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PubMed2000

Ventricular function and cardiac hypertrophy after coronary thrombolysis with tissue-type plasminogen activator (t-PA) in dogs with coronary artery thrombi.

Subacute prognosis of cardiac function after thrombolysis with a modified tissue-type plasminogen activator (t-PA) YM866 was determined in dogs with coronary artery thromboses induced by injection of a thrombin, fibrinogen and autogenous blood mixture. The left ventricular ejection fraction (LVEF) decreased 30 min after occlusion and had not improved 1 week later. Examination after sacrifice revealed myocardial infarction as well as increases in both the left ventricular myocardial area and heart mass. Occluded coronary arteries reperfused by YM866 (0.1 mg kg(-1) i.v.) treatment 30 min after occlusion, by contrast, had improved LVEF and inhibited myocardial infarction development. In addition, the left ventricular myocardial area and heart mass were significantly reduced compared with the vehicle control group 1 week after administration. Although occluded coronary arteries reperfused by YM866 (0.1 mg kg(-1) i.v.) treatment 3 h after occlusion did not show an improvement in the LVEF or inhibition of myocardial infarction development, the left ventricular myocardial area and heart mass decreased significantly compared with the vehicle control group 1 week after administration. In conclusion, early reperfusion by t-PA treatment 30 min after occlusion improved the ventricular function and cardiac hypertrophy, whereas late reperfusion by t-PA treatment 3 h after occlusion did not improve the ventricular function but did inhibit hypertrophy in dogs with coronary artery thrombi.

Animals↗
PubMed1994

Ventricular unloading and improvement in left ventricular function after angiotensin converting enzyme inhibition with enalapril in patients with chronic congestive heart failure.

To clarify how angiotensin converting enzyme inhibition affects left ventricular function through ventricular unloading, ventricular wall stress, ventricular volumes, and other cardiac indices and exercise tolerance were evaluated in 17 patients with mild to moderate chronic congestive heart failure before and after 3 months of treatment with enalapril. Echocardiographic examination revealed that treatment with this angiotensin converting enzyme inhibitor resulted in significant reductions in end-systolic wall stress (117 +/- 25 to 89 +/- 28 g/cm2, p < 0.01) and left ventricular volume indices (end-diastolic: 163 +/- 56 to 143 +/- 60; end-systolic 99 +/- 51 to 77 +/- 57 ml/m2 p < 0.01). Ejection fraction (42 +/- 11 to 48 +/- 13%, p < 0.01) and systolic blood pressure/end-systolic volume (SBP/ESV; 1.06 +/- 0.30 to 1.33 +/- 0.48 mmHg/ml, p < 0.01) were both increased. By radionuclide ventriculography, ejection fraction and peak ejection rate (2.30 +/- 0.74 to 2.80 +/- 0.76 EDV/sec, p < 0.01) were increased, while time to peak ejection, time to peak filling, and peak filling rate were unchanged. Heart rate and double product at exercise were decreased and delta EF was significantly increased (-1.4 +/- 4.1 to 1.6 +/- 4.4%, p < 0.02). The decrease in end-systolic wall stress was consistently related to both the increase in ejection fraction and SBP/ESV, while the decrease in end-diastolic volume was related only to SBP/ESV and not to ejection fraction. Furthermore, there was a direct relationship between the decrease in systolic wall stress and the decrease in end-diastolic volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

[Clinical study on effect of Astragalus injection on left ventricular remodeling and left ventricular function in patients with acute myocardial infarction].

OBJECTIVE: To observe the effect of Astragalus injection (AI) on left ventricular remodeling and left ventricular function in patients with acute myocardial infarction (AMI). METHODS: AMI patients were randomly divided into the AI group (54 cases) treated with AI and the control group (54 cases) treated with conventional treatment. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), anterior endocardial segmental length (ASL), posterior endocardial segmental length (PSL) were assessed by echocardiogram at the 1st and the 4th week of treatment; and the cardiac systolic and diastolic functions were detected by nuclide gating cardiac blood pool imaging on the 4th week. Besides, the plasmic levels of lipid peroxide (MDA), count of endothelial cell (CEC) and superoxide dismutase (SOD) were determined before and after treatment. RESULTS: At the 4th week, changes of LVEDVI, LVESVI and ASL in the AI group were not obvious, but increased significantly in the control group, the significant difference in comparison between the two groups was shown (P < 0.05). As compared with the control group, in the AI group, the left ventricular ejection fraction, left ventricular peak ejecting rate and left ventricular peak filling rate were higher, and the left ventricular time for peak filling rate was shorter, moreover, MDA and CEC were lower and SOD was higher. The difference between groups and between before and after treatment were significant (P < 0.01 or P < 0.05). CONCLUSION: AI is one of the effective drugs in reversal of left ventricular remodeling and improving left ventricular function in patients with AMI.

Adult↗
PubMed1998

Suppression of frequent premature ventricular contractions and improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy.

OBJECTIVE: To examine the hypothesis that suppression of frequent premature ventricular contractions may be associated with improvement in left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. DESIGN: We conducted a retrospective case study and statistical analysis of the effect of cardiac medical therapy on outcome. MATERIAL AND METHODS: The study population consisted of 14 patients with more than 20,000 premature ventricular contractions in 24 hours recorded by Holter monitoring and associated left ventricular dysfunction (ejection fraction, 40% or less). Clinical characteristics, number of premature ventricular contractions per hour on 24-hour ambulatory Holter monitoring, and ejection fraction based on transthoracic echocardiography were compared before and after cardiac therapeutic intervention. RESULTS: Of the 14 patients, 10 had presumed idiopathic dilated cardiomyopathy, and 4 had ischemic heart disease. Of the overall study group, seven had received additional cardiac medical therapy after the index evaluation, including four patients who had amiodarone therapy. A significant reduction (75% or more from baseline) in premature ventricular contractions after medical therapeutic intervention was observed in five patients at the first follow-up examination. The mean interval to the first follow-up examination was 6 +/- 3 months. Of the five patients, four had significant improvement in clinical functional status and the ejection fraction. The mean ejection fraction of these five patients increased from 27 +/- 10% at baseline to 49 +/- 17% after medical therapy (P = 0.04). CONCLUSION: The suppression of frequent premature ventricular contractions may be associated with improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy.

Adrenergic beta-Antagonists↗
PubMed1981

Effect of verapamil and nifedipine on left ventricular function at rest and during exercise in patients with Prinzmetal's variant angina pectoris.

To assess the effects of verapamil and nifedipine on left ventricular function at rest and during exercise in patients with Prinzmetal's variant angina pectoris, 10 patients (6 men and 4 women with a mean age of 52 years) with variant angina were each treated for 2 months periods with placebo, verapamil (400 +/- 80 mg/day, mean +/- standard deviation [SD]) and nifedipine (82 +/- 31 mg/day). During the final week of each 2 month treatment period equilibrium gated blood pool scintigraphy was performed at rest and during exercise. At rest, heart rate during verapamil therapy was lower than during treatment with nifedipine; systolic blood pressure and left ventricular volumes and ejection fraction were similar for the three interventions. The maximal work load achieved was similar during placebo, verapamil and nifedipine therapy. At the maximal work load common to all three exercise studies, heart rate and systolic blood pressure were lower with verapamil than with placebo and nifedipine; ventricular volumes and ejection fraction were similar with the three agents. Thus, in patients with variant angina and a wide range of left ventricular function at rest, neither verapamil nor nifedipine significantly alters left ventricular volumes or ejection fraction at rest or during exercise.

Angina Pectoris↗
PubMed1998

Plasma concentration of brain natriuretic peptide as an indicator of cardiac ventricular function in patients on hemodialysis.

The plasma concentration of human brain natriuretic peptide (BNP) was measured by immunoradiometric assay in patients on maintenance hemodialysis (HD) to assess the possible relationship between the plasma levels of this peptide and cardiac ventricular function, as judged by M-mode echocardiography. The plasma BNP levels in the pre-HD state were significantly higher (688.5 +/- 154.5 pg/ml) than those of healthy subjects (<40 pg/ml). In addition, the plasma BNP levels were slightly decreased during HD (post-HD, 617.3 +/- 157.1 pg/ml). There was no correlation between the plasma levels of BNP and body weight changes during HD. The mean plasma BNP level was significantly higher in the group of patients with a low left ventricular ejection fraction (EF < 60%) than in the group with a normal EF. In the patients as a whole, there was an inverse correlation between plasma BNP levels and EF. Moreover, a positive correlation was found between plasma BNP levels and left ventricular mass index (r = 0.57, p < 0.05). These results suggest that plasma BNP levels increase in response to chronic stimulation in accordance with increased cardiac load, and that they may be a possible indicator of reduced ventricular function in HD patients.

Atrial Natriuretic Factor↗
PubMed2001

[Aortic stenosis with low transvalvular pressure gradients and impaired left ventricular function. Dobutamine stress echocardiography helps in therapy planning].

BACKGROUND: Aortic valve replacement is recommended in case of symptomatic severe aortic stenosis. This decision is difficult for patients with low-gradient aortic stenosis and severely impaired left ventricular function because of high perioperative mortality in this group. Although aortic valve replacement is usually justified if severe aortic stenosis is proved, patients with primary myocardial dysfunction and subsequent reduced aortic valve opening do not benefit from aortic valve replacement. Distinguishing these two groups of patients is necessary but not possible with echocardiography at rest. Positive inotropic stimulation with dobutamine stress echocardiography enables a more reliable graduation of aortic stenosis under these circumstances. CASE REPORT: We report on a symptomatic 58-year-old man with aortic stenosis and severely impaired left ventricular function. Using echocardiography at rest, there was a severely reduced aortic valve area of 0.6 cm2 and a mean pressure gradient of 24 mm Hg. Determined by cardiac catheterization, the peak-to-peak gradient was 20 mm Hg and the aortic valve area calculated by the Gorlin formula was 0.6 cm2. After positive inotropic stimulation using dobutamine stress echocardiography, the aortic valve area increased to 1.5 cm2 indicating an only moderate aortic stenosis. Thus aortic valve replacement was not performed and myocardial failure was medically treated. After 1.5 years of follow-up, the patient is in good condition and without complaints.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

Myocardial oedema and ventricular function after cardioplegia with added mannitol.

Myocardial oedema may contribute to the impaired myocardial performance which commonly follows open heart surgery with cardioplegia-induced cardiac arrest. The rate of oedema formation during crystalloid cardioplegia and the relation of this to changes in ventricular compliance and ventricular function following reperfusion were studied using an isolated rabbit heart preparation. Myocardial tissue water content increased during cardioplegic arrest and the water content prior to reperfusion demonstrated an inverse correlation with ventricular function after reperfusion. In further studies the effect of adding mannitol to a standard crystalloid cardioplegic solution was investigated. The preparations were divided into two groups: nine were administered a standard cardioplegic solution (Plegisol*) (control group) and a further eight were administered the same solution mixed with mannitol to adjust the osmotic pressure to 360 mOsmol.L-3 (mannitol group). The mannitol group demonstrated less increase in RV water content and superior LV dP/dtmax following reperfusion. It is concluded that mannitol enhances protection of the myocardium during cardioplegic cardiac arrest.

Animals↗
PubMed1993

Recovery of left ventricular function after acute myocardial infarction: efficacy of domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial.

BACKGROUND: The objective was to compare the effect of thrombolytic therapy given either at home or in hospital on the recovery of left ventricular function after acute myocardial infarction. METHODS: In a randomized double-blind trial, 311 patients with suspected acute myocardial infarction were given 30 units anistreplase intravenously either at home, or later, in hospital. The median time-saving made with domiciliary thrombolysis was 130 min. All patients were admitted to hospital where left ventricular stroke distance was measured daily using a simple bedside ultrasound technique, and expressed as a percentage of the age-predicted normal value. The last recorded inpatient stroke distance measurement was used to assess residual left ventricular function after recovery from myocardial infarction. RESULTS: The mean stroke distance in patients with confirmed myocardial infarction was 74% on the day of admission, rising to 83% on the last inpatient day; it did not change between discharge and 3 months after admission. For 180 patients assigned randomly to treatment within 2 h of the onset of symptoms, mean stroke distance was greater by 6.8% in those given active anistreplase at home rather than in hospital (95% confidence interval 1.0 to 12.7%, P = 0.02), but there was no significant difference in stroke distance following home or hospital thrombolysis in 111 patients assigned treatment after that time (difference -2.0%, 95% confidence interval -8.4 to 4.5%, P = 0.54). CONCLUSIONS: The efficacy of thrombolytic therapy is enhanced when administered within 2 h of the onset of symptoms.

Adult↗
PubMed1981

Acebutolol and left ventricular function: assessment by radionuclide angiography.

We assessed the effects of acebutolol, a cardioselective beta blocker, on global and regional left ventricular function in 26 patients with chronic angina pectoris. All patients underwent rest and maximal supine bicycle exercise radionuclide angiography while on placebo and oral acebutolol (400 mg three times a day). Resting ejection fraction on placebo was 51 +/- 3% and on acebutolol was 54 +/- 3% (p less than 0.05). No resting ejection fraction decreased greater than or equal to 7%. Only one patient (resting ejection fraction 28% on placebo and 21% on acebutolol) developed signs of fluid retention. Exercise nuclear studies on placebo revealed responses consistent with coronary artery disease (abnormal ejection fraction response to exercise and regional wall motion abnormalities) in 24 of 26 patients. Peak exercise ejection fraction was of the same order on placebo and acebutolol (51 +/- 3% and 54 +/- 3%, p = NS). In four patients the ejection fraction response to exercise became normal and in five patients all regional wall motion abnormalities became normal on acebutolol. Cardioselective beta blockade with acebutolol in effective antianginal doses is safe and may improve resting and exercise ventricular function.

Acebutolol↗
PubMedDate not supplied

[Hemodynamic effects of quinacainol administered via an intravenous route. Study in patients with normal left ventricular function].

The haemodynamic effects of a new antiarrhythmic drug quinacainol (RP 54272) were evaluated in 12 untreated patients with normal left ventricular function referred for diagnostic cardiac catheterisation. The haemodynamic data were obtained before, 5 and 25 minutes after the injection of the drug (0.21 mg/kg/min during 6 minutes). A slight decrease of cardiac contractility indexes was constantly observed: dp/dtmax decreased (-15%) in all patients (p less than 0.05), with no concomitant change of left ventricular pressure or left ventricular end diastolic volume with respect to control values. Cardiac output and left ventricular ejection fraction did not change significantly. Heart rate increased in all patients from 74.3 +/- 9.8 to 79.9 +/- 8.6 beats per minute after 5 minutes (paired t test p less than 0.05), and was 79.8 +/- 9.0 beats per minute after 25 minutes. Systemic arterial resistance increased in 7 patients due to a reflex adrenergic discharge. The interpretation of the haemodynamic data was difficult in 3 cases due to systemic vasodilatation, which was poorly tolerated in one patient. The contribution of vagolytic reaction and adrenergic reaction to the negative inotropic effects of the drug must be evaluated before giving in to patients with impaired left ventricular function.

Adult↗
PubMed2002

MR assessment of left ventricular function: quantitative comparison of fast imaging employing steady-state acquisition (FIESTA) with fast gradient echo cine technique.

PURPOSE: To evaluate the agreement of fast imaging employing steady-state acquisition (FIESTA) cine technique with segmented k-space fast gradient echo (GRE) cine technique when using them for assessment of cardiac function. MATERIALS AND METHODS: Eleven MR cine studies were performed on six healthy volunteers and five patients, using FIESTA and fast GRE techniques. The quantitative measurements of ventricular function obtained from the two techniques were compared. The data analysis was performed by two observers independently. RESULTS: Compared to fast GRE cine technique, FIESTA cine technique consistently resulted in higher end-diastolic volume (10.2%) and end-systolic volume (21.6%), but lower myocardial mass of left ventricle (19.2%) and ejection fraction (9.9%). The stroke volume obtained from the two techniques was very close. The primary explanation for this variability is that the two techniques have different mechanisms on establishing signal contrast. CONCLUSION: Compared to fast GRE technique, FIESTA provides significantly different results when using it for assessment of left ventricular function. It is important to consider this difference in the assessment of cardiac function.

Adult↗
PubMed1989

Estimation of left ventricular function on ECG-gated thallium-201 myocardial perfusion images.

ECG-gated thallium-201 perfusion images (GT) may provide information concerning left ventricular contraction. To assess the objectivity of this information, qualitative and quantitative evaluations of left anterior oblique GT images were performed in 600 patients and compared with contrast ventriculography (n = 180) and gated blood pool scintigraphy (n = 60). Cinematic playback of GT allowed qualitative rating of ventricular performance in 98% of studies. Abnormal GT (focal or global hypokinesis) was found in 41% of cases and could be related to myocardial infarction, nonischemic cardiomyopathy or left bundle branch block. Blinded readings showed reasonable interobserver agreement and correlation with blood pool scintigraphy regarding segmental and overall left ventricular function; decreased tracer uptake in an abnormally perfused segment presented only occasional difficulty. A quantitative index was derived by relating the increment in left ventricular cavity activity during contraction to myocardial count density; results were expressed as a planar ejection fraction (PEF). PEF correlated well with ejection fraction on blood pool scintigraphy (r = 0.83, P less than 0.001) and with contractility scores derived from ventriculography (P less than 0.001) and seemed suited for identification of hypokinetic ventricles. Thus, GT allows objective estimation of left ventricular function as an addendum to myocardial perfusion imaging.

Cardiac Output↗
PubMed1982

[The effect of disopyramide, mexiletine and propafenon after intravenous and oral administration on left ventricular function in the M-mode echocardiogram].

The effects of the antiarrhythmic drugs disopyramide (D), mexiletine (M), and propafenone (P) on left ventricular function after intravenous injection and after oral therapy of at least 48 hours, and of the combined oral application of D and M, were studied by M-mode echocardiography in patients with ventricular arrhythmias in whom antiarrhythmic therapy was indicated. The drugs were given in doses comparable in terms of clinical efficacy. The results showed that the three drugs had varying negative inotropic power. The intravenous injection resulted in a more pronounced cardiac depression than the oral therapy. The most significant decrease in left ventricular wall motion after intravenous and oral application was seen after D, the smallest negative inotropic effect after M. P caused a cardiac depression between these extremes. After the combined oral application of D and M the impairment of left ventricular function was more pronounced than after therapy with the single drugs.

Administration, Oral↗
PubMed1995

Short-term effects of captopril on exercise tolerance in patients with chronic stable angina pectoris and normal left ventricular function.

A double-blind, placebo-controlled, crossover study was carried out to evaluate the short-term effects of captopril on exercise tolerance in 18 normotensive patients with chronic stable angina pectoris and normal left ventricular function. Captopril 25 mg (or placebo) was given twice, i.e. in the evening (10 p.m.) and the following morning (8 a.m.), prior to a maximal symptom-limited bicycle exercise test (11 a.m.). Captopril reduced the systolic and diastolic blood pressures at rest (p < 0.01) without causing any reflex tachycardia. The time to onset of S-T depression was prolonged (p < 0.05), and the maximal S-T depression was reduced (p < 0.02). No differences were found between captopril and placebo in total exercise duration or time to onset of angina. The effects of captopril on exercise-induced ischemia were demonstrated most clearly in patients who responded with a greater than 10 mm Hg fall in the resting systolic blood pressure. In conclusion, this study suggests that captopril has anti-ischemic properties, which may be of importance in the treatment of patients with chronic stable angina and normal left ventricular function. These beneficial effects probably relate to a reduction in afterload and myocardial wall stress and therefore a reduction in myocardial oxygen demand.

Adult↗
PubMed1989

[Left ventricular function a short time after myocardial revascularization surgery: radioisotope angiographic study].

The short-term effects after coronary bypass surgery on left ventricular function were studied in 65 patients with coronary artery disease. Each patient underwent gated radionuclide left ventriculography on the second-third day before and 5-7 days after coronary bypass surgery. After surgery, global ventricular ejection fraction had a significant increase, anteroseptal wall motion was unchanged, while apical motion and mainly inferoposterior motion were significantly increased. The most important improvement of inferoposterior motion was observed in 18 patients who had complete revascularization of the previously infarcted inferior segments, while in the 11 patients with incomplete revascularization of the same area, inferoposterior motion had a slight increase. There was a slightly significant direct linear correlation between size and direction of the anteroseptal and inferoposterior motion changes. The patients were divided in subgroups related to the site and number of obstructed coronary vessels as well as of implanted grafts; the computed parameters showed similar changes in all subgroups. After surgery, peak ejection rate showed an evident increase, and time to peak reciprocally shortened. Peak filling rate, which had reduced preoperative values, was found clearly improved, with a corresponding shortening of the time to peak; these results confirmed that diastolic ventricular damage was a reversible disturbance related to myocardial ischemia. In 8 of the 65 patients, 24 hours urinary catecholamine levels showed similar values at both pre and postoperative radionuclide controls. In conclusion, the radionuclide angiography showed an evident improvement of left ventricular function during a short period following surgery, suggesting a better myocardial perfusion after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Increased right ventricular afterload alters left ventricular function in newborn lambs.

The effects of acutely increased right ventricular afterload induced by mechanical constriction of the main pulmonary artery or with alveolar hypoxia on function of the left ventricle were assessed in six and nine lambs, respectively (aged 1 to 3 days). Mechanical constriction of the main pulmonary artery in newborn lambs compromised left ventricular function with significant decreases in systemic blood flow and the peak first derivative of left ventricular pressure when considered simultaneously and as single variables. In contrast, alveolar hypoxia augmented left ventricular function with significant increases in systemic blood flow and the peak first derivative of left ventricular pressure when considered simultaneously or as single variables. Interaction appears to exist between the right and left ventricles during the newborn period. The mechanically increased afterload may have compromised left ventricular function by altering its end-diastolic size, inotropic state, or both. On the other hand, the augmented left ventricular function in the presence of hypoxia may have been due to an increase in inotropic background. The clinical implications in some infants with pulmonary hypertension and left ventricular dysfunction are raised.

Animals↗