the core laboratory. Among the objectives of the nuclear substudy are (1) to determine the impact of the mode of therapy on left ventricular function, extent of ischemia, and scar; (2) to determine the impact of therapy on the progression/regression of ischemia/scar and changes in left ventricular function between years 1 and 3; and (3) to determine the independent and incremental prognostic value of ischemia, scar, and left ventricular function on the primary and secondary endpoints of the trial in the entire patient population and specified subgroups such as women, elderly patients, and minorities. CONCLUSIONS: This article describes the methodology and the initial experience of the nuclear core laboratory in this large multicenter trial and provides a summary of variables that are available for future analysis by the working group.

Adenosine↗
PubMed1979

[Left ventricular function in chronic obstructive pulmonary disease after decompensation (author's transl)].

13 patients with chronic obstructive pulmonary disease (COPD) were studied for left ventricular function immediately after acute decompensation. Parameters of right and left ventricular function were measured. Mean pulmonary wedge pressure (Paw) was elevated (11.9 mm Hg) but there was no correlation between Paw and left ventricular end-diastolic pressure (LVEDP). The indices of left ventricular contractility were in the normal range. In 4 patients, LVEDP was too high. A correlation was established between RVEDP and LVEDP. Left ventricular compliance, as studied by the index of Diamond and Forrester, was abnormal. Two conclusions are discussed: (1) in COPD, Paw cannot indicate left ventricular dysfunction; (2) alteration of left ventricular compliance is possibly related to an elevation of RVEDP.

Aged↗
PubMed1978

[Regional ventricular function at rest during exercise before and after bypass surgery (author's transl)].

In 9 patients with coronary heart disease isovolumetric contractility indices and ejection phase parameters were measured simultaneously, using an angiographic catheter with a manometer at the tip (Millar). Regional wall motion at rest, after leg raising and during physical exercise (bicycle ergometer) was analyzed applying the hemiaxis method. Five weeks after aortocoronary bypass surgery the same examinations were repeated. Preoperatively left ventricular enddiastolic pressure (LVEDP) increased from 21 to 37 mm Hg following leg raising. The velocity mean of fiber shortening (Vcf) and of regional fiber shortening in the anterior wall decreased significantly.--All patients discontinued physical exercise due to angina pectoris. LVEDP increased from 21 to 39 mm Hg. Large hypokinetic and akinetic areas developed especially in the anterior wall. Velocity of fiber shortening of the anterior wall decreased from 1.43 to 0.76/s. Enddiastolic volume remained unchanged while endsystolic volume increased significantly. In six patients with patent grafts surgery had a beneficial effect. Comparing angiograms at rest no significant changes were found. After leg raising and physical exercise, however, marked improvement in ventricular function occurred, compared to the preoperative performance. All 6 patients were exercised without complaints at a load of 100 watts for 8 minutes. Velocity of fiber shortening in the anterior wall increased significantly from 0.76 to 2.56/s, mean Vcf from 1.11 to 2.12 circ/s, max dP/dt from 2302 to 4280 mm Hg/s and Vpm from 27.8 to 55.7/s. Functional improvement in individual wall segments amounted to 500% in the mean. Ejection fraction increased from 54 to 76%. Enddiastolic volume remained unchanged while endsystolic volume decreased from 67 to 33 ml/1.37 m2 (p less than 0.002). In three patients the bypass occluded or myocardial infarction occurred intraoperatively. Postoperative findings at rest and during exercise were unchanged as compared to preoperative values. Following successful bypass surgery ventricular function at rest did not change. During exercise, however, a marked improvement in overall and in regional ventricular function was found.

Angiocardiography↗
PubMed1991

Seismocardiography for monitoring changes in left ventricular function during ischemia.

Seismocardiography is a new noninvasive technique for recording cardiac vibrations. Changes in the recorded waves have been correlated with acute and chronic changes in left ventricular function. In this report, we describe a patient who developed ischemia induced by coronary angiography in the cardiac catheterization laboratory. The patient's seismocardiogram showed distinct changes during the ischemic episode that actually preceded the onset of symptoms and resolved after nitroglycerin therapy. The patient's seismocardiographic recordings were significantly different from the recordings from five control individuals. This observation suggests that seismocardiography may be helpful for monitoring left ventricular function during episodes of myocardial ischemia.

Cardiac Catheterization↗
PubMed1998

Depressed heart rate variability is associated with events in patients with stable coronary artery disease and preserved left ventricular function. REGRESS Study Group.

BACKGROUND: Little is known about the value of heart rate variability in patients with symptomatic coronary artery disease with a preserved left ventricular function. We hypothesized that in these patients heart rate variability might be a helpful adjunct to conventional parameters to predict clinical events. METHODS: In a prospective 2-year follow-up study ambulatory electrocardiographic recordings were performed in 263 consecutive male patients (mean age 56+/-8 years) with stable angina pectoris and a mean left ventricular ejection fraction of 71%+/-12%. Clinical events consisted mainly of coronary events such as percutaneous transluminal angioplasty or coronary artery bypass graft operation. RESULTS: Low measures of standard deviation of normal R-R intervals, standard deviation of the mean R-R intervals of 5 minutes, and two spectral components of heart rate variability were found in patients who had had an event compared with patients with no event. Adjusted for severity of angina, the presence of a previous myocardial infarction, and the use of beta-blockers in a logistic regression model this relation remained statistically significant for SDNN. Healthy volunteers appeared to have the highest measures of heart rate variability. CONCLUSION: In patients with ischemic heart disease and normal or near normal ventricular function decreased heart rate variability is associated with adverse clinical events.

Adrenergic beta-Antagonists↗
PubMed2005

[Interrelationship between functional state of the right ventricle and severity of heart failure in patients with ischemic heart disease and depressed left ventricular function].

Dobutamine Doppler echocardiography was carried out in 56 patients (n=56) with ischemic heart disease and depressed left ventricular function (left ventricular ejection fraction <40%) and chronic heart failure. Clinical signs of heart failure were moderate (NYHA class I-II) in 34 and severe (NYHA class III-IV) in 22 patients. Patients with moderate and severe clinical heart failure had similar degree of left ventricular myocardium impairment however those with severe symptoms had more pronounced right ventricular (RV) dysfunction (greater suppression of global and local RV contractility, greater percentage of irreversibly dysfunctional RV myocardium, lower RV contractile response to dobutamine infusion, more pronounced disturbances of RV diastolic filling). Dependence of RV pump function on pulmonary artery pressure was more evident in patients with severe clinical heart failure and marked dysfunction of RV myocardium than in patients with moderate symptoms and moderate RV myocardial dysfunction.

Blood Pressure↗
PubMed1997

Implantable cardioverter-defibrillator therapy: influence of left ventricular function on long-term results.

The degree of left ventricular impairment in an acknowledged important prognostic marker of long-term outcome for patients being evaluated for implantation of cardioverter-defibrillators. Just how left ventricular function impacts freedom from all-cause mortality, as well as from sudden death and cardiac death, is a subject of current major debate, and is analyzed hereunder from a large, recent multicenter ICD patient cohort. The multicenter database consists of data from 361 patients receiving implantable cardioverter-defibrillators for standard indications, that is, documented episodes of ventricular fibrillation or sustained ventricular tachycardias with poor hemodynamic toleration. Data were collected from 1988 to 1995 at three centers in Germany. Two-hundred and three patients (56%) had a left ventricular ejection fraction (LVEF) > 0.30 (group I), and 158 patients (44%) had a LVEF < or = 0.30 respectively (group II). The mean follow-up was 23.9 months (range 3-98 months). Overall survival at 5 years for group II patients was lower, as expected, at 74.1% versus 94.2%, respectively (P < 0.0001). Mortality was higher for each different cause of death in group II patients than in Group I: sudden arrhythmic deaths, 5 versus 1 (P < 0.048); nonsudden cardiac deaths, 16 versus 5 (P < 0.002); noncardiac deaths, 7 versus 2 (P < 0.03). Group II patients received a higher rate of at least one presumably appropriate shock at 86 (54.4%) versus 89 (43.8%) in group I (P < 0.05). However (and somewhat surprisingly), neither the time from ICD implantation to death, comparing only the patients who died, nor the event-free probability of appropriate shocks due to very rapid, sustained ventricular arrhythmias (> 230 beats/min), including a presumed risk of sudden arrhythmogenic death, differed between groups I and II. Sudden cardiac death was only marginally affected by LVEF (group I, 1.5% actuarial, 5-year survival 99.5%; group II, 3.1% and 95.8%, respectively). Therefore, the lower overall survival in ICD patients with LVEF < or = 0.30 resulted mainly from causes of death that cannot be directly influenced by cardioverter-defibrillator therapy. However, because group II patients had a far higher incidence of at least one ventricular tachyarrhythmia terminated by ICD shocks than group I patients, they also probably derived benefit from ICD therapy.

Cohort Studies↗
PubMed1994

Determinants of the rate of right ventricular pressure rise by Doppler echocardiography: potential value in the assessment of right ventricular function.

Tricuspid regurgitation (TR) is common and the rate of right ventricular (RV) pressure rise in early systole can be obtained from the TR velocity profile. Right ventricular function has important implications in patients with valvular heart disease. Fifty five patients with mild or moderate TR and a wide range of pulmonary artery (PA) pressures were studied. The RV dP/dt was obtained as the ratio of the calculated rise in RV pressure from 0.5 m/s to 1.5 m/s of the TR velocity signal (8 mmHg based on simplified Bernoulli equation) to the time taken for this change. The RV dP/dt correlated positively with PA systolic pressure (r = 0.73, p < 0.001), tricuspid anular plane systolic excursion which is an echocardiographic index of RV ejection systolic function (r = 0.45, p < 0.001) and left ventricular (LV) fractional shortening (r = 0.40, p < 0.01). Multivariate analysis showed that all these three parameters independently influenced RV dP/dt (multivariate R = 0.83) accounting for 69% of its variability. In conclusion, it is suggested that right ventricular dP/dt is easily obtainable from Doppler TR velocity signal. It is influenced independently in a positive manner by PA systolic pressure and RV and LV systolic function. Despite its predominant dependence on PA systolic pressure, it may give useful insight into RV systolic function for a given level of PA pressure. It may also be useful for longitudinal follow up of the RV function in patients with heart disease.

Adult↗
PubMed2000

Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting.

BACKGROUND: Preservation of right ventricular myocardium is unsatisfactory in patients with critical stenosis or occlusion of the right coronary artery. The aim of this study was to investigate whether ischemic preconditioning (IP) improved the recovery of right ventricular function after coronary artery bypass grafting. METHODS: Forty patients with three-vessel disease who had coronary artery bypass grafting were randomly assigned to the IP group (n = 20) or control group (n = 20). In the IP group, two cycles of two minutes of ischemia after three minutes of reperfusion were given before cross-clamping. Hemodynamic data were collected. Right ventricular ejection fraction was measured by thermodilution. RESULTS: Right ventricular ejection fraction and right ventricular systolic volume index were decreased post-operatively (lowest value at 6 hours postoperatively). The changes in right ventricular ejection fraction were significantly milder in the IP group postoperatively (p = 0.012). The decrease in right ventricular systolic volume index postoperatively was also less in IP patients (p = 0.002). Fewer inotropic drugs were used in the IP group compared with controls. CONCLUSIONS: Ischemic preconditioning had a myocardial protective effect on recovery of right ventricular contractility in patients who had coronary artery bypass grafting.

Aged↗
PubMed1989

Beat-to-beat regulation of left ventricular function in the intact cardiovascular system.

A variety of regulatory mechanisms have evolved to control the heart's pump function because the cardiovascular system must continually adapt to the changing demands that body functions place on it. This regulation takes place through many physiological systems; however, fine adjustments in cardiac pumping probably require adaptations more quickly than external control mechanisms (such as the autonomic nervous system) can compensate. Thus cardiac pumping is also regulated by mechanisms intrinsic to the heart. To better understand these intrinsic control mechanisms, we studied the beat-to-beat response of left ventricular function to continually varying changes in loading conditions produced by transiently occluding the pulmonary artery, venae cavae, and aorta. We used multiple linear regression to identify and quantify the important beat-to-beat determinants of left ventricular systolic function, quantified as stroke work. We could not adequately explain or predict beat-to-beat changes in stroke work with traditional determinants of ventricular function, preload, afterload, and heart rate, because a large systematic error remains after taking these traditional determinants of function into account. To eliminate this systematic error, we had to include some function of previous beat stroke volume and end-systolic size and pressure. This additional information significantly improved both our ability to model the observed transient changes in left ventricular stroke work and to predict additional observations that were not used to develop our model. We conclude that previous beat contraction history is an important determinant of left ventricular function and implies an important regulatory mechanism whereby the left ventricle can fine tune its function from beat to beat in response to continually changing loading conditions.

Animals↗
PubMed1979

Influence of surgery for ischemic heart disease on early postoperative left ventricular function.

The pre- and postoperative systolic time intervals, hemodynamics and serum catecholamines were studied in 30 patients with successful myocardial revascularization surgery or left ventricular aneurysmectomy and the influence of the surgery on the left ventricular function was evaluated. 1. Significant depression of left ventricular performance was recognized in the group of patients with left ventricular aneurysm as compared to the patients with angina pectoris with or without previous myocardial infarction before the operation. 2. At 2 hours after the operation, signigicant decrease of ET/PEP, cardiac index and stroke work index and marked elevation of systemic vascular resistance were seen in the group of patients with aortocoronary bypass surgery who had previous myocardial infarction and with left ventricular aneurysmectomy as compared to the group of patients without previous myocardial infarction. 3. At 2 hours after the operation, ET/PEP seemed to reflect the left ventricular stroke work and the depression of the left ventricular function was mainly affected by the elevation of systemic vascular resistance due to the hypersecrection of serum catecholamines. 4. Reduction of systemic vascular resistance by vasodilator brought an improvement of EG/PEP, cardiac index and stroke work index.

Cardiac Output↗
PubMedDate not supplied

[Standardized protodiastolic median velocity of the posterior wall (dpwV) used as an index of relaxation in the construction of left ventricular function curves].

The standardized mean protodiastolic speed of the posterior wall (Vpwd), non standardized speed (DEV) and maximum speed (DEVM) obtained with ultrasounds, are capable of distinguishing subjects with hypertrophic subaortic stenosis (IHSS), in whom there is a diminution in compliance, from normal subjects. As this compliance diminution is liable to limit fibrocell lengthening to the extent of its distension speed, the Vpwd has been used in the plotting of ventricular function curves in replacement of telediastolic volume (as an expression of fibre lengthening). An excellent correlation was found between Vpwd and mean speed of circumferential shortening of the fibre (Mvcf) and the ejection fraction (EF) used as indices of cardiac work. The comparison shows that the two groups lie on the same curve of ventricular function and that subjects with IHSS operate low down owing to the brevity of their sarcomeres. The Vpwd can thus be utilized as an indirect index of fibre length and in the plotting of left ventricular function curves.

Cardiomyopathy, Hypertrophic↗
PubMed1987

Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction.

In a double-blind trial of streptokinase for acute myocardial infarction, 219 consecutive patients presenting with infarction within four hours (mean, 3.0 +/- 0.8) of the onset of chest pain were randomly assigned to treatment with streptokinase (1.5 million units) or placebo, given intravenously over 30 minutes. The primary end point of the study was left ventricular function in patients with first infarctions. Patients who could undergo beta-blockade also received intravenous propranolol. Heparin (for 48 hours) and a combination of low-dose aspirin and dipyridamole were administered to both groups until cineangiography was performed at three weeks. In the patients with first infarctions treated with streptokinase, the left ventricular ejection fraction was 6 percentage points higher (streptokinase vs. placebo, 59 +/- 10.5 vs. 53 +/- 13.5 percent; P less than 0.005), with benefit to patients with either anterior infarction (57 +/- 11.9 vs. 49 +/- 15.9 percent; P less than 0.05) or inferior infarction (60 +/- 9.1 vs. 55 +/- 11.3 percent; P less than 0.05). Left ventricular function was improved regardless of whether concomitant propranolol was given. Survival (at 30 days) was improved with streptokinase: 2 deaths occurred among 79 patients who received this drug, as compared with 12 deaths among 93 patients who received placebo (2.5 vs. 12.9 percent, P = 0.012). Rates of reinfarction (streptokinase vs. placebo, 3 vs. 1 percent) and requirements for surgery or angioplasty (7 vs. 5 percent) were similar in the two groups. We conclude that administration of intravenous streptokinase (1.5 million units) to patients with a first myocardial infarction results in improved left ventricular function and short-term survival.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Right ventricular function in congenital heart disease: pressure and volume overload lesions.

The right ventricle is often subject to both pressure and volume overload in congenital heart disease. Evaluating right ventricular function in both the native lesion and after surgery in light of these loading conditions, presents a unique challenge for investigators studying these misshapen hearts. The purpose of this article is to briefly delineate what is generally known about right ventricular function in congenital heart disease and to touch on some noninvasive imaging modalities which have helped shed some light on this matter.

Animals↗