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PubMed1992

Comparison of single and biplane ventriculography for determination of left ventricular volume and ejection fraction.

This study was done to compare single and biplane left ventriculography in quantitating left ventricular (LV) volumes and ejection fraction. LV volumes and ejection fraction were measured from a 30 degrees right anterior oblique single plane ventriculogram and a 30 degrees right anterior oblique 60 degrees left anterior oblique biplane ventriculogram in 152 men (aged 59 +/- 9 [mean +/- standard deviation] years), of whom 102 had hypokinesia, akinesia, or dyskinesia. There was excellent agreement between the results of single and biplane ventriculography with respect to LV end-diastolic volume (r = 0.96), end-systolic volume (r = 0.98) and ejection fraction (r = 0.97). The end-diastolic and end-systolic volumes measured by biplane ventriculography were consistently slightly larger than those measured by single plane, whereas ejection fractions measured by the 2 techniques were remarkably similar, even for the 46 patients with biplane ejection fractions less than 0.50 and the 102 with hypokinesia, akinesia or dyskinesia. Thus, LV volumes and ejection fractions determined by single plane ventriculography correlate very well with those determined by biplane ventriculography, even in patients with hypokinesia, akinesia, or dyskinesia and depressed LV systolic performance. Biplane ventriculography appears to provide little information that cannot be obtained reliably from single plane.

Adult↗
PubMedDate not supplied

Gallbladder ejection fraction: an accurate evaluation of symptomatic acalculous gallbladder disease.

The use of cholecystokinin stimulation during cholescintigraphy to calculate the gallbladder ejection fraction has been associated with variable clinical results as a preoperative indicator for chronic acalculous cholecystitis and postoperative relief of biliary symptoms. A series of 56 consecutive patients was analyzed to determine the accuracy of a decreased gallbladder ejection fraction as a preoperative indicator for acalculous cholecystitis. Each patient had symptoms compatible with biliary disease. Each patient had a decreased gallbladder ejection fraction calculated by cholescintigraphy. The gallbladder ejection fraction was calculated using a 30-minute intravenous infusion of cholecystokinin at a dose of 0.02 microg/kg during cholescintigraphy. There was a 100% correlation found in this series of patients between a decreased gallbladder ejection fraction during cholescintigraphy, preoperative symptoms of gallbladder disease, and postoperative pathology evidence of acute or chronic cholecystitis. Only 1 patient had less than a complete resolution of her preoperative symptomatology after laparoscopic removal of her gallbladder. This patient had irritable bowel disease, which was diagnosed postoperatively. Six symptomatic patients with a gallbladder ejection fraction between 35% and 60% were also treated by laparoscopic removal of the gallbladder with complete resolution of their preoperative symptomatology. The use of a 30-minute infusion of cholecystokinin at a dose of 0.02 microg/kg to calculate the gallbladder ejection fraction during cholescintigraphy is an accurate test to preoperatively predict acalculous cholecystitis and postoperative relief of biliary symptoms. The gallbladder ejection fraction of less than 35% was abnormal. Cholecystectomy may be considered for patients whose gallbladder ejection fractions were calculated to be between 35% and 60% if the patient's symptoms were classical for biliary disease and have been present for 1 year. The use of a 30-minute intravenous infusion of cholecystokinin at a dose of 0.02 microg/kg to calculate the gallbladder ejection fraction during cholescintigraphy is an accurate test to preoperatively predict acalculous cholecystitis and postoperative relief of biliary symptoms.

Adult↗
PubMed1981

Effect of oral propranolol on rest and exercise left ventricular ejection fraction, volumes, and segmental wall motion in patients with angina pectoris. Assessment with equilibrium gated blood pool imaging.

The effect of oral propranolol on left ventricular ejection fraction, left ventricular volumes, cardiac output, and segmental wall motion was assessed with multigated blood pool imaging both at rest and during supine exercise in 15 patients with angina pectoris. Propranolol had no effect on resting left ventricular ejection fractions. Before propranolol, they did not change during exercise, whereas after propranolol the ejection fractions increased slightly. Exercise left ventricular ejection fractions increased with propranolol in three patients with resting left ventricular ejection fractions of less than 40 per cent. More specifically, left ventricular end-diastolic volume index, end-systolic volume index, stroke volume index, and cardiac index were not altered significantly at rest or during exercise by propranolol. Exercise left ventricular ejection fractions were increased in five and unchanged in eight patients by propranolol. Those patients with increases in left ventricular ejection fractions had a greater change in left ventricular end-diastolic volume indices and a greater change in left ventricular end-systolic volume indices during exercise while on propranolol. Left ventricular segmental wall motion was not altered significantly during exercise by propranolol. We conclude that: (1) Left ventricular functional responses to propranolol during exercise are heterogeneous and not easily predicted; (2) propranolol causes no consistent deterioration in exercise left ventricular ejection fraction even in patients with resting ventricular ejection fractions less than 40 per cent; (3) increased exercise left ventricular ejection fraction with propranolol is contributed to by significant increases in end-diastolic volume during exercise; and (4) gated blood pool imaging is a useful method for characterising rest and exercise left ventricular ejection fractions and left ventricular volumes during propranolol therapy.

Adult↗
PubMed1985

A format for integrating the interpretation of exercise ejection fraction and wall motion and its application in identifying equivocal responses.

The conventional interpretation of ejection fraction change with exercise may be limited because it does not consider the rest value, define equivocal responses or integrate wall motion data reproducibly. Thus, a format was developed for combined interpretation of rest and exercise radionuclide ejection fraction and wall motion by reviewing the reported data for the exercise responses of patients without prior myocardial infarction. The ejection fraction data of 202 normal patients and of 259 patients with coronary artery disease were first fitted to beta distributions. The true positive and false positive rates for coronary disease for each combination of rest and exercise ejection fraction were then determined directly from these distributions. A given rest/exercise ejection fraction combination was "normal" if the false positive rate was greater than the true positive rate, or "abnormal" if the true positive rate was greater than the false positive rate, and "equivocal" when the rates were similar (within a 50% confidence interval). This analytic format, which predicted an inverse relation between rest ejection fraction and the change required with exercise, was then validated prospectively in 854 patients without myocardial infarction (557 with and 297 without angiographic coronary artery disease). Using the conventional criterion of an abnormal test result (less than 0.05 absolute rise in ejection fraction with exercise or a wall motion abnormality), sensitivity was 85 +/- 2% and specificity only 42 +/- 3%. The statistical format had a sensitivity of 70 +/- 2% and specificity of 70 +/- 3%, resulting in a twofold increase in information content. This format has at least two advantages over conventional interpretation: 1) it provides an explicit definition of equivocal responses; and 2) it reproducibly integrates discordant ejection fraction and wall motion responses and allows for the combined analysis of other nonscintigraphic observations, such as age and sex.

Adult↗
PubMedDate not supplied

Effect of positioning on SvO2 in the critically ill patient with a low ejection fraction.

BACKGROUND: Critically ill patients with a low ejection fraction may be vulnerable to decreased mixed venous oxygen saturation (SvO2) resulting from position change. OBJECTIVES: The objectives of this study were to describe the effects of changes in positioning on SvO2 in critically ill patients with a low ejection fraction (< or = 30%) and to describe the contribution of variables of oxygen delivery (DO2) and oxygen consumption (VO2) to the variance in SvO2. METHOD: An experimental two-group repeated-measures design was used to study 42 critically ill patients with an ejection fraction of less than or equal to 30% (M= 19.5%). Patients were assigned randomly to one of two position sequences: supine, right lateral, left lateral; or supine, left lateral, right lateral. Data on SvO2 were collected at baseline, each minute after position change for 5 minutes, and at 15 and 25 minutes. RESULTS: Repeated-measures multivariate analysis of variance showed a difference in SvO2 among the three positions across time (p< .0001), with the greatest differences occurring within the first 4 minutes and in the left lateral position. Stepwise multiple regression showed that VO2 accounted for a greater proportion of the variance in SvO2 with position change than did DO2 (54% [p = .001] vs. 31% [p= .001]). CONCLUSIONS: Changes in SVO2 occur with positioning in critically ill patients with a low ejection fraction. These changes are transient and are the result of changes in VO2 rather than changes in DO2.

Aged↗
PubMed2004

Comparison of myocardial gated single photon emission computerised tomography, planar radionuclide ventriculography and echocardiography in evaluating left ventricular ejection fraction, wall thickening and wall motion.

Left ventricular ejection fraction (LVEF) and wall thickening are fundamental aspects of cardiac function. Recently, gated single photon emission computerised tomography (GSPECT) and anatomical M-mode echocardiography are new techniques, which have been introduced for the evaluation of left ventricular wall thickening and ejection fraction. These, however, have not been evaluated against established techniques, including equilibrium radionuclide ventriculography (ERNV), which remains the current gold standard for the evaluation of LVEF. We examined the concordance between LVEF, wall motion and wall thickening scores derived from GSPECT, echocardiography and ERNV, in a group of 16 patients with suspected ischaemic heart disease. Estimated ejection fraction correlated better between ERNV and gated SPECT (R2 = 0.93) than between echocardiography and either gated SPECT (R2 = 0.62) or ERNV (R2 = 0.71). There was poor correlation between gated SPECT and anatomical M-mode echocardiography in the assessment of wall thickening (83/150, 56%; kappa= 0.31, p < 0.05) and similar correlation (100/150, 66%; kappa = 0.29, p < 0.01) for wall motion analysis. In conclusion, estimations of ejection fraction by all the three studied modalities agreed to a degree sufficient for routine clinical practice. However, estimates of wall thickening from echocardiography cannot be used interchangeably with those derived from gated myocardial perfusion SPECT.

Adult↗
PubMed1990

[Prognostic stratification of survivors of lst myocardial infarction: evaluation of regional kinetics and ejection fraction by bidimensional echocardiography].

To determine the prognostic value of some echocardiographic indices of left ventricular function (ejection fraction, wall motion score index, left ventricular dimension) in the first year after acute myocardial infarction, we studied prospectively 162 consecutive patients (mean age: 61 +/- 11) who survived the hospital phase of a first acute myocardial infarction. Two-dimensional echocardiography was performed at hospital discharge (mean: 20 +/- 3 days after admission). For the analysis of wall motion, an 11 segment model of the left ventricle was used; from the scoring system of segmental ventricular function (1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic, 5 = aneurysmal) we derived the wall motion score index (sum of assigned number to each segment/11). The echocardiographic ejection fraction was determined using the monoplane ellipsoid formula for the calculation of end diastolic and end systolic volumes in apical four-chamber and two-chamber views; the assumed ejection fraction was the mean value resulting from values of ejection fraction calculated in the two views. The follow-up was protracted from 13 to 36 months (mean: 22 months). Fourteen patients (9%) died as a result of cardiac events within 13 months of myocardial infarction. Of the patients with ejection fraction greater than or equal to 45% (81/162 = 50%) two died (first year mortality = 2.4%); of those with 35-45% ejection fraction (58/162 = 35%) two died (first year mortality = 3.5%); while of those with less than or equal to 35% ejection fraction (25/162 = 15%) ten died (first year mortality = 40%). Of the patients with wall motion score index less than 1.5 (76/162 = 47%) none died in the follow-up period; of those with score index between 1.5 and 1.9 (61/162 = 37%) four died (first year mortality = 7%); of those with score index greater than or equal to 1.9 (25/162 = 15%) ten died (first year mortality = 40%). Thus, ejection fraction and score index have the same predictive value for mortality in the first year after a first acute myocardial infarction. However, an interesting datum is that in the sub-group of patients with less than or equal to 35% ejection fraction and score index less than 1.9 the first year mortality was 15%, while in the sub-group with less than or equal to 35% but score index greater than or equal to 1.9 the first year mortality was 57%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Abnormal left ventricular ejection fraction response to mental stress and exercise in cardiomyopathy.

BACKGROUND: A decline in left ventricular (LV) ejection fraction in response to mental stress and exercise is regarded as an indicator of myocardial ischemia. In patients with LV dysfunction, the ejection fraction is sensitive to afterload, which increases during stress. Thus, the effects of mental stress and exercise on LV systolic function in patients with cardiomyopathy were examined. METHODS: The ambulatory nuclear VEST (Capintec, Inc., Ramsey, N.J.) was used to monitor LV ejection fraction in patients with cardiomyopathy (10 idiopathic and 9 ischemic). Patients underwent a series of mental stress tests (serial 7s, Stroop color, and Paced auditory addition) and treadmill exercise. Heart rate, systolic blood pressure, and LV ejection fraction were measured. RESULTS: Mental stress and exercise increased heart rate and systolic blood pressure. For idiopathic cardiomyopathy, LV ejection fraction decreased during serial 7s, Stroop color, Paced auditory addition and exercise by -8% +/- 6%, -7% +/- 5%, -7% +/- 3%, -9% +/- 10%, respectively. For ischemic cardiomyopathy, LV ejection fraction declined by -4% +/- 3%, -7% +/- 5%, -6% +/- 3%, -2% +/- 6% during the same stress tests. There was no difference between the idiopathic and ischemic groups. Each patient showed a 5% or greater decline in LV ejection fraction during one mental stress test. There was an inverse relation between changes in LV ejection fraction and systolic blood pressure during all mental stress tests and exercise (r = -0.47, p < 0.0001). CONCLUSIONS: In patients with depressed baseline systolic function, the decline in systolic function during mental stress and exercise could be related in part to increases in LV afterload.

Adult↗
PubMed1983

Reliability of bedside evaluation in determining left ventricular function: correlation with left ventricular ejection fraction determined by radionuclide ventriculography.

Ninety-nine patients with chronic coronary artery disease were prospectively evaluated to determine the reliability of historical, physical, electrocardiographic and radiologic data in predicting left ventricular ejection fraction. The left ventricular ejection fraction measured by radionuclide angiography was normal (greater than or equal to 50%) in 44 patients (group 1) and abnormal (less than 50%) in 55 patients; 36 of those 55 patients had an ejection fraction between 30 and 49% (group 2) and the remaining 19 patients had an ejection fraction of less than 30% (group 3). The ejection fraction was correctly predicted in 33 of the 44 patients (75%) in group 1 and in 47 of the 55 patients (85%) with abnormal ejection fraction (groups 2 and 3), but the degree of ventricular dysfunction was correctly predicted in only 19 patients (53%) in group 2 and in only 9 patients (47%) in group 3. Stepwise linear regression analysis was performed. The single most predictive variable was cardiomegaly as seen on chest roentgenography (R2 = 0.52). Four optimal predictive variables--cardiomegaly, myocardial infarction as seen on electrocardiography, dyspnea and rales--could explain only 61% of the observed variables in left ventricular ejection fraction. Thus, radionuclide ventriculography adds significantly to the discriminant power of the clinical, radiographic and electrocardiographic characterization of ventricular function in patients with chronic coronary heart disease.

Adult↗
PubMed2002

Measurement of ejection fraction with standard thermodilution catheters.

Right ventricle ejection fraction (RVEF) is clinically used to evaluate right ventricular function. The thermodilution method can be modified to estimate the RVEF. However, this method requires a thermistor with a fast time response in order to yield correct estimates. Digital signal processing techniques that were developed in previous works, allow the use of industry-standard slow time response thermistors for the measurement EF. However, these algorithms were not automated, and the works did not present a complete evaluation of the method's performance. This article presents a modified automated version of these algorithms, and uses numerical and in vitro simulations to test their performance. In the simulations, the measured ejection fraction was compared to the true ejection fraction. RVEFs ranging from 0.20 to 0.80 were tested for heart rates ranging from 30 to 120 heart beats per min. Statistical analysis of data showed that the new method presents an improved performance.

Algorithms↗
PubMed1986

[Reliability of the ejection fraction determined with the nuclear stethoscope. Comparison with angiocardiography].

The purpose of this investigation was to compare the Ejection Fraction values simultaneously obtained with the Nuclear Stethoscope and with Cineangiography, in 25 patients (17M-8W) subjected to diagnostic cardiac catheterization. In all patients the determination of Ejection Fraction with the Nuclear Stethoscope always preceded the Cineangiography. Ejection Fraction values obtained with Nuclear Stethoscope change from 32 to 75%; those calculated with Cineangiography, between 18 and 88%. The average Ejection Fraction values obtained with Nuclear Stethoscope (59 +/- 13%) doesn't differ significantly from Cineangiography (59 +/- 21%). There was a direct relationship between Ejection Fraction determined by the Nuclear Stethoscope and Cineangiography (r = 0.93; p less than 0.001). In the obtained results the Authors point out that the Ejection Fraction with Nuclear Stethoscope gives assurance in most patients, although in some particular conditions Nuclear Stethoscope provides Ejection Fraction values which differ from those obtained with Cineangiography. They conclude that Nuclear Stethoscope, for its safe, repeating and simple application, is a methodology of useful employment for Ejection Fraction determination in the single patient, which allows a correct definition of the prognosis and a conforming therapeutic strategy.

Adolescent↗
PubMed1991

Accuracy and reproducibility of left ventricular ejection fraction measurements using an ambulatory radionuclide left ventricular function monitor.

The accuracy and reproducibility of a new ambulatory radionuclide detector system (the VEST) for ejection fraction measurement has not been fully validated. Thirty-six subjects, (19 volunteers and 17 patients) underwent repetitive bicycle exercise using sequences of both VEST monitoring and gamma camera imaging. A high intraclass correlation was noted for both absolute ejection fraction [0.84 (0.56, 0.95)] and delta ejection fraction [0.87 (0.63, 0.96)] during repeat VEST monitoring. The intraclass correlation for ejection fraction was comparable for data averaged over 30 sec versus 2 min. These correlations compared favorably to those obtained for assessment of absolute and delta ejection fraction as derived by gamma camera determination by the same computer operator (intraobserver variability), two different computer operators (interobserver variability), and during repeat exercise using gamma camera imaging. In concordance, correlations between VEST and gamma camera measurements were relatively high for both absolute ejection fraction (0.78 [0.61, 0.88]) and delta ejection fraction (0.63 [0.39, 0.79]). Thus, the VEST represents a reproducible means of measuring ejection fraction change during dynamic physical activity. Its accuracy in ejection fraction measurements is similar to gamma camera imaging during exercise testing.

Adult↗
PubMed1991

Significance of changes in resting left ventricular ejection fraction after coronary artery bypass grafting.

The prognostic significance of changes in resting left ventricular ejection fraction was examined in 102 patients who underwent successful coronary artery bypass grafting. Between preoperative and early postoperative radionuclide ventriculography, mean resting left ventricular ejection fraction improved from 47.2% to 53.9% (p less than 0.01). Left ventricular ejection fraction increased by 5% or greater in 64 patients (63%), remained unchanged (within 4%) in 31 (30%), and decreased by at least 5% in 7 (7%). During 14 to 39 months (mean 27 months) of clinical follow-up, patients with normal preoperative left ventricular ejection fraction had a lower prevalence of recurrent angina, congestive heart failure, and mortality resulting from cardiovascular disease. Cardiovascular morbidity and mortality occurred with equal frequency for patients who did and did not show early postoperative improvement in left ventricular ejection fraction (36% versus 39%). Among 69 patients who had a third radionuclide ventriculography at late follow-up, left ventricular ejection fraction was less than the early postoperative value in 69% and less than the preoperative result in 36%. Patients with early postoperative improvement in left ventricular ejection fraction were more likely to retain resting left ventricular contractile function, at least at the preoperative level (71% versus 46%).

Adult↗
PubMed1997

Estimation of the left ventricular ejection fraction using a novel multiphase, dark-blood, breath-hold MR imaging technique.

OBJECTIVE: In this paper, we evaluate a recently proposed dual-phase dark-blood MR sequence for estimating the left ventricular ejection fraction, compare Simpson's method of estimation of ejection fraction with a model based on the biplane method, assess the reproducibility of both methods, and finally, test a semiautomated method for contouring the endocardial border. SUBJECTS AND METHODS: An MR pulse sequence was implemented to acquire cardiac images in both diastolic and systolic phases within a single breath-hold. A special magnetization preparation scheme rendered blood dark while a segmented acquisition allowed breath-hold scan times. Five healthy volunteers and five patients with cardiac disease were imaged. Ejection fractions were estimated using (1) long-axis and four-chamber biplane views with an ellipsoid model and (2) a series of short-axis views in combination with Simpson's model. These values of ejection fractions were then compared with values obtained from echocardiography. RESULTS: Estimates of ejection fractions obtained using biplane ellipsoid volume and Simpson's rule methods varied by 14% in healthy volunteers. However, for patients with severe cardiomyopathy, differences between the values of ejection fraction obtained with the two methods varied by as much as 150%. Ejection fraction estimates obtained from MR images with the biplane ellipsoid method and from echocardiography varied by approximately 14% for all subjects. Ejection fraction estimates obtained with the semiautomated algorithm agreed well with estimates obtained with manual contours made by experienced radiologists. Intraobserver variability was low for both the short-axis (3%) and biplane (4%) methods. However, interobserver variability of the biplane method (12%) exceeded that of the short-axis method (4%). Interexamination variability (9%) was the largest factor in determining the reproducibility of the ejection fraction estimates. CONCLUSION: Breath-hold dark-blood MR imaging technique with simultaneous acquisition of a series of short-axis views during systolic and diastolic phases permits rapid and accurate estimates of ejection fractions in healthy subjects and in patients. Model based biplane MR imaging methods are less reliable in patients with global cardiomyopathy. The estimation of ejection fractions can be automated using the proposed contouring algorithm and the dark-blood short-axis views.

Adult↗
PubMed1994

Gallbladder ejection fraction. Nondiagnostic for sphincter of Oddi dysfunction in patients with intact gallbladders.

Thirty consecutive patients with intact gallbladders and biliary pain were evaluated to determine whether gallbladder ejection fraction could identify sphincter of Oddi dysfunction. The mean gallbladder ejection fraction was 45% in patients with abdominal pain and 72% in normal controls. Gallbladder ejection fractions were then correlated with endoscopically measured sphincter of Oddi pressures in patients with abdominal pain. The mean gallbladder ejection fraction was 41% in 7 patients with elevated sphincter pressures and 46% in 23 patients with normal pressures (P = NS). Thirty-six percent of patients with elevated pressures and 33% of patients with normal pressures had abnormal gallbladder ejection fractions. Gallbladder ejection fraction had a sensitivity of 33%, a specificity of 63%, and a positive predictive value of 25% for detection of elevated pressures. Regression analysis revealed a poor correlation between sphincter pressure and gallbladder ejection fraction (r2 = 0.02). These findings suggest that gallbladder ejection fraction cannot be used to diagnose sphincter of Oddi dysfunction in patients before they undergo cholecystectomy.

Abdominal Pain↗
PubMed2002

Early decline in left ventricular ejection fraction predicts doxorubicin cardiotoxicity in lymphoma patients.

Thirty adult patients with non-Hodgkin's lymphoma were studied to evaluate prospectively the significance of early decline in left ventricular ejection fraction after low cumulative doxorubicin dose (200 mg x m(-2)) in predicting the later impairment of left ventricular function. Cardiac function was monitored with radionuclide ventriculography at baseline and after cumulative doxorubicin doses of 200, 400 and 500 mg x m(-2). Cardiotoxicity was defined as a decrease in left ventricular ejection fraction of more than 10% units to a final left ventricular ejection fraction < or =50%. Twenty-eight patients received doxorubicin > or =400 mg x m(-2) and were evaluable for cardiotoxicity. Clinical heart failure developed in two patients (7%) after a cumulative doxorubicin dose of 500 mg m(-2). Left ventricular ejection fraction decreased more than 10% absolute ejection fraction units to a final left ventricular ejection fraction < or =50% in 10 patients (36%). Left ventricular ejection fraction decreased from 56+/-1.5% to 53.6+/-1.5% (P=0.016) in patients with no cardiotoxicity, and from 60.8+/-2.4% to 41.8+/-2.0% (P<0.001) in patients with cardiotoxicity. For patients who developed cardiotoxicity, the fall in left ventricular ejection fraction after a cumulative doxorubicin dose of only 200 mg x m(-2) was highly significant (left ventricular ejection fraction 49.7+/-1.8%, P=0.001 vs baseline). In receiver operator characteristic analysis, the area under the curve for the decrease in left ventricular ejection fraction at a cumulative doxorubicin dose of 200 mg x m(-2) for predicting cardiotoxicity in all patients was 0.858. The decrease in left ventricular ejection fraction of more than 4% units after a cumulative doxorubicin dose of 200 mg x m(-2) had a 90% sensitivity and 72% specificity for predicting later cardiotoxicity. Our results show that the significant impairment of left ventricular function during doxorubicin therapy can be predicted early, already at low cumulative doxorubicin doses. This finding may be of value in identifying patients at high or low risk for the development of anthracycline cardiotoxicity.

Adult↗
PubMed1984

Mechanism and significance of a decrease in ejection fraction during exercise in patients with coronary artery disease and left ventricular dysfunction at rest.

The purpose of this study was to determine whether an exercise-induced decrease in ejection fraction in patients with coronary artery disease and left ventricular dysfunction at rest represents ischemia or the nonspecific response of a compromised left ventricle to exercise stress. Accordingly, radionuclide ejection fraction responses of 246 patients with coronary artery disease and an ejection fraction at rest of less than 0.50 were compared with those of a "nonischemic" control group of 48 patients with idiopathic dilated cardiomyopathy and a similar degree of ventricular dysfunction. The significance of the ejection fraction response in the group with coronary artery disease was further examined by relating it to the angiographic extent of coronary artery disease, severity of angina, incidence of chest pain and electrocardiographic ST segment depression during exercise and long-term prognosis. The ejection fraction decreased by greater than or equal to 0.01 and greater than or equal to 0.05 during exercise in 48 and 28%, respectively, of the patients with coronary artery disease compared with only 8 and 2%, respectively, of the patients with cardiomyopathy. When exercise was limited by fatigue at a submaximal heart rate, the ejection fraction decreased in 25% of the patients with coronary artery disease but in none of the patients with cardiomyopathy. Patients with coronary artery disease whose ejection fraction decreased during exercise had a significantly higher incidence of three vessel disease, exercise-induced chest pain or ST depression and late mortality than did patients whose ejection fraction did not decrease. These relations were confirmed equally in subgroups of patients with moderate (ejection fraction 0.30 to 0.49) and severe (ejection fraction less than 0.30) left ventricular dysfunction. Thus, in patients with coronary artery disease and left ventricular dysfunction at rest, a decrease in ejection fraction during exercise is more likely to indicate ischemia than a nonspecific left ventricular response to exercise stress. In the individual patient, a decrease of 0.05 or greater, or a decrease during submaximal exercise, appears to be highly specific for ischemia. A decrease in ejection fraction identifies a subgroup of patients with a high prevalence of multivessel coronary artery disease and a high risk of death during long-term follow-up on medical therapy.

Adult↗
PubMed2004

An echocardiogram-based 16-segment model for predicting left ventricular ejection fraction improvement.

An important goal of cardiac revascularization is to improve the left ventricular ejection fraction, which is an important clinical determinant of the long-term outcome for patients with coronary artery disease. Regional myocardium function improvement may be expected from revascularization when viable myocardium is detected using non-invasive cardiac imaging. However, the quantitative relation between regional myocardial function recovery and global heart function improvement has not been determined and there is no tool to predict the amount of ejection fraction improvement prior to revascularization. A 16 segment biomechanical model of the left ventricle is proposed to establish the relationship between the ejection fraction improvement and the viable segments detected by echocardiography. With the assumption that the viable segments would potentially improve contractility after revascularization, the ejection fraction improvement is estimated for all possible wall motion score improvement in viable segments. The model shows that the ejection fraction improvement is linearly related to the contractility in the normal segments and a weighted sum of the numbers of viable segments that recover to normal or hypokinetic contractility. The predictive value of the model is illustrated for a group of patients reported in the literature. The model predictions of the post-revascularization ejection fraction are very close to the follow-up data with a very strong correlation (R2 = 0.92). By predicting the ejection fraction improvement, the model may provide a tool for evaluating the efficacy of revascularization and for selecting patients who would benefit from revascularization.

Coronary Disease↗