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PubMed1994

Does septal position affect right ventricular function during left ventricular assist in an experimental porcine model?

Right ventricular (RV) failure has been a major problem with patients supported by left ventricular (LV) assist devices (LVADs). To assess the importance of interventricular septal (IVS) position as a mechanism of RV failure, 7 Yorkshire pigs underwent implantation of a Thoratec LVAD. RV function was assessed before and during LVAD operation under differing conditions: (1) with an LV intraventricular latex balloon inflated or deflated to alter IVS position and (2) with and without pulmonary artery (PA) constriction to assess the effect of changes in afterload. RV stroke work, RV dP/dt, and RV end-diastolic length did not change significantly with LVAD operation or with changing afterload conditions. Septal shift was documented as a change in LV shape index (LVSI) calculated using echocardiography. LVSI decreased by 11% when the LVAD was turned on, indicating leftward shifting of the IVS (P = .01). During LVAD support and increased RV afterload, the LVSI decreased by 14.8% (P = .02). RV cardiac output decreased somewhat during LVAD support. However, RV output was worst when the septal position was normalized using the inflated intraventricular balloon during increased RV afterload (P = .05). Unloading by the LVAD of the left ventricle results in a leftward shift of the interventricular septum, which does not appear to adversely affect RV function. However, during conditions of increased RV afterload, septal shifting may be beneficial to RV function.

Animals↗
PubMed1996

Analysis of effect of two concurrent ischaemic zones on left ventricular function.

Left ventricular (LV) function due to two concurrent ischaemic zones (IZs) is investigated using a cardiovascular system model. The model comprises a three-compartment LV, the venous return and the arterial system. Haemodynamic responses of the LV to changes in the IZ size and myocardial contraction timings are explored. Results show that the greater the degree of asynschonisation is between the normal zone and the IZ, and the larger the ischaemic size, the more severe the LV dysfunction. Pre-load augmentation improves LV function. Model-predicted features are consistent with reported observations associated with myocardial ischaemia. The extent of the usefulness and limitations of this model is also discussed.

Computer Simulation↗
PubMed1983

Pindolol and propranolol in patients with angina pectoris and normal or near-normal ventricular function. Lack of influence of intrinsic sympathomimetic activity on global and segmental left ventricular function assessed by radionuclide ventriculography.

To investigate the role of intrinsic sympathomimetic activity on left ventricular (LV) function during antianginal therapy with beta-adrenoreceptor antagonists, 23 patients with chronic, exercise-induced angina pectoris and normal or near normal LV function underwent radionuclide ventriculography at rest and during exercise, during 3 randomly allocated periods: (a) treatment with oral propranolol, a drug without intrinsic sympathomimetic activity, 40 to 80 mg 4 times a day; (2) treatment with pindolol, a drug with marked intrinsic sympathomimetic activity, 5 to 10 mg 2 times a day; and (3) a control period. During the control period, the LV ejection fraction decreased from rest (58.9 +/- 8.2%) to exercise (54.3 +/- 10.7%), and the wall motion score decreased from 0.57 +/- 1.08 at rest to 2.39 +/- 2.10 during exercise, p less than 0.001. After propranolol, the ejection fraction did not change significantly at rest (57.2 +/- 8.1%) but improved during exercise (56.8 +/- 11.8%), compared with control values. After pindolol, the ejection fraction did not change at rest (57.9 +/- 8.6%) but improved during exercise (56.9 +/- 8.1%), compared with control values. Similarly, the wall motion score after administration of both agents did not change significantly at rest, but improved during exercise (p less than 0.001). The number of anginal episodes, nitroglycerin tablets consumed, and magnitude of S-T segment depression decreased significantly with both pindolol and propranolol. With both drugs, a similar improvement in exercise tolerance and a similar decrease in exercise heart rate and blood pressure were obtained. It is concluded that pindolol and propranolol, beta-adrenoreceptor antagonists with and without intrinsic sympathomimetic activity, respectively, have similar effects on global and regional LV function in patients with angina pectoris, at doses producing equal suppression of exercise heart rate and similar antianginal effect.

Adult↗
PubMed2000

Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography.

Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60 +/- 8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31% +/- 7%) were studied. Rest 201Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at > or = 5%. In identifying viable segments, rest 201Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased > or = 5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on 201Tl SPET in group 1 than in group 2 (2.6 +/- 1.9 vs 0.6 +/- 1.2, P < 0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7 +/- 1.6 vs 1.1 +/- 1.6). A significant correlation was found between the number of a/dyskinetic segments viable on 201Tl SPET and post-revascularization changes in ejection fraction (r = 0.52, P < 0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest 201Tl SPET had a higher sensitivity (82% vs 53%, P = 0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization.

Adrenergic beta-Agonists↗
PubMed1982

Clinical evaluation of left ventricular function in acute myocardial infarction--analysis of factors affecting left ventricular function.

The clinical significance of the possible factors which may affect the cardiac function and prognosis of the patients with acute myocardial infarction were evaluated in 112 patients with this disease. Patients were subdivided into 4 groups according to the levels of pulmonary capillary wedge pressure (PCWP) and left ventricular stroke work index (SWI): Group I (52 patients) PCWP less than 18 mmHg, SWI less than or equal to 30 g.m/m2; Group II (18 patients) PCWP greater than or equal to 18 mmHg, SWI greater than or equal to 30 g.m/m2; Group III (15 patients) PCWP less than 18 mmHg, SWI less than 30 g.m/m2; Group IV (27 patients) PCWP greater than or equal to 18 mmHg, SWI less than 30 g.m/m2. Immediate mortality rate (4 weeks after the onset of myocardial infarction) was 17.0% in all patients and Group IV had the highest mortality rate (48.1%), in contrast to the lowest mortality rate (3.8%) in Group I. The episodes of previous myocardial infarction were noted more frequently in Group IV (74.1%) than in Groups I (7.7%) and II (11.1%) (p less than 0.001). Mean age in Group IV (68.0 +/- 5.2 (SE) years) was also significantly higher than those of the remaining 3 groups (p less than 0.001). In 55 patients without previous myocardial infarction, mean infarct size estimated from total released creatine phosphokinase (CPK) (sigma CPK) in Group IV was largest among the 4 groups, although it was similar to that in Group II: 919.0 +/- 70.0 (SE) IU/ml in Group I, 1470.0 +/- 126.0 in Group II, 958.0 +/- 107.0 in Group III and 1493.0 +/- 145.0 in Group IV. The number of involved coronary arteries differed significantly between Groups I and IV: in Group I involved coronary artery (75% narrowing) was absent or one at most, while in Group IV all 9 patients had at least one coronary lesion and 3 of 9 had triple vessel disease. In this study no significant difference was observed between the incidence of anterior and inferior myocardial infarctions in Groups I, III and IV. Thus, we conclude that age, previous myocardial infarction, infarct size and the number of involved coronary arteries may determine the cardiac function in acute phase of myocardial infarction and hence, immediate mortality of this disease.

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↗
PubMed1982

Recovery of right ventricular function following repair of acute ventricular septal defect.

Ventricular septal defect is a serious complication of acute myocardial infarction with a high mortality rate. Right ventricular dysfunction, which frequently accompanies septal defect, can be due to several etiologies. We describe two cases of septal defect following infarction, with sequential studies of right and left ventricular function. Right ventricular infarction was found in both patients. Postoperatively, the right ventricular ejection fraction improved significantly. The pathophysiology and expectation for recovery are discussed.

Aged↗
PubMed1980

[Histological and ultrastructural study of the left ventricular myocardium in mitral stenosis. Correlations with angiocardiographic indices of left ventricular function. Eleven cases].

Left ventricular myocardial biopsy was carried out at operation in 11 patients with pure, isolated mitral stenosis after preoperative angiocardiographical assessment of left ventricular function. The biopsy specimens were examined by light and electron microscopy. The diameter of the myocytes was normal (20 +/- 1.6 mu). The changes observed were probably of a degenerative type with anarchy and irregularities in the sarcomeres, modification of the Z bands, as seen in Nemaline myopathies, and changes in the intercalatory discs. Moderate interstitial fibrosis with scanty histiocytes was also observed. A quantitative assessment by two dimensional planimetry showed a significant increase in the interstitial space (37 +/- 5.5%) compared to a control group without fibrosis (22 +/- 1.1%). The angiocardiographical indices of left ventricular function were all decreased. The amplitude of circumferential fibre shortening was reduced: 25 +/- 6% the ejection fraction by 52 +/- 9% and the average speed of circumferential fibre shortening by 1.0 +/- 0.3 circ/s. Only four patients had normal left ventricular function (ejection fraction > 55%). However, it was not possible to establish a significant correlation between the degree of fibrosis and the reduction in left ventricular function. Left ventricular fibrosis may be one of the factors responsible for the reduction of myocardial function, but it does not in itself explain all the changes in left ventricular function observed in mitral stenosis.

Adolescent↗
PubMed1983

Effects of coronary artery bypass grafting on left ventricular function assessed by multiple gated ventricular scintigraphy.

The effect of coronary artery bypass grafting on global left ventricular ejection fraction and regional contraction was studied in 56 consecutive patients with chronic stable angina pectoris by means of multiple gated ventricular scintigraphy at rest and during dynamic supine exercise before and six weeks after myocardial revascularisation. Before operation, exercise induced a significant fall in ejection fraction and regional wall motion score. Six weeks after operation 52 patients were symptomless. Resting ejection fraction and regional wall motion score were unchanged but during exercise ejection fraction increased significantly, and the previous exercise induced regional wall motion abnormalities were abolished. All four patients with persisting angina showed the same pattern as before operation, with a fall in left ventricular ejection fraction and regional wall motion score during exercise. Multiple gated ventricular scintigraphy affords a safe, objective, reproducible, and non-invasive means of assessing serial ventricular function at rest and during exercise in patients with ischaemic heart disease. The technique confirms that coronary bypass surgery abolishes exercise induced abnormalities of left ventricular function, but has no influence on resting function.

Angina Pectoris↗
PubMed2004

Angiographic right and left ventricular function in arrhythmogenic right ventricular dysplasia.

We prospectively documented right ventricular (RV) and left ventricular (LV) volumes and ejection fractions in a large series of patients with arrhythmogenic RV dysplasia/cardiomyopathy (ARVD/C). Eighty-five patients with ARVD/C and 11 controls underwent 2 successive orthogonal right and left monoplane x-ray-digitized cineangiographies. Volumes were calculated using the hemielliptical RV and ellipsoidal LV models. All controls and 58 of 85 patients (ARVD/C-I) had a RV ejection fraction > or =35% and 27 patients had a RV ejection fraction <35% (ARVD/C-II). Tricuspid annulus plane systolic excursion (TAPSE) was lower in ARVD/C-II than in ARVD/C-I patients (6 +/- 3 vs 14 +/- 3 mm) and controls (16 +/- 2 mm) (each p <0.001). In patients with ARVD/C, TAPSE was positively related to RV ejection fraction (r = 0.79) and to crista supraventricularis shortening (r = 0.81) (each p <0.001). Sensitivity and specificity of TAPSE <12 mm in identifying patients with RV ejection fraction <35% were 96% and 78%, respectively. LV ejection fraction was > or =50% in 68 patients, 40% to 49% in 10, and <40% in 7. Diffuse RV outflow tract aneurysm was observed in 9 patients, all belonging to ARVD/C-II, and this sign identified patients with LV ejection fraction <40% with 86% sensitivity and 96% specificity. In conclusion, 68% of ARVD/C patients had normal RV ejection fraction and RV volumes, and 80% of ARVD/C patients had normal LV ejection fraction. Decreased TAPSE <12 mm and a diffuse RV outflow tract aneurysm were sensitive and specific indicators of RV ejection fraction <35% and LV ejection fraction <40%, respectively.

Adult↗
PubMed1998

[Effect of aqueous extract of Lepidium apetalum on dog's left ventricular function].

Left ventricular myocardial contractility, function of pump-blood and coronary flow in dog were increased by i.v. aqueous extract of Lepidium apetalum (AELA) 0.2 ml/kg (containing crude medicinal herb 2 g/ml). The effects were similar to i.v. isoperaline 10 micrograms/kg, but AELA did not obviously change heart rate, arterioveno-oxygen partial pressure difference and arteriovenooxygen solubility. The results indicated the AELA had advantages of cordial effect and increasing coronary flow instead of enhancing oxygen consumption of cardiac muscle.

Animals↗
PubMed1990

Transfer function analysis of the ventricular function: a new method for calculating right ventricular ejection fraction.

The relationship between the ventricular transfer function and ejection fraction has been investigated by the routine procedure of first-pass radionuclide angiocardiography. Ejection fraction has been shown to equal 1-e(-b), where b is the ratio of the R-R interval over the mean transit time difference between ventricular and atrial time-activity curves. To evaluate the effect of region of interest (ROI) on the right ventricular ejection fraction (RVEF), the results of the transfer function analysis (TFA) technique using precise ROI, TFA using rectangular ROI, and the routine method were compared. Regression analyses among RVEFs obtained from the above ROI methods yielded good correlations. Reliable RVEFs have been obtained even in the case of an improper bolus injection. Thus, the TFA technique is a new, simple, and reliable method for calculating RVEF without needing to outline the right ventricle precisely.

Heart↗
PubMed2005

The effect of vitamin E on endothelial function of micro- and macrocirculation and left ventricular function in type 1 and type 2 diabetic patients.

We examined the effects of high-dosage vitamin E treatment over a 12-month period on the vascular reactivity of micro- and macrocirculation and left ventricular function in diabetic patients. Subjects (n = 89) were randomized to vitamin E (1,800 IU daily) or placebo and were followed for 12 months. High-resolution ultrasound images were used to measure the flow-mediated dilation (FMD; endothelium dependent) and nitroglycerin-induced dilation (NID; endothelium independent) of the brachial artery. Laser Doppler perfusion imaging was used to measure vascular reactivity in the forearm skin. Left ventricular function was evaluated using transthoracic echocardiogram. At the end of the 6-month period, a worsening in endothelium-dependent skin vasodilation (P = 0.02) and rise in endothelin levels (P = 0.01) were found in the vitamin E compared with the placebo group. At the end of the 12-month period, a worsening was observed in NID (P = 0.02) and a marginal worsening was seen in systolic blood pressure (P = 0.04) and FMD (P = 0.04) in the vitamin E compared with the placebo group. In addition C-reactive protein levels decreased marginally in the vitamin E compared with the placebo group (P = 0.05). No changes were observed in left ventricular function. We concluded that long-term treatment with 1,800 IU of vitamin E has no beneficial effects on endothelial or left ventricular function in diabetic patients. Because vitamin E-treated patients had a worsening in some vascular reactivity measurements when compared with control subjects, the use of high dosages of vitamin E cannot be recommended.

Adult↗
PubMed1987

[Right ventricular function in patients with chronic right ventricular infarction].

To assess right ventricular function in patients with chronic right ventricular infarction, Tc-99m angiocardiography was performed in 64 patients one to three months after the onset of myocardial infarction. These patients were categorized into four groups according to their hemodynamic data in the acute stage using the Forrester classification: 39 patients in group I, 15 in group II, eight in group III and two in group IV. Mean right atrial pressure was nearly equal to or greater than diastolic pulmonary arterial pressure in all patients in group III. We calculated right ventricular ejection fraction (RVEF) and the right ventricular end-diastolic volume index (RVEDVI) as the parameter of right ventricular function, and assessed right ventricular wall motion using the right ventricular regional ejection fraction images (RVREFI). 1. RVEF in group III (25 +/- 3%) was significantly lower than those in groups I, II and IV (44 +/- 6%, 45 +/- 7% and 37 +/- 4%, respectively), and RVEF of all patients in group III was less than 30%. 2. RVEDVI in group III (150 +/- 25 ml/m2) was significantly greater than those in groups I, II and IV (74 +/- 20 ml/m2, 59 +/- 14 ml/m2 and 91 +/- 36 ml/m2, respectively). 3. RVREFI in group III decreased at the inferior and/or septal regions of the right ventricle, indicating wall motion abnormalities at the corresponding sites. 4. Six patients in group III were examined by coronary angiography and all had definite lesions in the proximal portion of the right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Determinants of subsequent late postoperative left ventricular function and reversal of ventricular dilatation after mitral valve replacement for chronic mitral regurgitation.

We studied 16 patients with chronic mitral regurgitation by echocardiography before, and at 3 weeks, at 6-8 months and at 1-9 years after mitral valve replacement (MVR) to investigate serial changes in left ventricular (LV) function and reversal of ventricular dilatation. All patients at an average of 2.6 years after, and 8 patients before MVR were also studied by echocardiography and, except for 3 patients by measuring plasma catecholamines from the right atrium during bicycle exercise. Before operation, all patients were divided into group A (n = 12) with end-systolic dimension (ESD) < 4 cm and systolic blood pressure (SBP)/ESD > 3, and group B (n = 4) with ESD > 4 cm and SBP/ESD < 3. Maximum reduction in end-diastolic dimension (EDD) occurred at 3 weeks in all patients after MVR (from 60.5 +/- 3.7 to 49.0 +/- 4.5 mm, p < 0.05). ESD was reduced significantly (p < 0.5) only in group A. LV function was normal in group A, but it was depressed in group B at early and late periods after MVR. The slopes of the relationship between the mean velocity of circumferential fiber shortening (Vcf) and plasma norepinephrine (NE) during exercise in all patients in group B decreased along with the depression in LV function. After operation, all patients in group A reached New York Heart Association (NYHA) functional class I, while patients in group B were in NYHA class II. It is concluded that the surgical outcome after MVR for chronic MR will be better if preoperative ESD < 4 cm and SBP/ESD > 3. The relationship between mean Vcf and plasma NE during exercise seemed to be a useful index to evaluate the inotropic reserve of the LV.

Echocardiography↗
PubMed1969

Studies in clinical shock and hypotension: VI. Relationship between left and right ventricular function.

Left ventricular end diastolic (LVEDP) and mean right atrial (RAP) pressures were recorded simultaneously in 30 patients with shock (14 acute myocardial infarction, 10 acute pulmonary embolism or severe bronchopulmonary disease, and 6 sepsis). Myocardial infarction was characterized by a predominant increase in LVEDP, pulmonary disease by a predominant increase in RAP, and sepsis by a normal relationship between LVEDP and RAP. In all three groups a significant positive correlation was noted between RAP and LVEDP, with the regression line in cor pulmonale deviated significantly toward the RAP axis and the regression line in myocardial infarction exhibiting a zero RAP intercept at an elevated LVEDP.Low cardiac outputs with elevated LVEDP in myocardial infarction indicated severe left ventricular failure. Low outputs with elevated RAP in cor pulmonale were consistent with right ventricular overload. Although cardiac outputs often were normal in sepsis, low outputs with elevated cardiac filling pressures in some patients were consistent with a hemodynamic or humoral-induced generalized depression of cardiac performance.Vasoconstrictor and inotropic drugs often produced a functional disparity between the two ventricles, with the gradient between LVEDP and RAP increasing, apparently because of an increase in left ventricular work or an inadequacy of left ventricular oxygen delivery. Acute plasma volume expansion with dextran in patients with pulmonary vascular disease resulted in a somewhat more rapid rise in RAP than in LVEDP. In septic and myocardial infarction shock, however, LVEDP and RAP usually rose proportionally, with the absolute rise of LVEDP surpassing that of RAP. Although the absolute level of the central venous pressure thus may not be a reliable indicator of left ventricular function in shock, changes in venous pressure during acute plasma volume expansion should serve as a fairly safe guide to changes in LVEDP.

Journal Article↗
PubMed2000

Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction.

The aim of the present study was to assess the utility of the myocardial performance index in patients with right ventricular infarction. During the study period, 120 patients were evaluated: 50 patients had a right ventricular infarction and 70 patients had an inferior left ventricular infarction without right ventricular involvement. On admission, an echocardiogram was obtained from all patients prior to the initiation of thrombolytic therapy. The right ventricular myocardial performance index was calculated, as were the Doppler-derived parameters of the right side of the heart. All patients with right ventricular infarction had undergone a right ventricular dilation, compared with 70 patients with left ventricular infarction (right ventricular end diastolic diameter 32 +/- 13 versus 26 +/- 24 mm; P < 0.01) and increased areas (diastolic area 24.8 +/- 9.9 versus 15.1 +/- 6.8 cm2; P < 0.01). Tricuspid regurgitation was detected in 26 patients. The mean peak velocity of tricuspid regurgitation was 3.8 +/- 0.8 m/s. The Doppler intervals, isovolumetric contraction times (136 +/- 30 versus 49 +/- 11 ms; P < 0.01), and relaxation times (71 +/- 28 versus 37 +/- 9 ms; P < 0.01) were prolonged in patients with right ventricular infarction, whereas the ejection time was significantly reduced (250 +/- 31 versus 330 +/- 26 ms; P < 0.001). The myocardial performance index was significantly increased in patients with right ventricular infarction (0.85 +/- 0.2 versus 0.26 +/- 0.1; P < 0.01). The inferior vena cava collapse was reduced in all patients with right ventricular infarction (35 +/- 20%). The right ventricular myocardial performance index was a useful indicator of right ventricular performance in patients with right ventricular infarction. The use of echocardiographic parameters of the right side of the heart and Doppler echocardiographic parameters of right ventricular function provides a reliable diagnosis of right ventricular infarction.

Aged↗