Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Ejection fraction”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMed1993

[Value of the ejection fraction in patients with right ventricular necrosis during the rehabilitation period].

The right ventricular ejection fraction was determined in 58 patients with simultaneous right and left ventricular myocardial infarction and in 77 patients with only left ventricular myocardial infarction. The results were analysed in four groups of patients (patients with anterior, anterior and right ventricular, posterior, posterior and right ventricular myocardial infarction). Furthermore, the relation between left and right ventricular ejection fraction, stress capacity and heart volume was investigated. There was no influence of the age and gender of patients on the observed values of right and left ventricular ejection fraction. In younger patients, after myocardial infarction, the heart volume was found to be less and the stress capacity to be higher then in elderly patients. The right ventricular ejection fraction was normal in patients with "poor" left ventricular infarction, and it was decreased in patients with right ventricular myocardial infarction. The right ventricular ejection fraction did not influence the stress capacity and the heart volume of the patients. The left ventricular ejection fraction found to be less in anterior, compared to posterior myocardial infarction. This difference was independent on the presence of right ventricular infarction. The authors consider the decreased right ventricular ejection fraction as a valuable indicator of the abnormal contractility of the right ventricle even at the time of the rehabilitation after myocardial infarction.

Age Factors↗
PubMed1989

Resting gated pool ejection fraction: a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery for infrainguinal bypass grafting.

Ventricular ejection fraction is widely regarded as a prognostic indicator of perioperative myocardial infarction. To evaluate this premise the prevalence of perioperative myocardial infarction or cardiac death was analyzed in relation to preoperative resting gated pool ejection fraction in 85 patients undergoing vascular surgery for infrainguinal bypass grafting. Patients were divided into three groups on the basis of ejection fraction. Group I consisted of 50 patients with ejection fractions of 56% to 92%. Nine (18%) perioperative myocardial infarctions occurred in group I, and there were no cardiac deaths. Group II consisted of 20 patients with ejection fractions of 37% to 55%. Three (15%) myocardial infarctions occurred in this group, and there were no cardiac deaths. Group III included 15 patients with ejection fractions of 20% to 35%. Three (20%) cardiac events occurred in group III including one nonfatal myocardial infarction and two (13%) cardiac deaths. Statistical analysis showed no significant difference in prevalence of cardiac events between any group. These results suggest that resting ejection fraction is a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery. Patients with normal ejection fractions, but underlying coronary artery disease, are still at significant risk for a perioperative cardiac event.

Adult↗
PubMed1990

Comparison of physiologic ejection fraction responses to activities of daily living: implications for clinical testing.

The recent development of the VEST, an ambulatory radionuclide detector, to measure left ventricular ejection fraction may enhance the detection of ischemia during daily activities in patients with coronary artery disease. The normal range and determinants of ejection fraction responses to stimuli other than physical exercise, however, are not adequately characterized. Therefore, ejection fraction responses to various activities were measured in 18 normal subjects utilizing the VEST. Uniform increases (greater than 5%) in ejection fraction were seen during physical exercise, uniform decreases were seen during cold pressor testing and modest changes (including decreases greater than 5%) were seen in ejection fraction during mental stress, micturition and hyperventilation. Different forms of stress produced significantly different changes in ejection fraction, even when values were controlled for changes in heart rate. Ventricular loading conditions in the form of enhanced blood pressure responses during mental stress may have contributed to the relatively smaller changes in ejection fraction compared with those during exercise. Subjects demonstrating a decrease in ejection fraction during mental stress did not differ from other subjects in hemodynamic reactivity during mental testing but did have evidence of increased parasympathetic tone during cold pressor and bicycle exercise testing. The results reveal that normal ejection fraction response differs among varying physiologic stimuli. These changes are in part related to changes in heart rate and blood pressure; however, other factors, such as neurohumoral regulation, may also play a role. These findings indicate that the patient's activity and the setting in which it occurs must be considered when interpreting ambulatory ejection fraction responses.

Activities of Daily Living↗
PubMed2003

Comparison of 99mTc tetrofosmin gated SPECT measurements of left ventricular volumes and ejection fraction with MRI over a wide range of values.

The calculation of ejection fraction using gated single photon emission computed tomography (SPECT) has been widely validated against a range of other techniques. There have been fewer studies validating left ventricular volumes. We compared quantitative gated SPECT (QGS) with magnetic resonance imaging (MRI) measurements of left ventricular ejection fraction and end diastolic volume in 50 patients with a large range of ventricular dimensions. MRI data were obtained using a turbo gradient echo pulse sequence (TGE) in 17 patients and a steady state free precession pulse sequence (SSFP) in 33 patients. There was good correlation between ejection fraction and end diastolic volume measurements from SPECT and MRI (r=0.82, r=0.90, respectively) but the mean SPECT values were significantly lower (ejection fraction, 6.6+/-6.4% points; end diastolic volume, 18.4+/-25.4 ml) than those obtained from MRI. Bland-Altman analysis showed some large differences in individual patients but no trends in the data either in ejection fraction over a range from 15% to 70% or in end diastolic volume, range 75-400 ml. SSFP gave a larger difference for end diastolic volume measurement compared to SPECT than did TGE, although this difference did not reach significance. Both SSFP and TGE gave similar values for the difference between MRI and SPECT for the measurement of ejection fraction. We suggest that the difference in EF may be a result of 8 frames being used for gating in QGS but 12-18 for MR. Differences in volumes may be related to the different spatial resolution and the exclusion or inclusion of trabeculation and papillary muscles between SPECT and MRI. Differences between SSFP and TGE may be caused by differing delineation of the endocardial border, dependent on the particular acquisition sequence. In conclusion, QGS values correlated well with MRI, but a correction factor may be needed if direct comparison is made.

Female↗
PubMed1978

Percentage of shortening of the echocardiographic left ventricular dimension. Its use in determining ejection fraction and stroke volume.

The percentage of shortening of the echocardiographic left ventricular dimension (% delta D) was prospectively evaluated in 42 patients without detectable asynergy during diagnostic cardiac catheterization and was found to correlate well with angiographic ejection fraction (r = 0.90). Ejection fraction was calculated as the product of % delta D X 1.7 or as % delta (D2), both formulae having similar degrees of accuracy and a better correlation with the angiographic determination than conventional formulae. Ejection fractions (angiographic and echocardiographic) of 51 percent or greater were always associated with a % delta D of 30 percent or more. In five patients the echocardiographically derived ejection fractions were normal (greater than or equal to 51 percent), while the angiographic ejection fractions were reduced; four of these patients had valvular regurgitation. End-diastolic volumes were calculated from end-diastolic echocardiographic dimensions utilizing a linear regression equation derived from correlating the end-diastolic echocardiographic dimension with the end-diastolic volume in 27 patients without valvular regurgitation (end-diastolic echocardiographic dimension ranged from 3.7 to 8.2 cm). The value for stroke volume determined as the product of calculated end-diastolic volume times ejection fraction correlated with the angiographically determined stroke volume (r = 0.88; standard error of estimate, +/- 11 ml) better than the value for stroke volume derived from conventional echocardiographic formulae.

Adolescent↗
PubMed1997

Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy.

BACKGROUND: In idiopathic dilated cardiomyopathy, long-term outcome is poor and left ventricular ejection fraction is a major powerful predictor of survival. However, right ventricular function might also play an important role in the long-term prognosis of this disease. AIM: The aim of this study was to determine the role of right ventricular parameters, mainly right ventricular ejection fraction, on survival in idiopathic cardiomyopathy. METHODS: We prospectively assessed long-term follow-up and predictors of survival in 62 consecutive patients referred from 1990 to 1992 for evaluation of idiopathic dilated cardiomyopathy, including haemodynamic evaluation, thermodilution right ventricular ejection fraction and volume measurements. RESULTS: At the time of catheterization, dyspnoea class III or IV was present in 60% of the patients, atrial fibrillation in 19% and complete left bundle branch block in 35%. Left ventricular ejection fraction was 30 +/- 10% and right ventricular ejection fraction was 30 +/- 16%. During follow-up (2.2 +/- 1.3 years), 15 patients (24%) had heart transplantation and nine (14%) died before cardiac transplantation. Cumulative survival rate without heart transplantation was 74% and 56% at 1 and 4 years, respectively. In univariate analysis, survival was related to: dyspnoea class I or II (P < 0.04), absence of complete left bundle branch block (P < 0.05), administration of lower doses of furosemide (P < 0.01), high left ventricular ejection fraction (P < 0.001), low pulmonary artery pressure (P < 0.002), high cardiac index (P < 0.006), and low right ventricular volumes (P < 0.001). Multivariate analysis showed only two independent predictors of survival: left ventricular ejection fraction (P < 0.001) and right ventricular ejection fraction (P < 0.004). CONCLUSION: In addition to left ventricular ejection fraction, right ventricular ejection fraction appears to be a complementary predictor of survival in idiopathic dilated cardiomyopathy, suggesting the importance of assessing right ventricular function in this disease.

Adult↗
PubMed1992

The effects of valvular regurgitation on thermodilution ejection fraction measurements.

Through the use of thermodilution principles and rapid response thermistors, it is now possible to measure right ventricular ejection fractions serially in patients. However, to our knowledge, the extent to which tricuspid regurgitation affects the accuracy of thermodilution ejection fraction measurements has not been quantified. The purpose of this study was to compare actual and thermodilution ejection fraction measurements in an in vitro model of tricuspid regurgitation over a wide range of ejection fractions. Stepwise perforation of the inlet valve resulted in regurgitant fractions ranging from 4 to 40 percent. At each increment of inlet valve regurgitation, triplicate sets of thermodilution (EFthermo) ejection fraction measurements were obtained and compared with actual ejection fractions (EFactual). The mean difference between EFactual and EFthermo significantly increased with 8 percent regurgitation and significantly increased with greater increments of inlet valve regurgitation. EFthermo consistently underestimated EFactual over the entire range of regurgitant values. Linear regression analysis revealed a significant correlation between EFactual and EFthermo for all degrees of regurgitation; however, the correlation coefficient significantly declined from control valves with 13 percent regurgitation and declined further with 33 percent regurgitation. Qualitative classification of the inlet valve regurgitation into mild, moderate, and severe regurgitation was performed using pulsed Doppler echocardiography. Mild inlet valve regurgitation resulted in a significantly increased difference between EFactual and EFthermo from control values. A significant increase in the difference between EFactual and EFthermo was observed with both moderate and severe regurgitation. In summary, thermodilution underestimated actual ejection fraction in a direct linear relationship to the degree of inlet valve regurgitation. Thus, in the presence of tricuspid regurgitation, this method may still be useful in serially measuring changes in right ventricular ejection fraction.

Cardiac Output↗
PubMed1983

Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease.

The predictive value of radionuclide ventriculography was studied in 34 patients with depressed left ventricular ejection fraction (less than 40%) and clinically evident congestive heart failure secondary to atherosclerotic coronary artery disease. In addition to left ventricular ejection fraction, right ventricular ejection fraction and extent of left ventricular paradox were obtained in an attempt to identify a subgroup at increased risk of mortality during the ensuing months. The 16 patients who were alive after a 2 year follow-up period had a higher right ventricular ejection fraction and less extensive left ventricular dyskinesia. When a right ventricular ejection fraction of less than 35% was used as a discriminant, mortality was significantly greater among the 21 patients with a depressed right ventricular ejection fraction (71 versus 23%), a finding confirmed by a life table analysis. Depressed right ventricular function was further linked to more severely compromised left ventricular function, as confirmed by a greater reduction in left ventricular ejection fraction and by an increased extent of left ventricular dyskinesia. These patients had a greater prevalence of chronic obstructive pulmonary disease and previous inferior myocardial infarction but the differences between groups were not statistically significant. It appears that the multiple factors contributing to the reduction in right ventricular ejection fraction make it a useful index not only for assessing biventricular function, but also for predicting patient outcome.

Actuarial Analysis↗
PubMed1996

Mild systolic dysfunction in heart failure (left ventricular ejection fraction >35%): baseline characteristics, prognosis and response to therapy in the Vasodilator in Heart Failure Trials (V-HeFT)

OBJECTIVES: This analysis sought to evaluate the clinical characteristics and outcome in heart failure with mild systolic dysfunction. BACKGROUND: Although heart failure with mild systolic dysfunction occurs commonly, this is an understudied area because clinical trials have usually excluded patients with ejection fraction >35%. METHODS: The 422 patients with left ventricular ejection fraction </=35% were compared with 172 with a left ventricular ejection fraction >35% in the Vasodilator in Heart Failure Trial (V-HeFT I), whereas in V-HeFT-II 554 patients with a left ventricular ejection fraction </=35% were compared with 218 patients with a left ventricular ejection fraction >35% for mortality and clinical care. For a left ventricular ejection fraction >35%, treatment with hydralazine/isosorbide dinitrate was compared with prazosin and placebo therapy in V-HeFT I, and hydralazine/isosorbide dinitrate was compared with enalapril in V-HeFT II for mortality, clinical course and change in physiologic variables: ejection fraction, plasma norepinephrine levels, ventricular tachycardia and echocardiographic variables. RESULTS: In both studies, patients with a left ventricular ejection fraction >35% differed principally in hypertensive history, higher functional capacity and radiographic and echocardiographic cardiac dimension from patients with a left ventricular ejection fraction </=35%, and plasma norepinephrine levels differed in V-HeFT II (p < 0.01). Patients with a left ventricular ejection fraction >35% had a lower cumulative mortality than those with a left ventricular ejection fraction </=35% (p < 0.0001) and less frequent hospital admissions for heart failure (p < 0.014, V-HeFT I; p < 0.005, V-HeFT II). Although cumulative mortality and morbidity did not differ between treatment groups in V-HeFT I, enalapril decreased overall mortality versus hydralazine/isosorbide dinitrate (p < 0.035) in V-HeFT II. For physiologic variables in V-HeFT II, enalapril decreased ventricular tachycardia at follow-up (p < 0.05). CONCLUSIONS: In V-HeFT, heart failure with mild systolic dysfunction was associated with different characteristics and a more favorable prognosis than heart failure with more severe systolic dysfunction. Enalapril decreased overall mortality and sudden death compared with hydralazine/isosorbide dinitrate. Prospective trials are needed to address therapy for heart failure with mild systolic dysfunction.

Aged↗
PubMed2002

Beating heart revascularization with minimal extracorporeal circulation in patients with a poor ejection fraction.

BACKGROUND: Coronary artery bypass grafting with cardioplegia in patients with a low ejection fraction carries a risk of myocardial ischemia. Beating heart surgery is associated with hemodynamic changes when the heart is manipulated. We assessed an alternative: minimal extracorporeal circulation for coronary artery bypass grafting on a beating heart in patients with a poor ejection fraction. METHODS: From January 2000 to January 2002, 50 patients with an ejection fraction of less than 35%, who represented 10% of all patients undergoing coronary artery procedures, underwent revascularization on a beating heart with assistance. We used a closed cardiopulmonary bypass system with a centrifugal pump without reservoir, and the surgical strategy was modified to avoid aortic cross-clamping and to decrease bypass time. RESULTS: The main preoperative characteristics were: age (mean +/- SD) of 64 +/- 11.2 years (range, 41-87 years), 35 male patients (70%), mean left ejection fraction of 24.8% +/- 11.2%, and a mean EuroSCORE of 5.8 +/- 2.7. Revascularizations of 146 distal anastomoses (2.9 +/- 0.7 grafts/patient) were completed. Twelve percent were double bypass, 86% were triple bypasses, and 2% were quadruple bypasses; the mean bypass time was 64.2 +/- 26.2 minutes. The mean graft number was 2.9, and the hospital mortality was 2%. Perioperative hematocrit levels were 30.1%, and 26% of patients received transfusions. Postoperative data showed a median extubation time of 9 hours, a median intensive care unit stay of 48 hours, and a hospital stay of 8 +/- 2 days. Postoperative complications included inotropic support (14%), cerebrovascular events (2%), reoperation for homeostasis (4%), delayed sternal closure (2%), and mediastinitis (2%). Peak troponin Ic level remained a low 2.4 +/- 1.9 g/mL. Follow-up at 6 months was complete with 1 late mortality and with a mean ejection fraction of 30.5% +/- 10.8% for the survivors. CONCLUSIONS: Coronary revascularization on a beating heart with extracorporeal assistance can be done in patients with a low ejection fraction. It avoids the myocardial injury associated with aortic cross-clamping and allows safe and complete coronary revascularization.

Adult↗
PubMed1985

[Evaluation of left ventricular ejection fraction in coronary disease patients by the gated blood pool method and cineangiography. Critical analysis of divergences between the 2 methods].

In order to assess the reliability of left ventricular ejection fraction as estimated by gated blood pool method, radionuclide angiography (LAO) and single plane (RAO) contrast cineangiocardiography were performed within 14 days in 60 patients with coronary artery disease. The mean value of radionuclide ejection fraction was found to be 55 +/- 16%; contrast cineangiographic ejection fraction was 57 +/- 15%; r = 0.92. In 23 patients with previous anterior myocardial infarction gated blood pool method was found to underestimate left ventricular ejection fraction when compared with contrast cineangiography. The observed underestimation was wide significant in 11 patients with previous anterior infarction, low (less than 50%) radioisotopic ejection fraction and septal akinesia and/or apical dyskinesia; radionuclide ejection fraction = 33 +/- 8%; contrast cineangiographic ejection fraction = 42 +/- 9%; r = 0,76. This study confirms that the values of left ventricular ejection fraction as estimated by gated blood pool method in coronary patients are quite reliable; moreover, the intrinsic variability of the data is low. This may be not true in patients with previous anterior myocardial infarction. The Authors discuss the possible causes of disagreement between radioisotopic and contrastographic ejection fraction in patients with previous anterior infarction and poor left ventricular function: physical problems of measuring ejection fraction by gated blood pool in dilated ventricles; possible mistakes in evaluating blood pool due to the low mobility of the blood mass nearest to the scintillation camera; inhability of contrast cineangiography in RAO to recognize the interventricular septum and evaluate its kinetic abnormalities; unreliability of the geometrical model of revolution elypsoid in calculating end-systolic volumes in ventricles with abnormal wall-kinesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cineangiography↗
PubMed1999

The independent effects of left ventricular ejection fraction on short-term outcomes and resource utilization following hospitalization for heart failure.

BACKGROUND: While depressed left ventricular ejection fraction is clearly associated with poor long-term outcome in heart failure (HF), the effect of ejection fraction on short-term outcomes and resource utilization following hospitalization for HF remains unclear. HYPOTHESIS: We evaluated the independent effect of depressed ejection fraction (< or = 40%) on short-term outcomes and resource utilization following hospitalization for HF. METHODS: The study population included 443 consecutive patients hospitalized for DRG 127 (HF and shock) with known ejection fraction. For each patient, we assessed the hospitalization cost (1995 US$), length of stay, in-hospital mortality, 30-day mortality, and 30-day readmission rates. RESULTS: Despite similar disease severity at admission, patients with ejection fraction < or = 40% (Group 1) had longer length of stay (4.0 vs. 3.7 days; p = 0.03), a tendency toward higher hospitalization cost ($3,054 vs. $2,770; p = 0.08), more readmissions for any cause (0.4 vs. 0.3; p = 0.05) and for HF (0.2 vs. 0.1; p = 0.01), but similar in-hospital (2.5 vs. 2.6%) and 30-day mortality (4.0 vs. 4.6%) compared with patients with ejection fraction > 40% (Group 2). In multivariate analyses, Group 1 patients were more likely to have higher than median hospitalization cost [odds ratio (OR) = 1.98; 95% confidence intervals (CI) = 1.02-3.91] and longer than median hospital stay (OR = 1.68; CI = 1.08-3.91); they were also more likely to be readmitted for any cause (OR = 2.07; CI = 1.15-3.78) or for HF (OR = 5.71; CI = 1.64-21.94), and they tended to have a higher 30-day incidence of death or readmission (OR = 1.65; CI = 0.96-2.84). CONCLUSIONS: Depressed left ventricular ejection fraction is associated with higher resource utilization and readmission rates following hospitalization for HF. Greater focus on patients with depressed ejection fraction may increase cost savings from HF disease management programs.

Aged↗
PubMed1984

Measurement of left ventricular ejection fraction after acute myocardial infarction. A serial cross sectional echocardiographic study.

Left ventricular ejection fraction was assessed by biplane cross sectional echocardiography in 65 patients with a first acute myocardial infarction on the first day. In 30 patients (group 1) measurements were repeated on the third day and in another 35 patients (group 2) at three months. Changes in ejection fraction of 0.05 or less were arbitrarily called insignificant. In group 1 only two patients showed a decrease of more than 0.1 between days 1 and 3, and both had an enzymatically confirmed infarct extension. The remaining patients had no complications. In group two 11 patients had decreases of more than 0.1 between day 1 and three months: three of them had an enzymatically confirmed reinfarction (perioperative in one) and four a possible reinfarction, and in two an angiographically confirmed left ventricular aneurysm developed. In two no complications occurred. The other complications that occurred were an enzymatically confirmed but small reinfarction, an angiographically confirmed but circumscript aneurysm, and an uncomplicated bypass operation in one patient each. These three patients had a small increase (between 0.05 and 0.1) in ejection fraction. Reproducibility of the method of measuring the ejection fraction was assessed concurrently in 20 outpatients with a previous myocardial infarction who were studied twice on the same day (with a 30 minute interval) by two different observers. The mean absolute difference in ejection fraction between the paired observations was 0.036 +/- 0.023 with a range of 0 to 0.07. Thus only changes in ejection fraction of more than 0.1 correlate with clinically recognised complications. Changes between 0.05 and 0.1 may be due to spontaneous variability or to the limited reproducibility of the method.

Adult↗
PubMed1984

Correlation among right ventricular preload, afterload and ejection fraction in mitral valve disease: radionuclide, echocardiographic and hemodynamic evaluation.

The relation among right ventricular preload, afterload and ejection fraction in patients with mitral valve disease has not been well elucidated. In this study, measurements were made of intracardiac pressures and forward cardiac output during cardiac catheterization (n = 43), the ejection fraction by radionuclide angiography (n = 43) and end-systolic radius and wall thickness by M-mode echocardiography (n = 22). There was a linear correlation between pulmonary artery pressure and right atrial pressure (r = 0.57, p less than 0.01). The right ventricular peak circumferential systolic wall stress was increased in 68% of the patients (in comparison with wall stress measurements obtained in 10 normal subjects). The right ventricular ejection fraction was abnormal in 38 patients (88%) and abnormal in 14 of the 15 patients with high wall stress. There was an inverse correlation between ejection fraction and end-diastolic volume (r = -0.61, p less than 0.001). The right ventricular ejection fraction measurement was repeated within 3 months after mitral valve replacement in 16 patients; the ejection fraction increased from 21 +/- 9 to 29 +/- 10% (mean +/- standard deviation) after surgery (p less than 0.01), but normalization of the ejection fraction was observed in only 3 patients (19%). Thus, abnormal right ventricular ejection fraction, which is observed in most patients with rheumatic mitral valve disease, results from inappropriate wall stress or depressed inotropic response of the right ventricle due to damage. Right ventricular dilation appears to be a compensatory mechanism to maintain the cardiac output.

Aged↗
PubMed1995

Value of radionuclide rest and exercise left ventricular ejection fraction in assessing survival of patients after thrombolytic therapy for acute myocardial infarction: results of Thrombolysis in Myocardial Infarction (TIMI) phase II study. The TIMI Study Group.

OBJECTIVES: This study sought to determine the prognostic value of rest and exercise left ventricular ejection fraction in patients receiving thrombolytic therapy as part of the Thrombolysis in Myocardial Infarction (TIMI) trial. BACKGROUND: In the prethrombolytic era, ejection fraction at rest as well as during exercise was an important prognostic index in patients recovering from acute myocardial infarction. The prognostic value of these measurements in the thrombolytic era is not clear. METHODS: As part of the TIMI II protocol, we obtained radionuclide left ventricular ejection fraction at rest and during symptom-limited submaximal supine exercise. Measurements were related to 1-year all-cause as well as cardiac mortality. In addition, the relation between ejection fraction obtained at rest and 1-year cardiac mortality in this study was compared with the relation established previously in the prethrombolytic era by the Multicenter Postinfarction Research Group. RESULTS: A distinct relation was noted between left ventricular ejection fraction at rest and all-cause mortality. The highest mortality rate (9.9%) was noted in patients with an ejection fraction < 30%. Those not undergoing a study had a 1-year mortality rate of 6.2%. Peak exercise ejection fraction provided prognostic information similar to that of rest ejection fraction. Likewise, change in ejection fraction from rest to exercise did not appreciably improve prognostic impact. CONCLUSIONS: Rest left ventricular ejection fraction is an important prognostic index in patients receiving thrombolytic therapy. Peak exercise ejection fraction and the change in ejection fraction from rest to exercise do not provide appreciable prognostic data beyond those obtained at rest. Patients unable to exercise or those not having a rest study have a poor prognosis. When compared with the Multicenter Postinfarction Research Group data, there was strong evidence of a difference in survival in the two studies. At any level of ejection fraction, mortality was lower in TIMI II patients than in patients in the prethrombolytic era.

Aged↗
PubMed2002

Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography.

OBJECTIVE: To evaluate the relation between changes in ejection fraction during the first three months after acute myocardial infarction and myocardial viability. PATIENTS: Myocardial viability was assessed using low dose dobutamine echocardiography in 107 patients at mean (SD) 3 (1) days after acute myocardial infarction. Cross sectional echocardiography was repeated three months later. Left ventricular volumes and ejection fraction were determined from apical views using the Simpson biplane formula. RESULTS: In patients with viability, ejection fraction increased by 4.4 (4.3)%; in patients without viability it remained unchanged (0.04 (3.6)%; p < 0.001). A > or = 5% increase in ejection fraction was present in 21 of 107 patients (20%). Receiver operating characteristic analysis showed that myocardial viability in > or = 2 segments predicted this increase in ejection fraction with a sensitivity of 81% and a specificity of 65%. Multivariate logistic regression analysis was used to define which clinical and echocardiographic variables were related to > or = 5% improvement in ejection fraction. Myocardial viability, non-Q wave infarction, and anterior infarction all emerged as independent predictors, myocardial viability being the best (chi(2) = 14.5; p = 0.0001). Using the regression equation, the probability of > or = 5% improvement in ejection fraction for patients with a non-Q wave anterior infarct with viability was 73%, and for patients with a Q wave inferior infarct without viability, only 2%. CONCLUSIONS: Myocardial viability after acute myocardial infarction is the single best predictor of improvement in ejection fraction. In combination with infarct location and Q wave presence, the probability of > or = 5% improvement can be estimated in individual patients at the bedside.

Cardiotonic Agents↗
PubMed1999

Effect of exercise on left and right ventricular ejection fraction and wall motion.

OBJECTIVE: We evaluated the diagnostic value of response of left and right ventricular ejection fraction and wall motion to exercise using electron beam computed tomography. METHODS AND RESULTS: We attempted to determine the value of exercise electron beam computed tomography for detecting coronary artery disease, including evaluation of the right ventricular ejection fraction and wall motion abnormalities. A study of 35 patients undergoing electron beam tomography exercise cine studies and coronary artery angiography for the evaluation of chest pain was performed. Of the 18 patients with significant coronary disease (> or = 50% luminal diameter stenosis in at least one coronary artery), 17 (94%) had failure to increase global left ventricular ejection fraction with exercise. Fourteen of 18 (78%) developed a wall motion abnormality during peak exercise, and eight (44%) developed a regional right ventricular wall motion abnormality during peak exercise. Of the 17 patients without obstructive disease, 14 (82%) had a increase in ejection fraction > or = 5% and none had an abnormal response in left ventricular wall motion during peak exercise (specificity = 100%). The change in right ventricular ejection fraction with exercise was not a significant predictor of obstructive coronary disease in this study (P=NS). Using different criteria during stress to predict coronary disease, the accuracy was 89% (31/35) using an increase of <5% in ejection fraction, 89% (31/35) using the development of a new or worsened wall motion abnormality, and 91% (32/35) using both left ventricular criteria. CONCLUSION: Our study suggests that exercise electron beam computed tomography appears to be a useful tool for the detection of coronary disease. A increase of <5% in ejection fraction and abnormal left ventricular response to exercise were important predictors, while the exercise induced changes of right ventricular ejection fraction was not a significant predictor of obstructive disease. Both left and right ventricular wall motion abnormalities are useful and important parameters in identifying patients with obstructive disease from those with normal coronary arteries.

Adult↗
PubMed2000

Echocardiographic determinants of left ventricular ejection fraction after acute myocardial infarction.

OBJECTIVE: This study was performed to determine if factors other than the size of regional dysfunction influence the global left ventricular ejection fraction after acute myocardial infarction. BACKGROUND: Left ventricular ejection fraction is an important prognostic variable after acute myocardial infarction. Although infarct size is known to affect the subsequent global left ventricular ejection fraction, it remains unclear whether other factors such as site or severity of the wall motion abnormality influence the ejection fraction after acute myocardial infarction. METHODS: Sixty-nine consecutive patients (mean age 61 +/- 14 years, 46 [67%] male) who did not receive thrombolytic therapy or undergo early revascularization were studied by echocardiography 1 week after Q-wave myocardial infarction. The absolute size of the region of abnormal wall motion (AWM) and the percentage of the endocardium involved (%AWM) were quantitated along with the wall motion score. A severity index was then derived as the mean wall motion score within the region of AWM. Site of myocardial infarction was classified as either anterior or inferior from the endocardial map. Left ventricular ejection fraction was measured by Simpson's method with 2 apical views. RESULTS: Twenty-nine (42%) patients had anterior and 40 had inferior myocardial infarction. The mean left ventricular ejection fraction was significantly lower in anterior than in inferior myocardial infarction (44.8% +/- 11.5% vs 53% +/- 8.6%; P =. 001). The mean %AWM was greater in anterior than in inferior myocardial infarction (32.1 +/- 15.5 vs 22.4 +/- 14.1; P =.01). The mean wall motion score was greater in anterior than in inferior myocardial infarction (9.8 +/- 6.4 vs 6.4 +/- 4.4; P =.01). The mean severity index did not differ by site. Multiple regression analysis demonstrated that, in descending order of importance, %AWM, extent of apical involvement, and site of myocardial infarction were independent determinants of global left ventricular ejection fraction. CONCLUSIONS: For myocardial infarctions of similar size, left ventricular ejection fraction is lower when apical involvement is extensive and the site of infarction is anterior. This site-dependent difference may be related to characteristics specific to the apex.

Adult↗