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PubMed2004

Effects of glucagon-like peptide-1 in patients with acute myocardial infarction and left ventricular dysfunction after successful reperfusion.

BACKGROUND: Glucose-insulin-potassium infusions are beneficial in uncomplicated patients with acute myocardial infarction (AMI) but are of unproven efficacy in AMI with left ventricular (LV) dysfunction because of volume requirements associated with glucose infusion. Glucagon-like peptide-1 (GLP-1) is a naturally occurring incretin with both insulinotropic and insulinomimetic properties that stimulate glucose uptake without the requirements for concomitant glucose infusion. METHODS AND RESULTS: We investigated the safety and efficacy of a 72-hour infusion of GLP-1 (1.5 pmol/kg per minute) added to background therapy in 10 patients with AMI and LV ejection fraction (EF) <40% after successful primary angioplasty compared with 11 control patients. Echocardiograms were obtained after reperfusion and after the completion of the GLP-1 infusion. Baseline demographics and background therapy were similar, and both groups had severe LV dysfunction at baseline (LVEF=29+/-2%). GLP-1 significantly improved LVEF (from 29+/-2% to 39+/-2%, P<0.01), global wall motion score indexes (1.94+/-0.11-->1.63+/-0.09, P<0.01), and regional wall motion score indexes (2.53+/-0.08-->2.02+/-0.11, P<0.01) compared with control subjects. The benefits of GLP-1 were independent of AMI location or history of diabetes. GLP-1 was well tolerated, with only transient gastrointestinal effects. CONCLUSIONS: When added to standard therapy, GLP-1 infusion improved regional and global LV function in patients with AMI and severe systolic dysfunction after successful primary angioplasty.

Adult↗
PubMed1993

[Relationship between reduced myocardial uptake of beta-methyl-p-(123I)- iodophenyl-pentadecanoic acid (123I-BMIPP) and regional diastolic ventricular dysfunction in patients with hypertrophic cardiomyopathy].

To assess whether regionally depressed myocardial uptake of beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP), is related to regional ventricular diastolic dysfunction in patients (pts) with hypertrophic cardiomyopathy (HCM), we carried out 123I-BMIPP myocardial SPECT and radionuclide ventriculography (RNV) at rest in 9 HCM pts (eight pts with asymmetric septal hypertrophy (ASH), and one patient with apical hypertrophy). The defects of 123I-BMIPP were semiquantitatively estimated by segmental analysis. Regional LV function was determined by sector analysis in RNV: regional peak filling rate (rPFR), regional time to peak filling rate (rTPFR), and early 1/3 filling rate (1/3 fil) were estimated in the LV septal and posterior sectors. Wall thickness was evaluated with M-mode echocardiography. As results, the defects of 123I-BMIPP myocardial SPECT, were found frequently in septal wall, but any defect was not recognized in all septum with significant hypertrophy. Also, the degree of septal hypertrophy was not significantly related to BMIPP defect score. However, the regional diastolic function (rPFR, rTPFR, 1/3 fil) in the septal lesions with 123I-BMIPP defects was decreased more than those without 123I-BMIPP defect in HCM. Furthermore, the relative regional diastolic dysfunction (the differences between rTPFR and 1/3 fil in the septum and in the posterior wall) was significantly related to BMIPP defect score. In conclusion, this results suggest that the decreased uptake of 123I-BMIPP is related to regional diastolic dysfunction more than wall hypertrophy.

Aged↗
PubMed1999

Transplantation versus coronary artery bypass in patients with severe ventricular dysfunction. Surgical outcome and quality of life.

BACKGROUND: The purpose of this study is to evaluate the quality of life, functional status and survival rate of patients with left ventricular ejection fraction (LVEF) < or = 20% following coronary bypass (CABG) versus heart transplantation. METHODS EXPERIMENTAL DESIGN: comparative study, mean follow-up of 20 months. SETTING: division of cardiac surgery at a McGill University-based hospital in Montreal, Canada. PATIENTS: the charts of 65 consecutive patients with angiographic LVEF < or = 20% were reviewed. Among these patients, 14/65 were referred for transplantation but instead underwent CABG (Group I) after consultation with the transplant committee. The charts of 14 matched transplant patients (Group II) were reviewed. The SF-36 and Duke's questionnaire forms were mailed to both groups in order to evaluate their quality of life and functional capacity, respectively. INTERVENTIONS: comparison between coronary bypass and heart transplantation. MEASURES: main outcome measures were mortality, quality of life, and functional capacity. RESULTS: Results are expressed as mean+/-SEM. The in-hospital mortality rate of CABG among all patients with LVEF < or = 20% was 4.6% (3/65). Among the 14 CABG patients initially referred for transplantation, perioperative mortality was 1/14 (7.1%), same as in the matched transplant group. Three additional group I patients were reported by family to have died of cardiac events at follow-up period. Postoperative death identified at follow-up was assigned the lowest life quality score. The transformed quality of life scores were as follows: physical functioning: I=42.5+/-10.6, II=73.2+/-7.2, p=0.029; physical role: I=35.0+/-13.5, I=61.4+/-13.2, p=0.180; bodily pain: I=54.0+/-14.0, II=69.8+/-8.5, p=0.349; general health: I=34.7+/-9.2, II=84.6+/-5.2, p=0.0003; vitality: I=36.5+/-9.3, II=60.0+/-5.2, p=0.045; social functioning: I=55.0+/-4.0, II=87.5+/-5.1, p=0.050; emotional role: I=36.7+/-15.3, II=87.9+/-6.8, p=0.009; mental health: I=52.8+/-12.4, II=81.5+/-4.2, p=0.054. Duke's activity status index: I=16.8+/-4.2, II=31.8+/-4.2, p=0.021. CONCLUSIONS: Heart transplant is associated with a significantly superior postoperative quality of life and functional capacity than bypass surgery. However, in patients with LVEF < or = 20%, CABG can be performed with an acceptable perioperative mortality of 4.6%-7.1%, similar to the rate for transplantation.

Activities of Daily Living↗
PubMed2002

Effects of pre-existing left ventricular hypertrophy on ventricular dysfunction and remodeling following myocardial infarction in rats.

BACKGROUND: Myocardial hypertrophy is a characteristic component of left ventricular (LV) remodeling that may, at least initially, have a beneficial effect on LV function following myocardial infarction (MI). In the present study, we examine the effects of pre-existing left ventricular hypertrophy (LVH) on LV function and chamber enlargement following MI in inbred Lewis rats. METHODS: The one-kidney, one-clip model (1K1C) of hypertension was used to produce LVH. Four weeks after 1K1C, rats were randomized to left anterior descending coronary artery ligation (LVH + MI group, n = 8) or sham ligation (LVH group, n = 11). Another group of rats underwent sham 1K1C. Four weeks later, they were randomized to coronary ligation (MI group, n = 12) or sham ligation (Sham group, n = 12). LV end-diastolic pressure (EDP, mm Hg), end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml) and ejection fraction (EF) (determined by angiography) were measured in all groups 2 months after MI. RESULTS: LV EDP was 20 +/- 2 mm Hg in the LVH + MI group compared with 9 +/- 1 mm Hg in the MI group (p < 0.05). LV EDV and ESV were significantly greater with LVH + MI than with MI alone (EDV 0.90 +/- 0.03 vs 0.75 +/- 0.02 ml; ESV 0.68 +/- 0.02 vs 0.50 +/- 0.03 ml; p < 0.05). Pre-existing LVH resulted in a greater reduction in EF following MI (25 +/- 2% for LVH + MI vs 34 +/- 2% for MI alone; p < 0.05). CONCLUSIONS: Pre-existing LVH is an important determinant of progressive LV dysfunction and remodeling following MI in Lewis inbred rats.

Animals↗
PubMedDate not supplied

[Chronic myocardial infarct with left ventricular dysfunction: the clinical aspects and exertion tolerance].

UNLABELLED: The objective of the study is the assessment of the exercise functional capacity of the patients with chronic myocardial infarction and left ventricular disfunction and the relevance of some clinical peculiarities of them in contrast with patients without left ventricular performance. METHODS: There have been studied 105 patients with chronic myocardial infarction, in a period of time between 1992-1995. There has been taken, as an objective criterium of the assessment of LV disfunction, the ejection fraction (EF) measured by echo 2D at 52 patients. There were created the groups with EF 50%(32p), EF = 35-50% (12p) and EF = 35% (8p). The clinical parameters were: the number of coronary risk factors (CRF), the NYHA class, the exercise test and the assessment of VO2max. The statistical comparison has been made by using an IBM computer 486, programme FoxPro and EPI/INFO. RESULTS AND DISCUSSIONS: 50% of the patients with EF > 50% (16/32) had a good exercise tolerance (MET > 5); 13 patients (65%) from the patients with EF < 50% had MET < 5. Similarly, there is no correlation between the low EF (50%) and VO2max. The analysis of the exercise tolerance correlated with the functional class NYHA shows its diminution at patients with cardiac failure (classes I and II) compared with those without dyspnea (67% vs 42%, p < 0.01 and respectively 80% vs 42%, p < 0.05). There are similar differences in the assessment of VO2max at patient from classes III (p < 0.01) and II (p < 0.03) compared with class 0. Dyspnea, as a clinical parameter, does not correlate with low EF, but has significant association with VO2max. The study of the degree of charge in CRF at patients with EF < 50% reveals the following: older age (p < 0.02), the presence of arterial hypertension (p < 0.01) and the greater prevalence of DM (p < 0.05). CONCLUSION: 1. There is no correlation between the degree of the left ventricular disfunction and the exercise capacity. 2. VO2max is significantly lower at patients with dyspnea, especially from classes II and III. 3. Patients with myocardial infarction and LV disfunction have statistically more CRF, like older age, HTA, DM.

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PubMed2004

[Usefulness of dobutamine stress echocardiography in a patient with aortic valve stenosis and left ventricular dysfunction: a case report].

A 76-year-old man with previous antero-septal myocardial infarction and aorto-coronary bypass surgery developed exertional dyspnea. Echocardiography revealed diffuse left ventricular hypokinesis and aortic stenosis with a mean pressure gradient of 29 mmHg. Coronary angiography showed no significant lesions in the bypass grafts and total occlusions of the proximal left anterior descending artery and mid circumflex artery. Dobutamine stress echocardiography was performed to evaluate the severity of aortic stenosis and left ventricular functional reversibility. Administration of dobutamine increased the mean pressure gradients to 48 mmHg and increased the stroke volume by 28% without change in aortic valve area of about 0.5 cm2. We considered that our patient had severe aortic stenosis with contractile reserve. After aortic valve replacement, he improved with better left ventricular function.

Aged↗
PubMed2005

Left ventricular dysfunction after acute myocardial infarction--the impact of cardiovascular risk factors.

INTRODUCTION: Left ventricular (LV) systolic function is an important prognostic factor in coronary heart disease. Left ventricular ejection fraction (LVEF) should be assessed in all patients after acute myocardial infarction (AMI). Although reperfusion therapy has been found effective in the reduction of complications of AMI, LVEF impairment is a common consequence of an acute coronary event. The aim of this study was to estimate the incidence of LVEF depression after ST-elevation myocardial infarction (STEMI) and to evaluate the effect of previous cardiovascular risk factors on the risk of LV dysfunction. METHODS: One hundred and forty-seven consecutive patients with a first STEMI were included in this study. Most patients were male (70.7%) and mean age was 60.7 years. LVEF was assessed by echocardiography (using the single-plane area-length method and automatic border detection). LV systolic function was considered depressed when ejection fraction was less than 45 %. The chi-square test was used in the statistical analysis to compare proportions and a logistic regression model was fitted to assess the independent effect of each variable. RESULTS: Incidence of LV dysfunction was 55.8% in STEMI patients. No association was found between gender or age and LVEF impairment. The proportion of patients with diabetes was higher in the impaired LVEF group than in normal LVEF patients (44.7% vs. 31.7%, p = 0.12); the prevalence of smoking was also higher in patients with LV dysfunction (46.9% vs. 33.8%, p = 0.11). On the other hand, dyslipidemia was less common in patients with depressed LV function (35.4% vs. 56.9%, p = 0.01). Hypertension was not associated with impaired LVEF. After adjustment for ST-elevation location and number of vessels with critical stenosis, diabetes and smoking were associated with a significantly higher risk of LVEF impairment (diabetes: OR = 3.73, 95% CI 1.25-11.16; smoking: OR = 3.9, 95% CI 1.37-11.07) and dyslipidemia with a significantly lower risk of LV dysfunction (OR: 0.37, 95% CI 0.15-0.88). CONCLUSIONS: In STEMI patients, previous cardiovascular risk factors have a significant impact on the likelihood of LV dysfunction and hence could influence long-term prognosis.

Aged↗
PubMed2002

Left ventricular dysfunction is a risk factor for sudden cardiac death in adults late after repair of tetralogy of Fallot.

OBJECTIVES: The purpose of this study was to determine if left ventricular (LV) systolic dysfunction was also a predictor of sudden cardiac death (SCD) in adults late after repair of tetralogy of Fallot (TOF). BACKGROUND: Previous studies looking at risk factors for SCD in adults with repair of TOF have focused on the right ventricle (RV). METHODS: A retrospective chart review of patients assessed at the Toronto Congenital Cardiac Centre for Adults was performed. Twelve adult patients with repaired TOF and SCD were identified (SCD group). A total of 125 living adult patients with repaired TOF were randomly selected for comparison (control group). RESULTS: Patients with SCD were more likely to exhibit moderate or severe pulmonary regurgitation (92% vs. 51%, p = 0.02), have a history of sustained ventricular tachycardia (42% vs. 6%, p < 0.01), and have a QRS > or =180 ms (56% vs. 13%, p = 0.02). Moderate or severe LV systolic dysfunction was also significantly more common in patients with SCD than in the control group (42% vs. 9%, p < 0.01) with a positive predictive value of 29%. The combination of moderate or severe LV systolic dysfunction and QRS > or =180 ms had a positive and negative predictive value for SCD of 66% and 93%, respectively. CONCLUSIONS: Moderate or severe LV systolic dysfunction is significantly more common in adult patients with repaired TOF and SCD. The combination of QRS > or =180 ms and significant LV systolic dysfunction has high positive and negative predictive value for SCD. The implication of the role of prophylactic antiarrhythmic implantable cardiac defibrillator insertion in these patients needs further elucidating.

Adult↗