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PubMed2004

[Relationship between coronary flow reserve and recovery of regional left ventricular function in patients with tako-tsubo-like transient left ventricular dysfunction].

OBJECTIVES: This study assessed the relationship between coronary flow reserve and functional recovery of left ventricular wall motion in patients with tako-tsubo-like transient left ventricular dysfunction. METHODS: Coronary flow reserve was measured using the Doppler guide wire technique in the left descending coronary artery in nine consecutive patients (three men, six women, mean age 71 +/- 11 years) with tako-tsubo-like transient left ventricular dysfunction. Regional wall motion was analyzed to estimate anterior wall motion score index (anterior WMSI) by transthoracic echocardiography on admission and 3 weeks after the onset of symptoms. RESULTS: Anterior WMSI was 2.2 +/- 0.4 on admission and improved to 1.4 +/- 0.5 at 3 weeks later (p < 0.001). Coronary flow reserve on admission was not correlated to the anterior WMSI on admission (r = 0.19, p = 0.63). However, coronary flow reserve on admission was correlated to the improvement in anterior WMSI (r = 0.74, p = 0.02). CONCLUSIONS: Coronary microcirculation is damaged in acute phase of tako-tsubo-like transient left ventricular dysfunction. The severity of coronary microvascular dysfunction influences the degree of left ventricular wall motion recovery.

Aged↗
PubMed2002

Effects of vasopressin on right ventricular function in an experimental model of acute pulmonary hypertension.

OBJECTIVE: Arginine vasopressin is a promising systemic vasopressor in settings such as vasodilatory shock and cardiopulmonary resuscitation. The evidence that arginine vasopressin may also have a pulmonary vasodilatory effect makes it an attractive drug for the treatment of circulatory shock secondary to right ventricular failure and pulmonary hypertension. In the present study, we evaluated the effects of arginine vasopressin on right ventricular function and ventriculovascular coupling in the setting of moderate acute pulmonary hypertension and compared these effects with those of phenylephrine. DESIGN: Prospective laboratory investigation using an established model of acute pulmonary hypertension. SETTING: University hospital laboratory. SUBJECTS: Seven adult beagle dogs weighing 8-14 kg. INTERVENTIONS: After acute instrumentation to measure right ventricular pressure and volume with the conductance technique and pulmonary artery flow and pressure with high-fidelity transducers, the stable thromboxane analogue U46619 was infused continuously to obtain stable pulmonary hypertension. Phenylephrine and arginine vasopressin were administered consecutively in continuous infusions at doses titrated to achieve a 25% increase in aortic pressure. MEASUREMENTS AND MAIN RESULTS: Phenylephrine and arginine vasopressin both increased total pulmonary vascular resistance and arterial elastance without influencing characteristic impedance. Both drugs decreased cardiac output and stroke volume. Right ventricular hydraulic power output was reduced by arginine vasopressin but not by phenylephrine. Most importantly, arginine vasopressin caused a 31% decrease in right ventricular contractility measured as the slope of the preload recruitable stroke work relationship, whereas contractility was preserved during phenylephrine infusion. CONCLUSIONS: In the present model, arginine vasopressin causes pulmonary vascular constriction and exerts an important negative inotropic effect on the right ventricle. These findings suggest that one should be cautious in the use of arginine vasopressin when right ventricular function is compromised.

Acute Disease↗
PubMed1975

[Regional myocardial blood flow and left ventricular function in critical coronary stenosis and after coronary artery bypass grafting in the dog (author's transl)].

In 7 mongrel dogs myocardial ischemia is produced by means of an ameroid constrictor placed on the left circumflex coronary artery (CCA). Myocardial blood flow (MBF) is diminished by 56% in an area of 25% of the anterior wall of the left ventricle. A decrease in dp/dtmax suggests a small depression of left ventricular function. After bypass operation the slight changes in EDP, dp/dtmax and Vmax indicate no significant improvement of total ventricular function. MBF increases from 42 +/- 10 ml/100 g/min to 67 +/- 21 ml/100 g/min (p smaller than 0.02) in the area supplied by the bypass. In this region intramyocardial pressure rises significantly suggesting improvement of regional myocardial function.

Animals↗
PubMed1996

Transthoracic echocardiography for right ventricular function late after the Mustard operation.

The aim of the study was to assess echocardiographic measurements of right ventricular function in 24 patients aged 10.7 to 28.9 years (mean 18.9 years) receiving the Mustard baffle repair for transposition of the great arteries. Right ventricular ejection fraction (RVEF) from single-plane areas and area length volumes, pulsed Doppler mean aortic acceleration, and tricuspid annular plane systolic excursion were correlated with first-pass radionuclide RVEF. The mean radionuclide RVEF was 39%, the mean echocardiographic apical four-chamber RVEF was 41%, and the mean short-axis RVEF was 37%. Echocardiographic apical four-chamber right ventricular end-diastolic volumes were 102 +/- 24 ml/m2, and RVEF interobserver and intraobserver correlation coefficients were 0.73 and 0.81, respectively. Radionuclide and echocardiographic RVEF correlation coefficients were short axis, 0.40; apical four-chamber, 0.24; average four-chamber and short axis, 0.38; mean aortic acceleration, 0.26; and tricuspid annular plane systolic excursion, 0.06. The range of echocardiographic right ventricular volumes for young adults receiving the Mustard repair is established allowing serial observation of dilatation. However, simple and reliable echocardiographic prediction of RVEF remains elusive in this age group.

Adolescent↗
PubMed2002

Effect of hypertonic saline solution on the left ventricular functions of isolated hearts from burned rats.

OBJECTIVE: To study the effect of hypertonic saline solution on the left ventricular functions of isolated hearts from burned rats. METHODS: Thirty-six Wistar rats were used and divided into 4 groups: (1) normal hearts perfused with isotonic Krebs-Henseleit solution; (2) normal hearts perfused with Krebs-Henseleit solution which contained 215 mmol/L Na+; (3) hearts of rats suffered from 25% TBSA third degree burn and perfused with isotonic Krebs-Henseleit solution; (4) hearts of the burned rats perfused with Krebs-Henseleit solution which contained 215 mmol/L Na+. The systolic and diastolic functions of the left ventricle were observed. RESULTS: During perfusion, there were very short periods of decrease in heart systolic and diastolic functions at first, but they recovered very soon and even became stronger than normal both in the normal and burned rats. The systolic and diastolic functions of the hearts increased very significantly when the perfusion solution was changed to isotonic solution from the hypertonic solutions. The effect of the hypertonic saline solution on the ventricular systolic and diastolic improvements was stronger in the hearts of the burned rats than that in the normal hearts. CONCLUSIONS: Hypertonic saline solution can directly affect myocardium and significantly improve the ventricular systolic and diastolic functions, especially in the hearts of the burned rats.

Animals↗
PubMed1980

Total anomalous pulmonary venous connection in infancy. Ten years' experience including studies of postoperative ventricular function.

The surgical experience with total anomalous pulmonary venous connection (TAPVC) at the Venderbilt Hospital between the years 1969 and 1979 was reviewed. Twenty-five patients with TAPVC were studied. All but one patient presented at less than 1 year of age, and 11 patients were operated upon in the first 2 weeks of life. Operative mortality rate was 20% (5/25). Four of the five deaths were in critically ill neonates requiring preoperative ventilatory support. All operative deaths were in patients with pulmonary venous obstruction. All operative survivors have been followed for a mean 4.5 years (6 months to 10 years). There have been no late deaths or cases of symptomatic pulmonary venous obstruction. All children have had normal growth patterns. Ten patients have been recatheterized. Pulmonary artery systolic pressure, which was markedly elevated prior to operation, fell to normal levels after operation. Ventricular function has been evaluated by quantitative angiocardiography in nine patients before and after operation. Left ventricular size and function were markedly depressed preoperatively and rose to normal levels in postoperative survivors. Left atrial maximal volume was found to be 94% of normal values. These data support the contention that preoperative pulmonary venous obstruction is the single risk factor predicting higher risk of operative death. The presence of severe depression of left ventricular size and function preoperatively does not predict a higher operative risk, and postoperative survivors can expect normal ventricular function.

Angiocardiography↗
PubMed1986

[Early changes in ventricular function in diastolic phase in the resting coronary patient].

The aim of this study is to test left ventricular diastolic function in coronary artery disease patients with preserved systolic performance. Two groups of patients (25 coronary artery disease patients with angiographic proved coronary artery stenosis, but with normal hemodynamic and angiographic indices of systolic phase, first group; and 14 normal subjects for control, second group) were tested comparing their systolic and diastolic ventricular function indices, obtained by using a Millar microtip catheter and a computerized program. Systolic ventricular function was similar in the two groups (EF: 0.61 +/- 0.05 vs 0.62 +/- 0.03, p: n.s.; Vmax:120 +/- 28 vs 112 +/- 24 sec-1, p: n.s.), while diastolic indices were significantly different (lowest diastolic pressure: 3.7 +/- 2.4 vs -1.72 +/- 1.45 mmHg, p less than 0.01; end-diastolic pressure: 11.2 +/- 4.2 vs 6.5 +/- 2.8 mmHg, p less than 0.05; T constant: 45 +/- 8 vs 35 +/- 6 mmHg, p less than 0.001; end-diastolic compliance: 2.79 +/- 0.3 X 10(-2) vs 5.68 +/- 0.4 X 10(-2) mmHg-1, p less than 0.001; Kp: 0.041 +/- 0.006 vs 0.003 +/- 0.004 p less than 0.001). In conclusion, impairment of left ventricular diastolic phase may be one of the earliest manifestations of functional alterations of ischemic ventricle.

Cardiac Catheterization↗
PubMedDate not supplied

Hemodynamics and left ventricular function: a comparison between adult racing greyhounds and greyhounds completely untrained from birth.

Trained racing greyhounds are known to have cardiomegaly, higher mean arterial pressure and cardiac indices and lower systemic arterial resistances at rest than mongrel dogs. In order to distinguish between those hemodynamic and left ventricular functional characteristics that are inborn in the greyhound as opposed to those which are acquired through training, we studied 9 adult (mean age 22.9 +/- 4.2 [S.D.] months) trained racing greyhounds within 8 days of the cessation of training and 9 adult greyhounds raised under sedentary conditions (mean age 21.7 +/- 1.4 months). Seven healthy adult mongrel dogs served as additional controls. Right and left heart catheterizations of chloralose-anesthetized animals included hemodynamic and left ventricular functional measurements before and after volume loading with 500 ml 6% dextran in normal saline. Heart weight/body weight ratios were the same in both trained and untrained greyhounds, favoring the concept that the cardiomegaly of greyhounds is genetic and not acquired. Trained greyhounds had significantly decreased systemic vascular resistance, increased cardiac index and stroke volume, and a tendency (non significant) toward elevated systemic arterial pressure in comparison to mongrels. Life-long untrained adult greyhounds had hemodynamic measurements that did not differ from mongrels; they also had significantly higher systemic vascular resistances and lower cardiac indices than trained greyhounds. Some hemodynamic characteristics of the trained adult greyhound dog are not present in completely untrained greyhounds and are the result of either training alone or training superimposed on genetic predisposition.

Animals↗
PubMed1988

Left ventricular function in ischemic mitral regurgitation--a precatheterization assessment.

The clinical characteristics of 150 patients with unstable ischemic heart disease were evaluated for the ability to diagnose mitral regurgitation (MR). A careful assessment of physical findings, ECG- and radionuclide-determined global and regional left ventricular function was performed in all patients to characterize the population with ischemic MR. Twenty-nine patients were found to have MR and in 65% the degree of MR was 2+ or more. All of the patients with significant MR had a systolic murmur on physical examination, and although this finding was 90% sensitive for MR it had a poor predictive value (42%). Even a characteristic apical holosystolic murmur, although specific for MR (90%), had a low sensitivity and predictive value. Two regional wall motion abnormalities (inferoposterior akinesis and apical dyskinesis with an ejection fraction less than or equal to 35%) identified 26 of 29 patients with MR and all with 2+ or more MR, as well as the 10 patients who required mitral valve replacement in addition to coronary artery bypass grafting. This finding was complementary to the results of physical examination and when used together improved the diagnostic accuracy of identifying MR. The radionuclide regurgitant index was evaluated for its predictive value in assessing MR in this group of patients but was found to be a poor discriminator in patients with abnormal ejection fractions and regional wall motion abnormalities. The precatheterization assessment of left ventricular function with radionuclide angiography can provide important insight into the presence of ischemic MR.

Adult↗
PubMed1994

Gender differences in left ventricular functional response to aortic valve replacement.

BACKGROUND: To characterize gender differences in recovery of ventricular function and survival after aortic valve replacement (AVR), baseline characteristics related to outcome were analyzed in 1012 consecutive patients (329 women and 683 men) undergoing AVR in 1983 through 1990. METHODS AND RESULTS: Seventy-seven percent of patients had aortic stenosis (AS), 11% insufficiency (AI), and 12% mixed AS/AI; 42% underwent concomitant coronary artery bypass. Women as a group had a greater mean age (P < .0001), had AS more frequently than AI or AS/AI (P < .01), had coronary disease less frequently (P < .01), and had a higher preoperative left ventricular ejection fraction (EF) (P < .0001), although preoperative New York Heart Association (NYHA) functional class was similar (P = NS) compared with men. Male sex (P < .0001), advanced age (P < .0003), AI rather than AS (P < .01), and greater extent of coronary disease (P < .04) were independently associated with lower preoperative EF. Women with coronary disease were as likely as men (P = NS) to undergo concomitant coronary bypass, and completeness of revascularization did not differ (P = NS) by gender. Observed survival probabilities after AVR (expressed as 30-day/5-year) were .97/.81 overall, .94/.77 for women, and .98/.83 for men (P < .02). Cox model analysis showed advanced age, decreased preoperative EF, greater extent of coronary disease, requirement for annular enlargement, smaller prosthetic valve size, and advanced NYHA class (all P < .04) but neither female sex nor smaller body surface area (both P = NS) as multivariate risk factors for overall mortality. In 664 patients (66%), postoperative EF was measured a mean 1.4 years after AVR. In patients with preoperative EF < or = 45% (n = 167), the change in EF after AVR was greater (P < .02) in women (from 33 +/- 8% to 48 +/- 15%, P < .001) than in men (from 32 +/- 9% to 42 +/- 15%, P < .001). By multivariate regression analysis, female sex (P < .02) and lesser extent of coronary disease (P < .05) were independent predictors of early improvement in EF. Improvement in EF conveyed an independent subsequent survival benefit to both women (P < .03) and men (P < .001), and the magnitude of benefit did not differ (P = .4) between the two groups. CONCLUSIONS: These data suggest that gender-related factors importantly influence the adaptive and recovery response of the left ventricle to pressure and volume overload. However, gender differences in LV adaptation do not influence survival after AVR.

Aged↗
PubMed1977

Early changes in regional and global left ventricular function induced by graded reductions in regional coronary perfusion.

To determine the sequence of changes in segmental myocardial function, regional lactate metabolism and global left ventricular function induced by mild regional ischemia, blood flow in the left anterior descending coronary artery of 10 dogs was reduced by 10 percent decrements with use of a screw clamp. At each level of flow, segmental mechanical function and regional metabolism were assessed, the former with use of a mercury-in-Silastic length gauge and the latter with transmyocardial lactate balance measurements obtained with sampling from the anterior interventricular vein. Coronary arterial flow at the onset of regional lactate production was 48 +/- 4 percent (mean +/- standard error of the mean) of the control value. The onset of segmental mechanical dysfunction coincided with the onset of lactate production. Epicardial S-T segment abnormalities over the ischemic zone usually could not be detected until coronary flow was further reduced. After the onset of regional ischemia there was a linear correlation between coronary arterial flow and regional lactate production. At the onset of mild regional ischemia, defined as the onset of regional lactate production, no significant or directionally consistent changes were noted in standard measurements of global left ventricular performance, including heart rate, mean aortic pressure, left ventricular end-diastolic pressure, cardiac output, stroke volume, stroke work and peak positive dP/dt (maximal rate of rise of pressure). However, peak negative dP/dt (maximal rate of pressure decrease) decreased from 99 +/- 2 to 89 +/- 3 percent of the control value (P less than 0.0005) coincident with the onset of ischemia. It is hypothesized that dyssynchronous wall motion in the ischemic zone during isometric relaxation accounts for this decrease in peak negative dP/dt.

Animals↗
PubMed1991

Left ventricular function and wall thickness in long-term insulin-dependent diabetes mellitus: an echocardiographic study.

Left ventricular function and wall thickness were evaluated in 111 type I diabetic subjects (mean age 25.5 +/- 9 years, mean duration of diabetes 13.4 +/- 6.2 years), using 2-D-derived M-mode echocardiography. Patients were carefully selected for the absence of major coronary risk factors or manifest cardiac disorders, and compared with 91 age- and sex-matched control subjects. Fractional shortening and the maximal velocity of cirumferential fibre shortening did not differ significantly between the two groups. Furthermore, no differences were found in the diastolic functional parameter of velocity of circumferential fibre extension. Posterior wall thickness was significantly increased in the diabetic patients compared to the controls (9.5 +/- 1.8 mm vs. 8.4 +/- 1.3 mm. P less than 0.01). As the thickness of the interventricular septum was also moderately increased (9.2 +/- 2.2 mm vs. 8.9 +/- 1.7 mm, NS), these findings provide evidence for an early structural change of the myocardium in young diabetic patients without clinically relevant functional consequences.

Adult↗
PubMed1996

Preservation of left ventricular function in mitral valve surgery.

Surgery for degenerative mitral regurgitation has become complex. Preservation of annulo-ventricular continuity through the chordae tendineae is an important determinant of operative survival, postoperative left ventricular function, long-term survival, and quality of life. Some cardiologists believe that NYHA I function is never achieved after conventional mitral replacement with chordal transection. Valve repair is the procedure of choice but when valve replacement is inevitable every effort should be made to preserve the posterior leaflet and its chordal attachments. Valve replacement with preservation of the subvalvar apparatus provides a functional outcome similar to that after valve repair but usually leads to life long anti-coagulation.

Heart Valve Diseases↗
PubMed1990

[Left ventricular function after Konno procedure for congenital aortic stenosis].

From February, 1984 to September, 1988, eighteen patients with congenital aortic stenosis underwent Konno procedure. There was no operative death, but one late death (5.6%). The annular diameter ranged from 9 mm to 23 mm (mean 15 mm). Preoperative left ventricular ejection fraction (LVEF) measured by cineangiography ranged from 0.59 to 0.92 (mean 0.77) and half of the patients had more than 0.80 of LVEF. Left ventricular function after the operation was evaluated at rest or during exercise by radionuclide ventriculography. Postoperative LVEF ranged from 0.59 to 0.89 (mean 0.75). Although there were no statistically significant changes between preoperative and postoperative LVEF, there was a trend that preoperative supernormal LVEF improved to normal after surgery. The response to exercise also improved in some cases after surgery. We concluded that Konno procedure can be safely undertaken with improvement of left ventricular function.

Adolescent↗
PubMed2006

Evaluation of right and left ventricular function by quantitative blood-pool SPECT (QBS): comparison with conventional methods and quantitative gated SPECT (QGS).

Though quantitative ECG-gated blood-pool SPECT (QBS) has become a popular tool in research settings, more verification is necessary for its utilization in clinical medicine. To evaluate the reliability of the measurements of left and right ventricular functions with QBS, we performed QBS, as well as first-pass pool (FPP) and ECG-gated blood-pool (GBP) studies on planar images in 41 patients and 8 healthy volunteers. Quantitative ECG-gated myocardial perfusion SPECT (QGS) was also performed in 30 of 49 subjects. First, we assessed the reproducibility of the measurements of left and right ventricular ejection fraction (LVEF, RVEF) and left and right ventricular end-diastolic volume (LVEDV, RVEDV) with QBS. Second, LVEF and RVEF obtained from QBS were compared with those from FPP and GBP, respectively. Third, LVEF and LVEDV obtained from QBS were compared with those from QGS, respectively. The intra- and inter-observer reproducibilities were excellent for LVEF, LVEDV, RVEF and RVEDV measured with QBS (r = 0.88 to 0.96, p < 0.01), while the biases in the measurements of RVEF and RVEDV were relatively large. LVEF obtained from QBS correlated significantly with those from FPP and GBP, while RVEF from QBS did not. LVEF and LVEDV obtained from QBS were significantly correlated with those from QGS, but the regression lines were not close to the lines of identity. In conclusion, the measurements of LVEF and LVEDV with QBS have good reproducibility and are useful clinically, while those of RVEF and RVEDV are less useful compared with LVEF and LVEDV. The algorithm of QBS for the measurements of RVEF and RVEDV remains to be improved.

Adult↗
PubMed1993

Left ventricular function during dynamic exercise in untrained and moderately trained subjects.

The influence of exercise training on left ventricular function at rest (R), at anaerobic threshold (AT), and during peak exercise (PE) was evaluated in 12 healthy untrained and 13 trained (T) subjects who underwent Doppler echocardiography at R and radionuclide ventriculography at R and during exercise. The end-diastolic volume and stroke volume were significantly higher in the T group than in the untrained group at R. The ejection fraction rose significantly from R to AT and from AT to PE (80.0 +/- 0.84 vs. 83.6 +/- 0.91%), but no significant difference was observed between groups. The peak diastolic filling rate rose significantly during exercise, with a further significant increase observed in the T group (AT, 6.38 +/- 0.40 vs. 5.01 +/- 0.16 end-diastolic counts/s; PE, 8.24 +/- 0.42 vs. 7.15 +/- 0.35 end-diastolic counts/s). The percent variation of minimal systolic counts fell significantly at AT and PE in relation to R. Our data demonstrate that exercise training produces a significant increase in peak diastolic filling rate but no change in systolic function during exercise and that metabolic acidosis caused by exercise does not limit systolic function.

Acidosis↗
PubMed1981

Effect of valve replacement for chronic mitral insufficiency on left ventricular function during rest and exercise.

In this study we measured left ventricular function at rest and during exercise before and after operation in 18 patients who underwent mitral valve replacement (MVR) for chronic mitral insufficiency. First-transit radionuclide angiocardiography was employed a week before operation and 5 to 19 months after operation to calculate left ventricular ejection fraction, volumes, output, filling, and emptying rates. Preoperatively, left ventricular ejection fraction increased from 0.56 +/- 0.09 (mean +/- S.D.) at rest to 0.62 +/- 0.11 during exercise, and this response was not altered for the group after operation. After valve replacement, there was no consistent change in end-diastolic volume (EDV), and cardiac function was not related to an alteration in filling rates of the left ventricle. After operation, the patient group achieved a maximal ventricular filling rate during exercise comparable to that measured before operation. In addition, postoperative maximal filling rates did not correlate with prosthetic valve size. These data suggest that the hemodynamic changes elicited by MVR for chronic insufficiency are primarily related to the elimination of the regurgitant flow but no attributable to alterations of the myocardium. It is suggested that limitation in exercise performance after operation may be primarily related to the functional status of the myocardium prior to operation.

Adult↗