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PubMed1982

[Is the aorto-coronary bypass operation useful in patients with advanced coronary sclerosis and poor ventricular function?].

The prognosis and long term results in 56 patients with coronary artery disease and impaired left ventricular function (EF less than or equal to 40%) who underwent aortocoronary bypass surgery (all cases) and aneurysmectomy (26 cases) between 1972 and 1980 were compared with those in 47 equally ill patients treated medically. Survival was significantly higher in the surgical than in the non-surgical group, the survival rate being 80% and 58% respectively at 41 months after study entry (p = 0.012). No difference in survival was observed between grafted patients and patients in whom additional aneurysmectomy was performed. 26 patients were recatheterized postoperatively and this revealed an increase in left ventricular ejection fraction at rest from 33 +/- 5% to 44 +/- 11% (p less than 0.001) and a decrease in left ventricular end-diastolic pressure from 18 +/- 8 mm Hg to 14 +/- 8 mm Hg (p less than 0.025). Postoperatively the patients had less angina and physical working capacity increased. At restudy the average NYHA class had decreased in the surgical group from 2.9 +/- 0.7 to 2.1 +/- 0.9 (p less than 0.001) but was unchanged in the non-surgical group (2.6 +/- 0.6 and 2.6 +/- 0.7 respectively). It is concluded that aortocoronary bypass surgery improves survival, left ventricular function and symptoms in patients with coronary artery disease and severely impaired myocardial function.

Adult↗
PubMed1984

[Impedance cardiography during exercise in the evaluation of left-ventricular function].

The measurement of mean pulmonary artery pressure is an important parameter for the assessment of left ventricular function. Transthoracic impedance cardiography is a method which, by measurement of transthoracic impedance, gives information on hemodynamic events, parameters of contractility, and valvular heart disease. In 50 patients mean pulmonary artery pressure was measured at rest and during exercise and compared to the corresponding changes in the impedance cardiogram. It was examined whether by means of impedance cardiography an elevated pulmonary artery pressure could be predicted. Group I consisted of 25 patients with normal pulmonary artery pressure at rest and during exercise, group II of 25 patient with pathologic pressure elevation. While the behavior of stroke volume, cardiac output, left ventricular ejection time, and Heather Index as measured by impedance cardiography did not allow a prediction of elevated pulmonary artery pressure, the impedance ratio O/dz/dtmin (IQ) was significantly greater in group II than in group I. In the patients tested elevated and normal pulmonary artery pressure during exercise could be predicted with an accuracy of 84%. The mean value of dz/dtmin at a work load of 100 watt was slightly but significantly higher in group I than in group II. The results show that the impedance ratio (IQ) can be used to assess left ventricular function non-invasively.

Adult↗
PubMed1994

[The variable effect of coronary reperfusion on survival and left-ventricular function: how do thrombolytics act?].

The favourable effects of thrombolytic therapy on survival after acute myocardial infarction can not be attributed solely to a partial recovery of systolic left ventricular function. This is mainly due to the fact that with the current therapeutic regimens early, optimal tissue reperfusion is obtained in only a small percentage of patients with an acute myocardial infarction. However, recanalization of an occluded coronary vessel in itself has beneficial effects by mechanisms other than salvage of ischemic myocardium and preservation of left ventricular function. In view of the striking relationship between reperfusion (early or late) and survival as recently demonstrated by the GUSTO study, new therapeutic developments must be aimed at increasing the percentage of early, optimal and persistent reperfusion.

Coronary Circulation↗
PubMed1995

[Usefulness of 123I-MIBG and 123I-BMIPP myocardial scintigraphy for detecting coronary artery disease and for evaluating left ventricular function].

We evaluated the diagnostic value of 123I-metaiodobenzylguanidine (MIBG) and 123I-labeled beta-methyliodophenyl pentadecanoic acid (BMIPP) myocardial SPECTs for evaluating coronary artery disease and left ventricular function, in comparison with the diagnostic value of 201Tl (Tl) SPECT. For forty-nine patients with coronary artery disease, resting MIBG and BMIPP SPECTs were performed to detect coronary artery stenosis, compared with the diagnostic value of exercise Tl. Left ventricular ejection fraction and regional wall motion were compared with the total US (TUS) and regional US (RUS) of resting MIBG and BMIPP SPECTs, and in turn, compared with resting Tl SPECT. The sensitivity of resting BMIPP SPECT for detecting coronary artery stenosis was lower, and the specificity of resting MIBG SPECT was lower than the other two methods. The accuracy of resting MIBG SPECT for evaluating coronary lesions was nearly the same as the accuracy of exercise Tl, but higher than that of BMIPP SPECT. Left ventricular ejection fraction was well correlated with TUS of resting MIBG SPECT (r = 0.80), resting BMIPP SPECT (r = 0.77), and resting Tl SPECT (r = 0.68). Regional wall motion was most correlated with RUS of resting BMIPP SPECT, compared with that of resting Tl and MIBG SPECTs. These data suggest that resting MIBG SPECT is useful for detecting coronary artery disease and that resting BMIPP SPECT is valuable in evaluating regional left ventricular function.

3-Iodobenzylguanidine↗
PubMed1991

Left ventricular function changes after cardiomyoplasty in patients with dilated cardiomyopathy.

Dynamic cardiomyoplasty has been reported in the treatment of severe myocardial failure. In this investigation significant improvement of left ventricular function with dynamic cardiomyoplasty was demonstrated in patients with dilated cardiomyopathy or Chagas' disease for more than 1 year of follow-up. Thirteen patients with advanced heart failure who were in New York Heart Association class III or IV were operated on. There were no operative deaths. Patients were followed up for a mean of 11.5 months, and two patients died during the late follow-up period. Five of nine patients observed long term are in New York Heart Association class I, three in class II, and one in class III. At 3 months of follow-up, Doppler echocardiography demonstrated that left ventricular segmental wall shortening increased from 11.4% +/- 2.3% to 16.4% +/- 3.9% (p less than 0.01), and left ventricular stroke volume from 23.9 +/- 5.7 to 34.4 +/- 10 ml (p less than 0.01). Radioisotopic left ventricular ejection fraction improved from 20.9% +/- 3.3% to 25.4% +/- 7.7% (p = 0.06), and its better increases occurred in patients with lesser left ventricular end-diastolic dimensions. Cardiac catheterization showed that left ventricular stroke work index increased from 14.6 +/- 3.8 to 23.7 +/- 6.7 gm.m/m2 (p less than 0.01), whereas pulmonary wedge pressure decreased from 24.8 +/- 3.7 to 17.2 +/- 5.8 mm Hg (p less than 0.01). At 6 and 12 months of follow-up, all the preceding values remained essentially unchanged. Thus cardiomyoplasty improves left ventricular function and may halt the steady evolution of severe cardiomyopathies.

Adolescent↗
PubMed1997

Relation of duration of ST reelevation at reperfusion and improvement of left ventricular function after successful primary angioplasty of the left anterior descending coronary artery in anterior wall acute myocardial infarction.

We conducted a prospective study to investigate the relation between ST reelevation during primary angioplasty and improvement in left ventricular function. The duration, not the occurrence, of ST reelevation at reperfusion was associated with improvement in left ventricular function in patients with anterior wall acute myocardial infarction successfully recanalized by primary angioplasty.

Aged↗
PubMed1993

Importance of ischemic preconditioning and collateral circulation for left ventricular functional recovery in patients with successful intracoronary thrombolysis for acute myocardial infarction.

We studied the effects of myocardial ischemic preconditioning and preexistent collateral circulation on the preservation of left ventricular function in 30 patients who had successful intracoronary thrombolysis within 6 hours after the onset of a first acute anterior myocardial infarction. The existence of ischemic preconditioning was defined as the episode of recurrent ischemic chest pain within 4 hours before the onset of acute myocardial infarction. In 16 patients with ischemic preconditioning (group A), the left ventricular ejection fraction during the convalescence of myocardial infarction was 57% +/- 11% (mean +/- SD); regional wall motion in the infarct area was 13% +/- 9%. In 14 patients without ischemic preconditioning (group B), the left ventricular ejection fraction and regional wall motion in the infarct area were 46% +/- 9% and 5% +/- 9% (both p < 0.05 vs group A). Moreover, among group A patients, seven patients having a well-developed collateral circulation during the acute stage of myocardial infarction showed a more prominent improvement in regional wall motion in the infarct area compared with nine patients having poor or no collateral circulation (18% +/- 8% vs 9% +/- 7%, p < 0.05). These data indicate that ischemic preconditioning is effective for the preservation of left ventricular function in patients with successful intracoronary thrombolysis and that preexistent coronary collateral circulation potentiates this favorable effect of ischemic preconditioning.

Adult↗
PubMed2004

Aortic valve replacement in patients with severely reduced left ventricular function.

Aortic valve replacement (AVR) can be done safely in patients with severe aortic stenosis (AS) and depressed ventricular function (ejection fraction < or =35%). Dobutamine echocardiography is useful to identify AS patients with contractile reserve who will benefit from AVR and can be used for risk stratification of these patients. AVR can also be undertaken in patients with severe aortic regurgitation and depressed ventricular function with an acceptable operative mortality. AVR in both groups results in a 5-year survival of approximately 70%, which is similar to that of orthotopic heart transplantation. Due to the comorbidities of immunosuppression and limited donor organ supply, AVR should be attempted prior to transplantation in both these high-risk groups.

Aortic Valve↗
PubMed1992

Effect of chronic supraventricular tachycardia on left ventricular function and structure in newborn pigs.

OBJECTIVES: The purpose of this study was to examine the effects of supraventricular pacing tachycardia on left ventricular function and myocardial structure in newborn, immature pigs and to determine whether immature pigs respond to supraventricular tachycardia differently from adults. BACKGROUND: Previous studies have shown that supraventricular tachycardia causes dilated cardiomyopathy in adult animals; however, in humans, supraventricular tachycardia-induced congestive heart failure occurs most frequently in children and newborns. Because some clinical diseases may cause myocardial failure in adults but rarely do so in children, it was hypothesized that the effects of supraventricular tachycardia in newborns may be different from those in adults. METHODS: In two groups of newborn swine (3 weeks of age), left ventricular volume, mass and function were assessed with simultaneous echocardiography and cardiac catheterization and myocardial structure was examined with light and electron microscopy. Six piglets underwent 3 weeks of left atrial pacing tachycardia (240 beats/min) and six littermates served as a control group. Both groups were followed up for 3 weeks. RESULTS: At the end of the protocol, left ventricular dimensions increased in the piglets with supraventricular tachycardia compared with values in the control group, but there were no differences in left ventricular mass. Systolic function, assessed by fractional shortening, peak ejection rate and maximal rate of pressure development, was decreased in the group with supraventricular tachycardia. The fractional shortening-end-systolic stress relation in the piglets with supraventricular tachycardia decreased below normal values. Left ventricular diastolic function assessed by the relaxation time constant was prolonged, the peak filling rate was decreased and left ventricular stiffness was increased in the supraventricular tachycardia group. The morphologic data demonstrated that supraventricular tachycardia did not change total myocyte volume but did decrease total myofibrillar volume. CONCLUSIONS: Supraventricular tachycardia caused dilated cardiomyopathy in immature pigs. These changes in left ventricular function were associated with a decrease in cellular contractile proteins. Thus, the effects of supraventricular tachycardia on left ventricular function and structure in immature animals were comparable to previous findings in mature animals.

Age Factors↗
PubMed1983

Sustained improvement in left ventricular function and mortality by intracoronary streptokinase administration during evolving myocardial infarction.

One hundred eighty-eight patients with acute myocardial infarction were studied prospectively from August 1980 to September 1982. One hundred thirty-six of these patients were entered into a intracoronary streptokinase study after informed consent was obtained. The remaining 52 patients, who either met exclusion criteria for the study or refused to participate, served as a control group and were treated as those in the study group except that they did not undergo emergency cardiac catheterization. Left ventricular function was determined in both groups by gated radionuclide ejection fraction (EF) on admission to the hospital, at discharge, and 6 months after discharge. With successful reperfusion up to 18 hr after onset of chest pain, mean left ventricular function in the study group improved (EF 39 +/- 13% on admission and 46 +/- 12% at discharge; p less than .001). Mean EF in control patients and those not achieving reperfusion did not change from admission to discharge. Mean EF at 6 month follow-up was not significantly different than at discharge in the study group or the control group. Total cardiac mortality in the control group was 19% compared with 10% in the study group (p = .06, NS). When patients admitted in pulmonary edema or shock (Killip class III or IV) were excluded from both groups, total cardiac mortality in the study group was significantly lower (4%) compared with in the control group (12.5%, p less than .05. The administration of intracoronary streptokinase during evolving myocardial infarction up to 18 hr after onset of chest pain may result in decreased mortality and sustained improvement in left ventricular function.

Aged↗
PubMed1989

Disparity between improvement in left ventricular function and changes in clinical status and exercise capacity during chronic enoximone therapy.

Twenty patients with moderately severe congestive heart failure were randomized to chronic enoximone (n = 10) or placebo (n = 10) therapy in a double-blind manner and serially evaluated over a 16-week-period. The purpose of the study was to determine if the addition of standard doses (1 and 2 mg/kg) of this new phosphodiesterase inhibitor to conventional therapy (digitalis and diuretics) would alter the clinical and laboratory course of this patient population. Except for a transient improvement in the quality of life score, none of the symptomatology indicators were significantly affected by enoximone. Similarly, maximal exercise capacity was not altered. Enoximone did elicit a statistically significant augmentation of echocardiographic, radionuclide angiographic, and systolic time interval parameters of left ventricular function. These enoximone-induced effects were accompanied by a significant increase (7% to 11%) in resting heart rate. Enoximone is capable of improving ventricular function when added to digitalis-diuretic therapy in moderately severe congestive heart failure. While individual patients may benefit from enoximone, the ability of standard doses of this agent to improve symptoms and exercise capacity over a 16-week period appears somewhat limited in a moderately severe heart failure population as a whole. Furthermore, a disparity between improvement in ventricular function parameters and changes in clinical status and exercise performance is apparent in this heart failure population.

Adult↗
PubMed1991

Effects of immunosuppressive therapy in biopsy-proved myocarditis and borderline myocarditis on left ventricular function.

Twenty patients with decreased left ventricular (LV) function and endomyocardial biopsy-proved myocarditis (9 patients) or borderline myocarditis (11 patients) were studied to determine whether these 2 histologic subsets of patients with inflammatory heart disease differed in their response to a 6- to 8-week course of immunosuppressive therapy. All patients received a regimen of prednisone, 1.0 mg/kg/day, and azathioprine, 1.5 mg/kg/day, followed by repeat endomyocardial biopsy and reevaluation of LV function. LV function improved significantly in the group with borderline myocarditis, as assessed by LV stroke work--end-diastolic volume ratio (0.26 +/- 0.17 to 0.54 +/- 0.31 kg.m.ml-1, p less than 0.02), heart rate corrected velocity of circumferential shortening (0.49 +/- 0.30 to 0.80 +/- 0.29 circ.s-1, p less than 0.05), and LV ejection fraction (0.30 +/- 0.15 to 0.47 +/- 0.13, p less than 0.05). LV end-diastolic and end-systolic volume indexes also decreased significantly from 129 +/- 40 to 94 +/- 38 (p less than 0.05) and 90 +/- 37 to 49 +/- 26 ml (p less than 0.02), respectively. No significant change in these indexes of LV function or volume occurred in the myocarditis group. Whereas salutory improvements in cardiac output and filling pressures were found in both groups, objective improvement in LV function assessed by complementary indexes of contractility was greatest in the borderline myocarditis group. It is concluded that short-term immunosuppressive therapy improves LV contractile function and appears to be associated with regression of ventricular dilatation in patients with borderline myocarditis to a greater extent than patients with myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Ventricular function determination during extracorporeal membrane oxygenation (ECMO) following Norwood operation: a case report.

Extracorporeal membrane oxygenation has been used successfully to support both cardiac and pulmonary function following Stage I Norwood operation. Determination of the return of native cardiac function and pulmonary function can be easily accomplished because of the single ventricle physiology. The pulmonary function can be assessed while on full flow ECMO by isolating the membrane oxygenator gas compartment, allowing evaluation of native pulmonary gas exchange through the modified Blalock-Taussig shunt. Cardiac output can be calculated by using the following oxygen delivery equation: Total O2 delivery = ECMO oxygen delivery + ventricular oxygen delivery. The ventricular O2 saturation used in the formula for oxygen delivery is same as the mixed venous O2 saturation returning to the ECMO pump because of the large atrial communication following the Norwood operation. A 3.2 kilogram patient was placed on a pediatric ECMO circuit utilizing a heparin-coated centrifugal pump and a microporous membrane oxygenate after failure to wean from bypass because of a low oxygen saturation and poor ventricular function. On day 1 of support, the systemic arterial oxygen saturation was 100% and matched the ECMO arterial saturation. On day 2 of the support, the patient's arterial saturation decreased to 96%, and the ECMO mixed venous saturation was 87%. Using the oxygen delivery formula, the ventricular cardiac output was calculated to be 175 mL/min, with an ECMO flow of 400 mL/min for a total cardiac output of 575 mL/min. The native ventricular contribution was, therefore, 30% of total cardiac output. Calculation of cardiac output would normally require a left ventricular sample in a patient with biventricular physiology. The single ventricle physiology in the post-operative Norwood patient makes this calculation a useful tool for assessing return of ventricular function in these patients.

Extracorporeal Membrane Oxygenation↗
PubMed1979

[Effects of isometric exercise on the right ventricular function and on the pulmonary circulation, in normal subjects (author's transl)].

The pulmonary circulatory response and right ventricular haemodynamics were assessed in normal subjects who sustained hand-grip exercise (HG) at 50% of the maximum voluntary contraction (M.V.C.) for 3 minutes. Ten normal subjects, aged 25 to 66 years, who underwent full right catheterization were studied. The following parameters were taken into consideration: heart rate (HR), end diastolic right ventricular pressure (EDRVP) end diastolic right ventricular volume (EDRVV), mean pulmonary arterial pressure (PAP), pulmonary wedge pressure (PWP), total pulmonary resistance (TPR), cardiac output (CO) and right ventricular sistolic work minute index (RVSWMI). These data were obtained by means of a tip-micromanometer connected with an polygraphic recorder and by means of thermodilution cardiac output computer. The statistical significance of the difference between the resting control values and those after isometric exercise was calculated with the Student's paired t test. A comparison of the control data with those obtained after isometric exercise, demonstrate a statistical significant (p less than 0,001) increase of the HR, PAP, PWP, TRP, CO, RVSWMI, a less significant (p less than 0.01) increase RVEDP. Our findings show that the HG causes changes in the pulmonary circulation and the right ventricular function. Our data seem to sustain that the pulmonary circulation respondes differently under isometric stress than it does under isotonic stress. The use of HG can thus be postulated as a useful means of evaluation of the response of the pulmonary circulation and right ventricular function.

Adult↗
PubMedDate not supplied

Stress-related variations in left ventricular function as assessed with gated myocardial perfusion SPECT.

BACKGROUND: There is inconsistency in reported patient characteristics associated with differences in basal and poststress left ventricular function (delta ejection fraction [DeltaEF]) assessed by gated single photon emission computed tomography (SPECT). This inconsistency may therefore hamper adequate interpretation. In this study we first determined the reproducibility of serial gated SPECT-assessed left ventricular function. Second, we determined whether left ventricular ejection fraction (LVEF) assessed directly after stress reflects basal LVEF and, if not, what patient characteristics were associated with this discrepancy in LVEF. METHODS AND RESULTS: Serial reproducibility of technetium 99m tetrofosmin gated SPECT-assessed LVEF in 22 patients showed a mean difference between two sequential measurements at rest of 0.09% EF units, with a 95% limit of agreement (2 SDs) at 5.8% EF units. In 229 patients Tc-99m tetrofosmin gated SPECT was performed after stress and at rest. Independent predictors of DeltaEF were the presence of scintigraphically proven ischemia (standardized coefficient, -1.256; P =.003) and difference in heart rate at the time of acquisition (standardized coefficient, 0.121; P =.001). CONCLUSIONS: Gated SPECT-assessed LVEF at rest is reproducible under standard clinical conditions. However, LVEF assessed after stress does not represent LVEF at rest in patients with scintigraphically proven ischemia and in patients with increased heart rate after stress compared with heart rate at rest.

Coronary Artery Disease↗
PubMed1995

The effect of left ventricular function on the echocardiographic assessment of heart valve disease.

Transvalvar velocities or derived pressure differences are highly dependent on flow. They must be corrected for flow for research studies or in the clinical situation where values are intermediate and difficult to interpret. This can be done using the continuity equation or using formulae based on ratios of mean pressure drop and flow of which resistance is probably more accurate than the Gorlin formula. Left ventricular diastolic behavior is a major determinant of mitral pressure half-time where the mitral stenosis is mild and also of the slope of the continuous wave recording in mild or moderate aortic regurgitation. Methods for assessing mitral regurgitation including patterns of pulmonary vein flow are also dependent on left ventricular function. The echocardiographic methods of describing valve function cannot be interpreted without regard to left ventricular function and loading conditions.

Aortic Valve Insufficiency↗
PubMed1995

Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echo-Doppler study.

OBJECTIVE: To assess left ventricular function in patients presenting with pulmonary edema following scorpion envenomation. DESIGN: Cohort study. SETTING: Medical intensive care unit of a teaching hospital. PATIENTS: Nine consecutive adult patients stung by Androctonus australis and presenting with pulmonary edema entered the study. Fourteen normal volunteers comprised the control group. INTERVENTIONS: Upon admission, all patients had right heart catheterization and, within the first 8 h, a Doppler echocardiographic study. Results of Doppler echocardiographic studies were compared to those of controls. MEASUREMENTS AND RESULTS: Usual hemodynamic information (heart and vascular pressures, derived data and tissue oxygenation parameters), left ventricular dimensions and indicators of systolic function, and Doppler-derived parameters of left ventricular filling and diastolic function were obtained upon admission. Serial echocardiographic measurements were repeated daily until full clinical recovery (eight patients) or death (one patient). All patients had a hemodynamic profile of acute congestive heart failure (mean PAOP = 24 +/- 2 mmHg; mean SVI = 22 +/- 7 ml/m2; mean CI = 2.5 +/- 0.5 l/min/m2). However, SVR were not increased (mean = 22 +/- 3 U/m2). Left ventricle was hypokinetic in all patients with transient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS = 12 +/- 6%; EF = 26 +/- 12%). An associated diastolic dysfunction is suggested by Doppler records of mitral inflow. Left ventricular systolic function evolved toward normalization within 6 +/- 2 days preceded by full clinical recovery. CONCLUSIONS: These data suggest that pulmonary edema in scorpion envenomation is of hemodynamic origin and is related to a severe and prominent impairment of left ventricular systolic function.

Adolescent↗
PubMed1992

[Computer-assisted electrocardiographic mapping and left ventricular function in patients with acute myocardial infarct].

In 22 patients with a first myocardial infarction the authors assessed the relationship between morphological changes of the QRS complex and systolic left ventricular function. Using a 56-lead computer-assisted electrocardiogram from the precordium in the form of a map (apparatus Cardiomap-1), the authors prepared a record during the first days after initiating treatment with a thrombolytic agent and again after a period of three weeks. They found only one correlation between the decrement of Q waves and the increase of the left ventricular ejection fraction (p less than 0.05). This correlation, however, is of no practical importance due to the low correlation coefficient. The relationship is moreover markedly influenced by the time of the first record. After the third day of thrombolytic treatment it is not expedient to make the initial record. No relationship between the change of R waves, ST segments and left ventricular function was found. Similarly, due to the great dispersal of values it is not possible to differentiate between patients with inferior infarctions of the heart muscle and anterior myocardial infarctions.

Adult↗